Ultracompact fluorescence smartphone attachment using built-in optics for protoporphyrin-IX quantification in skin

Smartphone-based dual radiometric fluorescence and white-light imager for quantification of protoporphyrin IX in skin

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.

Equivalent efficacy of indoor daylight and lamp‐based 5‐aminolevulinic acid photodynamic therapy for treatment of actinic keratosis

Background

Photodynamic therapy (PDT) is widely used as a treatment for actinic keratoses (AK), with new sunlight-based regimens proposed as alternatives to lamp-based treatments. Prescribing indoor daylight activation could help address the seasonal temperature, clinical supervision, and access variability associated with outdoor treatments.

Objective

To compare the AK lesion clearance efficacy of indoor daylight PDT treatment (30 min of 5-aminolevulinic acid (ALA) pre-incubation, followed by 2 h of indoor sunlight) versus a lamp-based PDT treatment (30 min of ALA preincubation, followed by 10 min of red light).

Methods

A prospective clinical trial was conducted with 41 patients. Topical 10% ALA was applied to the entire treatment site (face, forehead, scalp). Patients were assigned to either the lamp-based or indoor daylight treatment. Actinic keratosis lesion counts were determined by clinical examination and recorded for pre-treatment, 1-month, and 6-month follow-up visits.

Results

There was no statistical difference in the efficacy of AK lesion clearance between the red-lamp (1-month clearance = 57 ± 17%, 6-month clearance = 57 ± 20%) and indoor daylight treatment (1-month clearance = 61 ± 19%, 6-month clearance = 67 ± 20%). A 95% confidence interval of the difference of the means was measured between -4.4% and 13.4% for 1-month, and -2.2% and +23.6% for 6-month timepoints when comparing the indoor daylight to the red-lamp treatment, with a priori interval of equivalence of ±20%.

Limitations

Ensuring an equivalent dose between the indoor and lamp treatment cohorts limited randomisation since it required performing indoor daylight treatments only during sunny days.

Conclusion

Indoor-daylight PDT provided equivalent AK treatment efficacy to a lamp-based regimen while overcoming temperature limitations and UV-block sunscreen issues associated with outdoor sunlight treatments in the winter.

Clinical trial registration

Clinicaltrials.gov listing: NCT03805737.

Effective fluence and dose at skin depth of daylight and lamp sources for PpIX-based photodynamic therapy

SIGNIFICANCE

Skin-based photodynamic therapy (PDT) is used for the clinical treatment of actinic keratosis (AKs) and other skin lesions with continued expansion into the standard of care. Due to the spectral dependency of photosensitizer activation and skin optical fluence, there is a need for more accurate methods to estimate the delivered dose at depth from different PDT light sources and treatment regimens.

AIM

Develop radiometric methods for calculating photosensitizer-effective fluence and dose at depth and determine differences between red-lamp, blue-lamp, and daylight-based PDT treatments.

METHODS

Radiometric measurements of FDA-approved PDT lamp sources, outdoor daylight, and indoor daylight were performed for clinically relevant AK treatments. The protoporphyrin IX (PpIX) equivalent irradiance, fluence, and dose for each light source were calculated from the PpIX absorption spectrum and a 7-layer skin fluence model. The effective fluence and dose at depth was estimated by combining the spectral attenuation predicted at each wavelength and depth with the source fluence at each wavelength.

RESULTS

The red-lamp source had the highest illuminance (112,000 lumen/m²), but lowest PpIX-effective irradiance (9.6 W/m²), and highest effective fluence at depth (10.8 W/m² at 500 µm). In contrast, the blue light source had the lowest illuminance (2300 lumen/m²), but highest PpIX effective irradiance (37.0 W/m²), and ultimately the lowest effective fluence at depth (0.18 W/cm² at 500 µm). The daylight source had values of (outdoor | indoor) illuminance of (49,200 | 37,800 lumen/m²), effective irradiance of (19.2 | 10.7 W/m²), and effective fluence of (1.50 | 1.08 W/m² at 500 µm). The effective fluence and dose at depth facilitated the comparison of treatment regimens, for example, calculating an equivalent dose for a 2 hr indoor daylight treatment and a 10 min red-light treatment for the 300-1000 μm depth range.

CONCLUSIONS

The consideration of PpIX-effective fluence at varying depths is necessary to provide adequate comparisons of the delivered dose from PDT light sources. Methods for calculating radiometric fluence and delivered dose at depth were introduced, with open source MATLAB code, to help overcome the limitations of commonly used photometric and irradiance-based reporting.

Construction of ratiometric fluorescence sensor and test strip with smartphone based on molecularly imprinted dual-emission quantum dots for the selective and sensitive detection of domoic acid

Domoic acid (DA), a highly neurotoxic metabolite produced by phytoplankton, contaminates seafood products and threats humankind. Herein, we have proposed a molecular imprinting fluorescence sensor with internal standard ratiometric mode for sensing of DA in seafood and seawater. In this study, the silicon-coated blue luminous carbon dots (B-CDs@SiO₂) and CdTe acted as reference probe (430 nm) and response probe (610 nm), respectively. Subsequently, the two probes were assembled and the molecularly imprinted polymer (MIP) was introduced as the recognition element to construct the core component of the sensor (B-CDs@SiO₂/CdTe MIP). When DA exists, it can be specifically adsorbed by the amino-rich imprinted sites on surface of B-CDs@SiO₂/CdTe MIP and further assembled into the hydrogen-bonds complex, which can lead to the decrease in the fluorescence signal of MIP at 610 nm owing to the electron transfer from CdTe to DA. However, the fluorescence signal of MIP at 430 nm is not affected because of the protection of silica layer. Based on this principle, the designed internal standard ratiometric fluorescence sensor reveals high sensitivity, excellent selectivity, and wide linear range of 0.03-1 μM with a detection limit of 18 nM. Further, the portable fluorescent test strip with smartphone has been designed for semi-quantitative sensing of DA, which has potential application prospects for field analysis.

Simplifying the complex: accessible microfluidic solutions for contemporary processes within in vitro diagnostics

In vitro diagnostics (IVDs) form the cornerstone of modern medicine. They are routinely employed throughout the entire treatment pathway, from initial diagnosis through to prognosis, treatment planning, and post-treatment surveillance. Given the proven links between high quality diagnostic testing and overall health, ensuring broad access to IVDs has long been a focus of both researchers and medical professionals. Unfortunately, the current diagnostic paradigm relies heavily on centralized laboratories, complex and expensive equipment, and highly trained personnel. It is commonly assumed that this level of complexity is required to achieve the performance necessary for sensitive and specific disease diagnosis, and that making something affordable and accessible entails significant compromises in test performance. However, recent work in the field of microfluidics is challenging this notion. By exploiting the unique features of microfluidic systems, researchers have been able to create progressively simple devices that can perform increasingly complex diagnostic assays. This review details how microfluidic technologies are disrupting the status quo, and facilitating the development of simple, affordable, and accessible integrated IVDs. Importantly, we discuss the advantages and limitations of various approaches, and highlight the remaining challenges within the field.