1
|
Chowdhury P, Velalopoulou A, Verginadis II, Morcos G, Loo PE, Kim MM, Motlagh SAO, Shoniyozov K, Diffenderfer ES, Ocampo EA, Putt M, Assenmacher CA, Radaelli E, Lu J, Qin L, Liu H, Leli NM, Girdhani S, Denef N, Vander Stappen F, Cengel KA, Busch TM, Metz JM, Dong L, Lin A, Koumenis C. Proton FLASH radiotherapy ameliorates radiation-induced salivary gland dysfunction and oral mucositis and increases survival in a mouse model of head and neck cancer. Mol Cancer Ther 2024:742918. [PMID: 38593239 DOI: 10.1158/1535-7163.mct-23-0663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/16/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Abstract
Head and neck cancer radiotherapy often damages salivary glands and oral mucosa, severely negatively impacting patients' quality of life. The ability of FLASH- Proton Radiation therapy (F-PRT) to decrease normal tissue toxicity while maintaining tumor control compared to Standard Proton Radiation therapy (S-PRT) has been previously demonstrated for several tissues. However, its potential in ameliorating radiation-induced salivary gland dysfunction and oral mucositis and controlling orthotopic head and neck tumor growth has not been reported. The head and neck area of C57BL/6 mice was irradiated with a single dose of RT (ranging from 14-18 Gy) or a fractionated dose of 8 Gy x 3 of F-PRT (128 Gy/s) or S-PRT (0.95 Gy/s). Following irradiation, the mice were studied for radiation-induced xerostomia by measuring their salivary flow. Oral mucositis was analyzed by histopathological examination. To determine the ability of F-PRT to control orthotopic head and neck tumors, tongue tumors were generated in the mice and then irradiated with either F-PRT or S-PRT. Mice treated with either a single dose or fractionated dose of F-PRT showed significantly improved survival than those irradiated with S-PRT. F-PRT-treated mice showed improvement in their salivary flow. S-PRT-irradiated mice demonstrated increased fibrosis in their tongue epithelium. F-PRT significantly increased the overall survival of the mice with orthotopic tumors compared to the S-PRT-treated mice. The demonstration that F-PRT decreases radiation-induced normal tissue toxicity without compromising tumor control, suggests that this modality could be useful for the clinical management of head and neck cancer patients.
Collapse
Affiliation(s)
| | | | | | - George Morcos
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | | | - Michele M Kim
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | | | | | - Eric S Diffenderfer
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | | | - Mary Putt
- University of Pennsylvania, Philadelphia, PA, United States
| | | | | | - Jiawei Lu
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Ling Qin
- University of Pennsylvania, Philadelphia, PA, United States
| | - Hengxi Liu
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | | | | | | | | | - Keith A Cengel
- University of Pennsylvania, Philadelphia, PA, United States
| | | | - James M Metz
- University of Pennsylvania, Philadelphia, PA, United States
| | - Lei Dong
- University of Pennsylvania, Philadelphia, PA, United States
| | - Alexander Lin
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | | |
Collapse
|
2
|
Cengel KA, Kim MM, Diffenderfer ES, Busch TM. FLASH Radiotherapy: What Can FLASH's Ultra High Dose Rate Offer to the Treatment of Patients With Sarcoma? Semin Radiat Oncol 2024; 34:218-228. [PMID: 38508786 DOI: 10.1016/j.semradonc.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
FLASH is an emerging treatment paradigm in radiotherapy (RT) that utilizes ultra-high dose rates (UHDR; >40 Gy)/s) of radiation delivery. Developing advances in technology support the delivery of UHDR using electron and proton systems, as well as some ion beam units (eg, carbon ions), while methods to achieve UHDR with photons are under investigation. The major advantage of FLASH RT is its ability to increase the therapeutic index for RT by shifting the dose response curve for normal tissue toxicity to higher doses. Numerous preclinical studies have been conducted to date on FLASH RT for murine sarcomas, alongside the investigation of its effects on relevant normal tissues of skin, muscle, and bone. The tumor control achieved by FLASH RT of sarcoma models is indistinguishable from that attained by treatment with standard RT to the same total dose. FLASH's high dose rates are able to mitigate the severity or incidence of RT side effects on normal tissues as evaluated by endpoints ranging from functional sparing to histological damage. Large animal studies and clinical trials of canine patients show evidence of skin sparing by FLASH vs. standard RT, but also caution against delivery of high single doses with FLASH that exceed those safely applied with standard RT. Also, a human clinical trial has shown that FLASH RT can be delivered safely to bone metastasis. Thus, data to date support continued investigations of clinical translation of FLASH RT for the treatment of patients with sarcoma. Toward this purpose, hypofractionated irradiation schemes are being investigated for FLASH effects on sarcoma and relevant normal tissues.
Collapse
Affiliation(s)
- Keith A Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania..
| | - Michele M Kim
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric S Diffenderfer
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
3
|
Sourvanos D, Zhu TC, Dimofte A, Busch TM, Lander B, Burrell JC, Neiva R, Fiorellini JP. A novel investigational preclinical model to assess fluence rate for dental oral craniofacial tissues. Photodiagnosis Photodyn Ther 2024; 46:104015. [PMID: 38373469 DOI: 10.1016/j.pdpdt.2024.104015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Photodynamic Therapy (PDT) and Photobiomodulation (PBM) are recognized for their potential in treating head and neck conditions. The heterogeneity of human tissue optical properties presents a challenge for effective dosimetry. The porcine mandible cadaver serves as an excellent model and has several similarities to human tissues of the dental oral craniofacial complex. This study aims to validate a novel modeling system that will help refine PDT and PBM dosimetry for the head and neck region. METHODS AND MATERIALS Light transmission was analyzed through several tissue combinations at distances of 2 mm to 10 mm. Maximum light fluence rates (mW/cm2) were compared across tissue types to reveal the effects of tissue heterogeneity. RESULTS The study revealed that light fluence is affected by tissue composition, with dentin/enamel showing reduced transmission and soft tissue regions exhibiting elevated values. The porcine model has proven to be efficient in mimicking human tissue responses to light, enabling the potential to optimize future protocols. CONCLUSION The porcine mandible cadaver is a novel model to understand the complex interactions between light and tissue. This study provides a foundation for future investigations into dosimetry optimization for PDT and PBM.
Collapse
Affiliation(s)
- Dennis Sourvanos
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA; Center for Innovation and Precision Dentistry (CiPD), School of Dental Medicine, School of Engineering, University of Pennsylvania, PA, USA.
| | - Timothy C Zhu
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Andreea Dimofte
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Bradley Lander
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Justin C Burrell
- Center for Innovation and Precision Dentistry (CiPD), School of Dental Medicine, School of Engineering, University of Pennsylvania, PA, USA; Department of Oral and Maxillofacial Surgery, Hospital of the University of Pennsylvania and University of Pennsylvania School of Dental Medicine, University of Pennsylvania, PA, USA; Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michal J. Crescenz Veterans Affairs Medical Center, PA, USA
| | - Rodrigo Neiva
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Joseph P Fiorellini
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA
| |
Collapse
|
4
|
Sourvanos D, Sun H, Zhu TC, Dimofte A, Byrd B, Busch TM, Cengel KA, Neiva R, Fiorellini JP. Three-dimensional printing of the human lung pleural cavity model for PDT malignant mesothelioma. Photodiagnosis Photodyn Ther 2024; 46:104014. [PMID: 38346466 DOI: 10.1016/j.pdpdt.2024.104014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE The primary aim was to investigate emerging 3D printing and optical acquisition technologies to refine and enhance photodynamic therapy (PDT) dosimetry in the management of malignant pleural mesothelioma (MPM). MATERIALS AND METHODS A rigorous digital reconstruction of the pleural lung cavity was conducted utilizing 3D printing and optical scanning methodologies. These reconstructions were systematically assessed against CT-derived data to ascertain their accuracy in representing critical anatomic features and post-resection topographical variations. RESULTS The resulting reconstructions excelled in their anatomical precision, proving instrumental translation for precise dosimetry calculations for PDT. Validation against CT data confirmed the utility of these models not only for enhancing therapeutic planning but also as critical tools for educational and calibration purposes. CONCLUSION The research outlined a successful protocol for the precise calculation of light distribution within the complex environment of the pleural cavity, marking a substantive advance in the application of PDT for MPM. This work holds significant promise for individualizing patient care, minimizing collateral radiation exposure, and improving the overall efficiency of MPM treatments.
Collapse
Affiliation(s)
- Dennis Sourvanos
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA; Center for Innovation and Precision Dentistry (CiPD), School of Dental Medicine, School of Engineering, University of Pennsylvania, PA, USA.
| | - Hongjing Sun
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Timothy C Zhu
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Andreea Dimofte
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Brook Byrd
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Keith A Cengel
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Rodrigo Neiva
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Joseph P Fiorellini
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA
| |
Collapse
|
5
|
Sun H, Ong Y, Yang W, Sourvanos D, Dimofte A, Busch TM, Singhal S, Cengel KA, Zhu TC. Clinical PDT dose dosimetry for pleural Photofrin-mediated photodynamic therapy. J Biomed Opt 2024; 29:018001. [PMID: 38223299 PMCID: PMC10787190 DOI: 10.1117/1.jbo.29.1.018001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
Significance Photodynamic therapy (PDT) is an established cancer treatment utilizing light-activated photosensitizers (PS). Effective treatment hinges on the PDT dose-dependent on PS concentration and light fluence-delivered over time. We introduce an innovative eight-channel PDT dose dosimetry system capable of concurrently measuring light fluence and PS concentration during treatment. Aim We aim to develop and evaluate an eight-channel PDT dose dosimetry system for simultaneous measurement of light fluence and PS concentration. By addressing uncertainties due to tissue variations, the system enhances accurate PDT dosimetry for improved treatment outcomes. Approach The study positions eight isotropic detectors strategically within the pleural cavity before PDT. These detectors are linked to bifurcated fibers, distributing signals to both a photodiode and a spectrometer. Calibration techniques are applied to counter tissue-related variations and improve measurement accuracy. The fluorescence signal is normalized using the measured light fluence, compensating for variations in tissue properties. Measurements were taken in 78 sites in the pleural cavities of 20 patients. Results Observations reveal minimal Photofrin concentration variation during PDT at each site, juxtaposed with significant intra- and inter-patient heterogeneities. Across 78 treated sites in 20 patients, the average Photofrin concentration for all 78 sites is 4.98 μ M , with a median concentration of 4.47 μ M . The average PDT dose for all 78 sites is 493.17 μ MJ / cm 2 , with a median dose of 442.79 μ MJ / cm 2 . A significant variation in PDT doses is observed, with a maximum difference of 3.1 times among all sites within one patient and a maximum difference of 9.8 times across all patients. Conclusions The introduced eight-channel PDT dose dosimetry system serves as a valuable real-time monitoring tool for light fluence and PS concentration during PDT. Its ability to mitigate uncertainties arising from tissue properties enhances dosimetry accuracy, thus optimizing treatment outcomes and bolstering the effectiveness of PDT in cancer therapy.
Collapse
Affiliation(s)
- Hongjing Sun
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Department of Bioengineering, Philadelphia, Pennsylvania, United States
| | - Yihong Ong
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | - Weibing Yang
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | - Dennis Sourvanos
- University of Pennsylvania, School of Dental Medicine, Department of Periodontics, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Schools of Engineering and Dental Medicine, Center for Innovation and Precision Dentistry, Philadelphia, Pennsylvania, United States
| | - Andreea Dimofte
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | - Theresa M. Busch
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | - Sunil Singhal
- University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania, United States
| | - Keith A. Cengel
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | - Timothy C. Zhu
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| |
Collapse
|
6
|
Tian Y, Carrillo-Malani N, Feng K, Miller J, Busch TM, Sundaram KM, Cheng Z, Amirshaghaghi A, Tsourkas A. Theranostic Phthalocyanine and Naphthalocyanine Nanoparticles for Photoacoustic Imaging and Photothermal Therapy of Tumors. Nanotheranostics 2024; 8:100-111. [PMID: 38164502 PMCID: PMC10750118 DOI: 10.7150/ntno.88892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024] Open
Abstract
Background: Phthalocyanine (PC) and naphthalocyanine (NC) dyes have long garnered interest as theranostic agents for optical imaging and phototherapy due to their near-infrared absorbance, photostability, imaging contrast, and proven safety in clinical trials. Yet, only a small fraction of these dyes has been evaluated as photothermal therapy (PTT) agents for cancer treatment. Methods: Nearly 40 distinct NC and PC dyes were encapsulated within polymeric PEG-PCL micelles via oil-in-water emulsions. The optimal NC/PC-loaded micelle formulations for PTT and photoacoustic (PA) imaging were identified through in vivo and in vitro studies. Results: The most promising candidate, CuNC(Octa)-loaded micelles, demonstrated a strong PA signal with a peak absorbance at ~870 nm, high photothermal efficiency, and photostability. The CuNC(Octa)-loaded micelles exhibited heat generation as good or better than gold nanorods/nanoshells and >10-fold higher photoacoustic signals. Micelle preparation was reproducible/scalable, and the CuNC(Octa)-loaded micelles are highly stable under physiological conditions. The CuNC(Octa)-loaded micelles localize within tumors via enhanced permeability and retention and are readily detectable by PA imaging. In a syngeneic murine tumor model of triple-negative breast cancer, CuNC(Octa)-loaded micelles demonstrate efficient heat generation with PTT, leading to the complete eradication of tumors. Conclusions: CuNC(Octa)-loaded micelles represent a promising theranostic agent for PA imaging and PTT. The ability to utilize conventional ultrasound in combination with PA imaging enables the simultaneous acquisition of information about tumor morphology and micelle accumulation. PTT with CuNC(Octa)-loaded micelles can lead to the complete eradication of highly invasive tumors.
Collapse
Affiliation(s)
- Yiran Tian
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Kailin Feng
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joann Miller
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Theresa M. Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Karthik M. Sundaram
- Department of Radiology, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Zhiliang Cheng
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ahmad Amirshaghaghi
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Andrew Tsourkas
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
7
|
Sun H, Yang W, Ong Y, Busch TM, Zhu TC. Fractionated Photofrin-Mediated Photodynamic Therapy Significantly Improves Long-Term Survival. Cancers (Basel) 2023; 15:5682. [PMID: 38067385 PMCID: PMC10705090 DOI: 10.3390/cancers15235682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 02/12/2024] Open
Abstract
This study investigates the effect of fractionated (two-part) PDT on the long-term local control rate (LCR) using the concentration of reactive oxygen species ([ROS]rx) as a dosimetry quantity. Groups with different fractionation schemes are examined, including a 2 h interval between light delivery sessions to cumulative fluences of 135, 180, and 225 J/cm2. While the total treatment time remains constant within each group, the division of treatment time between the first and second fractionations are explored to assess the impact on long-term survival at 90 days. In all preclinical studies, Photofrin is intravenously administered to mice at a concentration of 5 mg/kg, with an incubation period between 18 and 24 h before the first light delivery session. Fluence rate is fixed at 75 mW/cm2. Treatment ensues via a collimated laser beam, 1 cm in diameter, emitting light at 630 nm. Dosimetric quantities are assessed for all groups along with long-term (90 days) treatment outcomes. This study demonstrated a significant improvement in long-term survival after fractionated treatment schemes compared to single-fraction treatment, with the optimal 90-day survival increasing to 63%, 86%, and 100% vs. 20%, 25%, and 50%, respectively, for the three cumulative fluences. The threshold [ROS]rx for the optimal scheme of fractionated Photofrin-mediated PDT, set at 0.78 mM, is significantly lower than that for the single-fraction PDT, at 1.08 mM.
Collapse
Affiliation(s)
- Hongjing Sun
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA; (H.S.); (W.Y.); (T.M.B.)
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Weibing Yang
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA; (H.S.); (W.Y.); (T.M.B.)
| | - Yihong Ong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA; (H.S.); (W.Y.); (T.M.B.)
| | - Theresa M. Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA; (H.S.); (W.Y.); (T.M.B.)
| | - Timothy C. Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA; (H.S.); (W.Y.); (T.M.B.)
| |
Collapse
|
8
|
Davis RW, Klampatsa A, Cramer GM, Kim MM, Miller JM, Yuan M, Houser C, Snyder E, Putt M, Vinogradov SA, Albelda SM, Cengel KA, Busch TM. Surgical Inflammation Alters Immune Response to Intraoperative Photodynamic Therapy. Cancer Res Commun 2023; 3:1810-1822. [PMID: 37700795 PMCID: PMC10494787 DOI: 10.1158/2767-9764.crc-22-0494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/15/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
Surgical cytoreduction for patients with malignant pleural mesothelioma (MPM) is used for selected patients as a part of multi-modality management strategy. Our group has previously described the clinical use of photodynamic therapy (PDT), a form of non-ionizing radiation, as an intraoperative therapy option for MPM. Although necessary for the removal of bulk disease, the effects of surgery on residual MPM burden are not understood. In this bedside-to-bench study, Photofrin-based PDT introduced the possibility of achieving a long-term response in murine models of MPM tumors that were surgically debulked by 60% to 90%. Thus, the addition of PDT provided curative potential after an incomplete resection. Despite this success, we postulated that surgical induction of inflammation may mitigate the comprehensive response of residual disease to further therapy. Utilizing a previously validated tumor incision (TI) model, we demonstrated that the introduction of surgical incisions had no effect on acute cytotoxicity by PDT. However, we found that surgically induced inflammation limited the generation of antitumor immunity by PDT. Compared with PDT alone, when TI preceded PDT of mouse tumors, splenocytes and/or CD8+ T cells from the treated mice transferred less antitumor immunity to recipient animals. These results demonstrate that addition of PDT to surgical cytoreduction significantly improves long-term response compared with cytoreduction alone, but at the same time, the inflammation induced by surgery may limit the antitumor immunity generated by PDT. These data inform future potential approaches aimed at blocking surgically induced immunosuppression that might improve the outcomes of intraoperative combined modality treatment. Significance Although mesothelioma is difficult to treat, we have shown that combining surgery with a form of radiation, photodynamic therapy, may help people with mesothelioma live longer. In this study, we demonstrate in mice that this regimen could be further improved by addressing the inflammation induced as a by-product of surgery.
Collapse
Affiliation(s)
- Richard W. Davis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Astero Klampatsa
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gwendolyn M. Cramer
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michele M. Kim
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joann M. Miller
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Min Yuan
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cassandra Houser
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emma Snyder
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Putt
- Department of Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sergei A. Vinogradov
- Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven M. Albelda
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith A. Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theresa M. Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
9
|
Sun H, Kim MM, Ong YH, Dimoft A, Singhal S, Busch TM, Cengel KA, Zhu TC. Evaluation of Detector Position and Light Fluence Distribution Using an Infrared Navigation System during Pleural Photodynamic Therapy †. Photochem Photobiol 2023; 99:814-825. [PMID: 35996976 PMCID: PMC9947188 DOI: 10.1111/php.13697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022]
Abstract
Photodynamic therapy (PDT) has been used to treat malignant pleural mesothelioma. Current practice involves delivering light to a prescribed light fluence with a point source, monitored by eight isotropic detectors inside the pleural cavity. An infrared (IR) navigation system was used to track the location of the point source throughout the treatment. The recorded data were used to reconstruct the pleural cavity and calculate the light fluence to the whole cavity. An automatic algorithm was developed recently to calculate the detector positions based on recorded data within an hour. This algorithm was applied to patient case studies and the calculated results were compared to the measured positions, with an average difference of 2.5 cm. Calculated light fluence at calculated positions were compared to measured values. The differences between the calculated and measured light fluence were within 14% for all cases, with a fixed scattering constant and a dual correction method. Fluence-surface histogram (FSH) was calculated for photofrin-mediated PDT to be able to cover 80% of pleural surface area to 50 J cm-2 (83.3% of 60 J cm-2 ). The study demonstrates that it will be possible to eliminate the manual measurement of the detector positions, reducing the patient's time under anesthesia.
Collapse
Affiliation(s)
- Hongjing Sun
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Yi Hong Ong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Andreea Dimoft
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Sunil Singhal
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Theresa M. Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| |
Collapse
|
10
|
Zou W, Kim H, Diffenderfer ES, Carlson DJ, Koch CJ, Xiao Y, Teo BK, Kim MM, Metz JM, Fan Y, Maity A, Koumenis C, Busch TM, Wiersma R, Cengel KA, Dong L. A phenomenological model of proton FLASH oxygen depletion effects depending on tissue vasculature and oxygen supply. Front Oncol 2022; 12:1004121. [PMID: 36518319 PMCID: PMC9742361 DOI: 10.3389/fonc.2022.1004121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Radiation-induced oxygen depletion in tissue is assumed as a contributor to the FLASH sparing effects. In this study, we simulated the heterogeneous oxygen depletion in the tissue surrounding the vessels and calculated the proton FLASH effective-dose-modifying factor (FEDMF), which could be used for biology-based treatment planning. Methods The dose and dose-weighted linear energy transfer (LET) of a small animal proton irradiator was simulated with Monte Carlo simulation. We deployed a parabolic partial differential equation to account for the generalized radiation oxygen depletion, tissue oxygen diffusion, and metabolic processes to investigate oxygen distribution in 1D, 2D, and 3D solution space. Dose and dose rates, particle LET, vasculature spacing, and blood oxygen supplies were considered. Using a similar framework for the hypoxic reduction factor (HRF) developed previously, the FEDMF was derived as the ratio of the cumulative normoxic-equivalent dose (CNED) between CONV and UHDR deliveries. Results Dynamic equilibrium between oxygen diffusion and tissue metabolism can result in tissue hypoxia. The hypoxic region displayed enhanced radio-resistance and resulted in lower CNED under UHDR deliveries. In 1D solution, comparing 15 Gy proton dose delivered at CONV 0.5 and UHDR 125 Gy/s, 61.5% of the tissue exhibited ≥20% FEDMF at 175 μm vasculature spacing and 18.9 μM boundary condition. This percentage reduced to 34.5% and 0% for 8 and 2 Gy deliveries, respectively. Similar trends were observed in the 3D solution space. The FLASH versus CONV differential effect remained at larger vasculature spacings. A higher FLASH dose rate showed an increased region with ≥20% FEDMF. A higher LET near the proton Bragg peak region did not appear to alter the FLASH effect. Conclusion We developed 1D, 2D, and 3D oxygen depletion simulation process to obtain the dynamic HRF and derive the proton FEDMF related to the dose delivery parameters and the local tissue vasculature information. The phenomenological model can be used to simulate or predict FLASH effects based on tissue vasculature and oxygen concentration data obtained from other experiments.
Collapse
|
11
|
Ivanick NM, Oakley ER, Kunadharaju R, Brackett C, Bellnier DA, Tworek LM, Kurenov SN, Gollnick SO, Hutson AD, Busch TM, Shafirstein G. First-In-Human Computer-Optimized Endobronchial Ultrasound-Guided Interstitial Photodynamic Therapy for Patients With Extrabronchial or Endobronchial Obstructing Malignancies. JTO Clin Res Rep 2022; 3:100372. [PMID: 36188632 PMCID: PMC9523383 DOI: 10.1016/j.jtocrr.2022.100372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Patients with inoperable extrabronchial or endobronchial tumors who are not candidates for curative radiotherapy have dire prognoses with no effective long-term treatment options. To reveal that our computer-optimized interstitial photodynamic therapy (I-PDT) is safe and potentially effective in the treatment of patients with inoperable extra or endobronchial malignancies inducing central airway obstructions. Methods High-spatial resolution computer simulations were used to personalize the light dose rate and dose for each tumor. Endobronchial ultrasound with a transbronchial needle was used to place the optical fibers within the tumor according to an individualized plan. The primary and secondary end points were safety and overall survival, respectively. An exploratory end point evaluated changes in immune markers. Results Eight patients received I-PDT with planning, and five of these received additional external beam PDT. Two additional patients received external beam PDT. The treatment was declared safe. Three of 10 patients are alive at 26.3, 12, and 8.3 months, respectively, after I-PDT. The treatments were able to deliver a prescribed light dose rate and dose to 87% to 100% and 18% to 92% of the tumor volumes, respectively. A marked increase in the proportion of monocytic myeloid-derived suppressor cells expressing programmed death-ligand 1 was measured in four of seven patients. Conclusions Image-guided light dosimetry for I-PDT with linear endobronchial ultrasound transbronchial needle is safe and potentially beneficial in increasing overall survival of patients. I-PDT has a positive effect on the immune response including an increase in the proportion of programmed death-ligand 1-expressing monocytic myeloid-derived suppressor cells.
Collapse
Affiliation(s)
- Nathaniel M. Ivanick
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Emily R. Oakley
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Rajesh Kunadharaju
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Craig Brackett
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - David A. Bellnier
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Lawrence M. Tworek
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Sergei N. Kurenov
- Department of Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Sandra O. Gollnick
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Alan D. Hutson
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Theresa M. Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gal Shafirstein
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| |
Collapse
|
12
|
Morales RDH, Hong Ong Y, Finlay J, Dimofte A, Simone CB, Friedberg JS, Busch TM, Cengel KA, Zhu TC. In vivo spectroscopic evaluation of human tissue optical properties and hemodynamics during HPPH-mediated photodynamic therapy of pleural malignancies. J Biomed Opt 2022; 27:JBO-220136GR. [PMID: 36316298 PMCID: PMC9621284 DOI: 10.1117/1.jbo.27.10.105006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/10/2022] [Indexed: 05/12/2023]
Abstract
Significance Dosimetry for photodynamic therapy is dependent on multiple parameters. Critically, in vivo tissue optical properties and hemodynamics must be determined carefully to calculate the total delivered light dose. Aim Spectroscopic analysis of diffuse reflectance measurements of tissues taken during a clinical trial of 2-(1-hexyloxyethyl)-2-devinyl pyropheophorbide-a-mediated photodynamic therapy for pleural malignancies. Approach Diffuse reflectance measurements were taken immediately before and after photodynamic therapy. Measurements were analyzed with a nonlinearly constrained multiwavelength, multi-distance algorithm to extract tissue optical properties, tissue oxygen saturation, StO2, and total hemoglobin concentration (THC). Results A total of 25 patients were measured, 23 of which produced reliable fits for optical property extraction. For all tissue types, StO2 ranged through [24, 100]% and [22, 97]% for pre-photodynamic therapy (PDT) and post-PDT conditions, respectively. Mean THC ranged through [ 69,152 ] μM and [ 48,111 ] μM, for pre-PDT and post-PDT, respectively. Absorption coefficients, μa, ranged through [ 0.024 , 3.5 ] cm - 1 and [ 0.039 , 3 ] cm - 1 for pre-PDT and post-PDT conditions, respectively. Reduced scattering coefficients, μs', ranged through [ 1.4 , 73.4 ] cm - 1 and [ 1.2 , 64 ] cm - 1 for pre-PDT and post-PDT conditions, respectively. Conclusions There were similar pre- and post-PDT tissue optical properties and hemodynamics. The high variability in each parameter for all tissue types emphasizes the importance of these measurements for accurate PDT dosimetry.
Collapse
Affiliation(s)
- Ryan D. Hall Morales
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | - Yi Hong Ong
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | - Jarod Finlay
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | - Andreea Dimofte
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | | | - Joseph S. Friedberg
- Temple University Health System, Department of Surgery, Philadelphia, Pennsylvania, United States
| | - Theresa M. Busch
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | - Keith A. Cengel
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | - Timothy C. Zhu
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
- Address all correspondences to Timothy C. Zhu,
| |
Collapse
|
13
|
Nieves LM, Dong YC, Rosario-Berríos DN, Mossburg K, Hsu JC, Cramer GM, Busch TM, Maidment ADA, Cormode DP. Renally Excretable Silver Telluride Nanoparticles as Contrast Agents for X-ray Imaging. ACS Appl Mater Interfaces 2022; 14:34354-34364. [PMID: 35867906 PMCID: PMC9482380 DOI: 10.1021/acsami.2c06190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The use of nanoparticles in the biomedical field has gained much attention due to their applications in biomedical imaging, drug delivery, and therapeutics. Silver telluride nanoparticles (Ag2Te NPs) have been recently shown to be highly effective computed tomography (CT) and dual-energy mammography contrast agents with good stability and biocompatibility, as well as to have potential for many other biomedical purposes. Despite their numerous advantageous properties for diagnosis and treatment of disease, the clinical translation of Ag2Te NPs is dependent on achieving high levels of excretion, a limitation for many nanoparticle types. In this work, we have synthesized and characterized a library of Ag2Te NPs and identified conditions that led to 3 nm core size and were renally excretable. We found that these nanoparticles have good biocompatibility, strong X-ray contrast generation, and rapid renal clearance. Our CT data suggest that renal elimination of nanoparticles occurred within 2 h of administration. Moreover, biodistribution data indicate that 93% of the injected dose (%ID) has been excreted from the main organs in 24 h, 95% ID in 7 days, and 97% ID in 28 days with no signs of acute toxicity in the tissues studied under histological analysis. To our knowledge, this renal clearance is the best reported for Ag2Te NP, while being comparable to the highest renal clearance reported for any type of nanoparticle. Together, the results herein presented suggest the use of GSH-Ag2Te NPs as an X-ray contrast agent with the potential to be clinically translated in the future.
Collapse
Affiliation(s)
- Lenitza M Nieves
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Biochemistry and Molecular Biophysics Graduate Group, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Yuxi C Dong
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Derick N Rosario-Berríos
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Biochemistry and Molecular Biophysics Graduate Group, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Katherine Mossburg
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Jessica C Hsu
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Gwendolyn M Cramer
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Andrew D A Maidment
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - David P Cormode
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Department of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| |
Collapse
|
14
|
Velalopoulou A, Karagounis IV, Skoufos G, Verginadis II, Kim M, Shoniyozov K, Hatzigeorgiou AG, Diffenderfer E, Dong L, Metz J, Koumenis C, Cengel KA, Maity A, Busch TM. Abstract 3304: Gene expression profiling of full-thickness skin after FLASH proton radiotherapy. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: To investigate the transcriptomic changes induced by FLASH proton radiotherapy (F-PRT) that could be responsible for the protection of normal epithelial tissues by radiation-induced toxicities as have been previously shown by us and others.
Methods: C57BL/6J mice received 30 Gy of F-PRT or S-PRT to the hind leg at respective dose rates of 69-124 Gy/sec or 0.39-0.65 Gy/sec. RNA sequencing was performed using full-thickness leg skin at 5 days after radiation revealing major pathways regulated by F-PRT and S-PRT. In an endeavor to identify the full repertoire of cells and gene expression profiles that are involved in the sparing effects of FLASH PRT, we expanded our studies to include single-cell RNA sequencing (sc-RNA seq) and examined additional time points such as Day 2 and Day 10 after radiation. Single-cell transcriptome libraries were generated on a 10X Genomics Chromium system. Datasets were acquired from cell samples derived and sequenced from pooled skin samples of three mice per group. Skin from the sequenced mice was also embedded for spatial analysis of gene expression.
Results: RNA sequencing revealed that F-PRT uniquely upregulates almost four times more genes compared to S-PRT (F-PRT-uniquely upregulated 489 genes vs S-PRT-uniquely upregulated 129 genes). Also, F-PRT uniquely downregulated 178 genes, compared to the 125 genes uniquely downregulated by S-PRT. GO analysis demonstrates that the keratinization and apoptosis pathways are uniquely upregulated by S-PRT, whereas F-PRT uniquely upregulates genes involved in vascular development pathway. During submission of the abstract, analysis of sc-RNA seq samples was pending.
Conclusion: Our comprehensive studies inform on the transcriptomic profiling of skin cell populations that are affected by F-PRT vs S-PRT; this insight will further spur discoveries on the biology of FLASH radiotherapy effects.
Citation Format: Anastasia Velalopoulou, Ilias V. Karagounis, Giorgos Skoufos, Ioannis I. Verginadis, Michele Kim, Khayrullo Shoniyozov, Artemis G. Hatzigeorgiou, Eric Diffenderfer, Lei Dong, James Metz, Constantinos Koumenis, Keith A. Cengel, Amit Maity, Theresa M. Busch. Gene expression profiling of full-thickness skin after FLASH proton radiotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3304.
Collapse
Affiliation(s)
| | | | | | | | - Michele Kim
- 1University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Lei Dong
- 1University of Pennsylvania, Philadelphia, PA
| | - James Metz
- 1University of Pennsylvania, Philadelphia, PA
| | | | | | - Amit Maity
- 1University of Pennsylvania, Philadelphia, PA
| | | |
Collapse
|
15
|
Van Slyke AL, El Khatib M, Velalopoulou A, Diffenderfer E, Shoniyozov K, Kim MM, Karagounis IV, Busch TM, Vinogradov SA, Koch CJ, Wiersma RD. Oxygen Monitoring in Model Solutions and In Vivo in Mice During Proton Irradiation at conventional and FLASH Dose Rates. Radiat Res 2022; 198:181-189. [PMID: 35640166 PMCID: PMC10176203 DOI: 10.1667/rade-21-00232.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/06/2022] [Indexed: 11/03/2022]
Abstract
FLASH is a high-dose-rate form of radiation therapy that has the reported ability, compared with conventional dose rates, to spare normal tissues while being equipotent in tumor control, thereby increasing the therapeutic ratio. The mechanism underlying this normal tissue sparing effect is currently unknown, however one possibility is radiochemical oxygen depletion (ROD) during dose delivery in tissue at FLASH dose rates. In order to investigate this possibility, we used the phosphorescence quenching method to measure oxygen partial pressure before, during and after proton radiation delivery in model solutions and in normal muscle and sarcoma tumors in mice, at both conventional (Conv) (∼0.5 Gy/s) and FLASH (∼100 Gy/s) dose rates. Radiation dosimetry was determined by Advanced Markus Chamber and EBT-XL film. For solutions contained in sealed glass vials, phosphorescent probe Oxyphor PtG4 (1 μM) was dissolved in a buffer (10 mM HEPES) containing glycerol (1 M), glucose (5 mM) and glutathione (5 mM), designed to mimic the reducing and free radical-scavenging nature of the intracellular environment. In vivo oxygen measurements were performed 24 h after injection of PtG4 into the interstitial space of either normal thigh muscle or intra-muscular sarcoma tumors in mice. The "g-value" for ROD is reported in mmHg/Gy, which represents a slight modification of the more standard chemical definition (μM/Gy). In solutions, proton irradiation at conventional dose rates resulted in a g-value for ROD of up to 0.55 mmHg/Gy, consistent with earlier studies using X or gamma rays. At FLASH dose rates, the g-value for ROD was ∼25% lower, 0.37 mmHg/Gy. pO2 levels were stable after each dose delivery. For normal muscle in vivo, oxygen depletion during irradiation was counterbalanced by resupply from the vasculature. This process was fast enough to maintain tissue pO2 virtually unchanged at Conv dose rates. However, during FLASH irradiation there was a stepwise decrease in pO2 (g-value ∼0.28 mmHg/Gy), followed by a rebound to the initial level after ∼8 s. The g-values were smaller and recovery times longer in tumor tissue when compared to muscle and may be related to the lower initial endogenous pO2 levels in the former. Considering that the FLASH effect is seen in vivo even at doses as low as 10 Gy, it is difficult to reconcile the amount of protection seen by oxygen depletion alone. However, the phosphorescence probe in our experiments was confined to the extracellular space, and it remains possible that intracellular oxygen depletion was greater than observed herein. In cell-mimicking solutions the oxygen depletion g-vales were indeed significantly higher than observed in vivo.
Collapse
Affiliation(s)
| | - Mirna El Khatib
- Department of Biochemistry and Biophysics, Perelman School of Medicine, and Department of Chemistry, School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Eric Diffenderfer
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia
| | | | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia
| | - Ilias V Karagounis
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia
| | - Sergei A Vinogradov
- Department of Biochemistry and Biophysics, Perelman School of Medicine, and Department of Chemistry, School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cameron J Koch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia
| | - Rodney D Wiersma
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia
| |
Collapse
|
16
|
Zhong L, Yao L, Holdreith N, Yu W, Gui T, Miao Z, Elkaim Y, Li M, Gong Y, Pacifici M, Maity A, Busch TM, Joeng KS, Cengel K, Seale P, Tong W, Qin L. Transient expansion and myofibroblast conversion of adipogenic lineage precursors mediate bone marrow repair after radiation. JCI Insight 2022; 7:150323. [PMID: 35393948 PMCID: PMC9057603 DOI: 10.1172/jci.insight.150323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 02/23/2022] [Indexed: 11/19/2022] Open
Abstract
Radiation causes a collapse of bone marrow cells and elimination of microvasculature. To understand how bone marrow recovers after radiation, we focused on mesenchymal lineage cells that provide a supportive microenvironment for hematopoiesis and angiogenesis in bone. We recently discovered a nonproliferative subpopulation of marrow adipogenic lineage precursors (MALPs) that express adipogenic markers with no lipid accumulation. Single-cell transcriptomic analysis revealed that MALPs acquire proliferation and myofibroblast features shortly after radiation. Using an adipocyte-specific Adipoq-Cre, we validated that MALPs rapidly and transiently expanded at day 3 after radiation, coinciding with marrow vessel dilation and diminished marrow cellularity. Concurrently, MALPs lost most of their cell processes, became more elongated, and highly expressed myofibroblast-related genes. Radiation activated mTOR signaling in MALPs that is essential for their myofibroblast conversion and subsequent bone marrow recovery at day 14. Ablation of MALPs blocked the recovery of bone marrow vasculature and cellularity, including hematopoietic stem and progenitors. Moreover, VEGFa deficiency in MALPs delayed bone marrow recovery after radiation. Taken together, our research demonstrates a critical role of MALPs in mediating bone marrow repair after radiation injury and sheds light on a cellular target for treating marrow suppression after radiotherapy.
Collapse
Affiliation(s)
- Leilei Zhong
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lutian Yao
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Research Program in Pediatric Orthopaedics, Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Orthopaedics, The First Hospital of China Medical University, Shenyang, China
| | - Nicholas Holdreith
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wei Yu
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Gui
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zhen Miao
- Department of Biostatistics, Epidemiology and Informatics
| | - Yehuda Elkaim
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mingyao Li
- Department of Biostatistics, Epidemiology and Informatics
| | - Yanqing Gong
- Division of Translational Medicine and Human Genetics
| | - Maurizio Pacifici
- Translational Research Program in Pediatric Orthopaedics, Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - Kyu Sang Joeng
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Patrick Seale
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wei Tong
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ling Qin
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
17
|
Khatib ME, Van Slyke AL, Velalopoulou A, Kim MM, Shoniyozov K, Allu SR, Diffenderfer EE, Busch TM, Wiersma RD, Koch CJ, Vinogradov SA. Ultrafast Tracking of Oxygen Dynamics during Proton FLASH. Int J Radiat Oncol Biol Phys 2022; 113:624-634. [DOI: 10.1016/j.ijrobp.2022.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/01/2022] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
|
18
|
Abstract
In 1978, a Cancer Research article by Dougherty and colleagues reported the first large-scale clinical trial of photodynamic therapy (PDT) for treatment of 113 cutaneous or subcutaneous lesions associated with ten different kinds of malignancies. In classic applications, PDT depends on excitation of a tissue-localized photosensitizer with wavelengths of visible light to damage malignant or otherwise diseased tissues. Thus, in this landmark article, photosensitizer (hematoporphyrin derivative) dose, drug-light interval, and fractionation scheme were evaluated for their therapeutic efficacy and normal tissue damage. From their observations came early evidence of the mechanisms of PDT's antitumor action, and in the decades since this work, our knowledge of these mechanisms has grown to build an understanding of the multifaceted nature of PDT. These facets are comprised of multiple cell death pathways, together with antivascular and immune stimulatory actions that constitute a PDT reaction. Mechanism-informed PDT protocols support the contribution of PDT to multimodality treatment approaches. Moreover, guided by an understanding of its mechanisms, PDT can be applied to clinical needs in fields beyond oncology. Undoubtedly, there still remains more to learn; new modes of cell death continue to be elucidated with relevance to PDT, and factors that drive PDT innate and adaptive immune responses are not yet fully understood. As research continues to forge a path forward for PDT in the clinic, direction is provided by anchoring new applications in mechanistically grounded protocol design, as was first exemplified in the landmark work conducted by Dougherty and colleagues. See related article by Dougherty and colleagues, Cancer Res 1978;38:2628-35.
Collapse
|
19
|
Carter S, Miller J, Cramer G, Yuan M, Guzman S, Putt ME, Cengel KA, Freedman GM, Busch TM. Adjuvant Photodynamic Therapy, Mediated via Topical Versus Systemic Administration of 5-Aminolevulinic Acid for Control of Murine Mammary Tumor after Surgical Resection. Photochem Photobiol 2022; 98:117-126. [PMID: 34224156 PMCID: PMC9682898 DOI: 10.1111/php.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/04/2021] [Accepted: 07/02/2021] [Indexed: 01/03/2023]
Abstract
Treatment de-escalation is sought in the management of precursor lesions of early stage breast cancer, driving the appeal of adjuvant modalities to lumpectomy that reduce toxicity and minimally detract from patient quality of life. We investigate photodynamic therapy (PDT), with the photosensitizing prodrug, 5-aminolevulinic acid (ALA), as adjuvant therapy to complete resection of murine mammary tumor (propagated from TUBO cells). ALA was delivered either systemically (oral, 250 mg kg-1 ) at 5 h before 632 nm illumination or topically (20% solution) to the resection site at 10 min before light delivery to 135 J cm-2 . Treatment with either oral-ALA-PDT (oALA-PDT) or topical-ALA-PDT (tALA-PDT) to the mammary fat pad after TUBO complete resection (CR) produced long-term tumor control with 90-day complete response rates of 21% and 32%, respectively, compared to control rates of 0-5% in mice receiving only CR. Thus, CR/tALA-PDT was equipotent to CR/oALA-PDT despite ~10-fold lower levels of ALA-induced protoporphyrin XI as photosensitizer after topical versus oral-ALA administration. CR/oALA-PDT produced more vascular damage, greater proportion of tissue-resident neutrophils and stronger inflammation when compared to CR/tALA-PDT. Collectively, these data provide rationale for ongoing investigation of ALA-PDT as adjuvant therapy after lumpectomy for increased probability of local control in the treatment of breast cancer.
Collapse
Affiliation(s)
- Shirron Carter
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joann Miller
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gwendolyn Cramer
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Min Yuan
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stacy Guzman
- Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary E. Putt
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Keith A. Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gary M. Freedman
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Theresa M. Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Corresponding author (Theresa M. Busch)
| |
Collapse
|
20
|
Rubtsova NI, Hart MC, Arroyo AD, Osharovich SA, Liebov BK, Miller J, Yuan M, Cochran JM, Chong S, Yodh AG, Busch TM, Delikatny EJ, Anikeeva N, Popov AV. NIR Fluorescent Imaging and Photodynamic Therapy with a Novel Theranostic Phospholipid Probe for Triple-Negative Breast Cancer Cells. Bioconjug Chem 2021; 32:1852-1863. [PMID: 34139845 DOI: 10.1021/acs.bioconjchem.1c00295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
New exogenous probes are needed for both imaging diagnostics and therapeutics. Here, we introduce a novel nanocomposite near-infrared (NIR) fluorescent imaging probe and test its potency as a photosensitizing agent for photodynamic therapy (PDT) against triple-negative breast cancer cells. The active component in the nanocomposite is a small molecule, pyropheophorbide a-phosphatidylethanolamine-QSY21 (Pyro-PtdEtn-QSY), which is imbedded into lipid nanoparticles for transport in the body. The probe targets abnormal choline metabolism in cancer cells; specifically, the overexpression of phosphatidylcholine-specific phospholipase C (PC-PLC) in breast, prostate, and ovarian cancers. Pyro-PtdEtn-QSY consists of a NIR fluorophore and a quencher, attached to a PtdEtn moiety. It is selectively activated by PC-PLC resulting in enhanced fluorescence in cancer cells compared to normal cells. In our in vitro investigation, four breast cancer cell lines showed higher probe activation levels than noncancerous control cells, immortalized human mammary gland cells, and normal human T cells. Moreover, the ability of this nanocomposite to function as a sensitizer in PDT experiments on MDA-MB-231 cells suggests that the probe is promising as a theranostic agent.
Collapse
Affiliation(s)
- Natalia I Rubtsova
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, Pennsylvania 19104, United States
| | - Michael C Hart
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, Pennsylvania 19104, United States
| | - Alejandro D Arroyo
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, Pennsylvania 19104, United States
| | - Sofya A Osharovich
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, Pennsylvania 19104, United States
| | - Benjamin K Liebov
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, Pennsylvania 19104, United States
| | - Joann Miller
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Bldg 421, Philadelphia, Pennsylvania 19104, United States
| | - Min Yuan
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Bldg 421, Philadelphia, Pennsylvania 19104, United States
| | - Jeffrey M Cochran
- Department of Physics and Astronomy, University of Pennsylvania, 3231 Walnut Street, Philadelphia, Pennsylvania 19104, United States
| | - Sanghoon Chong
- Department of Physics and Astronomy, University of Pennsylvania, 3231 Walnut Street, Philadelphia, Pennsylvania 19104, United States
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, 3231 Walnut Street, Philadelphia, Pennsylvania 19104, United States
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Bldg 421, Philadelphia, Pennsylvania 19104, United States
| | - E James Delikatny
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, Pennsylvania 19104, United States
| | - Nadia Anikeeva
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, United States
| | - Anatoliy V Popov
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, Pennsylvania 19104, United States
| |
Collapse
|
21
|
Velalopoulou A, Karagounis IV, Cramer GM, Kim MM, Skoufos G, Goia D, Hagan S, Verginadis II, Shoniyozov K, Chiango J, Cerullo M, Varner K, Yao L, Qin L, Hatzigeorgiou AG, Minn AJ, Putt M, Lanza M, Assenmacher CA, Radaelli E, Huck J, Diffenderfer E, Dong L, Metz J, Koumenis C, Cengel KA, Maity A, Busch TM. FLASH proton radiotherapy spares normal epithelial and mesenchymal tissues while preserving sarcoma response. Cancer Res 2021; 81:4808-4821. [PMID: 34321243 DOI: 10.1158/0008-5472.can-21-1500] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/29/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022]
Abstract
In studies of electron and proton radiotherapy, ultrahigh dose rates of FLASH radiation therapy appear to produce fewer toxicities than standard dose rates while maintaining local tumor control. FLASH-proton radiotherapy (F-PRT) brings the spatial advantages of PRT to FLASH dose rates (>40 Gy/sec), making it important to understand if and how F-PRT spares normal tissues while providing anti-tumor efficacy that is equivalent to standard-proton radiotherapy (S-PRT). Here we studied PRT damage to skin and mesenchymal tissues of muscle and bone and found that F-PRT of the C57BL/6 murine hind leg produced fewer severe toxicities leading to death or requiring euthanasia than S-PRT of the same dose. RNAseq analyses of murine skin and bone revealed pathways upregulated by S-PRT yet unaltered by F-PRT, such as apoptosis signaling and keratinocyte differentiation in skin, as well as osteoclast differentiation and chondrocyte development in bone. Corroborating these findings, F-PRT reduced skin injury, stem cell depletion, and inflammation, mitigated late effects including lymphedema, and decreased histopathologically detected myofiber atrophy, bone resorption, hair follicle atrophy, and epidermal hyperplasia. F-PRT was equipotent to S-PRT in control of two murine sarcoma models, including at an orthotopic intramuscular site, thereby establishing its relevance to mesenchymal cancers. Finally, S-PRT produced greater increases in TGF-β1 in murine skin and the skin of canines enrolled in a phase 1 study of F-PRT versus S-PRT. Collectively, these data provide novel insights into F-PRT-mediated tissue sparing and support its ongoing investigation in applications that would benefit from this sparing of skin and mesenchymal tissues.
Collapse
Affiliation(s)
| | | | | | - Michele M Kim
- Radiation Oncology, University of Pennsylvania School of Medicine
| | | | - Denisa Goia
- Radiation Oncology, University of Pennsylvania
| | - Sarah Hagan
- Radiation Oncology, University of Pennsylvania
| | | | | | - June Chiango
- Department of Clinical Studies and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine
| | - Michelle Cerullo
- Department of Clinical Studies and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine
| | - Kelley Varner
- Department of Clinical Studies and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine
| | - Lutian Yao
- Orthopedic Surgery, University of Pennsylvania
| | - Ling Qin
- Orthopedic Surgery, University of Pennsylvania
| | | | - Andy J Minn
- Abramson Family Cancer Research Institute, Philadelphia
| | - Mary Putt
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania
| | - Matthew Lanza
- Pathobiology, University of Pennsylvania School of Veterinary Medicine
| | | | | | - Jennifer Huck
- Department of Clinical Studies and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine
| | | | - Lei Dong
- Radiation Oncology, University of Pennsylvania
| | - James Metz
- Radiation Oncology, University of Pennsylvania
| | | | | | - Amit Maity
- Radiation Oncology, University of Pennsylvania School of Medicine
| | | |
Collapse
|
22
|
Li AC, Ong YH, Li C, He J, Dimofte A, Busch TM, Wilson BC, Weersink R, Zhu TC. A Comparison of Two Probes to Determine Rectum Optical Properties. Proc SPIE Int Soc Opt Eng 2021; 11628:1162808. [PMID: 34083859 PMCID: PMC8171236 DOI: 10.1117/12.2582395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Tissue optical properties are crucial for determining the light dose delivered to the tumor. Two probes are compared: the two-catheter probe is based on transmittance measurement between one point source and one isotropic detector inside parallel catheters spaced at 0.5 cm along a 1-inch diameter transparent cylinder; and a 1-inch trans-rectal diffuse optical tomography (DOT) probe designed for prostate measurements, using a multiple fiber-array with source-detector separations of 1.4-10 mm. The two-catheter probe uses an empirical model for primary and scatter light fluence rates in the cylindrical cavity condition for anal PDT to determine optical properties along the source catheter using dual motors to move the source and detector along the catheters. The DOT probe uses finite element method (FEM) to obtain distribution of optical properties in 3D. Validations for the two probes were performed in liquid and solid phantoms. For each method, validation was performed in tissue-mimicking liquid phantoms for a range of known optical properties (μa between 0.05 and 0.9 cm-1 and μs' between 5.5 and 16.5 cm-1). To cross-check the two methods, solid phantoms were created of known optical properties at the University of Pennsylvania and sent for measurement to Princess Margaret Cancer Centre (PMH) to mimic realistic patient simulating conditions. Measurements were taken and optical properties were then recovered without knowing the expected values to cross-validate each probe. The results show modest agreement between the measured μa and μs'values, but high degree of agreement between the measured μeff performed independently using the two methods.
Collapse
Affiliation(s)
- Andrew C Li
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104
| | - Yi Hong Ong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104
| | - Celina Li
- University of Toronto/University Health Network, Toronto, ON M5G 2C4, Canada
| | - Jie He
- University of Toronto/University Health Network, Toronto, ON M5G 2C4, Canada
| | - Andreea Dimofte
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104
| | - Brian C Wilson
- University of Toronto/University Health Network, Toronto, ON M5G 2C4, Canada
| | - Robert Weersink
- University of Toronto/University Health Network, Toronto, ON M5G 2C4, Canada
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104
| |
Collapse
|
23
|
Ong YH, Li AC, Busch TM, Zhu TC. Determination of the distribution of drug concentration and tissue optical properties for ALA-mediated anal photodynamic therapy. Proc SPIE Int Soc Opt Eng 2021; 11628:1162806. [PMID: 34083860 PMCID: PMC8171263 DOI: 10.1117/12.2581824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PDT efficacy depends on the availability and dynamic interactions of photosensitizer, light, and oxygen. Tissue optical properties influence the delivered light dose and impact PDT outcome. In-vivo measurements of tissue optical properties and photosensitizer concentration enable determination of explicit and implicit dose factors affecting PDT and helps to understand the underlying biophysical mechanism of PDT. In this study, we measure tissue optical properties (absorption μa (λ) and scattering μs' (λ) coefficients) and PpIX concentration in tissue simulating liquid phantoms with a geometry that resembles anal canal. In-vivo light fluence rate and photosensitizer fluorescence of 405nm excitation light source were acquired using a dual-motor continuous wave transmittance spectroscopy system. We characterized the tissue optical properties correction factor of fluorescence signal using a series of tissue simulating phantoms with known PpIX concentrations and with absorption coefficient between 0.1 - 0.9 cm-1 and reduced scattering coefficient between 5 - 40 cm-1. The results demonstrated that our spectroscopy system could determine the distribution of tissue optical properties and PPIX concentration during anal PDT.
Collapse
Affiliation(s)
- Yi Hong Ong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104
| | - Andrew C. Li
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104
| | - Theresa M. Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104
| | - Timothy C. Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104
| |
Collapse
|
24
|
Zou W, Diffenderfer ES, Cengel KA, Kim MM, Avery S, Konzer J, Cai Y, Boisseu P, Ota K, Yin L, Wiersma R, Carlson DJ, Fan Y, Busch TM, Koumenis C, Lin A, Metz JM, Teo BK, Dong L. Current delivery limitations of proton PBS for FLASH. Radiother Oncol 2020; 155:212-218. [PMID: 33186682 DOI: 10.1016/j.radonc.2020.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Proton Pencil Beam Scanning (PBS) is an attractive solution to realize the advantageous normal tissue sparing elucidated from FLASH high dose rates. The mechanics of PBS spot delivery will impose limitations on the effective field dose rate for PBS. METHODS This study incorporates measurements from clinical and FLASH research beams on uniform single energy and the spread-out Bragg Peak PBS fields to extrapolate the PBS dose rate to high cyclotron beam currents 350, 500, and 800 nA. The impact of the effective field dose rate from cyclotron current, spot spacing, slew time and field size were studied. RESULTS When scanning magnet slew time and energy switching time are not considered, single energy effective field FLASH dose rate (≥40 Gy/s) can only be achieved with less than 4 × 4 cm2 fields when the cyclotron output current is above 500 nA. Slew time and energy switching time remain the limiting factors for achieving high effective dose rate of the field. The dose rate-time structures were obtained. The amount of the total dose delivered at the FLASH dose rate in single energy layer and volumetric field was also studied. CONCLUSION It is demonstrated that while it is difficult to achieve FLASH dose rate for a large field or in a volume, local FLASH delivery to certain percentage of the total dose is possible. With further understanding of the FLASH radiobiological mechanism, this study could provide guidance to adapt current clinical multi-field proton PBS delivery practice for FLASH proton radiotherapy.
Collapse
Affiliation(s)
- Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA.
| | - Eric S Diffenderfer
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Steve Avery
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Joshua Konzer
- IBA PT-Inc., PT Engineer-Beam Physics, Louvain-La-Neuve, Belgium
| | - Yongliang Cai
- IBA PT-Inc., PT Engineer-Beam Physics, Louvain-La-Neuve, Belgium
| | - Paul Boisseu
- Pyramid Technical Consultants, Systems Engineering, Boston, USA
| | - Kan Ota
- Pyramid Technical Consultants, Systems Engineering, Boston, USA
| | - Lingshu Yin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Rodney Wiersma
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - David J Carlson
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Yi Fan
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Costas Koumenis
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - James M Metz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - BoonKeng K Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
25
|
Teng CW, Amirshaghaghi A, Cho SS, Cai SS, De Ravin E, Singh Y, Miller J, Sheikh S, Delikatny E, Cheng Z, Busch TM, Dorsey JF, Singhal S, Tsourkas A, Lee JYK. Combined fluorescence-guided surgery and photodynamic therapy for glioblastoma multiforme using cyanine and chlorin nanocluster. J Neurooncol 2020; 149:243-252. [PMID: 32914293 PMCID: PMC7720701 DOI: 10.1007/s11060-020-03618-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/04/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Glioblastoma multiforme (GBM) is the most common primary intracranial malignancy; survival can be improved by maximizing the extent-of-resection. METHODS A near-infrared fluorophore (Indocyanine-Green, ICG) was combined with a photosensitizer (Chlorin-e6, Ce6) on the surface of superparamagnetic-iron-oxide-nanoparticles (SPIONs), all FDA-approved for clinical use, yielding a nanocluster (ICS) using a microemulsion. The physical-chemical properties of the ICS were systematically evaluated. Efficacy of photodynamic therapy (PDT) was evaluated in vitro with GL261 cells and in vivo in a subtotal resection trial using a syngeneic flank tumor model. NIR imaging properties of ICS were evaluated in both a flank and an intracranial GBM model. RESULTS ICS demonstrated high ICG and Ce6 encapsulation efficiency, high payload capacity, and chemical stability in physiologic conditions. In vitro cell studies demonstrated significant PDT-induced cytotoxicity using ICS. Preclinical animal studies demonstrated that the nanoclusters can be detected through NIR imaging in both flank and intracranial GBM tumors (ex: 745 nm, em: 800 nm; mean signal-to-background 8.5 ± 0.6). In the flank residual tumor PDT trial, subjects treated with PDT demonstrated significantly enhanced local control of recurrent neoplasm starting on postoperative day 8 (23.1 mm3 vs 150.5 mm3, p = 0.045), and the treatment effect amplified to final mean volumes of 220.4 mm3 vs 806.1 mm3 on day 23 (p = 0.0055). CONCLUSION A multimodal theragnostic agent comprised solely of FDA-approved components was developed to couple optical imaging and PDT. The findings demonstrated evidence for the potential theragnostic benefit of ICS in surgical oncology that is conducive to clinical integration.
Collapse
Affiliation(s)
- Clare W Teng
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 801 Spruce Street, 8th Floor, Philadelphia, PA, 19107, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ahmad Amirshaghaghi
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Steve S Cho
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 801 Spruce Street, 8th Floor, Philadelphia, PA, 19107, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shuting S Cai
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Emma De Ravin
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 801 Spruce Street, 8th Floor, Philadelphia, PA, 19107, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yash Singh
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 801 Spruce Street, 8th Floor, Philadelphia, PA, 19107, USA
| | - Joann Miller
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Saad Sheikh
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Delikatny
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Zhiliang Cheng
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jay F Dorsey
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sunil Singhal
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Tsourkas
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - John Y K Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 801 Spruce Street, 8th Floor, Philadelphia, PA, 19107, USA.
| |
Collapse
|
26
|
Sheng T, Ong Y, Busch TM, Zhu TC. Reactive oxygen species explicit dosimetry to predict local tumor growth for Photofrin-mediated photodynamic therapy. Biomed Opt Express 2020; 11:4586-4601. [PMID: 32923066 PMCID: PMC7449736 DOI: 10.1364/boe.393524] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 05/31/2023]
Abstract
Although photodynamic therapy (PDT) is an established modality for cancer treatment, current dosimetric quantities, such as light fluence and PDT dose, do not account for the differences in PDT oxygen consumption for different fluence rates (ϕ). A macroscopic model was adopted to calculate reactive oxygen species concentration ([ROS]rx) to predict Photofrin-PDT outcome in mice bearing radiation-induced fibrosarcoma (RIF) tumors. Singlet oxygen is the primary cytotoxic species for ROS, which is responsible for cell death in type II PDT, although other type I ROS is included in the parameters used in our model. Using a combination of fluences (50-250 J∕cm2) and ϕ (75 or 150 mW∕cm2), tumor regrowth rate, k, was determined for each condition by fitting the tumor volume versus time to V0 *exp(k*t). Treatment was delivered with a collimated laser beam of 1 cm diameter at 630 nm. Explicit dosimetry of light fluence rate on tissue surface, tissue oxygen concentration, tissue optical properties, and Photofrin concentration were performed. Light fluence rate at 3 mm depth (ϕ 3mm) was determined for the treatment volume based on Monte-Carlo simulations and measured tissue optical properties. Initial tissue oxygenation [3 O 2]0 was measured by an Oxylite oxygen probe before PDT and used to calculate [ROS]rx,calc. This value was compared to [ROS]rx,meas as calculated with the entire tissue oxygen spectrum [3 O 2](t), measured over the duration of light delivery for PDT. Cure index, CI = 1-k/kctr , for tumor growth up to 14 days after PDT was predicted by four dose metrics: light fluence, PDT dose, and [ROS]rx,calc, and [ROS]rx,meas. PDT dose was defined as the product of the time-integral of photosensitizer concentration and ϕ at a 3 mm tumor depth. These studies show that [ROS]rx,meas best correlates with CI and is an effective dosimetric quantity that can predict treatment outcome.
Collapse
|
27
|
Cramer GM, Moon EK, Cengel KA, Busch TM. Photodynamic Therapy and Immune Checkpoint Blockade
†. Photochem Photobiol 2020; 96:954-961. [DOI: 10.1111/php.13300] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Gwendolyn M. Cramer
- Department of Radiation Oncology Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
| | - Edmund K. Moon
- Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
| | - Keith A. Cengel
- Department of Radiation Oncology Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
| | - Theresa M. Busch
- Department of Radiation Oncology Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
| |
Collapse
|
28
|
Cramer G, Lewis R, Gymarty A, Hagan S, Mickler M, Evans S, Punekar SR, Shuman L, Simone CB, Hahn SM, Busch TM, Fraker D, Cengel KA. Preclinical Evaluation of Cetuximab and Benzoporphyrin Derivative‐Mediated Intraperitoneal Photodynamic Therapy in a Canine Model. Photochem Photobiol 2020; 96:684-691. [DOI: 10.1111/php.13247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/22/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Gwendolyn Cramer
- Department of Radiation Oncology University of Pennsylvania School of Medicine Philadelphia PA
| | - Robert Lewis
- St. Francis Hospital and Medical Center Bloomfield CT
| | - Ashley Gymarty
- Department of Radiation Oncology University of Pennsylvania School of Medicine Philadelphia PA
| | - Sarah Hagan
- Department of Radiation Oncology University of Pennsylvania School of Medicine Philadelphia PA
| | - Michela Mickler
- Department of Radiation Oncology University of Pennsylvania School of Medicine Philadelphia PA
| | - Sydney Evans
- Department of Radiation Oncology University of Pennsylvania School of Medicine Philadelphia PA
| | - Salman R. Punekar
- Department of Radiation Oncology University of Pennsylvania School of Medicine Philadelphia PA
| | - Lee Shuman
- Department of Radiation Oncology University of Pennsylvania School of Medicine Philadelphia PA
| | | | - Stephen M. Hahn
- Department of Radiation Oncology MD Anderson Cancer Center Houston TX
| | - Theresa M. Busch
- Department of Radiation Oncology University of Pennsylvania School of Medicine Philadelphia PA
| | - Douglass Fraker
- Department of Radiation Oncology University of Pennsylvania School of Medicine Philadelphia PA
| | - Keith A. Cengel
- Department of Radiation Oncology University of Pennsylvania School of Medicine Philadelphia PA
| |
Collapse
|
29
|
Cramer GM, Sandell Meo J, Finlay JC, Zhu TC, Busch TM, Cengel KA. In vivo Spectroscopic Evaluation of the Intraperitoneal Cavity in Canines. Photochem Photobiol 2020; 96:426-433. [PMID: 32060914 DOI: 10.1111/php.13226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/12/2020] [Indexed: 12/17/2022]
Abstract
As part of a preclinical trial for the treatment of peritoneal carcinomatosis (PC) with photodynamic therapy (PDT), we have assessed changes in optical properties, tissue oxygenation and drug concentration as a result of benzoporphyrin derivative (BPD)-mediated PDT using diffuse reflectance and fluorescence measurements. PDT can effectively treat superficial disease spread, but treatment efficacy is influenced by physical properties of the treated tissue which can change over the treatment time. In this study, healthy canines were given BPD and irradiated with 690 nm light during a partial bowel resection, and spectroscopic and fluorescence measurements were made using an in-house built spectroscopic probe. Hemoglobin concentration, oxygenation and optical properties were determined to be highly heterogeneous between canines and at different anatomical locations within the same subject, so further development of PDT dosimetry systems will need to address this patient and location-specific dose optimization. Compared to other photosensitizers, we found no apparent BPD photobleaching after PDT.
Collapse
Affiliation(s)
- Gwendolyn M Cramer
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Julia Sandell Meo
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, United States
| | - Jarod C Finlay
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
30
|
Dupre PJ, Ong YH, Friedberg J, Singhal S, Carter S, Simone CB, Finlay JC, Zhu TC, Cengel KA, Busch TM. Light Fluence Rate and Tissue Oxygenation (S t O 2 ) Distributions Within the Thoracic Cavity of Patients Receiving Intraoperative Photodynamic Therapy for Malignant Pleural Mesothelioma. Photochem Photobiol 2020; 96:417-425. [PMID: 32048732 DOI: 10.1111/php.13224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/29/2019] [Indexed: 01/22/2023]
Abstract
The distributions of light and tissue oxygenation (St O2 ) within the chest cavity were determined for 15 subjects undergoing macroscopic complete resection followed by intraoperative photodynamic therapy (PDT) as part of a clinical trial for the treatment of malignant pleural mesothelioma (MPM). Over the course of light delivery, detectors at each of eight different sites recorded exposure to variable fluence rate. Nevertheless, the treatment-averaged fluence rate was similar among sites, ranging from a median of 40-61 mW cm-2 during periods of light exposure to a detector. St O2 at each tissue site varied by subject, but posterior mediastinum and posterior sulcus were the most consistently well oxygenated (median St O2 >90%; interquartile ranges ~85-95%). PDT effect on St O2 was characterized as the St O2 ratio (post-PDT St O2 /pre-PDT St O2 ). High St O2 pre-PDT was significantly associated with oxygen depletion (St O2 ratio < 1), although the extent of oxygen depletion was mild (median St O2 ratio of 0.8). Overall, PDT of the thoracic cavity resulted in moderate treatment-averaged fluence rate that was consistent among treated tissue sites, despite instantaneous exposure to high fluence rate. Mild oxygen depletion after PDT was experienced at tissue sites with high pre-PDT St O2 , which may suggest the presence of a treatment effect.
Collapse
Affiliation(s)
- Pamela J Dupre
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Yi Hong Ong
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Joseph Friedberg
- Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Sunil Singhal
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Shirron Carter
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, United States
| | - Jarod C Finlay
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Timothy C Zhu
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Keith A Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
31
|
Busch TM, Cengel KA, Zhu TC. In Memoriam Jarod C. Finlay, PhD. Photochem Photobiol 2020. [DOI: 10.1111/php.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Theresa M. Busch
- Department of Radiation Oncology University of Pennsylvania Philadelphia PA United States
| | - Keith A. Cengel
- Department of Radiation Oncology University of Pennsylvania Philadelphia PA United States
| | - Timothy C. Zhu
- Department of Radiation Oncology University of Pennsylvania Philadelphia PA United States
| |
Collapse
|
32
|
Diffenderfer ES, Verginadis II, Kim MM, Shoniyozov K, Velalopoulou A, Goia D, Putt M, Hagan S, Avery S, Teo K, Zou W, Lin A, Swisher-McClure S, Koch C, Kennedy AR, Minn A, Maity A, Busch TM, Dong L, Koumenis C, Metz J, Cengel KA. Design, Implementation, and in Vivo Validation of a Novel Proton FLASH Radiation Therapy System. Int J Radiat Oncol Biol Phys 2020; 106:440-448. [PMID: 31928642 DOI: 10.1016/j.ijrobp.2019.10.049] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/11/2019] [Accepted: 10/31/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Recent studies suggest that ultrahigh-dose-rate, "FLASH," electron radiation therapy (RT) decreases normal tissue damage while maintaining tumor response compared with conventional dose rate RT. Here, we describe a novel RT apparatus that delivers FLASH proton RT (PRT) using double scattered protons with computed tomography guidance and provide the first report of proton FLASH RT-mediated normal tissue radioprotection. METHODS AND MATERIALS Absolute dose was measured at multiple depths in solid water and validated against an absolute integral charge measurement using a Faraday cup. Real-time dose rate was obtained using a NaI detector to measure prompt gamma rays. The effect of FLASH versus standard dose rate PRT on tumors and normal tissues was measured using pancreatic flank tumors (MH641905) derived from the KPC autochthonous PanCa model in syngeneic C57BL/6J mice with analysis of fibrosis and stem cell repopulation in small intestine after abdominal irradiation. RESULTS The double scattering and collimation apparatus was dosimetrically validated with dose rates of 78 ± 9 Gy per second and 0.9 ± 0.08 Gy per second for the FLASH and standard PRT. Whole abdominal FLASH PRT at 15 Gy significantly reduced the loss of proliferating cells in intestinal crypts compared with standard PRT. Studies with local intestinal irradiation at 18 Gy revealed a reduction to near baseline levels of intestinal fibrosis for FLASH-PRT compared with standard PRT. Despite this difference, FLASH-PRT did not demonstrate tumor radioprotection in MH641905 pancreatic cancer flank tumors after 12 or 18 Gy irradiation. CONCLUSIONS We have designed and dosimetrically validated a FLASH-PRT system with accurate control of beam flux on a millisecond time scale and online monitoring of the integral and dose delivery time structure. Using this system, we found that FLASH-PRT decreases acute cell loss and late fibrosis after whole-abdomen and focal intestinal RT, whereas tumor growth inhibition is preserved between the 2 modalities.
Collapse
Affiliation(s)
- Eric S Diffenderfer
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ioannis I Verginadis
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Khayrullo Shoniyozov
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anastasia Velalopoulou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Denisa Goia
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Putt
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah Hagan
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen Avery
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samuel Swisher-McClure
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cameron Koch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann R Kennedy
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andy Minn
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amit Maity
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Costas Koumenis
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - James Metz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
33
|
Ong YH, Dimofte A, Kim MM, Finlay JC, Sheng T, Singhal S, Cengel KA, Yodh AG, Busch TM, Zhu TC. Reactive Oxygen Species Explicit Dosimetry for Photofrin-mediated Pleural Photodynamic Therapy. Photochem Photobiol 2019; 96:340-348. [PMID: 31729774 DOI: 10.1111/php.13176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/18/2019] [Indexed: 01/10/2023]
Abstract
Explicit dosimetry of treatment light fluence and implicit dosimetry of photosensitizer photobleaching are commonly used methods to guide dose delivery during clinical PDT. Tissue oxygen, however, is not routinely monitored intraoperatively even though it is one of the three major components of treatment. Quantitative information about in vivo tissue oxygenation during PDT is desirable, because it enables reactive oxygen species explicit dosimetry (ROSED) for prediction of treatment outcome based on PDT-induced changes in tumor oxygen level. Here, we demonstrate ROSED in a clinical setting, Photofrin-mediated pleural photodynamic therapy, by utilizing tumor blood flow information measured by diffuse correlation spectroscopy (DCS). A DCS contact probe was sutured to the pleural cavity wall after surgical resection of pleural mesothelioma tumor to monitor tissue blood flow (blood flow index) during intraoperative PDT treatment. Isotropic detectors were used to measure treatment light fluence and photosensitizer concentration. Blood-flow-derived tumor oxygen concentration, estimated by applying a preclinically determined conversion factor of 1.5 × 109 μMs cm-2 to the blood flow index, was used in the ROSED model to calculate the total reacted reactive oxygen species [ROS]rx. Seven patients and 12 different pleural sites were assessed and large inter- and intrapatient heterogeneities in [ROS]rx were observed although an identical light dose of 60 J cm-2 was prescribed to all patients.
Collapse
Affiliation(s)
- Yi Hong Ong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA.,Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Andreaa Dimofte
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Jarod C Finlay
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Tianqi Sheng
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Sunil Singhal
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
34
|
Yan L, Luo L, Amirshaghaghi A, Miller J, Meng C, You T, Busch TM, Tsourkas A, Cheng Z. Dextran-Benzoporphyrin Derivative (BPD) Coated Superparamagnetic Iron Oxide Nanoparticle (SPION) Micelles for T 2-Weighted Magnetic Resonance Imaging and Photodynamic Therapy. Bioconjug Chem 2019; 30:2974-2981. [PMID: 31661959 DOI: 10.1021/acs.bioconjchem.9b00676] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Photodynamic therapy (PDT) has attracted extensive attention in recent years as a noninvasive and locally targeted cancer treatment approach. Nanoparticles have been used to improve the solubility and pharmacokinetics of the photosensitizers required for PDT; however, nanoparticles also suffer from many shortcomings including uncontrolled drug release and low tumor accumulation. Herein, we describe a novel biodegradable nanoplatform for the delivery of the clinically used PDT photosensitizer benzoporphyrin derivative monoacid ring A (BPD-MA) to tumors. Specifically, the hydrophobic photosensitizer BPD was covalently conjugated to the amine groups of a dextran-b-oligo (amidoamine) (dOA) dendron copolymer, forming amphiphilic dextran-BPD conjugates that can self-assemble into nanometer-sized micelles in water. To impart additional imaging capabilities to these micelles, superparamagnetic iron oxide nanoparticles (SPIONs) were encapsulated within the hydrophobic core to serve as a magnetic resonance imaging (MRI) contrast agent. The use of a photosensitizer as a hydrophobic building block enabled facile and reproducible synthesis and high drug loading capacity (∼30%, w/w). Furthermore, covalent conjugation of BPD to dextran prevents the premature release of drug during systemic circulation. In vivo studies show that the intravenous administration of dextran-BPD coated SPION nanoparticles results in significant MR contrast enhancement within tumors 24 h postinjection and PDT led to a significant reduction in the tumor growth rate.
Collapse
Affiliation(s)
- Lesan Yan
- Department of Bioengineering, School of Engineering and Applied Sciences , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States
| | - Lijun Luo
- Department of Bioengineering, School of Engineering and Applied Sciences , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States.,School of Agricultural Equipment Engineering , Jiangsu University , Zhenjiang , Jiangsu 212013 , China
| | - Ahmad Amirshaghaghi
- Department of Bioengineering, School of Engineering and Applied Sciences , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States
| | - Joann Miller
- Department of Radiation Oncology, Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States
| | - Cathy Meng
- Department of Bioengineering, School of Engineering , University of California Berkeley , Berkeley , California 94720 , United States
| | - Tianyan You
- School of Agricultural Equipment Engineering , Jiangsu University , Zhenjiang , Jiangsu 212013 , China
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States
| | - Andrew Tsourkas
- Department of Bioengineering, School of Engineering and Applied Sciences , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States
| | - Zhiliang Cheng
- Department of Bioengineering, School of Engineering and Applied Sciences , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States
| |
Collapse
|
35
|
Zhu TC, Ong Y, Kim MM, Liang X, Finlay JC, Dimofte A, Simone CB, Friedberg JS, Busch TM, Glatstein E, Cengel KA. Evaluation of Light Fluence Distribution Using an IR Navigation System for HPPH-mediated Pleural Photodynamic Therapy (pPDT). Photochem Photobiol 2019; 96:310-319. [PMID: 31556122 DOI: 10.1111/php.13166] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 12/29/2022]
Abstract
Uniform light fluence distribution for patients undergoing photodynamic therapy (PDT) is critical to ensure predictable PDT outcomes. However, current practice when delivering intrapleural PDT uses a point source to deliver light that is monitored by seven isotropic detectors placed within the pleural cavity to assess its uniformity. We have developed a real-time infrared (IR) tracking camera to follow the movement of the light point source and the surface contour of the treatment area. The calculated light fluence rates were matched with isotropic detectors using a two-correction factor method and an empirical model that includes both direct and scattered light components. Our clinical trial demonstrated that we can successfully implement the IR navigation system in 75% (15/20) of the patients. Data were successfully analyzed in 80% (12/15) patients because detector locations were not available for three patients. We conclude that it is feasible to use an IR camera-based system to track the motion of the light source during PDT and demonstrate its use to quantify the uniformity of light distribution, which deviated by a standard deviation of 18% from the prescribed light dose. The navigation system will fail when insufficient percentage of light source positions is obtained (<30%) during PDT.
Collapse
Affiliation(s)
- Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Yihong Ong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Xing Liang
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Jarod C Finlay
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Andreea Dimofte
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Eli Glatstein
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
36
|
Higbee‐Dempsey E, Amirshaghaghi A, Case MJ, Miller J, Busch TM, Tsourkas A. Indocyanine Green–Coated Gold Nanoclusters for Photoacoustic Imaging and Photothermal Therapy. Adv Therap 2019; 2. [DOI: 10.1002/adtp.201900088] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Elizabeth Higbee‐Dempsey
- Biochemistry and Molecular Biophysics Graduate GroupPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA 19104 USA
| | - Ahmad Amirshaghaghi
- Department of BioengineeringUniversity of Pennsylvania Philadelphia PA 19104 USA
| | - Matthew J. Case
- College of MedicineMedical University of South Carolina Charleston SC 29425 USA
| | - Joann Miller
- Department of Radiation OncologyPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA 19104 USA
| | - Theresa M. Busch
- Department of Radiation OncologyPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA 19104 USA
| | - Andrew Tsourkas
- Department of BioengineeringUniversity of Pennsylvania Philadelphia PA 19104 USA
| |
Collapse
|
37
|
Sheng T, Ong YH, Busch TM, Zhu TC. Reactive oxygen species explicit dosimetry to predict local tumor control for Photofrin-mediated photodynamic therapy. Proc SPIE Int Soc Opt Eng 2019; 10860. [PMID: 31327886 DOI: 10.1117/12.2508803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Although photodynamic therapy (PDT) is an established modality for cancer treatment, current dosimetric quantities, such as light fluence and PDT dose, do not account for the differences in PDT oxygen consumption for different fluence rates (ϕ). A macroscopic model was adopted to calculate reactive oxygen species concentration ([ROS]rx) to predict Photofrin-PDT outcome in mice bearing radiation-induced fibrosarcoma (RIF) tumors. Singlet oxygen is the primary cytotoxic species for ROS, which is responsible for cell death in type II PDT, although other type I ROS is included in the parameters used in our model. Using a combination of fluences (50-250 J/cm2) and ϕ (50 - 150 mW/cm2), tumor regrowth rate, k, was determined for each condition by fitting the tumor volume vs. time to V0*exp(k*t). Treatment was delivered with a collimated laser beam of 1 cm diameter at 630 nm. Explicit dosimetry of initial tissue oxygen concentration, tissue optical properties, and Photofrin concentration was used to calculate [ROS]rx,cal. ϕ was determined for the treatment volume based on Monte-Carlo simulations and measured tissue optical properties. Tissue oxygenation is measured using an oxylite oxygen probe to throughout the treatment to calculate the measured [ROS]rx,mea. Cure index, CI = 1-k/k ctr , for tumor gowth up to 14 days were determined as an endpoint using five dose metrics: light fluence, PDT dose, and [ROS]rx,cal, and [ROS]rx,mea. PDT dose was defined as the product of the time-integral of photosensitizer concentration and ϕ at a 3 mm tumor depth. Preliminary studies show that [ROS]rx,mea best correlates with CI and is an effective dosimetric quantity that can predict treatment outcome.
Collapse
Affiliation(s)
- Tianqi Sheng
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Yi Hong Ong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| |
Collapse
|
38
|
Amirshaghaghi A, Yan L, Miller J, Daniel Y, Stein JM, Busch TM, Cheng Z, Tsourkas A. Chlorin e6-Coated Superparamagnetic Iron Oxide Nanoparticle (SPION) Nanoclusters as a Theranostic Agent for Dual-Mode Imaging and Photodynamic Therapy. Sci Rep 2019; 9:2613. [PMID: 30796251 PMCID: PMC6385362 DOI: 10.1038/s41598-019-39036-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/11/2019] [Indexed: 01/10/2023] Open
Abstract
Photodynamic therapy (PDT) is an approved modality for the treatment of various types of maligancies and diseased states. However, most of the available photosensitizers (PS) are highly hydrophobic, which limits their solubility and dispersion in biological fluids and can lead to self-quenching and sub-optimal therapeutic efficacy. In this study, chlorin e6 (Ce6)-coated superparamagnetic iron oxide nanoparticle (SPION) nanoclusters (Ce6-SCs) were prepared via an oil-in-water emulsion. The physical-chemical properties of the Ce6-SCs were systematically evaluated. Dual-mode imaging and PDT was subsequently performed in tumor-bearing mice. Chlorin e6 is capable of solubilizing hydrophobic SPION into stable, water-soluble nanoclusters without the use of any additional amphiphiles or carriers. The method is reproducible and the Ce6-SCs are highly stable under physiological conditions. The Ce6-SCs have an average diameter of 92 nm and low polydispersity (average PDI < 0.2). Encapsulation efficiency of both Ce6 and SPION is ≈100%, and the total Ce6 payload can be as high as 56% of the total weight (Ce6 + Fe). The Ce6-SCs localize within tumors via enhanced permeability and retention and are detectable by magnetic resonance (MR) and optical imaging. With PDT, Ce6-SCs demonstrate high singlet oxygen generation and produce a significant delay in tumor growth in mice.
Collapse
Affiliation(s)
- Ahmad Amirshaghaghi
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Lesan Yan
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Joann Miller
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yonathan Daniel
- Department of Biology, College of Computer, Mathematical, & Natural Sciences, University of Maryland, College Park, Maryland, 20742, USA
| | - Joel M Stein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Zhiliang Cheng
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Andrew Tsourkas
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| |
Collapse
|
39
|
Sheng T, Ong YH, Busch TM, Zhu TC. Reactive oxygen species explicit dosimetry to predict tumor growth for BPD-mediated vascular photodynamic therapy. Proc SPIE Int Soc Opt Eng 2019; 10861:108610A. [PMID: 31080306 PMCID: PMC6510274 DOI: 10.1117/12.2514657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Photodynamic therapy (PDT) is a well-established treatment modality for cancer and other malignant diseases; however, quantities such as light fluence, and PDT dose do not fully account for all of the dynamic interactions between the key components involved. In particular, fluence rate (ϕ) effects are not accounted for, which has a large effect on the oxygen consumption rate. In this preclinical study, reacted reactive oxygen species ([ROS]rx) was investigated as a dosimetric quantity for PDT outcome. We studied the ability of [ROS]rx to predict the cure index (CI) after PDT of murine tumors; CI = 1 - k/kctr, where k and kctr are the growth rate of PDT-treated and control(untreated) tumor, respectively. Mice bearing radiation induced fibrosarcoma (RIF) tumors were treated with BPD-mediated PDT at different in-air fluences (22.5, 40, 45, 50, 70 and 100 J/cm2) and in-air ϕ (75 and 150 mW/cm2) with a BPD dose of 1 mg/kg and a drug-light interval of 15 mins. Treatment was delivered with a collimated laser beam of 1 cm diameter at 690 nm. Explicit dosimetry of initial tissue oxygen concentration, tissue optical properties, and BPD concentration was used to calculate [ 1 O 2 ] rx . ϕ was calculated for the treatment volume based on Monte-Carlo simulations and measured tissue optical properties. CI was used as an endpoint for four dose metrics: light fluence, PDT dose, and [ROS]rx. PDT dose was defined as the product of the time-integral of photosensitizer concentration and ϕ at a 3 mm tumor depth. Preliminary studies show that [ROS]rx best correlates with CI and is an effective dosimetric quantity that can predict treatment outcome. The threshold dose for [ROS]rx is determined to be 0.23 mM and is about 4.3 times smaller than the corresponding value for conventional BPD-mediated PDT using DLI of 3 hrs.
Collapse
Affiliation(s)
- Tianqi Sheng
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Yi Hong Ong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| |
Collapse
|
40
|
Mahmoudi K, Garvey KL, Bouras A, Cramer G, Stepp H, Jesu Raj JG, Bozec D, Busch TM, Hadjipanayis CG. 5-aminolevulinic acid photodynamic therapy for the treatment of high-grade gliomas. J Neurooncol 2019; 141:595-607. [PMID: 30659522 PMCID: PMC6538286 DOI: 10.1007/s11060-019-03103-4] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/11/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Photodynamic therapy (PDT) is a two-step treatment involving the administration of a photosensitive agent followed by its activation at a specific light wavelength for targeting of tumor cells. MATERIALS/METHODS A comprehensive review of the literature was performed to analyze the indications for PDT, mechanisms of action, use of different photosensitizers, the immunomodulatory effects of PDT, and both preclinical and clinical studies for use in high-grade gliomas (HGGs). RESULTS PDT has been approved by the United States Food and Drug Administration (FDA) for the treatment of premalignant and malignant diseases, such as actinic keratoses, Barrett's esophagus, esophageal cancers, and endobronchial non-small cell lung cancers, as well as for the treatment of choroidal neovascularization. In neuro-oncology, clinical trials are currently underway to demonstrate PDT efficacy against a number of malignancies that include HGGs and other brain tumors. Both photosensitizers and photosensitizing precursors have been used for PDT. 5-aminolevulinic acid (5-ALA), an intermediate in the heme synthesis pathway, is a photosensitizing precursor with FDA approval for PDT of actinic keratosis and as an intraoperative imaging agent for fluorescence-guided visualization of malignant tissue during glioma surgery. New trials are underway to utilize 5-ALA as a therapeutic agent for PDT of the intraoperative resection cavity and interstitial PDT for inoperable HGGs. CONCLUSION PDT remains a promising therapeutic approach that requires further study in HGGs. Use of 5-ALA PDT permits selective tumor targeting due to the intracellular metabolism of 5-ALA. The immunomodulatory effects of PDT further strengthen its use for treatment of HGGs and requires a better understanding. The combination of PDT with adjuvant therapies for HGGs will need to be studied in randomized, controlled studies.
Collapse
Affiliation(s)
- K Mahmoudi
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - K L Garvey
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Bouras
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G Cramer
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - H Stepp
- Laser-Research Laboratory, LIFE-Center, Department of Urology, University Hospital of Munich, Munich, Germany
| | - J G Jesu Raj
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - D Bozec
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - C G Hadjipanayis
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Neurosurgery, Mount Sinai Beth Israel, New York, NY, USA.
| |
Collapse
|
41
|
Cramer G, Shin M, Hagan S, Katz SI, Simone CB, Busch TM, Cengel KA. Modeling Epidermal Growth Factor Inhibitor-mediated Enhancement of Photodynamic Therapy Efficacy Using 3D Mesothelioma Cell Culture. Photochem Photobiol 2019; 95:397-405. [PMID: 30499112 DOI: 10.1111/php.13067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/19/2018] [Indexed: 12/29/2022]
Abstract
We have demonstrated that lung-sparing surgery with intraoperative photodynamic therapy (PDT) achieves remarkably extended survival for patients with malignant pleural mesothelioma (MPM). Nevertheless, most patients treated using this approach experience local recurrence, so it is essential to identify ways to enhance tumor response. We previously reported that PDT transiently activates EGFR/STAT3 in lung and ovarian cancer cells and inhibiting EGFR via erlotinib can increase PDT sensitivity. Additionally, we have seen higher EGFR expression associating with worse outcomes after Photofrin-mediated PDT for MPM, and the extensive desmoplastic reaction associated with MPM influences tumor phenotype and therapeutic response. Since extracellular matrix (ECM) proteins accrued during stroma development can alter EGF signaling within tumors, we have characterized novel 3D models of MPM to determine their response to erlotinib combined with Photofrin-PDT. Our MPM cell lines formed a range of acinar phenotypes when grown on ECM gels, recapitulating the locally invasive phenotype of MPM in pleura and endothoracic fascia. Using these models, we confirmed that EGFR inhibition increases PDT cytotoxicity. Together with emerging evidence that EGFR inhibition may improve survival of lung cancer patients through immunologic and direct cell killing mechanisms, these results suggest erlotinib-enhanced PDT may significantly improve outcomes for MPM patients.
Collapse
Affiliation(s)
- Gwendolyn Cramer
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael Shin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sarah Hagan
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sharyn I Katz
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Keith A Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
42
|
Rice SR, Li YR, Busch TM, Kim MM, McNulty S, Dimofte A, Zhu TC, Cengel KA, Simone CB. A Novel Prospective Study Assessing the Combination of Photodynamic Therapy and Proton Radiation Therapy: Safety and Outcomes When Treating Malignant Pleural Mesothelioma. Photochem Photobiol 2019; 95:411-418. [PMID: 30485442 PMCID: PMC6778401 DOI: 10.1111/php.13065] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022]
Abstract
Malignant pleural mesothelioma remains difficult to treat, with high failure rates despite optimal therapy. We present a novel prospective trial combining proton therapy (PT) and photodynamic therapy (PDT) and the largest-ever mesothelioma PT experience (n = 10). PDT photosensitizers included porfimer sodium (2 mg·kg-1 ; 24 h drug-light interval) or 2-[1-hexyloxyethyl]-2-devinyl pyropheophorbide-a (HPPH) (4 mg·m-2 ;48 h) with wavelengths of 630 nm to 60J·cm-2 and 665 nm to 15-45J·cm-2 , respectively. With a median age of 69 years, patients were predominantly male (90%) with epithelioid histology (100%) and stage III-IV disease (100%). PT was delivered to a median of 55.0 CGE/1.8-2.0 CGE (range 50-75 CGE) adjuvantly (n = 8) or as salvage therapy (n = 2) following extended pleurectomy/decortication (ePD)/PDT. Two-year local control was 90%, with distant and regional failure rates of 50% and 30%, respectively. All patients received chemotherapy, and four received immunotherapy. Surgical complications included atrial fibrillation (n = 3), pneumonia (n = 2), and deep vein thrombosis (n = 2). Median survival from PT completion was 19.5 months (30.3 months from diagnosis), and 1- and 2-year survival rates were 58% and 29%. No patient experienced CTCAEv4 grade ≥2 acute or late toxicity. Our prolonged survival in very advanced-stage patients compares favorably to survival for PT without PDT and photon therapy with PDT, suggesting possible spatial or systemic cooperativity and immune effect.
Collapse
Affiliation(s)
- Stephanie R. Rice
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Yun R. Li
- Helen Diller Family Comprehensive Cancer Center, Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Theresa M. Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michele M. Kim
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sally McNulty
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrea Dimofte
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Timothy C. Zhu
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Keith A. Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Charles B. Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
43
|
Davis RW, Snyder E, Miller J, Carter S, Houser C, Klampatsa A, Albelda SM, Cengel KA, Busch TM. Luminol Chemiluminescence Reports Photodynamic Therapy-Generated Neutrophil Activity In Vivo and Serves as a Biomarker of Therapeutic Efficacy. Photochem Photobiol 2018; 95:430-438. [PMID: 30357853 DOI: 10.1111/php.13040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/03/2018] [Indexed: 01/26/2023]
Abstract
Inflammatory cells, most especially neutrophils, can be a necessary component of the antitumor activity occurring after administration of photodynamic therapy. Generation of neutrophil responses has been suggested to be particularly important in instances when the delivered photodynamic therapy (PDT) dose is insufficient. In these cases, the release of neutrophil granules and engagement of antitumor immunity may play an important role in eliminating residual disease. Herein, we utilize in vivo imaging of luminol chemiluminescence to noninvasively monitor neutrophil activation after PDT administration. Studies were performed in the AB12 murine model of mesothelioma, treated with Photofrin-PDT. Luminol-generated chemiluminescence increased transiently 1 h after PDT, followed by a subsequent decrease at 4 h after PDT. The production of luminol signal was not associated with the influx of Ly6G+ cells, but was related to oxidative burst, as an indicator of neutrophil function. Most importantly, greater levels of luminol chemiluminescence 1 h after PDT were prognostic of a complete response at 90 days after PDT. Taken together, this research supports an important role for early activity by Ly6G+ cells in the generation of long-term PDT responses in mesothelioma, and it points to luminol chemiluminescence as a potentially useful approach for preclinical monitoring of neutrophil activation by PDT.
Collapse
Affiliation(s)
- Richard W Davis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emma Snyder
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joann Miller
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shirron Carter
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Cassandra Houser
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Astero Klampatsa
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steven M Albelda
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Keith A Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
44
|
Abstract
While ionizing radiotherapy (RT) can provide durable local control, the relative radiosensitivity of surrounding organs such as the lungs and heart and the distributed nature of the pleura limit the ability to safely deliver RT for patients with malignant pleural mesothelioma (MPM). Recent advances in the technological sophistication of RT planning and delivery devices have resulted in increased spatial control of irradiation dose that has extended the palliative and definitive applications of RT for patients with MPM. This review will outline the logistical, mechanistic and clinical basics of RT and the clinical trials supporting the use of RT in the multidisciplinary care of patients with MPM.
Collapse
Affiliation(s)
- Gwendolyn Cramer
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Theresa M Busch
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Keith A Cengel
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
45
|
Davis RW, Papasavvas E, Klampatsa A, Putt M, Montaner LJ, Culligan MJ, McNulty S, Friedberg JS, Simone CB, Singhal S, Albelda SM, Cengel KA, Busch TM. A preclinical model to investigate the role of surgically-induced inflammation in tumor responses to intraoperative photodynamic therapy. Lasers Surg Med 2018; 50:440-450. [PMID: 29799130 DOI: 10.1002/lsm.22934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Inflammation is a well-known consequence of surgery. Although surgical debulking of tumor is beneficial to patients, the onset of inflammation in injured tissue may impede the success of adjuvant therapies. One marker for postoperative inflammation is IL-6, which is released as a consequence of surgical injuries. IL-6 is predictive of response to many cancer therapies, and it is linked to various molecular and cellular resistance mechanisms. The purpose of this study was to establish a murine model by which therapeutic responses to photodynamic therapy (PDT) can be studied in the context of surgical inflammation. MATERIALS AND METHODS Murine models with AB12 mesothelioma tumors were treated with either surgical resection or sham surgery with tumor incision but no resection. The timing and extent of IL-6 release in the tumor and/or serum was measured using enzyme-linked immunosorbent assay (ELISA) and compared to that measured in the serum of 27 consecutive, prospectively enrolled patients with malignant pleural mesothelioma (MPM) who underwent macroscopic complete resection (MCR). RESULTS MPM patients showed a significant increase in IL-6 at the time MCR was completed. Similarly, IL-6 increased in the tumor and serum of mice treated with surgical resections. However, investigations that combine resection with another therapy make it necessary to grow tumors for resection to a larger volume than those that receive secondary therapy alone. As the larger size may alter tumor biology independent of the effects of surgical injury, we assessed the tumor incision model. In this model, tumor levels of IL-6 significantly increased after tumor incision. CONCLUSION The tumor incision model induces IL-6 release as is seen in the surgical setting, yet it avoids the limitations of surgical resection models. Potential mechanisms by which surgical induction of inflammation and IL-6 could alter the nature and efficacy of tumor response to PDT are reviewed. These include a wide spectrum of molecular and cellular mechanisms through which surgically-induced IL-6 could change the effectiveness of therapies that are combined with surgery. The tumor incision model can be employed for novel investigations of the effects of surgically-induced, acute inflammation on therapeutic response to PDT (or potentially other therapies). Lasers Surg. Med. 50:440-450, 2018. © 2018 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Richard W Davis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | | | - Astero Klampatsa
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Mary Putt
- Department of Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Luis J Montaner
- Wistar Institute, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Melissa J Culligan
- Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Sally McNulty
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Joseph S Friedberg
- Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Charles B Simone
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Sunil Singhal
- Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Steven M Albelda
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Keith A Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| |
Collapse
|
46
|
Yan L, Amirshaghaghi A, Huang D, Miller J, Stein JM, Busch TM, Cheng Z, Tsourkas A. Protoporphyrin IX (PpIX)-Coated Superparamagnetic Iron Oxide Nanoparticle (SPION) Nanoclusters for Magnetic Resonance Imaging and Photodynamic Therapy. Adv Funct Mater 2018; 28:1707030. [PMID: 29910700 PMCID: PMC5997278 DOI: 10.1002/adfm.201707030] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The ability to produce nanotherapeutics at large-scale with high drug loading efficiency, high drug loading capacity, high stability, and high potency is critical for clinical translation. However, many nanoparticle-based therapeutics under investigation suffer from complicated synthesis, poor reproducibility, low stability, and high cost. In this work, a simple method for preparing multifunctional nanoparticles is utilized that act as both a contrast agent for magnetic resonance imaging and a photosensitizer for photodynamic therapy for the treatment of cancer. In particular, the photosensitizer protoporphyrin IX (PpIX) is used to solubilize small nanoclusters of superparamagnetic iron oxide nanoparticles (SPIONs) without the use of any additional carrier materials. These nanoclusters are characterized with a high PpIX loading efficiency; a high loading capacity, stable behavior; high potency; and a synthetic approach that is amenable to large-scale production. In vivo studies of photodynamic therapy (PDT) efficacy show that the PpIX-coated SPION nanoclusters lead to a significant reduction in the growth rate of tumors in a syngeneic murine tumor model compared to both free PpIX and PpIX-loaded poly(ethylene glycol)-polycaprolactone micelles, even when injected at 1/8th the dose. These results suggest that the nanoclusters developed in this work can be a promising nanotherapeutic for clinical translation.
Collapse
Affiliation(s)
- Lesan Yan
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ahmad Amirshaghaghi
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dennis Huang
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joann Miller
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joel M Stein
- Department of Radiology, University of Pennsylvania, PA 19104, USA
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Zhiliang Cheng
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Andrew Tsourkas
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
47
|
Mohapatra PP, Chiemezie CO, Kligman A, Kim MM, Busch TM, Zhu TC, Greer A. 31 P NMR Evidence for Peroxide Intermediates in Lipid Emulsion Photooxidations: Phosphine Substituent Effects in Trapping. Photochem Photobiol 2017; 93:1430-1438. [PMID: 28722754 DOI: 10.1111/php.12810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/26/2017] [Indexed: 01/05/2023]
Abstract
Intralipid is a lipid emulsion used in photodynamic therapy (PDT) for its light scattering and tissue-simulating properties. The purpose of this study is to determine whether or not Intralipid undergoes photooxidation, and we have carried out an Intralipid peroxide trapping study using a series of phosphines [2'-dicyclohexylphosphino-2,6-dimethoxy-1,1'-biphenyl-3-sulfonate, 3-(diphenylphosphino)benzenesulfonate, triphenylphosphine-3,3',3''-trisulfonate and triphenylphosphine]. Our new findings are as follows: (1) An oxygen atom is transferred from Intralipid peroxide to the phosphine traps in the dark, after the photooxidation of Intralipid. 3-(Diphenylphosphino)benzenesulfonate is the most suitable trap in the series owing to a balance of nucleophilicity and water solubility. (2) Phosphine trapping and monitoring by 31 P NMR are effective in quantifying the peroxides in H2 O. An advantage of the technique is that peroxides are detected in H2 O; deuterated NMR solvents are not required. (3) The percent yield of the peroxides increased linearly with the increase in fluence from 45 to 180 J cm-2 based on our trapping experiments. (4) The photooxidation yields quantitated by the phosphines and 31 P NMR are supported by the direct 1 H NMR detection using deuterated NMR solvents. These data provide the first steps in the development of Intralipid peroxide quantitation after PDT using phosphine trapping and 31 P NMR spectroscopy.
Collapse
Affiliation(s)
| | - Callistus O Chiemezie
- Department of Chemistry, Brooklyn College, Brooklyn, NY
- Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, New York, NY
| | - Arina Kligman
- Department of Chemistry, Brooklyn College, Brooklyn, NY
- Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, New York, NY
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA
| | - Alexander Greer
- Department of Chemistry, Brooklyn College, Brooklyn, NY
- Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, New York, NY
| |
Collapse
|
48
|
Yan L, Miller J, Yuan M, Liu JF, Busch TM, Tsourkas A, Cheng Z. Improved Photodynamic Therapy Efficacy of Protoporphyrin IX-Loaded Polymeric Micelles Using Erlotinib Pretreatment. Biomacromolecules 2017; 18:1836-1844. [PMID: 28437090 DOI: 10.1021/acs.biomac.7b00274] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Photodynamic therapy (PDT) has attracted widespread attention in recent years as a noninvasive and highly selective approach for cancer treatment. We have previously reported a significant increase in the 90-day complete response rate when tumor-bearing mice are treated with the epidermal growth factor receptor (EGFR) inhibitor erlotinib prior to PDT with the photosensitizer benzoporphyrin-derivative monoacid ring A (BPD-MA) compared to treatment with PDT alone. To further explore this strategy for anticancer therapy and clinical practice, we tested whether pretreatment with erlotinib also exhibited a synergistic therapeutic effect with a nanocarrier containing the clinically relevant photosensitizer protoporphyrin IX (PpIX). The PpIX was encapsulated within biodegradable polymeric micelles formed from the amphiphilic block copolymer poly(ethylene glycol)-polycaprolactone (PEG-PCL). The obtained micelles were characterized systematically in vitro. Further, an in vitro cytotoxicity study showed that PDT with PpIX loaded micelles did exhibit a synergistic effect when combined with erlotinib pretreatment. Considering the distinct advantages of polymeric nanocarriers in vivo, this study offers a promising new approach for the improved treatment of localized tumors. The strategy developed here has the potential to be extended to other photosensitizers currently used in the clinic for photodynamic therapy.
Collapse
Affiliation(s)
- Lesan Yan
- Department of Bioengineering, School of Engineering and Applied Sciences, and ‡Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania 19104, United States
| | - Joann Miller
- Department of Bioengineering, School of Engineering and Applied Sciences, and ‡Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania 19104, United States
| | - Min Yuan
- Department of Bioengineering, School of Engineering and Applied Sciences, and ‡Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania 19104, United States
| | - Jessica F Liu
- Department of Bioengineering, School of Engineering and Applied Sciences, and ‡Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania 19104, United States
| | - Theresa M Busch
- Department of Bioengineering, School of Engineering and Applied Sciences, and ‡Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania 19104, United States
| | - Andrew Tsourkas
- Department of Bioengineering, School of Engineering and Applied Sciences, and ‡Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania 19104, United States
| | - Zhiliang Cheng
- Department of Bioengineering, School of Engineering and Applied Sciences, and ‡Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania 19104, United States
| |
Collapse
|
49
|
Qiu H, Kim MM, Penjweini R, Finlay JC, Busch TM, Wang T, Guo W, Cengel KA, Simone CB, Glatstein E, Zhu TC. A Comparison of Dose Metrics to Predict Local Tumor Control for Photofrin-mediated Photodynamic Therapy. Photochem Photobiol 2017; 93:1115-1122. [PMID: 28083883 DOI: 10.1111/php.12719] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/30/2016] [Indexed: 12/15/2022]
Abstract
This preclinical study examines light fluence, photodynamic therapy (PDT) dose and "apparent reacted singlet oxygen," [1 O2 ]rx , to predict local control rate (LCR) for Photofrin-mediated PDT of radiation-induced fibrosarcoma (RIF) tumors. Mice bearing RIF tumors were treated with in-air fluences (50-250 J cm-2 ) and in-air fluence rates (50-150 mW cm-2 ) at Photofrin dosages of 5 and 15 mg kg-1 and a drug-light interval of 24 h using a 630-nm, 1-cm-diameter collimated laser. A macroscopic model was used to calculate [1 O2 ]rx and PDT dose based on in vivo explicit dosimetry of the drug concentration, light fluence and tissue optical properties. PDT dose and [1 O2 ]rx were defined as a temporal integral of drug concentration and fluence rate, and singlet oxygen concentration consumed divided by the singlet oxygen lifetime, respectively. LCR was stratified for different dose metrics for 74 mice (66 + 8 control). Complete tumor control at 14 days was observed for [1 O2 ]rx ≥ 1.1 mm or PDT dose ≥1200 μm J cm-2 but cannot be predicted with fluence alone. LCR increases with increasing [1 O2 ]rx and PDT dose but is not well correlated with fluence. Comparing dosimetric quantities, [1 O2 ]rx outperformed both PDT dose and fluence in predicting tumor response and correlating with LCR.
Collapse
Affiliation(s)
- Haixia Qiu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA.,Department of Laser Medicine, Chinese PLA General Hospital, Beijing, China
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA.,Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Rozhin Penjweini
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Jarod C Finlay
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Tianhao Wang
- Department of Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Wensheng Guo
- Department of Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Charles B Simone
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Eli Glatstein
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
50
|
Simone CB, Busch TM, Cengel KA. Radiotherapy and Photodynamic Therapy for Malignant Pleural Mesothelioma. Asbestos and Mesothelioma 2017. [DOI: 10.1007/978-3-319-53560-9_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|