Bilirubin degradation in methanol induced by continuous UV-B irradiation: a UHPLC--ESI-MS study

Degradation of bilirubin in aerobic methanol solution by continuous UV-B irradiation has been investigated in this work. The purpose of this study was to shed more light on bilirubin interaction with the UV-B component of natural sunlight, since bilirubin is a very efficient UV-B absorber located in the skin epidermis. The degradation products have been detected and studied by a combined method of Ultra High Performance Liquid Chromatography-Electrospray Ionization Mass Spectrometry (UHPLC-ESI-MS). Bilirubin, a toxic pigment which itself is a product of (hemoglobin) degradation in organisms, undergoes its own degradation under aerobic conditions of UV-B continuous irradiation (e.g. photooxidation) that can be partly self-sensitized. Two dipyrrolic structures have been identified as a result of the bilirubin degradation, not including the bilirubin derivative biliverdin whose increase in the irradiated system is synchronous with a time dynamics of bilirubin degradation. It appears that one of dipyrrolic products originates directly from bilirubin and biliverdin molecules, while the other one is probably connected to bilirubin self-sensitized degradation. The precursor role of biliverdin in the degradation process--related to the detected dipyrroles--has not been confirmed.

[Pro- and antioxidant activity of bilirubin, EPR study]

The aim of the study was establishment of mechanisms of bilirubin oxidation and their involvement in the physiological and pathological processes in the living body (EPR study of photoradiated bilirubin). The photosensitized formation of free radical of bilirubin with g=2.003 and DeltaH=1.0 mTl, under action of the blue light with lambda(max)=450 nm by means of electronic spin resonance (ESR) was shown. Irradiation of sample in vacuum by visible light does not cause formation of free radicals. Irradiation of powder of bilirubin and also of its solution in chloroform leads to formation of the radical of bilirubin. The analysis of a spectrum (ESR) as powder also its solution in chloroform, that induced free radical belongs to bilirubin but not of solution was shown. Irradiation of a solution of bilirubin in chloroform causes absorption spectrum with lambda(max)=650 nm, characterized for absorption of solutions biliverdin in chloroform.

In vitro production of bilirubin photoisomers by light irradiation using neoBLUE

BACKGROUND

The light-emitting diode is used as one of the new light sources for phototherapy. NeoBLUE (Atom Medical, Tokyo, Japan) incorporates blue light-emitting diodes for the treatment of neonatal hyperbilirubinemia. The authors compared the in vitro efficacy of neoBLUE with conventional phototherapy devices.

METHODS

The three light devices used included neoBLUE and two conventional phototherapy devices with six blue-white (BW) or six green (GR) fluorescent tubes. A bilirubin/human serum albumin solution (15 mg/dL) in 200 x 300 mm elliptical bag was irradiated with each three light device. The average light intensity of neoBLUE, BW and GR was 22.5, 10.2 and 2.6 microW/cm(2) per nm, respectively, for the irradiated area. Bilirubin photoisomers and native bilirubin were measured by high-performance liquid chromatography.

RESULTS

In neoBLUE, BW and GR, the respective production rate of cyclobilirubin was 6.0, 3.7 and 3.9 x 10(-2) mg/dL/min, and the respective (4Z, 15E)-bilirubin/(4Z, 15Z)-bilirubin ratio after irradiation was 0.44, 0.33 and 0.12; the (4Z, 15Z)-bilirubin reduction rate at 20 min after irradiation was 60, 68 and 82%, respectively. The reduction rate of (4Z, 15Z)-bilirubin correlated with the (4Z, 15E)-bilirubin/(4Z, 15Z)-bilirubin ratio.

CONCLUSION

Phototherapy using the neoBLUE under high level may be clinically more effective than therapy using the conventional light source from the results of the production rate of cyclobilirubin.

Optimization of a High-Performance Liquid Chromatography Method to Quantify Bilirubin and Separate It From Its Photoproducts: Effect of Column Length, pH, Mobile Phase Composition, and Flow Rate

A rapid reversed-phase (RP) high-performance liquid chromatography method for the isolation of bilirubin from its photoproducts (e.g., biliverdin) is reported. The method is based on isocratic elution using methanol:water as the mobile phase. A 24 full-factorial experimental design approach was adopted. For the optimization, the best separation was obtained using a flow rate of 1.50 mL/min, a mobile phase of 99:1 methanol:water (v/v) at pH 3.60, and a 150 x 4.6 mm id RP (C18) column containing 5-microm particles. These conditions produced the fastest total retention time of 3.38 +/- 0.055 min, and other chromatographic parameters were acceptable. Under the optimum conditions, a linear calibration curve for bilirubin was obtained over the 1.0-40.0 microg/L concentration range studied. The limit of quantification was 0.79 g/L and the limit of detection was 0.24 microg/L. Bilirubin in solution was monitored by ultraviolet detection at 450 nm.

Phototherapy: current methods and future directions

Phototherapy is the most common therapeutic intervention used for the treatment of hyperbilirubinemia. Although it has become a mainstay since its introduction in 1958, a better understanding of the photobiology of bilirubin, characteristics of the phototherapy devices, the efficacy and safety considerations of phototherapy applications, and improvements in spectroradiometers and phototherapy devices are necessary for more predictable and improved clinical practices and outcomes. A step forward in instituting consistent, uniform, and effective use of phototherapy is the recent American Academy of Pediatrics clinical guideline on the management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation, which outlines a clinical strategy for the diagnosis of hyperbilirubinemia and contains direct recommendations for the application of phototherapy. This article reviews the parameters that determine the efficacy of phototherapy, briefly discusses current devices and methods used to deliver phototherapy, and speculates on future directions and studies that are still needed to complement our presently incomplete knowledge of the facets of this common mode of therapy.

Transcutaneous bilirubinometry during and after phototherapy

AIM

To evaluate the reliability of transcutaneous bilirubinometry (TcB) during and after phototherapy.

METHODS

TcB was performed on the forehead and chest of infants with neonatal jaundice when capillary blood was sampled for bilirubin determination in a control group of 240 neonates. In a second group of 70 neonates exposed to phototherapy the same procedure was performed after at least 24 h of exposure: on the forehead, TcB was done in the centre of the unexposed area and also on the adjacent exposed area, and the exposed chest. During the post-phototherapy period, TcB was again done during the first and second days, at least 18-24 h after cessation of phototherapy. The results were then statistically evaluated and regression curves were plotted.

RESULTS

A close correlation between TcB values and bilirubin levels was observed in the control group. In the phototherapy group, a correlation was also found between the TcB and the bilirubin values, but this correlation was significantly poorer than that of the controls; the correlation for the covered part of the forehead was significantly better than that of the exposed part but still poorer than that of the controls, though the difference was no longer significant. Skin colour recovered during the post-phototherapy period and correlation was better than that during exposure and no longer significantly different from that of the controls.

CONCLUSION

Through its bleaching effect on the skin, phototherapy affects the correlation between TcB and the bilirubin values, but does not totally eliminate it. The unexposed parts show a better correlation, though this was still poorer than that of the controls. Recovery of skin colour occurred within 18-24 h after cessation of exposure.

A comparative study on gamma irradiation of unconjugated bilirubin in aqueous and non-aqueous solutions

Dilute aqueous and non-aqueous solutions of bilirubin were exposed to gamma radiation to examine the effects of ionizing radiation on the concentrations of a specimen of this nature. The ionising radiation emanated from a (137)Cs source, and was applied to 5.2 x 10(-2) mmol L(-1) solutions of the unconjugated specimen in 0.05 mol L(-1) aqueous NaOH and chloroform. Depletion of bilirubin after exposure was common to both solvents. Complete degradation was accomplished with doses in excess of 100 Gy. In the case of NaOH, it was found that the presence of molecular oxygen contributed more efficiently to the degradation process, than irradiation in air. When the experimental conditions were changed to nitrogen, the degradation process was suppressed. The sole by-product of merit originating from the NaOH work was the short-wavelength isomer of biliverdin, at 330 nm. In the case of chloroform, the exclusive product of interest was characterised as the long-wavelength isomer of biliverdin that absorbs in the broad region commencing from about 620 nm. The non-aqueous study was conducted in the presence and absence of molecular oxygen, with no significant changes in the results. Optimum production of the isomers in question occurred at a gamma dose of about 80 Gy. The general species of interest were monitored spectrophotometrically, and the results were treated mathematically to facilitate evaluation of the data. Our work represents the development of a facile gamma-ray method for the exclusive production of specific isomers of biliverdin, which are useful components in biosynthetic research.

Can sunlight replace phototherapy units in the treatment of neonatal jaundice? An in vitro study

BACKGROUND/AIM

Light can be efficiently used for the treatment of neonatal jaundice. Sunlight, which covers a large portion of the light spectrum including the bilirubin-absorbing range, is abundant in the Middle East. Such advantages prompted the present study to investigate the efficiency of sunlight in isomerizing bilirubin. This may introduce a practical source of light for the treatment of hyperbilirubinic infants in areas where phototherapy units are not available.

METHODS

The efficiency of sunlight was quantified by a comparison with a phototherapy unit. Aqueous bilirubin solutions were exposed to periodic sunlight over the entire year and the reduction of bilirubin concentration was monitored spectrophotometrically. Bilirubin solutions were also exposed to a phototherapy unit intensity comparable to that of sunlight (17 cm away from the source).

RESULTS

The data indicated that at this comparable light intensity, the phototherapy unit was as effective as sunlight. However, for the treatment of neonatal jaundice, phototherapy units are usually operated at a distance of 50 cm (where the light intensity is six times less than that of sunlight). When this distance was tested, only 16% of bilirubin was isomerized in the first 5 min of exposure. In contrast, about 65% of bilirubin was isomerized when the phototherapy unit was placed at a distance of 17 cm and when the bilirubin solutions were exposed to sunlight for the same time period. The hourly and seasonal changes in sunlight intensity affected the reduction in bilirubin concentration significantly.

CONCLUSION

Data revealed that sunlight is almost 6.5 times more effective than a phototherapy unit when operating at the ward geometry after taking isomerization efficiency and area of exposure into consideration. Moreover, sunlight is still more effective during the winter season, when its intensity is lower. Thus, sunlight may be considered an alternative phototherapy source for the treatment of neonatal jaundice, particularly in areas where conventional phototherapy units are unavailable.

The effect of the irradiation wavelength on the processes sensitized by protoporphyrin IX dimethyl ester

The formation of triplet states of photosensitizers and singlet oxygen during reactions sensitized by protoporphyrin IX dimethyl ester (PPDME) and the products of its photo-oxidation in solution were studied by time-resolved spectroscopy. Irradiation with long-wavelength light (670 nm), which is absorbed by the products of photo-oxidation of PPDME, provides lower quantum yields of singlet oxygen than in sensitization with PPDME alone, which absorbs light with a wavelength of 630 nm. Spectroscopic measurements also confirmed the lower rate of sensitized photo-oxidation of bilirubin during irradiation with light with a wavelength of 670 nm.

Bilirubin, REM sleep, and phototransduction of environmental time cues. A hypothesis

The prevailing hypothesis for phototransduction is that visual (rod or cone) pigments mediate light's primary effects on biological clock systems. Common light-responsive chronobiological behavioral properties of plants and animals and some common molecular structures of plants and animals suggest the possibility that heme moieties and bile pigments in animals mediate some nonvisual influences of light on neuroactive gases and biological rhythms. As plant phytochrome resets the plant biological clock, the similar chromophore in bile pigments is proposed to transduce environmental light zeitgeber signals to endogenous biological clocks. The temporal association of plasma bilirubin and rapid-eye-movement (REM) sleep in populations, the correlation of secretion of biliary bilirubin with REM sleep among 10 different species (Spearman r = 0.89, p < 0.002), and the known responses of bilirubin to light lead to the hypothesis that bilirubin, in particular, plays an evolutionary role in the regulation of REM sleep and in mediating some of light's antidepressant effects.

Cross-linking of vitreous collagen and degradation of hyaluronic acid induced by bilirubin-sensitized photochemical reaction

To determine the mechanisms of vitreous liquefaction following vitreous hemorrhage, we investigated the effects of the free radicals produced by a bilirubin-sensitized photochemical reaction on collagen and hyaluronic acid (HA). Bovine vitreous collagen and HA were irradiated by visible light in the presence of bilirubin, which is produced from the degradation of hemoglobin, as a photosensitizer. Changes in molecular weight were monitored by sodium dodecyl sulfate-polyacrylamide gel electrophoresis for the collagen, and high-performance liquid chromatography for the HA. We found that free radicals caused an increase in high-molecular-weight components and insolubilization of the vitreous collagen, and a decrease in the molecular weight of HA. The changed molecular properties of the vitreous collagen could be attributed to the extensive cross-linking of the molecules. This cross-linking and the degradation of HA, both induced by the bilirubin-sensitized photochemical reaction, may contribute to vitreous liquefaction following vitreous hemorrhage.

Large intravenous loads of bilirubin photoconversion products, in contrast to bilirubin, do not cause cholestasis in bile acid-depleted pigs

BACKGROUND

Large intravenous bilirubin infusions in bile acid-depleted pigs (BADP) destroy hepatocyte canalicular membrane microvilli (CMV) and cause cholestasis. This study examines whether bilirubin photoconversion product infusions do the same.

METHODS

The effects of systemic infusion of 135 mumol.kg-1 body weight bilirubin photoconversion products on CMV density and choleretic response to intraportal bile acid infusion were studied in BADP. Furthermore, the effects of 135 mumol.kg-1 b.w. bilirubin infusion, either through an arteriovenous bilirubin photoconversion shunt device (PCD) or intravenously, were measured in PCD-connected BADP.

RESULTS

Intravenous bilirubin photoconversion product infusions affected neither the CMV density nor the choleretic response to cholic acid infusion, and neither did bilirubin infusion through the PCD. In contrast, intravenous bilirubin infusion caused canalicular injury and cholestasis in four of six PCD-connected BADP.

CONCLUSION

Bilirubin photoconversion products do not destroy CMV or cause cholestasis in BADP. A bilirubin photoconversion shunt device can confer cholestasis protection to bilirubin-loaded BADP.

Bilirubin phototoxicity to human cells by green light phototherapy in vitro

Phototherapy of newborn infants with blue or green light is the most common treatment of neonatal hyperbilirubinemia. Using bilirubin bound to human lymphoid and basal skin cells we obtained the green light dose dependency of the bilirubin phototoxicity to these cell types. Cells (3-5 x 10(6)/mL) were incubated with bilirubin complexed to human serum albumin (final concentrations 340 microM bilirubin, 150 microM albumin). Under these conditions all cells showed maximum binding of bilirubin. Irradiation with broadband green light (lambda max = 512 nm) over 24 h led to a light dose-dependent population of cells, which contained no bilirubin on the cell membrane as determined by Nomarski interference microscopy. The light-induced mechanism of the disappearance of bilirubin caused lethal membrane damage to the cells (trypan blue exclusion test). The cell kill rate increased with the irradiation dose and with the fraction of cells with no bilirubin. When 90% of lymphoid cells were bilirubin free, 46% of them were dead (using 480 J cm-1 green light). Similar results were obtained with basal skin cells. In addition, bilirubin-induced damage of cell membrane and nuclear membrane was also shown by transmission electron microscopy. Bilirubin (340 microM) in the dark led to 5% of the cells being killed. Basal skin cells bind 2.5 times more bilirubin molecules than lymphoid cells and showed a different bilirubin disappearance. Irradiation of bilirubin in carbon tetrachloride with 514.5 nm laser light showed generation of singlet oxygen via its luminescence at 1270 nm. These results demonstrate that green light phototherapy of hyperbilirubinemia may cause both skin and immune system damage.

Quantum yield and skin filtering effects on the formation rate of lumirubin

Photocyclization of bilirubin to lumirubin in the skin of jaundiced infants exposed to blue-green light irradiation is considered to be the most important process for bilirubin elimination from the organism. The quantum yield phi LR of the bilirubin-->lumirubin photoreaction has been recently measured and found to vary with the excitation wavelength, with a peak at about 520 nm. The quantum yield phi ZE for the strongly competing reversible configurational photoisomerization of bilirubin has also been recently shown to be wavelength dependent and to decrease significantly in the long-wavelength part of the absorption band of bilirubin. These new data are taken into account to model the bilirubin photochemistry in vivo by using a simplified skin optical model based on the Kubelka-Munk theory. The rate kappa LR of formation of lumirubin has been evaluated for the case of a four-layer skin and for monochromatic and narrow-band coloured fluorescent lamps. The effects of long-wavelength increase in phi LR, decrease in phi ZE and skin optical losses all combine to shift significantly the optimal rate of formation of lumirubin towards the green. These results suggest that a significant improvement in phototherapy might be obtained with the introduction of new lamps emitting in the blue-green spectral region between 490 and 510 nm.

Evaluation of the quantum yield for E-->Z isomerization of bilirubin bound to human serum albumin. Evidence of internal conversion processes competing with configurational photoisomerization

The quantum yield (phi zz) for the E--> photoisomerization of bilirubin (BR) bound to human serum albumin (HSA) under laser light irradiation has been evaluated with absorbance spectroscopy implemented by the high-performance liquid chromatography technique. The value at 458 nm is about 0.2, four times smaller than the value previously reported in the literature. As for the Z-->E configurational and the structural photoisomerization processes, the quantum yield varies with excitation wavelength, from 0.23 in the blue to 0.16 in the green. The sum of the quantum yields of the Z<-->E configurational photoisomerization reactions is 0.2-0.3 in the blue-green spectral region, thus giving direct evidence of the existence of internal conversion processes of the BR-HSA complex which compete with configurational photoisomerization. An evaluation of the quantum yields of the Z<-->E reactions for filtered broad-band light excitation in the 390-530 nm spectral region from data already published in the literature is also reported. Good agreement with our data of the quantum yields phi ZZ and phi ZE is found, despite the diversity of the experimental procedures in the two cases.

Selection of metalloporphyrin heme oxygenase inhibitors based on potency and photoreactivity

The heme oxygenase inhibitor, tin protoporphyrin, is being studied for the prevention of neonatal jaundice. This potential drug, however, is also a photosensitizer that could cause serious and unknown side effects when administered to newborns. Therefore, we have developed in vitro and in vivo procedures for the screening and further characterization of potentially safe heme oxygenase inhibitors. The ideal inhibitor: 1) contains a biocompatible metal, 2) is not degraded in tissues, 3) is a highly potent inhibitor of heme oxygenase, and 4) does not participate in photochemical reactions. Proto- and mesoporphyrin derivatives with the tin, zinc, manganese, chromium, nickel, and magnesium were screened in vitro for suitability. Chromium protoporphyrin and mesoporphyrin were further studied in vitro and in vivo and were found to meet the ideal criteria. Chromium mesoporphyrin appeared to be the most potent in vitro inhibitor of adult Wistar rat tissue heme oxygenase. Four mumol of chromium protoporphyrin or chromium mesoporphyrin/kg body weight, administered intraperitoneally to adult male Wistar rats given a heme load through intraperitoneal administration of 30 mumol heme/kg body weight, caused significant suppression of hemolysis-induced increase in carbon monoxide production to 72 and 44% of control, respectively, 5.5 h after treatment. At t = 6 h, the tissue heme oxygenase activity, measured in vitro, was significantly reduced to 33 and < 5% in liver and to 22 and < 5% in spleen after the administration of chromium protoporphyrin and mesoporphyrin, respectively, but was not reduced in brain. The results show that there exist effective metalloporphyrin heme oxygenase inhibitors without photosensitizing properties.

In vitro effects of light on serum bilirubin subfractions measured by high-performance liquid chromatography: comparison with four routine methods

The effects of light on serum bilirubin subfractions in vitro were investigated by HPLC and four routine methods for bilirubin analysis. By HPLC, the rate of photodegradation of unconjugated bilirubin (Bu) was nearly twice that of monoconjugated bilirubin (mBc) and threefold that of diconjugated bilirubin (dBc); delta bilirubin (Bd) was most stable against photoirradiation. In the diazo method, the rate of photodegradation of direct bilirubin was almost the same as that of the sum of mBc, dBc, and Bd determined by the HPLC method. However, the rate of photodegradation of indirect bilirubin was significantly lower (P < 0.001) than that obtained by HPLC, because approximately 30% of the bilirubin photoproducts reacted with the diazo reagent as indirect bilirubin. The rate of photodegradation of total bilirubin determined by the direct spectrometric method was lower than that determined by the diazo method, but equal to that of the total peak areas of HPLC. In the Ektachem method, bilirubin photoproducts affected total bilirubin negligibly, and Bc and Bu positively, so that the value of Bd decreased. In the bilirubin oxidase method, bilirubin photoproducts were oxidized enzymatically by both the total and direct bilirubin reagents. We re-emphasize the importance of shielding serum from light to avoid generating bilirubin photoproducts that interfere with the accurate determination of serum bilirubin subfractions. We also recommend HPLC analysis as a standard method for bilirubin measurement.

[Photoisomers of bilirubin in the blood of neonates during phototherapy]

In a group of mature neonates with hyperbilirubinaemia the authors investigated by chromatography, using the HPLC method, levels of bilirubin photoisomers before phototherapy, in the course of phototherapy and after its termination. The configuration isomer 4 Z, 15 E is detected in blood of all icteric neonates already before the onset of treatment in a mean concentration of 5.2 (s = 3.8) mumol/l, during phototherapy its mean concentration is 23.0 (s = 8.0) mumol/l. Photoisomers participate in non-conjugated bilirubinaemia on average by 10%: 92% are formed by isomer 4 Z, 15 E, 5% by isomer 4 E, 15 Z and 3% by the structural isomer lumirubin. On the day following discontinuation of treatment the mean photoisomer concentrations are significantly lower than during phototherapy and significantly higher than before its initiation.

Wavelength-dependent quantum yield for Z----E isomerization of bilirubin complexed with human serum albumin

The quantum yield, phi ZE, for configurational photoisomerization (4Z,15Z----4Z,15E) of bilirubin bound non-covalently to human serum albumin was determined (at 23 +/- 2 degrees C) by laser excitation and chromatographic analysis of products. Values obtained for photoexcitation at 465 nm were about one-half those previously reported. The quantum yield was dependent on excitation wavelength, decreasing from a value of 0.109 +/- 0.010 for excitation at 457.9 nm to a value of 0.054 +/- 0.005 for excitation at 514.5 nm. The wavelength dependence is consistent with rapid transfer of excitation energy between the two non-identical pyrromethenone chromophores of bilirubin in the singlet excited state. Since the quantum yields for photoisomerization and luminescence of bilirubin bound to serum albumin at room temperature are both low, internal conversion processes, rather than Z----E configurational isomerizations, are probably the major pathways for deactivation of photo-excited bilirubin.

[Nonspecific photophysiological immunization]

A hypothesis is suggested on the positive effect of light radiation on the formation of protective immune mechanism related to the photophysiological destruction of porphyrins. References to experimental data are given which illustrate the possibility for existence of such a mechanism.

Hepatic handling of photoirradiated bilirubin. A study in isolated perfused Wistar rat liver

Conjugation has been considered the rate-limiting step for bilirubin hepatic transport, and bypass of this metabolic step could explain why photobilirubins can be rapidly cleared by the liver. In this paper we assessed whether photoirradiation may enhance the bilirubin overall hepatic transport in the isolated perfused Wistar rat liver, a model possessing intact transport and conjugating systems. Bilirubin was administered as a bolus so as to reach a perfusate concentration of approximately 10 microM (bilirubin/albumin molar ratio 1:17). Perfusate light exposure (0.56.10(15) quanta s-1 cm-2) yielded 7-10% of configurational photoisomers, which were further identified as (4Z,15E/4E,15Z)-bilirubin IX alpha. Under such conditions, the perfusate removal rate was increased by 39% over that from dark conditions. Likewise, biliary excretion, estimated as total bilirubin recovery at 60 min, was also increased (+48%). This later improvement was mainly produced at the expense of unconjugated bilirubin, which most likely derived from its configurational photoisomers that, once excreted into bile, readily re-isomerized to the parent compound. In addition, this increment was partially due to a delayed improvement of monoglucuronide pigment excretion. The calculated hepatic pigment content was significantly higher under light conditions. A direct assessment of hepatic content of different bilirubin moieties at 20 min after bilirubin administration confirmed that such an increment was fully accounted for by unconjugated pigment. Our finding that hepatic pigment content rose (despite a higher biliary excretion) when the bilirubin was irradiated suggests a higher net uptake of photoisomers than native pigment. This observation, and the finding that bilirubin photoisomers were usually excreted without undergoing conjugation even if the metabolic system is active, contribute to explain the greater appearance of unconjugated bilirubin in Wistar rat bile under light exposure.

Study of the mechanism of the photoisomerization and photooxidation of bilirubin using a model for the phototherapy of hyperbilirubinemia

Liquid chromatography was employed for a study of photochemical degradation of bilirubin in the complex with human albumin, using a model system in the presence of riboflavin. The concentrations of bilirubin, the photoisomers and biliverdin were monitored. The reaction mechanism was verified using a quantified mathematical model and was represented by a reaction scheme. Photoisomerization is the initial process, followed by photooxidation to degradation products of the tetrapyrrole skeleton, with formation of biliverdin as an intermediate. The blood of newborns that were irradiated for treatment of hyperbilirubinemia was studied for the sake of comparison. The effect of some biochemically important substances was followed, in view of possible inhibition of the processes. The experimental results demonstrate that riboflavin acts as a catalyst, even at the concentrations typical for its occurrence in blood. The results are discussed from the point of view of the mechanism of bilirubin degradation during phototherapy.

Single-strand breaks in the DNA of human cells exposed to visible light from phototherapy lamps in the presence and absence of bilirubin

Clinical evidence indicates that phototherapy of hyperbilirubinaemia in newborn infants is a safe and efficient form of therapy. The short-term side effects are not serious and seem to be well controlled. There are few long-term follow-up studies of phototherapy-treated infants. Therefore one cannot completely exclude the possibility that side effects can be found in future studies. With this background we undertook the present study of possible genotoxic effects of phototherapy. Human cells of the established glioblastoma cell line TMG-1 were used. The cells were exposed to visible light in the presence of different concentrations of bilirubin or in the absence of bilirubin. DNA was unwound in alkaline solution and the induction of strand breaks was assayed by a method taking advantage of the fluorescence from the dye Hoechst 33258. Blue light induced single-strand breaks in the DNA of cells in culture in the absence of bilirubin. During irradiation of bilirubin solutions with blue and green phototherapy light, long-lived toxic photoproducts were formed under in vitro conditions. At high and clinically relevant bilirubin concentrations, the effects of blue and green light were relatively similar. At low concentrations, there was a smaller effect of green light as expected from the absorption spectrum of bilirubin. It remains to be seen whether the genotoxic effect observed in the present studies can occur in vivo.

New trends in photobiology (invited review). Recent advances in bilirubin photophysics

The high photosensibility of bilirubin represents the main reason why neonatal jaundice is treated with light. The relaxation processes of excited bilirubin appear to be governed by complex mechanisms which are not fully known. At room temperature, radiationless channels, such as Z----E configurational photoisomerizations and internal conversions, contribute mostly to the deactivation of singlet excited bilirubin. Exciton coupling processes between the two pyrromethenone chromophores constituting the molecule may play a crucial role in bilirubin photophysics.

[Changes in the synaptosomal membrane in the modelling of the phototherapeutic action used in bilirubin encephalopathy]

Continuous irradiation of bilirubin containing (3.10(-5) M) particles of the synaptosomal membrane (pH 7.2, at 10 degrees C) with blue light for 2 hours led to decrease of the total specific activity of ATPase, specific activity of Na, K-ATPase, and (less significantly and at a slower rate) specific activity of acetilcholinesterase. Pre-irradiation argon barbotage of the aqueous suspension of the synaptosomal membrane particles or addition of tocopherol acetate to the suspension counteracted the irradiation induced decrease of the enzyme activity. A counteraction was also produced by pre-irradiation alkalization of the suspension to pH 7.8 at 10 degrees C or addition of serum albumin to the suspension; the character of the effect of this protein on the activity of the membrane enzymes in irradiation was determined by certain peculiarities of its chemical composition. The strongest counteraction to the irradiation induced decrease of enzyme activity occurred in addition of monomeric albumin, freed of organophilic ligands, when pH of the suspension was 7.8 (10 degrees C). The activity of Na, K-ATPase and acetylcholinesterase was reduced most markedly when monomeric ligand containing albumin was added to a suspension of membrane particles which was acidified to pH 6.8 (10 degrees C) before the beginning of irradiation.

Metalloporphyrin-enhanced photodegradation of bilirubin in vitro

Solutions of bilirubin containing human serum albumin were exposed in vitro in the presence of 10 mumols/L of tin and zinc metalloporphyrins at 37 degrees C for 30 minutes to light sources used clinically for phototherapy of neonates. Bilirubin in the model solutions was photodegraded to approximately 60% of dark control in cool white light (17 microW/cm2 per nanometer). The presence of zinc protoporphyrin and zinc mesoporphyrin further reduced the bilirubin concentration slightly, but the tin analogues caused a significant enhancement of degradation to 35% and 25% of dark control, respectively. The results provide evidence that the zinc and tin metalloporphyrins are photosensitizers capable of enhancing the native photodegradation of bilirubin in biologic matrices, but that the tin compounds are more potent. The metalloporphyrin time course, dose-response curve, oxygen effects, and efficacy of phototherapy light sources were also studied.

Management of neonatal hyperbilirubinemia: rational use of phototherapy

Phototherapy has been used to treat neonatal hyperbilirubinemia for more than three decades; however, it is only during the last ten years that an understanding of the mechanism of action of phototherapy has emerged. While visible light is known to photooxidize and photoisomerize bilirubin, recent data suggest that the formation of bilirubin structural isomers (lumirubin) is responsible for the decrement in serum bilirubin. This paper discusses current clinical recommendations for light dosage and wavelength and develops new guidelines based upon recent information of how light effects a reduction in the serum bilirubin concentration.

Hypocrellin-A sensitized photooxidation of bilirubin

Hypocrellin A (HA) extracted from Hypocrellia bambusae (b.et Br.) sace, a derivative of 3,10-dihydroxy-4,9-perylenequinone, is a highly effective photosensitizer. Kinetic studies of the HA-sensitized photooxidation of bilirubin IX alpha (BR) in different solvents in the presence of various active oxygen quenchers indicate that in aprotic solvents the photooxidation goes via a Type II (1O2) mechanism, whereas in alkaline protic solvents Type I (electron transfer from an excited state of HA to the ground state of oxygen or the BR substrate). Type II and probably free radical reactions may occur simultaneously.

Quantum yields for laser photocyclization of bilirubin in the presence of human serum albumin. Dependence of quantum yield on excitation wavelength

The quantum yield for laser photocyclization of bilirubin to lumirubin in the presence of human serum albumin (phi LR) was measured at five monochromatic excitation wavelengths in the range 450-530 nm. Solutions used were optically thin throughout the wavelength range and precautions were taken to exclude contributions from photocyclization of bilirubin XIII alpha impurities. The values obtained (7.2-18 x 10(-4] were lower than those previously reported and showed the following wavelength dependence: 457.9 less than 488.0 less than 501.7 less than 514.5 approximately equal to 528.7. However, the rate of lumirubin formation, normalized to constant fluence, decreased with wavelength over the same wavelength range and no evidence was found that photoisomerization of bilirubin to lumirubin is faster with green (514.5 or 528.7 nm) than with blue (457.9 or 488.0 nm) light. The stereoselectivity of the configurational isomerization of bilirubin to 4Z,15E and 4E,15Z isomers also was studied. This reaction became less regioselective for the 4Z,15E isomer with increasing wavelength. The observed wavelength dependence of phi LR and of the [4E,15Z]: [4Z,15E] ratio at photoequilibrium are consistent with an exciton coupling model in which intramolecular energy transfer can occur between the two pyrromethenone chromophores of the bilirubin molecule in the excited state. Relative rates of lumirubin formation in vivo at different excitation wavelengths and constant fluence were estimated for different optical thicknesses and for different skin thicknesses. These estimates suggest that the recently reported clinical equivalence of blue and green phototherapy lights probably reflects the marked variation of skin transmittance with wavelength more than wavelength-dependent photochemistry. The calculations also indicated that the optimal wavelength for phototherapy is probably on the long wavelength side of the bilirubin absorption maximum.

UV excitable fluorescence of lumirubin

Solutions of bilirubin in different solvents show negligible fluorescence when they are excited with UV light. After irradiation, blue-violet fluorescence (400-450 nm) is observed, whose intensity and peak position depend on the irradiation time. The isolation of pure lumirubin led us to attribute this fluorescence specifically to this photoisomer, even if small contributions from other photoproducts cannot be ruled out. The emission peak of the pure lumirubin in aqueous solution (phosphate buffer) is at 415 nm while the main excitation peak is at 315 nm. Finally, an interpretation of the observed fluorescence is proposed on the basis of the similarity of the present results with previously reported experimental data.

Critical period of bilirubin-induced cerebellar hypoplasia in a new Sprague-Dawley strain of jaundiced Gunn rats

Homozygous (j/j) and heterozygous (j/+) newborn Gunn rats of the Sprague-Dawley strain were photoirradiated for 24 h at scheduled postnatal days and the effects of irradiation on the cerebellar development were examined at 30 days of life. Improvement of the survival rate was the most notable effect of photoirradiation. A single 24-h dose of photoirradiation during a period of postnatal days 4-11 effectively prevented hypoplasia in the j/j rat cerebellum. No prevention by light was observed at days 3 and 12. It was found that the most effective day of irradiation on the cerebellar development of j/j rats was centered on postnatal day 7. When plasma bilirubin was assessed during the period of postnatal days 7-10, a distinct diminution of the concentration was observed, restricted to only the period of the light treatment. Although there were some differences in the effective day as well as in the degree of efficacy of phototherapy among cerebellar lobules or sublobules, day 7 was the most critical for cerebellar hypoplasia due to bilirubin.

Bilirubin photoconversion induced by monochromatic laser radiation. Comparison between aerobic and anaerobic experiments in vitro

Structural and geometric photoisomerization of bilirubin bound to human serum albumin was investigated. Solutions were irradiated with monochromatic light emitted by an Ar ion laser, the 457.9, 488.0 and 514.5 nm wavelengths being selected. Photoproducts were separated and analysed by h.p.l.c. Visible-absorption spectra of pure ZZ-bilirubin, ZE-bilirubin and lumirubin in the eluent were registered in the 350-550 nm region by collecting single fractions by h.p.l.c. Wavelength-dependence of bilirubin photoconversion was studied within photoequilibrium and up to a large decrement of the total concentration. Experiments were performed in aerobic and anaerobic conditions in order to assess the contribution of the photo-oxidation to the overall process. The presence of O2 was found to increase the rate of bilirubin degradation and unexpectedly to favour lumirubin production. The ability of 514.5 nm irradiation to induce bilirubin cyclization was definitively confirmed.

Study of the mechanism of the photochemical oxidation of bilirubin by high-performance liquid chromatography

The photochemical degradation of bilirubin was studied in vitro using high-performance liquid chromatography and spectrophotometry. Attention was centered on the formation of biliverdin, which is produced as an intermediate in the photooxidation catalysed by riboflavin. approximate values of the overall and partial relative rate constants were calculated using the physiochemical criteria for a pseudo-monomolecular reaction. A more precise evaluation was made by non-linear regression programmes on a Hewlett-Packard 9835 A computer. In addition to the formation of biliverdin, attention was also paid to accompanying processes affecting the reaction mechanism, which were explained as aggregation and dimerization of bilirubin and biliverdin. It was also found that during phototherapy of newborn babies suffering from hyperbilirubinaemia the level of biliverdin in the plasma increased. The results are discussed from the point of view of phototherapy.

Renal handling of bilirubin photoderivatives

The renal handling of unconjugated bilirubin in the dark and during light exposure was analyzed using an isolated rat kidney preparation. The parameters tested were pigment disappearance from the perfusion medium, pigment uptake by tissue, and its renal clearance. The results indicated that despite the fact that pigment disappearance from the medium was similar for both forms of pigment, the extraction ratio was higher for irradiated pigment than for pigment in the dark. When renal clearance of pigment was plotted vs pigment uptake of tissue, the results indicated that irradiated pigment may be more efficiently removed by the kidney. In addition, data on the rate of secretion of p-aminohippurate suggested that both pigment forms shared a common site for secretion.

Wavelength dependence of the geometric and structural photoisomerization of bilirubin bound to human serum albumin

The two quantitatively important photoisomers in bilirubin metabolism during phototherapy are (ZE)-bilirubin and (EZ)-cyclobilirubin. We describe in vitro studies on the wavelength dependence for the geometric (delta 4Z, delta 15Z----delta 4Z, delta 15E) and structural (endovinyl cyclization) photoisomerization of bilirubin bound to human serum albumin by a high performance liquid chromatography method. For the geometric photoisomerization from (ZZ)-bilirubin to (ZE)-bilirubin, the most effective wavelength in vitro was 410 nm. For the structural photoisomerization, green light at 510 nm is the most efficient for causing cyclization of (ZZ)-bilirubin to (EZ)-cyclobilirubin via (EZ)-bilirubin and this may depend on a larger cross-section of (EZ)-bilirubin than (ZZ)-bilirubin in this spectral region and/or on a larger quantum yield for cyclization than geometric photoisomerization.

The effect of bilirubin photoisomers on unbound-bilirubin concentrations estimated by the peroxidase method

Unbound bilirubin is oxidized to nearly colourless substances in the presence of H2O2 or ethyl hydroperoxide and horseradish peroxidase. To predict the risk of kernicterus (degenerated yellow pigmentation of nerve cells), this principle has been widely utilized for estimating the concentration of unbound bilirubin in hyperbilirubinaemic serum. However, the serum contains polar geometric photoisomers of bilirubin. Therefore, to clarify the effect of bilirubin photoisomer concentrations on unbound-bilirubin concentration, the concentration of bilirubin and its photoisomer and of unbound bilirubin in samples obtained from experiments in vivo and in vitro were simultaneously and individually estimated by h.p.l.c. and the peroxidase method. During photoirradiation, both in vivo and in vitro, the serum polar (ZE)-bilirubin IX alpha concentration increased remarkably, but unbound-bilirubin values were not affected at all. However, during experiments in vitro, unbound bilirubin concentrations increased only when concentrations of the rather polar (EZ)- and (EE)-cyclobilirubin IX alpha increased considerably in a human serum albumin-bilirubin solution irradiated with blue light. Thus it is concluded that unbound-bilirubin concentrations, and consequently the initial rate of the peroxidase reaction, is not accelerated by the increase in either (ZE)-bilirubin or (EZ)-cyclobilirubin concentration within the clinically observed range.

Transcutaneous bilirubinometry. III. Dermal bilirubin kinetics under green and blue light phototherapy

Using the transcutaneous bilirubinometer, we studied the response of cutaneous bilirubin to different colors of light during phototherapy. Three groups of ten infants were exposed to blue, green, and blue-green lights at a mean postnatal age ranging from 50 to 77 hours. Patched areas served as controls. Every 15 minutes during four hours of phototherapy, we obtained simultaneous measurements from exposed and covered areas. After the onset of phototherapy, transcutaneous bilirubinometer values from the covered areas in all groups remained stable. The overall rate of bleaching was lowest in the green light group and highest in the blue-green combination group. In this group of infants, green light appeared to enhance the effectiveness of blue light in reducing dermal bilirubin concentrations as measured by the transcutaneous bilirubinometer.

Phototherapy in a new light

Visible light phototherapy has been used in the treatment of neonatal jaundice for more than 25 years. This article reviews the current state of knowledge of how phototherapy works and provides a framework for understanding why green may soon become the color of choice for phototherapy lamps.

Effect of combined treatment with 2,3,7,8-tetrachlorodibenzo-p-dioxin and phototherapy on bilirubin metabolism in the jaundiced Gunn rat

2,3,7,8-Tetrachlorodibenzo-p-dioxin, a potent inducer of microsomal cytochrome P448-dependent monoxygenases, and phototherapy both accelerate bilirubin metabolism and decrease jaundice in Gunn rats. The effects of combined treatment with 2,3,7,8-tetrachlorodibenzo-p-dioxin and light were studied in these rats by applying phototherapy for 65 hr, beginning 5 days after induction with 2,3,7,8-tetrachlorodibenzo-p-dioxin. 2,3,7,8-Tetrachlorodibenzo-p-dioxin pretreatment caused a 75% decline in plasma bilirubin in 5 days, with no change thereafter, whether or not the rats were exposed subsequently to phototherapy. In the uninduced rats, plasma bilirubin levels declined by 55% after 40 hr of phototherapy. As determined by [14C]bilirubin kinetics, both 2,3,7,8-tetrachlorodibenzo-p-dioxin and phototherapy increased fractional bilirubin turnover and decreased the total bilirubin pool. In the 2,3,7,8-tetrachlorodibenzo-p-dioxin-induced rats, the contracted bilirubin pool shifted from skin to liver, but these tissue pools did not change further during phototherapy. By contrast, in uninduced rats, phototherapy decreased the cutaneous bilirubin pool, which is the main target of phototherapy. 2,3,7,8-Tetrachlorodibenzo-p-dioxin was more effective than phototherapy in diminishing plasma bilirubin levels and the total bilirubin pool, but the combined treatment (2,3,7,8-tetrachlorodibenzo-p-dioxin followed by phototherapy) was no more effective than 2,3,7,8-tetrachlorodibenzo-p-dioxin alone.