Photodynamic Therapy Modalities Research Articles

Reactive oxygen species creation by laser-irradiated indocyanine green as photodynamic therapy modality: an in vitro study

Applications of lasers in phototherapy have been the trend for the last few decades. The photodynamic therapy process normally depends on photosensitizers and laser beams. Through this study, indocyanine green has been used as a photosensitizer, which is normally activated using laser lines between 750 and 805 nm. The activity of the indocyanine green to do fluorescence by other pulsed laser sources has been tested by fluorescence technique, and it has been proven that the laser lines at 810, 940, and 980nm are able to excite the indocyanine green with different extents. The indocyanine green activation has been tested by several laser lines (810, 940, and 980 nm) commonly used as surgical lasers. The generated oxygen has been measured after irradiating the indocyanine green with the different laser lines. A comparison has been made between laser irradiation as a pinpoint and a broad beam. It is found that the wide beam is more effective in activating oxygen production. In the end, it is concluded that lines 810 and 940nm were effective in activating the used dye, while the 980nm activity did not show enough efficiency.

Selective monitoring and treatment of neuroblastoma cells with hydrogen sulfide activatable phototheranostic agent

Activity-based photosensitizers (aPSs) are highly attractive as they offer improved selectivity and better therapeutic outcome in the scope of photodynamic therapy (PDT). Here, a hydrogen sulfide (H2S) responsive iodinated resorufin-based PS (RHS) was developed to treat neuroblastoma cancer cells selectively. RHS was shown to be a phototheranostic agent as it turned on its fluorescence signal and singlet oxygen (1O2) generation capability after reacting with H2S. RHS exhibited remarkable sensitivity towards H2S and proved to be highly cytotoxic in H2S rich SH-SY5Y human neuroblastoma cells upon light irradiation. In contrast, no photocytotoxicity was observed in H2S deficient nonmalignant fibroblast L929 cells. RHS marks the first example of a resorufin-based H2S activatable phototheranostic agent, which paves the way for effective treatment of neuroblastoma through PDT modality.

Interaction of protoporphyrinix (PPIX) and 5-amino levulinic acid (ALA) in nanoemulsion

Nanoemulsion is an interesting and unique fluid system in that it is used to solubilize both ionic and non-ionic molecules. Because of its uniqueness it has been used as a medium for drug delivery. It is therefore used in this work to study the interaction of Protoporphyrin (PPIX) and 5-Amino levulinic acid (ALA). While ALA is a distant precursor of PPIX, PPIX itself is not only a precursor of Heme but also a photosensitizer in the modality of Photodynamic Therapy (PDT). Both compounds are used use in PDT regimen. A steady-state fluorescence technique is used for the study of the interaction of these very important biological compounds. It is found that ALA quenches the fluorescence of PP IX in nanoemulsion. This observed quenching is diffusion controlled. The bimolecular quenching constant, kq, was determined as 2.86x 1010/M-s with an interaction constant, Ka, of 4.48 x 105 with the free energy of interaction, ΔGa of -32.234kJ/mole.

Locked and Loaded: β-Galactosidase Activated Photodynamic Therapy Agent Enables Selective Imaging and Targeted Treatment of Glioblastoma Multiforme Cancer Cells.

Selective detection and effective therapy of brain cancer, specifically, the very aggressive glioblastoma multiforme (GBM), remains one of the paramount challenges in clinical settings. While radiotherapy combined surgery is proposed as the main treatment course, it has several drawbacks such as complexity of the operation and common development of recurrent tumors in this course of patient care. Unique opportunities presented by photodynamic therapy (PDT) offer promising, effective, and precise therapy against GBM cells along with simultaneous imaging opportunities. However, activatable, theranostic molecular systems in PDT modality for GBM remained scarce. Specifically, even though elevated β-galactosidase (β-gal) activity in glioblastoma cells is well-documented, targeted, activatable therapeutic PDT agents have not been realized. Herein, we report a β-galactosidase (β-gal) activatable phototheranostic agent based on an iodinated resorufin core (RB-1) which was realized in only three steps with commercial reagents in 29% overall yield. RB-1 showed very high singlet oxygen (1O2) quantum yield (54%) accompanied by a remarkable turn-on response in fluorescence upon enzymatic activation. RB-1 was tested in different cell lines and revealed selective photocytotoxicity in U-87MG glioblastoma cells. Additionally, thanks to almost 7% fluorescence quantum yield (ΦF) despite extremely high 1O2 generation yield, RB-1 was also demonstrated as a successful agent for fluorescence imaging of U-87MG cells. Due to significantly lower (β-gal) activity in healthy cells (NIH/3T3), RB-1 stayed in a passive state and showed minimal photo and dark toxicity. RB-1 marks the first example of a β-gal activatable phototheranostic agent toward effective treatment of glioblastoma.

MO19-5 To establish a simulated hormonal microenvironment culture model for advancement of PDT modality in gynecological cancer

Conventional studies using monolayer cell culture models for evaluating cancer treatment efficacies usually substantiated treatment effects due to neglection of the physiological and pathological effects inside the body. The use of single hormonal dose exposure to monolayer cells at a fixed duration for current hormonal studies limits the effects posed by the real physiological hormonal conditions for cancer growth in patients. This study aims to establish a simulated hormonal microenvironment culture model to mimic the hormonal changes inside body over times for better evaluation of ALA-based Photodynamic Therapy (PDT) in breast cancer.

Aptamer‐Conjugated Biocompatible Nanospheres for Fluorescent Imaging–Guided Hepatocellular Carcinoma–Targeted Phototherapeutic Modality

Conventional strategies against hepatocellular carcinoma (HCC) remain unsatisfactory due to its invasiveness and poor prognosis. Herein, it is utmost imperative to require alternative modalities with less invasiveness, good clinical efficacy, and low side effects. A combination of photothermal therapy (PTT) and photodynamic therapy (PDT) is an emerging modality against refractory HCC. To date a majority of PTT/PDT paradigms has a disappointing therapeutic efficiency, owing to low targeting ability of nanotheranostic agents or imprecise irradiation of lasers. In this study, HCC‐specific targeting aptamer and chlorine e6 (Ce6)‐modified polydopamine (PDA) nanospheres with decoration of Pt quantum dots (termed Apt‐Ce6‐PDA@Pt bioconjugates) are explored to combat HCC in vivo by synergy of PTT and PDT modalities. The Apt‐Ce6‐PDA@Pt bioconjugates can effectively accumulate into tumor sites by specifically binding Glypican‐3 (GPC3)‐positive tumor cells, and core of PDA exerts strong optical absorption in near‐infrared (NIR) region to enable photothermal performance. Meanwhile, the moieties of Ce6 subsequently serve as photosensitizers and fluorophores to generate reactive oxygen species (ROS) and guide phototherapeutics, respectively. The current study finally suggests that Apt‐Ce6‐PDA@Pt bioconjugates can act as a protocol for programmable ablation of HCC and it is believed that it will have a significant impact on clinical translation of promising therapy.

Light-Decomposable Polymeric Micelles with Hypoxia-Enhanced Phototherapeutic Efficacy for Combating Metastatic Breast Cancer.

Oxygen dependence and anabatic hypoxia are the major factors responsible for the poor outcome of photodynamic therapy (PDT) against cancer. Combining of PDT and hypoxia-activatable bioreductive therapy has achieved remarkably improved antitumor efficacy compared to single PDT modality. However, controllable release and activation of prodrug and safety profiles of nanocarrier are still challenging in the combined PDT/hypoxia-triggered bioreductive therapy. Herein, we developed a near infrared (NIR) light-decomposable nanomicelle, consisting of PEGylated cypate (pCy) and mPEG-polylactic acid (mPEG2k-PLA2k) for controllable delivery of hypoxia-activated bioreductive prodrug (tirapazamine, TPZ) (designated TPZ@pCy), for combating metastatic breast cancer via hypoxia-enhanced phototherapies. TPZ@pCy was prepared by facile nanoprecipitation method, with good colloidal stability, excellent photodynamic and photothermal potency, favorable light-decomposability and subsequent release and activation of TPZ under irradiation. In vitro experiments demonstrated that TPZ@pCy could be quickly internalized by breast cancer cells, leading to remarkable synergistic tumor cell-killing potential. Additionally, metastatic breast tumor-xenografted mice with systematic administration of TPZ@pCy showed notable tumor accumulation, promoting tumor ablation and lung metastasis inhibition with negligible toxicity upon NIR light illumination. Collectively, our study demonstrates that this versatile light-decomposable polymeric micelle with simultaneous delivery of photosensitizer and bioreductive agent could inhibit tumor growth as well as lung metastasis, representing a promising strategy for potent hypoxia-enhanced phototherapies for combating metastatic breast cancer.

Super-Resolution Imaging of Intracellular Lipid Nanocarriers to Study Drug Delivery in Photodynamic Therapy.

Liposomal nanocarriers are intensively investigated as delivery vehicles for photoactivatable agents used in photodynamic therapy (PDT). The uptake, intracellular distribution, and processing of the nanocarriers are of paramount importance for the effectiveness of the therapy; visualization and analysis of these processes can, therefore, stimulate the development of improved PDT modalities. Here we describe a simple protocol, based on super-resolution imaging, that can be used for detailed quantification of concentration, distribution, and size of individual lipid nanocarriers in adherent mammalian cells.

Response of MCF-7 Breast Cancer Cells Overexpressed with P-Glycoprotein to Apoptotic Induction after Photodynamic Therapy.

Multidrug resistance (MDR) has posed a significant threat to cancer treatment and has led to the emergence of a new therapeutic regime of photodynamic therapy (PDT) to curb the menace. The PDT modality employs a photosensitiser (PS), excited at a specific wavelength of light to kill cancer cells. In the present study, we used a zinc phthalocyanine tetrasulfonic acid PS to mediate the photodynamic killing of MCF-7 cells overexpressed with P-glycoprotein (P-gp) and investigate the response to cell death induction. After photodynamic treatment, MCF-7 cells undergo cell death, and indicators like Annexin V/PI staining, DNA fragmentation, and measurement of apoptotic protein expression were investigated. Results showed increased externalisation of phosphatidylserine protein, measured as a percentage in flow cytometry indicative of apoptotic induction. This expression was significant (p < 0.006) for the untreated control cells, and there was no detection of DNA fragments after a laser fluence of 20 J/cm2. In addition, a statistically significant difference (p < 0.05) was seen in caspase 8 activity and Bax protein expression. These findings were indicative of apoptotic induction and thus seem to represent the extrinsic apoptotic pathway. This study shows the role of PDT in the treatment of a resistant phenotype breast cancer.

Light Technology for Efficient and Effective Photodynamic Therapy: A Critical Review.

Simple SummaryPhotodynamic therapy (PDT) is a promising treatment for cancerous tumours in which light technologies play a crucial role. An attempt to answer a long-standing question about which light source and light parameters are superior is carried out by reviewing the works reporting their effects on PDT outcome. We have identified the light characteristics that primarily affect the PDT process, based on the current evidence found in the literature. This review also examines cutting-edge technologies aiming to surpass the main challenge of PDT: low light penetration through the tissue. Whereas these technologies overcome several initial technical issues, they generate new challenges and pose limitations. We hope this review may be of interest to a broad audience, from bioengineers to clinical oncologists. The overall contribution we hope to make is to identify key roadblocks and provide a broad overview of light-based technologies, to foster improved developments and new perspectives towards enhanced PDT.Photodynamic therapy (PDT) is a cancer treatment with strong potential over well-established standard therapies in certain cases. Non-ionising radiation, localisation, possible repeated treatments, and stimulation of immunological response are some of the main beneficial features of PDT. Despite the great potential, its application remains challenging. Limited light penetration depth, non-ideal photosensitisers, complex dosimetry, and complicated implementations in the clinic are some limiting factors hindering the extended use of PDT. To surpass actual technological paradigms, radically new sources, light-based devices, advanced photosensitisers, measurement devices, and innovative application strategies are under extensive investigation. The main aim of this review is to highlight the advantages/pitfalls, technical challenges and opportunities of PDT, with a focus on technologies for light activation of photosensitisers, such as light sources, delivery devices, and systems. In this vein, a broad overview of the current status of superficial, interstitial, and deep PDT modalities—and a critical review of light sources and their effects on the PDT process—are presented. Insight into the technical advancements and remaining challenges of optical sources and light devices is provided from a physical and bioengineering perspective.

A red-light-activated sulfonamide porphycene for highly efficient photodynamic therapy against hypoxic tumor.

Photodynamic therapy (PDT) is an emerging alternative cancer treatment modality that utilizes photo-sensitivity to cause cell death upon photo-irradiation. However, PDT efficiency has been hampered by tumor hypoxia, blue-shifted excitation wavelengths, and the high dark toxicity of photo-sensitizers. We designed and synthesized two novel porphycene-based photosensitizers (TBPoS-OH and TBPoS-2OH) with potent photo-cytotoxicity and a LD50 in the nM range under both normoxic and hypoxic conditions in a variety of cell types after photo-irradiation (λ=640±15nm). Further studies showed fast-cellular uptake for TBPoS-OH that localized lysosomes and subsequently induced cell apoptosis via the lysosomal-mitochondrial pathway. Moreover, TBPoS-OH significantly reduced tumor growth in two xenografted mouse models bearing melanoma A375 and B16cells. Finally, TBPoS-OH exhibited no obvious immunogenicity and toxicity to blood cells and major organs in mice. These data demonstrated that these two porphycene-based photosensitizers, especially TBPoS-OH, could be developed as a potential PDT modality.

Endoplasmic Reticulum-Localized Iridium(III) Complexes as Efficient Photodynamic Therapy Agents via Protein Modifications.

Protein inactivation by reactive oxygen species (ROS) such as singlet oxygen ((1)O2) and superoxide radical (O2(•-)) is considered to trigger cell death pathways associated with protein dysfunction; however, the detailed mechanisms and direct involvement in photodynamic therapy (PDT) have not been revealed. Herein, we report Ir(III) complexes designed for ROS generation through a rational strategy to investigate protein modifications by ROS. The Ir(III) complexes are effective as PDT agents at low concentrations with low-energy irradiation (≤ 1 J cm(-2)) because of the relatively high (1)O2 quantum yield (> 0.78), even with two-photon activation. Furthermore, two types of protein modifications (protein oxidation and photo-cross-linking) involved in PDT were characterized by mass spectrometry. These modifications were generated primarily in the endoplasmic reticulum and mitochondria, producing a significant effect for cancer cell death. Consequently, we present a plausible biologically applicable PDT modality that utilizes rationally designed photoactivatable Ir(III) complexes.

Nanocomposite-Based Photodynamic Therapy Strategies for Deep Tumor Treatment.

Photodynamic therapy (PDT), as an emerging clinically approved modality, has been used for treatment of various cancer diseases. Conventional PDT strategies are mainly focused on superficial lesions because the wavelength of illumination light of most clinically approved photosensitizers (PSs) is located in the UV/VIS range that possesses limited tissue penetration ability, leading to ineffective therapeutic response for deep-seated tumors. The combination of PDT and nanotechnology is becoming a promising approach to fight against deep tumors. Here, the rapid development of new PDT modalities based on various smartly designed nanocomposites integrating with conventionally used PSs for deep tumor treatments is introduced. Until now many types of multifunctional nanoparticles have been studied, and according to the source of excitation energy they can be classified into three major groups: near infrared (NIR) light excited nanomaterials, X-ray excited scintillating/afterglow nanoparticles, and internal light emission excited nanocarriers. The in vitro and in vivo applications of these newly developed PDT modalities are further summarized here, which highlights their potential use as promising nano-agents for deep tumor therapy.

Daylight photodynamic therapy with methyl-aminolevulinate for the treatment of actinic cheilitis.

Actinic cheilitis (AC) is a common premalignant condition that requires an effective treatment to reduce the risk of malignant transformation. Photodynamic therapy (PDT) has been recently added to the armamentarium available for AC treatment. Daylight PDT (D-PDT) is a novel PDT modality in which the activation of the topical photosensitizer is induced by the exposure to natural daylight instead of artificial light sources without preliminary occlusion. This simplified procedure was found to be more tolerated as compared to conventional PDT. We report our preliminary experience on the use of D-PDT using methyl-aminolevulinate cream in 10 patients with refractory AC of the lower lip. Patients received two consecutive D-PDT sessions with an interval of 7-14 days. At 3 months after therapy, a complete response was observed in seven patients, with sustained results in five patients over an observational period of 6-12 months. Treatment was well tolerated.

Selective cell death by photochemically induced pH imbalance in cancer cells.

Singlet oxygen sensitized photodynamic therapy (PDT) relies on the concentration of oxygen in the tissue to be treated. Most cancer lesions, however, have poor vasculature and, as a result, are hypoxic, significantly hindering PDT efficacies. An oxygen-independent PDT method may circumvent this limitation. To address this, we prepared sulfonium salts that produced a pH drop within HCT 116 cells via the generation of a photoacid within the cytosol. This process was driven by one- or two-photon absorption (1PA or 2PA) of the endocytosed photoacid generators (PAGs). One of these PAGs, which had a significantly lower dark cytotoxicity and was more efficient in generating a photoacid, effectively induced necrotic cell death in the HCT 116 cells. The data suggest that PAGs may be an attractive alternative PDT modality to selectively induce cell death in oxygen-deprived tissue such as tumors.

Contributions of experiment designs in photodynamic therapy: Photosensitizer design, treatment analysis and optimization

Introduction One of the difficulties in the development of the photodynamic therapy (PDT) is inherent to the multidisciplinary feature of this treatment gathering mainly clinicians, physicists, biologists, and chemists. Another issue is the great number of biophysical and biochemical parameters involved in the design of new photosensitizers as well as in the in vivo application of this treatment. We present a global development approach based on the methodology and tools of experimental design. Three study cases are developed to assess to potential relevance of such an empirical model-based approach for the development of PDT. Methods & Results In a first study, an in vitro screening experimental design was carried out. The addressed question dealt with the determination of influent factors on the phototoxicity of a new photosensitizer based on quantum dots. Five factors were examined: the nature of quantum dots, the excitation light wavelength, the incubation time with cells, the photoactivable compound concentration and the fluence level. Relevance of each factor was finally estimated and compared to identify the significant parameters. In comparison with a typical factorial design, the total number of experiments (42 trials) was divided by 5. In a second study, an in vivo factorial experimental design was applied to detect potential synergic effects between four therapeutic factors: the phenotype of the cancer cell line, the food type, the nature of photosensitizer and the post-injection time, on the in vivo selectivity (cancer/normal tissue) of the tested photosensitizers. Results particularly pointed out the presence of a statistically significant synergic effect between these four factors and provided the optimal modalities to maximize the response in term of tumor-to-normal tissue ratio. In a third study, a Doehlert experimental design associated with a response surface model was used to determine the in vivo PDT modalities (photosensitizer concentration, irradiance and fluence) to both minimize the post-treatment growth rate of the tumor and maximize its growth delay. Only 13 experimental conditions were tested and the relevance of the optimized condition was corroborated by in vivo validation experiments. Conclusion These studies have confirmed the applicability and attractive contributions of experimental design techniques in the development and determination of optimal modalities of new photosensitizers in PDT. Their main advantages are to a priori organize experiments according to specific questions while minimizing the experimental cost and controlling as much as possible the experimental uncertainty.

Susceptibility of microcosm subgingival dental plaques to lethal photosensitization

Photodynamic therapy (PDT) offers potential as a non-invasive treatment of periodontal disease. In this study, microcosm biofilmswere grown in vitro under conditions designed to mimic subgingival plaques typically found in patients with periodontitis. To investigate potential PDT modalities, biofilms were exposed to light from a helium/neon laser in conjunction with a photosensitizer, toluidine blue O (TBO), at varying output and concentration, respectively. To determine cytotoxic effects, viability profiling was undertaken on whole biofilms using standard plating methods, and on horizontal cross-sections of biofilms using confocal laser-scanning microscopy (CLSM) in conjunction with a differential viability stain. A light energy dose of 94.5 J in combination with 81.7 µM TBO was found to be optimal, achieving significant kills of over 97%. CLSM enabled visualization of the effects of PDT in three dimensions. Viability profiling of the CLSM images revealed that lethal photosensitization was most effective in the upper layers of biofilm. PDT was found to reduce the viability of subgingivally modelled plaques in vitro by a magnitude similar to that of chlorhexidine digluconate, which is commonly used to treat periodontal disease. The findings of this study indicate that PDT may be an effective alternative to conventional modalities in the treatment of periodontal disease.

A New Method for Photodynamic Therapy of Melanotic Melanoma—Effects of Depigmentation with Violet Light Photodynamic Therapy

Melanotic melanomas have a poor response to photodynamic therapy (PDT). The reason for this is that melanin absorbs light over the entire wavelength region used for PDT (400-750 nm). Photobleaching of melanin is an approach to overcome this obstacle. In the present work, reflectance spectroscopy was applied to study depigmentation of human and murine skin with different melanin contents, and effects induced by PDT with topical application of methyl 5-aminolevulinate (MAL) on B16F10 melanotic melanomas transplanted to nude mice. Depigmentation and inhibition of tumor growth after violet light (420 nm) exposure, red light (634 nm) exposure, and combinations of both were studied. Reflectance spectroscopy was suitable for evaluation of the pigmentation of both human and murine skin. Skin depigmentation leads to increase in reflectance. PDT with violet light bleached some of the melanin in the skin above the B16F10 melanomas, and possibly also in the upper part of the melanomas. This resulted in a larger growth inhibition of tumors first given PDT with violet light and then with red light compared to treatments using the reverse order of illumination, namely, red light before violet light. It is concluded that violet light PDT can bleach melanin in melanotic tumors and therefore increase their sensitivity to red light PDT. This finding indicates a new PDT modality that can be further developed for treatment of superficial melanotic melanomas and possibly other diseases where pigmentation is a problem.

Phase II clinical study of photodynamic therapy using mono- l-aspartyl chlorin e6 and diode laser for early superficial squamous cell carcinoma of the lung

Photofrin is the most commonly used photosensitizer for photodynamic therapy (PDT). The major side effect of Photofrin is cutaneous photosensitivity. A second generation photosensitizer, mono- l-aspartyl chlorin e6 (NPe6) has shown anti-tumor efficacy and rapid clearance from skin. Therefore, we conducted a phase II clinical study to investigate the anti-tumor effects and safety of NPe6 in patients with early superficial squamous cell carcinoma of the lung. Enrollment criteria consisted of endoscopically evaluated early stage lung cancer with normal chest X-ray and CT images, no lymph node or distant metastasis. Tumors were located no more peripherally than subsegmental bronchi, the peripheral margin had to visible, and the tumor size had to not more than 2 cm in diameter. The histologic type of the tumor had to squamous cell carcinoma. Laser irradiation (100 J/cm 2) using a diode laser was performed at 4 h after administration of NPe6 (40 mg/m 2). Among 41 patients with 46 lesions, 40 with 45 lesions were eligible for safety evaluation, and 35 patients with 39 lesions were judged as eligible for efficacy evaluation. No serious adverse drug reactions were observed. Disappearance of skin photosensitivity was recognized within 2 weeks in 28 of 33 patients (84.8%) and in all the other seven patients first tested at 15–18 days. Complete response (CR) was seen in 84.6% of lesions (82.9% of patients). This study demonstrated excellent anti-tumor effects and safety, especially low skin photosensitivity in patients with early stage lung cancer. PDT using the second generation photosensitizer NPe6 and a diode laser will likely become a standard modality of PDT for central type early superficial squamous cell carcinoma of the lung.

Thermal imaging during photodynamic therapy (PDT)

This study was designed to measure the PDT associated changes in tumour tissue temperature and to calculate if tumoricidally relevant hyperthermia might be induced by the current clinically used PDT modalities. Syrian golden hamsters with amelanotic melanomas (A-Mel-3) received intravenous injections of Photofrin II (5 mg kg−1 b.w.) or 0.9% sodium chloride (2 ml kg−1 b.w.). Twenty-four hours later tumour surface and tumour centre temperature were quantified by an infra-red sensitive thermal imaging device and an implanted thermal probe during laser treatment at a wavelength of 630 nm. With laser light irradiation using power densities of 100 mW cm−2 or 200 mW cm−2, a significant temperature increase was noted in comparison to the baseline values. At total energy delivery of 100 J cm−2 the tumoricidally relevant threshold of 43°C was exceeded with 200 mW cm−2 only. However, no significant temperature differences were measured between photosensitized and control tumours receiving 100 mW cm−2 or 200 mW cm−2. Calculation of the corresponding applied hyperthermic dose revealed that submaximum hyperthermic effects were involved with irradiation intensities of 200 mW cm−2.