Marino A. Campo

5-Aminolevulinic Acid Derivatives in Photomedicine: Characteristics, Application and Perspectives

Abstract The introduction of lipophilic derivatives of the naturally occurring heme precursor 5-aminolevulinic acid (5-ALA) into photomedicine has led to a true revival of this research area. 5-ALA–mediated photodynamic therapy (PDT) and fluorescence photodetection (FD) of neoplastic disease is probably one of the most selective cancer treatments currently known in oncology. To date, this method has been assessed experimentally for the treatment of various medical indications. However, the limited local bioavailability of 5-ALA has widely prevented its use in daily clinical practice. Although researchers were already aware of this drawback early during the development of 5-ALA–mediated PDT, only recently have well-established concepts in pharmaceutical science been adapted to investigate ways to overcome this drawback. Recently, two derivatives of 5-ALA, methylaminolevulinate (MAL) and hexylaminolevulinate (HAL), gained marketing authorization from the regulatory offices in Europe and Australia. MAL is marketed under the trade name Metvix for the treatment of actinic keratosis and difficult-to-treat basal cell carcinoma. HAL has recently been launched under the trade name Hexvix to improve the detection of superficial bladder cancer in Europe. This review will first present the fundamental concepts underlying the use of 5-ALA derivatives in PDT and FD from a chemical, biochemical and pharmaceutical point of view. Experimental evidences from preclinical data on the improvements and limits observed with 5-ALA derivatives will then be introduced. The state-of-the-art from clinical studies with 5-ALA esters will be discussed, with special emphasis placed on the process that led to the development of MAL in dermatology and to HAL in urology. Finally, we will discuss promising medical fields in which use of 5-ALA derivatives might potentially lead to further use of this methodology in photomedicine.

Polymeric photosensitizer prodrugs for photodynamic therapy

A targeting strategy based on the selective enzyme‐mediated activation of polymeric photosensitizer prodrugs (PPP) within pathological tissue has led to the development of agents with the dual ability to detect and treat cancer. Herein, a detailed study of a simple model system for these prodrugs is described. We prepared “first‐generation” PPP by directly tethering the photosensitizer (PS) pheophorbide a to poly‐(l)‐lysine via epsilon amide links and observed that by increasing the number of PS on a polymer chain, energy transfer between PS units improved leading to better quenching efficiency. Fragmentation of the PPP backbone by trypsin digestion gave rise to a pronounced fluorescence increase and to more efficient generation of reactive oxygen species upon light irradiation. In vitro tests using the T‐24 bladder carcinoma cell line and ex vivo experiments using mouse intestines illustrated the remarkable and selective ability of these PPP to fluoresce and induce phototoxicity upon enzymatic activation. This work elucidated the basic physicochemical parameters, such as water solubility and quenching/activation behavior, required for the future elaboration of more adaptable “second‐generation” PPP, in which the PS is tethered to a proteolytically stable polymer backbone via enzyme‐specific peptide linkers. This polymer architecture offers great flexibility to tailor make the PPP to target any pathological tissue known to over‐express a specific enzyme.

Intracellular reactive oxygen species in monocytes generated by photosensitive chromophores activated with blue light

OBJECTIVESnDisinfection of the tooth pulp-canal system is imperative to successful endodontic therapy. Yet, studies suggest that 30-50% of current endodontic treatments fail from residual bacterial infection. Photodynamic therapy using red-light chromophores (630 nm) to induce antimicrobial death mediated by generated reactive oxygen species (ROS) has been reported, but red-light also may thermally damage resident tissues. In the current study, we tested the hypothesis that several blue light chromophores (380-500 nm) generate intracellular reactive oxygen species but are not cytotoxic to mammalian cells.nnnMETHODSnTHP1 monocytes were exposed to 10 microM of four chromophores (chlorin e6, pheophorbide-a, pheophorbide-a-PLL, and riboflavin) for 30 min before activation with blue light (27J/cm(2), 60s). After activation, intracellular ROS were measured using a dihydrofluorescein diacetate technique, and cytotoxicity was determined by measuring mitochondrial activity with the MTT method.nnnRESULTSnAll photosensitizers produced intracellular ROS levels that were dependent on both the presence of the photosensitizer and blue light exposure. Riboflavin and pheophorbide-a-PLL produced the highest levels of ROS. Photosensitizers except riboflavin exhibited cytotoxicity above 10 microM, and all except pheophorbide-a-PLL were more cytotoxic after blue light irradiation.nnnSIGNIFICANCEnThe current study demonstrated the possible utility of blue light chromophores as producers of ROS that would be useful for endodontic disinfection.

Production of reactive oxygen species from photosensitizers activated with visible light sources available in dental offices.

OBJECTIVESnThe aim of this study was to assess the ability of commonly available red- or blue-light dental sources to generate reactive oxygen species (ROS) from photosensitive chemicals that might be useful for photodynamic antimicrobial chemotherapy (PACT).nnnBACKGROUNDnAlthough the use of red diode lasers is well documented, there is limited information on how useful blue-light sources might be for PACT in dental contexts.nnnMATERIALS AND METHODSnA diode laser (Periowave; see Table 1 for material and equipment sources) emitting red light (660-675 nm) was used to activate toluidine blue; riboflavin and pheophorbide-a polylysine (pheophorbide-a-PLL) were photoactivated using an Optilux 501 curing unit emitting blue light (380-500 nm). Ozone gas (generated by OzoTop, Tip Top Tips, Rolle, Switzerland), sodium hypochlorite, and hydrogen peroxide were used for comparison. ROS production was estimated using an iodine-triiodide colorimetric assay, and ROS levels were plotted versus concentration of chemicals to determine each chemicals efficiency in ROS production. One-way ANOVA with Tukey post hoc analysis (alpha = 0.05) was used to compare the efficiencies of ROS production for the various chemicals.nnnRESULTSnSodium hypochlorite, hydrogen peroxide, and ozone gas produced ROS spontaneously, whereas pheophorbide-a-PLL, riboflavin, and toluidine blue required light exposure. The efficiency of ROS production was higher for pheophorbide-a-PLL and toluidine blue than for ozone gas or riboflavin (p < 0.05). Hydrogen peroxide was the least efficient ROS producer.nnnCONCLUSIONSnThe results of the current study support the use of blue- or red-light-absorbing photosensitizers as candidates to produce ROS for clinical applications. Blue-light photosensitizers were as efficient as red-light photosensitizers in producing ROS and more efficient than the oxidant chemicals currently used for dental disinfection.

5-ALA derivative-mediated photoinactivation of Propionibacterium acnes.

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Urokinase-plasminogen-activator sensitive polymeric photosensitizer prodrugs: design, synthesis and in vitro evaluation

Abstract Polymeric photosensitizer prodrugs (PPPs) to be selectively activated by urokinase plasminogen activator (uPA) have been developed. They are composed of uPA-cleavable photosensitizer-peptide-conjugates covalently attached to a poly-lysine backbone (25xa0kDa). Phototoxicity of PPPs is efficiently reduced by energy transfer between closely positioned photosensitizers (PSs) on the polymeric backbone. Enzymatic cleavage by uPA, a serine protease that is up-regulated in certain types of cancer, leads to the release of PS-peptidyl-fragments and restoration of phototoxicity. In the current study, conjugates with different e-lysine side chain modifications of the polymer-backbone were synthesized and characterized with respect to in vitro properties such as fluorescence and reactive oxygen species (ROS) quenching, as well as enzymatic cleavage by uPA. Based on these in vitro results and a cell screening experiment for photo- and dark toxicity, two compounds, PEG20-N-uPA-PPP and N-uPA-PPP, were selected as the most promising candidates for further evaluation in two uPA-expressing cell lines, DU-145 and PC-3. Here, the pegylated compound PEG20-N-uPA-PPP showed enhanced selective prodrug activation by uPA in comparison to N-uPA-PPP, pinpointing the need for prolonged extracellular residence time of uPA-sensitive prodrugs. In preliminary PDT-experiments, a dose-dependent phototoxic effect of this compound was found in both tested cell lines. In conclusion, this study highlights the fact that backbone substitution units may impact not only photochemical and physicochemical properties of the PPPs, but play an important role for cellular prodrug localization and thus site selective enzymatic activation.

Multivalent glibenclamide to generate islet specific imaging probes

The monitoring of diabetes mellitus, as it develops and becomes clinically evident, remains a major challenge for diagnostic imaging in clinical practice. Here we present a novel approach to beta-cell imaging by targeting the sulphonylurea receptor subtype 1 (SUR1), using multivalent derivatives of the anti-diabetic drug glibenclamide. Since glibenclamide has a high affinity for SUR1 but does not contain a suitable functional group to be linked to an imaging probe, we have synthesized 11 glibenclamide derivatives and evaluated their affinity to SUR1 in MIN6 cells. The most promising compound has been used to obtain multivalent glibenclamide-polyamidoamine (PAMAM) derivatives, containing up to 15 sulphonylurea moieties per dendrimer. The remaining functional groups on the dendrimers can consecutively be used for labeling with reporter groups for different imaging modalities, thus allowing for multifunctional imaging, and for the modification of pharmacokinetic properties. We synthesized fluorochrome-labeled multivalent probes, that demonstrate in cellular assays affinities to SUR1 in the nanomolar range, superior to native glibenclamide. The probes specifically label MIN6 cells, but not HeLa or PANC-1 cells which do not express SUR1. A very low cytotoxicity of the multivalent probes is demonstrated by the persistent release of insulin from MIN6 cells exposed to high glucose concentrations. Furthermore, the probes display positive labeling of beta-cells of primary mouse and human islet-cells ex vivo and of islets of Langerhans in vivo. The data document that multivalent probes based on glibenclamide derivatives provide a suitable platform for further developments of cell-specific probes, and can be adapted for multiple imaging modalities, including those that are now used in the clinics.