Photodynamic therapy (PDT) is a clinically approved, minimally invasive therapeutic procedure that can exert a selective cytotoxic activity toward malignant cells. The procedure involves administration of a photosensitizing agent followed by irradiation at a wavelength corresponding to an absorbance band of the sensitizer. In the presence of oxygen, a series of events lead to direct tumor cell death, damage to the microvasculature, and induction of a local inflammatory reaction. Clinical studies revealed that PDT can be curative, particularly in early stage tumors. It can prolong survival in patients with inoperable cancers and significantly improve quality of life. Minimal normal tissue toxicity, negligible systemic effects, greatly reduced long-term morbidity, lack of intrinsic or acquired resistance mechanisms, and excellent cosmetic as well as organ function-sparing effects of this treatment make it a valuable therapeutic option for combination treatments. With a number of recent technological improvements, PDT has the potential to become integrated into the mainstream of cancer treatment. CA Cancer J Clin 2011;61:250-281. V C

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Photodynamic therapy of cancer: An update†‡

1.1 Photodynamic Therapy and Imaging
The purpose of this review is to present the current state of the role of imaging in photodynamic therapy (PDT). In order for the reader to fully appreciate the context of the discussions embodied in this article we begin with an overview of the PDT process, starting with a brief historical perspective followed by detailed discussions of specific applications of imaging in PDT. Each section starts with an overview of the specific topic and, where appropriate, ends with summary and future directions. The review closes with the authors’ perspective of the areas of future emphasis and promise. The basic premise of this review is that a combination of imaging and PDT will provide improved research and therapeutic strategies.

PDT is a photochemistry-based approach that uses a light-activatable chemical, termed a photosensitizer (PS), and light of an appropriate wavelength, to impart cytotoxicity via the generation of reactive molecular species (Figure 1a). In clinical settings, the PS is typically administered intravenously or topically, followed by illumination using a light delivery system suitable for the anatomical site being treated (Figure 1b). The time delay, often referred to as drug-light interval, between PS administration and the start of illumination with currently used PSs varies from 5 minutes to 24 hours or more depending on the specific PS and the target disease. Strictly speaking, this should be referred to as the PS-light interval, as at the concentrations typically used the PS is not a drug, but the drug-light interval terminology seems to be used fairly frequently. Typically, the useful range of wavelengths for therapeutic activation of the PS is 600 to 800 nm, to avoid interference by endogenous chromophores within the body, and yet maintain the energetics necessary for the generation of cytotoxic species (as discussed below) such as singlet oxygen (1O2). However, it is important to note that photosensitizers can also serve as fluorescence imaging agents for which activation with light in the 400nm range is often used and has been extremely useful in diagnostic imaging applications as described extensively in Section 2 of this review. The obvious limitation of short wavelength excitation is the lack of tissue penetration so that the volumes that are probed under these conditions are relatively shallow.






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Figure 1


(A) A schematic representation of PDT where PS is a photoactivatable multifunctional agent, which, upon light activation can serve as both an imaging agent and a therapeutic agent. (B) A schematic representation of the sequence of administration, localization and light activation of the PS for PDT or fluorescence imaging. Typically the PS is delivered systemically and allowed to circulate for an appropriate time interval (the “drug-light interval”), during which the PS accumulates preferentially in the target lesion(s) prior to light activation. In the idealized depiction here the PS is accumulation is shown to be entirely in the target tissue, however, even if this is not the case, light delivery confers a second layer of selectivity so that the cytotoxic effect will be generated only in regions where both drug and light are present. Upon localization of the PS, light activation will result in fluorescence emission which can be implemented for imaging applications, as well as generation cytotoxic species for therapy. In the former case light activation is achieved with a low fluence rate to generate fluorescence emission with little or no cytotoxic effect, while in the latter case a high fluence rate is used to generate a sufficient concentration of cytotoxic species to achieve biological effects.

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Imaging and photodynamic therapy: mechanisms, monitoring, and optimization.

For more than 70 years, researchers in several areas of science have been intrigued by the physical and chemical properties of the lowest excited states of molecular oxygen. With two singlet states lying close above its triplet ground state, the O2 molecule possesses a very unique configuration, which gives rise to a very rich and easily accessible chemistry, and also to a number of important photophysical interactions. In particular, photosensitized reactions of the first excited state, O2(∆g), play a key role in many natural photochemical and photobiological processes, such as photodegradation and aging processes including even photocarcinogenesis. Reactions of O2(∆g) are associated with significant applications in several fields, including organic synthesis, bleaching processes, and, most importantly, the photodynamic therapy of cancer, which has now obtained regulatory approval in most countries for the treatment of several types of tumors. The development of both applications and novel observation techniques has strongly accelerated during the past few years. Significant recent advances include, for example, the development of novel luminescent singlet oxygen probes,1-4 the time-resolved detection of O2(∆g) in a transmission microscope,5 the first time-resolved measurements of singlet oxygen luminescence in vivo,6 and the observation of oxygen quenching of triplet-excited single molecules.7 Experimental and theoretical studies on the mechanisms of photosensitized formation of excited O2 states and of their deactivation have been performed for almost 40 years. While most early liquid-phase studies were exclusively concerned with O2(∆g), recent technological advances also made possible time-resolved investigations of the second excited state, O2(Σg), which can be formed in competition with O2(∆g) in many cases. A significant number of * Corresponding author. Tel.: ++49 69 79829448. Fax: ++49 69 79829445. E-mail: R.Schmidt@chemie.uni-frankfurt.de. 1685 Chem. Rev. 2003, 103, 1685−1757

Physical mechanisms of generation and deactivation of singlet oxygen.

: Edible oil is oxidized during processing and storage via autoxidation and photosensitized oxidation, in which triplet oxygen (3O2) and singlet oxygen (1O2) react with the oil, respectively. Autoxidation of oils requires radical forms of acylglycerols, whereas photosensitized oxidation does not require lipid radicals since 1O2 reacts directly with double bonds. Lipid hydroperoxides formed by 3O2 are conjugated dienes, whereas 1O2 produces both conjugated and nonconjugated dienes. The hydroperoxides are decomposed to produce off-flavor compounds and the oil quality decreases. Autoxidation of oil is accelerated by the presence of free fatty acids, mono- and diacylglycerols, metals such as iron, and thermally oxidized compounds. Chlorophylls and phenolic compounds decrease the autoxidation of oil in the dark, and carotenoids, tocopherols, and phospholipids demonstrate both antioxidant and prooxidant activity depending on the oil system. In photosensitized oxidation chlorophyll acts as a photosensitizer for the formation of 1O2; however, carotenoids and tocopherols decrease the oxidation through 1O2 quenching. Temperature, light, oxygen concentration, oil processing, and fatty acid composition also affect the oxidative stability of edible oil.

Mechanisms and Factors for Edible Oil Oxidation

A review of NIR dyes in cancer targeting and imaging.

Spectrofluorimetric study of porphyrin incorporation into membrane models - evidence for pH effects

Influence of trans weak or strong field ligands upon the affinity of deuteroheme for carbon monoxide. Monoimidazoleheme as a reference for unconstrained five-coordinate hemoproteins

Cellular uptake and subcellular distribution of chlorin e6 as functions of pH and interactions with membranes and lipoproteins

Reaction of the free-radical diphenylpicrylhydrazyl (DPPH˙) with Trolox® (TrOH) was investigated in buffered hydroalcoholic media by using a stopped-flow system. DPPH˙ was reduced to the hydrazine analogue DPPH-H with a measured stoichiometry of about 2. DPPH-H was characterized by an acid–base equilibrium (pKa = 8.6). Time-resolved absorption spectra recorded with an excess of either TrOH or DPPH˙ indicated that no significant amount of the TrO˙ radical was accumulated. The TrO˙ radical formed in a first step further reacted quickly with DPPH˙. For 1 : 1 ethanol–buffer mixtures at pH 7.4, the bimolecular rate constants of the first and second steps were 1.1 × 104 M−1 s−1 and 2 × 106 M−1 s−1, respectively. A significant increase of the measured rate constant was observed for ethanol–buffer solutions as compared to ethanol. The rate was also increased at higher pH. A deuterium isotopic effect of 2.9 was measured. These data are discussed with regards to mechanisms involving either electron or proton exchange as rate determining steps in the reaction of DPPH˙ with Trolox®. The importance of solvent acidity control in investigation of antioxidant properties is outlined.

Kinetics of the reaction between the antioxidant Trolox® and the free radical DPPH˙ in semi-aqueous solution

http://stephanie.bonneau.free.fr/BBA2007_1.pdf

Daniel Brault

Papers

Spectrofluorimetric study of porphyrin incorporation into membrane models - evidence for pH effects

Influence of trans weak or strong field ligands upon the affinity of deuteroheme for carbon monoxide. Monoimidazoleheme as a reference for unconstrained five-coordinate hemoproteins

Cellular uptake and subcellular distribution of chlorin e6 as functions of pH and interactions with membranes and lipoproteins

Kinetics of the reaction between the antioxidant Trolox® and the free radical DPPH˙ in semi-aqueous solution

The pH-dependent distribution of the photosensitizer chlorin e6 among plasma proteins and membranes: A physico-chemical approach