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The rationale of the therapeutic efficacy of photodynamic therapy is based on the cytotoxic action of products generated by excited photosensitizers. The excited photosensitizer can react directly with tissue constituents through the so-called type I process, yielding radicals or radical ions or through the type II process in which energy is transferred to singlet oxygen. The relation between damage to the normal tissue and that to the malignant tissue is determined by the difference in photosensitizer concentration. In summary, the optimal use of photobleaching enables the selective depth to coincide with the therapeutic depth, whereas the value for the therapeutic depth itself is rather unaffected by bleaching. The retention ratio is of only indirect importance in a procedure optimized for bleaching; the optimization procedure, in principle, requires, only that the retention ratio is larger than 1.

— The therapeutic effect of photodynamic therapy (PDT: photodynamic sensitizer + light) is partly due to vascular damage. This report describes a new vascular photodamage assay for PDT agents and a validation of the assay. The method described here quantitates changes in tissue blood perfusion based on the relative amount of injected fluorescein dye in treated and untreated tissues. A specially designed fluorometer uses chopped monochromatic light from an argon laser as a source for exciting fluorescein fluorescence. The fluorescent light emitted from the tissue is collected by a six element fiberoptic array, filtered and delivered to a photodiode detector coupled to a phase-locked amplifier for conversion to a voltage signal for recording. This arrangement permits a rather simple, inexpensive construction and allows for the simultaneous use of the argon laser by other investigators. The routine assay for characterizing a specific photosensitizer at a standard dose consists of the sequential allocation of eight mice to a set of different light doses designed to span the dose-response range of fluorescein fluorescence exclusion (measured 8–10 min after fluorescein injection). The assay validation experiment used an anionic photosensitizer, 2-[l-hexyloxyethyl]-2-devinyl pyropheophorbide-a at a dose of 0.4 μmol/kg. The parameter estimates (n = 34 mice) from fitting the standard Hill dose-response model to the data were: median fluorescence exclusion light dose FE50= 275 ± 8.3 J/cm2 and Hill sigmoidicity parameter m =−3.66 ± 0.28. Subsets of the full data set randomly selected to simulate a standard eight mice experiment yielded similar parameter estimates. The new assay provides reliable estimates of PDT vascular damage with a frugal sequential experimental design.

In situ conversion of bacteriochlorophyll-a, present in Rhodobacter sphaeroides (Rb. sphaeroides) gave bacteriopurpurin-18 in modest yield, which in a sequence of reactions was converted into two series of bacteriochlorins: bacteriopurpurinimide and bacteriopurpurin p6 with and without a fused imide ring system, respectively. To determine the effect of overall lipophilicity in photosensitizing efficacy, these bacteriochlorins were independently reacted with HBr gas and subsequently treated with various alkyl alcohols to afford the corresponding alkyl ether derivatives as diastereomeric mixtures (the R- and S-isomers were obtained in almost equal ratios). Between the two series of bacteriochlorins, the bacteriopurpurinimides containing a fused imide ring system were found to be more effective in vivo (C3H mice bearing RIF tumors). To investigate the effect of the presence of the chiral center at position 3 of the most effective purpurinimide 9 [3(1'-heptyloxy)ethyl-3-deacetyl-bacteriopurpurin-18-N-hexylimide propyl ester], the acetyl group was replaced with a hydroxymethyl substituent and converted into 3(1'-decyloxy)methyl-3-deacetyl-purpurin-18-N-hexylimide methyl ester 26 with a similar lipophilicity. Interestingly, compared to 26, the bacteriopurpurinimide 9 was found to be more effective, suggesting that the chiral center at position 3 certainly plays an important role in photosensitizing activity. Among a series of alkyl ether analogues, between the PDT efficacy and the lipophilicity (log P and log D) calculated by computational methods (PALLAS program), a parabolic relationship was observed to some extent. However, it was limited to a particular series, e.g., compounds with similar log P values between bacteriopurpurinimides and bacteriochlorin e6 did not produce similar in vivo efficacy. As expected, within a series, a linear relationship was observed between the log P values and the HPLC retention times of the photosensitizers. Some of the mitochondrial localized photosensitizers showed a significant peripheral benzodiazepine binding (PBR) affinity. However, limited correlation between PBR binding affinity and in vivo PDT efficacy was observed. Compared to the naturally occurring bacteriochlorophyll-a, the bacteriopurpurinimides with fused imide ring system showed higher in vitro/in vivo stability. In contrast to methyl pyropheophorbide-a, the ester functionalities in bacteriopurpurinimide did not convert into the corresponding carboxylic acid by the enzyme esterases.

A first report on the synthesis and comparative in vitro-in vivo photosensitizing efficacy of various fluorinated and the corresponding nonfluorinated, purpurinimide-based photosensitizers is discussed. In preliminary in vivo screening, compared with the nonfluorinated analogs, purpurinimides bearing trifluoromethyl substituents showed enhanced photosensitizing efficacy. Among compounds (isomers) with similar lipophilicity, the position of the substituents was found to play a decisive role in biological efficacy.

Background and Objective In this study, we evaluated 2-[1-hexyloxyethyl]-2-devinyl pyropheophorbide-α (HPPH or Photochlor) as a photosensitizer for the treatment of malignant gliomas by photodynamic therapy (PDT). Study Design/Materials and Methods We performed in vivo reflection spectroscopy in athymic rats to measure the attenuation of light in normal brain tissue. We also studied HPPH pharmacokinetics and PDT effects in nude rats with brain tumors derived from stereotactically implanted U87 human glioma cells. Rats implanted with tumors were sacrificed at designated time points to determine the pharmacokinetics of HPPH in serum, tumor, normal brain, and brain adjacent to tumor (BAT). HPPH concentrations in normal brain, BAT and tumor were determined using fluorescence spectroscopy. Twenty-four hours after intravenous injection of HPPH, we administered interstitial PDT treatment at a wavelength of 665 nm. Light was given in doses of 3.5, 7.5 or 15 J/cm at the tumor site and at a rate of 50 mW/cm. Results In vivo spectroscopy of normal brain tissue showed that the attenuation depth of 665 nm light is ∼30% greater than that of 630 nm light used to activate Photofrin, which is currently being evaluated for PDT as an adjuvant to surgery for malignant gliomas. The t½ of disappearance of drug from serum and tumor was 25 and 30 hours, respectively. Conclusion Twenty-four hours after injection of 0.5 mg/kg HPPH, tumor-to-brain drug ratios ranged from 5:1 to 15:1. Enhanced survival was observed in each of the HPPH/PDT-treated animal groups. These data suggest that HPPH may be a useful adjuvant for the treatment of malignant gliomas. Lasers Surg. Med. 29:397–405, 2001. © 2001 Wiley-Liss, Inc.

Starting from methylpheophorbide-a, a homologous series of purpurinimides containing alkyl substituents at two different positions [as 3-(1(1)-O-alkyl) and 13(2)-N-alkyl] were synthesized. These compounds with variable lipophilicity (log P 5.32-16.44) exhibit long wavelength absorption near lambda(max)700 nm (epsilon: 45 000 in dichloromethane) with singlet oxygen ((1)O2) production in the range of 57-60%. The shifts in in vivo absorptions and tumor/skin uptake of these compounds were determined in C3H mice bearing RIF tumors by in vivo reflectance spectroscopy. The results obtained from a set of photosensitizers with similar lipophilicity (log P 10.68-10.88) indicate that besides the overall lipophilicity, the presence and position of the alkyl groups (O-alkyl vs N-alkyl) in a molecule play an important role in tumor uptake, tumor selectivity, and in vivo PDT efficacy. At present, all purpurinimide analogues are being evaluated at various doses, and experiments are underway to establish a quantitative structure-activity relationship on a limited set of compounds. The 1D and 2D NMR and mass spectrometry analyses confirmed the structures of the desired purpurinimides and the byproducts formed during various reaction conditions. The mechanisms of the formation of the unexpected 12-formyl- and 12-(hydroxymethyl)purpurinimides under certain reaction conditions are also discussed.

Starting from commercially available Ni(II)octaethylporphyrin (OEP), an efficient approach for the preparation of a series of fluorinated and nonfluorinated benzochlorins with variable lipophicity has been developed. Their spectroscopic properties, preliminary in vitro photosensitizing efficacy, and tumor selectivity were determined. Our methodology provides a facile approach for the preparation of the free-base and the related Zn(II) benzochlorins containing alkyl and alkyl ether side chains with variable carbon units. For the preparation of benzochlorins containing alkyl groups attached to the exocyclic phenyl ring, the Ni(II) meso-(2-formylvinyl)octaethyl porphyrin 2 was reacted with various reagents such as (trifluoromethyl)trimethylsilane (TMS-CF3) or the Grignard reagents of various fluorinated or nonfluorinated alkyl halides. The corresponding intermediates 3, 6a−6e, and 8 obtained via intramolecular cyclization under acidic conditions afforded the related benzochlorins 5, 7a−d, and 9 in good yield...

This study presents a novel approach for the regioselective synthesis of a series of alkyl ether analogues of purpurin-18-N-alkylimide. In the purpurinimide series, this is the first example which demonstrates that the presence and position of the substituents in the macrocycle makes a remarkable difference in the in vivo PDT efficacy.

For a comparative study, 3-(alkyloxyethyl)-3-devinylpurpurin-18-N-hexylimides with ester and amide functionalities were investigated for tumor selectivity and in vivo photosensitizing efficacy. Compared to amide analogues, the related photosensitizers with ester functionalities were found to be more effective. Among these compounds the 3-devinyl-(3-hexyloxyethyl)-purpurin-18-N-hexylimide as methyl ester 12 Download : Download high-res image (209KB) Download : Download full-size image Scheme 1 . (a) Zn(Br)2/HMDS, hexylamine, toluene, reflux; (b) HBr/AcOH; (c) alkyl alcohol; (d) alkyl amine; (e) CH2N2; (g) MeOH/KOH; (f) aq LiOH/MeOH/THF; (g) DCC/H2N–(CH2)5CH3. showed excellent tumor uptake (tumor versus muscle ratio: 8:1), and produced 100% tumor cure on day 30 at a dose of 1.0 μmol/kg. The mice were treated with light (135 J/cm2, 705 nm) at 24 h post injection of the drug.

We have developed a device to divide the output from a dye laser into as many as eight beams of equal power with negligible total power loss. In this system, 630-nm s-plane polarized laser light was split by a series of highly polarization-sensitive plate beamsplitters. Each of the beams was coupled to a 200, 400, or 600 microm diameter optical fiber. Brewster-window-type attenuators allowed the power of each beam to be individually set. It was possible to reconfigure the device to produce four, two, or one output(s). We discuss the design requirements of the beamsplitter device and describe its construction from mostly commercially available components. An apparatus for positioning and stabilizing each optical fiber relative to the skin surface of a patient is also described. The illumination from the fiberoptic supported by such an apparatus strikes a defined surface area and is independent of patient movement. Both the beamsplitter device and the optical fiber positioner are used routinely in photodynamic therapy (PDT) of malignant tumors in the clinic and in the laboratory.

Human serum albumin (HSA) is one of the key components in human blood that may influence drug distribution. As such, it is important to know the affinity of any drug for albumin. Previously, Photofrin, a mixture of monomeric, dimeric and oligomeric porphyrins, has been subjected to HSA binding studies. However, due to its complex nature, binding studies on Photofrin or other hematoporphyrin derivatives with HSA are inconclusive. In this report, the binding properties of some components (dimers and trimers) of Photofrin and the relationship between murine photosensitizing efficacy and those binding properties were investigated. The interaction of these porphyrins with HSA was investigated by direct ultrafiltration and fluorescent titration techniques with fluorescent probes such as dansyl-L-proline (DP), which is known to interact selectively with site II on HSA. Porphyrins also were tested for antitumor activity in a mouse model following intravenous administration and exposure to laser light. Together, the results suggest that the photosensitizers that were preferentially bound to site II of HSA were most effective at controlling murine tumor regrowth.

A first report on the biological evaluation of a series of isomerically pure benzoporphyrin derivatives (cis- and trans-isomers) as methyl esters is described. In preliminary in vivo studies, the n-hexyl ether analogues of both cis- and trans-isomers of benzoporphyrin derivatives were found to be more active than the industrially prepared benzoporphyrin derivative, a mixture of monocarboxylic acids (BPDMA, Quadralogic Technologies, Vancouver). Further studies with 4-de-vinyl-4- (1-hexyloxyethyl) benzoporphyrin derivative showed that, like BPDMA, it had reduced residual skin phototoxicity compared in mice with Photofrin. The uptake and clearance characteristics of BPDMA were also compared with the 4-(1-hexyloxyethyl)-derivative by in vivo reflection spectroscopy.

Starting from methyl 9-deoxymesopyropheophorbide-a 5 , regioselective synthesis of a series of benzochlorins was achieved. These compounds have long wavelength absorptions in the range of 710–756 nm. The in vivo spectroscopic properties as well as the uptake and clearance characteristics of some of these compounds (e.g. 13 ) were determined by use of in vivo reflection spectroscopy.

Rhodamine 123 (R123)-photochemotoxicity was assessed in BALB/c nude mice bearing a xenografted human squamous cell carcinoma at various power densities and wavelengths and a given incident fluence of 150 Joules/cm2. One hour before light delivery, 1 mg R123/kg was injected i.p. in 20 animals. Surface irradiance was performed on the tumor and an equal size hind leg area of 40 animals. Three groups of 10 animals were treated at 514.5 nm and 0.1 W/cm2, 1 W/cm2, and 30 W/cm2, and one at 488 nm and 30 W/cm2. In each group, five animals received R123. The R123 concentration was measured in the tumor (0.023 ± 0.007 μg/g) and tumor-free tissue (0.023 ± 0.008 μg/g) in three additional animals by high performance liquid chromatography 1 hour after R123-administration. Histologic assessment 72 hours after light delivery revealed no tissue damage at nonthermal power densities, either in the tumor or in the tumor-free tissue, irrespective of R123-administration. At 30 W/cm2, neither in the tumor nor in tumor-free tissues was there any significant difference in the depth of necrosis, irrespective of R123-administration and the wavelength applied. Our results question the validity of R123 as a photosensitizer, at least in this rodent tumor model. © 1993 Wiley-Liss, Inc.

For a comparative study, 3-(alkyloxyethyl)-3-devinylpurpurin-18-N-hexylimides with ester and amide functionalities were investigated for tumor selectivity and in vivo photosensitizing efficacy. Compared to amide analogues, the related photosensitizers with ester functionalities were found to be more effective. Among these compounds the 3-devinyl-(3-hexyloxyethyl)-purpurin-18-N-hexylimide as methyl ester 12 Download : Download high-res image (209KB) Download : Download full-size image Scheme 1 . (a) Zn(Br)2/HMDS, hexylamine, toluene, reflux; (b) HBr/AcOH; (c) alkyl alcohol; (d) alkyl amine; (e) CH2N2; (g) MeOH/KOH; (f) aq LiOH/MeOH/THF; (g) DCC/H2N–(CH2)5CH3. showed excellent tumor uptake (tumor versus muscle ratio: 8:1), and produced 100% tumor cure on day 30 at a dose of 1.0 μmol/kg. The mice were treated with light (135 J/cm2, 705 nm) at 24 h post injection of the drug.

To teach medical students how to deliver a diagnosis of cancer using role-play with a cancer survivor volunteer.Medical students participated in a curricular module on "breaking bad news." Its novel aspect was the inclusion of role-playing exercises during which the student communicated the initial diagnosis of cancer to a cancer survivor volunteer. The clinical scenario was based on the volunteer's own history of cancer. The exercise required the student to become knowledgeable about the volunteer's cancer and its mode of presentation, deliver the diagnosis using previously demonstrated methods, and then receive verbal feedback from the volunteer. A panel discussion with the cancer survivor volunteers concluded the module. The efficacy of this curricular module was assessed by the students' performance during the role-playing exercise, gain in confidence in communicating bad news, and overall rating of the learning experience.The interaction of the students with the cancer survivors was the strength of this curriculum, providing the students with an important perspective on physician-patient relationships and coping with cancer. The students demonstrated a high level of adherence to preferred communication techniques, gained significant confidence with the task of "breaking bad news," and were very satisfied with the module. Participation in these role-playing exercises by the cancer survivor volunteers was viewed as emotionally demanding but also rewarding. Recruitment and retention of the volunteers were not obstacles to this activity.Role-playing with cancer survivor volunteers can be an effective method of teaching medical students how to communicate bad news.

The stable bacteriopurpurinimide (788 nm, epsilon: 38,600 in CH2Cl2), obtained by reducing the corresponding unstable Schiff base (803 nm, epsilon: 50,900 in CH2Cl2) that was isolated by reacting bacteriopurpurin methyl ester with 3,5-bis-(trifluoromethyl)benzylamine, produced promising photosensitizing efficacy. 1H NMR, mass spectrometry, and HPLC analyses confirmed the structures of new bacteriopurpurinimides and the metabolic product. The preliminary in vivo photosensitizing efficacy of this stable bacteriopurpurinimide was determined in C3H mice bearing radiation induced fibrosarcoma tumors as a function of variable drug doses. A drug dose of 1.0 micromol/kg and light exposure of 135 J/cm2 (75 mW/cm2; 24 h postinjection) at 796 nm for 30 min produced a 60% long-term tumor cure (3/5 mice were tumor-free on day 90). Colocalization study of the stable bacteriopurpurinimide with MitoTracker Green confirmed some mitochondrial localization. The fluorescein-exclusion assay and histological staining of CD31 confirmed vascular stasis at various time points post-PDT (post photodynamic therapy). The treatment parameters (time for maximum drug uptake and wavelength for light irradiation) were determined by in vivo reflectance spectroscopy.

Photodynamic therapy is an effective, minimally invasive skin cancer treatment modality with few side effects. Improved therapeutic selectivity and efficacy is expected if treatment is optimized individually for each patient based on detailed measurements prior and during the treatment. The handheld system presented allows measuring optical properties of the skin, the rate of photosensitizer photobleaching during the ALA PDT and oxygen saturation in the tissue. The photobleaching rate is monitored using fluorescence spectroscopy, where protoporphyrin IX in tissue is exited by 410 nm (blue) or 532 nm (green) laser light, and fluorescence in the 580-800 nm range is monitored. The photobleaching rate is calculated by correlating the measured spectrum with known protoporphyrin IX, photoproduct and nonspecific tissue autofluorescence spectra using correlation analysis. Double-wavelength excitation allows a rough estimation of the depth of the fluorescence source due to the significant difference in penetration depth for blue and green light. Blood concentration and oxygenation in the tissue are found from the white light reflectance spectrum in the 460-800 nm range. Known spectra for the oxy- and deoxyhemoglobin, melanin, and tissue baseline absorption and tissue scattering are substituted in nonlinear equations to find the penetration depth and diffuse reflectance coefficient. The nonlinear equation for the diffuse reflectance coefficient is solved for blood and melanin concentrations and blood oxygenation values that provide the best fit to the measured spectrum. The optical properties of the tissue obtained from the reflectance spectroscopy are used to correct the fluorescence data. A noncontact probe with 5 fibers (3 excitation and 2 detection) focused to the same 5 mm diameter spot: 2 excitation lasers, a white light lamp and a two-channel spectrometer are used. A LabView program with custom nonlinear equation solvers written in C++ automatically performs the measurements and calculations, and writes data to a database. The system is currently used in a clinical trial to find the relationship between skin pigmentation, oxygen saturation in blood, photobleaching rate and optimal fluence rate for skin cancer treatment of actinic keratoses.

A device that divides light into eight, four or two beams of equivalent power with only minor total power loss was designed, built and tested. The apparatus accepts light from a 200 microm diameter, 0.16 numerical aperture, silica-silica multimode optical fiber connected to one of several laser light sources for photodynamic therapy (PDT) of cancer. The incorporation of a variable iris diaphragm into the optical couplers allows the power of the beams to be independently set. Each of the beams can be coupled to a 400 or 600 microm diameter optical fiber to deliver the therapeutic light to the patient. This device is used in our institute for PDT of patients with either numerous small malignant tumors or single tumors with large surface area.

A first report on the synthesis and comparative in vitro-in vivo photosensitizing efficacy of various fluorinated and the corresponding nonfluorinated, purpurinimide-based photosensitizers is discussed. In preliminary in vivo screening, compared with the nonfluorinated analogs, purpurinimides bearing trifluoromethyl substituents showed enhanced photosensitizing efficacy. Among compounds (isomers) with similar lipophilicity, the position of the substituents was found to play a decisive role in biological efficacy.

This study presents a novel approach for the regioselective synthesis of a series of alkyl ether analogues of purpurin-18-N-alkylimide. In the purpurinimide series, this is the first example which demonstrates that the presence and position of the substituents in the macrocycle makes a remarkable difference in the in vivo PDT efficacy.

Photodynamic therapy (PDT) combines a photosensitizer such as Photofrin with red laser light (630 nm) to destroy cancer cells. Investigators have reported effectiveness of PDT in the management of patients with recurrent superficial bladder cancer. We retrospectively reviewed our experience in 58 patients to assess the long-term role of PDT in the management of resistant superficial transitional cell carcinoma (TCC) including Ta, T1, and refractory carcinoma in situ (CIS) of the urinary bladder.All 58 patients had failed at least one course of standard intravesical therapy or had contraindication for intravesical chemo- or immunotherapy. Patients with malignancy present (Ta-T1/Grade I-III, CIS) were accepted for ablative PDT. Patients undergoing prophylactic PDT after complete resection were confirmed to be tumor-free by cystoscopy and bladder was cytology before PDT. Post-PDT evaluations included weekly telephone contact to assess acute adverse reactions and assessment of efficacy and bladder toxicity at three months and quarterly thereafter.These 58 patients underwent a single PDT treatment with 2.0 or 1.5 mg/kg of Photofrin and 10-60 J/cm2 light (630 nm). At three months, complete response rates were 84% and 75% for residual resistant papillary TCC and refractory CIS respectively; and 90% of patients treated prophylactically had not had recurrences. At a median followup of 50 months (range 9-110), 59% (34/58) of the responders are alive, with 31/34 still disease-free.PDT using 1.5 mg/kg of Photofrin and 15 J/cm2 of light (630 nm) should be considered a safe and effective treatment for refractory CIS or recurrent papillary TCC.

The synthesis, preliminary in vivo biological activity, singlet oxygen and fluorescence yields of a series of alkyl ether derivatives of chlorophyll-alpha analogs are described. For short-chain carbon ethers (1-7 carbon units), it was observed that the biological activity increased by increasing the length of the carbon chain, being maximum in compounds with n-hexyl and n-heptyl chains. Related sensitizers prepared by reacting 2-(1-bromoethyl)-2-devinylpyropheophorbide-alpha with (sec)alcohols were found to be less effective. Under similar treatment conditions, photosensitizers containing cis- and trans- 3-hexenyl side chains were ineffective. Thus, both stereochemical and steric factors caused differences in sensitizing activity. In general, pyropheophorbide-alpha analogs were found to be more active than related chlorin e6 derivatives, in which the isocyclic ring (ring "E") was cleaved. Related photosensitizers in the 9-deoxy- series were found to be as effective as the corresponding pyropheophorbide-alpha analogs. The photosensitizers prepared from pyropheophorbide-alpha methyl ester and chlorin e6 trimethyl ester have long wavelength absorption at 660 nm (epsilon 45 000 to 50 000). Reduction of the carbonyl group in the pyropheophorbide-alpha to methylene (ring E) resulted in a blue shift to 648 nm (epsilon 38 000).

The photodynamic therapy (PDT) activity of the bis(dimethylthexylsiloxy)silicon 2,3-naphthalocyanine (SiNc 8) was evaluated against the EMT-6 tumor implanted intradermally in BALB/c mice. The SiNc 8 was formulated in aqueous emulsions based on Cremophor EL or Solutol HS 15. The formulation was shown to affect plasma clearance and overall pharmacokinetics. Compared to Cremophor, Solutol promoted rapid plasma clearance and high liver retention of the dye, combined with a slight increase of dye tumor concentrations. The PDT action spectrum for tumor response of SiNc 8 in Cremophor (190 mW cm-2, 200 J cm-2, 24 h postinjection [p.i.] of 1 mumol kg-1) showed a maximum at 780 nm, which corresponds to the absorption maximum of the monomeric dye as well as the in vivo maximum change in the "diffuse optical density" produced by the dye. The extent of tumor necrosis increased with augmented dye and light doses. Regardless of the formulation, at 1 h p.i. of 0.1 mumol kg-1 SiNc 8, PDT efficiency (190 mW cm-2, 400 J cm-2) was high but accompanied by severe damage to normal tissues, at 24 h p.i. PDT resulted in complete tumor regression in 80% of the animals without adverse effects to adjacent tissues, while at 72 h p.i. PDT induced no tumor response with Cremophor and only a partial response with Solutol. At the latter time point, plasma dye clearance was nearly complete while tumor tissue levels remained high, suggesting that tumor response correlates with plasma rather than tumor dye levels. Skin sensitivity of SKhI mice to solar-simulated radiation was lower with SiNc 8 as compared to Photofrin. Our data suggest the potential of SiNc 8 as a far-red absorbing photosensitizer in clinical PDT.

The kinetics of light absorbing compounds can be followed continuously in vivo by the use of reflection photometry to measure the changes in total optical attenuation of tissue. This method was employed in anesthetized DBA mice with SMT tumors. The pharmacokinetics in the tumor tissue of two closely related pheophorbides were followed continuously for the first two hours following tail vein injection2. The results of these measurements were correlated with the response of the tumors to photodynamic therapy and the plasma clearance. MPM (methyl pheophorbide methyl ether) cleared the tumor tissues with kinetics that matched the plasma clearance (20 min). MPH (methyl pheophorbide hexyl ether) showed steady accumulation and retention while the plasma was clearing the sensitizer. When the tumors were subsequently exposed to light (665 nm) the MPM tumor was not responsive even at short times (10 min) post injection. A response was produced in these two mice only when they were exposed to the treatment light and simultaneously injecting the MPM at high doses. MPH treated mice responded to treatment at 24 hours post injection. Reflection measurements of tissue attenuation at that time indicated that significant quantities2 of MPH were still present.

The field of photodynamic therapy or' PDT" has been the subject of a number of recent comprehensive review articles and books (for example the 1 989 publication by CRC press17). Thus in spite of my title I will give a review which is in no way comprehensive but which deals in some depth with the dosimetry of PDT.

Th space irradiance produced by a fiber with a cylindrical diffusing tip was measured under a variety of launch and mode miling conditions. The aim of these measurements was to determine the extent to which conditions of use would effect the light distribution and to assess the impact these variations in light distribution would have on the therapeutic effect when the fibers were used in Photodynamic therapy treatments.

The relative contribution, to cell death, of photodynamic damage to respiratory proteins (known targets of photodynamic therapy with many photosensitizers) and other cellular sites was examined. The models were a human ovarian carcinoma cell line 2008, and its mitochondrial DNA-deficient derivative ET3, which lacks several key respiratory protein subunits. Phototoxicity was compared in the two cell lines with photosensitizers that localized to different cellular compartments. Photosensitizers included Victoria Blue BO (VBBO; mitochondria); Photofrin with a short incubation, (plasma membrane) or a long incubation (intracellular membranes including mitochondria); and Nile Blue A (NBA; lysosomes). Photosensitizer content and localization did not differ between the 2008 and ET3 cells. For sensitizers without a primary mitochondrial localization (NBA and Photofrin with a short incubation), there was no significant difference between 2008 and ET3 toxicity. Consistent with a mitochondrial localization of VBBO and independence from respiratory-chain damage, ET3 cells were less susceptible than 2008 to both dark- and light-activated VBBO-mediated damage. Statistical analysis of the data demonstrated minimal photobleaching of VBBO and a significant difference between the phototoxicity curves of ET3 and 2008. For Photofrin with a long incubation, dark- and phototoxicity effects were similar for both cell lines. Inhibition of respiratory enzymes is thus only a minor component of Photofrin-mediated (long incubation) phototoxicity in these cell lines and is overwhelmed by more significant damage elsewhere, whereas it is a major but not the exclusive element of death mediated by VBBO.

An open three-compartment pharmacokinetic model was applied to the in vivo quantitative structure-activity relationship (QSAR) data of a homologous series of pyropheophorbide photosensitizers for photodynamic therapy (PDT). The physical model was a lipid compartment sandwiched between two identical aqueous compartments. The first compartment was assumed to clear irreversibly at a rate K0. The measured octanol-water partition coefficients, P(i) (where i is the number of carbons in the alkyl chain) and the clearance rate K0 determined the clearance kinetics of the drugs. Solving the coupled differential equations of the three-compartment model produced clearance kinetics for each of the sensitizers in each of the compartments. The third compartment was found to contain the target of PDT. This series of compounds is quite lipophilic. Therefore these drugs are found mainly in the second compartment. The drug level in the third compartment represents a small fraction of the tissue level and is thus not accessible to direct measurement by extraction. The second compartment of the model accurately predicted the clearance from the serum of mice of the hexyl ether of pyropheophorbide a, one member of this series of compounds. The diffusion and clearance rate constants were those found by fitting the pharmacokinetics of the third compartment to the QSAR data. This result validated the magnitude and mechanistic significance of the rate constants used to model the QSAR data. The PDT response to dose theory was applied to the kinetic behavior of the target compartment drug concentration. This produced a pharmacokinetic-based function connecting PDT response to dose as a function of time postinjection. This mechanistic dose-response function was fitted to published, single time point QSAR data for the pheophorbides. As a result, the PDT target threshold dose together with the predicted QSAR as a function of time postinjection was found.

— The development of an extraction procedure to quantitate dihematoporphyrin ether (DHE) concentration in tissues correlated to fluorescence measurements from instrumentation developed for in vivo fluorimetry was examined. In vivo fluorometric results from mouse mammary carcinoma (SMT-F) were calibrated against results of the chemical extraction assay quantitated spectrophotometrically. Fluorescence and drug extractable levels increase in a linear fashion with injected dose. Loss of porphyrin fluorescence (photobleaching) and intra-tumoral porphyrin level has been demonstrated both in vitro (NHIK cells) and in vivo (SMT-F tumor) during illumination with light following exposure to Hpd or DHE. This process is essentially independent of porphyrin tumor level in vivo and could lead to tumor protection at very low porphyrin levels. On the other hand, this photobleaching process which occurs concurrent with cellular inactivation and tissue damage due to the photodynamic process can be exploited to protect normal tissue during photodynamic therapy (PDT) and thus greatly enhance the therapeutic ratio. This has been demonstrated in patients undergoing PDT.

The stable free radical produced by ionizing radiation in the nucleoside thymidine has been studied by ENDOR spectroscopy. The radical is formed by addition of hydrogen to the C6 carbon atom of the thymine ring. The hyperfine couplings of the CH2 protons and the methyl group rotational splitting constant are deduced from ENDOR measurements at 4.2°K.

Radiation effects are compared in single crystals of xylitol, sorbitol, and dulcitol x‐irradiated at 4.2 °K. In xylitol and dulcitol, but not in sorbitol, a primary oxidation product is identified as an alkoxy radical. ENDOR measurements detected three proton hyperfine couplings associated with the alkoxy ESR absorption, one of which is attributed to a proton three bond lengths removed from the seat of unpaired spin density. Intermolecular trapping of electrons is observed in all three crystals. ENDOR measurements were made of the hyperfine couplings between the trapped electron and the hydroxy protons forming the trap.

— The dependence of photodynamic therapy (PDT) on changes in drug and light doses was determined in C3H/HeJ mice bearing the RIF tumor. Measurements of tumor clonogenicity were determined 24 h after PDT over a range of drug and light doses. Representative histological samples were prepared at each of these doses. Both the drug and light dose dependence experiments showed an exponential decrease in clonogenicity after an initial shoulder region. Reciprocity of drug and light dose was established from those clonogenicity curves. Histological examination of tumors gave information concerning the localization of gross damage within tumors. Increases of light dose in PDT were shown to extend the depth of necrosis within tumors. Increases of drug dose produced enlargements in the area of necrotic spots produced by PDT

In urology, important limiting factors in the application of hematoporphyrin derivative and photodynamic therapy appear to be the problems of standardization of dosimetry and the technique of transurethral photoradiation. Experimental photodynamic therapy on canine bladder with normal and altered epithelium was performed using an argon laser as an energy source. A 630 nanometer wavelength of light was delivered through a quartz-optical fiber with either a regular flat end for focal illumination or a bulb-type end which produced an isotropic light pattern. It was demonstrated that normal canine bladder was resistant to photodynamic therapy and that the bulb tip produced whole bladder illumination. With a moderate light dose of 18 to 30 Joules/cm.2 the effect following whole bladder illumination on the bladder was generalized and superficial. This approach appears to be ideal for treating superficial transitional cell carcinoma of the bladder. Additional work is needed in selecting appropriate energy doses.

The canine bladder model was employed to study the factors mediating the effect of photodynamic therapy (PDT) on the bladder. The recovery (time taken for the bladder volume to return to pre-PDT value), gross and microscopic findings, implicate both bladder high filling pressure (60 cm H2O) and high light dose as factors mediating the effect of photodynamic therapy on bladder capacity. We recommend that photodynamic therapy to the bladder be performed under a filling pressure of 30 cm H2O, which is physiologic, and whole bladder illumination at a light dose not greater than 30 J/cm2.

The intermolecular trapping of electrons has been observed in single crystals of dulcitol and L(+) arabinose x‐irradiated at 4.2 °K. Attribution of a major component of the ESR absorption to trapped electrons is based upon the character of the hyperfine pattern, which arises from multiple anisotropic hyperfine interactions with exchangeable protons, and on the g value of the absorption, which is always less than the free spin value. The removal of the trapped electron absorption upon irradiation with visible light has also been demonstrated. In these experiments all of the electrons are trapped in identical sites. This circumstance provides some important advantages in the study of the factors affecting the stabilization of charge in an environment of polarizable molecules.

Photoradiation therapy is a new technique being investigated for the treatment of solid malignant tumors. In this study, 17 patients with advanced, recurrent, biopsy-proven malignant lesions of the trachea or main-stem bronchus were treated by photoradiation therapy. Patients received hematoporphyrin derivative intravenously three days prior to light therapy. The light was delivered from a fiberoptic fiber attached to the output beam of a dye laser (633 +/- 3 nm). The fiber was passed through the large channel of a bronchoscope (Olympus BF 2T). Of the 17 patients, two had no measurable response to the photoradiation therapy, six had partial necrosis of the tumor, seven patients had a greater than 50 percent reduction in the intraluminal volume of tumor, and two were lost to follow-up. Survival ranged from 5 to 210 days (median survival, 40 days). Complications of the treatment were significant in this group of advanced-stage patients and included excessive secretions, fever, pneumonia, and abscess formation.

Electron spin resonance spectroscopy was used to observe the primary effects of x rays on a single crystal of KOOC–CH2–COOH irradiated at 4.2°K. Three effects were observed: (1) Anions are formed by the addition of an electron to the oxygen of the carbonyl group; (2) a unique paramagnetic center results from the loss of a hydrogen atom shared between two molecules; (3) pairs of radicals are created by the removal of a hydrogen atom from the CH2 groups of each of two adjacent molecules. In order to explain the hyperfine pattern associated with the radical pair absorption it is necessary to develop the theory of “forbidden” transitions for the triplet state.

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The stable free radical produced by ionizing radiation in the nucleoside thymidine has been studied by ENDOR spectroscopy. The radical is formed by addition of hydrogen to the C6 carbon atom of the thymine ring. The hyperfine couplings of the CH2 protons and the methyl group rotational splitting constant are deduced from ENDOR measurements at 4.2°K.

Determination of the dependence of Photofrin II concentration on the time integrated space irradiance in tissue allows the definition of Photodynamic dose to be formulated as an integral of sensitizer concentration over the time integrated space irradiance at each point in tissue. This integral, together with a measurement of the depth of necrosis produced by the clinically measurable sensitizer and light doses, and the tissue optical properties allows the calculation of the expected necrotic depth for any similar tissue. These predictive calculations are carried out for various dosimetric conditions and a variety of clinically interesting sources e.g. long cylinders or spherically symmetric sources imbedded in the tissue, uniform surface illumination over a wide field or a spherical source at the center of a water filled bladder. The results are presented in graphical form and are based on published clinical data.

Two additional carbohydrates are reported whose crystal structures trap electrons intermolecularly in single crystals x irradiated at low temperature, namely sucrose and rhamnose. Five carbohydrate and polyhydroxy compounds are now known which exhibit this phenomenon. The following characteristics of the phenomenon were investigated: (1) the hyperfine couplings of the electron with protons of the polarized hydroxy groups forming the trap; (2) the distances between these protons and the trapped electron; (3) the spin density of the electron at the protons and (4) the relative stabilities of the electron trapped in various crystal structures.

The newest developments in the evaluation of fluorescence detection in photodynamic therapy deal with the ability to distinguish tissue autofluorescence from that of injected photosensitizers. The ability to make this distinction as well as detect fluorescence slightly above background emanating from occult metastases is paramount for the diagnosis of disease. The delivery of light to excite and detect background fluorescence as well as photosensitizer fluorescence in tissues has been accomplished using two HeNe lasers emitting at 632.8 nm and 612 nm delivered through a single quartz fiber optic. Chopping at different frequencies, contributions of fluorescence may be separated. Fluorescence is picked up via a 400 micron quartz fiber optic positioned appropriately near the target tissue. Extraction procedures to quantitate Photofrino II concentration in tissues correlated with fluorescence measurements from instrumentation developed for in vivo fluorimetry were applied for the detection of low drug levels in occult metastases of the lymph nodes. These techniques have been initially applied to detect low levels of drug in DRA mice bearing the SMT-F tumor, which has been extensively studied in our laboratory. The data show the ability of the techniques to detect very low levels of porphyrin in the tumors after low, non-therapeutic doses of injected photosensitizer. The Pollard rat prostatic adenocarcinoma (PA-III) model was chosen for this study because of its characteristic pattern of metastases involving only ipsilateral lymph nodes. Early studies on this lymph node model have shown the ability of the detection device to measure low levels of drug in non-palpable occult metastases in the nodes. The findings show that the detection of small numbers of metastatic cells is possible (

Photoradiation therapy (PRT) for local treatment of malignant tumors utilizing hematoporphyrin derivative (Hpd) as photosensitizing drug is undergoing clinical trials in several centers in the U. S. and abroad. This therapy is based on the localization and retention of Hpd in most tumors, as well as its photodynamic action which likely generates singlet oxygen at least as a first step. The only drug toxicity encountered to date in over 1500 patients receiving Hpd has been a generalized photosensitivity which requires patients to avoid bright light, especially sunlight, for 30 days or more. While this toxicity is avoidable it presents a drawback to utilizing PRT for early stage disease in ambulatory and active patients.

The intermolecular trapping of electrons has been observed in single crystals of dulcitol and L(+) arabinose x‐irradiated at 4.2 °K. Attribution of a major component of the ESR absorption to trapped electrons is based upon the character of the hyperfine pattern, which arises from multiple anisotropic hyperfine interactions with exchangeable protons, and on the g value of the absorption, which is always less than the free spin value. The removal of the trapped electron absorption upon irradiation with visible light has also been demonstrated. In these experiments all of the electrons are trapped in identical sites. This circumstance provides some important advantages in the study of the factors affecting the stabilization of charge in an environment of polarizable molecules.

One of the effects of using Photofrin II as a sensitizer in clinical photodynamic therapy is skin photosensitivity. Avoiding the harmful effect of this photosensitivity typically requires the patient to remain indoors during daylight hours for 4 weeks post injection. Photosensitivity can last up to 8 weeks. A possible method of quickly eliminating skin photosensitivity is the use of photobleaching to eliminate the DHE (dihematoporphyrin ether, the active agent in Photofrin II) from the skin. The Photofrin II was used as supplied (Photomedica, Raritan, NJ) and will be referred to as DHE. We report a series of experiments using Swiss mice which demonstrate the ability to reduce the period of photosensitivity to 1 week. The Swiss mice received 5 mg kg-1 DHE intraperitoneal. Beginning at 24 h post injection they were given daily increasing light doses starting with 18 J cm-2 (at 630 nm). Only the left hind feet were treated with light. At 7 days post injection both hind feet were treated with 135 J cm-2. The pretreated left foot showed no reaction to this treatment whereas the right foot reacted as strongly as control mice which had received no pretreatment with light. The control mice were also injected 7 days prior to treatment. As a check for tolerance animals received a second injection of 5 mg kg-1 DHE intraperitoneally 96 h after the conclusion of the bleaching protocol. Twenty-four h later the left hind foot (previously desensitized by light) reacted to 135 J cm-2 as strongly as controls which had received the 5 mg kg-1 of DHE but no pretreatment.

Anions formed by the addition of an electron to the uracil base were observed in single crystals of the barium salt of uridine 5′ phosphate x‐irradiated at 4.2 °K. The hyperfine coupling tensor for the C6–H proton was deduced from ENDOR measurements; the principal values are −59.12, −32.92, and −16.24 MHz. Similar measurements were made on single crystals of cytidine 3′ phosphate. The principal values for the C6–H proton hyperfine coupling in the anion formed on the cytosine base are −59.26, −33.98, and −14.68 MHz.