Critical appraisal of the revised Ghent criteria for diagnosis of Marfan syndrome.

Marfan syndrome (MFS) is a connective tissue disorder with major features in cardiovascular, ocular and skeletal systems. Recently, diagnostic criteria were revised where more weight was given to the aortic root dilatation. We applied the revised Marfan nosology in an established adult Marfan population to define practical repercussions of novel criteria for clinical practice and individual patients. Out of 180 MFS patients, in 91% (n = 164) the diagnosis of MFS remained. Out of 16 patients with rejected diagnosis, four patients were diagnosed as MASS (myopia, mitral valve prolapse, borderline non-progressive aortic root dilatation, skeletal findings and striae) phenotype, three as ectopia lentis syndrome and in nine patients no alternative diagnosis was established. In 13 patients, the diagnosis was rejected because the Z-score of the aortic root was <2, although the aortic diameter was larger than 40 mm in six of them. In three other patients, the diagnosis of MFS was rejected because dural ectasia was given less weight in the revised nosology. Following the revised Marfan nosology, the diagnosis of MFS was rejected in 9% of patients, mostly because of the absence of aortic root dilatation defined as Z-score ≥2. Currently used Z-scores seem to underestimate aortic root dilatation, especially in patients with large body surface area (BSA). We recommend re-evaluation of criteria for aortic root involvement in adult patients with a suspected diagnosis of MFS.

In vitro and in vivo multidrug resistance reversal activity by a Betti-base derivative of tylosin.

BACKGROUND: The multidrug resistance (MDR) proteins are present in a majority of human tumours. Their activity is important to understand the chemotherapeutic failure. A search for MDR-reversing compounds was conducted among various Betti-base derivatives of tylosin. METHODS: Here, we evaluate the in vitro and in vivo P-glycoprotein (P-gp)-modulating activity of the most promising compound N-tylosil-1-alpha-amino-(3-bromophenyl)-methyl-2-naphthol (TBN) using human MDR1 gene-transfected and parental L5178 mouse lymphoma cell lines. RESULTS: In vitro experiments showed that TBN dramatically increased the P-gp-mediated cellular uptake of the fluorescent substrate rhodamine 123. Similarly, TBN was found to act as a very potent enhancer of the cytotoxicity of doxorubicin on the resistant cell line. We also provide in vivo evidence using DBA/2 mice in support for an increased tumoural accumulation of doxorubicin, without affecting its tissue distribution, resulting in an enhanced antitumoural effect. CONCLUSION: Our results suggest that TBN is a potent modulator of the P-gp membrane pump and that the compound could be of clinical relevance to improve the efficacy of chemotherapy in MDR cancers.

Ethanol and amino acids in the central nervous system: assessment of the pharmacological actions of acamprosate.

Ethanol induces alterations in the central nervous system by differentially interfering with a number of neurotransmitter systems, although the mechanisms by which such effects are executed are not well understood. The present review therefore, is designed to ascertain the effect of ethanol on both excitatory and inhibitory amino acid neurotransmitters, as well as the sulphonated amino acid taurine, assayed by the microdialysis technique within specific brain regions of rat during different types of alcohol intoxication, acute and chronic, as well as during the withdrawal period. Such an understanding of these pharmacological actions of ethanol on neurotransmitters is essential in order to provide the impetus for the development of appropriate therapeutic intervention to ameliorate the multitude of neurochemical disorders induced by ethanol. In addition the possible mode of action of a new therapeutic drug for the treatment of alcoholism, acamprosate will be discussed. The first part of this review will be limited to studies of the effect of ethanol on both amino acid neurotransmitters and the sulphonated amino acid taurine, a possible neuromodulator. While, the second part will seek to establish the possible mechanism of action of a new therapeutic drug, acamprosate, which is used to combat the effects of ethanol, particularly during the craving period, as well as maintaining abstinence in weaned alcoholics.

Epidermal growth factor-mediated targeting of chlorin e6 selectively potentiates its photodynamic activity.

Certain tumor cells, such as squamous carcinoma cells, express an increased number of epidermal growth factor (EGF) receptors. Therefore, we studied the targeted delivery of the photocytotoxic compound Sn-(IV)chlorin e6 monoethylenediamine [SnCe6(ED)] to tumors that overexpress the EGF receptor. EGF was conjugated to SnCe6(ED) through a carrier, such as dextran (Dex) and human serum albumin (HSA), and the photocytotoxicity on the EGF receptor-overexpressing MDA-MB-468 breast adenocarcinoma cell line was evaluated. The photobiological activities of these EGF conjugates, of the conjugates of the photosensitizer to HSA or Dex, or of the photosensitizer alone were compared. The affinity of EGF for its receptor was substantially impaired when conjugated in EGF-Dex-SnCe6(ED), in contrast to EGF-HSA-SnCe6(ED). In corresponding results, EGF-HSA-SnCe6(ED) displayed a high photocytotoxicity (IC50, 63 nM) on MDA-MB-468 cells at a light dose of 27 kJ/m2, whereas EGF-Dex-SnCe6(ED) showed very limited photocytotoxicity. EGF-HSA-SnCe6(ED) was no longer photocytotoxic in the presence of a competing EGF concentration. The high photocytotoxicity of EGF-HSA-SnCe6(ED) was shown to be the result of a high intracellular concentration in MDA-MB-468 cells, which could be lowered dramatically by incubating the conjugate with a competing EGF concentration. In contrast, EGF-Dex-SnCe6(ED) accumulated poorly in MDA-MB-468 cells, in agreement with its low EGF receptor affinity and photocytotoxicity. EGF-HSA-SnCe6(ED) produced much more intracellular reactive oxygen species on light irradiation than EGF-Dex-SnCe6(ED). It is concluded that the photodynamic activity of the EGF-HSA conjugate of SnCe6(ED) on MDA-MB-468 breast adenocarcinoma cells is EGF specific and is much more potent than EGF-Dex-SnCe6(ED) or free SnCe6.

[Persistent shoulder symptoms in calcific tendinitis: clinical and radiological predictors]. / Aanhoudende schouderklachten bij tendinitis calcarea.

OBJECTIVE: We assessed the most important demographics and radiological characteristics at the time of diagnosis of rotator cuff calcific tendinitis (RCCT), and their associations with long-term clinical outcome. DESIGN: Observational study. METHOD: Baseline characteristics and treatment were evaluated in 342 patients in whom RCCT had been diagnosed. Interobserver agreement of the radiological investigations was analysed. Patients were sent a general questionnaire and 2 shoulder questionnaires, the "Western Ontario rotator cuff" (WORC) and the "Disabilities of the arm, shoulder and hand" (DASH) for evaluation of long-term clinical outcome. Associations between baseline characteristics and long-term outcomes were analysed using logistic regression. RESULTS: Mean age at diagnosis was 49.0 years (SD = 10.0), and 60% were female. The dominant arm was affected in 66%, and 21% had bilateral RCCT. Calcifications were on average 18.7 mm in size (SD = 10.1, ICC = 0.84 (p < 0.001)) and located 10.1 mm (SD = 11.8) medially to the acromion (ICC = 0.77 (p < 0.001)). 32% of the calcifications had a Gärtner type I classification (κ: 0.47 (p<0.001)). After a mean follow-up of 14 years (SD =7.1), median WORC score was 72.5 (range: 3.0-100.0) and median DASH score 17.0 (range: 0.0-82.0). Female gender, dominant arm involvement, bilateral disease, longer duration of symptoms at presentation, and presence of multiple calcifications were associated with inferior long-term outcomes. CONCLUSION: RCCT is not self-limiting. Radiological variations have no significant predictive value. We identified specific prognostic factors for inferior long-term outcome; more intensive follow-up and treatment should be considered in patients with these characteristics.

Identification of the nuclear transcription factor NFkappaB in rat after in vivo ethanol administration.

NFkappaB, a nuclear transcription factor, was induced in the brain nuclear fraction of naive rats after an acute injection of ethanol, 2 g/kg. In contrast, rats which had been chronically alcoholised showed the constitutively active NFkappaB-like complex only after a further acute dose of ethanol. Hepatic nuclear fractions did not exhibit the specific NFkappaB-like complex during the first 45 min after acute ethanol injection, beyond that which was normally constitutively present. Such activation of NFkappaB-like complex in the brains of the naive rats may play an important role in the cellular protective response.

Hypericin-induced photosensitization of HeLa cells leads to apoptosis or necrosis. Involvement of cytochrome c and procaspase-3 activation in the mechanism of apoptosis.

Here we report that photoactivated hypericin can induce either apoptosis or necrosis in HeLa cells. Under apoptotic conditions the cleavage of poly(ADP-ribose) polymerase (PARP) into the 85-kDa product is blocked by the caspase inhibitors benzyloxycarbonyl-Val-Ala-Asp-fluoromethylketone (z-VAD-fmk) and benzyloxycarbonyl-Asp-Glu-Val-Asp-fluoromethylketone (z-DEVD-fmk). Both inhibitors protect cells from apoptosis but cannot prevent hypericin-induced necrosis. Conversely, HeLa cells overexpressing the viral cytokine response modifier A (CrmA), which inhibits caspase-1 and -8, still undergo hypericin-induced apoptosis and necrosis. Evidence is provided for the release of mitochondrial cytochrome c in the cytosol and for procaspase-3 activation in the hypericin-induced cell killing.

Kelatorphan, a potent enkephalinases inhibitor, and opioid receptor agonists DAGO and DTLET, differentially modulate self-stimulation behaviour depending on the site of administration.

Endogenous enkephalins have been found in the perikaryon of the mesolimbic dopaminergic ventral tegmental area and in axonal terminals in the nucleus accumbens. To examine whether endogenous opioid peptides may modulate this mesolimbic system, injections of dopamine receptor agonists and antagonist, the mu-opioid receptor agonists DAGO and morphine, the delta-opioid receptor agonist DTLET and kelatorphan, a new potent inhibitor of multiple enkephalin-degrading enzymes, were performed into the lateral ventricle and into the nucleus accumbens. Intracranial self-stimulation behaviour, obtained through electrodes chronically implanted into the medial forebrain bundle in the posterolateral hypothalamus of the rat, was used as behavioural paradigm. Injections of kelatorphan and DTLET into the lateral ventricle both induced an ICI 174,864-reversible increased self-stimulation behaviour, a similar increase was observed after injection of d-amphetamine, while morphine and DAGO reduced the rate of self-stimulation. In contrast, the administration of kelatorphan or dopamine receptor agonists into the nucleus accumbens reduced the rate of intracranial self-stimulation, while DTLET was without effect, when injected into the same structure. Finally, intra-accumbens injections of DAGO produced a similar behavioural profile to that produced by intraventricular injections of the drugs. Opioids may thus differentially affect intracranial self-stimulation behaviour, as a function of the neuroanatomical locus of administration. Furthermore, these results suggest that kelatorphan may increase self-stimulation behaviour through an action at delta-opioid receptor, while DAGO and morphine may reduce self-stimulation behaviour through an action at mu-opioid receptors.

Acetaldehyde-induced changes in monoamine and amino acid extracellular microdialysate content of the nucleus accumbens.

The effect of an acute intraperitoneal (i.p.) injection of acetaldehyde, 20 mg/kg or 100 mg/kg, on the microdialysate content of both amino acids and monoamines was studies in the nucleus accumbens (NA) by a microdialysis technique. Acetaldehyde, ACH, which was detectable at levels of 50-130 mumol/g brain tissue 10 min after injection, evoked a significant decrease in the extracellular microdialysis dopamine content, which was sustained for the period of the study, i.e. 120 min. Homovanillic acid, HVA, decreased significantly when the lower dose of ACH was administered while dihydrophenylacetic acid, DOPAC, showed no significant change with either dose of ACH during the period of the study. Serotonin levels decreased significantly after both doses of acetaldehyde, with significant increases of its major metabolite, hydroxyindolacetic acid, 5-HIAA, with the higher acetaldehyde dose. Taurine increased significantly, only during the first twenty minutes, after both doses of acetaldehyde, although neither of the excitatory amino acids assayed, glutamate and aspartate, nor the inhibitory amino acid, GABA, showed any significant changes. Acetaldehyde clearly evokes significant perturbation in the monoamine content of the NA, such changes being the converse to those reported for monoamines after ethanol administration, which might indicate a negative reinforcement effect.

Inhibition of enkephalin metabolism and activation of mu- or delta-opioid receptors elicit opposite effects on reward and motility in the ventral mesencephalon.

The coexistence of endogenous opioid systems and dopaminergic neurones in the midbrain tegmental area suggests functional interactions between dopamine and enkephalins. Nevertheless, the identification of the specific opioid receptors associated with modulation of tegmental dopamine activity and its behavioural concomitants on motility and reward is far from clear, considering the mixed nature of the ligands usually employed. In this way, kelatorphan, a potent inhibitor of enkephalinases and selective agonists for mu- and delta-opioid receptor subtypes (DAGO and DSTBULET, respectively) were infused directly into the ventral tegmental area of the rat to study the role of endogenous enkephalins and opioid receptors in regulating spontaneous motor activity and intracranial self-stimulation behaviour. A greater increase in the rate of intracranial self-stimulation behaviour was found after activation of mu-opioid receptors in the ventral tegmental area, as compared to activation of delta-opioid receptors, whereas enhancement of endogenous enkephalins by inhibiting their metabolism through kelatorphan, reduced the rate of intracranial self-stimulation behaviour. On the contrary, spontaneous motor activity was reduced by the delta-opioid receptor agonist, whereas kelatorphan increased the movements of the animal. Taken together, these results show that inhibition of the metabolism of enkephalins in the ventral tegmental area decreased positive reinforcement from the lateral hypothalamic medial forebrain bundle and increased spontaneous movements. On the contrary, activation of both mu- or delta-opioid receptors in the ventral tegmental area significantly increased self-stimulation and decreased spontaneous motor activity, supporting the view that different mechanisms underlie the behavioural effects, resulting from enhancement of endogenous enkephalins and from activation of specific opioid receptors in the ventral mesencephalon.

Influence of rhein anthrone on peristaltic reflex of guinea-pig isolated ileum: involvement of prostaglandins.

1 The influence of rhein anthrone on the peristaltic reflex was studied with a modified Trendelenburg technique in a range from 10(-8) M to 4 x 10(-5) M, on a normal and reversed guinea-pig ileum segment. Rhein anthrone had no significant effects on longitudinal muscle tension, intraluminal pressure or volume displacement when tested on the normal segment in doses up to 10(-5) M. When applied to the mucosal side (reversed segment), rhein anthrone produced a dose-dependent increase of longitudinal muscle tension (significant from 10(-7) M), of intraluminal pressure (significant from 3 x 10(-6) M) and of volume displacement (significant from 10(-7) M). The data show that rhein anthrone possesses in vitro activity which is dependent on contact with the mucosa. 2 The action of rhein anthrone on the reversed segment was inhibited by BW755C (a dual inhibitor of cyclo-oxygenase and lipoxygenase), by indomethacin and by SC19220 (an antagonist of prostaglandin E2 (PGE2) and PGF2 alpha). The effects remaining on longitudinal muscle tension, intraluminal pressure and volume displacement, calculated as percentage (mean +/- s.e.mean) of the initial value, were respectively: 13 +/- 8; 23 +/- 13; 112 +/- 5 for BW755C; 66 +/- 19; 51 +/- 8; 53 +/- 8 for indomethacin and 27 +/- 12; 13 +/- 7; 50 +/- 5 for SC19220. It is concluded that arachidonic acid metabolites, especially PGE2 and PGF2 alpha are involved in the effects of rhein anthrone on the reversed segment.

Photodynamic therapy efficacy and tissue distribution of hypericin in a mouse P388 lymphoma tumor model.

The phototherapeutic properties and tissue distribution of hypericin were investigated in DBA/2 mice bearing subcutaneously transplanted P388 lymphoma cells. The efficacy of the photodynamic therapy (PDT) 2 h after administration of hypericin (2, 5, or 20 mg/kg, i.p., 120 J/cm2, 595 nm) was substantially greater than the efficacy after a 24 h interval. PDT with Photofrin (5 mg/kg, i.p., 24-h interval, 120 J/cm2, 630 nm) showed no significant antitumoral effect. The hypericin uptake in some tissues was measured after administration of hypericin (5 or 20 mg/kg, i.p.) up to 168 h. A comparison of the distribution data and the PDT efficacy at various intervals suggests that the plasma concentration of hypericin, and to a lesser extent the tumor uptake, determines the tumor response to PDT with hypericin.

Inhibition of epidermal growth factor receptor tyrosine kinase activity by hypericin.

The naphthodianthrone hypericin produces a potent and irreversible inhibition of the epidermal growth factor (EGF) receptor tyrosine kinase activity. The inhibition was time and temperature dependent but did not depend on EGF activation. The IC50 values obtained were 0.37-8.7 microM with membranes incubated for 30 min at 30 degrees or 10 min at 0 degree, respectively. Kinetic analyses with poly(Glu,Ala,Tyr) 6:3:1 [poly(GAT)] as an exogenous substrate were in agreement with the irreversible nature of the inhibition. Irradiation for 30 min with fluorescent light caused a dramatic photosensitizing effect and resulted in an IC50 value of 44 nM. This effect was due to a type I mechanism, since the exclusion of oxygen did not alter the inhibition curve. The inhibition was inversely proportional to the amounts of membranes used, which probably reflects the non-specific sequestration of hypericin into the lipid bilayer. Ser/Thr protein kinases such as protein kinase A, casein kinase 1 and 2 and the enzyme 5'-nucleotidase, were not inhibited by hypericin not even at high concentrations (> 100 microM).

Photosensitized inhibition of growth factor-regulated protein kinases by hypericin.

The naphthodianthrone hypericin causes a photosensitized inhibition of protein kinases involved in growth factor signalling pathways. Nanomolar concentrations of hypericin inhibit the protein tyrosine kinase activities (PTK) of the epidermal growth factor receptor and the insulin receptor, while being ineffective towards the cytosolic protein tyrosine kinases Lyn, Fgr, TPK-IIB and CSK. Photosensitized inhibition by hypericin is not restricted to receptor-PTKs since the Ser/Thr protein kinases (protein kinase CK-2, protein kinase C and mitogen-activated kinase) are also extremely sensitive to inhibition (IC50 value for protein kinase CK-2 = 6 nM). A comparison of the hypericin-mediated inhibition of the epidermal growth factor-receptor PTK and protein kinase CK-2 revealed that the inhibition is irreversible, strictly dependent upon irradiation of the enzyme-inhibitor complex with fluorescent light and likely mediated by the formation of radical intermediates (type I mechanism). Although the exact molecular basis for the selectivity of enzyme inhibition by hypericin remains unknown, our results suggest that distantly related protein kinases could still share common reactive domains for the interaction with hypericin.

Decreased release of nitric oxide (NO) by alveolar macrophages after in vivo loading of rats with either iron or ethanol.

Alveolar macrophages were isolated by pulmonary lavage from rats which had been either chronically overloaded with iron by intraperitoneal injections of iron dextran for four weeks, or rendered alcoholic by administration of increasing concentrations of alcohol vapour, also for four weeks. Although the hepatic iron content increased in both groups of animals, only the macrophages isolated from the iron-loaded animals showed a significant increase in iron content (P = < 0.05). Furthermore, in these macrophages there was a significant increase in oxidative tone as demonstrated by a six fold increase in superoxide dismutase activity. In both the iron-loaded and chronically alcoholised macrophages, there was a significant diminution in nitric oxide release after stimulation with lipopolysaccharide and/or interferon-gamma, which impaired the ability of both of these groups of macrophages to inhibit the germination of spores from the fungus Rhizopus, a nitric oxide-dependent process. Such an alteration in nitric oxide release reduces the macrophage's microbicidal activity.

Photocytotoxic action of EGF-PVA-Sn(IV)chlorin e6 and EGF-dextran-Sn(IV)chlorin e6 internalizable conjugates on A431 cells.

Certain tumour cells, such as squamous carcinoma cells, express an increased number of epidermal growth factor (EGF) receptors. The goal of this study was the targeted delivery of Sn(IV)chlorin e6 (SnCe6) to tumours that overexpress the EGF receptor. Therefore EGF was conjugated to the photosensitizer through a carrier, such as dextran (Dex) and polyvinylalcohol (PVA). These conjugates were then compared to a conjugate of the photosensitizer to dextran or PVA alone. The EGF-Dex-SnCe6 conjugates bound specifically to the EGF receptors of the human squamous carcinoma cell line A431 in contrast to EGF-PVA-SnCe6. However, EGF-PVA-SnCe6 exhibited a higher photocytotoxicity (CC50, 2.8 microM) than EGF-Dex-SnCe6 (CC50, >10 microM) and SnCe6 (CC50, >10 microM). PVA-SnCe6 had a similar photocytotoxicity (CC50, 3.5 microM) to EGF-PVA-SnCe6, indicating that PVA, more than EGF, plays a determinant role in the uptake of the conjugates by A431 cells. Together with the improved affinity of EGF-Dex-SnCe6 over EGF-PVA-SnCe6 for the EGF receptor, the former displayed a small increased photocytotoxicity over Dex-SnCe6, reflecting a limited EGF receptor mediated uptake effect. It was concluded that the photodynamic activity of the EGF-conjugate turns out to be strongly dependent on the carrier used.

Photodynamic therapy with hypericin in a mouse P388 tumor model: vascular effects determine the efficacy.

Hypericin, a polycyclic quinone obtained from plants of the Hypericum genus, exhibits strong photodynamic antitumor effects. In the present study, PDT efficacy of hypericin under different conditions was compared in a P388 mouse tumor model. Plasma and tumor drug measurements and assessment of vascular damage by fluorescein dye exclusion were performed to determine the relative contributions of vascular effects and direct tumor cytotoxicity. Furthermore, the influence of modifying tumor oxygenation on PDT effect was also evaluated. Study of PDT efficacy and tissue distribution revealed that PDT efficacy was more dependent on plasma concentration than tumor drug level. Fluorescein dye exclusion indicated the complete microvascular occlusion in the tumor and surrounding skin immediately after effective PDT treatments, while only a limited vascular occulation was observed after non-effective PDT treatment. It was found that neither tumor hypoxia induced by hydralazine nor increasing tumor oxygenation achieved by nicotinamide could significantly affect the effectiveness of various PDT protocols. These results suggest that tumor vasculature damage might be the primary mechanism of hypericin-mediated PDT effect. The existence of this potent secondary vascular effect is likely to account for the inability of tumor oxygenation modifiers to affect tumor response after PDT with hypericin.

Synergistic effect of photodynamic therapy with hypericin in combination with hyperthermia on loss of clonogenicity of RIF-1 cells.

Hypericin is a natural photosensitizer produced in plants of the genus Hypericum. The compound exhibits a potent phototoxicity both in vitro and in vivo. In the present study we investigated the effect of hypericin-mediated PDT on hyperthermia (43 degrees C) in RIF-1 cell line. Our results demonstrated a synergistic effect on loss of cell clonogenicity when PDT exposure was followed immediately by hyperthermia. This synergistic effect was diminished by introducing an interval (at 37 degrees C) between the two treatments. Furthermore, it was found that combining PDT treatment with hyperthermia could significantly enhance the cell death by necrosis as indicated by morphological examination and significant loss of membrane integrity. Our data suggest that the common cell membrane damage by both PDT and hyperthermia is likely to be responsible for this synergistic effect.

Confluence dependent resistance to photo-activated hypericin in HeLa cells.

Hypericin is a natural photo-active pigment produced by plants of the genus Hypericum. The compound exhibits a potent photocytotoxic activity in vitro and in vivo. Using HeLa cells we further investigated whether the photocytotoxic in vitro effect of hypericin is influenced by the cell density. It was demonstrated that hypericin-induced photocytotoxicity in HeLa cells depends significantly on the amount of cells in culture, as low cell density cultures were more responsive to photodynamic therapy (PDT) than confluent or hyperconfluent cell cultures. This confluence dependent resistance (CDR) can be explained in terms of a decrease in hypericin cellular uptake. The phenomenon is not caused by the depletion of hypericin from the medium by high-density cell cultures since the extra-cellular availability of the drug is not altered by the increase in cell density and does not appear to be a limiting factor. Importantly, since confluent or hyperconfluent cell cultures can better mimic the high cell density of the solid tumour, CDR should be taken into consideration whenever resistance of solid tumours to PDT with hypericin is observed.

In vivo photodynamic activity of hypericin in transitional cell carcinoma bladder tumors.

In a recent clinical study, we showed that hypericin accumulates selectively in urothelial lesions of the bladder following intravesical administration of the compound in patients. This observation infers that hypericin, a potent photosensitizer, could be used as a selective photodynamic therapy (PDT) tool against superficial bladder cancer. In the present study we investigated the in vivo PDT activity of hypericin in transition cell carcinoma (TCC) tumors of the bladder. Both the distribution and tumor PDT response were carried out using subcutaneous heterotopic AY-27 TCC tumors in syngeneic rats. For both PDT and distribution studies, hypericin (1 or 5 mg/kg) was injected intravenously 0.5, 6 or 24 h before PDT or distribution evaluation. The data show that hypericin is a potent photosensitizer in the treatment of TCC tumors in vivo and that the interval between drug administration and photo-irradiation has a dramatic effect on the PDT outcome. Using a 0.5 h interval between drug administration and photo-irradiation the tumor regrowth study indicated that no tumor mass could me measured 9-10 days after PDT. On the contrary, lengthening the time interval between drug administration and photo-irradiation resulted in a gradual loss of PDT efficiency in these tumors. For instance, while the 6 h drug interval protocol produced a moderate PDT activity in which the tumor sizes decreased to about 50% of their original sizes 11-16 days after photo-irradiation, the 24 h interval protocol was even less effective. The distribution data indicate that the PDT efficiency of hypericin in TCC tumors corresponded to the plasma concentrations rather than to the over all concentrations in the tumor. It is therefore conceivable that the mechanism of PDT efficacy of hypericin in TCC tumors is through indirect (vascular effects) rather than through direct effects (cellular destruction) of hypericin in these tumors. In conclusion, our data indicate that hypericin is a potent photosensitizer against AY-27 TCC tumors and that the PDT efficacy of hypericin is largely determined by photosensitizer distribution in the tumor at the time of photo-irradiation.