An overview of synthetic approaches to porphyrin, phthalocyanine, and phenothiazine photosensitizers for photodynamic therapy.

The mechanistic basis of photodynamic therapy is reviewed briefly, and the factors that are important in improving photosensitizers are examined. The methods for preparing the three main classes of PDT photosensitizers, namely, porphyrins, phthalocyanines, and phenothiazines, are reviewed.

THE DEGRADATION OF CHLOROPHYLL - A BIOLOGICAL ENIGMA.

Some 109 tonnes of chlorophyll are destroyed each year on land and in the oceans. The fate of these chlorophylls is, however, largely unknown. This review describes the developmental stages at which chlorophyll breakdown occurs in aquatic and terrestrial biological systems, and the destruction arising from herbivory, disease, pollution and other physical hazards. At the cellular level, an attempt is made to separate the breakdown of chlorophyll during senescence from the many other events associated with cell destruction and death. A consideration of the more important chemical and biophysical properties of chlorophylls and their derivatives is provided, together with data on their spectral properties. The biosynthetic and biodegradative pathways of chlorophyll metabolism are, so far as is possible, described with some predictions as to the likely fate of the missing tonnes. Two types of degradation are recognized; the first involves up to five defined enzymes concerned with the early stages, the second covers the less well defined enzymic and non-enzymic destruction of the macrocyclic structure. These degradative reactions are compared with the reactions implicated in the breakdown of other porphyrins including haems in plants and animals. A brief description is given of the occurrence of breakdown products of chlorophyll in past biomass, including those of geological significance and those in a more recent archaeological context. Finally, the economic significance of chlorophyll breakdown is considered in the context of agriculture and horticulture, veterinary and medical sciences, food colouring and cosmetic industries, and the multi-million-dollar attraction of autumn leaf fall to tourism. Contents Summary 256 I. Introduction 256 II. Chlorophylls: global production and destruction 259 III. Chlorophylls: nomenclature and chemical characteristics 260 IV. Chlorophyll metabolism 268 V. Chlorophyll degradation during senescence 274 VI. Other degradative conditions 278 VII. Breakdown products in past biomass 287 VIII. Pathways of degradation 289 IX. Economic importance 291 Acknowledgements 294 References 294.

In vitro photodynamic activity of a series of methylene blue analogues.

We have synthesized a series of symmetrical phenothiazines in which the methyl groups of methylene blue have been substituted by longer alkyl chains. Intrinsic photosensitizing ability was not altered by increasing the chain length. However, in vitro phototoxicity after 2 h incubation of RIF-1 murine fibrosarcoma cells followed the order n-propyl > n-pentyl > n-butyl > n-hexyl > ethyl > methyl, with ethyl and n-propyl analogues being 14- and 130-fold more phototoxic than methylene blue, respectively. All analogues also had an improved ratio of phototoxicity: dark toxicity (4:1 to 27:1) compared with methylene blue (3:1). Phototoxicity did not correlate with cellular phenothiazine levels, suggesting that the site of subcellular localization may be more important. After 2 h incubation of RIF-1 cells with the phototoxicity LD50 concentration, methylene blue and all analogues were observed to be localized in the lysosomes by fluorescence microscopy. On exposure to light, methylene blue relocalized to the nucleus, the ethyl analogue did not relocalize, whereas the more phototoxic n-propyl - n-hexyl analogues relocalized to the mitochondria. Relocalization to the mitochondria was associated with an octanol: buffer partition coefficient > or = 1. Therefore, the longer-chain analogues of methylene blue show significantly improved phototoxicity in vitro and, in addition, are expected to avoid the problems of mutagenicity associated with the nuclear localization of methylene blue.

Fluorescence microspectroscopy technique for the study of intracellular protoporphyrin IX dynamics.

We describe a technique designed to monitor the fluorescence dynamics of photosensitizers used in photodynamic therapy (PDT) at micrometer-scale locations within individual formalin-fixed cells. The accumulation of protoporphyrin IX (PpIX) within keratinocytes and fibroblasts. following incubation with 5-aminolaevulinic acid (ALA), is shown to be dependent upon both incubation time and cell proliferation status. Also, the process of photobleaching within these cells is demonstrated via the depletion in PpIX fluorescence emission during exposure to 532 nm light. All spectra show a progressive reduction of the 634 nm PpIX peak, following a bi-exponential decay that is consistent with a singlet oxygen mediated process. The rate of photobleaching, when plotted as a function of light dose, increases with reduced incident laser power. The generation of the hydroxyaldehyde-chlorin photoproduct (photoprotoporphyrin), as monitored by the increase in fluorescence emission centered on 672 nm, is also greatest when the lowest laser power is applied. When light is delivered in two fractions, PpIX fluorescence recovers during the dark period and there is an increase in bleaching rate at the onset of the second exposure. These results are qualitatively consistent with measurements performed in vivo, which demonstrate that the photodynamic dose is dependent upon fluence rate and oxygen status.

In vivo and in vitro characterisation of a protoporphyrin IX-cyclic RGD peptide conjugate for use in photodynamic therapy.

Increasing treatment specificity is one of the major aims of cancer research. Photodynamic therapy is a clinically proven treatment for some cancers and certain other diseases. Photosensitisers generally have little intrinsic selectivity for tumours and any accumulation is dependent upon the type of tumour involved. Increasing tumour selective accumulation could improve the efficacy of PDT and reduce any risk of side effects caused by photosensitiser accumulation in non-target tissue. In order to target photosensitisers to tumours, a cyclic peptide, cRGDfK (arginine-glycine-aspartic acid-phenylalanine-lysine) has been synthesised using solid phase peptide chemistry and conjugated to the porphyrin photosensitiser, protoporphyrin IX. The arginine-glycine-aspartic acid (RGD) motif has been shown to specifically bind alphavbeta3 integrins, heterodimeric glycoproteins upregulated on the surface of proliferating endothelial cells such as those in tumour neovasculature. This study reports the synthesis, in vitro and in vivo characterisation of this novel compound and compares its properties to the free photosensitiser. The individual components in our system, protoporphyrin IX and cRGDfK retain their respective photodynamic and integrin binding activity following the coupling step and produce a conjugate of high purity. The PpIX:cRGDfK conjugate is shown to be a good photosensitiser in vitro in the integrin positive human SiHa cell line and in vivo in a mouse CaNT tumour model. Moreover, pharmacokinetic analysis of PpIX:cRGDfK treated mice shows significant retention and accumulation of photosensitiser in tumour tissue with higher tumour : normal tissue ratios than the free photosensitiser. However, although the conjugate shows this higher accumulation and improved tumour : non-target tissue ratios, the overall in vivo PDT effect, between dose-light intervals of 0 and 6 h, is not significantly better than for free protoporphyrin IX This is possibly due to differences in the target environment or in the subcellular localisation of the compounds.

Photosensitized inactivation of microorganisms.

Despite major advances in medicine in the last 100 years, microbiologically-based diseases continue to present enormous global health problems. New approaches that are effective, affordable and widely applicable and that are not susceptible to resistance are urgently needed. The photodynamic approach is known to meet at least some of these criteria and, with the creation and testing of new photosensitisers, may develop to meet all of them. The approach, involving the combination of light and a photosensitising drug, is currently being applied to the treatment of diseases caused by bacteria, yeasts, viruses and parasites, as well as to sterilisation of blood and other products.

The solid-phase conjugation of purpurin-18 with a synthetic targeting peptide.

It has been demonstrated that efficient site-specific coupling of the highly active photodynamic therapy sensitiser purpurin-18 to the synthetic targeting peptide G-G-V-K-R-K-K-K-P-G-Y-G can be achieved with greater than 85% purity.

The present and future role of photodynamic therapy in cancer treatment.

It is more than 25 years since photodynamic therapy (PDT) was proposed as a useful tool in oncology, but the approach is only now being used more widely in the clinic. The understanding of the biology of PDT has advanced, and efficient, convenient, and inexpensive systems of light delivery are now available. Results from well-controlled, randomised phase III trials are also becoming available, especially for treatment of non-melanoma skin cancer and Barrett's oesophagus, and improved photosensitising drugs are in development. PDT has several potential advantages over surgery and radiotherapy: it is comparatively non-invasive, it can be targeted accurately, repeated doses can be given without the total-dose limitations associated with radiotherapy, and the healing process results in little or no scarring. PDT can usually be done in an outpatient or day-case setting, is convenient for the patient, and has no side-effects. Two photosensitising drugs, porfirmer sodium and temoporfin, have now been approved for systemic administration, and aminolevulinic acid and methyl aminolevulinate have been approved for topical use. Here, we review current use of PDT in oncology and look at its future potential as more selective photosensitising drugs become available.

A randomised, double-blind, placebo-controlled trial of photodynamic therapy using 5-aminolaevulinic acid for the treatment of cervical intraepithelial neoplasia.

Photodynamic therapy (PDT) using topical 5-aminolaevulinic acid (ALA) has been used to treat histologically confirmed cervical intraepithelial neoplasia (CIN-I and -I/II) in a randomised, double-blind, placebo-controlled protocol. Fluorescence microscopy revealed that topical application of 3% ALA in Intrasite Gel to the cervix for 3 hr resulted in the accumulation of protoporphyrin IX in the cervical epithelium. Treatment of CIN with ALA-PDT was well tolerated, with only 3/12 patients in the PDT arm (0/13 in the placebo arm) reporting any discomfort during illumination. Histologic examination of the treated tissue following loop excision 3 months post-PDT indicated that 33% of patients had no evidence of CIN, 42% had no change in the grade of their disease, whilst 25% exhibited an apparent progression of disease. In the control group, the respective figures were 31%, 38% and 31%. There was no significant difference in response between the groups receiving ALA-PDT and those receiving placebo treatment.

A comparative analysis of phenothiazinium salts for the photosensitisation of murine fibrosarcoma (RIF-1) cells in vitro.

Photodynamic therapy (PDT) is a treatment combining a photosensitiser, molecular oxygen and visible light of characteristic wavelength to produce cytotoxic reactive oxygen species (ROS). Within our centre, a series of phenothiazinium salts were synthesised and initial characterisation studies performed to determine any potential use for PDT. All photosensitisers within the series were shown to have useful spectral properties for PDT, with absorbance lambdamax above 667 nm. The Log P values of the compounds were shown to range from -0.9 to > +2.0. Furthermore, Log P values were shown to be important in determining the site of subcellular localisation and as such the site of photooxidative damage. Derivatives with a Log P value of greater than +1.0 were shown to initially localise to the lysosomes then relocalise throughout the cytoplasm following illumination, whereas compounds with intermediate Log P values (-0.7 to +1.0) all remained lysosomal. Only methylene blue (Log P-0.9) was shown to redistribute to the nucleus upon illumination. Following treatment of RIF-1 cells with each phenothiazinium salt for 1 h and subsequent exposure to 665 nm laser light at a fluence rate of 10 mW cm(-2)(18 J cm(-2)), it was determined that the most potent photosensitiser was 260-fold more potent than methylene blue. Furthermore, the PDT efficacy of the photosensitisers was shown to be related to the level of mitochondrial damage induced directly following illumination.

Chronic UVB exposure enhances in vitro percutaneous penetration of 5-aminulevulinic acid in hairless mouse skin.

BACKGROUND AND OBJECTIVES: (Pre)cancerous skin lesions accumulate more protoporphyrin IX (PpIX) upon topical application of 5-aminolevulinic acid (ALA) than the surrounding normal skin. This might be the result of a higher percutaneous penetration of ALA into (pre)cancerous skin. STUDY DESIGN/MATERIALS AND METHODS: ALA penetration through (1) healthy skin with intact stratum corneum, (2) healthy skin with reduced stratum corneum (i.e. tape stripped skin) and (3) diseased skin with dysplastic and thickened epidermis (chronically UVB-exposed skin) was determined in an in vitro model with hairless mouse skin. RESULTS: More ALA had penetrated through chronically UVB-exposed skin than through normal non-exposed skin after 8 hours ALA application. The amount of ALA penetrated through chronically UVB-exposed skin was smaller than through tape stripped skin. CONCLUSIONS: The stratum corneum barrier function is less effective in chronically UVB-exposed skin than in normal non-exposed skin, but more effective than in tape stripped skin. A higher penetration rate of ALA into (pre)cancerous lesions may be (partly) responsible for the greater accumulation of PpIX in such lesions.

Comparative in vitro percutaneous penetration of 5-aminolevulinic acid and two of its esters through excised hairless mouse skin.

BACKGROUND AND OBJECTIVES: ALA esters have been developed to improve PpIX production in ALA-PDT, but they do not perform as well in skin as they do in cells and the bladder. STUDY DESIGN/MATERIALS AND METHODS: The in vitro penetration across normal mouse skin of ALA and its methyl and hexyl ester was determined for different application concentrations. ALA and the esters were also applied to tape stripped skin to determine the effect of the stratum corneum. RESULTS: The penetration of ALA and the esters was higher through tape stripped skin than through normal skin (P < 0.01), showing that the stratum corneum is an important barrier. The experiments with different application concentrations indicated that the skin penetration through normal skin and tape stripped skin is highest for ALA and lowest for the hexyl ester. CONCLUSIONS: The differences in skin penetration properties could be (co-)responsible for the finding that ALA esters do not induce substantially higher PpIX levels in in vivo skin.

Effect of elevating the skin temperature during topical ALA application on in vitro ALA penetration through mouse skin and in vivo PpIX production in human skin.

An approach to induce increased protoporphyrin IX (PpIX) production in aminolevulinic acid (ALA)-based photodynamic therapy (PDT) of skin lesions is to elevate the skin temperature during topical ALA application. Increased skin temperature may increase the (depth of) penetration of ALA into the skin, which may in turn increase PpIX production (in deeper layers). The effect of skin temperature on in vitro ALA penetration into mouse skin was determined in an in vitro percutaneous penetration model at two different temperatures. The effect of skin temperature on PpIX production in human skin during ALA application was measured with in vivo fluorescence spectroscopy in temperature-controlled areas (5 different temperatures). The data from the experiment with the in vitro percutaneous penetration model clearly show that the penetration of ALA into skin is temperature dependent. The penetration of ALA through the mouse skin was higher when its temperature was maintained at 37 [degree]C than through skin that was kept at 32 [degree]C. The fluorescence data from the in vivo experiment show that the PpIX fluorescence increases with increasing temperature of the skin during the application period. The overall activation energy (E(a)) for PpIX production was obtained for each hour of the ALA application period from the fluorescence data using the Arrhenius equation. The E(a) value in the first hour of ALA application was not significant, indicating that the PpIX production in that period is dominated by processes that are not temperature dependent, like the passive diffusion of ALA across the stratum corneum. In the second, third and fourth hours of ALA application, the E(a) for PpIX production proved to be significant, which indicates that the PpIX production in these time intervals is dominated by temperature-dependent processes. In conclusion, the data from the present study indicate that improving ALA-based PDT of skin lesions might be achieved by elevating the skin temperature during the ALA application.