Porphyrin photosensitised processes in the prevention and treatment of water- and vector-borne diseases.

Water- and vector-borne diseases are a global burden which is estimated to cause several million deaths and innumerable cases of sickness every year. These infectious illnesses are emerging or resurging as a result of several factors, such as changes in climate, in public health and demography policy, as well as the spread of resistance to insecticide and drug, and genetic changes in pathogens. Integrated prevention strategies must be developed and implemented in endemic disease areas to reverse the trend of emergent/resurgent water- and vector-borne diseases. With this perspective porphyrins and their analogues, that have been shown to act as very efficient photosensitising agents against a broad number of microbial pathogens (bacteria, fungi, protozoa) and parasitic animals, could represent an important tool for the prevention and control of these pathologies. The application of photosensitised processes can be exploited to address environmental problems of high significance, including the decontamination of waste waters, the disinfection of fish-farming tanks and the control of populations of noxious insects. Such diversified applications take advantage of the availability of a truly large number of porphyrin derivatives with chemical structures which can be tailored to comply with the physical and chemical properties, as well as the biological features of several milieus. In addition, the property typical of porphyrins to absorb essentially all the wavelengths in the sun emission spectrum allows the promotion of processes largely based on natural resources with significant energy saving and low impact on the ecosystems.

Porphyrin-photosensitized processes: their applications in the prevention of arterial restenosis.

Photodynamic therapy (PDT) is based on the use of a photozensitising compound which is accumulated by rapidly proliferating cells. Subsequent irradiation with light wavelengths specifically absorbed by the photosensitiser promotes the generation of reactive short-lived oxygen species which cause an irreversible and selective damage. Endovascular interventions to correct obstructive arterial disease have been developed worldwide with excellent short term results. However, long term patency is still limited by the onset of restenosis, due to subsequent intimal hyperplasia (IH). IH is characterized by proliferation and migration of smooth muscle cells (SMC) and extracellular matrix production. Targeting of SMC by photozensitisers can be efficiently achieved by taking advantage of the receptors for low density lipoproteins (LDL) expressed by such cells. Thus, preference is given to hydrophobic compounds which readily partition in the lipid matrix of LDL. We developed a liposomal formulation of a highly hydrophobic photozensitising agent, Zn(II)-phthalocyanine (ZnPc). The liposome-delivered ZnPc was readily taken up by cultured SMC cells and preferentially localized in the Golgi apparatus. Red light irradiation of incubated SMC induced cell death. Extension of these investigations to an in vivo rabbit model showed that ZnPc mainly accumulated in the media layer, where PDT induces the main damage through cellular depletion due to apoptosis of SMC, changes in the extracellular matrix with generation of a barrier to cellular migration, and acceleration of re-endothelization. Initial clinical applications showed that PDT safely and effectively prevents restenosis after angioplasty up to a 6 month follow-up.