Combination of photodynamic therapy + immunotherapy + chemotherapy in murine leukiemia.

Photodynamic therapy (PDT) is a treatment for cancer based on the photosensitization of tumor cells by photosensitive drugs and their subsequent destruction on exposure to light of particular wavelength. The combination of drug uptake in malignant tissues and selective delivery of laser-generated light provides an effective therapy with efficient tumor citotoxicity and minimal normal tissue damage. Since immune response of the host is important in the control of tumor growth and spreading, PDT is able to increase the antitumor immunity. In our laboratory we examined the antitumor effect of combination of PDT, with photoactivated M-THPC (meta-tetrahydroxyphenylchlorin, FOSCAN, Temoporphirin), adoptive immunotherapy, with immune lymphocytes, and chemotherapy on advanced murine tumors. Mice bearing L1210 tumor were treated at day +4 with Navelbine (NVB 1mg/Kg), at day +5,+6 with PDT (0.3mg/Kg of mTHPC and 100mW/cm(2) x 200'' of exposure of laser light), and at day + 7 with immune lymphocytes(IL), collected from mice pretreated with PDT(2x10(7) cells). The results show that the combination NVB + PDT + IL demonstrates a significant synergistic antitumor effect while the chemotherapy treatment with low dose of the drug is uneffective. The same positive results were obtained with the combination of Cisplatin (CDDP 0.5mg/Kg), PDT and IL, while the CDDP treatment alone is completely uneffective. In conclusion, these results suggest that it is possible to completely cure animals bearing advanced tumors, with a combined therapy, PDT + adoptive immunotherapy + low dose chemotherapy.

Photosensitization with zinc (II) phthalocyanine as a switch in the decision between apoptosis and necrosis.

Photodynamic therapy (PDT) of tumors and other diseases is based on the uptake of a photosensitizing dye in target cells, which are damaged by reactive oxygen intermediates generated on irradiation with light in which the wavelengths match the dye absorption spectrum. PDT can induce cell death by necrosis and apoptosis both in vivo and in vitro, but the factors determining the contribution of either mechanism to the overall process are not completely defined. Our studies on the photosensitization of 4R transformed fibroblasts with the second-generation photosensitizer zinc (II) phthalocyanine (ZnPc) aim at determining the effect of important experimental parameters such as time of cell incubation (2 or 24 h) with ZnPc before irradiation and ZnPc concentration in the incubation medium on cell death. Furthermore, we propose possible correlations between the cell death mechanism and primary photo-damage sites; these are mainly determined by the intracellular localization of the photosensitizer. The mechanism of cell death was determined by both electron microscopy analysis of the morphological alterations induced by photosensitization and measurement of caspase 3 activation. The initial photodamage sites were determined by measuring the activities of several functions typical of mitochondria, lysosomes, Golgi apparatus, cytosol, and plasma membrane. The intracellular localization of ZnPc after 2- or 24-h incubation was determined by fluorescence microscopy. Necrosis, associated with early loss of plasma membrane integrity and complete depletion of intracellular ATP, represents the prevailing mode of death for 4R cells dark-incubated for 2 h with ZnPc and irradiated with light doses reducing viability by 99.9%. In contrast, irradiation performed 24 h after ZnPc incubation causes only partial inhibition of plasma membrane activities, and cell death occurs largely by apoptosis. ZnPc is mainly localized in the Golgi apparatus after 2- and 24-h incubation, and in all of the cases this compartment represents a primary target of photodamage. Only after prolonged incubation is mitochondrial localization of ZnPc clearly detected by fluorescence microscopy; this could be a determining factor for promotion of apoptosis. Our data demonstrate that it is possible to modulate the mechanism of cell death by appropriate protocols; this may be relevant for enhancing the therapeutic efficacy of PDT.

Effect of the delivery system on the biodistribution of Ge(IV) octabutoxy-phthalocyanines in tumour-bearing mice.

The pharmacokinetic properties of the Ge(IV)-octabutoxy-phthalocyanines (GePc) with two axially ligated triethylsiloxy (GePcEt) or trihexyl-siloxy (GePcHex) chains were studied in BALB/C mice bearing a transplanted MS-2 fibrosarcoma. The GePcs were delivered to mice after incorporation into unilamellar liposomes of dipalmitoyl phosphatidylcholine (DPPC) or in an emulsion of Cremophor-EL. The Cremophor delivered GePcs were cleared from the blood circulation at a much slower rate than the liposome-delivered GePcs. At the same time, Cremophor induced a slower and reduced uptake of the GePcs in the liver and spleen while it greatly enhanced the uptake in the tumour as compared to liposomes. Maximum tumour uptake was observed at 24 h post-injection and was equivalent to 0.67 and 0.50 nmol/g, respectively, for the Cremophor delivered GePcHex and GePcEt. The corresponding values for the liposome-delivered drugs were approximately one fourth of that observed with Cremophor.

The distribution of the tumour photosensitizers Zn(II)-phthalocyanine and Sn(IV)-etiopurpurin among rabbit plasma proteins.

Zn-phthalocyanine (ZnPc) and Sn-etiopurpurin (SnET2) incorporated in unilamellar liposomes or solubilized in a Cremophor-EL emulsion have been incubated in vitro with rabbit plasma or intravenously administered to rabbits. Ultracentrifugation and chromatographic analysis of the plasma showed that ZnPc and SnET2 are mainly released to lipoproteins; within the lipoprotein family, both dyes are preferentially bound by low-density (LDL) and high-density (HDL) lipoproteins. The amount of dye bound with these two lipoprotein classes was related to their relative concentration in the plasma; in most cases a larger amount of photosensitizer was bound to HDL as compared to LDL on a protein concentration basis.

Evidence for a major role of plasma lipoproteins as hematoporphyrin carriers in vivo.

Hematoporphyrin (5 mg/ml), administered intravenously to tumor-bearing patients, becomes associated with different serum proteins, including lipoproteins (mainly HDL), globulin and albumin. No residual porphyrin is bound to the two latter classes of proteins after 48 h, whereas the complexation with the lipoproteins appears to be particularly stable probably owing to the hydrophobic nature of hematoporphyrin. The late persistence of hematoporphyrin in serum is due to the binding to the VLDL fraction with special regard to its cholesterol moiety. The importance of hematoporphyrin transport by lipoproteins for the photodynamic therapy of tumors is briefly discussed.

Delivery of the tumour photosensitizer zinc(II)-phthalocyanine to serum proteins by different liposomes: studies in vitro and in vivo.

Zn-phthalocyanine (Zn-Pc) incorporated into liposomes of different phospholipids has been incubated in vitro with human serum and administered i.v. to rabbits. In both cases, chromatographic and density gradient ultracentrifugation studies indicate that Zn-Pc is almost exclusively bound by the 3 major lipoprotein components of the plasma (VLDL, LDL and HDL). The amounts of Zn-Pc recovered from the different lipoprotein fractions reflect their relative concentration in the serum. The presence of 20% moles of cholesterol in liposomes of dipalmitoyl phosphatidylcholine (DPPC) optimizes the release of Zn-Pc to LDL. This fact is important for enhancing the selectivity of drug delivery to tumors since LDL display a preferential interaction with neoplastic cells.

Interaction of hydro- or lipophilic phthalocyanines with cells of different metastatic potential.

A highly metastatic (4R) and a nonmetastatic (RE4) transformed rat embryo fibroblast cell line were incubated with lipid-soluble Zn(II)-phthalocyanine (ZnPc) and its water-soluble tetrasulphonated derivative (ZnPcTS) and compared for phthalocyanine uptake. The hydrophobic liposome-delivered ZnPc showed a significantly greater uptake by both cell lines than did ZnPcTS. Moreover, the two phthalocyanines appear to interact with cells according to different pathways, as suggested by the different temperature-dependence of the binding process and the different inhibitory action exerted by selected serum proteins, such as lipoproteins and heavy proteins. Under all experimental conditions, the two cell lines exhibited similar interactions with ZnPc and ZnPcTS, suggesting that heterogeneity of the tumor cell population has a minor influence on the accumulation of photosensitizers.

Studies on the mechanism of the hematoporphyrin-sensitized photooxidation of 1,3-diphenylisobenzofuran in ethanol and unilamellar liposomes.

The 5 microM hematoporphyrin-sensitized photooxidation of 1,3-diphenylisobenzofuran (DPBF) was studied in homogeneous ethanolic solutions and in aqueous dispersions of unilamellar liposomes of dipalmitoylphosphatidylcholine; both the porphyrin and DPBF are embedded in the phospholipid bilayer. The rate and quantum yield of DPBF photooxidation were found to increase upon increasing the substrate concentration and were higher in the liposome system, while they were unaffected by the fluidity of the phospholipid bilayer. Time-resolved spectroscopic measurements showed that the photooxidation of DPBF in ethanol solution proceeds by a type II O2(1 delta g)-involving mechanism. In the liposomal vesicles the high local concentration of hematoporphyrin (Hp) and DPBF in the phospholipid bilayer (ca 2000-fold higher than the stoichiometric concentration) enhances the probability of energy transfer from triplet Hp to DPBF with generation of triplet DPBF; hence O2 (1 delta g) formation can be promoted by both triplet Hp and triplet DPBF. A minor fraction of triplet DPBF quenchings appears to generate radical species which propagate DPBF damage by chain reaction.

A comparison of fluorescence methods used in the pharmacokinetic studies of Zn(II)phthalocyanine in mice.

The pharmacokinetics of Zn phthalocyanine (ZnPc) encapsulated in dipalmitoyl-phosphatidylcholine (DPPC) liposomes, injected intravenously in Skh:HR-1 nude mice, was monitored by two in vitro techniques and one in vivo technique, all based on fluorescence spectroscopy. The in vitro methods involve either fluorescence measurements on thin tissue sections or on extracts from these tissues. The in vivo method involves the fluorescence measurement at the skin surface. Both in vitro techniques gave similar results which are consistent with previous findings on the pharmacokinetic behavior of ZnPc. The liver and spleen showed rapid ZnPc concentration increases, reaching a maximum level in 30 min. or less post drug administration. Relatively little ZnPc was detected in the skin, fat or muscle, the maximum concentration occurring at 12 h. In vivo fluorescence reached a maximum intensity approx. 6 h post injection at the mid-chest analysis site and at 12 h in the thigh. The in vivo measurements at two different anatomical sites showed pharmacokinetic behavior that reflects an overall integrated fluorescence originating from several tissue sites.

Unusually high affinity of Zn(II)-tetradibenzobarrelenooctabutoxy-phthalocyanine for low-density lipoproteins in a tumor-bearing mouse.

An important factor in determining the efficacy of photosensitizing compounds in photodynamic therapy of tumors is the level to which tumors take up the photosensitizers after systemic injection. This parameter seems to be related to the transport modalities of the photosensitizer in the bloodstream. In this work the photosensitizer Zn(II)-tetradibenzobarrelenooctabutoxyphthalocyanine was shown to have an unprecedentedly high association with low-density lipoproteins (71% of the phthalocyanine in the plasma) when delivered in Cremophor micelles to tumor-bearing mice. This was accompanied by a particularly high tumor uptake at 24 h post-injection.

Spectroscopic studies on Zn(II)-phthalocyanine in homogeneous and microheterogeneous systems.

The absorption and fluorescence properties of Zn2+-phthalocyanine (Zn-Pc) have been characterized in homogeneous and microheterogeneous media. By our preparation procedure, the phthalocyanine can be associated in a monomeric state with cationic micelles, unilamellar liposomes, and low-density lipoproteins; the distribution of Zn-Pc in the hydrophobic phases appears to be controlled by the nature of the lipid environment. The potential use of liposome-bound Zn-Pc for photosensitization studies in aqueous media and for phototherapeutic applications in vivo is briefly discussed.

Distribution of endogenous and injected porphyrins at the subcellular level in rat hepatocytes and in ascites hepatoma.

Different doses (0.5-20 mg/kg) of hematoporphyrin (HP) have been injected intraperitoneally into normal rats and rats affected by Yoshida ascites hepatoma. About 80% of HP reaching the liver was recovered in the extracellular compartment after liver perfusion, the ratio of extra- to intracellular HP being essentially independent of the administered dose. Similar data were obtained at different times after injection of 20 mg/kg HP. Intracellular HP largely accumulates in the mitochondria and in the membrane components of the nuclear fraction of isolated hepatocytes. Kinetic studies suggest that the cell receptors of highest affinity for HP are present in the external membrane. The latter result obtains for ascites hepatoma cells in an even more evident way, although the latter cells exhibit secondary HP binding sites probably constituted by cytoplasmatic proteins. Moreover, the clearance of intracellular HP from malignant cells occurs at a remarkably lower rate as compared with HP clearance from liver cells.

Role of delivery vehicles for photosensitizers in the photodynamic therapy of tumours.

The use of photosensitizing drugs associated with different types of delivery vehicle has received strong interest within the field of the photodynamic therapy of tumours. Lipid-based delivery vehicles, such as liposomes and oil emulsions, allow the administration of water-insoluble photosensitizers, widening the choice of photosensitizers potentially useful for treating tumours. In some cases, these delivery vehicles increase the selectivity of tumour targeting by favouring photosensitizer uptake in tumour tissue. However, a higher selectivity of tumour targeting could be obtained through the association of photosensitizers with delivery vehicles which can interact preferentially or specifically with tumour cells. With this aim in mind, low-density lipoproteins (LDLs) and monoclonal antibodies, in particular, are regarded as the most promising delivery systems for anticancer drugs. Some pharmacokinetic studies with LDL-associated photosensitizers have demonstrated a higher tumour uptake compared with the same photosensitizers delivered with other formulations. Monoclonal antibody-coupled photosensitizers have been tested mainly in vitro, and have shown a high selectivity towards cells expressing specific antigens. Only a limited number of reports are available on the biodistribution of immunoconjugated photosensitizers and on their selectivity in vivo, so that their importance for the selectivity of tumour targeting has not yet been defined.

Effect of extracellularly generated singlet oxygen on gram-positive and gram-negative bacteria.

In the separated surface-sensitizer system, a photosensitizer is physically separated from the substrate by a thin air layer under such conditions that only singlet oxygen can reach and oxidize the substrate, preventing the competition by type I photosensitized processes. This method has been used to study the reaction of singlet oxygen with Gram-positive (Streptococcus faecium) and Gram-negative (Escherichia coli) bacterial strains. Studies on cell samples exposed to singlet oxygen for different periods of time show a drastic decrease in survival for S. faecium, while E. coli becomes sensitive only when the integrity of the outer membrane is altered by treatment with CaCl2 or tris(hydroxymethyl)aminomethane-ethylenediaminetetraacetic acid (Tris-EDTA). Biochemical and ultrastructural analyses suggest that the cytoplasmic membrane and the genetic material are the main sites damaged by singlet oxygen.

Photochemical and photosensitizing properties of monomeric and dimeric Sn(IV)-protoporphyrin.

Sn(IV)-protoporphyrin IX (Sn-Pp) in aqueous media exists as a mixture of monomeric and dimeric species, which can be readily distinguished on the basis of their absorption maxima at around 410 and 386 nm respectively. Sn-Pp dimers prevail as the pH is decreased and are characterized by a lower fluorescence quantum yield, a larger tendency to undergo photobleaching and a reduced photosensitizing efficiency compared with the Sn-Pp monomer. The photosensitizing action of Sn-Pp appears to involve the intermediacy of singlet oxygen (1O2) as shown by photo-oxidation studies with N-acetyl-tryptophanamide in light and deuterated water solutions. Using 1,3-diphenyl-isobenzofuran as a substrate, the quantum yield of 1O2 generation by monomeric Sn-Pp was found to be about 0.6.

Polylysine-porphycene conjugates as efficient photosensitizers for the inactivation of microbial pathogens.

Porphycenes are electronic isomers of porphyrins which, when neutral, display no appreciable photosensitizing action towards Gram-negative bacteria. The covalent binding of oligomeric polylysine moieties, which are cationic at physiological pH values, endows porphycenes with a significant phototoxic activity against Gram-negative bacteria while retaining their photoefficiency against a variety of microbial pathogens, including Gram-positive bacteria, fungi and mycoplasmas. The effect of the polylysine moiety is dependent on both the polylysine concentration and the degree of oligomerization. A suitable interplay among the various parameters opens the possibility to obtain either a broad spectrum of antimicrobial activity or a selective action toward a specific pathogen while minimizing the damage to human fibroblasts.

Steady state and time-resolved spectroscopic studies on zinc(II) phthalocyanine in liposomes.

Zinc(II) phthalocyanine (ZnPc), a potential second-generation phototherapeutic agent for tumours, has been incorporated into small unilamellar vesicles (SUVs) (diameter, 52 nm) and large unilamellar vesicles (LUVs) (diameter, 84 nm) of dipalmitoyl-phosphatidylcholine (DPPC). Absorption spectroscopy, as well as steady state and time-resolved fluorescence emission studies, indicate that ZnPc is monomeric in SUVs at a stoichiometric concentration below 0.25 microM (corresponding to an actual endoliposomal concentration of about 0.5 mM), while in LUVs it is monomeric below 2 microM. The fluorescence lifetime of the monomer is 3-3.5 ns. Upon increasing the ZnPc concentration, aggregated derivatives are formed, which are characterized by shorter fluorescence lifetimes (1.2-1.5 ns; 0.4-0.6 ns). The possible implications of these observations for the phototherapeutic efficiency of ZnPc are briefly discussed.

Photothermal sensitization of amelanotic melanoma cells by Ni(II)-octabutoxy-naphthalocyanine.

Incubation of B78H1 amelanotic melanoma cells with a potential photothermal sensitizer, namely, liposome-incorporated Ni(II)-octabutoxy-naphthalocyanine (NiNc), induces an appreciable cellular accumulation of the naphthalocyanine, which is dependent on both the NiNc concentration and the incubation time. No detectable decrease in cell survival occurs upon red-light irradiation (corresponding to the longest-wavelength absorption bands of NiNc) in a continuous-wave (c.w.) regime of the naphthalocyanine-loaded cells. On the other hand, 850 nm irradiation with a Q-switched Ti:sapphire laser operating in a pulsed mode (30 ns pulses, 10 Hz, 200 mJ/pulse) induces an efficient cell death. Thus, ca. 98% decrease in cell survival is obtained upon 5 min irradiation of cells that have been incubated for 48 h with 5.1 microM NiNc. The efficiency of the photoprocess is strongly influenced by the NiNc cell incubation time prior to irradiation. Photothermal sensitization with NiNc appears to open new perspectives for therapeutic applications, as suggested by preliminary in vivo studies with C57/BL6 mice bearing a subcutaneously implanted amelanotic melanoma.

Skin-photosensitizing properties of Zn(II)-2(3), 9(10), 16(17), 23(24)-tetrakis-(4-oxy-N-methylpiperidinyl) phthalocyanine topically administered to mice.

A Zn-phthalocyanine derivative bearing four 4-oxy-N-methyl-piperidinyl peripheral substituents has been formulated in an azone-containing gel for topical administration and its potential as a photodynamic therapy agent has been investigated. The phthalocyanine displays an intense absorbance in the 680 nm range and shows a high photosensitizing activity toward a model biological substrate (N-acetyl-L-tryptophanamide). Upon administration of 20 microg cm(-2) onto the dorsal skin of Balb/c mice, maximal phthalocyanine concentrations (ca. 64.2 ng mg(-1) of skin) are reached at 1 h after the deposition. The photosensitizer appears to be localized in the epidermal layers, since (a) no detectable amounts of phthalocyanine are recovered from the mouse blood and liver; and (b) upon photoactivation with a diode laser at 675 nm, only the epidermis is heavily damaged, as shown by histological and ultrastructural analysis. The photodamage is largely of inflammatory nature and an essentially complete healing of the damaged skin is observed at 72 h after the end of the phototreatment. The minimal phototoxic dose for 20 microg cm(-2) photosensitizer and 675 nm irradiation is found to be (150 mW cm(-2)-120 J cm(-2)) or (180 mW cm(-2)-100 J cm(-2)).

Pharmacokinetic and phototherapeutic properties of axially substituted Si(IV)-tetradibenzobarreleno-octabutoxyphthalocyanines.

Three Si(IV)-tetradibenzobarreleno-octabutoxyphthalocyanines (TDiBOPcs) bearing different axial ligands on the metal ion were studied for their tumour-localizing and-photosensitizing properties after i.v. injection via a Cremophor emulsion (0.35 mumol kg-1 b.w.) to Balb/c mice bearing an intramuscularly implanted MS-2 fibrosarcoma. In all cases, the maximum tumour accumulation of the photosensitizer (0.8-1.9 nmol g-1 of tissue) was found at 24 h after injection. The efficiency and selectivity of tumour targeting appeared to be dependent on the nature of the axial ligands; optimal values of these parameters were obtained in the case of the bis(trihexyl-siloxy)-substituted Si(IV)-TDiBOPc, which gave a 7-9 tumour/muscle ratio of phthalocyanine concentration at 24-48 h after injection. The extent of tumour response to PDT treatment was correlated with the concentration of the photosensitizer in the tumour tissue: upon 740 nm irradiation (180 mW cm-2, 200 J cm-2) at 48 h after injection of 0.35 mumol kg-1 of Si(IV)-TDiBOPc-C6H13, the tumour growth exhibited a delay of about 7 days.