Induction of hepatic aminolevulinate acid synthetase activity by isoflurane in a genetic model for erythropoietic protoporphyria.

Erythropoietic Protoporphyria (EPP) is an inherited deficiency of ferrochelatase, the last enzyme of the heme pathway. Under general anaesthesia, some patients develop neurological dysfunction suggesting upregulation in heme biosynthesis similar to that described for acute porphyrias after xenobiotic administration. Our aim has been to evaluate whether Isoflurane induces alterations in the heme pathway in a mouse model for EPP. Administration of Isoflurane (a single dose of 2 ml/kg, i.p) to wild-type (+/+), heterozygous (+/Fechm1Pas) and homozygous (Fechm1Pas/Fechm1Pas) mice, was evaluated by measuring the activity of delta-aminolevulinic acid synthetase (ALA-S) and Porphobilinogen-deaminase (PBG-D) in different tissues, as well as Heme oxygenase (HO), cytochrome P-450, CYP2E1 and glutathione levels in liver. Porphyrin precursors were measured in 24 h-urine samples. Fechm1Pas/Fechm1Pas mice receiving anaesthesia show enhanced ALA-S and CYP2E1 activities in the liver and increased urinary excretion of porphyrin precursors. No alterations were found in either PBG-D or HO activities. Diminished glutathione levels suggest that anaesthesia may produce oxidative stress in these animals. In conclusion, Isoflurane induces ALA-S activity and increased excretion of porphyrin precursors in EPP mice. These findings appear to confirm our previous hypothesis and indicate that Isoflurane may be an unsafe anaesthetic not only for patients with acute porphyrias but also for individuals with non acute porphyrias.

Scavengers protection of cells against ALA-based photodynamic therapy-induced damage.

The exogenously stimulated formation of intracellularly generated protoporphyrin IX, a precursor of haem, is becoming one of the fastest developing areas in the field of photodynamic therapy (PDT). We tested the action of several free radical scavengers, amino acids, antioxidants and sulphur-containing compounds as protectors from photodamage induced by 5-aminolaevulinic acid (ALA)-mediated PDT, employing the LM2 cell line, derived from a mammary murine adenocarcinoma. We exposed the cells to different concentrations of the compounds, 24 h before PDT, during PDT, and 19 h after treatment. We defined the protection grade (PG) as the ratio between cell survival after ALA-PDT treatment in the presence of the protector and cell survival of ALA-PDT treatment alone. We found that l -tryptophan (PG=9.2 at 2 m m ), reduced glutathione (GSH) (PG=5.8 at 0.8 m m ), N-acetyl- l -cysteine (PG=4.86 at 30 m m ), melatonin (PG=4.5 at 8 m m ) and l -methionine (PG=4.0 at 0.8 m m ) are the best protectors from PDT damage, followed by l -cysteine (PG=2.8 at 0.8 m m ), mannitol (PG=2.6 at 20 m m ) and glycine (PG=2.4 at 40 m m ) whereas oxidised glutathione and S-adenosyl- l -methionine do not exert any protection. We did not found any photoactive action of the protectors in absence of ALA. These results can be considered to modulate the photodamage induced by ALA-PDT.

ALA and ALA hexyl ester in free and liposomal formulations for the photosensitisation of tumour organ cultures.

In spite of the wide range of tumours successfully treated with 5-aminolevulinic acid mediated photodynamic therapy, the fact that 5-aminolevulinic acid has low lipid solubility, limits its clinical application. More lipophilic 5-aminolevulinic acid prodrugs and the use of liposomal carriers are two approaches aimed at improving 5-aminolevulinic acid transmembrane access. In this study we used both 5-aminolevulinic acid and its hexyl ester in their free and encapsulated formulations to compare their corresponding endogenous synthesis of porphyrins. Employing murine tumour cultures, we found that neither the use of hexyl ester nor the entrapment of either 5-aminolevulinic acid or hexyl ester into liposomes increase the rate of tumour porphyrin synthesis. By light and electronic microscopy it was demonstrated that exposure of tumour explants to either free or liposomal 5-aminolevulinic acid and subsequent illumination induces the same type of subcellular damage. Mitochondria, endoplasmic reticulum and plasma membrane are the structures mostly injured in the early steps of photodynamic treatment. In a later stage, cytoplasmic and nuclear disintegration are observed. By electronic microscopy the involvement of the endocytic pathway in the incorporation of liposomal 5-aminolevulinic acid into the cells was shown.

Photodynamic therapy of activated and resting lymphocytes and its antioxidant adaptive response.

In this work we have studied the effects of ALA-mediated photodynamic therapy (PDT) on resting and mitogen-activated murine splenic lymphocytes, evaluating its impact on cell viability. We have also characterised the stress response, measuring the levels of antioxidant enzymes. A 2h exposure to ALA produced 50% lethality upon irradiation of activated cells with 2.1J/cm2. The decrease in cell survival with increasing time exposure to ALA, correlated well with the higher porphyrin accumulation. In resting lymphocytes, in spite of the low amount of porphyrins formed during 2h incubation with ALA, 40% of the cells died after irradiation, this response was not further increased when higher amounts of porphyrins were synthesised. Superoxide dismutase was impaired by light treatment independently of ALA exposure in activated lymphocytes and, to a lesser extent, in resting lymphocytes. PDT induced an antioxidant adaptive response in activated cells 19 h after irradiation, reflected as a net increase in GSHPx activity and a slight reversion of the catalase (CAT) activity already impaired by light treatment. PDT treatment of activated cells also produced a diminution in the GSH/GSSG ratio. Only activated cells are capable of developing an antioxidant adaptive response to PDT treatment.

Effect of acetaminophen on heme metabolism in rat liver.

BACKGROUND AND AIMS: Acetaminophen (APAP) or paracetamol is a hepatotoxic drug through mechanisms involving oxidative stress. To know whether mammalian cells possess inducible pathways for antioxidant defense, we have to study the relationship between heme metabolism and oxidative stress. METHODS: fasted female Wistar rats received a single injection of APAP (3.3 mmol kg(-1) body weight) and then were killed at different times. Heme oxygenase-1 (HO), delta-aminolevulinic acid (ALA) synthase, ALA dehydratase, and porphobilinogenase activities, lipid peroxidation, GSH, catalase and glutathione peroxidase, were measured in liver homogenates. The antioxidant properties of bilirubin and S-adenosyl-L-methionine were also evaluated. RESULTS: APAP increased lipid peroxidation (115% +/- 6; S.E.M., n=12 over control values) 1 h after treatment. GSH reached a minimum at 3 h (38% +/- 5) increasing thereafter. At the same time antioxidant enzymes reached minimum values (catalase, 5. 6 +/- 0.4 pmol mg(-1) protein, glutathione peroxidase, 0.101 +/- 0.006 U mg(-1) protein). HO induction was observed 6 h after treatment reaching a maximum value of 2.56 +/- 0.12 U mg(-1) protein 15 after injection. ALA synthase (ALA-S) induction occurred after enhancement of HO, reaching a maximum at 18 h (three-fold the control). ALA dehydratase activity was first inhibited (31 +/- 3%) showing a profile similar to that of GSH, while porphobilinogenase activity was not modified along the whole period of the assay. Administration of bilirubin (5 micromol kg(-1) body weight) or S-adenosyl L-methionine (46 micromol kg(-1) body weight) 2 h before APAP treatment entirely prevented the increase in malondialdehyde (MDA) content, the decrease in GSH levels as well as HO and ALA-S induction. CONCLUSION: This study shows that oxidative stress produced by APAP leads to increase in ALA-S and HO activities, indicating that toxic doses of APAP affect both heme biosynthesis and degradation.

The influence of the vehicle on the synthesis of porphyrins after topical application of 5-aminolaevulinic acid. Implications in cutaneous photodynamic sensitization.

BACKGROUND: The optimal vehicle to ensure adequate penetration of 5-aminolaevulinic acid (ALA) for its use in photodynamic therapy (PDT) of skin lesions has not been determined. OBJECTIVES: We aimed to study the effects of ALA in various vehicle formulations [saline lotion with and without dimethylsulphoxide (DMSO), cream, liposomes and vaseline] after topical application in a murine subcutaneous adenocarcinoma model. METHODS: The effect of DMSO on porphyrin synthesis and ALA penetration through the skin was studied by measuring the uptake of 14C label from ALA, ALA and porphobilinogen accumulation, and some haem enzyme activities. The tissue distribution and kinetics of porphyrin synthesis after topical application of ALA entrapped in large multilamellar liposomes was also determined. RESULTS: ALA in saline lotion, alone or with 10% DMSO, proved to be the most efficient vehicle for tumour porphyrin accumulation (mean +/- SD 1.75 +/- 0.25 and 2.09 +/- 0.39 microg g-1, respectively), whereas cream and liposomes induced lower levels and identical porphyrin accumulation (0.60 microg g-1). Using ALA + DMSO saline lotion, a higher porphyrin accumulation was found in skin overlying the tumour tissue and in the first 2 mm of tumour, probably due to increased ALA penetration, or greater interconversion to porphyrins, or greater retention of ALA and/or porphyrins. CONCLUSIONS: These findings reinforce the importance of the vehicle in topical ALA-based PDT, and explain the mechanism of action of DMSO in enhancing protoporphyrin IX biosynthesis in superficial lesions.

Porfiria variegata: signos cutáneos, agudos y bioquímicos. Primer estudio genético en pacientes Argentinos / Variegate porphyria: cutaneus sign, biochemistry and sharp. Genetic first study in Argentinean patients

Las porfirias son enfermedades metabólicas que surgen como consecuencia de una deficiencia enzimática parcial de alguna de las enzimas del hemo. En la porfiria Variegata (PV) este defecto se encuentra a nivel de la Protoporfirinógeno oxidasa (PPOX) quwe transforma el Protoporfirinógeno IX en Protoporfirina IX. Se caracteriza por presentar el síndromeagudo y cutáneo. Es una patología genéticamente heterogénea, al presente se han detectado 77 mutaciones diferentes en el gen de la PPOX, responsables de esta porfiria. Nuestro objetivo es el estudio bioquímico y molecular de pacientes con sintomatología de PV para llegar a un dignóstico certero de la enfermedad y hacerlo extensivo a sus familiares con el fin de identificar a los portadores asintomáticos y asesorarlos acerca del contacto con los factores desencadenantes de esta porfiria. Hasta el momento el estudio genético nos permitió detectar 2 mutaciones, una mutación puntual recientemente descripta que produce cambio de aminoácido, R168H en el exón 6 y una inserción nueva, 1320InT, que produce corrimiento del marco de lectura. Estos resultados han permitido confirmar el diagnóstico de PV en estos pacientes

Tissue distribution and kinetics of endogenous porphyrins synthesized after topical application of ALA in different vehicles.

The use of 5-aminolaevulinic acid (ALA) is gaining increasing attention for photosensitization in photodynamic therapy of superficially localized tumours. The aim of this work was to determine the kinetics of porphyrin generation in tissues after topical application of ALA delivered in different vehicles on the skin overlying the tumour and normal skin of mice. Maximal accumulation was found in tumour 3 h after ALA application in both cream and lotion preparations. Normal and overlying tumour skin tissues showed different kinetic patterns, reflecting histological changes when the latter is invaded by tumour cells. Liver, kidney, spleen and blood porphyrins also raised from basal levels, showing that ALA and/or ALA-induced porphyrins reach all tissues after topical application. During the first 24 h of ALA topical application, precursors and porphyrins are excreted by both urine and faeces. ALA lotion applied on the skin overlying the tumour induced higher accumulation of tumoural porphyrins than cream, and lotion applied on normal skin appeared to be the most efficient upon inducing total body porphyrins. This work has demonstrated the great influence of the formulation of ALA vehicle on penetration through the skin. Knowledge of the kinetics of porphyrin generation after different conditions of ALA application is needed for the optimization of diagnosis and phototherapy in human tumours.

Topical and intratumoral photodynamic therapy with 5-aminolevulinic acid in a subcutaneous murine mammary adenocarcinoma.

One of the most promising substances used in photodynamic therapy (PDT) is 5-aminolevulinic acid (ALA), which induces endogenous synthesis and accumulation of porphyrins in malignant cells. In this paper we have shown that both topical and intratumoral administration of ALA in a subcutaneously implanted mammary carcinoma produced a significant synthesis of porphyrins and subsequent sensitization to laser light. Porphyrin accumulation was greater when ALA was administered intratumorally and tumour/normal skin porphyrin concentration ratios were higher compared with topical application. Irradiation was optimal between 2 and 3 h after topical application of 50 mg of a 20% ALA cream and 2-4 h after intratumoral administration of 30 mg ALA/cm3. The pattern of tumour response evaluated as the delay of tumour growth was similar following either route of drug administration. Applications of PDT were performed once, twice or three times in the study. The response to successive applications was constant for the same tumour, indicating that no resistance was acquired. Microscopic analysis showed both induction of foci of necrosis and haemorrhage, morphological features of apoptotic cells and total absence of cellular immune response. This paper reports on PDT with topical ALA in a subcutaneous carcinoma leading to tumour growth delay. These findings may have great relevance in the treatment of cutaneous metastasis of mammary carcinomas.

Comparative effect of ALA derivatives on protoporphyrin IX production in human and rat skin organ cultures.

Samples of human and rat skin in short-term organ culture exposed to ALA or a range of hydrophobic derivatives were examined for their effect on the accumulation of protoporphyrin IX (PpIX) measured using fluorescence spectroscopy. With the exception of carbobenzoyloxy-D-phenylalanyl-5-ALA-ethyl ester the data presented indicate that, in normal tissues, ALA derivatives generate protoporphyrin IX more slowly than ALA, suggesting that they are less rapidly taken up and/or converted to free ALA. However, the resultant depot effect may lead to the enhanced accumulation of porphyrin over long exposure periods, particularly in the case of ALA-methyl ester or ALA-hexyl ester, depending on the applied concentration and the exposed tissue. Addition of the iron chelator, CP94, greatly increased PpIX accumulation in human skin exposed to ALA, ALA-methyl ester and ALA-hexyl ester. The effect in rat skin was less marked.

The photodynamic and non-photodynamic actions of porphyrins

Porphyrias are a family of inherited diseases, each associated with a partial defect in one of the enzymes of the heme biosynthetic pathway. In six of the eight porphyrias described, the main clinical manifestation is skin photosensitivity brought about by the action of light on porphyrins, which are deposited in the upper epidermal layer of the skin. Porphyrins absorb light energy intensively in the UV region, and to a lesser extent in the long visible bands, resulting in transitions to excited electronic states. The excited porphyrin may react directly with biological structures (type I reactions) or with molecular oxygen, generating excited singlet oxygen (type II reactions). Besides this well-known photodynamic action of porphyrins, a novel light-independent effect of porphyrins has been described. Irradiation of enzymes in the presence of porphyrins mainly induces type I reactions, although type II reactions could also occur, further increasing the direct non-photodynamic effect of porphyrins on proteins and macromolecules. Conformational changes of protein structure are induced by porphyrins in the dark or under UV light, resulting in reduced enzyme activity and increased proteolytic susceptibility. The effect of porphyrins depends not only on their physico-chemical properties but also on the specific site on the protein on which they act. Porphyrin action alters the functionality of the enzymes of the heme biosynthetic pathway exacerbating the metabolic deficiencies in porphyrias. Light energy absorption by porphyrins results in the generation of oxygen reactive species, overcoming the protective cellular mechanisms and leading to molecular, cell and tissue damage, thus amplifying the porphyric picture

beta-Carotene partially prevents the damage induced by 1,4-dimethylaminoazobenzene in mice.

Hepatocarcinogenesis (HC) induced by various carcinogens such as 1,4-dimethylaminoazobenzene (DAB) is a multistep and complex process. The anticancer efficacy of beta-carotene (beta C) was evaluated by estimating some biochemical parameters during the initiation stage of HC. beta C dietary supplementation partially prevented the rise in delta-aminolevulinate synthetase activity. P 450 levels were dramatically enhanced in all groups studied. beta C administration did not overcome catalase inactivation due to DAB treatment; however, superoxide dismutase activity levels showed to be less decreased in the DAB + beta C animals in comparison to the DAB group. The great enhancement provoked by DAB of glutathione S-transferase, a proposed marker of HC, was partially reversed by beta C. In conclusion, heme pathway regulation, drug metabolism, and natural oxidative defence systems, strikingly modified in DAB fed animals, were partially controlled by provitamin A. The potential use of beta C in preventing carcinogenesis is suggested.

Familial porphyria cutanea tarda: characterization of seven novel uroporphyrinogen decarboxylase mutations and frequency of common hemochromatosis alleles.

Familial porphyria cutanea tarda (f-PCT) results from the half-normal activity of uroporphyrinogen decarboxylase (URO-D). Heterozygotes for this autosomal dominant trait are predisposed to photosensitive cutaneous lesions by various ecogenic factors, including iron overload and alcohol abuse. The 3.6-kb URO-D gene was completely sequenced, and a long-range PCR method was developed to amplify the entire gene for mutation analysis. Four missense mutations (M165R, L195F, N304K, and R332H), a microinsertion (g10insA), a deletion (g645Delta1053), and a novel exonic splicing defect (E314E) were identified. Expression of the L195F, N304K, and R332H polypeptides revealed significant residual activity, whereas reverse transcription-PCR and sequencing demonstrated that the E314E lesion caused abnormal splicing and exon 9 skipping. Haplotyping indicated that three of the four families with the g10insA mutation were unrelated, indicating that these microinsertions resulted from independent mutational events. Screening of nine f-PCT probands revealed that 44% were heterozygous or homozygous for the common hemochromatosis mutations, which suggests that iron overload may predispose to clinical expression. However, there was no clear correlation between f-PCT disease severity and the URO-D and/or hemochromatosis genotypes. These studies doubled the number of known f-PCT mutations, demonstrated that marked genetic heterogeneity underlies f-PCT, and permitted presymptomatic molecular diagnosis and counseling in these families to enable family members to avoid disease-precipitating factors.

Hepatic enzymatic metabolism alterations and oxidative stress during the onset of carcinogenesis: protective role of alpha-tocopherol.

Oxidants play a role in several stages of carcinogenesis. A high antioxidant capacity is expected to protect 'initiated' cells from excessive oxidant toxicity. The aim of this study was to determine the chemopreventive effect of a-tocopherol (alpha-T) on the hepatocarcinogenesis induced with p-dimethylaminoazobenzene (DAB) in mice. The dietary administration of alpha-T completely reversed the induction of delta-aminolevulinate synthetase and glutathione-S-transferase (the tumoral marker enzyme). alpha-T greatly enhanced P 450 levels, which were even higher in animals exposed to DAB. Indirect evidence for the involvement of oxygen radicals in the DAB model of hepatocarcinogenesis was provided by increased levels of thiobarbituric acid reactive species, which were detected in animals with severe liver damage and were assessed by histological analysis. alpha-T reduced the degree of hepatic injury, although this vitamin produced only slight changes in the oxidative parameters evaluated. The use of alpha-T as a potential chemopreventive agent, particularly during the initiation stage of carcinogenesis provoked by DAB, is worthy of further study.

Porfiria cutanea tarda: detección de una mutación en la uroporfirinogena decarboxilasa mediante RT-PCR y secuenciación directa / Porphyria cutanea tarda: detection of the new mutation in the uroporphyrinogen decarboxylase intervening RT-PCR direct sequenced

La porfiria cutánea tardía familiar (PCT-F) y la porfiria hepatoeritropoyética (PHE), son dos porfirias cutáneas causadas por la deficiencia en la actividad de la Uroporfirinógeno Decarboxilasa (URO-D), que es la quinta enzima del camino biosintético del hemo y cataliza la conversión del Uroporfirinógeno(UROgen) a Coproporfirinógeno (COPROgen). La PCT-F es dominante y la actividad de la URO-D está reducida a un 50 por ciento en todos los tejidos mientras que la PHE es recesiva y en ella la activcidad de la URO-D es sólo de un 5-10 por ciento del valor normal. El gen de la URO-D está compuesto por 10 exones dentro de 3 kb. Partiendo de 15 ml de sangre entera, y realizando separación de linfocitos, extracción de ARN, RT-PCR y secuenciación directa de las casi 1,2 del ADNc de la URO-D, se ha encontrado en un paciente argentina con PCT-F una mutación nueva caracterizada por la deleción del exón 9, La PCR y secuenciación del ADN genómico revelo que la deleción es causada por la transición G A en la última base del exón 9 que afecta la maduración ("splicing") del mensajero ya que inactivaría el sitio doner de "splicing" del intrón 9, como consecuencia se produce la unión entre el exón 8 y 10 lo cual a su vez lleva a un corrimiento de marco de lectura, que predice la síntesis de una proteína truncada con una perdida total de casi el 20 por ciento de sus aminoácidos

Potentiation of the 5-aminolevulinic acid-based photodynamic therapy with cyclophosphamide.

We have investigated the efficacy of the Photodynamic Therapy (PDT) from 5-aminolevulinic acid (ALA) in combination with an antineoplastic agent using an in vitro-in vivo model developed in our laboratory. The alkylant cyclophosphamide (CY) was chosen because there is evidence of the porphyrinogenic properties of this drug. Male BALB/c mice bearing a transplantable mammary adenoarcinoma were given two doses of 35 mg de CY/kg wt. i.p. and 9 mg/kg wt intratumorally. At 16, 22 and 40 hrs after the last injection of CY the animals were sacrificed and explants of 2 mg of tumor were incubated 2 hrs in a medium containing 0.6 mM ALA; and then irradiated with a He-Ne laser. Innocula of 1 mm3 of irradiated and non-irradiated tissue were then injected subcutaneously under the right and left flanks of a normal mouse, respectively. The efficacy of the treatment was determined following the growth of the tumor from day 10 after tumor implantation. Under the present conditions a 30% increased efficacy was observed in the case of the explants treated with CY 40 hrs after the last i.p. injection. Porphyrins in the liver and tumor and other tissues of the injected mice were also determined; except for a slight increase in tumor and liver, 40 and 22 hrs after CY i.p. injection respectively, no other changes were observed in any tissue, as compared with not CY treated mice. These results indicate that future treatment, combining the tumor localizing properties of endogenously formed porphyrins from ALA and antineoplasic drugs such as cyclophosphamide, should be encouraged.

Modelo experimental de Porfiria Cutánea Tarda inducido por hexaclorobenceno en ratones Hairless / Experimental model of Porphyria Cutaneous Tarda by hexaclorobenceno in Hairless mice

En este trabajo se describe el efecto del HcB en ratones de la cepa hairless a fin de obtener un modelo experimental de PCT, lo que facilitaría el estudio de la fotosensibilización cutánea característica de la enfermedad y el ensayo de cremas dermatológicas. El HCB es un hidrocarburo polihalogenado que ha sido utilizado con éxito en ratones de las cepas Balb/C y C57BL. Los animales recibieron una única dosis de 200 mg HCB/Kg (vía i.p.). Dentro de los controles, un grupo no recibió ningún tratamiento y otro solo el pretratamiento con hierro. A distintos tiempos luego de comenzada la intoxicación, los animales fueron sacrificados y se determinó la relación porcentual peso hígado/peso corporal, se extrajeron y cuantificarón las porfirinas de piel, hígado, orina yheces; y se midió la actividad de la enzima Uro-D hepáica. Además se midieron los niveles de Cit-450 y LPO hepáticos y la concentración de glutation en hígado y piel, como indicadores del grado de intoxicación. Se observó en ambos sexos, un aumento del 40 por ciento en la relación porcentual peso hígado/ peso corporal tanto en los grupos intoxicados como en los control hierro. En hembras, los niveles de porfirinas aumentaron tanto en hígado como en piel, dicho aumento ocurrió luego de un descenso en los niveles de glutation. En cambio en machos , los niveles de prfirinas solo aumentarom en piel, registrándose una aumento en los niveles de glutation en ambos tejidos.

Porfiria cutanea tarda esclerodermiforme / Porphyria cutane tarda sclerodermoid

La porfiria cutánea tarda (PTC) es un desorden del metabolismo del hemo caracterizado por una masiva pofirinuria e incremento de porfirinas plasmáticas, como consecuencia de una disminución en la actividad de la enzima uroporfirinógeno decarboxilasa. El signo clínico salente es una típica fotosensibilización cutánea. En este trabajo se realiza una revisión de la PCT como entidad clínica, considerando en particular la variante esclerodermiforme(PCTE). Se ha llevado a cabo un estudio bioquimico clínico completop de 16 pacientes argentinos y 3 españoles, entre un total de 102 y 35 PCT respectivamente. En el momento del diagnóstico, los valores de porfirinas urinarias oscilaron entre 400 y 10000 ug/24 h(VN=50-250 ug/24h), con un patron cromatográfico típico: 40-50 por ciento uroporfirinas; (VN= 100 por ciento coproporfirionas) e indice de porfirinas plasmáticas (IPP) entre 1,6 y 5,3 con =618nm (VN<1,3). La aparición de lesiones esclerodermiformes fue más frecuente en el grupo argentino (15,58 por ciento) que en el español (8,57 por ciento) y a su vez más común en hombres que en mujeres. Un 35,7 por ciento de las PCTE argentinas presentaron lesiones de calcinosis en las zonas típicas, pre y retro auriculares, cuero cabelludo cuello y triángulo de escote; en un solo caso calcificación en helix y antihelix del pabellon auricular. En un 80 por ciento se hallo alopecía porfírica cicatricial y en un 72 por ciento placas de esclerosis. En un 35 por ciento de las PCTE argentinas las lesiones esclerodérmicas mejoraron con el tratamiento. En un 25 por ciento de los casos, las lesiones fueron previas a la aparición de los signos clásicos de la PCT en otro 25 por ciento casi concomitantes y en el 50 por ciento a 1 año después. En conclusión, se ha observado una alta incidencia de la PCTE en la población de pacientes argentinos , mucho mayor que en la serie española y qu en las descriptas en la literatura, sin poderse establecer ninguna correlación con los nivelrs de porfirinas plasmáticas o urinarias, ni con el tiempo de evolución de la enfermedad y la aparición de las lesiones esclerodérmicas. Cabe notar que los resultados terapéuticos fueron más satisfactorios que los esperados

Metabolic changes in the heme pathway driven by cyclophosphamide treatment in mice.

In previous work we found a 30% increase in the effectiveness of the photodynamic treatment of cancer when combined with the administration of cyclophosphamide (CPM). Here we have tried to elucidate the mechanism responsible for such potentiation. Male Balb/C mice bearing a transplantable adenocarcinoma were given 2 or 3 doses of 150 mg of CPM/kg weight intraperitoneally. At 16 and 40 hrs. after the last injection the animals were sacrificed. Tumor and liver were excised and 5-aminolevulinic acid dehydratase and porphobilinogen deaminase activities were determined. Intracellular levels of glutathione and cytochrome P450 were also measured. A 15 to 30% decrease in liver 5-aminolevulinic acid dehydratase activity was observed 40 hrs. after the last injection. The tumor enzyme was 30 to 40% inhibited. The activity of liver porphobilinogen deaminase in CPM treated mice decreased to a minimum (15% below the control) at 16 hrs. after administration of the drug and in tumors a decrease of 20% was shown 40 hrs. post CPM injection. The greater the number of CPM doses administered the higher the decrease in the enzymatic activities. CPM treatment did not change total tumor glutathione levels but the reduced/oxidized glutathione ratio was significantly modified in the tumoral tissue. Cytochrome P450 levels were not increased. These data indicate that CPM-induced potentiation of the photodynamic damage of tumoral tissue is mediated by a mechanism other than that of increased porphyrin synthesis.

Enhancement of aminolevulinic acid based photodynamic therapy by adriamycin.

This paper reports on studies that evaluate the interaction between delta-aminolevulinic acid (ALA)-based photodynamic therapy (PDT) and adriamycin (ADM) in an animal model system. Two groups of mice bearing a transplantable mammary adenocarcinoma received ADM i.p. in a single dose of 5 mg (low dose) and 30 mg (high dose) per kg body weight. Sixteen or 40 h after administration of the drug, mice were sacrificed, tumours, livers and hearts were removed and porphyrins, enzyme activities and malondialdehyde content were determined. Tumour explants of ADM-treated mice were incubated with ALA and irradiated with an He-Ne laser. Re-implantation of these in vitro PDT-treated explants into test animals showed that inhibition of tumour growth was significantly enhanced by combined treatment when the low dose of ADM was used. There were no significant changes in porphyrin content, ALA dehydratase and porphobilinogenase activities in the tissues analyzed after ADM treatment as compared with control values. ADM toxicity is thought to be related to semiquinone free radical formation with subsequent generation of reactive oxygen species such as peroxide and hydroxyl radical. These species are considered to initiate lipid peroxidation (LPO) and cause DNA damage. In the case of low-dose treatment with ADM a significant increase in the LPO product, malondialdehyde, was observed after PDT whereas with the high-dose regimen no changes were observed. In the case of explants of (non-irradiated) cardiac tissue malondialdehyde production was also found to be dependent on the dose and time of administration of adriamycin. In our in vivo/in vitro model system we have shown that pre-treatment with ADM increased the cytotoxicity of ALA-PDT at a dosage level of ADM which did not raise LPO levels in heart tissue. The mechanism of this effect has not been clearly elucidated but our data suggest that the observed enhancement of PDT may be attributed in part to the weakening of cellular defence mechanisms by the pre-treatment involving free radical generation by ADM.