5-aminolevulinic-acid-hexyl-ester and methyl-5-aminolevulinate

Topics: Administration, Cutaneous; Adult; Aminolevulinic Acid; Double-Blind Method; Erythema; Healthy Volunteers; Humans; Pain; Photochemotherapy; Photosensitizing Agents; Pilot Projects; Prodrugs; Skin; Time Factors

Topics: Administration, Cutaneous; Aged; Aged, 80 and over; Aminolevulinic Acid; Double-Blind Method; Female; Humans; Keratosis, Actinic; Male; Ointments; Photochemotherapy; Photosensitizing Agents; Pilot Projects; Prospective Studies; Treatment Outcome

Cervical intraepithelial neoplasia (CIN) 1-3 is the precursor of invasive cervical cancer and associated with human papillomavirus infection. Standard treatment is surgical and may be associated with subsequent pregnancy complications. Photodynamic therapy (PDT) of CIN may be an interesting alternative.. Patients were treated by PDT using hexaminolevulinate (HAL) and methylaminolevulinate in six dose and light groups and two incubation periods in a double-blind setting. Follow-up examinations were performed after 3, 6, and 12 months with histology, cytology, and HPV testing.. We included eight patients with CIN1, 23 with CIN2, and 36 with CIN3. Treatment was well tolerated. HAL 40 mM with 3-hour application turned out to be the most-effective group with 67% (10/15) complete response rate. The combined complete and partial response for patients with CIN2 was 83% (20/24).. PDT with CIN may be a safe and effective procedure for CIN treatment.

Topics: Adult; Aminolevulinic Acid; Double-Blind Method; Female; Humans; Papillomavirus Infections; Photochemotherapy; Photosensitizing Agents; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms

Cervical intraepithelial neoplasia (CIN) is associated with genital human papillomavirus (HPV) infection and represents the precursor of cervical cancer. Established ablative treatment methods may cause substantial complications in following pregnancies including premature delivery and the birth of low-weight babies. Photodynamic therapy (PDT) of CIN using esters of 5-aminolevulinic acid (5-ALA) represents a promising alternative. However, it has not been analyzed yet if the PDT itself leads to sustained damage of the cervical tissue. This study aims at evaluating the effect of hexylaminolevulinate (HAL) and methylaminolevulinate (MAL) PDT on cervical tissue.. Twenty-five patients underwent 1-2 PDT cycles for CIN 1-3 applying topical HAL and MAL. Before and 6 months after PDT, biopsies were obtained from the cervix. Macroscopic changes of the cervix were evaluated. We assessed H&E slides for signs of sustained tissue damage. Furthermore, expression profiles of p16(INK4a), Ki67, Bcl-2, Bax, and CD31 were evaluated.. PDT was performed satisfactory in all patients. No macroscopic changes of the cervix were encountered and histological evaluation revealed no signs of apoptosis, necrosis, irritation, vascular changes and fibroses 6 months after PDT. Ki67 and p16(INK4a) were useful for the prediction of response to PDT. Bcl-2 and Bax showed no significant expression profile changes after PDT and the micro-vessel pattern was not altered.. HAL and MAL PDT do not leave any sustained damage in normal cervical tissue. This is of paramount importance as cervical insufficiency or stenosis may have implications on pregnancy and cervical cancer screening.

Topics: Administration, Topical; Adult; Aminolevulinic Acid; Biomarkers, Tumor; Cohort Studies; Double-Blind Method; Epithelium; Female; Humans; Middle Aged; Photochemotherapy; Photosensitizing Agents; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Young Adult

Acne vulgaris is a common skin problem that affects up to 90% of adolescents. Colonization of the duct with Propionibacterium species is one of the factors implicated in the development of acne. Owing to the increasing incidence of antibiotic resistance, there has been an greater interest in the development of new methods to treat acne. Early studies have shown that photodynamic therapy (PDT) with aminolaevulinic acid (ALA) can lead to prolonged improvement in acne. Newer derivatives of ALA such as methyl aminolaevulinate hydrochloride (MAL) and hexyl aminolaevulinate hydrochloride (HAL) have been developed for use in PDT, with the potential benefits of higher lipophilicity and penetration potential.. To determine the microbiological effect and tolerability of a single application of HAL-PDT and to compare it with MAL-PDT in healthy volunteers.. This was a randomised double-blind study to examine the microbiological effects and safety of a single application of MAL-PDT and HAL-PDT on normal skin in 18 healthy volunteers. Bacterial skin samples for Propionibacterium spp. and Micrococceae were obtained at baseline and 2, 4, 7 and 14 days.. Following PDT with MAL and HAL, a statistically significant transient reduction in mean density of Propionibacterium spp. 2 days after treatment using each agent (P < 0.05 for both) was found. There were no significant changes in mean number of Micrococceae for the duration of the study period. Treatment with HAL-PDT and MAL-PDT was well tolerated. Overall, HAL-PDT was associated with fewer side-effects compared with MAL-PDT (P < 0.01) over the 14 day study period.. HAL-PDT and MAL-PDT transiently reduce density of Propionibacterium spp. density to a similar degree in normal healthy individuals. The transient reduction in Propionibacterium spp. suggests that the prolonged antiacne effect of PDT relies on factors independent of bacterial density. HAL-PDT appears to be better tolerated than MAL-PDT.

Topics: Adolescent; Adult; Aminolevulinic Acid; Double-Blind Method; Erythema; Female; Humans; Hyperpigmentation; Male; Middle Aged; Photochemotherapy; Photosensitizing Agents; Propionibacterium; Pruritus; Skin

Topical photodynamic therapy (PDT) with methyl-aminolevulinate (MAL) is a well-established treatment for precancerous skin lesions and non-melanoma skin cancer. Treatment outcomes are less effective for thick than for superficial lesions, which are presumed to be due to insufficient PpIX biodistribution in tumour tissue. Hexyl-aminolevulinate (HAL) is a more lipophilic photosensitizer precursor than MAL and may penetrate the skin to a greater depth and more homogeneously. We compared HAL- and MAL-induced PpIX accumulation in specific skin compartments using concentrations of 2%, 6% and 20% HAL and MAL on long-term UV-irradiated mouse skin. Furthermore, 20% HAL and 20% MAL were applied to non-irradiated skin. Porphyrin fluorescence was measured by fluorescence microscopy in selected skin regions: the epidermis, superficial dermis, deep dermis and sebaceous gland epithelium down to a depth of 1 mm. We found higher PpIX fluorescence intensities in epidermis and sebaceous gland epithelium from 2%, 6% and 20% HAL (median 72-104 au) than in corresponding concentrations of MAL (median 35-69 au) (P < 0.01). Fluorescence intensities in the superficial (35 au) and deep dermis (32 au) were similar for HAL and MAL (P = 0.51) and lower than epidermal fluorescence intensities (P < 0.001). Significantly, higher median PpIX fluorescence intensities (64 au) were found in 20% MAL-incubated skin irradiated with UV than in non-irradiated skin (48 au) (P < 0.001). HAL-induced fluorescence intensities did not depend on UV exposure (HAL 20%, UV: 72 au, non-UV: 70 au) (P = 0.87). In conclusion, HAL express high affinity for epidermis and sebaceous gland epithelium, and MAL for actinically damaged skin, which raises future perspectives for improved selectivity in PDT.

Topics: Administration, Topical; Aminolevulinic Acid; Animals; Biological Availability; Female; Humans; Mice; Mice, Hairless; Microscopy, Fluorescence; Models, Animal; Photochemotherapy; Photosensitizing Agents; Porphyrins; Precancerous Conditions; Protoporphyrins; Skin; Skin Neoplasms; Tissue Distribution; Ultraviolet Rays

Topical photodynamic therapy (PDT) is used for various skin disorders, and selective targeting of specific skin structures is desirable. The objective was to assess accumulation of PpIX fluorescence and photobleaching within skin layers using different photosensitizers and light sources. Normal human skin was tape-stripped and incubated with 20% methylaminolevulinate (MAL) or 20% hexylaminolevulinate (HAL) for 3 h. Fluorescence microscopy quantified PpIX accumulation in epidermis, superficial, mid and deep dermis, down to 2 mm. PpIX photobleaching by light-emitting diode (LED, 632 nm, 18 and 37 J/cm(2)), intense pulsed light (IPL, 500-650 nm, 36 and 72 J/cm(2)) and long-pulsed dye laser (LPDL, 595 nm, 7.5 and 15 J/cm(2)) was measured using fluorescence photography and microscopy. We found higher PpIX fluorescence intensities in epidermis and superficial dermis in HAL-incubated skin than MAL-incubated skin (P < 0.001). In mid and deep dermis, fluorescence intensities were higher (37%) in HAL-treated skin than MAL-treated skin, although not significant (P = ns). At skin surface, photobleaching was significantly higher (90-98%) after LED illumination (18 and 37 J/cm²) than IPL (29-53%, 36 and 72 J/cm²) and LPDL (43-62%, 7 and 15 J/cm²) (P < 0.001). Within the skin, photobleaching was steady from epidermis to deep dermis by LED illumination (37 J/cm², P = ns), but declined from epidermis to mid and deep dermis for IPL-treated skin and LPDL-treated skin (IPL 72 J/cm²: 26-15%; LPDL 15 J/cm²: 37-23%) (P < 0.04). Clinically, erythema correlated linearly with MAL and HAL-induced photobleaching (r² = 0.175, P < 0.001). In conclusion, selective PpIX accumulation indicates HAL as an alternative to MAL for epidermal-targeted PDT. In clinically relevant doses, PpIX photobleaching throughout the skin was more profound following LED than LPDL and IPL exposure.

Topics: Adolescent; Adult; Aminolevulinic Acid; Dermis; Epidermis; Humans; Lasers, Dye; Light; Microscopy, Fluorescence; Middle Aged; Photobleaching; Photochemotherapy; Photosensitizing Agents; Protoporphyrins; Skin; Young Adult

Hexyl aminolevulinate (HAL) is a long-chained 5-aminolevulinic acid-ester that has been proposed as a novel photosensitizing agent to methyl aminolevulinate (MAL) in topical photodynamic therapy (PDT). The more lipophilic HAL, may improve treatment outcome for non-melanoma skin cancer.. To compare the prophylactic and therapeutic effects of HAL- and MAL-PDT for ultraviolet-induced squamous cell carcinomas (SCCs) in hairless mice.. Mice (n = 249) were irradiated with solar UV-radiation (UVR) until SCC occurred. Before any skin changes developed, two prophylactic PDT treatments were given, using creams of HAL (2%, 6%, 20%) or MAL (20%) followed by illumination (632 nm, Aktilite, Photocure). Two therapeutic PDT-treatments were given by randomization to the first developed SCC of 1 mm. Primary end-points were time to first SCC of 1 mm and complete SCC clearance. Secondary end-points were time to SCC-recurrence, PpIX fluorescence and skin reactions to PDT.. The median time to first SCC was significantly longer for mice treated with prophylactic HAL-PDT (2%, 6% and 20% HAL, 264 days) and MAL-PDT (20% MAL, 269 days) than mice exposed to UVR (186 days) and UVR + placebo-PDT (199 days) (P < 0.0001). The therapeutic efficacy of HAL- and MAL-PDT showed cure rates of 23-61.5% (P = 0.11). Similar PpIX fluorescence intensity and severity of clinical reactions were seen for HAL- and MAL-groups, although mice developed more intense hyper-pigmentation when treated with 20% MAL-PDT compared with 2% HAL-PDT.. PDT with HAL (2%, 6% and 20%) and MAL (20%) is equally effective to prevent and treat UV-induced SCC in hairless mice.

Topics: Administration, Topical; Aminolevulinic Acid; Animals; Carcinoma, Squamous Cell; Disease Models, Animal; Dose-Response Relationship, Drug; Female; Mice; Mice, Hairless; Neoplasms, Radiation-Induced; Photochemotherapy; Photosensitizing Agents; Skin Neoplasms; Treatment Outcome; Ultraviolet Rays

Aminolaevulinic acid (ALA) is known to poorly penetrate into thick lesions, such as nodular basal cell carcinomas. Short chain ALA esters, possessing increased lipophilicity relative to their hydrophilic parent, have previously been shown to be highly efficient at inducing protoporphyrin IX (PpIX) production in cell culture, at equimolar concentrations. In contrast, in vitro skin permeation and in vivo animal studies, which up to now have compared prodrugs on a % w/w basis, have failed to demonstrate such benefits. For the first time, equimolar concentrations of ALA, methyl-ALA (m-ALA) and hexyl-ALA (h-ALA) have been incorporated into an o/w cream preparation. In vitro penetration studies into excised porcine skin revealed that increased levels of h-ALA, compared to ALA and m-ALA were found in the upper skin layers, at all drug loadings studied. Topical application of the formulations to nude murine skin in vivo, revealed that creams containing h-ALA induced significantly higher levels of peak PpIX fluorescence (F(max) = 289.0) at low concentrations compared to m-ALA (F(max) = 159.2) and ALA (F(max) = 191.9). Importantly, this study indicates that when compared on an equimolar basis, h-ALA has improved skin penetration, leading to enhanced PpIX production compared to the parent drug and m-ALA.

Topics: Administration, Topical; Aminolevulinic Acid; Animals; Animals, Newborn; Chemistry, Pharmaceutical; Drug Delivery Systems; In Vitro Techniques; Isotope Labeling; Mice; Mice, Inbred BALB C; Ointments; Photosensitizing Agents; Skin; Skin Absorption; Swine

5-Aminolaevulinic acid (ALA) and its ester derivatives are used in photodynamic therapy. Despite extensive investigations, the differences in biodistribution and pharmacokinetics of protoporphyrin IX (PpIX) induced by ALA and its derivatives are still not well understood, notably for humans.. To study porphyrin accumulation after topical application of ALA and two of its ester derivatives in normal human skin.. Creams containing 0.2%, 2% and 20% (w/w) of ALA, methyl 5-aminolaevulinate (MAL) and hexyl 5-aminolaevulinate (HAL) were applied on normal human skin of six volunteers. The amount and distribution of porphyrins formed in the skin was investigated noninvasively by means of fluorescence spectroscopy.. Fluorescence emission and excitation spectra exhibited similar spectral shapes for the all drugs, indicating that mainly PpIX was formed. Low concentrations (0.2% and 2%) of MAL induced considerably less PpIX in normal human skin than similar concentrations of ALA and HAL. A high concentration (20%) of ALA gave higher PpIX fluorescence in normal human skin than was found for MAL and HAL.. The concentrations inducing half of the maximal PpIX fluorescence are around 2% for ALA, 8% for MAL and 1% for HAL.

Topics: Administration, Cutaneous; Adult; Aminolevulinic Acid; Humans; Middle Aged; Photosensitizing Agents; Protoporphyrins; Skin; Skin Absorption; Spectrometry, Fluorescence