KEYWORDS: Photodynamic therapy, Bacteria, Tissues, Defense and security, Image processing, Light emitting diodes, In vivo imaging, Statistical analysis, Data analysis, Surgery
Photodynamic therapy (PDT) for cancer is known to induce an immune response against the tumor, in addition to its
well-known direct cell-killing and vascular destructive effects. PDT is becoming increasingly used as a therapy for
localized infections. However there has not to date been a convincing report of an immune response being generated
against a microbial pathogen after PDT in an animal model. We have studied PDT as a therapy for bacterial arthritis
caused by Staphylococcus aureus infection in the mouse knee. We had previously found that PDT of an infection
caused by injection of MRSA (5X107 CFU) into the mouse knee followed 3 days later by 1 μg of Photofrin and 635-
nm diode laser illumination with a range of fluences within 5 minutes, gave a biphasic dose response. The greatest
reduction of MRSA CFU was seen with a fluence of 20 J/cm2, whereas lower antibacterial efficacy was observed
with fluences that were either lower or higher. We then tested the hypothesis that the host immune response
mediated by neutrophils was responsible for most of the beneficial antibacterial effect. We used bioluminescence
imaging of luciferase expressing bacteria to follow the progress of the infection in real time. We found similar
results using intra-articular methylene blue and red light, and more importantly, that carrying out PDT of the noninfected
joint and subsequently injecting bacteria after PDT led to a significant protection from infection. Taken
together with substantial data from studies using blocking antibodies we believe that the pre-conditioning PDT
regimen recruits and stimulates neutrophils into the infected joint which can then destroy bacteria that are
subsequently injected and prevent infection.
Photodynamic therapy (PDT) has been shown to be an effective locally ablative anti-cancer treatment that has the
additional advantage of inducing tumor-directed immune response. We hypothesized that PDT could be combined
with anti-transforming growth factor (TGF) beta antibody that does not significantly affect the population of
cytotoxic T lymphocytes (CTL) but at the same time, has the potential to decrease the immunosuppressive effects of
regulatory T-cells (Treg) mediated by TGF beta. This hypothesis was tested with aTGF-beta antibody combined
with BPD-mediated PDT in a BALB/c renal cell carcinoma model. Evidence of positive benefits of the combination
therapy over individual treatments alone was obtained.
Skin cancer is the most common form of human cancer. Its early diagnosis and timely treatment is of paramount importance for dermatology and surgical oncology. In this study, we evaluate the use of reflectance and fluorescence confocal microscopy for detecting skin cancers in an in-vivo trial with B16F10 melanoma and SCCVII squamous cell carcinoma in mice. For the experiments, the mice are anesthetized, then the tumors are infiltrated with aqueous solution of methylene blue and imaged. Reflectance images are acquired at 658 nm. Fluorescence is excited at 658 nm and registered in the range between 690 and 710 nm. After imaging, the mice are sacrificed. The tumors are excised and processed for hematoxylin and eosin histopathology, which is compared to the optical images. The results of the study indicate that in-vivo reflectance images provide valuable information on vascularization of the tumor, whereas the fluorescence images mimic the structural features seen in histopathology. Simultaneous dye-enhanced reflectance and fluorescence confocal microscopy shows promise for the detection, demarcation, and noninvasive monitoring of skin cancer development.
Anti-tumor immunity is stimulated after PDT for cancer due to the acute inflammatory response, exposure and
presentation of tumor-specific antigens, and induction of heat-shock proteins and other danger signals. Nevertheless
effective, powerful tumor-specific immune response in both animal models and also in patients treated with PDT for
cancer, is the exception rather than the rule. Research in our laboratory and also in others is geared towards identifying
reasons for this sub-optimal immune response and discovering ways of maximizing it. Reasons why the immune
response after PDT is less than optimal include the fact that tumor-antigens are considered to be self-like and poorly
immunogenic, the tumor-mediated induction of CD4+CD25+foxP3+ regulatory T-cells (T-regs), that are able to inhibit
both the priming and the effector phases of the cytotoxic CD8 T-cell anti-tumor response and the defects in dendritic cell
maturation, activation and antigen-presentation that may also occur. Alternatively-activated macrophages (M2) have also
been implicated. Strategies to overcome these immune escape mechanisms employed by different tumors include
combination regimens using PDT and immunostimulating treatments such as products obtained from pathogenic
microorganisms against which mammals have evolved recognition systems such as PAMPs and toll-like receptors
(TLR). This paper will cover the use of CpG oligonucleotides (a TLR9 agonist found in bacterial DNA) to reverse
dendritic cell dysfunction and methods to remove the immune suppressor effects of T-regs that are under active study.
KEYWORDS: Melanoma, Photodynamic therapy, Picosecond phenomena, Tumors, Luminescence, Absorption, In vitro testing, Control systems, Near infrared, Skin cancer
Photodynamic therapy (PDT) has been successfully used to treat many malignancies, and has afforded highly
encouraging results in skin cancers such as basal cell carcinoma. However, pigmented melanoma remains a notable
exception from the range of tumors treated by PDT largely due to the fact that melanin has high absorption of light in
wavelength regions where most clinically approved photosensitizers (PS) absorb light (600-690 nm). Moreover,
melanoma cells sequester exogenous molecules including photosensitizers inside melanosomes. The aforementioned
drawbacks of the clinically used PS have motivated us to search for new classes of PS with improved spectral properties,
such as bacteriochlorins (BC) to be used in PDT of melanoma. To overcome the PDT-resistance mechanisms of
melanoma, particularly the high optical absorption of melanin, three near-infrared (NIR) absorbing synthetic stable BC
were used in PDT treatment of melanoma. Dose and fluence dependent cell killing, intracellular localization (particularly
in melanosomes), and correlation between the melanin level and cell death were examined. Intracellular melanosomes
are ruptured after illumination as shown by electron microscopy. The best in vitro performing BC were tested upon
delivery in micellar nanoparticles against a mouse pigmented melanoma. Two of the BC were effective at significantly
lower concentrations (<0.5 μM) than common photosensitizers in present use.
Anti-tumor immunity is stimulated after PDT due a number of factors including: the acute inflammatory response caused
by PDT, release of antigens from PDT-damaged tumor cells, priming of the adaptive immune system to recognize
tumor-associated antigens (TAA), and induction of heat-shock proteins. The induction of specific CD8+ T-lymphocyte
cells that recognize major histocompatibility complex class I (MHC-I) restricted epitopes of TAAs is a highly desirable
goal in cancer therapy as it would allow the treatment of tumors that may have already metastasized. The PDT killed
tumor cells may be phagocytosed by dendritic cells (DC) that then migrate to draining lymph nodes and prime naïve T-cells
that recognize TAA epitopes. We have carried out in vivo PDT with a BPD-mediated vascular regimen using a pair
of BALB/c mouse colon carcinomas: CT26 wild type expressing the naturally occurring retroviral antigen gp70 and
CT26.CL25 additionally expressing beta-galactosidase (b-gal) as a model tumor rejection antigen. PDT of CT26.CL25
cured 100% of tumors but none of the CT26WT tumors (all recurred). Cured CT26.CL25 mice were resistant to
rechallenge. Moreover mice with two bilateral CT26.CL25 tumors that had only one treated with PDT demonstrated
spontaneous regression of 70% of untreated contralateral tumors. T-lymphocytes were isolated from lymph nodes of
PDT cured mice that recognized a particular peptide specific to b-gal antigen. T-lymphocytes from LN were able to kill
CT26.CL25 target cells in vitro but not CT26WT cells as shown by a chromium release assay. CT26.CL25 tumors
treated with PDT and removed five days later had higher levels of Th1 cytokines than CT26 WT tumors showing a
higher level of immune response. When mice bearing CT26WT tumors were treated with a regimen of low dose
cyclophosphamide (CY) 2 days before, PDT led to 100% of cures (versus 0% without CY) and resistance to rechallenge.
Low dose CY is thought to deplete regulatory T-cells (Treg, CD4+CD25+foxp3+) and potentiate immune response after
PDT in the case of tumors that express self-antigens. These data suggest that PDT alone will stimulate a strong immune
response when tumors express a robust antigen, and in cases where tumors express a self-antigen, T-reg depletion can
unmask the immune response after PDT.
Epigenetic mechanisms, which involve DNA methylation and histone modifications, result in the heritable silencing of
genes without a change in their coding sequence. However, these changes must be actively maintained after each cell
division rendering them a promising target for pharmacologic inhibition. DNA methyltransferase inhibitors like 5-aza-deoxycytidine
(5-aza-dC) induce and/or up-regulate the expression of MAGE-type antigens in human and mice cancer
cells. Photodynamic therapy (PDT) has been shown to be an effective locally ablative anti-cancer treatment that has the
additional advantage of stimulating tumor-directed immune response. We studied the effects of a new therapy that
combined the demethylating agent 5-aza-dC with PDT in the breast cancer model 4T1 syngenic to immunocompetent
BALB/c mice. PDT was used as a locally ablating tumor treatment that is capable of eliciting strong and tumor directed
immune response while 5-aza-dC pretreatment was used promote de novo induction of the expression of P1A.protein.
This is the mouse homolog of human MAGE family antigens and is reported to function as a tumor rejection antigen in
certain mouse tumors. This strategy led to an increase in PDT-mediated immune response and better treatment outcome.
These results strongly suggest that the MAGE family antigens are important target for PDT mediated immune response
but that their expression can be silenced by epigenetic mechanisms. Therefore the possibility that PDT can be combined
with epigenetic strategies to elicit anti-tumor immunity in MAGE-positive tumor models is highly clinically significant
and should be studied in detail.
Photodynamic therapy (PDT) involves the administration of photosensitizers followed by illumination of the
primary tumor with red light producing reactive oxygen species that cause vascular shutdown and tumor cell
necrosis and apoptosis. Anti-tumor immunity is stimulated after PDT due to the acute inflammatory response,
priming of the immune system to recognize tumor-associated antigens (TAA). The induction of specific CD8+ Tlymphocyte
cells that recognize major histocompatibility complex class I (MHC-I) restricted epitopes of TAAs is a
highly desirable goal in cancer therapy. The PDT killed tumor cells may be phagocytosed by dendritic cells (DC)
that then migrate to draining lymph nodes and prime naïve T-cells that recognize TAA epitopes. This process is
however, often sub-optimal, in part due to tumor-induced DC dysfunction. Instead of DC that can become mature
and activated and have a potent antigen-presenting and immune stimulating phenotype, immature dendritic cells
(iDC) are often found in tumors and are part of an immunosuppressive milieu including regulatory T-cells and
immunosuppressive cytokines such as TGF-beta and IL10. We here report on the use of a potent DC activating
agent, an oligonucleotide (ODN) that contains a non-methylated CpG motif and acts as an agonist of toll like
receptor (TLR) 9. TLR activation is a danger signal to notify the immune system of the presence of invading
pathogens. CpG-ODN (but not scrambled non-CpG ODN) increased bone-marrow DC activation after exposure to
PDT-killed tumor cells, and significantly increased tumor response to PDT and mouse survival after peri-tumoral
administration. CpG may be a valuable immunoadjuvant to PDT especially for tumors that produce DC dysfunction.
Photodynamic therapy (PDT) involves the IV administration of photosensitizers followed by illumination of the tumor with red light producing reactive oxygen species that eventually cause vascular shutdown and tumor cell apoptosis. Anti-tumor immunity is stimulated after PDT due to the acute inflammatory response, recognition of tumor-specific antigens, and induction of heat-shock proteins, while the three commonest cancer therapies (surgery, chemotherapy and radiotherapy) all tend to suppress the immune system. Like many other immunotherapies, the extent of the immune response after PDT tends to depend on the antigenicity of the particular tumor, or in other words, whether the tumor contains proteins with the correct characteristics to provide peptides that can bind to MHC class I molecules and provide a target for cytolytic T lymphocytes. We have described certain mouse tumors containing defined or naturally occurring tumor associated antigens that respond particularly well to PDT, and potent immune responses capable of destroying distant untreated tumors can be induced. In this report we address the induction of immunity after PDT of the DBA2 mastocytoma known as P815. This tumor was the first mouse tumor to be shown to possess a tumor-rejection antigen capable of being recognized by cytotoxic T-cells.
Cancer is a leading cause of death among modern peoples largely due to metastatic disease. The ideal cancer
treatment should target both the primary tumor and the metastases with the minimal toxicity. This is best
accomplished by educating the body's immune system to recognize the tumor as foreign so that after the
primary tumor is destroyed, distant metastases will also be eradicated. Photodynamic therapy (PDT) involves
the IV administration of photosensitizers followed by illumination of the primary tumor with red light
producing reactive oxygen species that cause vascular shutdown and tumor cell apoptosis. Anti-tumor
immunity is stimulated after PDT due to the acute inflammatory response, priming of the immune system to
recognize tumor-associated antigens (TAA), and induction of heat-shock proteins. The induction of specific
CD8+ T lymphocyte cells that recognize major histocompatibility complex class I (MHC-I) restricted
epitopes of TAAs is a highly desirable goal in cancer therapy. We here report on PDT of mice bearing
tumors that either do or do not express an established TAA. We utilized a BALB/c colon adenocarcinoma
cell line termed CT26.CL25 retrovirally transduced to stably express &bgr;-galactosidase ( &bgr;-gal, a bacterial
protein), and its non-&bgr;-gal expressing wild-type counterpart termed CT26 WT, as well as the control cell line
consisting of CT26 transduced with the empty retroviral vector termed CT26-neo. All cells expressed class I
MHC restriction element H-2Ld syngenic to BALB/c mice. Vascular PDT with a regimen of 1mg/kg BPD
injected IV, and 120 J/cm2 of 690-nm laser light after 15 minutes successfully cured 100% of CT26.CL25
tumors but 0% of CT26-neo tumors and 0% of CT26 WT tumors. After 90 days tumor free interval the
CT26.CL25 cured mice were rechallenged with CT26.CL25 tumor cells and 96% rejected the rechallenge
while the CT26.CL25 cured mice did not reject a CT26 WT tumor cell challenge. Experiments with mice
bearing two CT26.CL25 tumors (one in each leg) and only one tumor treated with PDT, showed that the
immune response was strong enough to destroy an already established tumor in 70 of the mice and this effect
was not seen with mice bearing two CT26 WT tumors. We expect these studies will lead to an understanding
of the relevant determinants of immune response after PDT that could be rapidly applied to patient-selection
and improvement in outcome for PDT for cancer.
Cancer is a leading cause of death among modern people largely due to metastatic disease. The ideal cancer treatment should target both the primary tumor and the metastases with minimal toxicity towards normal tissue. This is best accomplished by priming the body's immune system to recognize the tumor antigens so that after the primary tumor is destroyed, distant metastases will also be eradicated. Photodynamic therapy (PDT) involves the IV administration of photosensitizers followed by illumination of the tumor with red light producing reactive oxygen species leading to vascular shutdown and tumor cell death. Anti-tumor immunity is stimulated after PDT due to the acute inflammatory response, generation of tumor-specific antigens, and induction of heat-shock proteins. Combination regimens using PDT and immunostimulating treatments are likely to even further enhance post-PDT immunity. These immunostimulants are likely to include products derived from pathogenic microorganisms that are effectively recognized by Toll-like receptors and lead to upregulation of transcription factors for cytokines and inflammatory mediators. The following cascade of events causes activation of macrophages, dendritic and natural killer cells. Exogenous cytokine administration can be another way to increase PDT-induced immunity as well as treatment with a low dose of cyclophosphamide that selectively reduces T-regulatory cells. Although so far these combination therapies have only been used in animal models, their use in clinical trials should receive careful consideration.
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