Inhalation of 5-aminolevulinic acid: A new technique for fluorescence detection of early stage lung cancer

被引:125
作者
Baumgartner, R
Huber, RM
Schulz, H
Stepp, H
Rick, K
Gamarra, F
Leberig, A
Roth, C
机构
[1] UNIV MUNICH, KLINIKUM INNENSTADT, MED KLIN, D-80366 MUNICH, GERMANY
[2] GSF, INST INHALAT BIOL, D-85758 OBERSCHLEISSHEIM, GERMANY
关键词
aerosol inhalation; 5-aminolevulinic acid; fluorescence detection; lung cancer;
D O I
10.1016/S1011-1344(96)07365-4
中图分类号
Q5 [生物化学]; Q7 [分子生物学];
学科分类号
071010 ; 081704 ;
摘要
Topical application of 5-aminolevulinic acid (5-ALA), with subsequent synthesis of protoporphyrin IX (PPIX),is a novel outstanding procedure for photodynamic treatment. So far, clinical experience has been reported with creams containing 5-ALA for the therapy of skin cancer, oral application for the treatment of gastrointestinal disease and intravesical instillation of 5-ALA solutions for fluorescence detection of superficial bladder cancer. Inhalation of 5-ALA for the staining of bronchial malignancies is a preferred method in clinical pulmonology. Since no adverse reaction was observed in lung function in a canine following inhalation of 5-ALA in increasing concentrations, clinical applications were performed. Seven patients with positive or suspicious sputum cytology, but negative white light bronchoscopy, received 5-10 wt.% 5-ALA in NaCl solution by means of a medical nebulizer. No side effects were observed during and after 5-ALA inhalation. After a period of 3 h, patients underwent fluorescence bronchoscopy using violet light for fluorescence excitation and an optical multichannel analyzer for fluorescence detection in situ. The results showed fluorescence spectra which could be related to PPIX induced by 5-ALA in the bronchial mucosa. The fluorescence intensity was sufficiently high for video imaging using a target integrating color CCD camera adapted to the flexible bronchoscope. Carcinoma in situ, as well as dysplasias, showed a clear positive fluorescence. A correlation of fluorescence contrast with histology on 30 biopsies revealed a high sensitivity, but a specificity below 50%. Improvements in light and drug dosimetry will form the basis for further clinical trials.
引用
收藏
页码:169 / 174
页数:6
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