光敏剂特性影响光动力治疗鲜红斑痣的数学仿真研究

目的：通过建立光动力治疗鲜红斑痣中激光、光敏剂、氧的分布及其相互作用关系的数学模型,对表皮、真皮、血管中单线态氧的产生过程进行仿真,了解光敏剂的药代动力学和扩散特性对单线态氧产生的影响,进而了解光敏剂特性在光动力治疗鲜红斑痣中的作用和意义。方法：用’Monte Carlo方法描述光在组织中的分布;用药代动力学描述光敏剂在血管中的变化规律;用Fick定律描述光敏剂和氧在组织中的扩散和分布;用与氧含量有关的二级动力学描述光敏剂的漂白;用Lambert—Beer定律和单线态氧的量子产率来计算各层组织中单线态氧的产生。结果：光敏剂药代动力学的变化,使注射光敏剂后开始照光的时间对各层组织中单线态氧产量有明显的影响。光敏剂扩散特性的改变,对真皮和表皮中单线态氧的产生有较大影响,对血管中单线态氧的产生没有影响。结论：光敏剂的特性对光动力治疗鲜红斑痣有明显的影响,数学仿真能较全面地反应这种作用的特点和意义。     

纳米氧化硅空心球负载光敏剂对肝癌体内外的杀伤作用研究

目的:探讨空心纳米粒子光敏剂与普通光敏剂在不同实验条件下对人HepG2肝癌细胞增殖的抑制作用及其作用机制。方法:应用体内外培养的HepG2肝癌细胞,以纳米化的photosan及photosan为光敏剂,半导体激光器(波长630 nm)为光源进行光照射,在不同的浓度光敏剂经不同剂量的光照后,用MTT法测定光动力治疗后肝癌细胞的残存率,并用流式细胞分析检测光动力治疗对肝癌细胞凋亡的影响,采取Western blot检测光动力治疗肝癌后凋亡相关蛋白caspase-3和caspase-9的表达情况,并建立裸鼠动物模型,比较纳米粒子光敏剂与普通光敏剂在动物体内对肝癌抑制作用。结果:纳米粒子光敏剂介导的光动力治疗对肝癌有明显的抑制作用,在一定范围条件下,随着光敏剂浓度的增加和激光剂量的的增大,肝癌细胞的的残存率明显下降,且纳米粒子光敏剂在同等条件下要优于普通光敏剂,流式细胞分析显示,空心纳米粒子光敏剂光动力治疗肝癌出现了明显的凋亡,且比普通光敏剂更显著。Western blot检测结果显示,两种光敏剂均引起凋亡蛋白caspase-3和caspase-9的表达,在空心纳米粒子光敏剂光动力作用组该两种蛋白的表达水平要明显高于普通光敏剂组。体内实验显示:用纳米粒子光敏剂与普通光敏剂分别对裸鼠肝癌模型干预,在生存期,瘤体的体积大小,纳米粒子光敏剂组显然优越于普通光敏剂组。结论:空心纳米粒子光敏剂对肝癌细胞在体内外具有明确的抑制作用,这种抑制作用可能通过引起凋亡相关蛋白高水平的表达,从而促发凋亡通路的开放,引起癌细胞发生凋亡。     

聚合物纳米粒在肿瘤光动力治疗中的研究进展

光动力治疗创伤小,在恶性肿瘤治疗方面的应用已经得到了临床认可。治疗过程中需要给予光敏剂,在光照下产生分子氧对肿瘤细胞产生杀伤作用。但是,大多数光敏剂缺乏对肿瘤细胞的特异性,其在肿瘤中的富集主要与细胞高代谢有关,并且在水相媒介中溶解度比较差。纳米技术应用于光动力治疗提供了一种有效地体内运输光敏剂的方式。目前,聚合物纳米粒与光动力药物传递的研究越来越多,光敏剂通过纳米粒的运输为弥补光动力治疗的不足提供了可能,这是因为纳米载体可以将治疗浓度的光敏剂运送到肿瘤细胞而不造成非靶向组织的副损伤。本文将介绍对肿瘤光动力治疗中具有特异性的聚合物纳米粒的种类及在临床中的应用情况,为肿瘤靶向治疗提供新思路。     

光动力疗法中氧的弥散模型仿真及其意义

组织中的氧是由血管中扩散而来,存在一定的差异。光动力疗法使用的卟啉类光敏剂主要是通过将能量转移到氧分子产生单线态氧来产生毒性物质,因此在光动力治疗中有氧的消耗,使组织中氧分布对光动力作用具有特殊意义。本文对氧在靶组织和正常组织中的分布、光动力效应对组织中氧含量的影响、以及氧含量对光动力效应的反作用等方面进行了综述。     

细胞功能的光动力调控

光动力作用所产生的单线态氧分子因其有限的寿命(1μs)和有效反应距离(10 nm),可亚细胞特异性调控细胞的不同生理活动。如质膜定位的光动力作用可导致胆囊收缩素(cholecystokinin,CCK)1型受体的永久性激活,及其它G蛋白耦联受体的增敏或脱敏。近年来涌现出来的基因编码的蛋白质光敏剂,使得光动力作用的亚细胞定位变得更加精细可控,因而可实现亚细胞部位及功能蛋白的靶向光动力调控。蛋白质光敏剂毒杀红(KillerRed)、迷你单(miniSOG)、单蛋敏(singlet oxygen protein photosensitiser,SOPP)等的亚细胞定位表达,可光动力调控细胞局部生理过程,通过对特定蛋白的光氧化活性改变,阐明该蛋白在细胞生理过程中的作用。选择性光照技术,可实现同步多点局部光照。多点局部光动力作用调控,可阐明细胞局部对整体细胞,及个体细胞对细胞团块的影响。蛋白质光敏剂的光动力作用,正逐渐成为细胞生理学研究的重要纳米调控工具。     

细胞器靶向光敏剂的研究进展

光动力治疗是一种利用特定波长的激光激发光敏剂产生活性氧物种(ROS),进而对肿瘤细胞进行杀伤的治疗模式。然而,ROS的半衰期很短,且只能作用在产生部位附近,这明显限制了光动力治疗的疗效。细胞器是细胞能正常工作和运转不可缺失的部分。因此,将光敏剂有效地靶向递送至细胞器是一种提高光动力治疗效果的有效策略。本文将介绍有机靶向光敏剂的设计原理、靶向策略、目前面临的挑战和未来的发展方向。     

新型光敏剂在肝癌中的应用

肝癌晚期,手术切除往往效果不佳,5年生存率低。因此,通过新的辅助治疗方式提高患者生存期是必要的。光动力疗法作为晚期肝癌的姑息性治疗方法,光敏剂是光动力疗法中至关重要的因素。几十年来,光敏剂经过不断发展,如今已出现了许多新型光敏剂,它们具有靶向性高、脂溶性强、生物利用度高等特点,随着肝脏肿瘤多学科合作模式的逐渐开展,新型光敏剂及光动力疗法也将在其中扮演重要的角色。     

共价连接BODIPY光敏剂的聚合物纳米胶束及其靶向光动力疗效的研究

目的:利用聚合物纳米胶束靶向输送光敏剂分子已经成为光动力治疗癌症的研究热点。方法:采用原子转移自由基聚合反应合成嵌段聚合物聚丙烯酸叔丁酯-聚甲基丙烯酸缩水甘油酯(Pt BA-b-PGMA),共聚物的一端脱除叔丁基,通过缩合反应共价键连接甘露糖分子,另一端环氧基开环引入叠氮基,并通过"click"反应共价连接氟硼二吡咯光敏剂分子,最后制备得到表面甘露糖修饰的负载光敏剂聚合物胶束。利用核磁共振氢谱仪和傅立叶变换红外光谱仪进行结构确认;通过透射电镜和动态光散射等考察其理化性质;经激光共聚焦显微镜和MTT细胞毒性实验对其甘露糖受体靶向性及光动力疗效进行考察和评价。结果:聚合物Pt BA-b-PGMA的相对分子量为16 924,其分散系数为1.36。聚合物中环氧基开环引入叠氮后在2 106 cm-1处出现叠氮基特征峰。经过"click"反应引入氟硼二吡咯光敏剂分子后,叠氮基特征峰消失,在1 637 cm-1处出现三氮唑特征峰。聚合物胶束粒径分布均一,稳定性良好。胶束平均流体力学直径为178 nm,在水溶液中粒度分布较窄(PDI=0.298)。聚合物胶束对人乳腺癌MDA-MB-231细胞和HEK293正常细胞均无暗毒性,在535 nm LED光照下对乳腺癌MDA-MB-231细胞具有较好的光动力治疗效果。结论:聚合物胶束能被MDA-MB-231癌细胞表面高表达的甘露糖受体特异性识别,并被内吞进入癌细胞内,具有较好的光动力杀伤作用。     

一种新型细胞摄取增强的两亲性卟啉类光敏剂及肿瘤光动力治疗研究

光敏剂能否被肿瘤细胞高效吸收是影响光动力治疗效率的重要因素。亲脂性光敏剂易于被肿瘤组织摄取,但会使光敏剂发生自猝灭;亲水性光敏剂则有利于光敏剂在体内的转运,但肿瘤细胞摄取率会下降。本工作通过亲酯性的乙二醇缩合支链和亲水性季膦基团与卟啉相连接,成功制备一种新型两亲性卟啉锌化合物(ZnTP-TP),实验表明该化合物具有较高的单线态氧量子产率和良好的两亲性,可被细胞快速摄取,并表现出较低的细胞毒性和良好的肿瘤光动力治疗效应。     

抗菌光敏剂的分类及研究进展

目前控制细菌和病毒感染性疾病的方法很多,但由于微生物菌株种类越来越多,且耐药微生物菌株不断涌现,已有的治疗手段无法取得良好疗效,因此探索新的抗微生物治疗方法迫在眉睫。光动力抗菌化学疗法是基于光动力疗法的原理,利用光敏剂在异常组织选择性聚集,在分子氧的参与下,由特定波长的光激发产生活性氧,引发一系列的光化学反应,对微生物进行选择性杀伤的一种新方法。光动力抗菌化学疗法对细菌、真菌和病毒引起的感染,特别是耐药菌感染均显示很好的疗效。本文将对光动力抗菌化学疗法中常使用的光敏剂进行分类,并对其研究进展进行综述。     

Failure of sequential therapy to eradicate Helicobacter pylori in previously treated subjects

BACKGROUND: Recently, studies in adults and subsequently in children have demonstrated a very high success rate for sequential therapy as a primary therapy when compared to traditional therapy regimens. METHODs: We report our experience with a sequential therapy regimen for the eradication of Helicobacter pylori in five infected children and a young adult, whose conventional therapy regimens had been unsuccessful. RESULTS: Five patients failed the sequential therapy. All of them experienced between two and four failures of traditional therapy prior to the sequential treatment protocol. The only patient who succeeded on the sequential therapy had just one previous failure. All of our patients who had failed sequential therapy achieved eradication of the bacteria with quadruple therapy. CONCLUSIONS: In view of our disappointing results, sequential therapy is unsuccessful as a therapy for children and young adults who have failed previous treatment regimens. At the present time, quadruple therapy is indicated for this group. Well-designed placebo-controlled trials are indicated to further characterize this group of patients.     

Metallic nanoparticle radiosensitisation of ion radiotherapy: A review

The use of gold nanoparticle (GNP) and other metal nanoparticle (MNP) radiosensitisers to enhance radiotherapy offers the potential of improved treatment outcomes. Originally intended for use with X-ray therapy, the possibility of enhanced hadron therapy is desirable due to the superior sparing of healthy tissue in hadron therapy compared to conventional X-ray therapy. While MNPs were not expected to be effective radiosensitisers for hadron therapy due to the limited Z dependence of interactions, recent experimental measurements have contradicted this expectation. Key experimental measurements and Monte Carlo simulations of MNP radiosensitisation for hadron irradiation are reviewed in the current work. Numerous experimental measurements have found a large radiosensitisation effect due to MNPs for proton and carbon ion irradiation. Experiments have also indicated that the radiosensitisation is due in large part to enhanced reactive oxygen species (ROS) production. Simulations have found a large radial dose and ROS enhancement on the nanoscale around a single MNP. However, the short range of the dose enhancement is insufficient for a large macroscale dose enhancement or enhanced biological effect in a cell model considering dose to the nucleus from GNPs in the cytoplasm (a distribution observed in most experiments).     

Adenoviral gene therapy, radiation, and prostate cancer

Viral gene therapy has exceptional potential as a specifically tailored cancer treatment. However, enthusiasm for cancer gene therapy has varied over the years, partly owing to safety concerns after the death of a young volunteer in a clinical trial for a genetic disease. Since this singular tragedy, results from numerous clinical trials over the past 10 years have restored the excellent safety profile of adenoviral vectors. These vectors have been extensively studied in phase I and II trials as intraprostatically administered agents for patients with locally recurrent and high-risk local prostate cancer. Promising therapeutic responses have been reported in several studies with both oncolytic and suicide gene therapy strategies. The additional benefit of combining gene therapy with radiation therapy has also been realized; replicating adenoviruses inhibit DNA repair pathways, resulting in a synergistic sensitization to radiation. Other, nonreplicating suicide gene therapy strategies are also significantly enhanced with radiation. Combined radiation/gene therapy is currently being studied in phase I and II clinical trials and will likely be the first adenoviral gene therapy mechanism to become available to urologists in the clinic. Systemic gene therapy for metastatic disease is also a major goal of the field, and clinical trials are currently under way for hormone-resistant metastatic prostate cancer. Second- and third-generation "re-targeted" viral vectors, currently being developed in the laboratory, are likely to further improve these systemic trials.     

Gene therapy. Therapeutic approaches and implications

The present article is an overview of gene therapy with an emphasis on different approaches and its implications in the clinic. Genetic interventions have been applied to the diagnosis of and therapy for an array of human diseases. The initial concept of gene therapy was focused on the treatment of genetic diseases. Subsequently, the field of gene therapy has been expanded, with a major focus on cancer. Although the results of early gene therapy-based clinical trials have been encouraging, there is a need for gene delivery vectors that feature reduced immunogenicity and improved targeting ability. The results of phases I/II clinical trials have suggested the important role of gene therapy as a versatile and powerful treatment tool, especially for human cancers. One reasonable expectation is that performing gene therapy at an earlier stage in the disease process or for minimal residual disease may be more advantageous.     

Breast reconstruction with postmastectomy radiation therapy: current issues

Two recent trials have demonstrated superior locoregional control, disease-free survival, and overall survival in node-positive breast cancer patients with the addition of postmastectomy radiation therapy to mastectomy and chemotherapy. Based on these results, there has been an increased use of postmastectomy in patients with early-stage breast cancer. The inability to determine which patients will require postmastectomy radiation therapy has increased the complexity of planning for immediate breast reconstruction. There are two potential problems with performing an immediate breast reconstruction in a patient who will require postmastectomy radiation therapy. One problem is that postmastectomy radiation therapy can adversely affect the aesthetic outcome of an immediate breast reconstruction. Several studies have evaluated the outcomes of breast reconstructions that were performed before radiation therapy and have revealed a high incidence of complications and poor aesthetic outcomes. Furthermore, these studies have found that often an additional flap is required to restore breast shape and symmetry. The other potential problem is that an immediate breast reconstruction can interfere with the delivery of postmastectomy radiation therapy. During planning for immediate breast reconstruction, it is imperative to carefully review the stage of disease and the likelihood the patient will require postmastectomy radiation therapy. Unfortunately, the ability to detect and predict the presence or extent of axillary lymph node involvement is limited, and the need for postmastectomy radiation therapy is usually not known until after mastectomy. In all cases of decision making regarding possible postoperative radiation therapy and whether or not to perform immediate breast reconstruction, the situation should be discussed at a multidisciplinary conference or addressed among the various medical, surgical, and radiation teams, with active participation by the patient. Immediate breast reconstruction probably should be avoided in patients known to require postmastectomy radiation therapy and delayed until it is certain the therapy will be needed in patients who may require the therapy.     

History of gene therapy

Two decades after the initial gene therapy trials and more than 1700 approved clinical trials worldwide we not only have gained much new information and knowledge regarding gene therapy in general, but also learned to understand the concern that has persisted in society. Despite the setbacks gene therapy has faced, success stories have increasingly emerged. Examples for these are the positive recommendation for a gene therapy product (Glybera) by the EMA for approval in the European Union and the positive trials for the treatment of ADA deficiency, SCID-X1 and adrenoleukodystrophy. Nevertheless, our knowledge continues to grow and during the course of time more safety data has become available that helps us to develop better gene therapy approaches. Also, with the increased understanding of molecular medicine, we have been able to develop more specific and efficient gene transfer vectors which are now producing clinical results.     

Mesenchymal stem cells: weapons or dangers for cancer treatment?

Mesenchymal stem cells (MSC) have attracted recent attention for their cell therapy potential, based in particular on their immunosuppressive properties, which have served as the basis for the treatment of autoimmune diseases. Interestingly, MSC have been used in cell therapy strategies to deliver therapeutical genes. Cell therapy approaches taking advantages of MSC have been proposed, as MSC display a potential tropsim for tumors. However, all these strategies raise a series of questions about the safety of MSC, as MSC could enhance tumor growth and metastasis. This review summarizes recent findngs about MSC in carcinogenesis.     

An overview of gene therapy in head and neck cancer

Gene therapy is a new treatment modality in which new gene is introduced or existing gene is manipulated to cause cancer cell death or slow the growth of the tumor. In this review, we have discussed the different treatment approaches for cancer gene therapy; gene addition therapy, immunotherapy, gene therapy using oncolytic viruses, antisense ribonucleic acid (RNA) and RNA interference-based gene therapy. Clinical trials to date in head and neck cancer have shown evidence of gene transduction and expression, mediation of apoptosis and clinical response including pathological complete responses. The objective of this article is to provide an overview of the current available gene therapies for head and neck cancer.     

Targeting gene-virotherapy for cancer

Gene therapy and viral therapy for cancer have therapeutic effects, but there has been no significant breakthrough in these two forms of therapy. Therefore, a new strategy called “targeting gene-virotherapy”, which combines the advantages of gene therapy and viral therapy, has been formulated. This new therapy has stronger antitumor effects than either gene therapy or viral therapy. A tumor-specific replicative adenovirus vector ZD55 （E1B55KD deleted Adv.） was constructed and various single therapeutic genes were inserted into ZD55 to form ZD55-gene. These are the targeting gene-virotherapy genes. But experiments showed that a single gene was not effective in eliminating the tumor mass, and therefore two genes were separately inserted into ZD55. This strategy is called “targeting dual gene-virotherapy” （with PCT patent）. Better results were obtained with this strategy, and all the xenograft tumor masses were completely eliminated in all mice when two suitable genes producing a synergetic or compensative effect were chosen. Twenty-six papers on these strategies have been published by researchers in our laboratory. Furthermore, an adenoviral vector with two targeting promoters harboring two antitumor genes has been constructed for cancer therapy. Promising results have been obtained with this adenoviral vector and another patent has been applied for. This antitumor strategy can be used to kill tumor cells completely with minimum damage to normal cells.     

Preliminary analysis for integration of spot-scanning proton beam therapy and real-time imaging and gating

PurposeSpot-scanning proton beam therapy (PBT) can create good dose distribution for static targets. However, there exists larger uncertainty for tumors that move due to respiration, bowel gas or other internal circumstances within the patients. We have developed a real-time tumor-tracking radiation therapy (RTRT) system that uses an X-ray linear accelerator gated to the motion of internal fiducial markers introduced in the late 1990s. Relying on more than 10 years of clinical experience and big log data, we established a real-time image gated proton beam therapy system dedicated to spot scanning.Materials and methodsUsing log data and clinical outcomes derived from the clinical usage of the RTRT system since 1999, we have established a library to be used for in-house simulation for tumor targeting and evaluation. Factors considered to be the dominant causes of the interplay effects related to the spot scanning dedicated proton therapy system are listed and discussed.Results/conclusionsTotal facility design, synchrotron operation cycle, and gating windows were listed as the important factors causing the interplay effects contributing to the irradiation time and motion-induced dose error. Fiducial markers that we have developed and used for the RTRT in X-ray therapy were suggested to have the capacity to improve dose distribution. Accumulated internal motion data in the RTRT system enable us to improve the operation and function of a Spot-scanning proton beam therapy (SSPT) system. A real-time-image gated SSPT system can increase accuracy for treating moving tumors. The system will start clinical service in early 2014.