Correlations between photoactivable porphyrins’ fluorescence, erythema and the pain induced by PDT on normal skin using ALA-derivatives

Summary Background Photodynamic therapy (PDT) with precursors of photoactivable porphyrins is a well-established treatment modality for skin pathologies as well as hair removal. Pain is a major side effect thereof, and it affects the treatment compliance and acceptance. Methods Five male subjects underwent a PDT procedure on normal skin, either with a diode laser (635nm) or a lamp (405nm), 3 or 6h after application of various precursors of photoactivable porphyrins (ALA 1M; Metvix® 1M; ALA-DGME 1M; ALA-DGME 3.66M). Light doses ranged from 30 to 150J/cm2 and irradiances were 100 or 180mW/cm2. Fluorescence measurements were performed just before PDT, pain was quantified during PDT, and erythema was determined 24h afterwards. Results Because precursor ALA-DGME was very selective for the pilosebaceous apparatus vs. the epidermis, we solely carried out the PDTs using this precursor. In the absence of light, no pain was reported. An increase in pain was observed when increasing the irradiance. A correlation was observed between the follicular fluorescence and the maximal pain score during PDT. A correlation was observed between follicular fluorescence and skin erythema, and between pain score and skin erythema. Conclusions With our well-controlled PDT parameters and homogenous subjects’ conditions, we showed that pain could be reduced by reducing irradiance during PDT procedures. With the various correlations observed, we conclude that both pain and PaP fluorescence are useful tools to predict the post-PDT tissue effects (side effects and outcome). We suggest that A∂ nerve fibres would be the best candidate as first generators of PDT-induced pain.

Optimalisation de la photothérapie dynamique et de la photodétection de cancers précoces par spectroscopie résolue en temps de luminophores endogènes et exogènes

Pascal Uehlinger

The aim of this thesis is to optimize and obtain fundamental information on i) the photodetection (PD) of early stage cancers in the tracheo-bronchial tree by spectroscopic imaging of the tissue autofluorescence, ii) photodynamic therapy (PDT) applied in dermatology based on the use of protoporphyrin IX (PPIX) precursors. These two areas of photomedecine have been the subject of investigation at the air and soil pollution laboratory (LPAS) for the last 10 years. PD and PDT are areas of research that evolve in parallel, both having similar objectives: i.e. improving the patients' chances of survival by the early detection and treatment of cancer. Three main studies are presented, each in relation to a particular type of chromophore : Endogenous fluorophores generate the autofluorescence of biological tissue; some of these fluorophores can be synthesized endogenously in excess of their normal concentration following the administration of a biochemical precursor; finally, exogenous luminophores are artificially synthesized and administered to the organism where they can be used for detection. The introduction of this thesis presents several aspects of cancer as well as the theoretical background necessary for this study. At first we address time-resolved autofluorescence spectroscopy of bronchial tissue and the mechanisms at the origin of the contrasts existing between normal tissue and early stage tumours. Several hypotheses explain the reduction in intensity and spectral changes of the autofluorescence observed between early epidermal carcinoma and normal bronchial mucosa : 1) the reduction in the concentration of fluorophores in the malignant tissue, 2) the quenching of the fluorescence due to a change in the physico-chemical environment of the tumour, 3) an architectural effect such as a thickening of the malignant epithelium due to an abnormal cellular proliferation and 4) an increase in the concentration of light absorbers such as haemoglobin. In the course of our measurements no statistically significant difference in the fluorescence lifetime was observed between carcinoma in situ, moderate dysplasia and normal tissue, which leads us to conclude that hypotheses 1, 3 and/or 4 may well be at the origin of the differences in fluorescence intensity. The fluorescence lifetime decays are consistent, identifiable by a triple-exponential decay in the green and red part of the spectrum. This seems to indicate that one or two dominant fluorophores are involved which possibly, given the measured lifetimes, could be collagen and/or elastine. The second part of this thesis concerns the modulation of the production of PPIX (an endogenously induced fluorophore) in the skin, following the administration of 5-aminolevulinic acid or one of its esterified derivatives. These investigations have been carried out on the epidermis of human volunteers as well as on the epidermal equivalent (Epidex™). The final goal of these studies was on the one hand to increase the production of PPIX well below the skin surface to improve certain dermatological treatments such as the PDT of nodular basal cell carcinomas (BCC), and, on the other hand, the ability to use the results obtained with the Epidex™ model to produce PPIX specifically in hair follicles, which permits the development of a new method of hair removal by PDT. The tests using the Epidex™ model demonstrated that it is possible, by adding Desferal® (an iron chelator) or (L+) ascorbic acid iron (II) salt, to increase respectively decrease the production of PPIX as well as to modulate its elimination. These results open new perspectives such as the specific use of zinc-protoporphyrin (produced by skin cells following the dermatological use of Desferal®), and the identification of a specific precursor of PPIX for hair follicles. This precursor is an excellent "candidate" in the field of research for the development of a new method of hair removal by PDT. In the third part of this thesis we describe a preliminary study of optical sensors for the intravascular partial pressure of oxygen via the measurement of phosphorescence lifetime quenching. The phosphorescence lifetime of these species is directly related to the partial pressure of the oxygen dissolved (pO2). These oxygen sensors allow us, for instance, to measure the reduction of the pO2 during PDT, without phototoxicity. Palladium and ruthenium complexes were among the most promising compounds, and certain types of nanoparticules were used as vectors. Another interesting lead consists in the covalent modification of these "luminophores-molecules": in this context, the experiments conducted in collaboration with the "Laboratoire de photonique et interfaces" of the EPFL, demonstrate that we can drastically reduce the speed of leakage outside the vascularisation of these molecules and/or improve their retention by the nanoparticules.

EPFL2004

Single molecule detection and fluorescence correlation spectroscopy on surfaces

Kai Hassler

In this thesis a new approach for single molecule detection and analysis is explored. This approach is based on the combination of two well established methods, fluorescence correlation spectroscopy (FCS) and total internal reflection fluorescence microscopy (TIRFM). In contrast to most existing fluorescence spectroscopy techniques, the subject of primary interest in FCS is not the fluorescence intensity itself but the random intensity fluctuation around the mean value. Intensity fluctuations are induced by thermal noise in a minute observation volume, which is in classical FCS the confocal volume of a confocal microscope. E.g. FCS is commonly utilized to investigate diffusion. In this case, diffusing fluorescent molecules entering or leaving the observation volume cause intensity fluctuations, which are analyzed by calculating the temporal autocorrelation of the observed signal. The autocorrelation is a measure for the self-similarity of a signal and contains information about the average fluctuation strength and duration. The confocal observation volume, i.e. the measurement volume that is actually seen by the detector is approximately given by the product of the optical transfer function with the fluorescence exciting intensity distribution of a focused laser beam. To achieve a high signal-to-background ratio a small observation volume is absolutely essential, first of all because the background from e.g. scattered light increases with the size of the observation volume. Second, a small volume assures for a small average number of fluorophores inside the observation volume and therefore for a high fluctuation amplitude i.e. FCS signal. This thesis proposes and discusses an alternative to confocal FCS specially conceived for measurements on surface-bound molecular systems, such as biological receptors or immobilized enzymes. In contrast to confocal FCS, fluorescence is excited within an evanescent field generated by total internal reflection (TIR) of a laser beam at the interface between a microscope coverslip and the sample. This is achieved by focusing the laser beam off-axis at the back focal plane of a high NA oil-immersion objective. The collimated beam that emerges from the objective is incident at an oblique angle at the coverslip-sample interface and totally internal reflected. In contrast to confocal FCS, the generated observation volume is completely confined to the surface and background fluorescence as well as scattered light from the bulk is efficiently suppressed. Our method, called objective-type TIR-FCS in the following, features an increased collection efficiency compared to existing techniques that combine evanescent wave excitation and FCS. Existing techniques use total internal reflection on the surface of a prism to generate an evanescent field. This leads to a configuration where the choice of objectives is limited to air or water-immersion objectives. In our system we use a high NA oil-immersion objective, specially conceived for TIR applications, which collects light efficiently. The collection efficiency is further enhanced by a naturally occurring change of the emission properties of fluorophores close to interfaces between dielectric media. The presence of the interface favors emission into the optically denser medium so that about 60% of the emitted light can be collected. These factors, together with a reduced observation volume lead to a very sensitive method with a high potential for applications in single molecule detection and analysis. The performance of the proposed method was experimentally shown for measurements on molecules subject to Brownian motion and binding to modified coverslips. In particular, it was experimentally shown that objective-type TIR-FCS features high signal-to-background ratio on a single molecule level. In this thesis, concise derivations of analytical expressions for autocorrelation functions for diffusion and most important, the case of ligands reversibly binding to a single and localized binding site are presented. The derived model allows for the quantitative determination of binding rates for a single receptor. We strongly believe that the application of these results in the context of investigations of receptor-ligand binding kinetics will allow for deeper understanding of cellular signaling. Moreover, this thesis discusses the applicability of the proposed method in enzymology. Enzymes, as most proteins are subject to continuous changes of their structure or conformation. These conformational changes are correlated with the function of the enzyme. In the discussed example the enzyme catalyzes an oxidation where the product is fluorescent but the substrate is not. The function of the enzyme i.e. the recurring product formation leads to observable intensity fluctuations. Since function and conformational states are correlated, conformational fluctuations can be investigated by means of FCS as was already shown for confocal FCS. A technique closely related to FCS is fluorescence lifetime spectroscopy (where lifetime refers to the mean lifetime of the electronic excited state). Whereas in FCS the relaxation after random deviations from thermal equilibrium is investigated, relaxation of excited fluorophores towards their electronic ground-state is investigated in lifetime spectroscopy. The technique is used for e.g. discrimination between fluorophores with different lifetimes. Lifetime spectroscopy combined with imaging is used in many domains of life-science, including microarray reading and medical diagnostics. In preliminary work we developed a novel approach to perform lifetime imaging that is based on a multiplexing technique. The proposed method requires no mechanical scanning stage and only a single-point detector. Furthermore, noise is reduced under certain circumstances if the signal is low. Characteristics of this technique as well as advantages and disadvantages are shortly discussed.

EPFL2006

Development of Minimally-Invasive Optical Methods to Individualize the Doses Used for Therapeutic Applications of Light

Filippo Piffaretti

Despite the experience gained over several decades in various types of light-based medical treatments, the optimization of the corresponding therapeutic protocols and accurate forecasting of their outcome have not yet been achieved in many cases. The difficulty often arises from the heterogeneity of living tissues, their variable optical properties, and from the heterogeneous distribution of the photoactive or photosensitive substances – whether naturally present in the tissue or artificially adde. Our work focuses on the individualization and control of irradiation parameters, in order for the physician to be able to elicit a predictable clinical response in the irradiated tissues. In this thesis, we present three separate studies in which we tried to evaluate the possibility of individualizing and optimizing the corresponding clinical outcomes by measuring or monitoring certain, particular parameters. In a first clinical study, performed at the medical practice of Dr Vezzola, MD, in Saló, Italy, the human eye's retinal reflectance was measured and mapped, in the framework of subthreshold thermal laser therapy, using an excitation wavelength identical to that of the treatment laser, i.e. at 810 nm. The specific goal of this study was to correlate the occurrence of retinal burns with the measured infrared retinal reflectance. This study was performed using a modified fundus camera to record infrared reflectance images of the retina, and by recording the slit-lamp based laser therapy parameters (irradiation parameters and spot location) in such a way so as to overlay the map of the laser treatment spots on the corresponding reflectance fundus image. The clinical study demonstrated the expected existence of spatial variations in light reflectance at 810 nm (probably due to changes of the tissue absorption), which we then tried to relate to the occurrences of retinal burns observed during the laser treatment. The analysis of the results obtained with the applied conditions, did not however show a clear correlation between the local retina reflectance, the laser beam parameters, and the occurrence of retinal burns. Therefore we postulate that either the absorbing structures of the retina cannot be seen with the imaging device we used, possibly due to its limited resolution, or other important elements play a role in the laser-tissue interactions during this type of lasers-light interaction with the local retinal tissue. The second study was pre-clinical, performed at EPFL, and aimed at monitoring in real-time the tissular oxygen concentration during photodynamic therapy (PDT). It was performed in vivo on the chicken embryo's chorio-allantoic membrane (CAM) model, which was submitted to aminolevulinic acid (ALA)-based PDT. The molecular oxygen, which is thought to be an essential actor in the cascade of reactions leading to the tissular PDT effect, is actually the main molecule responsible for the photosensitizer's (PS) triplet state quenching. Therefore, the delayed fluorescence lifetime of the photosensitizer, protoporphyrin IX (PpIX), was measured with a specially designed and assembled, optical fiber-based, time-resolved spectrofluorometer, and used as a proxy for tissular pO2. Simultaneously, vascular damages caused by PDT were characterized and quantified, to check for correlation between the two parameters. Using the PS's delayed fluorescence lifetime to evaluate tissular pO2 proved to be a quite reasonable strategy, due to the fact that it is possible to measure the pO2 at the location of the PS molecule. The study's results demonstrate a robust, linear correlation between tissular pO2 reduction and vascular damage extent. They also suggest that the amount of oxygen consumed during PDT could be a useful, measurable parameter for assessing and/or controlling the PDT's therapeutic effect. The third, clinical, study aimed at measuring the fluorescence photobleaching of the PpIX photosensitizer due to PDT. This study was performed at the "Hôpitaux Universitaires de Genève – HUG", in Geneva, Switzerland, in collaboration with Dr Denis Salomon, MD, and Dr Behrooz Kasraee, MD, in the framework of a series of standard clinical PDT treatments of aktinic keratoses (AK), which is a pre-cancerous skin lesion. The lesions' fluorescence intensity was quantified with a specially adapted quantitative imaging device, using a homogeneous and constant intensity fluorescence excitation light. The specific goal was to check for a relation between the extent of photobleaching of the PS (in this case PpIX, which was induced by the administration of Metvix®) and the clinical outcome (disappearance of AK) evaluated several months after the treatment. The study's results show that the amount of photobleached PS is strongly and linearly correlated to the fluorescence measured before the treatment. Likewise, the preliminary assessment of the clinical outcomes confirms the existence of a correlation of these outcomes with the PS's fluorescence bleaching, thus making it possible, in principle, to select and optimize the PDT's irradiation parameters before starting the treatment. The results of this study demonstrate the relevance of measuring the PS's photo-bleaching for optimizing PDT and forecasting of its outcome.

EPFL2010