ALA and its clinical impact, from bench to bedside

摘要: ALA-induced protoporphyrin IX (PpIX) is used for fluorescence diagnosis (ALA-FD) and fluorescence-guided resection of both (pre)malignant non-malignant diseases. ALA also applied in photodynamic therapy (ALA-PDT) superficial lesions dermatology, urology, neurosurgery, otorhinolaryngology, gynecology gastroenterology. Today, approved as Levulan® actinic keratoses, the ALA-methyl ester Metvix® keratoses basal cell carcinoma, ALA-hexyl Hexvix® bladder cancer Gliolan® malignant glioma. The use PDT FD was established around 25 years ago, with most fundamental knowledge gained at “bench” implemented “bedside” due to diligence a few researchers within first 10 research. After 1993 research taken up by many groups. For patient treatment, several factors are relevant. Administered mainly topical or oral form, penetrates tissue sub-optimal way, which currently improved special techniques ALA-esters. PpIX accumulation elevated tissues, abnormalities, mucosa. It found levels macrophages, dendritic cells activated lymphocytes. Following sufficient target cells, irradiation carried out may be accompanied burning sensation treatment site. Due saturation process formation rapid photobleaching during risk overtreatment relatively low. Pharmacokinetical studies have demonstrated low systemic photosensitivity excretion PpIXvia natural routes.