Clinical applications of 5-aminolevulinic acid-mediated fluorescence for gastric cancer
Clinical applications of 5-aminolevulinic acid-mediated fluorescence for gastric cancer
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DOI：
10.3748/wjg.v21.i29.8769
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发表时间：
2015-08-07
影响因子：
4.3
通讯作者：
Hanazaki, Kazuhiro
中科院分区：
文献类型：
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作者：
Namikawa, Tsutomu;Yatabe, Tomoaki;Hanazaki, Kazuhiro
5-氨基乙酰丙酸（ALA）是一种天然存在的氨基酸，是原卟啉IX（PpIX）前体和下一代光敏物质。在外源性给予ALA后，由于ALA在线粒体中代谢为PpIX受损，PpIX特异性地在癌细胞中积累，这导致蓝光照射后的红色荧光和单线态氧的形成。通过使用ALA的光动力学诊断（PDD）的荧光导航提供了良好的胃癌病变的可视化和检测，并且是用于评估手术切除边缘和病变延伸的胃癌的潜在有价值的诊断工具。此外，使用ALA的PDD可用于在术前分期腹腔镜检查期间检测腹膜转移，在那里它可以为治疗方法的选择提供有用的信息。这种方法的另一个有前景的应用是在淋巴结转移的评价。光动力学疗法（PDT）利用ALA在恶性组织中的光敏剂积累来引起选择性损伤，有望成为浅表早期胃癌的非侵入性内镜治疗。ALA不仅可以作为诊断剂，还可以作为治疗药物，为癌症的诊断和治疗提供了新的策略。在这里，我们回顾了目前使用的PDD和PDT在胃癌和评估其未来的潜力超越传统的方式结合光能上转换器，发光二极管和近红外线作为光源。
5-aminolevulinic acid (ALA) is a naturally occurring amino acid that is a protoporphyrin IX (PpIX) precursor and a next-generation photosensitive substance. After exogenous administration of ALA, PpIX specifically accumulates in cancer cells owing to the impaired metabolism of ALA to PpIX in mitochondria, which results in a red fluorescence following irradiation with blue light and the formation of singlet oxygen. Fluorescence navigation by photodynamic diagnosis (PDD) using ALA provides good visualization and detection of gastric cancer lesions and is a potentially valuable diagnostic tool for gastric cancer for evaluating both the surgical resection margins and extension of the lesion. Furthermore, PDD using ALA might be used to detect peritoneal metastases during preoperative staging laparoscopy, where it could provide useful information for the selection of a therapeutic approach. Another promising application for this modality is in the evaluation of lymph node metastases. Photodynamic therapy (PDT) using ALA to cause selective damage based on the accumulation of a photosensitizer in malignant tissue is expected to be a non-invasive endoscopic treatment for superficial early gastric cancer. ALA has the potential to be used not only as a diagnostic agent but also as a therapeutic drug, resulting in a new strategy for cancer diagnosis and therapy. Here, we review the current use of PDD and PDT in gastric cancer and evaluate its future potential beyond conventional modalities combined with a light energy upconverter, a light-emitting diode and near-infrared rays as light sources.