Photodynamic therapy (PDT) is used clinically to treat a wide range of medical conditions, including malignant cancers,[1] and is recognised as a treatment strategy which is both minimally invasive and minimally toxic. While the applicability and potential of PDT has been known for over a hundred years,[2] the development of modern PDT has been a gradual one, involving scientific progress in the fields of photobiology and cancer biology, as well as the development of modern photonic devices, such as lasers and LEDs.[3]
Most modern PDT applications involve three key components[1]: a photosensitizer, a light source and tissue oxygen. The wavelength of the light source needs to be appropriate for exciting the photosensitizer to produce reactive oxygen species. The combination of these three components leads to the chemical destruction of any tissues which have either selectively taken up the photosensitizer or have been locally exposed to light. In understanding the mechanism of PDT it is important to distinguish it from other light-based and laser therapies such as laser wound healing and rejuvenation which do not require a photosensitizer.
In order to achieve the selective destruction of the target area using PDT while leaving normal tissues untouched, either the photosensitizer can be applied locally to the target area or photosensitive targets can be locally excited with light. For instance, in the treatment of skin conditions, including acne, psoriasis, and also skin cancers, the photosensitizer can be applied topically and locally excited by a light source. In the local treatment of internal tissues and cancers, after photosensitizers have been administered intravenously, light can be delivered to the target area using endoscopes and fiber optic catheters (see figure).
Compared to normal tissues, most types of cancers are especially active in both the uptake and accumulation of photosensitizers agents, which makes cancers especially vulnerable to PDT.[4] Since photosensitizers can also have a high affinity for vascular endothelial cells,[5] PDT can be targetted to the blood carrying vasculature that supplies nutrients to tumours, increasing further the destruction of tumours.
Photosensitizers can also target many viral and microbial species, including HIV and MRSA.[6] Using PDT, pathogens present in samples of blood and bone marrow can be decontaminated before the samples are used further for transfusions or transplants.[7] PDT can also eradicate a wide variety of pathogens of the skin and of the oral cavities. Given the seriousness that drug resistant pathogens have now become, there is increasing research into PDT as a new antimicrobial therapy.[8]
Over the last thirty years, PDT has seen considerable development in a wide range of medical applications. At the cutting edge of new PDT developments, many scientists worldwide are exploring ways of enhancing photosensitizer efficacy and targetting, while new research in Russia looks to use PDT to kill internal pathogens such as mycobacterium tuberculosis, and a significant development in Asia involves whole body Next Generation PDT (NGPDT) using a tumour-specific chlorophyll-based photosensitizer to treat a wide variety of solid cancers, including deep tissue and multisite cancers.
