WO1993013403A1 - DIAGNOSTICS PAR FLUORESCENCE DU CANCER A L'AIDE DE L'ACIDE LEVULIQUE δ-AMINO - Google Patents

DIAGNOSTICS PAR FLUORESCENCE DU CANCER A L'AIDE DE L'ACIDE LEVULIQUE δ-AMINO Download PDF

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Publication number
WO1993013403A1
WO1993013403A1 PCT/SE1992/000879 SE9200879W WO9313403A1 WO 1993013403 A1 WO1993013403 A1 WO 1993013403A1 SE 9200879 W SE9200879 W SE 9200879W WO 9313403 A1 WO9313403 A1 WO 9313403A1
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WO
WIPO (PCT)
Prior art keywords
fluorescence
recited
tissue
substance
detection
Prior art date
Application number
PCT/SE1992/000879
Other languages
English (en)
Inventor
Sune Svanberg
Katarina Svanberg
Roger Berg
Jonas Johansson
Original Assignee
Sune Svanberg
Katarina Svanberg
Roger Berg
Jonas Johansson
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Sune Svanberg, Katarina Svanberg, Roger Berg, Jonas Johansson filed Critical Sune Svanberg
Publication of WO1993013403A1 publication Critical patent/WO1993013403A1/fr

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K49/00Preparations for testing in vivo
    • A61K49/001Preparation for luminescence or biological staining
    • A61K49/0013Luminescence
    • A61K49/0017Fluorescence in vivo
    • A61K49/0019Fluorescence in vivo characterised by the fluorescent group, e.g. oligomeric, polymeric or dendritic molecules
    • A61K49/0021Fluorescence in vivo characterised by the fluorescent group, e.g. oligomeric, polymeric or dendritic molecules the fluorescent group being a small organic molecule
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0071Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence by measuring fluorescence emission
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/185Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19Carboxylic acids, e.g. valproic acid
    • A61K31/195Carboxylic acids, e.g. valproic acid having an amino group
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0075Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence by spectroscopy, i.e. measuring spectra, e.g. Raman spectroscopy, infrared absorption spectroscopy
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0082Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
    • A61B5/0084Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0082Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
    • A61B5/0091Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for mammography
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/43Detecting, measuring or recording for evaluating the reproductive systems
    • A61B5/4306Detecting, measuring or recording for evaluating the reproductive systems for evaluating the female reproductive systems, e.g. gynaecological evaluations
    • A61B5/4312Breast evaluation or disorder diagnosis

Definitions

  • Cancer diseases are very widespread and have a major social and socio-economic impact. The incidence of cancer has shown a steady increase during the last tens of years. It is generally accepted that an early cancer diagnosis and a radical treatment is of great importance for the prognosis for the patient.
  • Conventional diagnostic methods for cancer comprise different types of X-ray investigations, endoscopic investigations with biopsy sampling in the hollow organs of the body, cytological puncture of resistances, as well as smear cytology.
  • the present invention describes the use of ⁇ -amino levulinic acid (abbreviated ALA below) as a specifically tumour seeking agent, to be visualized through its specific fluorescence on irradiation with a laser or other suitable radiation source.
  • ALA ⁇ -amino levulinic acid
  • a point monitoring or an imaging fluorescence system can be used for the detection.
  • ALA intravenously administered, or applied as an unguent over superficial tumours, is very selectively taken up by tumour cells, in which the substance is transformed into protoporphyrin IX, which exhibits a very strong and characteristic fluorescence in the red wavelength region.
  • This procedure can be used, e.g. for the detection of early bronchial or bladder cancer and for the demarcation of the extension of a tumour for assuring a radical tumour treatment.
  • tumour marking can be used in two ways, for diagnostics thorugh the fluorescence of the agent and for tumour treatment by photodynamic techniques, where the photo- excited agent transfers its energy to oxygen molecules, that make a transition from their normal triplet state to an aggressive singlet state. The release of singlet oxygen selectively in the tumour causes tissue necrosis.
  • Photofrin Quadra Logic Technologies, Vancouver, Canada
  • the present invention is based on our observation, in animal experiments as well as clinically, that the agent ⁇ -amino levulinic acid is an extremely efficient fluorescence marker for tumours. This is true for intravenous injection as well as for superficial treatment with ALA unguent direct on the tumour.
  • the small non-fluorescing ALA molecules penetrate the cell membrane of malignant tumour cells and undergo in the mitochondria parts of the haem cycle, leading to the formation of protoporphyrin IX. Fluorescence can be induced by illumination by radiation from, e.g. a pulsed laser. This can be a dye laser pumped by a nitrogen laser. An especially suitable excitation wavelength is 405 nm, where porphyrins have their absorption maximum.
  • the radiation can be conducted to the tissue through a quartz fibre, which can also be used to collect fluorescence light and to conduct it to a spectral analyzer.
  • a quartz fibre which can also be used to collect fluorescence light and to conduct it to a spectral analyzer.
  • This can be a spectrometer equipped with a diode-array detector or a more simple instrument based on optical filters.
  • Tumours are marked by the occurrence of a fluorescence peak at 635 nm and a weaker peak at 710 nm.
  • a demarcation ratio (the ratio between the specific fluorescence signal in a tumour and the signal in close-lying normal tissue) of about 10 or better can be obtained using this naturally occurring molecule in the body. It has no known side effects.
  • a strong tumour demarcation is obtained after intra-venous injection if the investigation is performed about 1/2 hour after injection.
  • ALA can also be prepared in an unguent base (about 20 % ALA) and be spread over superficial tumours
  • An especially effective form of diagnostics for ultraviolet or violet excitation is to evaluate the background-free fluorescence at 635 nm and divide it by the fluorescence intensity at about 470 nm. Such a ratio is dimensionless and therefore the signal will be independent of the measurement distance, the angle of incidence for the light, and fluctuations in the excitation and detection equipment.
  • the procedure given in this invention can also be used in combination with an imaging cancer detection system, which has been described in the Swedish patent # 455646.
  • a simultaneous recording of images in three different fluorescence colours is then made (635 nm, 600 nm and 470 nm).
  • An image intensifier which is activated in synchronism with the exciting light source, is used for the recording.
  • a new, generalized and tumour enhancing image is obtained by subtracting the 600 nm image (background) from the 635 nm image, followed by a division of the result by the blue image, pixel by pixel.
  • Cancer detection with fluorescence techiques using ALA is illustrated in Figure 1, where 1 indicates the excitation source, 2 indicates optical components to bring the exciting light to the tissue, 3 indicates the tissue that has been exposed to ALA, 4 indicates optical components for conducting the fluorescence light to a wavelength-dividing system 5 placed in front of the detection system 6. Finally, 7 indicates a signal processing system for tumour recognition based on the fluorescence properties.
  • the system proposed enables strongly improved possibilities for early detection of malignant tumours, also small tumours in the hollow organs of the body, and for clear demarcation of diseased tissue from surrounding normal tissue. No side effects occur.
  • a patient with basal cell carcinoma of the forehead was investigated with the method described in this invention. 6 hours before the fluorescence investigation the tumour areas were exposed to an unguent containing ALA in hydrochloric form (Porphyrin Products, Inc., Logan, Utah; catalogue # A 167). The unguent also covered a 10 mm wide zone of normal tissue.
  • Fluorescence light was collected through the same fibre, and after passing a dichroic beam splitter, used for injecting the laser light into the fibre, the fluorescence light was focussed on the entrance slit of a Jobin-Yvon 0.25 m grating monochromator equipped with an EG&G Optical Multichannel Analyser (OMA) HI system.
  • Huorescence spectra from a basal cell cancer tumour and from close-lying, ALA-exposed normal skin are shown in Figure 2.
  • Using the intensity of the characteristic red fluorescence a demarcation ratio of 50 between the tumour and the normal tissue is obtained. If instead the ratio between the red and the blue- green fluorescence is used a demarcation ratio of 150 is obtained.
  • Figure 1 Schematic arrangment for fluorescence detection with ALA.
  • Figure 2 Fluorescence recordings for basal cell carcinoma and normal tissue for a patient that was exposed to an ALA unguent in the tumour area.
  • Figure 3 Fluorescence recordings for metastasis of breast cancer and normal tissue for a patient that was exposed to an ALA unguent in the tumour area.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Epidemiology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Pathology (AREA)
  • Chemical & Material Sciences (AREA)
  • Medicinal Chemistry (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Biophysics (AREA)
  • Investigating, Analyzing Materials By Fluorescence Or Luminescence (AREA)
  • Medicines Containing Antibodies Or Antigens For Use As Internal Diagnostic Agents (AREA)

Abstract

On décrit un procédé de détection de tumeurs malignes à l'aide de l'acide levulique δ-amino (hydrochlorure) comme marqueur de tumeur. Le tissu est exposé à l'agent soit par injection intraveineuse ou par application d'un onguent sur les tumeurs superficielles. Après une temporisation adéquate, la fluorescence est induite dans le tissu à l'aide d'une source d'excitation, par exemple, un laser. Le cancer apparaît ensuite avec une forte pointe de fluorescence spécifique à 635 nm. En divisant cette intensité de pointe rouge par l'intensité de l'autofluorescence bleue-verte du tissu, on obtient une démarcation améliorée ainsi qu'une insensibilité aux variations de nombreux paramètres expérimentaux.
PCT/SE1992/000879 1991-12-21 1992-12-18 DIAGNOSTICS PAR FLUORESCENCE DU CANCER A L'AIDE DE L'ACIDE LEVULIQUE δ-AMINO WO1993013403A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
SE9103837A SE9103837L (sv) 1991-12-21 1991-12-21 Fluorescensdiagnostik av cancer utnyttjande delta- aminolevulinsyra
SE9103837-2 1991-12-21

Publications (1)

Publication Number Publication Date
WO1993013403A1 true WO1993013403A1 (fr) 1993-07-08

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Country Status (3)

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EP (1) EP0588994A1 (fr)
SE (1) SE9103837L (fr)
WO (1) WO1993013403A1 (fr)

Cited By (12)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1997011636A2 (fr) * 1995-09-26 1997-04-03 Karl Storz Gmbh & Co. Dispositif de diagnostic photodynamique
EP0783867A1 (fr) * 1995-12-21 1997-07-16 Unilever Plc Dispositif destiné à l'identification d'acné, des comedons et des bactéries sur la peau humaine
DE19618963A1 (de) * 1996-05-10 1997-11-13 Herbert Dr Stepp Zusatzvorrichtung für ein Endoskop
WO1998009155A1 (fr) * 1996-08-27 1998-03-05 Medeikonos Ab Technique de detection du cancer de la peau chez les humains et les mammiferes et dispositif mettant en oeuvre cette technique
EP0845457A1 (fr) * 1995-07-12 1998-06-03 Mitsubishi Chemical Corporation Acide 2,2-dideutero-5-aminolevulinique
US6989140B2 (en) 2001-12-21 2006-01-24 Threshold Pharmaceuticals, Inc. Methods for cancer imaging
EP1742038A1 (fr) * 2005-07-06 2007-01-10 Academisch Medisch Centrum bij de Universiteit van Amsterdam Dispositif et procédé pour déterminer la concentration d'une substance
US7289205B2 (en) 2003-09-19 2007-10-30 The General Hospital Corporation Fluorescence polarization imaging devices and methods
US7627363B2 (en) 2003-03-18 2009-12-01 The General Hospital Corporation Polarized light imaging devices and methods
CZ301399B6 (cs) * 2004-09-03 2010-02-17 Stabilizacní disperzní základ pro fotodynamickou diagnostiku a terapii
CN103608662A (zh) * 2011-06-29 2014-02-26 京都府公立大学法人 肿瘤部位的识别装置以及识别方法
US10920260B2 (en) 2008-08-15 2021-02-16 Erasmus University Medical Center Rotterdam Methods and devices for assessment of mitochondrial function

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
SE455646B (sv) * 1984-10-22 1988-07-25 Radians Innova Ab Fluorescensanordning
GB2203831A (en) * 1986-07-07 1988-10-26 Academy Of Applied Sciences Diagnosis of malignant tumours by fluorescence
WO1990010219A1 (fr) * 1989-02-22 1990-09-07 Spectraphos Ab Ameliorations relatives au diagnostic, au moyen d'emissions de lumiere fluorescente provenant de tissus
WO1991001727A2 (fr) * 1989-07-28 1991-02-21 Queen's University At Kingston Procede de detection et de traitement de lesions malignes et non malignes par photochimiotherapie

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
SE455646B (sv) * 1984-10-22 1988-07-25 Radians Innova Ab Fluorescensanordning
GB2203831A (en) * 1986-07-07 1988-10-26 Academy Of Applied Sciences Diagnosis of malignant tumours by fluorescence
WO1990010219A1 (fr) * 1989-02-22 1990-09-07 Spectraphos Ab Ameliorations relatives au diagnostic, au moyen d'emissions de lumiere fluorescente provenant de tissus
WO1991001727A2 (fr) * 1989-07-28 1991-02-21 Queen's University At Kingston Procede de detection et de traitement de lesions malignes et non malignes par photochimiotherapie

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
Applied Optics, Volume 28, No. 12, June 1989, G.C. TANG et al., "Pulsed and cw laser fluorescense spectra from cancerous, normal, and chemically treated normal human breast and lung tissues", see the whole document. *

Cited By (26)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0845457A4 (fr) * 1995-07-12 1998-10-07 Mitsubishi Chem Corp Acide 2,2-dideutero-5-aminolevulinique
US5945564A (en) * 1995-07-12 1999-08-31 Mitsubishi Chemical Corporation 2,2-dideutero-5-aminolevulinic acid
EP0845457A1 (fr) * 1995-07-12 1998-06-03 Mitsubishi Chemical Corporation Acide 2,2-dideutero-5-aminolevulinique
WO1997011636A3 (fr) * 1995-09-26 1997-06-05 Storz Karl Gmbh & Co Dispositif de diagnostic photodynamique
WO1997011636A2 (fr) * 1995-09-26 1997-04-03 Karl Storz Gmbh & Co. Dispositif de diagnostic photodynamique
EP0783867A1 (fr) * 1995-12-21 1997-07-16 Unilever Plc Dispositif destiné à l'identification d'acné, des comedons et des bactéries sur la peau humaine
US5760407A (en) * 1995-12-21 1998-06-02 Elizabeth Arden Co., Division Of Conopco, Inc. Device for the identification of acne, microcomedones, and bacteria on human skin
DE19618963C5 (de) * 1996-05-10 2004-01-22 Stepp, Herbert, Dr. Zusatzvorrichtung für ein Endoskop und Verfahren zur endoskopischen Erfassung von Fluoreszenzlicht unter Verwendung derselben
DE19618963C2 (de) * 1996-05-10 2000-01-27 Herbert Stepp Zusatzvorrichtung für ein Endoskop und Verfahren zur endoskopischen Erfassung von Fluoreszenzlicht unter Verwendung derselben
DE19618963A1 (de) * 1996-05-10 1997-11-13 Herbert Dr Stepp Zusatzvorrichtung für ein Endoskop
WO1998009155A1 (fr) * 1996-08-27 1998-03-05 Medeikonos Ab Technique de detection du cancer de la peau chez les humains et les mammiferes et dispositif mettant en oeuvre cette technique
AU718207B2 (en) * 1996-08-27 2000-04-13 Medeikonos Ab Method for detecting cancer on skin of humans and mammals and arrangement for performing the method
US6421455B1 (en) 1996-08-27 2002-07-16 Medeikonos Ab Method for detecting cancer on skin of humans and mammals and arrangement for performing the method
US6989140B2 (en) 2001-12-21 2006-01-24 Threshold Pharmaceuticals, Inc. Methods for cancer imaging
US7627363B2 (en) 2003-03-18 2009-12-01 The General Hospital Corporation Polarized light imaging devices and methods
US7289205B2 (en) 2003-09-19 2007-10-30 The General Hospital Corporation Fluorescence polarization imaging devices and methods
US7564550B2 (en) 2003-09-19 2009-07-21 The General Hospital Corporation Fluorescence polarization imaging devices and methods
US8139211B2 (en) 2003-09-19 2012-03-20 The General Hospital Corporation Fluorescence polarization imaging device and method
CZ301399B6 (cs) * 2004-09-03 2010-02-17 Stabilizacní disperzní základ pro fotodynamickou diagnostiku a terapii
WO2007004873A1 (fr) * 2005-07-06 2007-01-11 Academisch Medisch Centrum Bij De Universiteit Van Amsterdam Dispositif et procede de determination de la concentration d'une substance
EP1742038A1 (fr) * 2005-07-06 2007-01-10 Academisch Medisch Centrum bij de Universiteit van Amsterdam Dispositif et procédé pour déterminer la concentration d'une substance
EP2273255A1 (fr) * 2005-07-06 2011-01-12 Academisch Medisch Centrum bij de Universiteit van Amsterdam Dispositif et procédé pour déterminer la concentration d'une substance
US8008038B2 (en) 2005-07-06 2011-08-30 Academisch Medicsh Centrum bij de Universiteit van Amsterdam Methods for determining oxygen concentration with protoporphyrin IX
US10920260B2 (en) 2008-08-15 2021-02-16 Erasmus University Medical Center Rotterdam Methods and devices for assessment of mitochondrial function
CN103608662A (zh) * 2011-06-29 2014-02-26 京都府公立大学法人 肿瘤部位的识别装置以及识别方法
CN103608662B (zh) * 2011-06-29 2016-09-28 京都府公立大学法人 肿瘤部位的识别装置以及识别方法

Also Published As

Publication number Publication date
EP0588994A1 (fr) 1994-03-30
SE9103837L (sv) 1993-06-22
SE9103837D0 (sv) 1991-12-21

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