In vitro photodynamic inactivation effects of benzylidene cyclopentanone photosensitizers on clinical fluconazole-resistant Candida albicans.

BACKGROUND: The incidence of Candida infections has increased for various reasons, including, the more frequent use of immunosuppresants or broad-spectrum antibiotics. Photodynamic inactivation (PDI) is a promising approach for treating localized Candida infections. METHODS: The PDI efficacies of three benzylidene cyclopentanone-based (BCB) photosensitizers (PSs: P1, P2 and Y1) against three fluconazole-resistant C. albicans (cal-1, cal-2, and cal-3) and one control C. albicans (ATCC 90028), respectively, were evaluated using an established plate dilution method. The binding of PSs to C. albicans was determined by fluorescence spectroscopy. The mechanism of antifungal PDI was investigated using confocal laser scanning microscopy (CLSM) and transmission electron microscopy (TEM). RESULTS: Three BCB PSs all bound rapidly to C. albicans. After incubation with PSs for 30 min and irradiation with a 532 nm laser for 10 min (40 mW cm-2, 24 J cm-2), the fungicidal activity was achieved as 7.5 µM for P1 and P2, and 25 µM for Y1. CLSM confirmed that P1 and Y1 were located in intracellular components, including mitochondria, while P2 bound to the protoplast exterior and failed to enter the cells. TEM revealed the damage of mitochondria ultrastructures after P1- or Y1-mediated PDI, consistenting with the CLSM results. However, most cells became edematous, enlarged or deformation after P2-mediated PDI. CONCLUSIONS: The three BCB PSs all have remarkable PDI effects on C. albicans. The best effect is obtained by P1, which has one cationic charge with a proper lipophilicity. The respective subcellular localization of the three PSs led to different PDI mechanisms.

Modulating mitochondrial morphology enhances antitumor effect of 5-ALA-mediated photodynamic therapy both in vitro and in vivo.

5-aminolevulinic acid mediated PDT (5-ALA-PDT) is an approved therapeutic procedure for treating carcinomas of the cervix. However, when employed as a monotherapy, 5-ALA-PDT could not produce satisfactory results toward large and deep tumors. Therefore, developing a method to improve the efficacy of 5-ALA-PDT becomes important. In this study, we demonstrate an enhanced antitumor effect of 5-ALA-PDT by the modulation of mitochondrial morphology. The mitochondria in the cells were regulated into tubular mitochondria or fragmented mitochondria through over expression of Drp1 or Mfn2. Then these cells were treated with identical dose of 5-ALA-PDT. Our results suggest that HeLa cells predominantly containing fragmented mitochondria were more sensitive to 5-ALA-PDT than the cells predominantly containing tubular mitochondria. The morphology of mitochondria changed as the cell cycle progressed, with tubular mitochondria predominantly exhibited in the S phase and uniformly fragmented mitochondria predominantly displayed in the M phase. Paclitaxel significantly increased the population of M-phase cells, while 5-fluorouracil significantly increased the population of S-phase cells in xenograft tumors. Furthermore, low-dose paclitaxel significantly increased the antitumor effects of PDT. However, 5-fluorouracil didn't improve the antitumor effects of PDT. These results demonstrated an enhanced antitumor effect of 5-ALA-PDT from the modulation of mitochondrial morphology. We anticipate that our results will provide an insight for selecting potential chemotherapeutic agents to combine with PDT for tumor treatment.

Liposomal hypocrellin B as a potential photosensitizer for age-related macular degeneration: pharmacokinetics, photodynamic efficacy, and skin phototoxicity in vivo.

Photodynamic therapy (PDT) has been successfully implemented as a treatment for wet age-related macular degeneration (AMD), but very few photosensitizers have been developed for clinical use. Herein, we describe a novel formulation of liposomal hypocrellin B (LHB) that was prepared by high-pressure homogenization. The encapsulation efficiency and PDT efficacy in vitro of this new preparation were found to remain nearly constant over 1 year. Moreover, LHB is rapidly cleared from the blood, with a half-life of 2.319 ± 0.462 h and a very low serum concentration at 24 h after injection. Testing in a rat model of choroidal neovascularization (CNV) showed that leakage of blood vessels in CNV lesions was significantly reduced when LHB PDT was given at a dose of 1 mg kg(-1) along with yellow laser irradiation; the damage to the collateral retina and the retinal pigment epithelium was minimal. Skin phototoxicity assays showed that only two of the 200 mice given a 4 mg per kg dose of LHB experienced an inflammatory reaction in the auricle irradiated at 24 h after dosing. These data collectively indicate that LHB may be a safe and effective photosensitizer for vascular-targeted PDT of AMD.

A medical manipulator system with lasers in photodynamic therapy of port wine stains.

Port wine stains (PWS) are a congenital malformation and dilation of the superficial dermal capillary. Photodynamic therapy (PDT) with lasers is an effective treatment of PWS with good results. However, because the laser density is uneven and nonuniform, the treatment is carried out manually by a doctor thus providing little accuracy. Additionally, since the treatment of a single lesion can take between 30 and 60 minutes, the doctor can become fatigued after only a few applications. To assist the medical staff with this treatment method, a medical manipulator system (MMS) was built to operate the lasers. The manipulator holds the laser fiber and, using a combination of active and passive joints, the fiber can be operated automatically. In addition to the control input from the doctor over a human-computer interface, information from a binocular vision system is used to guide and supervise the operation. Clinical results are compared in nonparametric values between treatments with and without the use of the MMS. The MMS, which can significantly reduce the workload of doctors and improve the uniformity of laser irradiation, was safely and helpfully applied in PDT treatment of PWS with good therapeutic results.

A randomized, double-blind, placebo-controlled study of oral oxycodone plus acetaminophen for the treatment of pain in photodynamic therapy on port wine stains.

BACKGROUND: The major side-effect of photodynamic therapy (PDT) on port wine stains (PWS) is pain during the treatment. Although several strategies for controlling the pain during topical PDT achieve a reduction in the levels of pain, none were completely effective and convenient. This randomized, double-blind, placebo-controlled clinical trial was designed to evaluate the efficacy and safety of an oral analgesic for the treatment of pain in PDT on PWS. METHODS: Fifty-eight patients with PWS on the face were included. The treatment and placebo groups were selected by computer randomization. The patients, doctor and statistician were blinded to the patients' groups. The analgesic contained 5mg of oxycodone in combination with 325 mg of acetaminophen. The patient took the tablet orally 30 min before PDT. The patient was injected intravenously with 4-5mg/kg photosensitizer PSD-007 within 5 min, and then the lesion was exposed to a 532 nm laser immediately for 30-60 min at 100 mW/cm(2). The intensity of the pain during irradiation, the characteristic and beginning time of pain, and adverse effects were recorded. A visual analog scale (VAS) was used to assess the pain. RESULTS AND CONCLUSIONS: The time of the pain beginning was 8.31 ± 4.58 min in the treatment group and 7.10 ± 3.54 min in the placebo group, which was not significantly different (P=0.266). The VAS score in the treatment group was 7.88 ± 1.52 compared with 8.17 ± 1.12 in the placebo group, with no significant difference (P=0.422). The subgroup of age, gender, lesion location and classification between two groups had similar VAS score (P>0.05). No serious adverse events were reported. This study found that oral oxycodone 5mg/acetaminophen 325 mg was completely ineffective for pain relief, and age, gender, lesion location and classification did not influence the pain perception and the analgesic effect. The challenge of controlling pain during PDT on PWS remains.

In vitro and in vivo antitumor activity of a novel hypocrellin B derivative for photodynamic therapy.

BACKGROUND: Photodynamic therapy (PDT) is an approved therapeutic procedure that exerts cytotoxic activity toward tumor cells by irradiating photosensitizers with light exposure to produce reactive oxygen species (ROS). An ideal photosensitizer is a crucial element to PDT. In the current study, we evaluated the photodynamic activity of a novel photosensitizer, the derivative of hypocrellin B (HB), 17-(3-amino-1-pentanesulfonic acid)-substituted hypocrellin B Schiff-base (PENSHB), both in vitro and in vivo. METHODS: Physicochemical characteristics of the novel photosensitizer were compared with that of its parent HB. The intracellular distribution of photosensitizers and mitochondrial membrane potential were detected with laser scanning confocal microscopy. The pathway of cell death was analyzed by flow cytometry. The release of proapoptotic proteins was evaluated by Western blot. S180 tumor model was used to evaluate the antitumor effects of PENHB-mediated PDT. RESULTS: Compared with its parent HB, water solubility of the derivative was improved enormously (6.6 mg/ml vs. 4.6 µg/ml), rendering its intravenous injection feasible without auxiliary solvent. The derivative had better PDT effect than HB in vitro under similar dark cytotoxicity. Moreover, PENSHB-mediated PDT was able to induce mitochondrial inner membrane permeabilisation, cytochrome c release, caspase-3 activation and subsequent apoptotic death. In vivo study showed that more than half of tumor bearing mice were cured by PENSHB-mediated PDT. CONCLUSIONS: In vitro and in vivo studies suggest that PENSHB is an effective photosensitizer for PDT to tumors. Therefore, PENSHB as a novel photosensitizer has a good prospect of clinical application.

The potential of photodynamic therapy to treat esophageal candidiasis coexisting with esophageal cancer.

BACKGROUND: Photodynamic therapy (PDT) has been used in recent years to deal with fungal infections because of the prevalence of fungi resistance to drugs. However, PDT for gastrointestinal fungal infection has not been reported. This study was conducted to assess the potential of PDT to deal with esophageal candidiasis. METHODS: Two male patients with histological evidence of esophageal candidiasis coexisting with esophageal cancer were included in this retrospective study. Both patients were treated with PDT. This treatment was repeated at least 1month after the initial PDT if the patient still had residual cancer or esophageal candidiasis. Short-term efficacy was evaluated on the basis of endoscopy and histology findings. Further follow-up data were obtained from endoscopy results or telephone conversation. RESULTS: The esophageal candidiasis located 21-24cm and 25-28cm from the incisors of case 1 reached complete remission after one and two PDT sessions, respectively. The esophageal cancer coexisting with esophageal candidiasis located 21-24cm from the incisors reached complete remission after two PDT sessions. No recurrence was found at a 14-month follow-up. The esophageal cancer located 30-35cm from the incisors reached partial response after three PDT sessions. Both of the esophageal candidiasis and the coexisting esophageal cancer at 23-26cm from the incisors of case 2 reached complete remission and the esophageal cancer at 34-37cm from the incisors reached complete remission after one PDT session. No recurrence was found at a 24-month follow-up. There were no serious adverse events found in either of the two cases. CONCLUSION: Results of this preliminary study indicate that PDT may be a potential method to deal with esophageal candidiasis.

Eco-friendly synthesis of size-controllable amine-functionalized graphene quantum dots with antimycoplasma properties.

Size-controllable amine-functionalized graphene quantum dots (GQDs) are prepared by an eco-friendly method with graphene oxide sheets, ammonia and hydrogen peroxide as starting materials. Using a Sephadex G-25 gel column for fine separation, for the first time we obtain GQDs with either single or double layers. By atomic force microscopy characterization, we confirm that hydrogen peroxide and ammonia play a synergistic role on graphene oxide (GO), in which the former cuts the GO into small pieces and the latter passivates the active surface to give amine-modified GQDs. Due to the low cytotoxicity and excellent biocompatibility of the obtained amine-functionalized GQDs, besides the multiwavelength imaging properties of GQDs, for the first time we find that this kind of GQD exhibits good antimycoplasma properties. Given the superior antimycoplasma effect of the GQDs and their eco-friendly mass production with low cost, these new GQDs may offer opportunities for the development of new antimycoplasma agents, thus extending their widespread application in biomedicine.

Imaging of skin microvessels with optical coherence tomography: potential uses in port wine stains.

The knowledge of vascular structures of port wine stains (PWSs) may be useful to select treatment doses and improve therapeutic efficacy. Biopsies are impractical to implement, therefore, it is necessary to develop non-invasive techniques for morphological evaluation. This study aimed to evaluate the application of a novel optical coherence tomography (OCT) system to characterize the vascular structures of PWSs. First, OCT images were obtained from the skin of healthy rabbit ears and compared with the histopathological images. Second, OCT was used to document the differences between PWS lesions and contralateral normal skin; the size and depth of the vascular structures of two clinical types of PWSs were measured and statistically analyzed. The dermal blood vessels of healthy rabbit ears were clearly distinguished from other tissue. There was no statistical difference between the vascular diameter or depth measured by OCT images and histopathological sections (P>0.05). The OCT images of the PWSs could be distinguished from normal skin. There was no statistical difference in the depth of vessels between the purple-type and the proliferative-type PWSs (P>0.05), while there was statistical difference in the diameter of vessels between them (P<0.01). Therefore, OCT is a promising, real-time, in vivo and non-invasive tool with which to characterize the vascular structures of PWSs.

New optional photodynamic therapy laser wavelength for infantile port wine stains: 457 nm.

To expand the optional laser wavelengths of photodynamic therapy (PDT) for port wine stain (PWS), the feasibility of applying a 457 nm laser to the PDT for infantile PWS was analyzed by mathematical simulation and was validated by clinical experiment. Singlet oxygen yield of 457 nm PDT or 532 nm PDT in an infantile PWS model and an adult PWS model was theoretically simulated. Fifteen PWS patients (14 infants and 1 adult) with 40 spots were treated with 457 nm (20 spots) and 532 nm (20 spots), respectively, in two PDT courses. Simulation results showed that under the same power density and irradiation time, singlet oxygen yield of 457 nm PDT and 532 nm PDT are similar in infantile PWS vessels. Yet, in adult PWS vessels, singlet oxygen yield of 457 nm PDT is lower than 532 nm PDT. Clinical outcomes showed that no statistic difference existed between 457 nm PDT and 532 nm PDT for infantile PWS. The result of this study suggested that 457 nm wavelength laser has the potential to be applied in PDT for infantile PWS.

Monitoring microcirculation changes in port wine stains during vascular targeted photodynamic therapy by laser speckle imaging.

This study was conducted to test laser speckle perfusion imaging (LSPI) for imaging microcirculation and monitoring microcirculatory changes of port wine stains (PWS) during vascular targeted photodynamic therapy (V-PDT). Before and 5 min after V-PDT, PWS lesions and the corresponding contralateral healthy skins of 24 PWS patients were scanned, whereas seven PWS patients were scanned throughout V-PDT. V-PDT was conducted immediately after intravenous injection of photocarcinorin (4-5 mg kg(-1)). A 532 nm laser was used for irradiation (power density: 80-100 mW cm(-2), exposure time: 20-50 min). Before V-PDT, all 24 PWS patients demonstrated a significant difference in perfusion between the PWS lesion and the contralateral healthy control skin (1132 ± 724 and 619 ± 478 PU, respectively, P < 0.01). Five minutes after V-PDT, the mean perfusion value of the 24 PWS lesions was 1246 ± 754 PU. There was no significant difference compared to the perfusion before V-PDT (P > 0.05). During V-PDT, the perfusion of seven PWS patients increased rapidly after initiation of V-PDT, reached a maximum within 10 min, lasted for several minutes, and slowly returned to a relatively lower level at the end of V-PDT. On the basis of these results, LSPI is capable of imaging PWS microvasculature and monitoring microvascular reactivity to V-PDT.

Quantitative and site-directed chemical modification of hypocrellins toward direct drug delivery and effective photodynamic activity.

For photodynamic therapy (PDT) treatment of microvascular diseases, drugs are delivered via blood circulation and the targets are vasculature endothelial cells, for which the contradictory requirements of hydrophilicity and lipophilicity of the drugs have been achieved by liposome preparations. Herein, it is demonstrated that the drug delivery and target affinity are achieved by a single chemical compound, hypocrellin B (HB) derivative 6 selected from three novel aminoalkanesulfonic acid HB derivatives, 5-7. 6 exhibits a much higher PDT activity (IC(50) = 22 nM) on human gastric carcinoma BGC823 cells than HB, while it has no cellular toxicity in the dark. On the basis of estimation of the clinically required concentration according to relative PDT activity and clinical criteria, it can be predicted that 6 is directly deliverable to and PDT effective on target cells. The enhanced red absorption and superhigh photoactivity suggest that 6 is more powerful for PDT of tumors than HB.

Full range characterization of the Raman spectra of organs in a murine model.

Raman spectroscopy is a minimally-invasive optical technique with great potential for in vivo cancer detection and disease diagnosis. However, there is no systematic study of the Raman spectra from different organs to date. We measured and characterized the Raman spectra eighteen naïve mouse organs in a broad frequency range of 700 to 3100 cm⁻¹. The peaks of generic proteins and lipids appeared in Raman spectra of all organs. Some organs like bone, teeth, brain and lung had unique Raman peaks. The autofluorescence was strong in liver, spleen, heart, and kidney. These results suggest that organ specific Raman probe design and specific data processing strategies are required in order to get the most useful information.

Twenty years of clinical experience with a new modality of vascular-targeted photodynamic therapy for port wine stains.

BACKGROUND: Port wine stains (PWS) are congenital capillary malformations of the skin and are difficult to treat without scarring. Since January 1991, our group has performed a new modality of vascular-targeted photodynamic therapy (PDT) for PWS treatment. OBJECTIVE: To summarize our clinical experiences with vascular-targeted PDT for PWS at Chinese PLA General Hospital. METHODS AND MATERIALS: Our group has collected and reviewed retrospective clinical research data of vascular-targeted PDT for treating PWS since January 1991. RESULTS: Clinical studies showed that vascular-targeted PDT is an effective treatment for all types of PWS. Repetitive treatment sessions were usually needed to obtain a better cosmetic effect. No recurrence was seen in patients followed up for longer than 19 years. There were no significant side effects or adverse reactions. CONCLUSION: This new PDT is an effective, safe, and noninvasive modality with no recurrence for PWS, although the protocol for PDT requires further optimization.

Choosing optimal wavelength for photodynamic therapy of port wine stains by mathematic simulation.

Many laser wavelengths have been used in photodynamic therapy (PDT) for port wine stains (PWS). However, how these wavelengths result in different PDT outcomes has not been clearly illuminated. This study is designed to analyze which wavelengths would be the most advantageous for use in PDT for PWS. The singlet oxygen yield in PDT-treated PWS skin under different wavelengths at the same photosensitizer dosage was simulated and the following three situations were simulated and compared: 1. PDT efficiency of 488, 532, 510, 578, and 630 nm laser irradiation at clinical dosage (100 mW∕cm(2), 40 min); 2. PDT efficiency of different wavelength for PWS with hyperpigmentation after previous PDT; 3. PDT efficiency of different wavelengths for PWS, in which only deeply located ectatic vessels remained. The results showed that singlet oxygen yield is the highest at 510 nm, it is similar at 532 nm and 488 nm, and very low at 578 nm and 630 nm. This result is identical to the state in clinic. According to this theoretical study, the optimal wavelength for PDT in the treatment of PWS should near the absorption peaks of photosensitizer and where absorption from native chromophores (haemoglobin and melanin) is diminished.

Polyethylene glycol-functionalized benzylidene cyclopentanone dyes for two-photon excited photodynamic therapy.

A series of polyethylene glycol-functionalized benzylidene cyclopentanone dyes with varying lipid/water partition coefficients were synthesized in high yields by a simple process. Detailed characterization and systematic studies of these molecules, including linear and nonlinear photophysical properties, reactive oxygen yields, and in vitro photodynamic therapy (PDT) activities, were conducted. Four of these dyes exhibited good solubility in PBS (>2 mg ml(-1), which is sufficient for clinical venous injection), high reactive oxygen yields, large two-photon absorption and low dark toxicity, under the therapy dosage. Among them, two dyes could be absorbed efficiently by human rectal cancer 1116 cells, and presented strong two-photon excited PDT activity in in vitro cell experiments.

Development and clinical evaluation of medical robot assisted photodynamic therapy of port wine stains.

BACKGROUND: Port wine stains (PWS) are a kind of skin disease for which photodynamic therapy (PDT) has already achieved good results. With manual operation of clinical PDT, the laser density is uneven and laser irradiation of the lesion is arbitrary and non-uniform. In addition, lengthy manual operation tires doctors; thus a robot system has been developed to assist them. METHODS: First, a novel medical manipulator consisting of five passive joints (robot arm) and two active joints (robot wrist) was developed to automatically improve the uniformity of laser irradiation. Second, image processing of the lesion was introduced. Third, kinematics and path planning of the robot were analysed, and safety precautions were introduced. Then, accuracy tests of the robot wrist and robot system were conducted separately before clinical application. Finally, a total of 50 PWS cases were treated using the robot system. The clinical outcomes and comparison of non-parametric values were employed to evaluate the robot system. RESULTS: The accuracies of the robot wrist and robot system were shown to meet the requirements of clinical PDT treatment. The robot system performed successfully in 50 PWS cases. Doctors can devote more energy to clinical judgments during treatment with the assistance of the robot system. All the PWS have shown different degrees of improvement. The results show that the robot system is useful in assisting doctors for the PDT treatment of PWS. CONCLUSIONS: The experiments show the feasibility and usefulness of the robot system in assisting doctors giving PDT treatment for PWS. The robot system can lighten the load on doctors and improve the therapeutic effect.

Influence of laser wavelength on the damage of comb's vasculature by photodynamic therapy--simulation and validation of mathematical models.

Lasers of different wavelengths have been used as a photodynamic therapy (PDT) light source in the treatment of port-wine stains. This study attempts to investigate the influence of wavelength on depth of vascular damage using a cock comb model and mathematical modeling/simulation. Monte Carlo simulation was used to calculate the distribution of laser light in skin tissue. A series of equations including the diffusion equation for modeling the distribution of photosensitizers and oxygen, and the photobleaching equation were established to calculate the singlet oxygen generation in PDT. The singlet oxygen generation in comb tissue model with vasculature was simulated with 532- and 627.8-nm laser, respectively. In the animal experiment, the comb was treated using hematoporphyrin monomethyl ether (HMME) (10 mg/kg dose) as a photosensitizer and lasers of two different wavelengths (532 and 627.8 nm) at an identical power density (100 mW/cm(2), fluence 120 J/cm(2)). The simulation results showed that the 627.8-nm laser was more effective in generating singlet oxygen in blood vessels at deep dermis. The animal experiments showed that the average depth of thrombosis was 1,012.5 ± 647.06 µm with the 532-nm laser, and 2,204.2 ± 410.35 µm with the 627.8-nm laser. The results showed that the laser wavelength had a strong effect on the depth of thrombosis in PDT treatment for the comb model. The simulation results were consistent with the animal experimental results.

Single-wall carbon nanotubes assisted photothermal cancer therapy: animal study with a murine model of squamous cell carcinoma.

BACKGROUND AND OBJECTIVES: There has been a dramatic increase in photothermal therapy as a minimally invasive treatment modality for cancer treatment due to the development of novel nanomaterials as the light absorption agents. Single-wall carbon nanotubes (SWNTs) with strong optical absorption in the broad visible and near IR offer unique advantages for photothermal cancer therapy. A broad range of wavelengths can be used for the treatment with SWNTs, whereas conventional photothermal therapeutic agent is designed to absorb light only near one selected wavelength. The objective of this study is to validate the hypothesis that intratumoral injected SWNTs can absorb 785 nm near IR laser light and generate significant local hyperthermia to destroy tumors. STUDY DESIGN/MATERIALS AND METHODS: SCCVII tumor in C3H/HeN mice was exposed to 785-nm laser after intratumoral injection of SWNTs with different light and SWNTs dose combinations. The temperatures of the tumor with laser irradiation were monitored. In vivo and ex vivo Raman spectra in different organs were obtained with a rapid Raman system. Tumor responses (tumor volume and mouse survival) were documented daily after treatment up to day 45 to assess the effectiveness of the treatment. RESULTS: The temperature within the tumors increased in a light- and SWNTs-dose dependent manner. Squamous cell carcinomas can be eradicated at a moderate light irradiance and fluence (200 mW/cm² and 120 J/cm²). This light dose is also comparable to those used with photodynamic therapy. Tissue Raman spectroscopy measurements revealed that SWNTs remained localized in the tumor even 3 months after injection but was not found in other organs. CONCLUSIONS: This animal study represents a significant step forward towards the goal of advancing SWNTs based photothermal cancer therapy into clinical applications.

Expression of complement and pentraxin proteins in acute phase response elicited by tumor photodynamic therapy: the engagement of adrenal hormones.

Treatment of solid tumors by photodynamic therapy (PDT) was recently shown to trigger a strong acute phase response. Using the mouse Lewis lung carcinoma (LLC) model, the present study examined complement and pentraxin proteins as PDT-induced acute phase reactants. The results show a distinct pattern of changes in the expression of genes encoding these proteins in the tumor, as well as host liver and spleen, following PDT mediated by photosensitizer Photofrin™. These changes were influenced by glucocorticoid hormones, as evidenced by transcriptional activation of glucocorticoid receptor and the upregulation of gene encoding this receptor. The expression of gene for glucocorticoid-induced zipper (GILZ) protein, whose activity is particularly susceptible to glucocorticoid regulation, was also changed in PDT-treated tumors. A direct demonstration that tumor PDT induces glucocorticoid hormone upregulation is provided by documenting elevated levels of serum corticosterone in mice bearing PDT-treated LLC tumors. Tumor response to PDT was negatively affected by blocking glucocorticoid receptor activity, which suggests that glucocorticoid hormones have a positive impact on the therapeutic outcome with this therapy.