There are multiple determinants of PDT efficacy. An in vitro study showed that the head and neck tumor lines derived from patients with an HPV infection showed a substantial decrease in the degree of photokilling by PDT directed at ER/mitochondria. We previously reported that this was not correlated with altered photosensitizer uptake, sites of sub-cellular concentration, or rate of ROS formation. PDT targeted to the ER can lead to the initiation of parapotis, a death pathway associated with ER stress. This pathway appears to be operational even cell lines with an impaired apoptotic pathway and can lead to an apoptotic response. Impaired PDT-induced photokilling in HPV(+)line was associated with a decrease of both the paraptotic response to ER photodamage and the loss of mitochondrial membrane potential (ΔΨm) after mitochondrial photodamage. This may explain, in part, the impaired response to PDT when BPD (benzoporphyrin derivative, Vidsudyne) was the photosensitizing agent.
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