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Photodiagnosis Photodyn Ther. 2018 Dec;24:58-68. doi: 10.1016/j.pdpdt.2018.07.004. Epub 2018 Jul 7.

5-Aminolevulinic acid-mediated photodynamic therapy can target human glioma stem-like cells refractory to antineoplastic agents.

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Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan.
Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan. Electronic address:
Department of Neurological Surgery and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan; NGO Personalized Medicine & Healthcare, Yokohama, Kanagawa, Japan.



Glioblastoma (GBM) is a highly malignant lethal brain cancer. Accumulated evidence suggests that elevated resistance of GBM to both chemo- and radio-therapy is, at least in part, due to the presence of a small population of glioma stem cells (GSC). In the present study, we aimed to determine the sensitivity of GSCs to 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT).


For this purpose, we established GSC-enriched cell cultures (termed glioma stem-like cells or GSLCs) from A172 human GBM cell line. Under our cultivation conditions, GSLCs formed floating spheroid clusters that contained increased population of CD133/Sox2 expressing cells. Firstly, to compare the activity of protoporphyrin IX (PpIX) biosynthesis in the GSLCs and the parental A172 glioma cells, we examined the expression levels of biosynthesis enzymes and transporters for PpIX using qRT-PCR, and investigated the intracellular levels of PpIX with use of flow cytometry analysis. Then, we evaluated the sensitivity of these cells to ALA-PDT in vitro. Finally, to confirm the therapeutic impact of ALA-PDT on GSLCs with more clinically relevant model, we performed the same experiment using three different patient-derived glioma sphere lines, which cultivated them either in stem cell media or under differentiation conditions in the presence of serum.


GSLCs expressed higher mRNA levels of PpIX biosynthesis enzymes and its transporters PEPT1/2 and ABCB6, when compared to the parental A172 glioma cells. Consistently, flow cytometry analysis revealed that upon incubation with ALA, GSLCs accumulate a higher level of PpIX. Finally, we showed that GSLCs were more sensitive to ALA-PDT than the original A172 cells, and confirmed that all patient-derived glioma sphere lines also showed significantly increased sensitivity to ALA-PDT if cultivated under the pro-stem cell condition. Our data indicate that ALA-PDT has potential as a novel clinically useful treatment that might eliminate GBM stem cells that are highly resistant to current chemo- and radio-therapy.


Aminolevulinic acid; Chemoresistance; Glioma stem cell; Glioma stem-like cell; Malignant glioma; Phtodyanamic therapy; Protoporphyrin-IX

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