Sonodynamic Therapy Using 5-ALA for Malignant Gliomas: A Review

In recent years, sonodynamic therapy (SDT) has attracted attention as a promising new approach for the treatment of high-grade gliomas, as it is a non-invasive form of therapy that specifically kills tumor cells with limited side effects. SDT combines low-intensity ultrasound with a sonosensitizer to produce cytotoxic effects in tumor cells. 5-Aminolevulinic acid (5-ALA), an endogenous amino acid that is metabolized to protoporphyrin IX (PpIX), has shown promise as a sonosensitizer for malignant gliomas in SDT. Ultrasound can penetrate deeper body regions and activate PpIX, leading to an increase in tumor immunogenicity and induction of apoptosis. This review highlights the current state of knowledge on the mechanisms of action, the results of preclinical, clinical and ongoing studies on 5-ALA-SDT in malignant gliomas and discusses the future benefits of SDT.