Photodiagnosis and photodynamic therapy of endometriotic epithelial cells using 5-aminolevulinic acid and steroids

BACKGROUND: The photodynamic diagnosis and therapy represent relatively new methods used, i.a., in the detection of some preneoplastic and neoplastic conditions. They are based on selective accumulation of photosensitizers in the altered cells, which can be identified by fluorescence of the sensitizers and, using light of an appropriate wavelength, can be eliminated. Currently, investigations continue on application of the methods in diagnosis and therapy of endometriosis, one of the most prevalent causes of a reduced fertility in women. METHODS: In this study protoporphyrin IX, a photosensitizer derived from 5-aminolevulinic acid, was used to locate and destroy endometrial epithelium. Material for the investigations involved primary epithelial cells, isolated from 15 normal endometria and 15 ovarian endometriotic epithelia. Taking into account the cyclical hormonal alterations, which affect endometrial cells in individual phases of the menstrual cycle, experiments were conducted on accumulation of the photosensitizer and photodestruction of the cells preceded by their hormonal stimulation (17β-estradiol and progesterone). RESULTS AND CONCLUSION: It was found that following 48 h stimulation with 17β-estradiol and/or progesterone a significantly augmented synthesis of protoporphyrin IX can be obtained in cells of endometrial epithelium as compared to the normal epithelium. Moreover, the endometriotic epithelial cells were most effectively eliminated following 48 h prestimulation with progesteron alone. The obtained result permits to assume that photodynamic diagnosis and photodynamic therapy of endometrial epithelium should be performed in the secretory phase of endometrium in order to optimise their results.