5-Aminolevulinic Acid: Pitfalls of Fluorescence-guided Resection for Malignant Gliomas and Application for Malignant Glioma Therapy

Junkoh YAMAMOTO; Takehiro KITAGAWA; Ryo MIYAOKA; Kohei SUZUKI; Seishiro TAKAMATSU; Takeshi SAITO; Yoshiteru NAKANO

doi:10.7888/juoeh.42.27

Junkoh YAMAMOTO , Takehiro KITAGAWA, Ryo MIYAOKA, Kohei SUZUKI, Seishiro TAKAMATSU, Takeshi SAITO, Yoshiteru NAKANO

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Keywords: 5-aminolevulinic acid, glioma, mitochondria-targeting drug, reactive oxygen species, radiosensitizer

JOURNAL FREE ACCESS

2020 Volume 42 Issue 1 Pages 27-34

DOI https://doi.org/10.7888/juoeh.42.27

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Abstract

5-Aminolevulinic acid (ALA) has been widely used as an intravital fluorescence marker in the fluorescence-guided resection of malignant gliomas. Although not a photosensitizer itself, 5-ALA is a prodrug that accumulates protoporphyrin IX (PpIX) in the mitochondria of glioma cells; PpIX acts as a photosensitizer. Fluorescence-guided resection for malignant gliomas has some pitfalls. Moreover, 5-ALA is not merely a fluorescence marker but has potential as a mitochondria-targeting drug for malignant glioma therapy. In this article, we review the literature related to 5-ALA, discuss the pitfalls of fluorescence-guided resection using 5-ALA for malignant gliomas, and describe the application of 5-ALA for malignant glioma therapy with personal opinions.

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