2018 Volume 25 Issue 3 Pages 13-21
5-aminolevulinic acid (5-ALA) is a natural biochemical precursor of heme, which is converted by the heme synthesis pathway into protoporphyrin IX (PpIX) in mitochondria. Under the administration of 5-ALA, cancer cells, such as malignant glioma cells, cannot convert PpIX into heme at the final step of the heme biosynthesis pathway, and consequently, PpIX accumulates within mitochondria. PpIX has photosensitive characteristics, and thus, leads to the visualization of cancer cells that accumulate PpIX. Fluorescence-guided resection using 5-ALA for malignant gliomas can improve the resection rate of lesions during surgery because of the visualization of highly invasive gliomas. Recent studies have demonstrated that 5-ALA also interacts with ultrasound, hyperthermia and ionizing irradiation in cancer. In this article, we review the literature and discuss a role of 5-ALA for glioma therapy, in particular, malignant gliomas, with personal opinions.