In a recent study, Malik and Lugaci 1 described the research and development of 5-aminolevulinic acid (5-ALA) as a new-generation photosensitizer with high tumor specificity. The use of 5-ALA-based photodynamic technology has since been examined in a number of studies worldwide, such as in photodynamic diagnosis (PDD), in which it is used to detect tumors by illuminating the lesion with a specific wavelength of light to produce fluorescence after administration of 5-ALA; photodynamic therapy (PDT), in which it is used to induce cell death; and in photodynamic screening (PDS), in which porphyrin excretion in the blood and urine is used as a tumor biomarker. Thus, a number of applications using 5-ALA are expected to emerge in the clinical setting. | 5-Aminolevulinic acid (5-ALA) as a photosensitizer5-ALA is a natural amino acid produced in plants and animals, and it is a common precursor of hemoglobin and chlorophyll (Figures 1, 2).Endogenous 5-ALA is generated from glycine and succinyl CoA in the mitochondria by an enzymatic reaction induced by the 5-ALA synthetic enzyme, whereas exogenous 5-ALA may also be introduced into cells by its administration. In normal cells, both endogenous and exogenous 5-ALA produce a precursor through the same biosynthetic and metabolic pathways in the cytoplasm, and the precursor is transported to the mitochondria via the ATP-binding cassette (ABC) subfamily B member 6 (ABCB6) to produce protoporphyrin IX (PpIX). Subsequently, ferrochelatase catalyzes the insertion of ferrous iron into PpIX to form

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