Addition of anaerobic culture to our routine STABC would significantly increase the detection rate of bacterial contaminated PC. However, since only slow-growing bacteria were detected, and because their clinical significance was uncertain, it is concluded that there was no clear justification to introduce anaerobic culture locally if 5-day shelf life for PCs was to be maintained.

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vitro. The in vivo combined anti-tumor effect of EGFR-TKI and FP-PDT was then evaluated. Result: FOLR1 and EGFR were expressed in 79 % and 89 % of the MPM samples, respectively. The intracellular uptake of FP corresponded well with FOLR1 expression. When MPM cells were incubated in FP and then irradiated at 671 nm, there was significant in vitro cell kill, which was inhibited in the presence of free folic acid, suggesting the specificity of FPs. FOLR1 targeting resulted in disassembly of the porphysomes and subsequent fluorescence activation in intrathoracic disseminated MPM tumors, as demonstrated by ex vivo tissue imaging. FP-PDT resulted in significant cellular damage and apoptosis in vivo. Furthermore, the combination of pre-treatment with EGFR-TKI plus FP-PDT showed further marked improvement of treatment responses. Conclusion: Folate-porphysome based PDT shows selective destruction of MPM cells based on FOLR1 targeting, and pre-treatment with EGFR-TKI further enhances the therapeutic response. Keywords: folate receptor 1 (FOLR1), Mesothelioma, photodynamic therapy (PDT)

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