Abstract. Treatment of childhood rhabdomyosarcoma is limited by recurrent disease and the development of multidrug resistance. Therefore, novel treatment options are desirable. Photodynamic therapy (PDT) using the photodynamic agent hypericin is proposed as an alternative approach for intraoperative visualization and treatment of this disease. The aim of this study was to investigate in vitro effects of hypericin on childhood rhabdomyosarcoma and to evaluate photodynamic therapy as a possible basis for treatment. Rhabdomyosarcoma cells and fibroblasts (control) were incubated with increasing concentrations of hypericin. In vitro uptake and visualization of hypericin was evaluated by fluorescence microscopy and FACS. For photodynamic therapy, cells were exposed to white light for different time periods. Cytopathologic effects were assessed using standard histology. Cancer cells were investigated for cell viability (MTT assay), proliferative activity (Ki-67 assay), and apoptosis (TUNEL test). A 100% uptake of hypericin was found within the population of rhabdomyosarcoma cells. Uptake of hypericin in the fibroblasts was much less than in rhabdomyosarcoma cells. Hypericin without exposure to white light had no effect on tumor cell viability. After irradiation, PDT resulted in a nearly complete inhibition of cell proliferation of rhabdomyosarcoma cells with a corresponding increase in the frequency of apoptosis. In fibroblasts, PDT was less effective compared to tumor cells. Our data suggest hypericin as a novel tool for visualization and photodynamic therapy of childhood rhabdomyosarcoma.
IntroductionRhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. About two thirds of all sarcomas and 7-8% of all solid malignant tumors in childhood are rhabdomyosarcomas (1). The two main histopathological subtypes of this malignancy in children are embryonal and alveolar RMS (2). Specific genetic alterations (3) such as the translocation t(2;13)(q35;q14) which occurs in 55% of all cases and t(1;13)(p36;q14) in 22% contribute to the diagnosis of alveolar RMS (1). No specific genetic alterations are found in embryonal rhabdomyosarcomas (1).The prognosis of these tumors is still poor and therapy is limited due to recurrent disease, development of metastases and multidrug resistance. Radical surgery plays a key role for the prognosis of these tumors. Mutilating surgery is often necessary for survival. Surgical procedures are complicated due to a lack of possible visualization of these tumors in vivo.In vivo visualization of childhood rhabdomyosarcoma can be performed using fluorescent proteins. Tumors and their behaviour can be studied in vivo using this imaging tool (4). Up to now, fluorescent proteins are mainly a basic research tool and have not been used in humans. Therefore, the investigation of other treatment modalities is of increasing interest.Photodynamic therapy (PDT) can be performed after local or systemic administration of a photodynamic drug. Exposure to light and the presence of oxygen result in...