Conspectus
The advent of photochemical
techniques has revolutionized the landscape
of biology and medical sciences. Especially appealing in this context
is photodynamic therapy (PDT), which is a photon-initiated treatment
modality that uses cytotoxic reactive oxygen species (ROS) to kill
malignant cells. In the past decade, PDT has risen to the forefront
of cancer therapy. Its optical control enables noninvasive and spatiotemporal
manipulation of the treatment process, and its photoactive nature
allows unique patterns to avoid drug resistance to conventional chemotherapeutics.
However, despite the impressive advances in this field, achieving
widespread clinical adoption of PDT remains difficult. A major concern
is that in the hostile tumor microenvironment, tumor cells are hypoxic,
which hinders ROS generation during PDT action. To overcome this “Achilles’
heel”, current strategies focus primarily on the improvement
of the intratumoral O2 perfusion, while clinical trials
suggest that O2 enrichment may promote cancer cell proliferation
and metastasis, thereby making FDA approval and clinical transformation
of these paradigms challenging.
In an effort to improve hypoxia
photodynamic therapy (hPDT) in
the clinic, we have explored “low to no O2-dependent”
photochemical approaches over the years to combat hypoxia-induced
resistance. In this Account, we present our contributions to this
theme during the past 5 years, beginning with low O2-dependent
approaches (e.g., type I superoxide radical (O2
•–) generator, photodynamic O2-economizer, mitochondrial
respiration inhibition, cellular self-protective pathway modulation,
etc.) and progressing to O2-independent strategies (e.g.,
autoadaptive PDT/PTT complementary therapy, O2-independent
artificial photoredox catalysis in cells). These studies have attracted
tremendous attention. Particularly in the pioneering work of 2018,
we presented the first demonstration that the O2
•–-mediated partial O2-recyclability mechanism can overcome
PDT resistance (J. Am. Chem.
Soc.20181401485114859). This launched an era of
renewed interest in type I PDT, resulting in a plethora of new O2
•– photogenerators developed by many
groups around the world. Moreover, with the discovery of O2-independent photoredox reactions in living cells, artificial photoredox
catalysis has emerged as a new field connecting photochemistry and
biomedicine, stimulating the development of next-generation phototherapeutic
tools (J. Am. Chem. Soc.2022144163173). Our recent work also disclosed that “photoredox
catalysis in cells” might be a general mechanism of action
of PDT (e2210504119Proc. Natl. Acad.
Sci. U.S.A.2022119). These emergent concepts,
molecular designs, photochemical mechanisms, and applications in cancer
diagnosis and therapeutics, as well as pros and cons, are discussed
in depth in this Account. It is expected that our contributions to
date will be of general use to researchers and inspire future efforts
to identify more promising hPDT approaches that better meet the clinical
needs of cancer therapy.