Aminolevulinic acid

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δ-Aminolevulinic acid
Clinical data
Trade namesLevulan, NatuALA, Ameluz, others
Other names5-aminolevulinic acid
AHFS/Drugs.comMonograph
MedlinePlusa607062
License data
Topical, By mouth
ATC code
Legal status
Legal status
Identifiers
  • 5-Amino-4-oxo-pentanoic acid
JSmol)
Melting point118 °C (244 °F)
  • O=C(CN)CCC(=O)O
  • InChI=1S/C5H9NO3/c6-3-4(7)1-2-5(8)9/h1-3,6H2,(H,8,9) checkY
  • Key:ZGXJTSGNIOSYLO-UHFFFAOYSA-N checkY
  (verify)

δ-Aminolevulinic acid (also dALA, δ-ALA, 5ALA or 5-aminolevulinic acid), an endogenous

non-proteinogenic amino acid, is the first compound in the porphyrin synthesis pathway, the pathway that leads to heme[3] in mammals, as well as chlorophyll[4]
in plants.

5ALA is used in photodynamic detection and surgery of cancer.[5][6][7][8]

Medical uses

As a precursor of a photosensitizer, 5ALA is also used as an add-on agent for photodynamic therapy.[9] In contrast to larger photosensitizer molecules, it is predicted by computer simulations to be able to penetrate tumor cell membranes.[10]

Cancer diagnosis

Photodynamic detection is the use of photosensitive drugs with a light source of the right wavelength for the detection of cancer, using fluorescence of the drug.[5] 5ALA, or derivatives thereof, can be used to visualize bladder cancer by fluorescence imaging.[5]

Cancer treatment

Aminolevulinic acid is being studied for

brain cancer is currently experimental.[13] It has been studied in a number of gynecological cancers.[14]

Aminolevulinic acid is indicated in adults for visualization of malignant tissue during surgery for malignant glioma (World Health Organization grade III and IV).

US FDA approved aminolevulinic acid hydrochloride (ALA HCL) for this use in 2017.[16]

Intra-operative Cancer Delineation

Aminolevulinic acid utilization is promising in the field of cancer delineation, particularly in the context of fluorescence-guided surgery. This compound is utilized to enhance the visualization of malignant tissues during surgical procedures. When administered to patients, 5-ALA is metabolized to protoporphyrin IX (PpIX) preferentially in cancer cells, leading to their fluorescence under specific light wavelengths.[17] This fluorescence aids surgeons in real-time identification and precise removal of cancerous tissue, reducing the likelihood of leaving residual tumor cells behind. This innovative approach has shown success in various cancer types, including brain and spine gliomas, bladder cancer, and oral squamous cell carcinoma.[18][19][20]

Side effects

Side effects may include

nerve problems.[12] Hyperthermia may also occur.[13] Deaths have also resulted.[12]

Biosynthesis

In non-photosynthetic eukaryotes such as animals, fungi, and protozoa, as well as the class

ALA synthase, from glycine and succinyl-CoA. This reaction is known as the Shemin pathway, which occurs in mitochondria.[21]

In plants, algae, bacteria (except for the class Alphaproteobacteria) and archaea, it is produced from glutamic acid via glutamyl-tRNA and glutamate-1-semialdehyde. The enzymes involved in this pathway are glutamyl-tRNA synthetase, glutamyl-tRNA reductase, and glutamate-1-semialdehyde 2,1-aminomutase. This pathway is known as the C5 or Beale pathway.[22][23] In most plastid-containing species, glutamyl-tRNA is encoded by a plastid gene, and the transcription, as well as the following steps of C5 pathway, take place in plastids.[24]

Importance in humans

Activation of mitochondria

In humans, 5ALA is a precursor to

mitochondria.[25][26] This protoporphyrin molecule chelates with iron in presence of enzyme ferrochelatase to produce Heme.[25][26]

Heme increases the mitochondrial activity thereby helping in activation of respiratory system

Electron Transport Chain[27] leading to formation of adenosine triphosphate (ATP) for adequate supply of energy to the body.[27]

Accumulation of Protoporphyrin IX

Cancer cells lack or have reduced ferrochelatase activity and this results in accumulation of

Protoporphyrin IX, a fluorescent substance that can easily be visualized.[5]

Induction of Heme Oxygenase-1 (HO-1)

Excess heme is converted in macrophages to Biliverdin and ferrous ions by the enzyme HO-1. Biliverdin formed further gets converted to Bilirubin and carbon monoxide.[28] Biliverdin and Bilirubin are potent anti oxidants and regulate important biological processes like inflammation, apoptosis, cell proliferation, fibrosis and angiogenesis.[28]

Plants

In plants, production of 5-ALA is the step on which the speed of synthesis of chlorophyll is regulated.[4] Plants that are fed by external 5-ALA accumulate toxic amounts of chlorophyll precursor, protochlorophyllide, indicating that the synthesis of this intermediate is not suppressed anywhere downwards in the chain of reaction. Protochlorophyllide is a strong photosensitizer in plants.[29] Controlled spraying of 5-ALA at lower doses (up to 150 mg/L) can however help protect plants from stress and encourage growth.[30]

References

  1. ^ "Levulan Kerastick Product information". Health Canada. 25 April 2012. Retrieved 4 June 2022.
  2. ^ "Gleolan Product information". Health Canada. 25 April 2012. Retrieved 4 June 2022.
  3. ^
    doi:10.1016/S0021-9258(18)68695-8
    .
  4. ^
    PMID 12242396
    .
  5. ^ a b c d Wagnières, G.., Jichlinski, P., Lange, N., Kucera, P., Van den Bergh, H. (2014). Detection of Bladder Cancer by Fluorescence Cystoscopy: From Bench to Bedside - the Hexvix Story. Handbook of Photomedicine, 411-426.
  6. ^
    S2CID 20352840
    .
  7. ^
    PMID 16648043
    .
  8. ^
    PMID 23049761
    .
  9. PMID 27272080
    .
  10. doi:10.1016/j.cplett.2008.08.021
    .
  11. PMID 28191719
    .
  12. ^
    PMID 23423151
    .
  13. ^
    S2CID 38534019
    .
  14. PMID 23691448
    .
  15. ^ "Gliolan EPAR". European Medicines Agency (EMA). 17 September 2018. Retrieved 6 January 2021.
  16. ^ FDA Approves Fluorescing Agent for Glioma Surgery.June 2017
  17. PMID 26308630
    .
  18. PMID 33767664
    .
  19. S2CID 266164983
    .
  20. S2CID 260485667
    .
  21. ISBN 9781904933342
  22. PMID 16667613
    .
  23. ISBN 0-8247-4268-0
  24. ISBN 9789400757233
  25. ^
    PMID 288514
    .
  26. ^
    PMID 24310585
    .
  27. ^
    PMID 21414200
    .
  28. ^
    PMID 27100828
    .
  29. S2CID 42965243
    .
  30. doi:10.1016/j.sajb.2014.10.015
    .
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