Abstract
5-aminolevulinic acid (5-ALA) is a porphyrin precursor in the heme synthesis pathway. When supplied exogenously, certain cancers consume 5-ALA and convert it to the fluorogenic metabolite protoporphyrin IX (PpIX), causing tumor-specific tissue fluorescence. Preoperative administration of 5-ALA is used to aid neurosurgical resection of high-grade gliomas such as glioblastoma, allowing for increased extent of resection and progression free survival for these patients. A subset of gliomas, especially low-grade tumors, do not accumulate PpIX intracellularly or readily fluoresce upon 5-ALA administration, making gross total resection difficult to achieve in diffuse lesions. We review existing literature on 5-ALA metabolism and PpIX accumulation to explore potential mechanisms of 5-ALA-induced glioma tissue fluorescence. Targeting the heme synthesis pathway and understanding its dysregulation in malignant tissues could aid the development of adjunct therapies to increase intraoperative fluorescence after 5-ALA treatment.
Original language | English (US) |
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Article number | 580 |
Pages (from-to) | 1-15 |
Number of pages | 15 |
Journal | Cancers |
Volume | 13 |
Issue number | 3 |
DOIs | |
State | Published - Feb 1 2021 |
Keywords
- 5-ALA
- High-grade glioma
- Intraoperative fluorescence
- Low-grade glioma
- Protopor-phyrin IX
ASJC Scopus subject areas
- Oncology
- Cancer Research