The Clinical And Basic Research Of Photodynamics On Diagnosis And Therapy Of Condylomata Acuminata

Background & Objectives:Condylomata acuminata(CA) is one of the most common sexually transmitted diseases caused by human papillomavirus(HPV).The incidence of CA has been increasing year after year.There is still a high recurrent rate in patients with CA after various therapies.The recurrence of CA may be closely related to many factors,such as subclinical infetion harboring HPV,abnormal function of individual local immunity,insufficient and inefficient therapies and so forth.Topical photodynamic therapy(PDT) with 5-aminolaevulinic acid(ALA) is a promising attractive technique for the local treatment of HPV-related diseases,and promising results have been reported for the treatment of CA these years,especially for urethral CA.PDT has been shown to augment anti-tumor immunity in lots of researches.The reason for the lower recurrence rate of ALA-PDT may be related to simultaneous treatments of microscale and subclinical lesions,which improves the current situation of the treatments of CA.The purpose of this study is to discuss the application of photodynamics in different aspects including photodynamic diagnosis (PDD) of CA,the function of Langerhans cell(LC) in local immunity around PDT and PDT for cervical CA.Methods:1) The clinical and basic research on ALA-PDD of CA:PDD was performed on the lesions of 40 patients of primary CA and the adjacent normal skin (2-cm border) after 2h topical application of 20%ALA in the dark,and HPV DNA loads of clinical and subclinical fluorescence lesions were detected by real-time quantitative polymerase chain reaction(RQ-PCR).2) The alteration of Langerhans cell in local lesions before and after PDT:The expression of LC in 15 specimens of CA around PDT and 5 positive controls were determined by immuohistochemical technique,and the changes of LC were observed through high power lens.3) ALA-PDT for the treatment of cervical CA:Patients with cervical CA were allocated into primary(21 cases) and recurrent group(9 cases),and were given topical ALA under occlusive dressing for 3 hs followed by irradiation with semiconductor laser at a dose of 100 Jcm^-2 and a power of 100mW.The treatment was repeated once a week for maxinum of 3 weeks if the lesion was not completely removed after the first treatment.The prior managements in the recurrent group were considered as own controls.Results:1) The clinical and basic research on ALA- PDD of CA:All CA lesions(40 cases) showed intense red fluorescence.Among them,32 cases(70%) showed distinct red fluorescence spots with well-defined margin within 2-cm zone and 17 cases showed diffused red fluorescence without well-defined margin.All the 20 CA fluorescent specimens taking RQ-PCR were HPV 6/11 positive.The average HPV 6/11 DNA load in clinical group and subclinical group were 4.34×10⁸±2.03×10⁸ copies/ml and 7.51×10⁶±1.16×10⁷ copies/ml respectively.All the specimens were HPV16/18 negative.The HPV subtype of subclinical group accorded wth the clinical group,and the DNA load possessed a significant difference between groups(p＜0.01). The PCR results were consistent with the fluorescent diagnosis of CA.2) The alteration of Langerhans cell in local lesions before and after PDT:Histopathological study showed that compared with normal controls(18.8±4.0/highpower field),the mean number of LC in CA lesions(before or after PDT) was significantly lower (p＜0.01),and the dendritic structure of LC decreased,shortened or even disappeared. Atypical LCs without dendritic structure were detected in the dermis.The number of LC at the moment immediately after PDT(9.2±2.0/highpower field) was significant higher than that in the goup before treatment(6.2±1.8/highpower field) (p＜0.05).Seven days later,the number of LC(6.4±1.1/highpower field) decreased to the level before PDT(p＞0.05,without statistics difference).3) ALA-PDT for the treatment of cervical CA:The total complete removal rate of PDT was 100%and the total recurrence rate was 5%after 3 months of follow-up.Recurrence rate in recurrent group was significantly different,compared with prior managements(100%)(p＜0.01). The side-effects of PDT in patients mainly included mild burning and/or stinging restricted to the illuminated areas,and was significant lower than their own control in the recurrent group(p＜0.05).Conclusions:1) ALA-PDD is an accurate and reliable method in detecting clinical and subclinical lesions,and is of crucial clinical value. 2) Patients with CA have low cellular cell-mediated immunity.PDT could modify the alteration of number and distribution of antigen presenting cell—LC, which might be as an immunologic regulator in the cure of CA.3) Compared with conventional therapies,topical application of ALA-PDT is a simple,effective,safe,well-tolerated and low recurrence rate treatment for cervical condylomata acuminata.