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Keywords = 5-aminolevulinic acid (ALA)

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16 pages, 610 KiB  
Review
From Deficiency to Therapy: Systemic Consequences of ALAS1 Disruption and the Protective Role of 5-ALA
by Koen van Wijk and Osamu Nakajima
Life 2025, 15(8), 1259; https://doi.org/10.3390/life15081259 (registering DOI) - 7 Aug 2025
Abstract
Heme, an essential prosthetic group involved in mitochondrial respiration and transcriptional regulation, is synthesized via the rate-limiting enzyme 5-aminolevulinic acid synthase (ALAS). Utilizing heterozygous mouse models for ALAS1 and ALAS2, our studies have revealed diverse systemic consequences of chronic heme deficiency. ALAS1-heterozygous (ALAS1+/−) [...] Read more.
Heme, an essential prosthetic group involved in mitochondrial respiration and transcriptional regulation, is synthesized via the rate-limiting enzyme 5-aminolevulinic acid synthase (ALAS). Utilizing heterozygous mouse models for ALAS1 and ALAS2, our studies have revealed diverse systemic consequences of chronic heme deficiency. ALAS1-heterozygous (ALAS1+/−) mice develop metabolic dysfunction characterized by insulin resistance, glucose intolerance, and abnormal glycogen accumulation, linked mechanistically to reduced AMP-activated protein kinase (AMPK) signaling. These mice also exhibit pronounced mitochondrial dysfunction, impaired autophagy, and accelerated aging phenotypes, including sarcopenia and metabolic decline, highlighting heme’s role as a critical metabolic regulator. Additionally, ALAS2 heterozygosity (ALAS2+/−) leads to impaired erythropoiesis, resulting in anemia and ineffective iron utilization. Importantly, supplementation with the heme precursor 5-aminolevulinic acid (5-ALA) significantly mitigates ALAS1+/− phenotypes, restoring metabolic function, mitochondrial health, autophagy, and immune competence. This review encapsulates key findings from our group’s research together with advances made by multiple research groups over the past decade, collectively establishing heme homeostasis as a central regulator of systemic physiology and highlighting the therapeutic potential of 5-ALA in treating heme-deficient pathologies. Full article
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14 pages, 4690 KiB  
Article
Systematic Analysis of Dof Gene Family in Prunus persica Unveils Candidate Regulators for Enhancing Cold Tolerance
by Zheng Chen, Xiaojun Wang, Juan Yan, Zhixiang Cai, Binbin Zhang, Jianlan Xu, Ruijuan Ma, Mingliang Yu and Zhijun Shen
Int. J. Mol. Sci. 2025, 26(15), 7509; https://doi.org/10.3390/ijms26157509 - 4 Aug 2025
Viewed by 97
Abstract
Late-spring frost events severely damage low-chill peach blossoms, causing significant yield losses. Although 5-aminolevulinic acid (ALA) enhances cold tolerance through the PpC3H37-PpWRKY18 module, the regulatory mechanism of ALA on PpC3H37 remains to be elucidated. Using yeast one-hybrid screening with the PpC3H37 promoter as [...] Read more.
Late-spring frost events severely damage low-chill peach blossoms, causing significant yield losses. Although 5-aminolevulinic acid (ALA) enhances cold tolerance through the PpC3H37-PpWRKY18 module, the regulatory mechanism of ALA on PpC3H37 remains to be elucidated. Using yeast one-hybrid screening with the PpC3H37 promoter as bait, we identified PpDof9 as a key interacting transcription factor. A genome-wide analysis revealed 25 PpDof genes in peaches (Prunus persica). These genes exhibited variable physicochemical properties, with most proteins predicted as nuclear-localized. Subcellular localization experiments in tobacco revealed that PpDof9 was localized to the nucleus, consistent with predictions. A synteny analysis indicated nine segmental duplication pairs and tandem duplications on chromosomes 5 and 6, suggesting duplication events drove family expansion. A conserved motif analysis confirmed universal presence of the Dof domain (Motif 1). Promoter cis-element screening identified low-temperature responsive (LTR) elements in 12 PpDofs, including PpDof1, PpDof8, PpDof9, and PpDof25. The quantitative real-time PCR (qRT-PCR) results showed that PpDof1, PpDof8, PpDof9, PpDof15, PpDof16, and PpDof25 were significantly upregulated under low-temperature stress, and this upregulation was further enhanced by ALA pretreatment. Our findings demonstrate ALA-mediated modulation of specific PpDof TFs in cold response and provide candidates (PpDof1, PpDof9, PpDof8, PpDof25) for enhancing floral frost tolerance in peaches. Full article
(This article belongs to the Section Molecular Genetics and Genomics)
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21 pages, 2330 KiB  
Article
Assessing 5-Aminolevulinic Acid as a Natural Biocide Precursor for Light-Activated Eradication of Pseudomonas spp.
by Irena Maliszewska and Anna Zdubek
Int. J. Mol. Sci. 2025, 26(15), 7153; https://doi.org/10.3390/ijms26157153 - 24 Jul 2025
Viewed by 178
Abstract
Photodynamic inactivation (aPDI) involves the interaction of three components: non-toxic photosensitizer molecules (PS), low-intensity visible light, and molecular oxygen. This interaction leads to the generation of toxic reactive oxygen species. The present work demonstrated the efficacy of light-induced antimicrobial photodynamic inactivation against Pseudomonas [...] Read more.
Photodynamic inactivation (aPDI) involves the interaction of three components: non-toxic photosensitizer molecules (PS), low-intensity visible light, and molecular oxygen. This interaction leads to the generation of toxic reactive oxygen species. The present work demonstrated the efficacy of light-induced antimicrobial photodynamic inactivation against Pseudomonas aeruginosa and Pseudomonas putida using 5-aminolevulinic acid (5-ALA) as a prodrug to produce the photosensitizer protoporphyrin IX. The photoeradication efficiency of these pathogens under blue (405 nm; 45 mW cm−2) and red (635 nm; 53 mW cm−2) light was investigated. Results showed that at least 30 min of blue light irradiation was necessary to achieve a 99.999% reduction of P. aeruginosa, whereas red light was less effective. P. putida exhibited limited susceptibility under similar conditions. To enhance aPDI efficiency, exogenous glucose was added alongside 5-ALA, which significantly increased the photodynamic efficacy—particularly against P. aeruginosa—leading to complete eradication after just 5 min of exposure. Spectroscopic analyses confirmed that glucose increased the levels of protoporphyrin IX, which correlated with enhanced photodynamic efficacy. Furthermore, multiple aPDI exposure reduced key virulence factors, including alkaline protease activity, biofilm formation, and swarming motility (in P. aeruginosa). These findings suggest that 5-ALA-mediated photodynamic inactivation offers a promising strategy to improve efficacy against resistant Gram-negative pathogens. Full article
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14 pages, 2340 KiB  
Article
Oral Administration of 5-Aminolevulinic Acid Does Not Ameliorate Autoimmune Diabetes in NOD Mice
by Shinpei Nishikido, Satoru Akazawa, Tetsuro Niri, Shin-Ichi Inoue, Katsuya Matsuda, Taiki Aoshi, Masahiro Nakashima, Ai Haraguchi, Ichiro Horie, Masakazu Kobayashi, Minoru Okita, Atsushi Kawakami and Norio Abiru
Diabetology 2025, 6(7), 62; https://doi.org/10.3390/diabetology6070062 - 1 Jul 2025
Viewed by 317
Abstract
Background/Objectives: 5-Aminolevulinic acid (5-ALA) is a biosynthetic precursor of heme that induces heme oxygenase-1 (HO-1). Therapeutic induction of HO-1 has shown effectiveness in various autoimmune disease models, including type 1 diabetes (T1D). However, the efficacy of 5-ALA as an HO-1 inducer in [...] Read more.
Background/Objectives: 5-Aminolevulinic acid (5-ALA) is a biosynthetic precursor of heme that induces heme oxygenase-1 (HO-1). Therapeutic induction of HO-1 has shown effectiveness in various autoimmune disease models, including type 1 diabetes (T1D). However, the efficacy of 5-ALA as an HO-1 inducer in T1D models remains unexplored. This study aimed to investigate the therapeutic efficacy of oral 5-ALA administration in preventing autoimmune diabetes development in nonobese diabetic (NOD) mice. Methods: We evaluated diabetes incidence, levels of insulin autoantibody, and severity of insulitis in 5-ALA-treated and control NOD mice. HO-1 expression of dendritic cells in the pancreatic islets and spleen of 5-ALA-treated NOD mice was measured. The IFN-γ/IL-17 of islet-infiltrating T cells and IL-10/IL-12 productions of dendritic cells in the spleen of 5-ALA-treated NOD mice were assessed. We stimulated islet antigen-specific CD4+ T cells with islet antigen-pulsed dendritic cells in the presence of 5-ALA and examined the proliferation of the T cells. Finally, we adoptively transferred islet antigen-specific CD4+ T cells into 5-ALA-treated, immunodeficient NOD-Rag1 knockout mice, and diabetes incidence in recipients was determined. Results: Oral 5-ALA treatment did not significantly impact diabetes incidence, levels of insulin autoantibody, and insulitis. No significant difference was observed in HO-1 expression in dendritic cells and cytokine production of T cells and dendritic cells. Similarly, there was no significant difference in the proliferation of islet antigen-specific CD4+ T cells in vitro and diabetes induction in transfer experiments. Conclusions: Oral administration of 5-ALA has a limited effect on suppressing the development of autoimmune diabetes in NOD mice. Full article
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24 pages, 13737 KiB  
Article
Cold Atmospheric Plasma Improves the Therapeutic Success of Photodynamic Therapy on UV-B-Induced Squamous Cell Carcinoma in Hairless Mice
by Stephanie Arndt, Petra Unger, Irina Ivanova, Wolfgang Bäumler, Konstantin Drexler, Mark Berneburg and Sigrid Karrer
Pharmaceuticals 2025, 18(6), 907; https://doi.org/10.3390/ph18060907 - 17 Jun 2025
Viewed by 552
Abstract
Background/Objectives: Actinic keratosis (AK) occurs on sun-damaged skin and is considered a precursor to squamous cell carcinoma (SCC). Photodynamic therapy (PDT), using 5-aminolevulinic acid (ALA) and red light, is a common treatment for AK. However, its clinical efficacy for invasive tumors such as [...] Read more.
Background/Objectives: Actinic keratosis (AK) occurs on sun-damaged skin and is considered a precursor to squamous cell carcinoma (SCC). Photodynamic therapy (PDT), using 5-aminolevulinic acid (ALA) and red light, is a common treatment for AK. However, its clinical efficacy for invasive tumors such as SCC is limited by the poor penetration and distribution of the photosensitizer. Cold atmospheric plasma (CAP), a partially ionized gas, increases skin permeability and exhibits anti-cancer properties through the generation of reactive oxygen species (ROS). In a previous study, CAP showed promising synergistic effects when combined with ALA-PDT for the treatment of SCC cells in vitro. The present study investigated the effects of combining CAP with ALA-PDT on cutaneous AK and SCC induced by ultraviolet B (UV-B) irradiation in SKH1 hairless mice. Methods: We compared various application sequences (CAP-ALA–red light, ALA–red light–CAP, and ALA-CAP–red light) against conventional ALA-PDT using visual, histological, and molecular assessments of the affected skin. Results: The results demonstrated that combined treatments strongly inhibited the growth of UV-B-induced skin lesions. TUNEL staining revealed increased apoptosis following both single and combined therapies, while Ki-67 staining indicated reduced keratinocyte proliferation and diminished DNA damage in treated areas. mRNA expression analysis showed the upregulation of apoptosis-related genes (p16INK4a, p21CIP1) alongside enhanced anti-tumor immune responses (IL-6, IL-8) in the affected tissue samples. Notably, the combined treatment enhances the therapeutic effect, whereas the sequence of application does not seem to be relevant for therapeutic efficacy in vivo. Conclusions: Overall, these results suggest that CAP may enhance the anti-tumor effect of conventional ALA-PDT, supporting previous findings on SCC cells. Full article
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16 pages, 678 KiB  
Article
5-Aminolevulinic Acid Phosphate as an Immune System Enhancer Along with Vaccination Against SARS-CoV-2 Virus Infection: An Open-Label, Randomized Pilot Study
by Norbert Berenzen, Riyadh Rehani, Andrea Ebeling, Marcus Stocker and Motowo Nakajima
Life 2025, 15(6), 953; https://doi.org/10.3390/life15060953 - 13 Jun 2025
Viewed by 595
Abstract
Previous studies have shown that 5-aminolevulinic acid phosphate together with sodium ferrous citrate, which is marketed as a food supplement, appears to be an important metabolic regulator in depleted T cell metabolism. Therefore, it was hypothesized that its administration in subjects vaccinated against [...] Read more.
Previous studies have shown that 5-aminolevulinic acid phosphate together with sodium ferrous citrate, which is marketed as a food supplement, appears to be an important metabolic regulator in depleted T cell metabolism. Therefore, it was hypothesized that its administration in subjects vaccinated against COVID-19 could enhance their immune system. Therefore, the aim of our proof-of-concept study was to determine the safety (by adverse events monitoring) and the tolerability (by subject questionnaires) and to investigate immune-boosting properties (by Immunoglobulins) in which 200 subjects were randomized in a ratio of 1:1 within 2 arms. In the intervention arm, the study product was administered together with the vaccines Covishield or Covaxin, and up to 21 days thereafter with a 150 mg daily dose, whereas in the control arm, the subjects were vaccinated only. No safety issues were detected, and the evaluation of the subject questionnaires showed no limitation of the well-being, which confirms the excellent tolerability of 5-aminolevulinic acid phosphate with sodium ferrous citrate. Moreover, the ‘Change in Immunoglobulin G levels’, although statistically insignificant, showed strong signals of its immune supportive potential. However, further studies are recommended to verify the results. Full article
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16 pages, 2086 KiB  
Article
Comparative Analysis of Clinical Outcomes in High-Grade Glioma Patients: 5-ALA Fluorescence-Guided Surgery vs. Conventional White-Light Resection
by Nurzhan Ryskeldiyev, Aidos Moldabekov, Dinara Berdibayeva, Aiman Maidan, Torebek Tursynbekov, Dimash Davletov, Muratbek Tleubergenov, Assel Kabykenova, Diana Kerimbayeva, Aidos Doskaliyev and Serik Akshulakov
Cancers 2025, 17(12), 1897; https://doi.org/10.3390/cancers17121897 - 6 Jun 2025
Viewed by 976
Abstract
Background High-grade gliomas (HGGs) are aggressive brain tumors with poor prognoses. Maximizing the extent of resection (EOR) is a critical surgical goal. Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) has been proposed to enhance tumor visualization and resection. MethodsWe retrospectively analyzed 141 patients with [...] Read more.
Background High-grade gliomas (HGGs) are aggressive brain tumors with poor prognoses. Maximizing the extent of resection (EOR) is a critical surgical goal. Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) has been proposed to enhance tumor visualization and resection. MethodsWe retrospectively analyzed 141 patients with histologically confirmed HGGs who underwent either 5-ALA-guided (n = 71) or conventional white-light (n = 70) resection between 2018 and 2023. Propensity score matching and multivariate Cox regression models were used to assess the impact of 5-ALA on surgical outcomes and survival. Results: Gross total resection (GTR) was significantly more common in the 5-ALA group than the conventional white-light group (28.17% vs. 12.86%, p = 0.0245). Kaplan–Meier analysis showed no statistically significant difference in overall survival between groups after matching (log-rank p = 0.6371). However, patients with GTR had significantly improved survival compared to those with subtotal resection (log-rank p = 0.0423). Multivariate Cox regression identified radiotherapy (HR = 0.291, 95% CI: 0.166–0.513, p < 0.001), higher Karnofsky Performance Status (HR = 0.962, 95% CI: 0.942–0.982, p = 0.0003), and GTR (HR = 0.476, 95% CI: 0.272–0.834, p = 0.0091) as independent predictors of improved survival. 5-ALA usage was not an independent predictor (HR = 0.885, 95% CI: 0.554–1.413, p = 0.612). Radiotherapy and chemotherapy were more frequently administered in the conventional white-light group (p = 0.0404 and p = 0.0085, respectively). Conclusions 5-ALA fluorescence-guided surgery significantly increases the rate of gross total resection in high-grade glioma patients but does not independently confer a survival advantage. Survival outcomes are primarily influenced by the extent of resection, adjuvant therapy, and functional status. Integration of 5-ALA within a comprehensive oncological framework may enhance its clinical utility. Full article
(This article belongs to the Special Issue Research on Fluorescence-Guided Surgery in Cancer Treatment)
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20 pages, 1267 KiB  
Review
Fluorescence-Guided Surgery for Gliomas: Past, Present, and Future
by Benjamin Rodriguez, Cole S. Brown, Jhair Alejandro Colan, Jack Yin Zhang, Sakibul Huq, Daniel Rivera, Tirone Young, Tyree Williams, Varun Subramaniam and Constantinos Hadjipanayis
Cancers 2025, 17(11), 1837; https://doi.org/10.3390/cancers17111837 - 30 May 2025
Viewed by 1255
Abstract
Background/Objectives: Glioblastoma (GBM) is the most common primary malignant central nervous system tumor, accounting for 50.9% of malignant CNS diagnoses and carrying a median survival of 15 months despite maximal standard therapy. High recurrence rates are driven by residual infiltrative tumor cells [...] Read more.
Background/Objectives: Glioblastoma (GBM) is the most common primary malignant central nervous system tumor, accounting for 50.9% of malignant CNS diagnoses and carrying a median survival of 15 months despite maximal standard therapy. High recurrence rates are driven by residual infiltrative tumor cells at the resection margin. Fluorescence-guided surgery (FGS) has emerged as a key innovation to improve intraoperative tumor visualization and maximize the extent of resection (EOR). This review examines the historical development, current clinical applications, and future directions of FGS in GBM surgery. Methods: A comprehensive literature review was conducted, covering the evolution of fluorophores (fluorescein, indocyanine green [ICG], and 5-aminolevulinic acid [5-ALA]), visualization technologies (wide- and narrow-field modalities), therapeutic adjuncts (photodynamic and sonodynamic therapies), and clinical adoption patterns and outcomes. Results: Early intraoperative fluorescence using fluorescein dates to 1947. ICG angiography has broad surgical utility, while 5-ALA received FDA approval in 2017, with phase III trials demonstrating gross total resection rates of 65% versus 36% with white-light surgery. Adjunct technologies—3D exoscopes, FGS-compatible loupes, and quantitative spectroscopy probes—enhance detection of residual tumor. Preliminary studies of intraoperative photodynamic and sonodynamic therapies show feasibility and potential survival benefits. Global adoption of 5-ALA FGS exceeds 75% among surveyed neurosurgeons. Conclusions: FGS significantly improves EOR in GBM surgery, translating into better patient outcomes. Ongoing clinical trials and technological refinements—novel fluorophores, quantitative imaging, and therapeutic applications—promise to further optimize tumor visualization and treatment. Full article
(This article belongs to the Special Issue Neurosurgical Management of Gliomas)
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12 pages, 2616 KiB  
Article
Intelligent Ultrasonic Aspirator Controlled by Fiber-Optic Neoplasm Sensor Detecting 5-Aminolevulinic Acid-Derived Porphyrin Fluorescence
by Yoshinaga Kajimoto, Hidefumi Ota, Masahiro Kameda, Naosuke Nonoguchi, Motomasa Furuse, Shinji Kawabata, Toshihiko Kuroiwa, Toshihiro Takami and Masahiko Wanibuchi
Sensors 2025, 25(11), 3412; https://doi.org/10.3390/s25113412 - 28 May 2025
Viewed by 525
Abstract
The development of an intelligent ultrasonic aspirator controlled by a fiber-optic neoplasm sensor that detects 5-aminolevulinic acid-derived porphyrin fluorescence presents a significant advancement in glioma surgery. By leveraging the fluorescence phenomenon associated with 5-aminolevulinic acid in malignant neoplasms, this device integrates an excitation [...] Read more.
The development of an intelligent ultrasonic aspirator controlled by a fiber-optic neoplasm sensor that detects 5-aminolevulinic acid-derived porphyrin fluorescence presents a significant advancement in glioma surgery. By leveraging the fluorescence phenomenon associated with 5-aminolevulinic acid in malignant neoplasms, this device integrates an excitation laser and a high-sensitivity photodiode into the tip of an ultrasonic aspirator handpiece. This setup allows for real-time tumor fluorescence detection, which in turn modulates the aspirator’s power based on fluorescence intensity. Preliminary testing demonstrated high sensitivity, with the device capable of differentiating between weak, strong, and no fluorescence. The sensor sensitivity was comparable to human visual perception, enabling effective tumor differentiation. Tumors with strong fluorescence were effectively crushed, while the aspirator ceased operation in non-fluorescent areas, enabling precise tissue resection. Furthermore, the device functioned efficiently in bright surgical environments and was designed to maintain a clean sensor tip through constant saline irrigation. The system was successfully applied in a surgical case of recurrent glioblastoma, selectively removing tumor tissue while preserving surrounding brain tissue. This innovative approach shows promise for safer, more efficient glioma surgeries and may pave the way for sensor-based robotic surgical systems integrated with navigation technologies. Full article
(This article belongs to the Section Biomedical Sensors)
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12 pages, 1777 KiB  
Article
Comparison of Pyrazinamide with Isoniazid for Their Effects on the Heme Biosynthetic Pathway in Mouse Liver
by Fu-Ying Qin, Ruizhi Gu, Jiaojiao Zhang, Jaden Leigh Weiss, Jie Lu, Qing Ma and Xiaochao Ma
Metabolites 2025, 15(6), 355; https://doi.org/10.3390/metabo15060355 - 28 May 2025
Viewed by 531
Abstract
Background/Objectives: Isoniazid (INH) and pyrazinamide (PZA) are first-line drugs used to treat tuberculosis (TB), but their use is generally contraindicated in patients with porphyria, a group of metabolic disorders caused by defects in the heme biosynthetic pathway. To investigate the basis for these [...] Read more.
Background/Objectives: Isoniazid (INH) and pyrazinamide (PZA) are first-line drugs used to treat tuberculosis (TB), but their use is generally contraindicated in patients with porphyria, a group of metabolic disorders caused by defects in the heme biosynthetic pathway. To investigate the basis for these contraindications, we compared the effects of INH and PZA on the heme biosynthetic pathway in mouse liver. Method: We investigated the hepatic expression and activity of the key enzymes involved in the heme biosynthetic pathway, including aminolevulinic acid synthase 1 (Alas1) and ferrochelatase (Fech). Additionally, we employed a metabolomic approach to analyze liver and fecal samples from the mice treated with INH or PZA. Result: We found that INH, but not PZA, significantly upregulated the expression and activity of Alas1, the rate-limiting enzyme in heme biosynthesis, while concurrently downregulating Fech, which converts protoporphyrin IX (PPIX) to heme. These changes resulted in the accumulation of the toxic intermediate aminolevulinic acid (ALA) and PPIX in the liver of INH-treated mice. In contrast, PZA had no measurable effect on the expression or function of Alas1 or Fech. Conclusions: These findings provide mechanistic insight into INH-induced porphyria exacerbation and suggest that PZA may not carry the same risk, challenging its current contraindication. Full article
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23 pages, 3100 KiB  
Article
Integrated Transcriptomic and Metabolomic Analyses Reveal the Positive Effects of 5-Aminolevulinic Acid (ALA) on Shading Stress in Peanut (Arachis hypogaea L.)
by Qi Wu, Liyu Yang, Haiyan Liang, Miao Liu, Dianxu Chen and Pu Shen
Agronomy 2025, 15(5), 1211; https://doi.org/10.3390/agronomy15051211 - 16 May 2025
Viewed by 441
Abstract
Shading stress is a major negative abiotic environmental factor seriously affecting peanut growth, development, and ultimately resulting in a yield decrease in peanut in peanut/maize intercropping systems. However, 5-aminolevulinic acid (ALA) is a potential plant growth regulator that can enhance its tolerance to [...] Read more.
Shading stress is a major negative abiotic environmental factor seriously affecting peanut growth, development, and ultimately resulting in a yield decrease in peanut in peanut/maize intercropping systems. However, 5-aminolevulinic acid (ALA) is a potential plant growth regulator that can enhance its tolerance to various abiotic stresses. However, there is limited information on how ALA affects plant physiology and molecular mechanisms under shading stress. To address this, field experiments were designed involving two shading conditions (CK and AS0, no shading; S40 and AS40, 40% shading) and two ALA foliar sprayed levels (CK and S40, no ALA application; AS0 and AS40, 20 mg L−1 (0.15 mM) ALA application) to investigate the effects of the exogenous application of ALA under shading stress via the evaluation of both transcriptome and metabolome. The research results suggested that the exogenous ALA application under normal light conditions significantly enhanced photosynthesis, while exogenous ALA application could improve the stability of the cell membrane structure and biological function in response to shading stress and thereby enhance shading tolerance of the plant. The results also implied that exogenous ALA regulates the adaptability of peanuts under different light conditions by affecting the concentration of endogenous ALA. This finding improves the understanding of ALA’s regulatory molecular mechanisms and the metabolic pathways of peanuts under shading stress. Our results extend the application of ALA in agricultural production and will provide a reference for crop cultivation, especially for peanut/maize intercropping systems. Full article
(This article belongs to the Section Plant-Crop Biology and Biochemistry)
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22 pages, 1049 KiB  
Review
Agents for Fluorescence-Guided Glioblastoma Surgery
by Eleni Romeo, Andreas G. Tzakos, Timothy Crook, Nelofer Syed, Spyridon Voulgaris and George A. Alexiou
Pharmaceutics 2025, 17(5), 637; https://doi.org/10.3390/pharmaceutics17050637 - 11 May 2025
Viewed by 861
Abstract
Glioblastoma (GBM) is the most aggressive primary brain tumor, characterized by rapid progression and a median survival of no more than 12–18 months. Fluorescence-guided surgery is crucial, as it allows for tumor visualization and aids in its complete removal, which is essential for [...] Read more.
Glioblastoma (GBM) is the most aggressive primary brain tumor, characterized by rapid progression and a median survival of no more than 12–18 months. Fluorescence-guided surgery is crucial, as it allows for tumor visualization and aids in its complete removal, which is essential for improving survival rates. We conducted a literature review to identify fluorescent agents that have been utilized in the removal of GBM and to assess their benefits in achieving maximum tumor resection. Our analysis focuses on their advantages, limitations, and potential impact on improving surgical precision and patient outcomes. We searched the PubMed database for studies published on fluorescence-guided resection of GBM and evaluated the utility of each agent in terms of outcomes, gross total resection (GTR), and their sensitivity and specificity for the tumor. The literature review revealed that the three agents successfully utilized are 5-aminolevulinic acid (5-ALA), sodium fluorescein, and indocyanine green. In addition to these, a variety of dyes have been investigated in studies, including peptides, lipids, and nanosystems, which appear to be very promising. To date, numerous fluorescent agents have been proposed for the surgical resection of GBM. However, 5-aminolevulinic acid (5-ALA) remains the only agent widely adopted in clinical practice, as its safety and efficacy have been well-established. Further clinical trials and studies are necessary to assess the utility, effectiveness, and potential advantages of emerging fluorescent dyes in enhancing GBM resection and improving patient outcomes. Full article
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12 pages, 221 KiB  
Review
Comparative Analysis of 5-ALA and Fluorescent Techniques in High-Grade Glioma Treatment
by José E. Valerio, Guillermo de Jesús Aguirre Vera, Jorge Zumaeta, Noe Santiago Rea, Maria P. Fernandez Gomez, Penelope Mantilla-Farfan, Laurel Valente and Andrés M. Alvarez-Pinzon
Biomedicines 2025, 13(5), 1161; https://doi.org/10.3390/biomedicines13051161 - 10 May 2025
Cited by 1 | Viewed by 1097
Abstract
Background: 5-Aminolevulinic acid (5-ALA) serves as a precursor in the heme biosynthesis pathway, resulting in the selective accumulation of protoporphyrin IX (PpIX) within glioma cells. This property facilitates fluorescence-guided resection (FGR) in high-grade gliomas (HGGs), enhancing surgical precision and oncological results. Nonetheless, its [...] Read more.
Background: 5-Aminolevulinic acid (5-ALA) serves as a precursor in the heme biosynthesis pathway, resulting in the selective accumulation of protoporphyrin IX (PpIX) within glioma cells. This property facilitates fluorescence-guided resection (FGR) in high-grade gliomas (HGGs), enhancing surgical precision and oncological results. Nonetheless, its clinical implementation is restricted by factors such as accessibility, cost, and technical limitations. Methods: A systematic review of PubMed literature (2019–2024) was conducted to assess the efficacy of 5-ALA in HGG surgery compared to conventional white light microscopy. Studies focusing on non-neurosurgical applications, pediatric populations, and non-HGG indications were excluded. Results: Nineteen articles met the criteria. Recent studies indicate that 5-ALA-guided resection significantly enhances gross total resection (GTR) rates compared to white light surgery (75.4% vs. 54.3%, p < 0.001). Patients receiving 5-ALA-assisted resection exhibit enhanced progression-free survival (PFS) at 6 months (median 8.1 months compared to 5.4 months, p = 0.002) and overall survival (OS) (median 15.2 months versus 12.3 months, p = 0.008). The necessity for specialized neurosurgical microscopes equipped with blue light filters restricts accessibility, especially in low-resource environments. Recent advancements in fluorescence-enhancing technologies, particularly loupe-based systems, have demonstrated increases in fluorescence intensity by up to tenfold through direct emission. Sodium fluorescein, originally designed for ophthalmological use, has been adapted for enhancing contrast in intracranial tumors; however, its non-specific binding to serum albumin restricts its accuracy in glioma resection. Conclusions: Recent publications demonstrate that 5-ALA fluorescence-guided surgery significantly improves gross total resection rates and survival outcomes in patients with high-grade gliomas. Although it offers clinical advantages, cost and equipment constraints continue to pose substantial obstacles to broad implementation. Additional research is required to enhance fluorescence-guided techniques and increase accessibility in resource-constrained environments. Full article
(This article belongs to the Special Issue Advanced Cancer Diagnosis and Treatment: Second Edition)
14 pages, 1494 KiB  
Article
Dietary 5-Aminolevulinic Acid Alleviates Heat Stress-Induced Renal Injury in Laying Hens by Improving Mitochondrial Quality and Enhancing Antioxidant Activity
by Fumika Nanto-Hara and Haruhiko Ohtsu
Antioxidants 2025, 14(5), 556; https://doi.org/10.3390/antiox14050556 - 7 May 2025
Viewed by 677
Abstract
This study aimed to evaluate the effects of dietary 5-aminolevulinic acid (ALA) on laying hens to alleviate chronic heat stress-induced renal damage, resulting in improved egg productivity and eggshell quality. A total of 57 white-leghorn laying hens (46 weeks old) were randomly assigned [...] Read more.
This study aimed to evaluate the effects of dietary 5-aminolevulinic acid (ALA) on laying hens to alleviate chronic heat stress-induced renal damage, resulting in improved egg productivity and eggshell quality. A total of 57 white-leghorn laying hens (46 weeks old) were randomly assigned to three groups and fed three experimental diets with different levels of ALA (0, 10, and 100 ppm) for 1 week. The birds in each group were then divided into two subgroups; one of the two subgroups was subjected to heat stress (33 °C for 3 weeks), whereas the other group was maintained at 24 °C. Heat exposure significantly decreased the laying rate and eggshell strength and caused renal damage, whereas ALA supplementation alleviated heat-induced poor productivity and renal damage. ALA increased the renal mitochondrial DNA copy number and downregulated the expression of the cGAS-STING pathway-related genes in the kidneys of heat-stressed hens. Furthermore, ALA upregulated the renal expression levels of NRF2 and HO-1, whereas it downregulated those of NF-κB and tended to decrease the content of TBARS in the kidney (p = 0.07). Dietary ALA confers a renal protective effect by reducing heat-induced mitochondrial damage and enhancing antioxidant activity, which may contribute to improved productivity under chronic heat stress. Full article
(This article belongs to the Special Issue Novel Antioxidants for Animal Nutrition—2nd Edition)
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19 pages, 1679 KiB  
Review
Sonodynamic Therapy Using 5-Aminolevulinic Acid for Malignant Gliomas: A Review
by Andrea Ebeling and Francesco Prada
Life 2025, 15(5), 718; https://doi.org/10.3390/life15050718 - 29 Apr 2025
Viewed by 1573
Abstract
In recent years, sonodynamic therapy (SDT) has attracted attention as a promising new approach for the treatment of high-grade gliomas, as it is a non-invasive form of therapy that specifically kills tumor cells with limited side effects. SDT combines low-intensity ultrasound with a [...] Read more.
In recent years, sonodynamic therapy (SDT) has attracted attention as a promising new approach for the treatment of high-grade gliomas, as it is a non-invasive form of therapy that specifically kills tumor cells with limited side effects. SDT combines low-intensity ultrasound with a sonosensitizer to produce cytotoxic effects in tumor cells. 5-Aminolevulinic acid (5-ALA), an endogenous amino acid that is metabolized to protoporphyrin IX (PpIX), has shown promise as a sonosensitizer for malignant gliomas in SDT. Ultrasound can penetrate deeper body regions and activate PpIX, leading to an increase in tumor immunogenicity and induction of apoptosis. This review highlights the current state of knowledge on the mechanisms of action, the results of preclinical, clinical and ongoing studies on 5-ALA-SDT in malignant gliomas, and discusses the future benefits of SDT. Full article
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