Mouse sarcoma 180 or rat ascites hepatoma (AH) 130 cells were exposed to ultrasound (US; 1.27, 2.21 and 3.18 W/cm2; 1.92 MHz) for up to 60 s in vitro in the presence or absence of hematoporphyrin (Hp; 10, 25 and 50 μg/ml). The cell‐damaging effects of treatments were determined by means of the Trypan Blue dye exclusion test. Hp alone did not show any cell‐damaging effect, whereas US alone damaged 30 and 50% of sarcoma and AH 130 cells, respectively, at the maximum intensity for 60 s. In the presence of 50 μg/ml Hp, US damaged 99 and 95% of the above tumor cells, respectively. These results show that Hp increased the sensitivity of tumor cells to US.

The mechanism of cell damage by ultrasound in combination with hematoporphyrin was studied. Mouse sarcoma 180 cell suspensions were exposed to ultrasound for up to 60 s in the presence and absence of hematoporphyrin, with and without active oxygen scavengers. The cell damage enhancement by hematoporphyrin was suppressed by adding histidine but not by mannitol. The enhancement was doubled in rate by substitution of deuterium oxide medium for normal water. Sonoluminescence was produced in a saline solution under similar acoustic conditions and observed to have spectral components that can excite hematoporphyrin molecules. These results suggest that cell damage enhancement is probably mediated via singlet oxygen generated by ultrasonically activated hematoporphyrin.

Enhancement of ultrasonically induced cell damage by a gallium‐porphyrin complex [ATX‐70, 2,4‐ bis(l‐decyloxyethyl)‐Ga(III)‐1,3,5,8‐tetramethylporphyrin‐6,7‐dipropionyl diaspartic acid] was investigated. The rate of damage to isolated sarcoma 180 cells in air‐saturated suspension induced by 2 MHz ultrasound irradiation was enhanced more than four times by 80 μM ATX‐70 in contrast to only twice by the same concentration of hematoporphyrin (Hp). The enhancement was almost completely inhibited in the presence of 10 mM histidine in the suspension, but not at all by 100 mM mannitol, which suggests that the enhanced cell damage was mostly mediated by singlet oxygen. Ultrasonically induced active oxygen generation in an air‐saturated aqueous solution of ATX‐70 was studied by detecting the electron spin resonance signals of 2,2,6,6,‐tetramethyl‐4‐piperidone‐N‐oxyl produced by the reaction of 2,2,6,6‐tetramethyl‐4‐piperidone with the generated active oxygen species. The rate of ultrasonically induced nitroxide generation was enhanced five times by 80 μM ATX‐70 in contrast to only twice by Hp. The enhancement was inhibited significantly in the presence of 10 mM histidine in the suspension, but not at all by 100 mM mannitol. The singlet oxygen generation in air‐saturated aqueous solution was further confirmed by the bleaching of N, N‐dimethyl‐4‐nitrosoaniline in the presence of imidazole. The ultrasonically induced bleaching rate was enhanced six times by ATX‐70, in contrast to only twice by Hp.

The antitumor effects of combined use of ultrasound (US) and a photosensitizer, hematoporphyrin (Hp), were determined in mice bearing sarcoma 180. In order to find the optimum timing of the US irradiation after the administration of Hp, the Hp concentrations in the tumor and in the plasma were determined and were analyzed pharmacokinetically. Antitumor effects were evaluated by measuring the tumor size and the tumor weight. Hp alone showed no antitumor effect but US alone showed a slight antitumor effect. The combined treatment with US and Hp showed marked synergistic effects on sarcoma 180 (inhibition ratio was 74% of the control). From these results, the enhancement of antitumor effect is thought to be caused by the sensitization of tumor cells to US mediated by Hp.

We studied a combination of photodynamic therapy (PDT) and sonodynamic therapy (SDT) for improving tumoricidal effects in a transplantable mouse squamous cell carcinoma (SCC) model. Two sensitizers were utilized: the pheophorbide-a derivative PH-1126, which is a newly developed photosensitizer, and the gallium porphyrin analogue ATX-70, a commonly used sonosensitizer. Mice were injected with either PH-1126 or ATX-70 i.p. at doses of 5 or 10 mg/kg.bw. At 24 (ATX-70) or 36 hr (PH-1126) (time of optimum drug concentration in the tumor) after injection, SCCs underwent laser light irradiation (88 J/cm2 of 575 nm for ATX-70; 44J/cm2 of 650 nm for PH-1126) (PDT), ultrasound irradiation (0.51 W/cm2 at 1.0 MHz for 10 minutes) (SDT), or a combination of the two treatments. The combination of PDT and SDT using either PH-1126 or ATX-70 as a sensitizer resulted in significantly improved inhibition of tumor growth (92-98%) (additive effect) as compared to either single treatment (27-77%). The combination using PH-1126 resulted in 25% of the treated mice being tumor free at 20 days after treatment. Moreover, the median survival period (from irradiation to death) of PDT + SDT-treated mice (> 120 days) was significantly greater than that in single treatment groups (77-95 days). Histological changes revealed that combination therapy could induce tumor necrosis 2-3 times as deep as in either of the single modalities. The combination of PDT and SDT could be very useful for treatment of non-superficial or nodular tumors.

In this study, we investigated the induction of apoptosis by ultrasound in the presence of the novel porphyrin derivative DCPH-P-Na(I). HL-60 cells were exposed to ultrasound for up to 3 min in the presence and absence of DCPH-P-Na(I), and the induction of apoptosis was examined by analyzing cell morphology, DNA fragmentation, and caspase-3 activity. Reactive oxygen species were measured by means of ESR and spin trapping technique. Cells treated with 8 μM DCPH-P-Na(I) and ultrasound clearly showed membrane blebbing and cell shrinkage, whereas significant morphologic changes were not observed in cells exposed to either ultrasound or DCPH-P-Na(I) alone. Also, DNA ladder formation and caspase-3 activation were observed in cells treated with both ultrasound and DCPH-P-Na(I) but not in cells treated with ultrasound or DCPH-P-Na(I) alone. In addition, the combination of DCPH-P-Na(I) and the same acoustical arrangement of ultrasound substantially enhanced nitroxide generation by the cells. Sonodynamically induced apoptosis, caspase-3 activation, and nitroxide generation were significantly suppressed by histidine. These results indicate that the combination of ultrasound and DCPH-P-Na(I) induced apoptosis in HL-60 cells. The significant reduction in sonodynamically induced apoptosis, nitroxide generation, and caspase-3 activation by histidine suggests active species such as singlet oxygen are important in the sonodynamic induction of apoptosis. These experimental results support the possibility of sonodynamic treatment for cancer using the induction of apoptosis.

The Sonodynamically induced antitumor effect of a gallium‐porphyrin complex, ATX‐70, was evaluated in mice bearing colon 26. In order to find the optimum timing for the ultrasonic exposure after the administration of ATX‐70, the ATX‐70 concentrations in the plasma, skin, and tumor were measured and analyzed. Antitumor effect was estimated by measuring the tumor size. When used alone, ultrasound showed a slight antitumor effect, which became increasingly significant as the dose of ATX‐70 was increased, while use of ATX‐70 alone had no significant effect. At an ATX‐70 dose of 2.5 mg/kg or higher, the average tumor size decreased to smaller than a half by three days after the ultrasonic exposure. This was smaller than a third of the size of the untreated tumors on the same day. From these results, it is concluded that ATX‐70 significantly sensitizes tumors to ultrasound, demonstrating a synergistic antitumor effect.

The sonodynamically induced antitumor effect of Photofrin II (PF), was evaluated in mice bearing colon 26 carcinoma. In order to find the optimum timing for ultrasonic exposure after the administration of PF, the PF concentrations in the plasma, skin, muscle, and tumor were measured. The antitumor effect was estimated by measuring the tumor size. Since the highest concentration of PF in the tumor was observed 24 h after administration, an ultrasonic exposure timing of 24 h after the intravenous administration of PF was chosen. When used alone, ultrasound showed a slight antitumor effect, which became increasingly significant as the dose of PF was increased, while use of PF alone showed no significant effect. From these results, it is concluded that PF significantly sensitizes solid tumors to ultrasound, demonstrating a synergistic antitumor effect.