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Protoporfirin IX ve Sono-Fotodinamik Terapi ile HepG2 Karaciğer Kanseri Hücrelerinde Apoptozun Sinerjistik Artışı

Yıl 2026, Cilt: 48 Sayı: 1, 13 - 22, 15.12.2025
https://doi.org/10.20515/otd.1752148

Öz

Hepatoselüler karsinom (HSK), ileri evrelerde etkili tedavilerden yoksundur. Bu çalışma, Protoporfirin IX (PpIX) aracılı sonodinamik (SDT), fotodinamik (PDT) ve kombine sono-fotodinamik terapinin (SPDT) HepG2 hücreleri üzerindeki sitotoksik ve pro-apoptotik etkilerini değerlendirmeyi amaçlamıştır. HepG2 hücreleri, 50 µM PpIX ile tek başına veya SDT (1 MHz, 0.5 W/cm², 60 s), PDT (630 nm, 2 mJ/cm², 30 s) ya da ardışık SPDT ile kombine edilerek muamele edildi. Canlılık (MTT), oksidatif stres (TOC, TAC), apoptoz (Annexin V-FITC/PI boyaması) ve apoptotik protein ekspresyonu (Western blot ile Bax, Bcl-2, kesilmiş kaspaz-3, -9) değerlendirildi. Tek başına PpIX sitotoksisite göstermedi (p > 0,05). SDT ve PDT, canlılığı sırasıyla %24,33 (p < 0,05) ve %43,33 (p < 0,01) oranında anlamlı olarak azaltırken, SPDT canlılığı %83,33 (p < 0,001) oranında azalttı. TOC seviyeleri SDT ve PDT gruplarında anlamlı şekilde arttı (p < 0,01) ve SPDT grubunda en yüksek seviyeye ulaştı (p < 0,001). Apoptoz oranları en yüksek SPDT ile elde edildi (tüm gruplara karşı p < 0,001). SPDT, Bax ve kesilmiş kaspazların ekspresyonunu belirgin şekilde artırırken, Bcl-2'yi düşürdü (p < 0,001). PpIX aracılı SPDT, HepG2 hücrelerinde artırılmış oksidatif stres ve mitokondriyal apoptoz yolaklarının aktivasyonu yoluyla sinerjistik sitotoksisite indüklemektedir. Bu bulgular, SPDT'nin HSK tedavisi için umut verici bir strateji olduğunu ve daha ileri preklinik araştırmaları gerektirdiğini göstermektedir.

Kaynakça

  • 1. Yang Z, Leng K, Shi G. Causes of death among patients with hepatocellular carcinoma in United States from 2000 to 2018. Cancer Medicine. 2023;12(12):13076-85.
  • 2. Ding Z, Wang L, Sun J, Zheng L, Tang Y, Tang H. Hepatocellular carcinoma: pathogenesis, molecular mechanisms, and treatment advances. Frontiers in Oncology. 2025;15:1526206.
  • 3. Papaconstantinou D, Tsilimigras DI, Pawlik TM. Recurrent hepatocellular carcinoma: patterns, detection, staging and treatment. Journal of hepatocellular carcinoma. 2022:947-57.
  • 4. Zafar A, Khatoon S, Khan MJ, Abu J, Naeem A. Advancements and limitations in traditional anti-cancer therapies: a comprehensive review of surgery, chemotherapy, radiation therapy, and hormonal therapy. Discover oncology. 2025;16(1):607.
  • 5. Yan P, Liu L-H, Wang P. Sonodynamic therapy (SDT) for cancer treatment: advanced sensitizers by ultrasound activation to injury tumor. ACS applied bio materials. 2020;3(6):3456-75.
  • 6. Lin X, Song J, Chen X, Yang H. Ultrasound‐activated sensitizers and applications. Angewandte Chemie International Edition. 2020;59(34):14212-33.
  • 7. Ding Y, Pan Q, Gao W, Pu Y, Luo K, He B. Reactive oxygen species-upregulating nanomedicines towards enhanced cancer therapy. Biomaterials Science. 2023;11(4):1182-214.
  • 8. Gunaydin G, Gedik ME, Ayan S. Photodynamic therapy—current limitations and novel approaches. Frontiers in Chemistry. 2021;9:691697.
  • 9. Ayala ETP. Analysis of sono-photodynamic effects with PpIX-in Vitro and in vivo studies: Universidade de São Paulo; 2020.
  • 10. Kiening M, Lange N. A recap of heme metabolism towards understanding protoporphyrin IX selectivity in cancer cells. International Journal of Molecular Sciences. 2022;23(14):7974.
  • 11. Allegra A, Pioggia G, Tonacci A, Musolino C, Gangemi S. Oxidative stress and photodynamic therapy of skin cancers: Mechanisms, challenges and promising developments. Antioxidants. 2020;9(5):448.
  • 12. Yang F, Xu M, Chen X, Luo Y. Spotlight on porphyrins: Classifications, mechanisms and medical applications. Biomedicine & Pharmacotherapy. 2023;164:114933.
  • 13. Ebrahimi S, Ghadiri MK, Stummer W, Gorji A. Enhancing 5-ALA-PDT efficacy against resistant tumor cells: Strategies and advances. Life Sciences. 2024:122808.
  • 14. Yavaş A, Kesmez Ö, Demir F, Aksel M. Synergistic Cytotoxicity of Nano-titanium Dioxide and Phthalocyanine on HepG2 Cells via Sonophotodynamic Therapy. Biological Trace Element Research. 2025:1-13.
  • 15. Singal AG, Kanwal F, Llovet JM. Global trends in hepatocellular carcinoma epidemiology: implications for screening, prevention and therapy. Nature reviews Clinical oncology. 2023;20(12):864-84.
  • 16. Yeo YH, Abdelmalek M, Khan S, Moylan CA, Rodriquez L, Villanueva A, et al. Current and emerging strategies for the prevention of hepatocellular carcinoma. Nature Reviews Gastroenterology & Hepatology. 2025;22(3):173-90.
  • 17. Fiorito V, Chiabrando D, Petrillo S, Bertino F, Tolosano E. The multifaceted role of heme in cancer. Frontiers in oncology. 2020;9:1540.
  • 18. de Oliveira Miguel J, da Silva DB, da Silva GCC, Corrêa RJ, de Oliveira Miguel NC, Lione VdOF, et al. Polymeric nanoparticles favor the in vitro dermal accumulation of Protoporphyrin IX (PpIX) with optimal biocompatibility and cellular recovery in culture of healthy dermal fibroblasts after Photodynamic Therapy. Journal of Photochemistry and Photobiology A: Chemistry. 2020;386:112109.
  • 19. Krieg RC, Messmann H, Schlottmann K, Endlicher E, Seeger S, Schölmerich J, et al. Intracellular Localization is a Cofactor for the Phototoxicity of Protoporphyrin IX in the Gastrointestinal Tract: In Vitro Study¶. Photochemistry and photobiology. 2003;78(4):393-9.
  • 20. Zhang J, Yuan S, Fan M, Wang K, Guo J, Zang A, et al. Photodynamic anticancer activity evaluation of novel 5-aminolevulinic acid and 3-hydroxypyridinone conjugates. Bioorganic & Medicinal Chemistry. 2024;105:117726.
  • 21. Ding H, Sumer BD, Kessinger CW, Dong Y, Huang G, Boothman DA, et al. Nanoscopic micelle delivery improves the photophysical properties and efficacy of photodynamic therapy of protoporphyrin IX. Journal of Controlled Release. 2011;151(3):271-7.
  • 22. Wang M, Geilich BM, Keidar M, Webster TJ. Killing malignant melanoma cells with protoporphyrin IX-loaded polymersome-mediated photodynamic therapy and cold atmospheric plasma. International journal of nanomedicine. 2017:4117-27.
  • 23. An X, Yu W, Liu J, Tang D, Yang L, Chen X. Oxidative cell death in cancer: Mechanisms and therapeutic opportunities. Cell Death & Disease. 2024;15(8):556.
  • 24. Maharjan PS, Bhattarai HK. Singlet oxygen, photodynamic therapy, and mechanisms of cancer cell death. Journal of oncology. 2022;2022(1):7211485.
  • 25. Wang P, Wang X, Zhang K, Gao K, Song M, Liu Q. The spectroscopy analyses of PpIX by ultrasound irradiation and its sonotoxicity in vitro. Ultrasonics. 2013;53(5):935-42.
  • 26. Liu X, Pan X, Wang C, Liu H. Modulation of reactive oxygen species to enhance sonodynamic therapy. Particuology. 2023;75:199-216.
  • 27. He J, Liu Z, Zhu X, Xia H, Gao H, Lu J. Ultrasonic microbubble cavitation enhanced tissue permeability and drug diffusion in solid tumor therapy. Pharmaceutics. 2022;14(8):1642.
  • 28. Zhu K, Wang J, Wang Z, Chen Q, Song J, Chen X. Ultrasound‐Activated Theranostic Materials and Their Bioapplications. Angewandte Chemie International Edition. 2025;64(22):e202422278.
  • 29. Xu Y, Liu R, Yang H, Qu S, Qian L, Dai Z. Enhancing photodynamic therapy efficacy against cancer metastasis by ultrasound-mediated oxygen microbubble destruction to boost tumor-targeted delivery of oxygen and renal-clearable photosensitizer micelles. ACS Applied Materials & Interfaces. 2022;14(22):25197-208.
  • 30. Merlin JJ, Crous A, Abrahamse H. Combining Photodynamic Therapy and Targeted Drug Delivery Systems: Enhancing Mitochondrial Toxicity for Improved Cancer Outcomes. International journal of molecular sciences. 2024;25(19):10796.

Synergistic Enhancement of Apoptosis by Protoporphyrin IX-Mediated Sono-Photodynamic Therapy in HepG2 Hepatocellular Carcinoma Cells

Yıl 2026, Cilt: 48 Sayı: 1, 13 - 22, 15.12.2025
https://doi.org/10.20515/otd.1752148

Öz

Hepatocellular carcinoma (HCC) lacks effective therapies at advanced stages. This study aimed to evaluate the cytotoxic and pro-apoptotic effects of Protoporphyrin IX (PpIX)-mediated sonodynamic (SDT), photodynamic (PDT), and combined sono-photodynamic therapy (SPDT) on HepG2 cells. HepG2 cells were treated with 50 µM PpIX alone or combined with SDT (1 MHz, 0.5 W/cm², 60 s), PDT (630 nm, 2 mJ/cm², 30 s), or sequential SPDT. Viability (MTT), oxidative stress (TOC, TAC), apoptosis (Annexin V-FITC/PI staining), and apoptotic protein expression (Bax, Bcl-2, cleaved caspase-3, -9 via Western blot) were assessed.PpIX alone showed no cytotoxicity (p > 0.05). SDT and PDT significantly reduced viability by 24.33% (p < 0.05) and 43.33% (p < 0.01), respectively, while SPDT reduced it by 83.33% (p < 0.001). TOC levels increased significantly in SDT and PDT groups (p < 0.01), peaking in SPDT (p < 0.001). Apoptosis rates were highest with SPDT (p < 0.001 vs. all). SPDT markedly upregulated Bax and cleaved caspases while downregulating Bcl-2 (p < 0.001).PpIX-mediated SPDT induces synergistic cytotoxicity in HepG2 cells through enhanced oxidative stress and activation of mitochondrial apoptosis pathways. These findings suggest SPDT as a promising strategy for HCC treatment, warranting further preclinical investigation.

Etik Beyan

As our research utilises a commercially available cancer cell line, approval by an ethics committee is not necessary.

Teşekkür

This investigation was conducted without financial assistance from any governmental, commercial, or non-profit entities. We extend our sincere appreciation to the Agricultural Biotechnology and Food Safety Application and Research Center (TARBIYOMER) at Aydin Adnan Menderes University for granting access to their state-of-the-art facilities, which were instrumental in executing the analytical components of this research project.

Kaynakça

  • 1. Yang Z, Leng K, Shi G. Causes of death among patients with hepatocellular carcinoma in United States from 2000 to 2018. Cancer Medicine. 2023;12(12):13076-85.
  • 2. Ding Z, Wang L, Sun J, Zheng L, Tang Y, Tang H. Hepatocellular carcinoma: pathogenesis, molecular mechanisms, and treatment advances. Frontiers in Oncology. 2025;15:1526206.
  • 3. Papaconstantinou D, Tsilimigras DI, Pawlik TM. Recurrent hepatocellular carcinoma: patterns, detection, staging and treatment. Journal of hepatocellular carcinoma. 2022:947-57.
  • 4. Zafar A, Khatoon S, Khan MJ, Abu J, Naeem A. Advancements and limitations in traditional anti-cancer therapies: a comprehensive review of surgery, chemotherapy, radiation therapy, and hormonal therapy. Discover oncology. 2025;16(1):607.
  • 5. Yan P, Liu L-H, Wang P. Sonodynamic therapy (SDT) for cancer treatment: advanced sensitizers by ultrasound activation to injury tumor. ACS applied bio materials. 2020;3(6):3456-75.
  • 6. Lin X, Song J, Chen X, Yang H. Ultrasound‐activated sensitizers and applications. Angewandte Chemie International Edition. 2020;59(34):14212-33.
  • 7. Ding Y, Pan Q, Gao W, Pu Y, Luo K, He B. Reactive oxygen species-upregulating nanomedicines towards enhanced cancer therapy. Biomaterials Science. 2023;11(4):1182-214.
  • 8. Gunaydin G, Gedik ME, Ayan S. Photodynamic therapy—current limitations and novel approaches. Frontiers in Chemistry. 2021;9:691697.
  • 9. Ayala ETP. Analysis of sono-photodynamic effects with PpIX-in Vitro and in vivo studies: Universidade de São Paulo; 2020.
  • 10. Kiening M, Lange N. A recap of heme metabolism towards understanding protoporphyrin IX selectivity in cancer cells. International Journal of Molecular Sciences. 2022;23(14):7974.
  • 11. Allegra A, Pioggia G, Tonacci A, Musolino C, Gangemi S. Oxidative stress and photodynamic therapy of skin cancers: Mechanisms, challenges and promising developments. Antioxidants. 2020;9(5):448.
  • 12. Yang F, Xu M, Chen X, Luo Y. Spotlight on porphyrins: Classifications, mechanisms and medical applications. Biomedicine & Pharmacotherapy. 2023;164:114933.
  • 13. Ebrahimi S, Ghadiri MK, Stummer W, Gorji A. Enhancing 5-ALA-PDT efficacy against resistant tumor cells: Strategies and advances. Life Sciences. 2024:122808.
  • 14. Yavaş A, Kesmez Ö, Demir F, Aksel M. Synergistic Cytotoxicity of Nano-titanium Dioxide and Phthalocyanine on HepG2 Cells via Sonophotodynamic Therapy. Biological Trace Element Research. 2025:1-13.
  • 15. Singal AG, Kanwal F, Llovet JM. Global trends in hepatocellular carcinoma epidemiology: implications for screening, prevention and therapy. Nature reviews Clinical oncology. 2023;20(12):864-84.
  • 16. Yeo YH, Abdelmalek M, Khan S, Moylan CA, Rodriquez L, Villanueva A, et al. Current and emerging strategies for the prevention of hepatocellular carcinoma. Nature Reviews Gastroenterology & Hepatology. 2025;22(3):173-90.
  • 17. Fiorito V, Chiabrando D, Petrillo S, Bertino F, Tolosano E. The multifaceted role of heme in cancer. Frontiers in oncology. 2020;9:1540.
  • 18. de Oliveira Miguel J, da Silva DB, da Silva GCC, Corrêa RJ, de Oliveira Miguel NC, Lione VdOF, et al. Polymeric nanoparticles favor the in vitro dermal accumulation of Protoporphyrin IX (PpIX) with optimal biocompatibility and cellular recovery in culture of healthy dermal fibroblasts after Photodynamic Therapy. Journal of Photochemistry and Photobiology A: Chemistry. 2020;386:112109.
  • 19. Krieg RC, Messmann H, Schlottmann K, Endlicher E, Seeger S, Schölmerich J, et al. Intracellular Localization is a Cofactor for the Phototoxicity of Protoporphyrin IX in the Gastrointestinal Tract: In Vitro Study¶. Photochemistry and photobiology. 2003;78(4):393-9.
  • 20. Zhang J, Yuan S, Fan M, Wang K, Guo J, Zang A, et al. Photodynamic anticancer activity evaluation of novel 5-aminolevulinic acid and 3-hydroxypyridinone conjugates. Bioorganic & Medicinal Chemistry. 2024;105:117726.
  • 21. Ding H, Sumer BD, Kessinger CW, Dong Y, Huang G, Boothman DA, et al. Nanoscopic micelle delivery improves the photophysical properties and efficacy of photodynamic therapy of protoporphyrin IX. Journal of Controlled Release. 2011;151(3):271-7.
  • 22. Wang M, Geilich BM, Keidar M, Webster TJ. Killing malignant melanoma cells with protoporphyrin IX-loaded polymersome-mediated photodynamic therapy and cold atmospheric plasma. International journal of nanomedicine. 2017:4117-27.
  • 23. An X, Yu W, Liu J, Tang D, Yang L, Chen X. Oxidative cell death in cancer: Mechanisms and therapeutic opportunities. Cell Death & Disease. 2024;15(8):556.
  • 24. Maharjan PS, Bhattarai HK. Singlet oxygen, photodynamic therapy, and mechanisms of cancer cell death. Journal of oncology. 2022;2022(1):7211485.
  • 25. Wang P, Wang X, Zhang K, Gao K, Song M, Liu Q. The spectroscopy analyses of PpIX by ultrasound irradiation and its sonotoxicity in vitro. Ultrasonics. 2013;53(5):935-42.
  • 26. Liu X, Pan X, Wang C, Liu H. Modulation of reactive oxygen species to enhance sonodynamic therapy. Particuology. 2023;75:199-216.
  • 27. He J, Liu Z, Zhu X, Xia H, Gao H, Lu J. Ultrasonic microbubble cavitation enhanced tissue permeability and drug diffusion in solid tumor therapy. Pharmaceutics. 2022;14(8):1642.
  • 28. Zhu K, Wang J, Wang Z, Chen Q, Song J, Chen X. Ultrasound‐Activated Theranostic Materials and Their Bioapplications. Angewandte Chemie International Edition. 2025;64(22):e202422278.
  • 29. Xu Y, Liu R, Yang H, Qu S, Qian L, Dai Z. Enhancing photodynamic therapy efficacy against cancer metastasis by ultrasound-mediated oxygen microbubble destruction to boost tumor-targeted delivery of oxygen and renal-clearable photosensitizer micelles. ACS Applied Materials & Interfaces. 2022;14(22):25197-208.
  • 30. Merlin JJ, Crous A, Abrahamse H. Combining Photodynamic Therapy and Targeted Drug Delivery Systems: Enhancing Mitochondrial Toxicity for Improved Cancer Outcomes. International journal of molecular sciences. 2024;25(19):10796.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Eczacılık Biyokimyası, Farmasotik Toksikoloji, Tıbbi Farmakoloji
Bölüm Araştırma Makalesi
Yazarlar

Adem Yavaş 0000-0003-3506-4306

Mehran Aksel 0000-0002-3942-2257

Gönderilme Tarihi 27 Temmuz 2025
Kabul Tarihi 1 Ekim 2025
Yayımlanma Tarihi 15 Aralık 2025
Yayımlandığı Sayı Yıl 2026 Cilt: 48 Sayı: 1

Kaynak Göster

Vancouver Yavaş A, Aksel M. Synergistic Enhancement of Apoptosis by Protoporphyrin IX-Mediated Sono-Photodynamic Therapy in HepG2 Hepatocellular Carcinoma Cells. Osmangazi Tıp Dergisi. 2025;48(1):13-22.


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