Treatment of viral infections with 5-aminolevulinic acid and light

Background and Objective: When 5-aminolevulinic acid (ALA) is exogenously supplied, protoporphyrin IX (PpIX) is accumulated in various cells and makes them light sensitive. The possibility of using such an approach for the treatment of vital infections was studied in this work. Study Design/Materials and Methods: ALA was added to cultured cells infected with human immunodeficiency virus (HIV). Accumulation of PpIX in the cells as well as virus infectivity after photodynamic treatment (PDT) were assessed. For in vivo studies, guinea pigs were infected with herpes simplex virus (HSV) and then administered ALA at intervals after infection. The animals were exposed to PDT at the site of infection 3 hours after ALA administration. Clinical observations and virus titration were made daily. For clinical studies, two patients with Molluscum contagiosum and Verrucae vulgares were treated with ALA fortified with an iron chelating agent and dimethyl-sulfoxide, followed 4 hours later by PDT. Results: Cells that are infected with HIV accumulated PpIX upon addition of ALA in vitro. This accumulation was enhanced ~two-fold in the presence of an iron chelator. Subsequent exposure to red light PDT drastically reduced the virus titer (> 99% for U1 cells latently infected with HIV). In guinea pigs infected with HSV, subsequent administration of ALA and exposure of the lesions to red light shortened the duration of vesicles' appearance from more than a week to a few days and reduced HSV titer in the lesions by ≤ 5 log₁₀. ALA-PDT treated AIDS patient suffering from Molluscum cotagiosum or a kidney transplant patient with Verrucae vulgares showed greatly improved clinical symptoms one month after treatment. Conclusion: It is concluded that ALA-PDT could be effective in treating certain viral infections, particularly those resulting in warts.