Sexually Transmitted Disease Unit, Department of Dermatological Sciences, University of Florence, Villa S. Chiara, Piazza dell'Indipendenza 11 50129 Florence, Italy.
Br J Dermatol. 2011 Feb;164(2):448-51. doi: 10.1111/j.1365-2133.2010.10089.x.
An increasing body of evidence supports the usefulness of photodynamic therapy (PDT) in the treatment of non-neoplastic pathological conditions, including genital warts. In particular, PDT has demonstrated good clinical cure rates and low recurrence, and is now suggested as a safe alternative means of treating condylomata.
To confirm the suitability of aminolaevulinic acid (ALA)-PDT for the treatment of this condition and to investigate the recruitment and significance of immune cells in lesional areas by immunohistochemical analysis at different time intervals after treatment.
Fifteen subjects with histologically proven, recalcitrant condylomata acuminata of the penis, urethra, vulva or perianal area underwent several cycles of PDT following ALA application. Biopsies were taken at baseline and at different intervals during the trial, and infiltrating immune cells, CD3, CD4, CD8, CD1a and CD68, were evaluated by double immunocytochemical alkaline phosphatase antialkaline phosphatase (APAAP) staining.
Our trial provided a complete cure rate of nine of 15 subjects after five PDT sessions. Perianal lesions showed a particularly rapid remission. While progressing towards total lesion clearance, the immunohistochemical pattern was dominated by dense CD4+ T lymphocytes infiltrating the superficial dermis, accompanied by an accumulation of Langerhans cells. Simultaneously, CD8 began to increase in the lesions of responding patients, and Langerhans cells seemed to migrate towards the dermis. CD68+ macrophages apparently did not participate in the immune inflammatory response.
This study, to the best of our knowledge, represents the first attempt to clarify the effect of ALA-PDT on infiltrating immune cells in condylomata acuminata. Our results appear to confirm previously reported clinical data, suggesting that rapid activation of specific immunity in lesional skin, CD4+ T lymphocytes and dendritic cells could be responsible for healing.
越来越多的证据支持光动力疗法（PDT）在治疗非肿瘤性病理状况中的有效性，包括生殖器疣。特别是，PDT 已显示出良好的临床治愈率和低复发率，并且现在被建议作为治疗尖锐湿疣的安全替代方法。
通过免疫组织化学分析在治疗后不同时间点，确认氨基酮戊酸（ALA）-PDT 治疗该疾病的适宜性，并研究病变区域募集和免疫细胞的意义。
15 名经组织学证实的、难治性生殖器尖锐湿疣的阴茎、尿道、外阴或肛周区域的患者，在接受 ALA 治疗后进行了几个周期的 PDT。在基线和试验期间的不同时间点进行活检，并通过双免疫细胞化学碱性磷酸酶抗碱性磷酸酶（APAAP）染色评估浸润性免疫细胞、CD3、CD4、CD8、CD1a 和 CD68。
我们的试验在五次 PDT 治疗后为 15 名患者中的 9 名提供了完全治愈率。肛周病变的缓解特别迅速。在朝着完全清除病变的过程中，免疫组织化学模式主要由浸润表皮真皮的密集 CD4+T 淋巴细胞主导，同时 Langerhans 细胞积聚。同时，在反应患者的病变中 CD8 开始增加，Langerhans 细胞似乎向真皮迁移。CD68+巨噬细胞显然没有参与免疫炎症反应。
就我们所知，这项研究代表了首次尝试阐明 ALA-PDT 对尖锐湿疣中浸润性免疫细胞的影响。我们的结果似乎证实了先前报道的临床数据，表明病变皮肤、CD4+T 淋巴细胞和树突状细胞的特异性免疫快速激活可能是愈合的原因。
