Cancer is a leading cause of death that affects millions of people across the globe each year. Photodynamic therapy (PDT) is a relatively new treatment approach for cancer in which anticancer drugs are activated by light at an appropriate wavelength to generate highly cytotoxic reactive oxygen species (ROS) and achieve tumor destruction. Compared with conventional chemo- and radiotherapy, PDT can be performed with minimal invasiveness, local targeting and reduced side effects. However, most of the currently available PDT drugs mainly absorb in the visible part of the spectrum, where light penetration depth into human tissues is very limited. Therefore, increasing the treatment depth of PDT has been considered to be an important approach to improve the effectiveness of PDT for treating larger and thicker tumor masses. In this thesis, we present our investigation into the potential of two-photon activated PDT (2-γ PDT), combination therapy of PDT and chemotherapy, and bioluminescence-activated PDT as a means to increase the treatment depth of this modality. In 2-γ PDT, the photosensitizing agents are activated through simultaneous absorption of two photons. This approach allows the use of near-infrared (NIR) light that can penetrate deeper into tissues and thus, has the potential of treating deep-seated tumors and reducing side effects, while the non-linear nature of two-photon excitation (TPE) may improve tumor targeting. We have evaluated the PDT efficacy of a second-generation photosensitizer derived from chlorophyll a, pyropheophorbide a methyl ester (MPPa), through both one- and two-photon activation. We observed that MPPa had high one-photon (1-γ PDT efficacy against both cisplatin-sensitive human cervical (HeLa) and cisplatin-resistant human lung (A549) and ovarian (NIH:OVCAR-3) cancer cells when activated by femtosecond (fs) laser pulses at 674 nm. At a low light dose of 0.06 J cm-2, the MPPa concentration required to produce a 50% cell killing effect (IC50) was determined to be 5.3 ± 0.3, 3.4 ± 0.3 and 3.6 ± 0.4 μM in HeLa, A549 and NIH:OVCAR-3 cells, respectively. More significantly, we also found that MPPa could be effectively activated at the optimal tissue-penetrating wavelength of 800 nm through TPE. At a light dose of 886 J cm-2, where no measurable photodamage was observed in the absence of MPPa, the IC50 values were measured to be 4.1 ± 0.3, 9.6 ± 1.0 and 1.6 ± 0.3 μM in HeLa, A549 and NIH:OVCAR-3 cells, respectively. We obtained corresponding LD50 (the light dose required to produce a 50% killing effect) values of 576 ± 13, 478 ± 18 and 360 ± 16 J cm-2 for 10 μM MPPa, which were approximately 3-5 times lower than the published 2-γ LD50 of Visudyne® and 20-30 times lower than that of Photofrin®. These results indicate that MPPa may serve as a photosensitizer for both 1- and 2-γ activated PDT treatment of difficult-to-treat tumors by conventional therapies. Indocyanine green (ICG), a dye having an absorption maximum near 800 nm, has been considered to be a potential NIR PDT agent. However, the PDT efficacy of ICG has been found to be very limited probably due to the low yield of cytotoxic ROS. In the present work, we have evaluated the combination effects of ICG-mediated PDT with conventional chemotherapy mediated by two types of chemotherapeutic drugs, namely the type II topoisomerase (TOPII) poisons etoposide (VP-16)/teniposide (VM-26) and the platinum-based drugs cisplatin (CDDP)/oxaliplatin (OXP). Synergistic enhancement of cytotoxicity and increased yields of DNA double strand breaks (DSBs) were observed in HeLa, A549 and NIH:OVCAR-3 cancer cells treated with the combination of ICG-PDT and VP-16. The presence of VP-16 during the laser irradiation process was found to be critical for producing a synergistic effect. An electron-transfer-based mechanism, in which ICG could increase the yield of highly cytotoxic VP-16 metabolites, was proposed for the observed synergistic effects, although direct spectroscopic detection of the reaction products was found to be very challenging. Moreover, we observed a much lower degree of synergy in the human normal fibroblast GM05757 cells than that in the three cancer cell lines investigated. Synergistic effects were also observed in A549 cells treated with the combination of ICG-PDT and VM-26 (i.e. an analog of VP-16). Furthermore, the combination of low-dose CDDP/OXP and ICG-PDT was demonstrated to produce an additive or synergistic effect in selected cancer cell lines. These preliminary results suggest that the combination of ICG-PDT with VP-16/VM-26 or CDDP/OXP chemotherapy may offer the advantages of enhancing the therapeutic effectiveness of ICG-PDT and lowering the side effects associated with the chemotherapeutic drugs. Bioluminescence, the generation of light in living organisms through chemical reactions, has been explored as an internal light source for PDT in recent years. This approach, in principle, does not suffer from the limited tissue penetration depth of light. In the present project, we have evaluated the effectiveness of luminol bioluminescence in activating the porphyrin photosensitizers meso-tetra(4-sulfonatophenyl)porphine dihydrochloride (TPPS4) and Fe(III) meso-tetra(4-sulfonatophenyl)porphine chloride (FeTPPS). The combination treatment induced significant killing of HeLa cells, while additive effects were observed in two normal human fibroblast cell lines (GM05757 and MRC-5). Our observations indicate that bioluminescence of luminol may generate sufficient light for intracellular activation of PDT sensitizers. Furthermore, the combination treatment may have intrinsic selectivity towards cancerous tissues. In summary, we have demonstrated effective killing of cancer cells by MPPa-mediated 1- and 2-γ PDT, combination of ICG-PDT and VP-16/VM-26 or CDDP/OXP chemotherapy, and bioluminescence of luminol activated PDT mediated by TPPS4/FeTPPS. These positive preliminary results indicate that all these three approaches have the potential of increasing the treatment depth of PDT and facilitating the development of more effective PDT treatment strategies.

L’objectif de cette thèse était de mettre au point une analyse critique de vecteurs polymères utilisés pour la thérapie photodynamique (PDT) et de faire le lien avec l’efficacité thérapeutique observée. Pour cela, une analyse complète des vecteurs a été réalisée par des techniques classiques comme la diffusion dynamique de la lumière ou la microscopie électronique, mais aussi grâce au fractionnement flux-force, technique peu utilisée jusqu’à présent dans le domaine des auto-assemblages polymères. Dans un deuxième temps, les auto-assemblages ont été utilisés comme vecteurs d’un photosensibilisateur, le Phéophorbide a, et l’efficacité thérapeutique évaluée en travaillant sur culture cellulaire 2D et 3D de lignées HCT116 (cancer du colon) ou FaDu (cancer tête et cou). Différents vecteurs polymères simples ont tout d’abord été examinés, à savoir des micelles ou des polymersomes à base de copolymères diblocs amphiphiles comme le poly(oxyde d’éthylène-b--caprolactone), le poly(oxyde d’éthylène-b-lactide) ou le poly(oxyde d’éthylène-b-styrène). Ceci a permis d’obtenir des vecteurs présentant des tailles et des morphologies variables. Les résultats en PDT ont montré des comportements différents et une meilleure efficacité en 3D pour les systèmes à base de PEO-PDLLA. La technique de fractionnement flux-force asymétrique (AsFlFFF) a particulièrement été utilisée pour ces vecteurs afin de démontrer la pureté des auto-assemblages. Les connaissances acquises dans cette première partie ont permis de caractériser des vecteurs faits à base de mélanges d’auto-assemblages micelles/vésicules. Ceux-ci ont révélé des phénomènes d’antagonisme ou de synergie dans l’efficacité en PDT, démontrant l’existence de processus complexes au niveau de la réponse cellulaire.Des auto-assemblages figés par réticulation ont aussi été développés, caractérisés et examinés en PDT. Ils se sont avérés extrêmement intéressants pour la PDT sur les cultures cellulaires en 3D, démontrant une efficacité accrue comparée aux systèmes simples. La comparaison de ces résultats avec ceux obtenus en culture 2D pour les mêmes objets a de plus permis de mettre en évidence la différence entre ces deux modèles biologiques. Enfin, des auto-assemblages à base de complexes poly-ioniques ont aussi été formés et caractérisés. Le fractionnement flux-force s’est là encore avéré efficace, mais a nécessité l’utilisation d’une injection spéciale par Frit-inlet. Leur efficacité en PDT s’est avérée faible. / The objective of this study was to critically analyze different polymer self-assemblies used for photodynamic therapy (PDT) and to link this analysis to their therapeutic efficiency. To do that, a thorough characterization of the vectors has been performed by classical techniques such as Dynamic Light Scattering or electron Microscopy, but also using flow fractionation, which has been seldomly used so far for polymeric self-assemblies. In a second step, these have been used as vectors of a photosensitizer, namely Phéophorbide a, and the therapeutic efficiency assessed on both 2D and 3D cell cultures of HCT 116 (colon cancer) and FaDu (head and neck cancer) cells. Different simple polymer vectors have first been evaluated, namely micelles and polymersomes based on diblock amphiphilic copolymers such as poly(ethylene-oxide-b--caprolactone), poly(ethylene-oxide-b-lactide) or poly(ethylene-oxide-b-styrene). This enabled obtaining vectors exhibiting various sizes and morphologies. Results in PDT showed different behaviours and a better efficiency in 3D for PEO-PDLLA. The Asymmetric Flow Field Flow Fractionation was particularly used for these systems to demonstrate their purity. The acquired expertise on this part enabled us to also characterize vectors made of known mixtures of micelles and polymersomes. These revealed antagonism and synergy effects in PDT, demonstrating the presence of complex processes for the cell response. Other self-assemblies consisting of crosslinked systems have also been developed and characterized. These were observed to be particularly efficient for PDT on 3D cell cultures. The comparison of these results with those for the 2D cell culture enabled to highlight the difference between those two biological systems. Finally, self-assemblies based on Polyion Complexes were also formed and characterized. Field Flow Fractionation was once again used as a powerful technique for this, although this implied the use of a special injection device called Frit Inlet. Their PDT efficiency however proved to be low.

La thérapie photodynamique (PDT) est une technique utilisée cliniquement pour traiter certaines maladies de la peau, la dégénérescence maculaire liée à l’âge et certains types de cancer. Elle fait intervenir trois composants : une molécule photosensible ou photosensibilisateur (PS), la lumière et l’oxygène. Après administration du PS, celui-ci va se localiser plus ou moins sélectivement dans les zones tumorales où il est alors activé par irradiation lumineuse à une longueur d’onde et une puissance données. Ceci engendre la formation d’espèces réactives de l’oxygène (ROS) très réactives, dont l'oxygène singulet1 O2, qui entraînent la destruction des tissus tumoraux par nécrose ou apoptose. Afin d’améliorer la sélectivité du traitement, différentes pistes sont actuellement exploitées dont l’élaboration de « photodynamic molecular beacons » (PMB). Dans un PMB, le photosensibilisateur (PS) est associé via un peptide à un inhibiteur 1O2, appelé quencher. Ce quencher inhibe la formation d’1O2 tant que le composé n’a pas atteint sa cible. Une fois la zone cancéreuse atteinte, des enzymes spécifiques clivent le peptide, libérant ainsi le PS qui retrouve alors sa capacité à former de l’1O2. Trouver un couple PS/quencher adéquat reste un challenge en PDT. Les propriétés photophysiques particulières des caroténoïdes et leur aptitude à inhiber la production d’1O2 font de ces derniers des quenchers potentiellement utilisables pour l’élaboration de PMBs. Chez les plantes, les caroténoïdes (carotènes et xanthophylles) sont des pigments associés à la photosynthèse, qui ont deux rôles principaux : un rôle de collecteur de lumière et un rôle photoprotecteur en protégeant le(s) système(s) photosynthétique(s) contre les dommages photooxydatifs liés à une exposition trop intense à la lumière. Ceci s’opère, entre autre, via le cycle des xanthophylles. Cette aptitude à capter de l’énergie présente un intérêt potentiel à ne pas négliger dans la perspective de la conception de PMB utilisables en thérapie photodynamique. Dans le cadre de cette thèse en co-tutelle avec la Faculté des Sciences de Bizerte nous avons ciblé les caroténoïdes présents dans trois fruits produits en Tunisie à savoir les kakis (Diospyros kaki L.), les abricots (Prunus armeniaca L.) et les pêches (Prunus persica L.) connus pour leur richesse globale en ces pigments. Divers procédés d’extractions ont été étudiés : (i) L’extraction de type Soxhlet par solvants organiques à pression atmosphérique, utilisée comme référence, (ii) l'extraction accélérée par solvant organique (ASE : Accelerated solvent Extraction) effectuée sous pression, enfin (iii) l'extraction par CO2 supercritique avec l’éthanol comme cosolvant. Pour ces deux derniers procédés, une approche par plan d’expériences (surfaces de réponses) a été utilisée pour identifier les facteurs clé et les conditions optimales d’extractions de divers caroténoïdes (pression, température, débit, % de cosolvant, temps, nombre de cycles). L'analyse par chromatographie liquide à haute performance couplée à la détection UV-Visible et à la spectrométrie de masse a ensuite permis l'identification et la quantification des caroténoïdes présents dans les extraits obtenus, permettant ainsi de comparer les profils caroténoïdiques propres à chaque fruit et les performances de chaque procédé d’extraction. Cette étude ayant révélé un profil caroténoïdique particulièrement intéressant chez le kaki par rapport aux autres fruits, une extraction et une purification des caroténoïdes de ce fruit par chromatographie liquide haute pression préparative a ensuite été effectuée afin de disposer d’une quantité suffisante de chaque caroténoïde, et parfois de leurs isomères conformationnels, en vue de l’étude de leurs propriétés photophysiques (absorption, émission de fluorescence, inhibition d’1O2) et de l’évaluation de leur intérêt potentiel en tant que quencher d’1O2 dans un édifice de type PMB / Photodynamic therapy (PDT) is a clinically used technique for treating skin diseases, age-relatedmacular degeneration but mainly some types of cancer. PDT involves three components: a photosensitive molecule named photosensitizer (PS), light and oxygen. After administration of the PS, this one will be located more or less selectively in tumoral regions where it is activated by light irradiation at appropriate wavelength and power. This leads to the formation of highly reactive and cytotoxic reactive oxygen species (ROS), especially singlet oxygen, resulting in the destruction of the tumor by necrosis or apoptosis. To improve the treatment selectivity, different strategies are being exploited, one of which is the development of "photodynamic molecular beacons" (PMB). In PMB the photosensitizer is linked via a peptide to an inhibitor of 1O2 (quencher). This quencher inhibits the formation of 1O2 as long as the compound has not reached its target, namely cancer cells. In order to inhibit the toxicity of the PS in non-target cells and restore toxicity only close to the biological target, it is necessary to find an adequate PS/quencher couple. This remains a challenge for PDT. Carotenoids are interesting candidates due to their specific photophysical properties and ability to inhibit 1O2, which makes them potential quenchers for building PMBs. In plants, carotenoids (carotenes and xanthophylls) are pigments involved in the photosynthesis, in which they play two main roles: a light collecting role and a protecting role by preserving the photosynthetic systems against photoxydative damages induced by a too intense light exposure. This protection can for instance occur via the well-known xanthophylls cycle. This capacity to catch energy presents a potential interest that should not be neglected in the framework of the design of PMBs usable in photodynamic therapy. Within the framework as part of this PhD thesis in Cotutelle with the Faculty of Sciences of Bizerte, we focused on carotenoids from three fruits produced in Tunisia: persimmon (Diospyros kaki L.), apricot (Prunus armeniaca L.) and peache (Prunus persica L.), known for their global richness in these natural pigments. Three extraction processes were investigated: (i) the Soxhlet extraction based on the use of organic solvent at atmospheric pressure and used as reference, (ii) the accelerated solvent extraction (ASE) using organic solvent under high pressure, and (iii) the supercritical fluid extraction (SFE) using supercritical CO2 and ethanol as cosolvent. For these two last processes, a design of experiments (Surface Response Design) was used to identify the key factors and optimal extraction conditions of various carotenoids (pressure, temperature, flow, % cosolvent, time, number of cycles). Then, HPLC-PDA coupled with mass spectrometry (MS) enabled the identification and quantification of carotenoids from the extracts. Thus it was possible to compare the profiles in carotenoids content from each fruit as well as the performances of each extraction process. This study showed that the carotenoidic profile in the persimmon was the most interesting as compared to the profiles in the two other fruits. Extraction and purification of the carotenoids from persimmon by preparative high pressure liquid chromatography were then performed in order to have a sufficient amount of each carotenoid and sometimes of their conformational isomers. We finally performed a study of their photophysical properties (absorption, fluorescence emission, 1O2 inhibition) in order to evaluate their potential as 1O2 quencher in molecular construction such as a PMB

La thérapie photodynamique (PDT pour Photodynamic Therapy) met en jeu des molécules nommées photosensibilisateurs (PS), de l'oxygène et de la lumière. Les PS, non cytotoxiques à l'obscurité, produisent des espèces réactives de l'oxygène (ROS) lorsqu'ils sont excités avec une longueur d'onde appropriée en présence d'oxygène. Les ROS regroupent les radicaux de l'oxygène et l'oxygène singulet (1O2), qui est la principale forme de ROS formés lors du processus de PDT. En présence de tissus vivants, l'1O2 va conduire à la mort cellulaire par apoptose ou par nécrose. Pour améliorer l'efficacité photodynamique, une des pistes étudiées par la communauté scientifique consiste à améliorer la sélectivité du traitement. Le traitement des tumeurs primaires malignes du cerveau, dont le glioblastome multiforme (GBM ou astrocytome de grade IV) est la forme la plus agressive, reste un challenge. Lorsqu'elle est possible, la chirurgie occupe une place prépondérante. L'exérèse ne concerne que la partie volumineuse centrale de la tumeur, tandis que la zone périphérique infiltrante est, quant à elle ciblée par des traitements supplémentaires. Malgré les progrès de la neurochirurgie et de la radiothérapie, l'espérance de vie à 5 ans ne dépasse pas 10%. La thérapie photodynamique se présente comme une alternative thérapeutique grâce aux améliorations apportées par le contrôle local. Pour traiter le gliobastome par PDT, une première approche a consisté à coupler un peptide, à un photosensibilisateur (la chlorine) via un bras espaceur Ahx (acide aminohexanoïque). Le peptide utilisé (ATWLPPR) est un ligand spécifique du récepteur neuropiline 1 (NRP-1). NRP-1 est lui-même un co-récepteur au récepteur du facteur vasculaire de croissance endothéliale (VEGFR) qui est surexprimé au niveau des néovaisseaux et qui favorise la néoangiogenèse au cours du développement des tumeurs solides. L'assemblage PS-Ahx-ATWLPPR a montré une stabilité peptidique in vivo et in vitro avec une bonne pharmacocinétique et une bonne biodistribution. Ses efficacités anti-tumorales et anti-vasculaires ont notamment été prouvées. Cependant, in vivo, le peptide ATWLPPR montrait une dégradation par le système réticulo-endothélial et l'assemblage présentait une affinité moindre pour NRP-1 par rapport au peptide seul. Afin de résoudre ces problèmes, une nouvelle stratégie décrite dans cette thèse a consisté à développer des nanoparticules multifonctionnelles. Ces nanoparticules sont constituées d'un coeur d'oxyde de gadolinium (Gd2O3) pour permettant un réhaussement de contraste positif en IRM, enrobé d'une couche de polysiloxane biocompatible dans laquelle est greffé le photosensibilisateur par liaison amide. La nanoparticule est ensuite fonctionnalisée en surface avec des agents chélatants (DOTA, DTPA) par l'intermédiaire de fonctions amines libres de la couche de polysiloxane. Les peptides de type ATWLPPR sont greffés sur les agents chélatants, ce qui permet un ciblage spécifique de NRP-1. De cette façon, on obtient des nanoparticules qui offrent à la fois une possibilité de ciblage actif des néovaisseaux tumoraux, de visualisation par IRM et un effet PDT. Dans l'objectif d'obtenir un effet PDT optimal, une augmentation du contraste en imagerie IRM et une sélectivité maximale pour les cellules endothéliales, un plan d'expérience a été élaboré. Chaque lot du plan d'expérience a été synthétisé en faisant varier la composition chimique du coeur, l'épaisseur de la couche de polysiloxane, le nombre de photosensibilisateurs, le type de surfactant, le nombre et le type de peptides. Une fois la synthèse et la purification de ces nanoparticules effectuées, chaque lot a été caractérisé pour vérifier la conservation des propriétés photophysiques, en particulier la formation d'oxygène singulet. Des études biologiques sur des cellules tumorales de type MDA-MB-231 et U87 ont été réalisées, pour étudier la cytototoxicité, la phototoxicité et le réhaussement de contraste IRM de ces nanoparticules / Photodynamic therapy (PDT) involves molecules called photosensitizers (PS), molecular oxygen and light. PS are non-cytotoxic in the dark but produce reactive oxygen species (ROS) when they are excited with light of an appropriate wavelength in the presence of oxygen. ROS include oxygen radicals and singlet oxygen (1O2), which is the main form of ROS formed during PDT processes. In the presence of living tissue, 1O2 leads to cell death by apoptosis or necrosis. To improve photodynamic efficiency, a strategy developed by scientists consists in improving the selectivity of the treatment. The treatment of primary malignant brain tumors, including glioblastoma multiforme (GBM or astrocytoma level IV) which is the most aggressive form, remains a challenge. When it is possible, surgery is performed by removing the central volume of the tumor, while infiltrating peripheral zone is treated by additional treatments. Despite advances in neurosurgery and radiotherapy, the life expectancy at 5 years after the tumor detection does not exceed 10 %. PDT appears as an alternative treatment. In preliminary study a photosensitizer (chlorin) coupled to a peptide (ATWLPPR) through an Ahx linker (aminohexanoic acid) has been designed. The peptide is a specific ligand of neuropilin-1 receptor (NRP-1). NRP-1 is a co-receptor of vascular endothelial growth factor receptor (VEGFR) overexpressed in neovessels and which promotes the formation of new vessels during the development of solid tumors. This targeted photosensitizer presented a peptidic stability in vivo and in vitro with good pharmacokinetic and biodistribution. Its anti-tumor and anti-vascular efficiencies have been proven. However, the ATWLPPR peptide showed degradation in the reticuloendothelial system (RES) and a reduced affinity for NRP-1 compared with peptide alone. To solve these problems, a new strategy using multifunctional nanoparticles has been developed in this thesis. The nanoparticles consist of a core of gadolinium oxide (Gd2O3) for MRI contrast, coated with a layer of biocompatible polysiloxane wherein the photosensitizer is covalenty grafted. The nanoparticle surface is functionalized by chelating agents (DOTA, DTPA) via free amine functions of the polysiloxane layer. ATWLPPR peptides are grafted on chelating agents, which allows specific targeting of NRP-1. Nanoparticles allow a MRI visualization, a PDT effect and an active targeting of the tumor neovasculature. With the aim to obtain an optimal PDT effect, an enhancement of contrast in MRI imaging and a high selectivity for endothelial cells, an experimental design has been developed. Each batch of the experimental design was synthesized with various chemical compositions of the core, the size of the polysiloxane layer, the number of photosensitizers, the number and the type of peptides and the type of surfactant. Once the synthesis and purification of these nanoparticles done, each batch was characterized to ensure the conservation of the photophysical properties, in particular the formation of the singlet oxygen. Biological studies on tumor cell type MDA- MB-231 and U87 were carried out, especially their cytototoxicity and phototoxicity

Age-related maculopathy (ARM) is a central retinal disease with unclear pathogenesis. It is the major cause of permanent vision loss in adults over 50 years and is increasing in prevalence and incidence, faster than the aging population would suggest. Early in the disease process (early ARM) there is little or no vision loss and there are only slight retinal changes with abnormal deposits within Bruch's membrane. As the disease progresses (late ARM or age-related macular degeneration, AMD) vision loss may be quite severe due to atrophy (dry AMD) or the development of chorioretinal neovascularisation (CNV, wet AMD). It is hard to predict from conventional eye examinations and clinical vision tests which cases will progress to the severe, dry or wet forms of the disease. Moreover, most of the conventional clinical tests are based upon subjective vision measures. Objective tests which detect ARM earlier would be a useful aid to diagnosis and to monitoring progression. The multifocal electroretinogram (mfERG) is a relatively new clinical tool which enables the recording of electrical potentials from multiple, small areas of the central retina and thus assesses function from specific retinal locations. It is therefore useful in detecting focal retinal diseases such as hereditary or acquired maculopathies or in monitoring retinal laser or surgical treatment effects. There is cone and rod impairment in ARM and histopathological and psychophysical evidence for a preferential vulnerability of rods compared to cones. This research project investigated if an objective tool such as the mfERG could detect early ARM,its progression and the treatment effects of multiple photodynamic therapies (PDT) on retinal function in late ARM, prior to a battery of subjective vision measures. For comparison purposes a subjective assessment of central retinal function was performed using high and low contrast distance visual acuities (VA), near VA, low luminance VA (SKILL cards), contrast sensitivity (Pelli-Robson, P-R), saturated and desaturated Panel D-15 (sat Panel D-15, desat Panel D-15) and central visual fields (Humphrey 10-2, mean sensitivity, MS and mean defects, MD). As an objective assessment of central retinal function the cone- and rod-mediated multifocal electroretinograms were recorded. Subjective and objective tests of retinal function were compared in early ARM and an age-matched control group (chapter 3). Seventeen eyes of seventeen subjects with early ARM and twenty control subjects with normal vision were measured. For the cone-mediated mfERG responses conventional averaging methods were used and results were correlated with subjective vision tests. The conventional cone-mediated mfERG failed to distinguish between the early ARM and control subjects whereas subjective vision measures such as HC- and LC-VA, desat Panel D-15, MS, P-R were significantly reduced in the ARM group. However, there were significant correlations between the cone-mediated mfERG and the desat Panel D-15 results in the ARM group. This suggests that the mfERG measures similar retinal processes that detect colour vision deficiency under desaturated conditions. There was no significant correlation between cone-mediated mfERG measures and funduscopic changes. The conclusion from this study was that the subjective vision tests detected early ARM better than the objective cone-mediated mfERG. Thus the aim of detecting early ARM objectively was not met by the cone-mediated mfERG suggesting the need to develop other objective tests such as a rod-mediated mfERG. Whether the preferential rod vulnerability others have reported in early ARM could be detected by the rod-mediated mfERG was determined in the next study (chapter 4). A protocol for recording rod-mediated mfERG responses was developed by determining the optimal testing luminance to reduce the effect of stray light and elicit maximal rod-mediated responses. Sixteen of the seventeen ARM subjects and seventeen control subjects from the previous study were tested. For analysis, a customized computer template fitting method was developed in MATLAB (Mathworks, Natick, MA, USA). This method has been shown to be useful for low signal-to-noise ratio responses that characterize the rod-mediated mfERG. Significantly delayed rod-mediated mfERG responses were found whereas cone-mediated mfERG responses were within the normal range. This suggested that the effect of ARM on the rod system could be detected objectively with the rod-mediated mfERG before changes in the cone-mediated mfERG. Which of the tests best detected progression of vision loss was investigated in chapter 5. Visual function of 26 (13 ARM and 13 control subjects) of the original 37 subjects (17 ARM and 20 control subjects) had cone- and rod-mediated mfERG and the subjective vision measures repeated after one year. The main purpose was to determine which of the tests best detected progression of vision loss. The mfERG results were analysed by using both averaged and local responses and by using the computer template fitting procedure. On average no significant worsening of either objective or subjective function measures was evident after one year. These results reinforce the slow progression of the disease. With a longer follow-up period progression of ARM may translate into measurable changes in the mfERG and the other visual function tests. The effect of multiple photodynamic therapies (PDT) on cone- and rod-mediated function was assessed with the mfERG in the last study (chapter 6). The cumulative treatment effects of PDT in five subjects with late ARM were determined. Having demonstrated that the rod-mediated mfERG was applicable in early ARM, this study also aimed to investigate how useful it was in late ARM where there is substantially greater rod loss. Cone- and rod-mediated mfERGs, visual acuities, contrast sensitivities and central visual fields were investigated a week before treatment began and then one month after each PDT treatment. The subjects received three treatments each over an average period of five and a half months. In some subjects there were significant transient reductions in cone- and rod-mediated amplitudes possibly reflecting alterations in choroidal hypoperfusion dynamics one month after treatment. Further, b-wave component of the mfERG became increasingly misshapen after each PDT treatment suggesting an ischemic insult mainly targeting post-receptoral sites. However, objective and subjective function was stabilized after multiple PDT treatments in most of the subjects. This pilot study of five cases showed that there was no additional damage to cone- and rod-mediated outer retinal function after three PDT treatments. One of the novel findings of this research was that the rod-mediated function measured with the mfERG was impaired in early ARM. This finding supports histopathological and psychophysical evidence of rod vulnerability in early ARM. The results of these studies also suggest that early ARM affects different aspects of visual function which is reflected by different outcomes from objective and subjective vision tests. A model (chapter 7) based upon the results was developed proposing a hypoxic insult with a preferential alteration of post-receptoral sites in early ARM. The cone-mediated mfERG documented the retinal damage and possible treatment effects on outer retinal function of the multiple PDTs which did not further deteriorate. Thus, this technique might assist in the development of optimal treatment modalities for ARM, especially in retreatment regimes. Greater variability was found for the rod-mediated mfERG and its clinical use in PDT treatment regimes still needs to be investigated. In conclusion, this research has provided a better understanding of the disease process and treatment effects in ARM and might contribute to improvements in diagnosis and treatment of ARM.

This thesis presents the development and in-vivo applications of wearable and portable devices for the investigation of light interaction with tissue involved in Photodynamic therapy (PDT) and during contraction of muscles. A hand-held device and a clinical method were developed for time course in-vivo imaging of the fluorescence of the photosensitizer Protoporphyrin IX (PpIX) in healthy and diseased skin with the aim to guide improvement of PDT protocols. The device was used in a small clinical study on 11 healthy volunteers and 13 patients diagnosed with non-melanoma skin cancer (NMSC). Two types of PpIX precursors were administered: Ameluz gel and Metvix® cream. The fluorescence was imaged with a 10 minute time step over three hours which was the recommended metabolism time before commencing PDT treatment at Ninewells Hospital, Dundee. The fluorescence time course was calculated by integrating the areas with the highest intensity. The fluorescence continued to grow in all subjects during the three hours. The time course varied between individuals. There was no statistical significance between either healthy volunteers or patients in Ameluz vs Metvix® groups; nor was there statistical difference between the three lesions groups (Actinic keratosis (AK) Ameluz vs AK Metvix® vs Basal cell carcinoma (BCC) Metvix®). The p-value was larger than 0.05 in a two sample t-test with unequal variances for all the groups. However, there was strong body site dependence between the head & neck compared to the lower leg & feet, or the trunk & hands body site groups (p-value < 0.01). One of the possible explanations for this was temperature and vasculature variation in skin at different body sites: the temperature is higher and the vasculature structure is denser at the head and the neck compared to the lower leg or the trunk. The temperature was not measured during the study. So in order to support this hypothesis, typical skin temperatures at the lesion sites were taken from the IR thermal images of healthy skin available in literature. PpIX fluorescence had a positive correlation to temperature. If this hypothesis is true, it will be highly important to PDT treatment. Increasing the temperature could speed up the metabolism and reduce the waiting time before starting the treatment; ambient temperature should be taken into account for daylight PDT; cooling air as pain management should be administered with caution. Potential improvements for wearable PDT light sources were investigated by modelling light transport in skin for the current LED-based Ambulight PDT device, a commercial OLED for future devices and a directional OLED developed in the group. The optical models were implemented in commercial optical software (with intrinsic Monte Carlo ray tracing and Henyey-Greenstein scattering approximation) which was validated on diffuse reflectance and transmittance measurements using in-house made tissue phantoms. The modelling was applied to investigate the benefits from diffusive and forward scattering properties of skin on light transmission in treatment light sources. 1 mm thick skin can only compensate approximately 10% of non-uniform irradiance. It means that uniform illumination is crucial for the treatment light sources. Forward scattering in skin showed a 10% improved light transmission from a collimated emission compared to a wide angle Lambertian emission. However, depth-dependent transmission measurements of directional vs Lambertian emission from organic light emitting films (a nano-imprinted grating was fabricated to provide directional emission in one of the films), collimated vs diffused HeNe laser light through fresh porcine skin did not show the expected improvement. This could be explained by skin roughness which was previously found to change the optical properties and may also affect light coupling. The modelling was applied to guide an optical design of another wearable device – a muscle contraction sensor. Muscle is fibrous and because of that scatters light differently in different directions. The sensor detects the change in backscattered light in parallel and perpendicular directions with respect to muscle fibres. The sensor was implemented on a wearable bandage on fully flexible substrate with flexible OLED and organic photodiodes. The major advantages of organic optoelectronic sensing compared to conventional electromyography (EMG) sensors are the ability to distinguish two types of contractions (isotonic and isometric), insensitivity to electromagnetic interference and the absence of an immune response due to non-invasive electrode-free sensing. Optical modelling was performed to understand the operation of the sensor. A 3D anisotropic optical model of scattering in muscle was created by geometrical manipulations with the standard Henyey-Greenstein scattering volumes. The penetration depth from the Super Yellow OLED was found to be 20-25 mm; the optimal separation between the source and the detector was found to be 20 mm. This distance provided a still detectable signal along with the best discrimination between the two backscatterings. When a 2 mm thick layer of skin and a 2 mm thick layer of adipose tissue were added to the model, the signal was hugely diffused. The discrimination between the two backscatterings decreased by three orders of magnitude, the penetration depth in muscle was reduced, and the intensity of the signal dropped down but was still detectable. With 5 mm thick adipose tissue and 2 mm thick skin the signal was too diffused and interacted with very shallow layers of muscle which approached the limits of the optical sensing of muscle activity.

5-aminolevulinic acid (5-ALA) and derivatives thereof are widely usedprodrugs in treatment of pre-malignant skin diseases of the cancer treatmentmethod photodynamic therapy (PDT). The target molecule in 5-ALAPDTis protoporphyrin IX (PpIX), which is synthesized endogenously from5-ALA via the heme pathway in the cell. This thesis is focused on 5-ALA,which is studied in different perspectives and with a variety of computationalmethods. The structural and energetic properties of 5-ALA, itsmethyl-, ethyl- and hexyl esters, four different 5-ALA enols, and hydrated5-ALA have been investigated using Quantum Mechanical (QM) first principlesdensity functional theory (DFT) calculations. 5-ALA is found to bemore stable than its isomers and the hydrolysations of the esters are morespontaneous for longer 5-ALA ester chains than shorter. The keto-enoltautomerization mechanism of 5-ALA has been studied, and a self-catalysismechanism has been proposed to be the most probable. Molecular Dynamics(MD) simulations of a lipid bilayer have been performed to study themembrane permeability of 5-ALA and its esters. The methyl ester of 5-ALAwas found to have the highest permeability constant (PMe-5-ALA = 52.8 cm/s).The mechanism of the two heme pathway enzymes; Porphobilinogen synthase(PBGS) and Uroporphyrinogen III decarboxylase (UROD), have beenstudied by DFT calculations and QM/MM methodology. The rate-limitingstep is found to have a barrier of 19.4 kcal/mol for PBGS and 13.7kcal/mol for the first decarboxylation step in UROD. Generally, the resultsare in good agreement with experimental results available to date.

This thesis work deals with different aspects of the chemistry of La(III) and Gd(III) complexes, their interaction with DNA and proteins, photo-induced cleavage of double-stranded DNA, photocytotoxic effect on cancer cells, cell death mechanism and cellular localization behaviour. Chapter I gives an introduction to the metal-based anticancer agents with special emphasis on clinically used drugs and the growing field of lanthanide therapeutics. An overview of the current strategies of cancer treatment, especially photodynamic therapy (PDT), is presented. Mode of small molecule-DNA interactions and the mechanistic aspects associated with DNA photodamage reactions and PDT effect are discussed with selected examples of compounds that are known to photocleave DNA on exposure to light of different wavelengths. A brief discussion on the various therapeutic applications of the lanthanide compounds is also made. Chapter II presents the synthesis, characterization, DNA binding, BSA binding, photo-induced DNA cleavage activity and photocytotoxicity of La(III) and Gd(III) complexes of phenanthroline bases to explore the UV-A light-induced DNA cleavage activity and photocytotoxicity of the complexes. Chapter III describes the synthesis, characterization, DNA binding, photo-induced DNA cleavage activity and photocytotoxicity of La(III) and Gd(III) complexes of phenanthroline bases with an aim to improve the design of the complexes to achieve better solution stability and DNA binding of the complexes. Chapter IV presents the synthesis, characterization, DNA binding, and UV-A light-induced DNA photocleavage activity and photocytotoxicity of La(III) and Gd(III) complexes of pyridyl phenanthroline bases with an objective to improve the photoactivity of the complexes by introducing an additional pyridyl group. Cell death mechanism and confocal microscopic studies are also carried out to gain more insight into the PDT effect caused by light in the presence of the complex. Chapter V describes the synthesis and characterization of La(III) and Gd(III) complexes of terpyridine bases and acetylacetonate to study the complexes as a new class of photosensitizers to explore their DNA photocleavage activity and photocytotoxicity in HeLa cells. Effect of attaching a glucose moiety to the acetyl acetone (Hacac) ligand has been studied. The cellular uptake behaviour of the La(III) pyrenyl-terpyridine complexes has also been investigated. Finally, Chapter VI presents the synthesis and characterization of curcumin and glycosylated curcumin La(III) and Gd(III) complexes having terpyridine base with an objective to study the photoactivated anticancer activity of the complexes in visible light. This chapter describes the visible light-induced DNA cleavage activity and photocytotoxicity of the complexes by exploiting curcumin and glycosylated curcumin as the photosensitizer ligands. Study on the cellular uptake behavior of curcumin La(III) complexes having pyrenyl terpyridine ligand is also presented. The references have been assembled at the end of each chapter and indicated as superscript numbers in the text. The complexes presented in this thesis are represented by bold-faced numbers. Crystallographic data of the complexes which are characterized structurally by single crystal X-ray crystallography are provided in CIF format in the enclosed CD (Appendix-I). Due acknowledgements have been made wherever the work described is based on the findings of other investigators. Any unintentional omission that might have happened due to oversight or mistake is sincerely regretted.

PDT, psykodynamisk psykoterapi, och KBT, kognitiv beteendeterapi, är idag de dominerande psykoterapiinriktningarna i Sverige. Metoderna har i olika skeden rekommenderats av myndigheter och meningsmotsättningar om vilken metod som är mest lämplig har förekommit. Följande studie avsåg att utforska hur sex intervjuade KBT-psykoterapeuter samarbetar med sina PDT-kollegor och utifrån patienters behov eventuellt överväger PDT. En induktiv tematisk analys tillämpades där psykoterapeuterna beskrev upplevelsen av samarbete med PDT-terapeuter i termer av ett positivt dynamiskt utbyte samtsom en negativ upplevelse av fördomsfullt bemötande från PDT-terapeuter och mindre metodologiskt utbyte. Bilden av PDT som komplementär metod hos de intervjuade KBT-psykoterapeuterna speglade ambivalens kring PDT:s effektivitet och användbarhet. Alliansens kvalitet beskrevs som avgörande för om byte sker till PDT-kollega under pågående KBT-behandling. Studiens resultat jämfördes med en tidigare enkätstudie i vilken gruppsykologiska mekanismer antagits påverka samarbetet mellan terapeuter av olika metodinriktning.En tentativ beskrivning ges av processen bakom dessa gruppmekanismer.

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