We describe the first local use of hypericin as photosensitizer for photodynamic therapy in a patient with recurrent malignant mesothelioma. Hypericin is a polycyclic quinone, which has been shown to possess in vivo and in vitro antiretroviral and photosensitizing activity; moreover, it is used in depressive disorders. The semiquinone radical, singlet oxygen, and superoxide anion radical are reported to be the toxic agents in hypericin phototherapy. Our first experience with locally applied hypericin in a superficial tumor-plate was performed 8 weeks after the systemic administration of hematoporphyrin derivatives. For tumor light illumination we used an argon pumped dye laser tuned to 632 nm. Owing to satisfactory results, we repeated the same therapy 4 weeks later- and no therapeutic effect was noted. Following this, we proved the interstitial application of HPD and the combination of interstitial HDP and superficially applied hypericin. The subsequent light illumination 6 hours later had no efficacy in the HDP-photosensitized area but there was tumor destruction in the field with both administered photosensitizers. Our first experience suggests a potentiation of two photosensitizers: hematoporphyrin derivatives and hypericin.

Photodynamic therapy (PDT) involves the administration of a photosensitizer followed by light irradiation with a specific wavelength, giving rise to irreversible tissue destruction. Hypericin, a herbal extract derived from Hypericum perforatum or St. John's Wort, has minimal toxicity but exhibits potent photo-damaging effects in the presence of light. Hypericin is known to generate a high yield of singlet oxygen and other reactive oxygen species that are associated with photo-oxidative cellular damage. The application of PDT with hypericin for the treatment of cancers such as recurrent mesothelioma and skin cancer has been validated in clinical trials. This mini-review focuses on the investigative studies of hypericin as a potential photodynamic agent in the treatment of nasopharyngeal cancer (NPC) in in vitro and in vivo models. NPC is an enigmatic tumor with a multifactorial etiology and a high incidence in the populations of Southern China.

Photoactivation of hypericin is known to generate singlet oxygen and superoxide anion radicals. Reactive oxygen species (ROS) produced by photodynamic therapy (PDT) has the capacity to induce oxidative damage and tumor destruction. We have previously shown that hypericin-PDT induces tumor shrinkage and regression in the human nasopharyngeal cancer (NPC)/HK1 murine tumor model. In this extended study, we show by electron microscopy that subcutaneously implanted HK1 NPC cells from Balb/c nude mice perished by cell necrosis with hypericin-PDT treatment. There was evidence of cytoplasmic swelling accompanied by loss of cell membrane integrity and autophagic vacuolization of cytoplasm but no nuclear changes. There was also no significant difference in the apoptotic index of control and PDT-treated tumors, when analyzed by in situ end labeling of DNA strand breakage to detect apoptosis. This further supports the observation that cell death in PDT-treated NPC/HK1 tumors was by necrosis. Lipid peroxidative stress analyzed by the malonaldehyde assay was significantly elevated in PDT-treated cells. However, PDT had no effect on the activity of superoxide dismutase, an intracellular antioxidant enzyme. The findings show that hypericin-PDT of nasopharyngeal tumors in vivo induces tumor necrosis with accompanying lipid peroxidation.

The requirement for light in the anti-HIV-1 activity of hypericin was investigated. The hypericin concentration-dependence and light dosage-dependence of the reaction were measured. Under conditions in which hypericin caused substantial inactivation of HIV-1, there was a strict requirement for visible light. Only when the concentration of hypericin approached the cytotoxic level was there an apparent light-independent antiviral effect. This strict light-requirement for the antiviral effect could explain some of the apparently discrepant results reported by other workers. Furthermore if hypericin is contemplated for use in humans, the importance of light must be considered.