Site-specific pharmaco-laser therapy: A novel treatment modality for refractory port wine stains

M Ingmar van Raath; Jojanneke E van Amesfoort; Martin Hermann; Yasin Ince; Maurice J Zwart; Agustina V Echague; Yan Chen; Baoyue Ding; Xuan Huang; Gert Storm; Michal Heger

Site-specific pharmaco-laser therapy: A novel treatment modality for refractory port wine stains

J Clin Transl Res. 2019 May 1;5(1):1-24. eCollection 2019 Sep 8.

Authors

M Ingmar van Raath^{1

2}, Jojanneke E van Amesfoort², Martin Hermann³, Yasin Ince², Maurice J Zwart², Agustina V Echague⁴, Yan Chen⁵, Baoyue Ding¹, Xuan Huang¹, Gert Storm^{6

7}, Michal Heger^{1

6}

Affiliations

¹ Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China.
² Department of Experimental Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
³ Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
⁴ Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁵ Department of Clinical Medicine, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China.
⁶ Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
⁷ Department of Controlled Drug Delivery, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.

PMID: 31579838
PMCID: PMC6765152

Abstract

Despite extensive efforts to optimize laser therapy, i.e., the current gold standard treatment, a majority of port wine stain (PWS) patients responds suboptimally to laser therapy. This paper describes the niceties of a novel PWS treatment modality termed site-specific pharmaco-laser therapy (SSPLT). In contrast to the classic approach of enhancing the extent of intravascular photocoagulation (the photothermal response), SSPLT focuses on optimization of post-irradiation thrombus formation (i.e., the hemodynamic response) by combining conventional laser therapy with the administration of thermosensitive drug delivery systems that encapsulate prothrombotic and antifibrinolytic drugs. The aim of SSPLT is to instill complete lumenal occlusion in target vessels, which has been linked to optimal PWS blanching.

Relevance for patients: The current treatment options for PWS patients are limited in efficacy. Novel therapeutic modalities are needed to more effectively treat patients with recalcitrant PWSs. SSPLT is an experimental-stage treatment modality that could serve as an adjuvant to pulsed dye laser therapy for a selected group of patients whose PWS is ill-responsive to standard treatment. The expected clinical result of SSPLT is improved lesional blanching.

Keywords: antifibrinolytics; hemodynamics; liposomes; mild hyperthermia; photosensitizer; primary and secondary hemostasis; procoagulants; steric stabilization; thermal coagulum; tranexamic acid.

Publication types

Review