PYRIDINONE COMPOUNDS FOR USE IN PHOTODYNAMIC THERAPY

Field of the invention The present invention relates to a novel compound and its preparation and use, and to compositions comprising the compound.

Background to the invention

Photodynamic therapy (PDT) is a therapy employed routinely in the treatment of superficial dermatological malignancies and is under investigation for a range of additional tumour types. Most applications of PDT involve the use of an active compound, known as a photosensitizer, and a light source, the wavelength of which can be chosen to be appropriate for exciting the photosensitizer to produce reactive oxygen species. This leads to the destruction of any tissues which have either selectively taken up the photosensitizer or have been locally exposed to light. For example, a PDT treatment of human skin cancer may involve the following steps. Firstly, a photosensitizer precursor is administered to the patient. The photosensitizer precursor is taken up by the cells and converted to a photosensitizer. The area to be treated is then exposed to light of the appropriate wavelength. The photosensitizer absorbs light and reacts with nearby tissue oxygen, resulting in reactive oxygen species. These reactive oxygen species react with biomolecules, fatally damaging some of the cells in the treatment area.

PDT has particularly found a niche in the treatment of dermatological tumours where light can be readily applied to the surface of the skin; clinically substantial subsets of skin tumours are difficult to treat by conventional therapies (because of size, site or multiple lesions presentation). In the treatment of skin conditions, the photosensitizer or photosensitizer precursor can be applied topically, and locally excited by a light source. In the local treatment of internal cancer cells, on the other hand, photosensitizers or photosensitizer precursors can for example be administered intravenously and light can be delivered to the target area using endoscopes and fibre optic catheters. Compared to normal healthy tissues, most types of cancer cells are especially active in both the uptake and accumulation of photosensitizers, which makes cancer cells especially vulnerable to PDT, since having more photosensitizer present in a cell leads to more damage to that cell during PDT.

Photosensitizer precursors currently employed in dermatological PDT include aminolevulinic acid (ALA), methyl aminolevulinate (MAL) and hexyl aminolevulinate (HAL). If ALA, MAL or HAL is used as a photosensitizer precursor, it is converted by the cells to the photosensitizer protoporphyrin IX (PpIX).

Protoporphyrin IX

Porphyrins have long been considered as suitable agents for tumour photodiagnosis and tumour PDT because cancer cells exhibit a significantly greater uptake and affinity for porphyrins compared to normal quiescent tissues; cancer cells therefore naturally accumulate porphyrins.

An additional feature of the photosensitizer protoporphyrin IX (PpIX) is its ability to fluoresce, which in combination with cancer cells' natural accumulation of porphyrins allows for photodiagnosis (PD) of tumours. PD has been used by surgeons for enabling greater precision in the removal of tumours, such as for example brain tumours.

PpIX is naturally present in all nucleated mammalian cells at low concentrations; it is an intermediate in the biosynthesis of haem. In the haem biosynthesis, ALA is converted to PpIX (via a number of intermediate steps), after which PpIX is converted to haem by the insertion of a Fe ²⁺ ion into PpIX by the enzyme ferrochelatase.

In order for PDT to be effective, it is necessary to increase the amount of PpIX which is present in a cell. One way of doing this is to add more ALA, MAL or HAL to a cell, which will be converted to PpIX. However, the haem biosynthesis pathway has a maximum limit over which additional precursor administration does not produce any additional benefit.

Furthermore, excessive ALA oral administration has been demonstrated to induce liver toxicity in humans. Usually, the presence of free haem acts as a negative feedback mechanism inhibiting ALA synthesis. However, the exogenous administration of large amounts of ALA or MAL bypasses this negative feedback signal and results in a temporary accumulation of PpIX within the cells, since the insertion of Fe ²⁺ into PpIX to form haem is relatively slow.

Furthermore, PpIX may accumulate in the cell even more by slowing down the step of converting PpIX to haem by insertion of Fe ²⁺ , which may be achieved by limiting the iron supply in a cell. Bech, 0. etal., J Photochem Photobiol B, 1997, 41, 136-144; Curnow, A. et al., BJC, 1998, 78, 1278-1282; Pye, A. et al., Photochem Photobiol, 2007, 83(3), 766-73; and Blake, E. etal., Photochem Photobiol, 2010, 86(5), 1154-60 describe how the use of the iron chelator CP94, shown below, in combination with ALA can increase accumulation of PpIX.

A need however remains for new photosensitizer precursors which have an improved activity profile in photodynamic therapy, especially since currently photodynamic therapy is not effective for all tumour types; clearance rates for thicker nodular basal cell carcinoma (BCC), for example, remain lower than for superficial BCC.

It is an aim of the invention to provide a new compound which can be used as a

photosensitizer precursor, and which can show an improved activity profile in photodynamic therapy. Statements of the invention

According to a first aspect of the invention there is provided a compound which is a compound of formula (I) or any salt thereof:

wherein

R ¹ is a Ci-C ₆ alkyl group,

R ² is H or a Ci-C ₆ alkyl group,

R ³ is H or a Ci-C ₆ alkyl group, and

n is an integer from 0 to 5.

In an embodiment, the compound according to the first aspect of the invention is a compound of formula (I) as defined above, a salt of formula (la) or a salt of formula (lb):

wherein

R ¹ , R ² , R ³ and n are as defined above; and

each X ^" is independently selected from monovalent counterions.

In an embodiment, the compound according to the first aspect of the invention is a compound of formula (I) or a salt of formula (la) as defined above. In an embodiment, the compound according to the first aspect of the invention is a compound of formula (I) as defined above. In an embodiment, the compound according to the first aspect of the invention is a salt of formula (la) as defined above.

The monovalent counterion X ^" may be the conjugate base of any common acid. X ^" may, for example, be a halide, hydrogen sulphate, nitrate, or a carboxylate such as acetate or formate.

In an embodiment, X ^" is a halide, such as, for example, F, CI ^" , Br ^" or Γ. In an embodiment, X ^" is CI ^" . An alkyl group may be a straight or branched chain alkyl group.

In the compound according to the first aspect of the invention, R ¹ is a Ci-C ₆ alkyl group, which includes, for example, methyl, ethyl, n-propyl, /-propyl, n-butyl, t-butyl, n-pentyl, /- pentyl, t-pentyl and hexyl. In an embodiment, R ¹ is a Ci-C ₅ alkyl group, which includes, for example, methyl, ethyl, n-propyl, /-propyl, n-butyl, t-butyl, n-pentyl, /-pentyl, and t-pentyl. In an embodiment, R ¹ is a Ci-C ₄ alkyl group, which includes, for example, methyl, ethyl, n- propyl, /-propyl, n-butyl and t-butyl. In an embodiment, R ¹ is a Ci-C ₃ alkyl group, which includes, for example, methyl, ethyl, n-propyl and /-propyl. In an embodiment, R ¹ is a Ci-C ₂ alkyl group, i.e. methyl or ethyl. In an embodiment, R ¹ is a C ₂ alkyl group, i.e. ethyl. In the compound according to the first aspect of the invention, R ² is H or a Ci-C ₆ alkyl group, which includes, for example, methyl, ethyl, n-propyl, /-propyl, n-butyl, t-butyl, n-pentyl, /- pentyl, t-pentyl and hexyl. In an embodiment, R ² is H or a C ₁ -C5 alkyl group, which includes, for example, methyl, ethyl, n-propyl, /-propyl, n-butyl, t-butyl, n-pentyl, /-pentyl, and t-pentyl. In an embodiment, R ² is H or a C ₁ -C4 alkyl group, which includes, for example, methyl, ethyl, n-propyl, /-propyl, n-butyl and t-butyl. In an embodiment, R ² is H or a C ₁ -C3 alkyl group, which includes, for example, methyl, ethyl, n-propyl and /-propyl. In an embodiment, R ² is H or a C ₁ -C ₂ alkyl group, i.e. methyl or ethyl. In an embodiment, R ² is H.

In the compound according to the first aspect of the invention, R ³ is H or a Ci-C ₆ alkyl group, which includes, for example, methyl, ethyl, n-propyl, /-propyl, n-butyl, t-butyl, n-pentyl, /- pentyl, t-pentyl and hexyl. In an embodiment, R ³ is H or a C ₁ -C5 alkyl group, which includes, for example, methyl, ethyl, n-propyl, /-propyl, n-butyl, t-butyl, n-pentyl, /-pentyl, and t-pentyl. In an embodiment, R ³ is H or a C ₁ -C4 alkyl group, which includes, for example, methyl, ethyl, n-propyl, /-propyl, n-butyl and t-butyl. In an embodiment, R ³ is H or a C ₁ -C3 alkyl group, which includes, for example, methyl, ethyl, n-propyl and /-propyl. In an embodiment, R ³ is H or a Ci-C ₂ alkyl group, i.e. methyl or ethyl. In an embodiment, R ³ is H.

In an embodiment, R ² and R ³ are H.

In the compound according to the first aspect of the invention, n is an integer from 0 to 5. In an embodiment, n is from 0 to 4, or from 0 to 3, or from 0 to 2, or from 0 to 1, or from 1 to 5, or from 1 to 4, or from 1 to 3, or from 1 to 2. In an embodiment, n is 1. In an embodiment, R ¹ is methyl or ethyl; R ² is H, methyl or ethyl; R ³ is H, methyl or ethyl; and n is 1.

In an embodiment, R ¹ is ethyl, R ² and R ³ are H, and n is 1. This compound and its salt forms are effectively a combination of ALA and the iron chelating compound CP94, which have been linked via an ester linkage. Surprisingly, this linked compound has a better activity profile than a combination of ALA and CP94 as separate active agents.

This is highly surprising for a number of reasons. Firstly, delivering ALA and CP94 in a linked format (rather than separately) might be expected to alter the way the compounds enter the cell; bigger molecules tend to not enter cells as effectively as smaller molecules and may use different transporters. In fact, it is thought that ALA and MAL may enter cells via different membrane transporters and hence this might also have been true for the compound of the invention in which ALA and CP94 are linked. This new entity, therefore, was not guaranteed to produce even the same level of results as ALA and CP94 as separate agents, let alone better ones. In addition to this, it was very difficult to predict how the linked format would affect the innate cellular biochemistry relied on to produce the natural photosensitiser PpIX. ALA is normally formed by ALA synthase in the mitochondrion before entering the portion of the haem biosynthesis pathway that occurs in the cytosol. The later step of insertion of iron into the PpIX porphyrin ring to form haem occurs in the mitochondrion. In order to influence this pathway in such a way that PpIX accumulates, the iron chelator needs to be able to diminish mitochondrial levels of iron either directly or indirectly. However, the compound of the invention in which ALA and CP94 are linked first needs to be separated into the active agents by esterases present in the cytosol. The linked format might therefore be expected to alter the cellular compartments (such as the cytosol and the mitochondrion) in which the separate compounds end up, which could also alter the regulation of the haem biosynthetic pathway. In addition, in theory it might seem better to deliver the CP94 before the ALA, in order to chelate the iron prior to producing the PpIX, whereas delivering the agents in a linked format means that the agents are delivered simultaneously. These factors contributed further to render the utility of the invented compound even more surprising.

Furthermore, iron chelator CP94 is bidentate and it therefore takes three CP94 molecules to bind one Fe ²⁺ ion. In addition to this, in the haem biosynthesis pathway two molecules of ALA dimerize to form porphobilinogen after which four molecules of the latter are condensed, rearranged and cyclised to produce uroporphyrinogen III; this is then converted into protoporphyrin IX via coproporphyrinogen III. Therefore, eight molecules of ALA are needed to form one PpIX molecule, which binds to one Fe ²⁺ ion to form one molecule of haem. The theoretical ratio of ALA : CP94 required per Fe ²⁺ ion would, therefore, in simplistic biosynthetic terms, be 8 ALA : 3 CP94, i.e. over twice as much ALA as CP94. Despite this, the inventors have found that, highly surprisingly, equal quantities of ALA and CP94 in the specific linked format of the compound of the invention give an excellent activity profile. Without wishing to be bound by theory, in retrospect it may be the case that, in order to make haem formation from PpIX less likely to occur, more CP94 may be required than was theoretically predicted in order to drain the intracellular iron stores. As set out above, there are a large number of different factors in the environment inside a living cell which influence the activity profile of any active agent added to it, making it very difficult to predict the success of the active agent. It was, therefore, highly surprising to find that equal quantities of ALA and CP94 in the specific linked format of the compound of the invention gave such an excellent activity profile. In an embodiment, the compound according to the first aspect of the invention is a salt of formula (Ic):

As can be seen from .Example 2B, the salt of formula (Ic) is able to produce a significant increase in PpIX accumulation relative to ALA, MAL, a combination of ALA and CP94 as separate active agents, and a combination of MAL and CP94 as separate active agents. Furthermore, as can be seen from .Example 2C, the salt of formula (Ic) was also found to be significantly better at reducing cell viability following PDT, especially at low concentrations.

The clinical employment of the salt of formula (Ic) could, therefore, lead to a substantial benefit to patients undergoing dermatological PDT and other PDT applications.

According to a second aspect of the invention there is provided a pharmaceutical composition comprising a compound according to the first aspect of the invention and a pharmaceutically acceptable carrier. Throughout this specification, the term "pharmaceutical" includes veterinary. In an embodiment, the composition is a topical skin treatment formulation.

According to a third aspect of the invention there is provided a process for making a compound according to the first aspect of the invention, the method comprising the step of:

(a) reacting a compound of formula (II) with a compound of formula (III) via an esterification reaction to form a compound of formula (IV); in accordance with the following reaction scheme:

wherein R ¹ , R ² , R ³ and n are as defined for the first aspect; and

R ^PG1 and R ^re2 are protecting groups.

The term "protecting group" means a group capable of protecting an oxygen atom or a nitrogen atom, which protecting group may, subsequent to the reaction for which protection is employed, be removed without disturbing the remainder of the molecule. Protecting groups are well known and listed in standard texts such as Kocienski P. 1, Protecting Groups, 3rd ed., Georg Thieme Verlag, New York, 2005; and Greene T. W., Wuts P. G. M., Protective Groups In Organic Synthesis, 3rd ed., John Wiley & Sons, New York, 1998. In an embodiment, R is a protecting group selected from benzyl, benzoyl, methoxymethyl (MOM), methoxyethoxymethyl ether (MEM), tetrahydropyranyl (THP), and silicon protecting groups such as, for example, trimethylsilyl (TMS), triethylsilyl (TES), triisopropylsilyl (TIPS), triphenylsilyl (TPS), t-buty Id imethylsi lyl (TBDMS), t-butyldiphenylsilyl (TBDPS),

(dimethyl)thexylsilyl, and 2-(trimethylsilyl)ethoxymethyl (SEM).

R ^PG1 is an alcohol protecting group. Alcohol protecting groups are well-known to the skilled person and listed in standard texts such as those mentioned above.

In an embodiment, R ^PG2 is a protecting group selected from benzoyl and urethane-type protecting groups such as carboxybenzyl (Cbz), te†-butoxycarbonyl (Boc),

4-methoxybenzyloxycarbonyl, 4-nitrobenzyloxycarbonyl and 9-fluorenylmethyloxycarbonyl (Fmoc).

R ^PG2 is a primary amine protecting group. Primary amine protecting groups are well-known to the skilled person and listed in standard texts such as those mentioned above.

In an embodiment, the process according to the third aspect further comprises the step of:

(bl) deprotecting the compound of formula (IV) to give a compound of formula (I); in accordance with the following reaction scheme:

Protection and deprotection can be carried out in the usual ways known to the skilled person; these are routine steps in chemical synthesis.

In an embodiment, the process according to the third aspect further comprises the step of:

(b2) deprotecting the compound of formula (IV) in the presence of acid H ⁺ X ^" to give a salt of formula (la); in accordance with the following reaction scheme:

In an embodiment, the process according to the third aspect further comprises the step of:

(b3) deprotecting the compound of formula (IV) in the presence of acid H ⁺ X ^" to give a salt of formula (lb); in accordance with the following reaction scheme:

According to a fourth aspect of the invention there is provided a compound according to the first aspect of the invention for use in therapy.

According to a fifth aspect of the invention there is provided a compound according to the first aspect of the invention for use in photodynamic therapy.

In an embodiment, the compound for use according to the fifth aspect of the invention is for use in treating a condition, which is caused by and/or exacerbated by the abnormal proliferation of cells, by photodynamic therapy.

In an embodiment, the compound for use according to the fifth aspect of the invention is for use in treating cancer, by photodynamic therapy. In an embodiment, the compound is for use in treating skin cancer, by photodynamic therapy. In an embodiment, the compound is for use in treating internal cancer cells, by photodynamic therapy. In an embodiment, the compound for use according to the fifth aspect of the invention is for use in treating scleroderma, lichen sclerosus, psoriasis or warts, by photodynamic therapy. In an embodiment, the compound for use according to the fifth aspect of the invention is for use in treating chronic wounds, by photodynamic therapy. Such chronic wounds may, for example, be leg ulcers in the eldery. In an embodiment, the compound for use according to the fifth aspect of the invention is for use in treating acne, by photodynamic therapy. In an embodiment, the compound for use according to the fifth aspect of the invention is for use in treating a microbial infection, by photodynamic therapy. Such a microbial infection may, for example, be caused by bacteria, fungi, viruses and/or yeasts. In an embodiment, the compound for use according to the fifth aspect of the invention is for use in treating a parasitic infestation, by photodynamic therapy. In an embodiment, the compound for use according to the fifth aspect of the invention is for use in treating rheumatoid arthritis, by photodynamic therapy. In an embodiment, the compound for use according to the fifth aspect of the invention is for use in bone marrow purging, by photodynamic therapy, in the treatment of leukaemia.

In an embodiment, the compound for use according to the fifth aspect of the invention is administered topically. In an embodiment, the compound for use according to the fifth aspect of the invention is administered orally. In an embodiment, the compound for use according to the fifth aspect of the invention is administered intravenously.

According to a sixth aspect of the invention there is provided the use of a compound according to the first aspect of the invention in photodynamic treatment for cosmetic purposes.

In an embodiment, the compound is used in the photodynamic treatment for cosmetic purposes of hypertrophic scars, acne scars, wrinkles (rhytides), actinically damaged skin (also known as photodamaged skin or sun damaged skin), rosacea, actinic keratosis, sebaceous gland hyperplasia, lentigines, hirsutism, telangiectasias, port wine stains, erythema, poikiloderma, melisma, dyschromia, hyperpigmentation, mottled or blotchy pigmentation, rough skin patches, poor skin texture, enlarged pores, and/or skin laxity. In an embodiment, the compound is used in cosmetic photorejuvenation of skin by photodynamic treatment. According to a seventh aspect of the invention there is provided a compound according to the first aspect of the invention for use in a diagnostic method practised on the human or animal body. In an embodiment, the diagnostic method is a method of diagnosing a condition which is caused by and/or exacerbated by the abnormal proliferation of cells. In an embodiment, the condition which is caused by and/or exacerbated by the abnormal proliferation of cells is cancer.

As mentioned above, PpIX has a fluorescent ability, which enables the photodiagnosis (PD) of tumours. The production of a significantly greater level of PpIX in a significantly shorter time by using the compound according to the first aspect of the invention, therefore, can also result in improved PD.

According to an eighth aspect of the invention there is provided the use of a compound according to the first aspect of the invention in a diagnostic method other than a diagnostic method practised on the human or animal body. In an embodiment, the diagnostic method is an in vitro diagnostic method. For example, PD could be used to enhance the histological and/or microscopic analysis of tumours; this may help to further distinguish normal cells from abnormal cells in a specimen.

In an embodiment, the diagnostic method is a method of diagnosing a condition which is caused by and/or exacerbated by the abnormal proliferation of cells. In an embodiment, the condition which is caused by and/or exacerbated by the abnormal proliferation of cells is cancer.

According to a ninth aspect there is provided the use of a compound according to the first aspect of the invention in the manufacture of a medicament for the treatment, by photodynamic therapy, of a condition which is caused by and/or exacerbated by the abnormal proliferation of cells. In an embodiment, the condition which is caused by and/or exacerbated by the abnormal proliferation of cells is cancer.

A compound according to the first aspect of the invention may also be used in the manufacture of a medicament for the treatment, by photodynamic therapy, of any of the conditions referred to in connection with the fifth aspect of the invention.

According to a tenth aspect of the invention there is provided a method of treatment of a human or animal patient suffering from or at risk of suffering from a condition which is caused by and/or exacerbated by the abnormal proliferation of cells, the method involving administering to the patient a therapeutically effective amount of a compound according to the first aspect of the invention, and exposing a region of the patient containing the compound to light as part of a photodynamic therapy. In an embodiment, the condition which is caused by and/or exacerbated by the abnormal proliferation of cells is cancer. A compound according to the first aspect of the invention may also be used in a method of treatment of a human or animal patient suffering from or at risk of suffering from any of the conditions referred to in connection with the fifth aspect of the invention, the method involving administering to the patient a therapeutically effective amount of a compound according to the first aspect of the invention, and exposing a region of the patient containing the compound to light as part of a photodynamic therapy.

Throughout the description and claims of this specification, the words "comprise" and "contain" and variations of the words, for example "comprising" and "comprises", mean "including but not limited to", and do not exclude other moieties, additives, components, integers or steps. Moreover the singular encompasses the plural unless the context otherwise requires: in particular, where the indefinite article is used, the specification is to be understood as contemplating plurality as well as singularity, unless the context requires otherwise.

Preferred features of each aspect of the invention may be as described in connection with any of the other aspects. Other features of the invention will become apparent from the following examples. Generally speaking the invention extends to any novel one, or any novel combination, of the features disclosed in this specification (including any accompanying claims and drawings). Thus features, integers, characteristics, compounds, chemical moieties or groups described in conjunction with a particular aspect, embodiment or example of the invention are to be understood to be applicable to any other aspect, embodiment or example described herein unless incompatible therewith. Moreover unless stated otherwise, any feature disclosed herein may be replaced by an alternative feature serving the same or a similar purpose.

Where upper and lower limits are quoted for a property, then a range of values defined by a combination of any of the upper limits with any of the lower limits may also be implied. In this specification, references to compound properties such as optical rotations are - unless stated otherwise - to properties measured under ambient conditions, i.e. at atmospheric pressure and at a temperature of from 16 to 22 or 25 °C, or from 18 to 22 or 25 °C, for example about 20 °C or about 25 °C.

The present invention will now be further described with reference to the following non- limiting examples, and the accompanying illustrative drawings, of which: Figure 1 shows the results from a neutral red uptake assay to assess the level of inherent (dark) toxicity possessed by compound AP2-18 (8); *** indicates significance at the P<0.001 level (student's t-test).

Figure 2A shows the accumulation of PpIX fluorescence (+/- the standard error of the mean) in human dermal fibroblasts (84BR) over time following exposure to i) compound AP2-18 (8), ii) ALA alone, iii) ALA and CP94 (3), iv) MAL alone, and v) MAL and CP94 (3).

Figure 2B shows the results of a statistical analysis of the PpIX accumulation data in Table 1 and Figure 2A for human dermal fibroblasts (84BR); Figure 2B shows a statistical comparison of each of the three concentrations of compound AP2-18 (8) tested vs the other compounds tested (ALA, ALA and CP94 (3), MAL, MAL and CP94 (3) and the other concentrations of AP2- 18 (8)) (obtained by 2 way ANOVA with Bonferroni post-test to compare replicate means).

Figure 3A shows the accumulation of PpIX fluorescence (+/- the standard error of the mean) in human epithelial squamous cell carcinoma cells (A431) over time following exposure to i) compound AP2-18 (8), ii) ALA alone, iii) ALA and CP94 (3), iv) MAL alone, and v) MAL and CP94 (3). Figure 3B shows the results of a statistical analysis of the PpIX accumulation data in Table 2 and Figure 3A for human epithelial squamous cell carcinoma cells (A431); Figure 3B shows a statistical comparison of each of the three concentrations of compound AP2-18 (8) tested vs the other compounds tested (ALA, ALA and CP94 (3), MAL, MAL and CP94 (3) and the other concentrations of AP2-18 (8)) (obtained by 2 way ANOVA with Bonferroni post-test to compare replicate means).

Figure 4A shows the accumulation of PpIX fluorescence (+/- the standard error of the mean) in human glioblastoma cells (U87MG) over time following exposure to i) compound AP2-18 (8), ii) ALA alone, iii) ALA and CP94 (3), iv) MAL alone, and v) MAL and CP94 (3). Figure 4B shows the results of a statistical analysis of the PpIX accumulation data in Table 3 and Figure 4A for human glioblastoma cells (U87MG); Figure 4B shows a statistical comparison of each of the three concentrations of compound AP2-18 (8) tested vs the other compounds tested (ALA, ALA and CP94 (3), MAL, MAL and CP94 (3) and the other concentrations of AP2-18 (8)) (obtained by 2 way ANOVA with Bonferroni post-test to compare replicate means).

Figure 5A shows the percentage PpIX photobleaching immediately post irradiation in human dermal fibroblasts (84BR) following exposure to ALA, ALA and CP94 (3), MAL, MAL and CP94 (3), and compound AP2-18 (8). Figure 5B shows the effect on viability of human dermal fibroblasts (84BR) following exposure to ALA, ALA and CP94 (3), MAL, MAL and CP94 (3), and compound AP2-18 (8), and irradiation with red light.

Figure 5C shows the results of a statistical analysis of the cell viability data in Table 5 and Figure 5B for human dermal fibroblasts (84BR); Figure 5C shows a statistical comparison of each of the three concentrations of compound AP2-18 (8) tested vs the other compounds tested (ALA, ALA and CP94 (3), MAL, MAL and CP94 (3) and the other concentrations of AP2- 18 (8)) (obtained by 1 way ANOVA with Tukey post-test comparing all pairs of columns).

Figure 6A shows the percentage PpIX photobleaching immediately post irradiation in human epithelial squamous cell carcinoma cells (A431) following exposure to ALA, ALA and CP94 (3), MAL, MAL and CP94 (3), and compound AP2-18 (8).

Figure 6B shows the effect on viability of human epithelial squamous cell carcinoma cells (A431) following exposure to ALA, ALA and CP94 (3), MAL, MAL and CP94 (3), and compound AP2-18 (8), and irradiation with red light.

Figure 6C shows the results of a statistical analysis of the cell viability data in Table 7 and Figure 6B for human epithelial squamous cell carcinoma cells (A431); Figure 6C shows a statistical comparison of each of the three concentrations of compound AP2-18 (8) tested vs the other compounds tested (ALA, ALA and CP94 (3), MAL, MAL and CP94 (3) and the other concentrations of AP2-18 (8)) (obtained by 1 way ANOVA with Tukey post-test comparing all pairs of columns). Figure 7A shows the percentage PpIX photobleaching immediately post irradiation in human glioblastoma cells (U87MG) following exposure to ALA, ALA and CP94 (3), MAL, MAL and CP94 (3), and compound AP2-18 (8).

Figure 7B shows the effect on viability of human glioblastoma cells (U87MG) following exposure to ALA, ALA and CP94 (3), MAL, MAL and CP94 (3), and compound AP2-18 (8), and irradiation with red light.

Figure 7C shows the results of a statistical analysis of the cell viability data in Table 9 and Figure 7B for human glioblastoma cells (U87MG); Figure 7C shows a statistical comparison of each of the three concentrations of compound AP2-18 (8) tested vs the other compounds tested (ALA, ALA and CP94 (3), MAL, MAL and CP94 (3) and the other concentrations of AP2- 18 (8)) (obtained by 1 way ANOVA with Tukey post-test comparing all pairs of columns).

Figure 8 shows the mean PpIX fluorescence measured in A431 cells following increasing doses (250, 500 or 1000 μΜ) of (A) ALA +/- CP94, (B) MAL +/- CP94 and (C) AP2-18 after varying incubation periods (2, 3 or 4 hours); *, ** and *** indicates statistical significance at the 0.050, 0.010 and 0.001 levels respectively.

Figure 9 shows the mean PpIX fluorescence measured in A431 cells following increasing doses (250, 500 or 1000 μΜ) of ALA +/- CP94, MAL +/- CP94 and AP2-18 after incubation periods of A(i) 2 hours, B(i) 3 hours and C(i) 4 hours with the corresponding statistical analysis for each time period presented in A(ii), B(ii) and C(ii) respectively. Figure 10 shows the mean cell viability of A431 cells following increasing doses (250, 500 or 1000 mM) of (A) ALA +/- CP94, (B) MAL +/- CP94 and (C) AP2-18 after varying incubation periods (2, 3 or 4 hours); *, ** and *** indicates statistical significance at the 0.050, 0.010 and 0.001 levels respectively.

Figure 11 shows the mean cell viability of A431 cells following increasing doses (250, 500 or 1000 mM) of ALA +/- CP94, MAL +/- CP94 and AP2-18 after incubation periods of A(i) 2 hours, B(i) 3 hours and C(i) 4 hours with the corresponding statistical analysis for each time period presented in A(ii), B(ii) and C(ii) respectively; DLI stands for 'drug-light interval', i.e. the incubation period during which the cells have been exposed to the drug before irradiation takes place. Examples

Example 1 - Synthesis of l-(2-(5-amino-4-oxopentanoyloxy)ethyl)-2-ethyl-3,4- dihydroxypyridinium chloride hydrochloride (AP2-18), 8

Synthesis of AP2-18 (8) was achieved via the coupling of benyloxycarbonyl-protected aminolevulinic acid 5 with CP94 analogue 6.

ALA-derivative 5 was synthesised by exposure of ALA.HCI (4) (obtained from Sigma-Aldrich) to benzyl chloroformate, under basic conditions, to give benzyloxy-protected ALA 5.

The complementary coupling partner, CP94 analogue 6, was synthesised from ethyl maltol (1) by benzyl protection then amination with ethanolamine.

1 6; 38%

Esterification of 5 and 6, promoted by DCC/DMAP, proceeded smoothly to give the coupled product 7, which was deprotected by hydrogenolysis to give the target compound AP2-18 (8):

8; 96%

Compound AP2-18 (8) is a compound according to the first aspect of the invention, and corresponds to the salt of formula (Ic).

Full experimental procedures for these steps are given below. 1A. ALA-derivative 5

ALA-derivative 5 is a known compound which can, for example, be obtained via the procedure in Neuberger A. et al., Biochemistry Journal, 1956, 64, 137-145.

IB. CP94 analogue 6

CP94 analogue 6 was prepared according to a previously published procedure (Dobbin, P.S., et al., J Med Chem, 1993. 36(17): p. 2448-58; Liu, Z. D. et al., J. Pharm. Pharmacol, 1999, 51, 555-564. 1C 2-(3-(Benzyloxy)-2-ethyl-4-oxopyridin-l(4H)-yl)ethyl 5-(benzyloxycarbonylamino)-4- oxopentanoate, 7

4-(Dimethylamino)pyridine (3.3 mg, 0.0274 mmol) was added to a stirred solution of 3- (benzyloxy)-2-ethyl-l-(2-hydroxyethyl)pyridin-4(lH)-one (6) (149 mg, 0.547 mmol), 5- (benzyloxycarbonylamino)-4-oxopentanoic acid (5) (145 mg, 0.547 mmol) and Λ/,Λ/'- dicyclohexylcarbodiimide (118 mg, 0.574 mmol) in dichloromethane (8 mL). After 24 h, the resulting suspension was filtered through cotton wool, eluting with dichloromethane. The filtrate was concentrated in vacuo and the residue was purified by flash chromatography on silica gel, eluting with ethyl acetate then methanol, to give the title compound 7 (247 mg, 87%) as a colourless oil, /¾= 0.7 (MeOH); δ _Η (300 MHz; CDCI ₃ ) 7.46-7.20 (11H, m, Ar and Pyr 6-tf), 6.40 (1H, d, J 9.0 Hz, Pyr 5-H), 5.97 (1H, br s, NH), 5.22 (2H, s, PhCH ₂ ), 5.09 (2H, s, PhCH ₂ ), 4.22 (2H, t, J 6.0 Hz, OCHzCH ₂ ), 4.10-3.95 (4H, m, HNCH ₂ and OCH ₂ CH ₂ ), 2.71-2.50 (6H, m, CH ₃ CH ₂ and C(0)CHjZH ₂ ) and 0.99 (3H, t, J 7.0 Hz, CH ₃ ); 5 _C (75 MHz; CDCI ₃ ) 204.7, 174.3, 172.3, 156.9, 146.2, 139.4, 138.0, 136.8, 129.1, 128.9, 128.8, 128.7, 128.5, 128.4, 128.3, 117.8, 73.3, 67.3, 63.3, 51.5, 50.9, 34.4, 27.9, 19.8 and 13.5. ID. l-(2-(5-amino-4-oxopentenoyloxy)ethyn-2-ethyl-3^-dihydroxypy ridinium chloride hydrochloride (AP2-18), 8

A stirred solution of 2-(3-(benzyloxy)-2-ethyl-4-oxopyridin-l(4/-/)-yl)ethyl 5- (benzyloxycarbonylamino)-4-oxopentanoate (7) (247 mg, 0.475 mmol) in 6:1 v/v ethanohwater (3.5 mL) was acidified to pH = 1 by addition of hydrochloric acid (37% aq.). Palladium on activated charcoal (11 mg, 10% w/w) was added, the reaction vessel was evacuated then filled with hydrogen and the reaction was stirred under hydrogen (at atmospheric pressure) for 2 h. The resulting suspension was filtered through Celite®, eluting with ethanol and the filtrate was then concentrated in vacuo to give the product as a mixture of mono- and di-salts. Three cycles of dissolution in water, addition of hydrochloric acid (37% aq.) then concentration in vacuo gave the title compound 8 (169 mg, 96%) as a brown oil, δ _Η (300 MHz; D ₂ 0) 7.82 (1H, d, J 8.0 Hz, Ar 6-H), 6.92 (1H, d, J 8.0 Hz, Ar 5-H), 4.27 (2H, t, J 6.0 Hz, OCHzCH ₂ ), 3.91 (2H, s, H ₃ N ⁺ CH ₂ ), 3.74 (2H, t, J 6.0 Hz, OCH ₂ CH ₂ ), 2.80 (2H, q, J 7.0 Hz, CH ₃ CH ₂ ), 2.66 (2H, t, J 6.0 Hz, C(0)CH ₂ ), 2.45 (2 H, t, J 6.0 Hz, C(0)CH ₂ ) and 0.98 ppm (3H, t, J 7.0 Hz, CH ₃ ); 5 _C (75 MHz; D ₂ 0) 204.3, 176.9, 158.6, 147.7, 142.5, 139.5, 111.0, 60.6, 57.8, 47.3, 34.6, 27.6, 20.1 and 11.3 ppm; m/z (ES+) 297.1445 (100%, [M-H-2CI] ⁺ ), Ci ₄ H ₂ iN ₂ 0 ₅ requires M, 297.1445.

Comparative Example 1 - Synthesis ofCP94 (3) Compound CP94 (3) was prepared according to a previously published procedure (Dobbin, P.S., et al., J Med Chem, 1993. 36(17): p. 2448-58). Ethyl maltol (1) was benzyl protected and aminated to give 2; and deprotection by hydrogenolysis gave CP94 (3), as shown below.

1 2; 63% 3; 67%

Example 2 - Experimental Testing of ΆΡ2-18 (8)

NB: Unless otherwise stated all data presented is the mean of three independent experiments each consisting of three internal repeats of each condition.

2A. Toxicity Testing

To establish if compound AP2-18 (8) possessed any inherent toxic properties, a 1000 μΜ test solution was prepared (the highest concentration to be tested in this study) in standard cell culture medium (minimum essential medium (MEM) containing 1% (v/v) fetal bovine serum (FBS), 200 mM L-glutamine, 200 U mL ¹ penicillin and 200 pg mL ¹ streptomycin). This was applied to MRC-5 (human embryonic lung fibroblast) cells, under reduced light conditions, and left for 4 hours (this time period was chosen as it is equivalent to that used in dermatological PDT clinics) in the dark and following this cell viability was determined using the neutral red uptake (NRU) assay. Neutral red is an inert dye actively taken up and stored by viable (living) cells, an action which is unable to be performed by non-viable cells, therefore the level of neutral red taken up is directly proportional to the number of viable cells present following a given exposure. Following uptake of the dye, cells are lysed and the level of neutral red quantified using a plate reader.

Control cells were incubated in standard cell culture medium. Cells were also exposed to 0.01% (v/v) hydrogen peroxide which acted as a positive control for the NRU assay. As can be seen from Figure 1, exposure to 0.01% (v/v) hydrogen peroxide resulted in a significant reduction in cell viability. Treatment with AP2-18 (8) did result in a very slight reduction in the number of viable cells, however on statistical analysis this was not found to be significantly different to control cells incubated in standard cell culture medium. AP2-18 (8), therefore, is not inherently toxic to MRC-5 (lung fibroblast) cells when compared to cells only exposed to cell medium. 2B. PpIX Fluorescence Accumulation

The level of protoporphyrin IX (PpIX) accumulation was monitored using a well-established previously validated fluorescence based assay described in Blake, E. etal., Photochem Photobiol, 2011, 87(6), 1419-26; Blake, E. et al., Photochem Photobiol, 2010, 86(5), 1154-60; Curnow, A. et al, J Environ Pathol Toxicol Oncol, 2007, 26(2), 89-103; and Pye, A. et a/., J Cancer Res Clin Oncol, 2008, 134(8), 841-9.

Briefly, cells were seeded at 2 x 10 ⁴ cells per well in a 96 well plate and left to adhere overnight. Test solutions were prepared on the day of the assay and applied to the cells. The level of PpIX produced was monitored using a multi-well fluorescent plate reader with a 400 (± 30) nm excitation filter and a 645 (± 40) nm emission filter, with the level of fluorescence produced being directly proportional to the level of PpIX present. Readings were taken hourly for 6 hours and were conducted under low light conditions to reduce photobleaching of PpIX.

To evaluate the ability of AP2-18 (8) to cause an increase in PpIX accumulation within cells a series of concentrations were prepared (250 μΜ; 500 μΜ; 1000 μΜ) which reflect those previously used by our group (see citations mentioned above). These were tested alongside equimolar concentrations of ALA, ALA and CP94 (3), MAL, and MAL and CP94 (3), with all test compounds being investigated in human dermal fibroblasts (84BR; Figures 2A and 2B), human epithelial squamous cell carcinoma cells (A431; Figures 3A and 3B) and human glioblastoma cells (U87MG; Figures 4A and 4B). The results are given in the tables below: Table 1 shows the results for the tests with human dermal fibroblasts (84BR) corresponding to Figures 2A and 2B); Table 2 shows the results for the tests with human epithelial squamous cell carcinoma cells (A431) corresponding to Figures 3A and 3B; and Table 3 shows the results for the tests with human glioblastoma cells (U87MG) corresponding to Figures 4A and 4B.

Exposure Time Drug

(hours) ALA (250 μΜ)

0 0 -3 -3 -6.33 -3.33 -4.33 0.33 2.33 3.33

1 8.33 7.33 4.33 -0.33 0.67 0.67 5 8 7

2 15 14 13 14.67 13.67 12.67 3 5 5

3 23 20 20 28 26 27 4.33 8.33 6.33

4 23 25 21 39.67 34.67 38.67 8 10 9

5 25 26 22 53 49 52 6.67 9.67 9.67

6 25.67 28.67 25.67 62.33 56.33 61.33 9.33 11.33 10.33

Exposure Time Drug

(hours) ALA (1000 μΜ)

0 -2 -11 -11 -4.67 -4.67 -3.67 -8.33 -9.33 -8.33

1 12.67 9.67 7.67 0 4 8 -4.33 -1.33 -1.33

2 48.67 43.67 41.67 31.33 37.33 44.33 13 14 12

3 85.67 81.67 80.67 65 73 84 35.33 35.33 30.33

4 117.67 115.67 113.67 95.67 105.67 115.67 57.33 56.33 47.33

5 154.67 154.67 149.67 131.33 142.33 158.33 79.33 77.33 69.33

6 186 191 186 163 175 195 104.33 100.33 89.33

Exposure Time Drug

(hours) ALA (250 μΜ) + CP94 (250 μΜ)

0 -4 -5 0 -9 -4 -12 -6.33 -5.33 -5.33

1 29 28 27 16 15 13 11.67 13.67 11.67

2 62 64 66 52.33 48.33 46.33 34.67 37.67 36.67

3 95 99 102 84.67 76.67 74.67 52 58 56

4 121.33 126.33 129.33 114.33 100.33 99.33 71.33 77.33 73.33

5 150 155 155 141.33 126.33 124.33 85.67 91.67 89.67

6 172.67 179.67 185.67 169.33 149.33 147.33 102.33 107.33 103.33

Exposure Time Drug

(hours) ALA (500 μΜ) + CP94 (500 μΜ)

0 -0.33 -3.33 4.67 -18.67 -7.67 -8.67 -7.67 -1.67 -0.67

1 40.33 38.33 35.33 -8 0 4 10.33 14.33 16.33

2 87.33 89.33 87.33 7.33 20.33 24.33 40.67 46.67 48.67

3 134.67 145.67 138.67 17.67 34.67 46.67 71.67 74.67 77.67

4 177.33 190.33 181.33 24 50 61 102.33 105.33 107.33

5 224.67 241.67 230.67 31 62 78 128.67 131.67 136.67

6 265 284 274 35.67 71.67 94.67 155 155 159 Exposure Time Drug

(hours) ALA (1000 μΜ) + CP94 (1000 μΜ)

0 1.67 -0.33 3.67 -10.67 -8.67 -7.67 -19.67 -19.67 -12.67

1 50 40 39 20 23 20 -1.67 1.33 6.33

2 101.33 101.33 95.33 70.67 73.67 70.67 17.67 29.67 35.67

3 169.33 167.33 158.33 122 123 119 39.33 55.33 65.33

4 226.33 224.33 210.33 170.67 171.67 162.67 58.33 78.33 91.33

5 292.67 287.67 270.67 222.67 224.67 212.67 77.33 101.33 116.33

6 360.67 352.67 330.67 268 273 259 98.33 126.33 136.33

Exposure Time Drug

(hours) MAL (1000 μΜ)

0 -2.33 8.67 7.67 -23.67 -17.67 -17.67 5 14 -7

1 1 7 6 -22 -11 -22 -9.33 -2.33 0.67

2 8.67 14.67 14.67 -8 4 -6 -5.67 2.33 3.33

3 16.33 22.33 20.33 11.67 21.67 19.67 2 10 9

4 21.33 23.33 27.33 27.67 36.67 33.67 9.33 14.33 14.33

5 29 28 32 39 51 49 14 23 20

6 34 32 38 53.33 62.33 63.33 14.67 26.67 20.67

Exposure Time Drug

(hours) MAL (250 μΜ) + CP94 (250 μΜ)

0 -0.33 -2.33 -3.33 -12.33 -7.33 -3.33 5 5 5

1 16 12 9 -2 2 3 12.67 10.67 13.67

2 28 27 23 9 14 15 19.33 17.33 22.33

3 37.33 37.33 35.33 18.67 25.67 26.67 24 24 30

4 48.33 48.33 44.33 27.33 32.33 34.33 33 31 37

5 60.33 59.33 56.33 39.67 43.67 46.67 38 35 43

6 74.33 68.33 66.33 47 54 52 43 42 51 Exposure Time Drug

(hours) MAL (500 μΜ) + CP94 (500 μΜ)

0 -11.67 -6.67 3.33 -12 -8 -10 -4.67 -1.67 0.33

1 16.33 16.33 15.33 -2.33 1.67 -0.33 4.67 8.67 10.67

2 35.67 37.67 39.67 19.67 24.67 17.67 21.67 24.67 25.67

3 58.33 59.33 62.33 40 40 35 32.67 33.67 40.67

4 77.33 78.33 79.33 54 54 48 45 48 53

5 103 101 103 72.33 71.33 62.33 59 59 66

6 123.67 120.67 121.67 83 85 77 70.67 68.67 76.67

Table 1: PpIX accumulation in human dermal fibroblasts (84BR)

Exposure Drug

Time (hours)

ALA (250 μΜ) + CP94 (250 μΜ)

0 -7.33 -7.33 -11.33 1.33 -0.67 -3.67

1 3 4 0 12 9 10

2 26.67 24.67 19.67 37 34 39

3 46 46 38 62 58 67

4 70.67 71.67 61.67 87.33 77.33 89.33

5 97.33 99.33 87.33 109 101 111

6 118.33 121.33 110.33 135.33 128.33 140.33 Exposure Drug

Time (hours)

ALA (500 μΜ) + CP94 (500 μΜ)

0 -11.67 -9.67 -5.67 0 7 0

1 9.67 6.67 9.67 11.33 16.33 14.33

2 38.67 33.67 37.67 38 44 40

3 69.33 61.33 69.33 68 73 71

4 108 95 102 95 100 94

5 145.67 131.67 140.67 123.67 127.67 121.67

6 177.67 160.67 171.67 152 155 152

Exposure Drug

Time (hours)

MAL (250 μΜ) + CP94 (250 μΜ)

0 -5.67 -8.67 -4.67 -127 -127 -127 6 11 3

1 27.67 15.67 17.67 5.67 5.67 9.67 13 15 5

2 36.33 30.33 35.33 16.67 14.67 20.67 10.33 23.33 13.33

3 51 42 50 28 24 31 21.33 30.33 19.33

4 65.67 53.67 61.67 35.67 34.67 39.67 27.33 37.33 26.33

5 77.67 63.67 74.67 49.33 47.33 52.33 33.33 45.33 34.33

6 95 80 92 54.33 55.33 60.33 39 51 38

Exposure Drug

Time (hours)

MAL (500 μΜ) + CP94 (500 μΜ)

0 -11 -16 -12 -134 -134 -134 0.33 -5.67 -4.67

1 18 13 15 10.33 -1.67 -6.67 6 2 0

2 38 33 39 31.33 19.33 7.33 17.67 16.67 14.67

3 57 54 61 54.33 40.33 19.33 26 27 24

4 73.67 72.67 79.67 68.33 55.33 27.33 39.33 36.33 33.33

5 93.33 95.33 103.33 87 75 39 50.33 50.33 43.33

6 112.33 119.33 123.33 108.33 91.33 48.33 51.67 57.67 51.67

Exposure Drug

Time (hours)

MAL (1000 μΜ) + CP94 (1000 μΜ)

0 -12.67 -8.67 -0.67 19.67 11.67 6.67

1 -6 -2 -2 26.67 16.67 10.67

2 13 18 15 55.67 44.67 37.67

3 34.33 40.33 40.33 82.67 74.67 63.67

4 51.33 61.33 60.33 110.67 96.67 86.67

5 76.33 84.33 86.33 114.67 117.67 111.67

6 93.67 107.67 104.67 144 147 137

Table 2: PpIX accumulation in human epithelial squamous cell carcinoma cells (A431) - missing data is due to an infection present in these wells in this replicate and therefore data was discarded

Exposure Drug

Time (hours)

ALA (250 μΜ) + CP94 (250 μΜ)

0 -2.67 -5.67 -8.67 -5 -7 -12 -8.33 -6.33 -6.33

1 18.67 14.67 12.67 33 33 30 5.33 6.33 6.33

2 47.67 49.67 43.67 86.33 94.33 92.33 26.67 30.67 31.67

3 77.33 78.33 68.33 148.67 162.67 158.67 44.67 54.67 51.67

4 107.33 111.33 92.33 213 239 226 61.67 70.67 70.67

5 139.33 142.33 118.33 262 297 278 79 88 90

6 165 170 144 325.33 363.33 341.33 97.67 108.67 107.67 Exposure Drug

Time (hours)

ALA (500 μΜ) + CP94 (500 μΜ)

0 -4 0 0 -18.33 -14.33 -11.33 -3.67 -7.67 -4.67

1 25.33 19.33 15.33 36 43 44 11.67 11.67 11.67

2 67.67 50.67 42.67 104 121 118 38.67 36.67 38.67

3 105.67 81.67 67.67 180.67 201.67 197.67 63.67 62.67 64.67

4 154.67 116.67 96.67 263.67 292.67 282.67 87.33 81.33 84.33

5 201.67 154.67 130.67 333.33 361.33 348.33 112.67 110.67 110.67

6 245.33 188.33 156.33 418 446 438 137.33 133.33 136.33

Exposure Drug

Time (hours)

MAL (500 μΜ) + CP94 (500 μΜ)

0 8.33 -19.67 -19.67 -6.33 -10.33 -27.33 9 1 1

1 21.33 -0.67 1.33 1.67 0.67 -7.33 9.67 20.67 15.67

2 22.67 3.67 11.67 22 19 15 15 36 33

3 37.67 14.67 23.67 40 36 35 19.33 45.33 43.33

4 50 24 34 58.67 50.67 48.67 29.67 54.67 54.67

5 65.33 33.33 47.33 78 70 63 35.33 63.33 67.33

6 78.67 43.67 56.67 94.67 82.67 81.67 40 70 76

Exposure Drug

Time (hours)

MAL (1000 μΜ) + CP94 (1000 μΜ)

0 -6 -6 -3 1.33 5.33 4.33 -3 -3 -3

1 2.67 4.67 2.67 54.33 52.33 39.33 7 11 6

2 30 31 28 120.67 113.67 82.67 28.33 33.33 31.33

3 57.67 56.67 45.67 192.67 179.67 131.67 47.33 59.33 50.33

4 80 83 72 270 253 186 62 82 73

5 107.33 114.33 93.33 325.67 305.67 226.67 78.67 101.67 93.67

6 135.33 141.33 113.33 407.67 379.67 284.67 101.33 124.33 117.33

Table 3: PpIX accumulation in human glioblastoma cells (U87MG)

Accumulation of PpIX fluorescence produced by each of the prodrugs investigated (AP2-18 (8), ALA, ALA and CP94 (3), MAL, and MAL and CP94 (3)) increased over time in each of the three cell types examined. Novel compound AP2-18 (8), which is a compound according to the first aspect of the invention, was found to significantly increase PpIX accumulation in all three cell types, above and beyond that achieved with ALA or MAL administration either alone or in combination with the iron chelator CP94 (3). These findings suggested that in vitro AP2- 18 (8) represents a compound which is able to produce a significantly greater level of PpIX in a potentially significantly shorter time, and hence that AP2-18 (8) has the potential to substantially improve PpIX-induced PDT. Further experimentation to determine whether this significant increase in PpIX accumulation could be translated into increased cell kill on irradiation was undertaken.

2C. PDT Efficacy

To assess the effect of AP2-18 (8) on PpIX-induced PDT efficacy, the same three cell types were exposed to equimolar concentrations of ALA, ALA and CP94 (3), MAL, MAL and CP94 (3), and AP2-18 (8) (as described previously) and incubated in the dark for 4 hours. The level of PpIX accumulation was then quantified as before, prior to irradiation with red light (37 J/cm ² ; 635 ± 2 nm; Aktilite, Galderma, UK). The level of PpIX remaining immediately post irradiation was also ascertained and the change in PpIX level (PpIX photobleaching) was calculated as a percentage (Figures 5A, 6A and 7A). Cell viability was then assessed using the NRU assay (as described previously) with these data being normalised against the blank control cells (which were exposed to normal cell media) and presented as a percentage of viable cells (Figures 5B, 6B and 7B). The results of the statistical analyses which were subsequently undertaken are presented in Figures 5C, 6C and 7C respectively.

The results of the tests with human dermal fibroblasts (84BR) are given in Tables 4 and 5 below and in Figures 5A, 5B and 5C. The results of the tests with human epithelial squamous cell carcinoma cells (A431) are given in Tables 6 and 7 below and shown in Figures 6A, 6B and 6C. The results of the tests with human glioblastoma cells (U87MG) are given in Tables 8 and 9 below and shown in Figures 7A, 7B and 7C.

Table 4: PpIX photobleaching in human dermal fibroblasts (84BR) following irradiation - missing data is due to an infection present in these wells in this replicate and therefore data was discarded



•218666? 4 1,72414 ?·ΐ WW® -1113333 51.36432 61.3665? 7075 13 723472? 7333767 β§.133

•35.33333 mm ΘΙ6 66 86.1814? 68S2IS7 mm 6323347 5626363

-2125 mmn. rnrn 57.40741 mm 12mm ?4,§1?3? 75.53127

-« mm 7232/04 3337096 imm §3 7038 17.1312:5

-250 -110.7143 B0-24891 S3 421 3763635 Aim 72.35773

24.53/53 47.24630 mm 6 433B3 07.71312

17.73333 T3.05I36 63.31121 66 §3429

144.444 ?4J§ 13 62.72» 57.2:30 4

Table 6: PpIX photobleaching in human epithelial squamous cell carcinoma cells (A431) following irradiation - missing data is due to an infection present in these wells in this replicate and therefore data was discarded

ALA (250 pi) mm n itwiis m* cmm m

%mm 4,8498?3 3 .00553 SI.2&S12 mim 144515 7.172601

103-8911 mn 1.72551 27.2S15? 8:3545?5 5.806345 7.3/1542

9§S5¾88 ' iiiif 2013594 1158132 ' ?35$1¾θ 5812198 5215373 u 04.33S2 5,718441 125.838? 111.2275 119,512 42.7513 35.35415 8.7857?

9251 61 4J75331 1¾.ft8 0575?3 86.84508 1¾§284§ 11 32778 8316076

103-1S02 4,815431 1271037 213715 18,867? mm 8.348173 S.0SSS3T

00.40414 12.241 6.313455 106» 42.58155 32.9127? 25.04367

110 :2 i.588 88 5177122 .nm 39,51185

1544357 1854115 1SJ0I32 38J9838 21.34401 3223253 3212113 28.14δ§8 lAt pi*«ppI « f« i

151,5655 95.23/82 91,78111 84,55451 78.8531 5.721582 7.817751 8.82211 81315338

§3.45258 115.211 85584 §3.39436 8o,4¾|85 5 » 5.381820 8,338878 8.88238

15 ,152! i.5132 118.3323 §5,46222 ¹ iii 5455272 5.5212 8.54581 5.58111?

151.415 113.2845 1387881 mm 115.7124 5.77881 7338521 7158335 758/833

§353815 104,8889 132.551? 1,55512 1031125 7.023862 8.M543 1111 8.758245 ^"

108.358? 7442275 1858882 1187433 183151 85255 8.511778 5.852834 7382404

105.2813 331554 32,02il 42.3782? 3I.88773

9172992: 33.74878 32,78443 32572? 84.15911

1511113 27.57518 31,15152 25.1851 25,25818

Table 7: human epithelial squamous cell carcinoma cells (A431) cell viability following irradiation - missing data is due to an infection present in these wells in this replicate and therefore data was discarded

1 AU! C268 :M ] ALA SOS j M}*€t 1Ι ¾1

40.30 S2 4t88§31 44,39164! 3§.8§43§ 3235639: 41 33228! 1δΤ.6§23|

48.3671? 44,31561 46.24574! 43.04462 38.65863; 427864 -226]

48,02033 407426? 47,24733! 46 95432 ¾8§?17! 44,4619 200 j

61 3 319 41.48485 4 14288! 51,61871 48.865461 40.42715 33.4S515 δΐ.81024 48.4?§6¾| 53.31818 50.625! 3S.4902 86,41)???

51.31064 53.33535 49.40742! 55.44933 52.01342: 37,32636 32,474281

35.71 29 653 95 52 17391 ! 5550166 46,44195! ¾ 12043 j j

4?J2SU9 3 022S9 65,24064

160 53,0548 58ϋ286δ! 59 34556 51,515151 45Β1§Ι3

Table 8: PpIX photobleaching in human glioblastoma cells (U87MG) following irradiation - missing data is due to an infection present in these wells in this replicate and therefore data was discarded

m *mm≠®M m pif *m p p fni _* <amtm ]

§4.14043 imm 3147201 2.3371? 1554720

1061374 imm 1J1S11 2.548126 2.012758 1.134175 2.4S3119 174308 .m.!.| 12. mi. J96 ..........Jlili 2481351 IM!l i!Z?46

90.18S43 1812221 3<1 0932 2.057353 2.200388 6412D9 mi 1,854331 020/84 2215271 52241 809212 1.848315 2353522 1.475343 2.165042

1077362 15825? 405757 1JI550S 2,17451 2.071414 i mm imm

1905656 23.02201 nmm 20.52205 25J0I51 3113727 25.23271 23,20079 rnmi 21.334251 m m 2§ W zm 2104302 24.38721

Table 9: human glioblastoma cells (U87MG) cell viability following irradiation - missing data is due to an infection present in these wells in this

replicate and therefore data was discarded

Substantial PpIX photobleaching (i.e. a reduction in PpIX fluorescence during light irradiation) was observed in the vast majority of the treatment groups investigated (see Figures 5A, 6A and 7A). This demonstrated that PpIX was being consumed during the light treatment and indicated that PDT was occurring within all three cell types investigated. Complete PpIX photobleaching was rarely achieved with the particular treatment parameters employed here however.

Analysis of the cell viability results (see Figures 5B and 5C, 6B and 6C, and 7B and 7C) revealed that both the blank control and hydrogen peroxide positive control groups were successful in all three cell types, producing little cytotoxicity and considerable cell death respectively. In human dermal fibroblasts (84BR; Figures 5B and 5C), the use of the iron chelator CP94 (3) improved the PDT effect of both ALA and MAL in a concentration dependent manner, but the novel compound AP2-18 (8) was found to be significantly better (than any of the other treatment parameters investigated) at reducing cell viability following PDT when the lowest concentration employed (250 μΜ) was considered. At higher doses when significance was not achieved, the level of cell kill produced by AP2-18 (8) was equivalent to (or better than) that observed with the other treatment groups. Very similar trends and significant reductions in cell viability were also observed in the human epithelial squamous carcinoma cells (A431; Figures 6B and 6C). It can therefore be concluded in these particular cell types that AP2-18 (8) is an efficacious prodrug for PpIX-induced PDT which achieved this effect at lower concentrations than possible with ALA or MAL with or without administration of the iron chelator CP94 (3). Less significant improvements in cell kill over and above the other prodrugs administered with and without the iron chelator CP94 (3) were observed with AP2-18 (8) in the human glioblastoma cells (U87MG; Figures 7B and 7C) however, as these cells appear to be more susceptible to the cytotoxic effects of PpIX-PDT at lower doses. Despite this, AP2-18 (8) still produced highly effective PpIX-induced PDT cell kill in this cell type as well.

The significant increases in cytotoxicity observed for PpIX-induced PDT conducted with compound AP2-18 (8) could potentially be translated into clinical PDT settings to produce substantial benefits for patients undergoing dermatological PDT and other PDT applications. 2D. PPT Efficacy in human epithelial squamous carcinoma cells (A431) with variable incubation periods

Human epithelial squamous carcinoma cells (A431) were exposed to equimolar concentrations of ALA, ALA and CP94 (3), MAL, MAL and CP94 (3), and AP2-18 (8) (as described previously) and incubated in the dark for incubation periods of 2, 3 or 4 hours. The level of PpIX accumulation was then measured; the results are given in Table 10 below and are shown in Figure 8A (ALA, ALA and CP94 (3)), Figure 8B (MAL, MAL and CP94 (3)) and Figure 8C (CP94 (3)). Figure 9 compares the level of PpIX accumulation measured in human epithelial squamous cell carcinoma cells (A431) following exposure to ALA, ALA and CP94 (3), MAL, MAL and CP94 (3), and AP2-18 (8), after the cells had been incubated with the compound(s) for 2 hours (Figure 9A(i)), 3 hours (Figure 9B(i)) and 4 hours (Figure 9C(i)). The results of corresponding statistical analyses for each incubation period are presented in Figure 9A(ii) (2 hours), Figure 9B(ii) (3 hours), and Figure 9C(ii) (4 hours).

After the relevant incubation period, the cells were irradiated with red light (37 J/cm ² ; 635 ± 2 nm; Aktilite, Galderma, UK). Cell viability was then assessed using the NRU assay (as described previously); the results of the cell viability tests are given in Table 11 below. These data were normalised against the blank control cells (which were exposed to normal cell media) and presented as a percentage of viable cells in Figures 10A (ALA, ALA and CP94 (3)), 10B (MAL, MAL and CP94 (3)), and IOC (AP2-18 (8)). Figure 11 compares the percentage of viable cells following exposure to ALA, ALA and CP94 (3), MAL, MAL and CP94 (3), and AP2- 18 (8), after the cells had been incubated with the compound(s) for 2 hours (Figure llA(i)), 3 hours (Figure llB(i)) and 4 hours (Figure llC(i)). The results of corresponding statistical analyses for each incubation period are presented in Figure llA(ii) (2 hours), Figure llB(ii) (3 hours), and Figure llC(ii) (4 hours).

Table 10: PpIX fluorescence measured in human epithelial squamous cell carcinoma cells (A431) after varying incubation periods

Table 11: cell viability of human epithelial squamous cell carcinoma cells (A431) after varying incubation periods - an extra viability experiment (of three more replicates) was conducted for the 3 hour time point resulting in more data at this time point than at 2 hours or 4 hours.

Figures 8 and 9 indicate a time dependent increase in PpIX levels with all three PpIX-prodrugs investigated. It is clear that although the addition of the iron chelator CP94 (3) to the ALA or MAL incubation period improved PpIX levels, this was outperformed by the combinational iron chelating PpIX-prodrug AP2-18 (8) (with four hours incubation of 1000 μΜ AP2-18 (8) in A431 human squamous epithelial carcinoma cells producing statistically significant higher PpIX levels than any other treatment parameters investigated). It should also be noted that the lowest dose of AP2-18 (8) (250 μΜ) at the shortest incubation time (2 hours) investigated also produced more PpIX than the highest doses of ALA or MAL (1000 μΜ) employed at the longest incubation time (4 hours). Importantly the increased PpIX accumulation observed with AP2-18 (8) was also translated on irradiation (Figures 10 and 11) into statistically significant increases in cell kill (when compared with that produced by either ALA or MAL) with the greatest cytotoxicity being produced at 4 hours.