Diffuse infiltrating gliomas are common brain tumors. Patients suffering from this disease undergo surgery and post-operative therapies that are determined based on the presence or absence of anaplastic foci. Anaplastic foci are circumscribed cancerous tissues that can promote the further progression of the disease.

George Widham and colleagues, Medical University Vienna, Austria, demonstrated that a reliable identification of anaplastic foci can be obtained during surgery by using 5-amminolevulinic acid (5-ALA; pictured). This compound is an oral prodrug that selectively accumulates in gliomas cells, where it leads to the synthesis of fluorescent porphyrins, natural heterocyclic macrocycles. The researchers administered 5-ALA to 59 patients suffering from diffuse infiltrating gliomas and demonstrated the emission of fluorescence correlates with the presence of anaplastic foci.

5-ALA-induced fluorescence may thus optimize the allocation of patients to the appropriate post-operative treatment.

• 5-Aminolevulinic Acid Induced Fluorescence Is a Powerful Intraoperative Marker for Precise Histopathological Grading of Gliomas with Non-Significant Contrast-Enhancement,
  Jonathan A. Coles, Georg Widhalm, Barbara Kiesel, Adelheid Woehrer, Tatjana Traub-Weidinger, Matthias Preusser, Christine Marosi, Daniela Prayer, Johannes A. Hainfellner, Engelbert Knosp, Stefan Wolfsberger,
  PLoS ONE 2013, 8, e76988.
  DOI: 10.1371/journal.pone.0076988