Fluorescein is a fluorescent organic dye used as tracer, contrasting agent or a diagnostic tool in various fields of medicine and natural sciences in general.
Fluorescein is a small-molecule organic dye that exhibits strong fluorescence at neutral and alkalic pH in aqueous media. In these conditions, its main absorption peak is at 490 nm (ε490 = 76 900 M−1 cm−1) and the quantum yield of the subsequent fluorescence is 0.93[1]. It is a dark orange powder soluble in water and when dissolved in proper conditions, emitting bright green fluorescence (with maximum emission at 515 nm[2]). It belongs to a group of xanthene dyes that includes substances like eosin Y or rhodamine B. It was first synthesized by Adolf von Baeyer around 1871 by condensation of resorcinol and phthalic anhydride catalyzed with zinc chloride[3][4].
Fluorescein is a broadly applied substance in various fields. For instance, it is commonly employed as a tracer. Some examples of this fluorescein application are utilization as a ground-water tracer[5], and use for investigating molecular movement in the bone lacunar-canalicular system[6] or for examining extravasation to study blood-spinal cord barrier permeability on animal models[7][8]. Fluorescein can be also applied as a topical fluorescent contrast agent for microendoscopy of gastrointestinal[9] or urinary tract[10] and as a pH sensitive corrosion indicator[11][12].
Moreover, it is extensively employed in ophthalmology as a diagnostic tool[13][14][15][16]. Having an important role in the diagnostics of ocular diseases, fluorescein has been included on the List of Essential Medicines, published by the World Health Organization[17]. An example of a well-established and frequently used fluorescein diagnostic technique is fluorescein angiography[13][18][19]. During diagnostic procedures, it can be administered locally[20], orally[21], or intravenously[22] with subsequent irradiation of the area of interest using blue light[13][23][24] (≈490 nm[25][26]). There are also studies that points to fluorescein’s utilization in the labeling of brain tumor tissue (high-grade gliomas) to obtain better results of its resection[27][28][29] . Fluorescein is capable of accumulating in cerebral areas with damaged blood-brain barrier[30] and therefore ensure better resection due to contrast-enhanced borderline of malignant and healthy tissue[28]. In addition, there exist studies supporting use in urology, specifically, in bladder[31][23] and penile[24] cancer surgery.
Fluorescein itself is a relatively nontoxic substance (LD50 = 6.7 g/kg for rats[32], which is almost 20x greater than LD50 for caffeine[33] or 2x more than this value for NaCl[34]). However, it is a photoactive compound whose biological effects associated with this activity have been neglected to date. For example, fluorescein is known to photosensitize oxygen to form singlet oxygen (1O2)[35][36]. Additionally, Martinek et al.[37] and Srankova et al.[38] had shown that carbon monoxide (CO) is produced through photochemical degradation of fluorescein in a relatively high chemical yield of 40%.
Both 1O2 and CO are biologically active molecules that affect physiological processes in the human body[39][40][41]. Over the past three decades, they have also been thoroughly studied for their use in the treatment of various diseases. 1O2 is a very reactive molecule, the cytotoxic properties of which are utilized in medicine, e.g., in photodynamic therapy[42]. CO, in low concentration, acts in the body as a gasotransmitter mediating anti-inflammatory[43], antiapoptotic[44], and antiproliferative effects[45]. Although 1O2 and CO are being investigated for their potential therapeutic use in the treatment of various diseases, they both exert cytotoxicity at higher concentrations, particularly when their transport to target sites is not strictly controlled. While 1O2 causes oxidative damage and cell death[46][47][48][49], the toxicity of CO is related to its high binding affinity to blood hemoglobin[50][51][52][53] or the heme moiety of extravascular hemoproteins[54][55] such as cytochrome c oxidase[56], affecting their oxygen carrier properties or enzymatic activities, respectively. In addition, CO can trigger oxidative stress[57] and lipoperoxidation[58].
As has been already mentioned in this entry, fluorescein posseses relatively low toxicity. Intracellular fluorescein (administrated in the form of fluorescein diacetate (FDA) which, unlike fluorescein, is able to penetrate the cellular membrane where is hydrolyzed to fluorescein[59]) also showed minimal toxicity (Figure 1, graphs A and B). Low toxicity was also observed for its stable photoproducts (Figure 1, graphs C and D). However, simultaneous irradiation of cells treated with fluorescein led to a significant and time-dependent decrease in cell viability (Figure 1, graphs E and F), suggesting that one or more photoproducts formed during irradiation, which were not present in the solutions upon exhaustive irradiation (= stable photoproducts), were responsible for the observed cytotoxicity. This means that these species must be either volatile or short-lived (although reactive), pointing to CO and 1O2[38].
Figure 1. Viability of HepG2 cells treated with solutions of non-irradiated FDA solution (A, B), solution of fluorescein photoproducts (C, D; tir = 24 h, I = 160 mW/cm2 prior to the treatment, FDA concentration = initial concentration of FDA prior irradiation), or simultaneously irradiated solutions of FDA (E, F; irradiation throughout the entire incubation time 2 or 24 h, I = 160 mW/cm2, FDA concentration = FDA initial concentration prior irradiation); *p ≤ 0.05 vs. untreated control.
Exposure of HepG2 cells to irradiation of intracellular fluorescein, furthermore, resulted in a significant decrease in the majority of metabolites, with the most significant changes in the concentrations of lactate, 2-hydroxyglutarate, 2-oxoglutarate, and citrate (<30% those of control)[38]. This indicates that the above-mentioned biologically active by-products of fluorescein photoexcitation might affect the overall cellular energetic metabolism.
A significant decrease in the concentrations of the Krebs cycle intermediates (2-hydroxyglutarate, glutamate, 2-oxoglutarate, and citrate) was also observed following CO treatment (enriched CO atmosphere, 100 ppm)[38], confirming the key role of this molecule in the observed attenuation of cell metabolism caused by fluorescein irradiation. These results correspond to those observed upon CO exposure that demonstrated the inhibition of respiration and glycolysis and a decrease in some Krebs cycle metabolites[60]. On the other hand, some published data have proved that CO can promote oxidative phosphorylation[61][62], mitochondrial biogenesis[63], and even an increase in cytochrome c oxidase activity[64], suggesting that the effect of CO is concentration- and tissue-dependent and reflects the overall cell/tissue status or oxygen level.
Irradiation of FDA-treated cells also resulted in a significant increase in the G0 phase and a simultaneous decrease in G2/M phase (18% decrease when compared to control) of cell cycle, indicating reduced proliferation and thus the antiproliferative and anticancer potential of fluorescein. No significant effect of CO (enriched CO atmosphere, 100 ppm) was observed on cell cycle progression, indicating no involvement of the CO released during the photoreaction in this process[38]. However, CO has been suggested to affect the cell cycle[65][66], showing that this effect might be both dose- and cell-dependent.
Treatment of cells with free fluorescein compared to treatment with FDA gave different results. Comparing the effects of these two modes of fluorescein treatment helped to assess the biological effects of 1O2 and CO when produced both intra- and extracellularly. Comparison of the cell viability indicated that when administered as a free acid, fluorescein’s negative impact on viability is significantly smaller[38]. In this case, the 1O2 molecules released during the photoreaction do not necessarily reach the intracellular compartment because of the short half-life of 1O2 (τ1/2 = 3–4 μs[67]). On the other hand, the long-lived CO (τ1/2 = 3–4 h) can freely pass through the plasma membrane and affect cellular processes when generated extracellularly, as shown by Lazarus et al.[68], who studied the intra- vs. extracellular delivery of CO using two types of CO-releasing molecules (CORMs) differing in their cellular localization. They showed that extracellular CO production exhibited a lower toxic effect on cells, whereas anti-inflammatory cell signaling processes were similar to those of intracellular delivery.
Fluorescein irradiation cytotoxicity experiments performed in a hypoxic chamber (9% O2 level) showed that hypoxia was associated with a significantly lower drop in the viability of cells when compared to that under normoxic conditions. Three different ways of how the O2 level may influence this parameter were proposed. A lower O2 level can result in: a lower yield of 1O2 (fewer O2 molecules available for sensitization); reduced efficiency of the fluorescein photoreaction (if 1O2 is responsible for its degradation) and thus less efficient CO release; or a different cellular metabolic status, any of which ultimately affects the cell’s survival[38].
Fluorescein is a widely used fluorescent dye that has found its application in many fields of natural sciences. Medicine is no exception, where fluorescein plays the role of a tracer, contrast compound or diagnostic agent, etc. For many of these applications is fluorescein irradiated to yield fluorescence. It was found that this irradiation results in the production of the biologically active molecules 1O2 and CO. Experiments on HepG2 cells also showed cytotoxicity, attenuation of metabolism and decreased proliferation as a result of fluorescein irradiation. This may indicate that volatile and reactive molecules produced during fluorescein photochemical reaction, from which 1O2 and CO were identified, are responsible for some adverse effects observed with fluorescein administration to patients. On the other hand, as fluorescein releases CO in substantial amounts, it might be used therapeutically as a photoCORM to release CO in target tissues. Another possibility of application is to employ both bioactive molecules, 1O2 and CO, for the therapeutic action, for example, in the treatment of cancer.
This entry is adapted from the peer-reviewed paper 10.3390/ijms23031504