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Topic:Sarcoids

Sarcoids are a type of skin tumor commonly found in horses, characterized by their locally aggressive behavior but non-metastatic nature. These tumors are associated with bovine papillomavirus infection and can appear in various forms, including nodular, verrucous, and fibroblastic types. Sarcoids are the most frequently diagnosed equine skin tumors and can affect horses of any age, breed, or sex. They often occur on the head, limbs, and ventral abdomen, causing discomfort and potential interference with tack and equipment. This page compiles peer-reviewed research studies and scholarly articles that investigate the etiology, pathology, clinical presentation, and management strategies for equine sarcoids.
Molecular approaches to equine sarcoids.
Equine veterinary journal    August 3, 2020   Volume 53, Issue 2 221-230 doi: 10.1111/evj.13322
Semik-Gurgul E.Sarcoids are the most commonly diagnosed skin tumours in equines. Bovine papillomaviruses (BPVs) are the primary causative agent of sarcoids. There has been intensive research to discover the molecular mechanisms that may contribute to the aetiopathogenesis of this disease and tumour suppressors and proto-oncogenes known to play a role in human neoplastic conditions have been investigated in equine sarcoids. Current approaches include the identification of gene expression profiles, characterising sarcoid and normal skin tissues, and an assessment of epigenetic alterations such as microRNA diff...
Mobility and Invasion Related Gene Expression Patterns in Equine Sarcoid.
Animals : an open access journal from MDPI    May 19, 2020   Volume 10, Issue 5 880 doi: 10.3390/ani10050880
Podstawski P, Witarski W, Szmatoła T, Bugno-Poniewierska M, Ropka-Molik K.Sarcoids are the most common skin neoplasm in the Equidae family. Sarcoids are benign, but may cause severe damage in affected animals. Due to the high risk of post-treatment recurrence and the lack of an effective method of treatment, it is reasonable to perform studies on the molecular aspects of this neoplasm. Therefore, the present studies analyzed five genes (cell cycle control binding protein alpha, coronin 1b, metalloproteinase 2, tissue inhibitor of metalloproteinases 3 and vimentin) related to cell mobility and invasion traits. Primary healthy fibroblasts and sarcoid cells were obtain...
Evaluation of Locally Injected Mycobacterium Cell Wall Fraction in Horses with Sarcoids.
Journal of equine veterinary science    April 22, 2020   Volume 90 103102 doi: 10.1016/j.jevs.2020.103102
Caston SS, Sponseller BA, Dembek KA, Hostetter JM.A reformulation of Mycobacterium cell wall fraction immunotherapeutic can be used to successfully treat sarcoids in horses. Sarcoids are reported to be the most common equine skin tumors with tumor type and location influencing the choice of treatment. Wide surgical excision is curative for many tumors, but may not always be feasible. Previous studies have reported sarcoid regression after injection with mycobacterial cell wall immunotherapeutics. A new formulation of the Mycobacterium phlei cell wall fraction immunostimulant (Immunocidin Equine) was used to treat cutaneous tumors in horses. E...
Periocular sarcoid with bone invasion in a Thoroughbred mare.
The Canadian veterinary journal = La revue veterinaire canadienne    April 8, 2020   Volume 61, Issue 4 415-419 
Giraldo A, Pinard CL, Plattner BL, Dubois MS.A periocular nodular sarcoid was diagnosed on the right upper eyelid and medial canthus of a 12-year-old Thoroughbred mare. Enucleation was performed and during the procedure the mass was noted to be firmly adhered to the underlying frontal bone. Partial ostectomy of the dorsal orbital rim was performed. Histopathology revealed invasion of the cortical lamellar bone and the bone marrow by neoplastic spindle cells and extension of these cells to multiple surgical margins. Recurrence at the level of the surgical site and its surroundings occurred 3 months after the procedure. The horse was eutha...
Calcium Electroporation of Equine Sarcoids.
Animals : an open access journal from MDPI    March 19, 2020   Volume 10, Issue 3 doi: 10.3390/ani10030517
Frandsen SK, Gehl J, Tramm T, Thoefner MS.Sarcoids are common equine skin tumors where the risk of recurrence after treatment is high, and better treatment options are warranted. Calcium electroporation is a novel anti-cancer treatment where lethally high calcium concentrations are introduced into the cells by electroporation, a method where short high-voltage pulses induce transient permeabilization of the cell membrane. This study investigated the safety and long-term response of calcium electroporation on sarcoids. Thirty-two sarcoids in eight horses were included. The study suggested that calcium electroporation is a safe and feas...
Evaluation of Hypoxia-Inducible Factor-1 Alpha (HIF-1α) in Equine Sarcoid: An Immunohistochemical and Biochemical Study.
Pathogens (Basel, Switzerland)    January 14, 2020   Volume 9, Issue 1 58 doi: 10.3390/pathogens9010058
equine sarcoids are the most frequent skin tumors in equidae worldwide. It is well known that delta bovine papillomaviruses are their causative agents. We have recently shown the presence in equine sarcoids of abnormal vessel structures, which could cause a hypoxic condition. The aim of this study was to analyze the expression of hypoxia-inducible factor-1 alpha (HIF-1α) in a subset of BPV positive equine sarcoids and explore the relationship with vascular endothelial growth factor (VEGF) expression. Results: 80% of equine sarcoids showed strong cytoplasmic staining in >60% of neoplastic f...
Surgical management of penile sarcoid in a stallion.
Journal of equine science    December 18, 2019   Volume 30, Issue 4 99-104 doi: 10.1294/jes.30.99
Saadi A, Azizi S, Farshid AA, Yousefi A.This report describes surgical management and breeding implications of a case of penile sarcoid associated with penis laceration in a 4-year-old Kurdish stallion. A large fleshy mass on the distal end of the penis that resulted in urethral meatus deviation and dysuria was detected in a physical examination. No evidence of local extent or metastasis was detected. Under general anaesthesia, the involved distal portion of the penis was removed through partial phallectomy. Histopathological examination of the mass confirmed a fibroblastic sarcoid. Partial phallectomy was successful for management ...
Multiple excisions of an equine sarcoid and the repercussions.
The Canadian veterinary journal = La revue veterinaire canadienne    October 11, 2019   Volume 60, Issue 10 1115-1117 
Melinyshyn H.A 13-year-old Morgan crossbred mare was presented in May 2018 with a 10-cm mass on the medial aspect of the left hind fetlock. In September and November 2018 and June 2019 the mass was incompletely excised and continued to grow. A diagnosis of spindle cell tumor, consistent with equine sarcoid, was made based on histopathology from the last excision. . Une jument Morgan croisée âgée de 13 ans a été présentée en mai 2018 avec une masse de 10 cm sur l’aspect médial du boulet arrière gauche. En septembre et novembre 2018 ainsi qu’en juin 2019, la masse avait été excisée de manièr...
Calcium electroporation: The bioelectrochemical treatment of spontaneous equine skin tumors results in a local necrosis.
Bioelectrochemistry (Amsterdam, Netherlands)    June 14, 2019   Volume 129 251-258 doi: 10.1016/j.bioelechem.2019.05.018
Galant L, Delverdier M, Lucas MN, Raymond-Letron I, Teissie J, Tamzali Y.Electrochemotherapy (ECT) is an anticancer bioelectrochemical therapy where electrical field pulses (electropermeabilization) increase intracellular concentration of antitumor drugs. The procedure is very effective against skin tumors. The restrictive regulations concerning anticancer drugs in veterinary medicine limit use of ECT. Electroporation with calcium (Electroporation Calcium Therapy)(ECaT) was proved to be effective in vivo on induced tumors in laboratory animals. This study evaluated the effects of ECaT in equine sarcoids (spontaneous skin tumors) on an animal cohort. Pulse parameter...
The Equine Sarcoid: Why Are There so Many Treatment Options?
The Veterinary clinics of North America. Equine practice    May 13, 2019   Volume 35, Issue 2 243-262 doi: 10.1016/j.cveq.2019.03.006
Knottenbelt DC.This article discusses the main treatments for sarcoid and the specific difficulties of these. It explains to some extent why the frustrations of a condition for which there is no single treatment option have led to the burgeoning of an industry of irrational treatments. The factors that need to be considered before selecting an option for treatment are wider than is the case in most other disease entities as a result of the complexity of the condition, its variable phenotypes, and the individual perceptions and experiences of both veterinarians and owners.
Genetic evaluation of bovine papillomavirus types detected in equine sarcoids in Poland.
Polish journal of veterinary sciences    April 19, 2019   Volume 22, Issue 1 25-29 doi: 10.24425/pjvs.2018.125602
Szczerba-Turek A, Siemionek J, Ras A, Bancerz-Kisiel A, Platt-Samoraj A, Lipczynska-Ilczuk K, Szweda W.Equine sarcoids are the most common neoplasms in horses. Bovine papilloma- virus type 1 (BPV-1) is the main viral type identified in equine sarcoids in Europe. Objective: The aim of the present study was to genetically evaluate BPV types based on DNA analyses of the CDS of the L1 gene. The presence of BPV DNA was confirmed by Degenerate Oligonucleotide-Primed Polymerase Chain Reaction (DOP PCR) with FAP59/FAP64 consensus primers. Results: The DNA was detected in 21/40 (52.5%) of clinically diagnosed sarcoids. More than half of 14 isolates (66.7%) shared 100% homology with BPV-1 Deltapapillomav...
Skin disease in donkeys (Equus asinus): a retrospective study from four veterinary schools.
Veterinary dermatology    March 4, 2019   Volume 30, Issue 3 247-e76 doi: 10.1111/vde.12733
White SD, Bourdeau PJ, Brément T, Vandenabeele SI, Haspeslagh M, Bruet V, Sloet van Oldruitenborgh-Oosterbaan MM.Donkeys are important throughout the world as work animals and occasionally as pets or a meat source. Most descriptions of skin disease in donkeys are reported in small case series, textbooks or review articles. Objective: To document skin diseases and their prevalence in donkeys and to investigate predilections for the most common conditions. Methods: Case populations at four veterinary schools totalling 156 donkeys. Methods: A retrospective study was performed by searching computerized medical records, using the key word "donkey", at the School of Veterinary Medicine, University of Californi...
Differentially expressed microRNAs, including a large microRNA cluster on chromosome 24, are associated with equine sarcoid and squamous cell carcinoma.
Veterinary and comparative oncology    February 15, 2019   Volume 17, Issue 2 155-164 doi: 10.1111/vco.12458
Bogedale K, Jagannathan V, Gerber V, Unger L.The aim of this study was to investigate microRNA (miRNA) differential expression in the two most common equine skin tumours, equine sarcoid (ES) and squamous cell carcinoma (SCC), and its potential influence on the tumour microenvironment at post-transcriptional level. We investigated miRNA fingerprints in four subgroups: mild (ESM) and aggressive (ESA) ES and ocular SCC (oSCC) and genital SCC (gSCC). Three tumours and three control samples were included in each of the four subgroups. Following next generation sequencing, miRNA differential expression analysis using DESeq2 was carried out. Pa...
Molecular Detection of Bovine Papillomavirus DNA in the Placenta and Blood of Healthy Mares and Respective Foals.
Veterinary sciences    February 6, 2019   Volume 6, Issue 1 doi: 10.3390/vetsci6010014
Savini F, Gallina L, Mazza F, Mariella J, Castagnetti C, Scagliarini A.Despite the characteristic species specificity of Papillomaviruses (PVs), the bovine papillomavirus (BPV) types 1, 2, and-more rarely-13, can cross-infect equids, where they are involved in the pathogenesis of sarcoid neoplasms. Sarcoids are locally invasive fibroblastic skin tumors that represent the most common skin neoplasms in horses worldwide. The transmission mechanism of BPV is still controversial in horses. Thus far, direct and indirect routes have been implicated, while vertical transmission has been suggested after the detection of viral DNA in the semen of healthy stallions. Testing...
No evidence of bovine papillomavirus type 1 or 2 infection in healthy equids.
Equine veterinary journal    January 28, 2019   Volume 51, Issue 5 612-616 doi: 10.1111/evj.13061
Pratscher B, Hainisch EK, Sykora S, Brandt S, Jindra C.There is a large body of evidence supporting bovine papillomavirus types 1 and 2 (BPV1; BPV2) as aetiological agents of equine sarcoids. However, there is conflicting data regarding BPV1/2 infection in sarcoid-free equids. Objective: Data obtained between 2007 and 2017 by BPV1/2 screening of sarcoids and nonsarcoid tumours vs. samples from healthy equids are presented to help clarify this issue. Methods: Cross-sectional study. Methods: Tumour material obtained from horses, donkeys and mules with confirmed sarcoids (n = 130), suspected sarcoids (n = 120), or nonsarcoid lesions (n = 70), s...
Differences in miRNA differential expression in whole blood between horses with sarcoid regression and progression.
Journal of veterinary internal medicine    December 2, 2018   Volume 33, Issue 1 241-250 doi: 10.1111/jvim.15375
Unger L, Jagannathan V, Pacholewska A, Leeb T, Gerber V.Currently no methods are available to predict the clinical outcome of individual horses with equine sarcoid (ES) disease. Objective: To investigate if whole blood microRNA (miRNA) profiles can predict the long-term development of ES tumors. Methods: Five horses with regression and 5 with progression of ES lesions monitored over 5-7 years and 5 control horses free of ES for at least 5 years. Methods: For this cohort study, RNA extracted from whole blood samples from the regression, progression, and control groups was used for high throughput sequencing. Known and novel miRNAs were identified us...
MicroRNA fingerprints in serum and whole blood of sarcoid-affected horses as potential non-invasive diagnostic biomarkers.
Veterinary and comparative oncology    November 28, 2018   Volume 17, Issue 1 107-117 doi: 10.1111/vco.12451
Unger L, Gerber V, Pacholewska A, Leeb T, Jagannathan V.Serum and whole blood microRNA (miRNA) fingerprints have been proposed as a new class of non-invasive human cancer biomarkers. In this study, we compared equine sarcoid (ES) disease-specific serum and whole blood miRNA fingerprints and correlated them to miRNA expression in sarcoid tissue. After high throughput sequencing, miRNA differential expression analysis between six ES-affected and five control horses was carried out in serum and whole blood using a DESeq algorithm, accounting for the influence of hemolysis and the white blood cell count. Target gene, pathway prediction and enrichment a...
Corrigendum to ‘DNA methylation patterns of the S100A14, POU2F3 and SFN genes in equine sarcoid tissues’ Research in Veterinary Science 119 (2018) 302-307.
Research in veterinary science    October 30, 2018   Volume 121 116 doi: 10.1016/j.rvsc.2018.10.012
Semik-Gurgul E, Ząbek T, Fornal A, Wnuk M, Pawlina-Tyszko K, Gurgul A, Klukowska-Rötzler J, Koch C, Mählmann K, Bugno-Poniewierska M.No abstract available
Expression of vascular endothelial growth factor (VEGF) in equine sarcoid.
BMC veterinary research    September 3, 2018   Volume 14, Issue 1 266 doi: 10.1186/s12917-018-1576-z
Sarcoids are the mostcommon skin tumors in horses, characterized by rare regression, invasiveness and high recurrence following surgical intervention and Delta Papillomaviruses are widely recognized as the causative agents of the disease. In order to gain new insights into equine sarcoid development, we have evaluated, in 25 equine sarcoids, by immunohistochemistry and western blotting analysis, the expression levels of VEGF, Ki67 and bcl-2. Moreover, we have measured microvessel density and specific vessel parameters. Results: All sarcoid samples showed a strong and finely granular cytoplasma...
The clinical diagnosis of equine sarcoids – Part 1: Assessment of sensitivity and specificity using a multicentre case-based online examination.
Veterinary journal (London, England : 1997)    September 1, 2018   Volume 242 77-82 doi: 10.1016/j.tvjl.2018.08.009
Koch C, Martens A, Hainisch EK, Schüpbach G, Gerber V, Haspeslagh M.Equine clinicians and researchers often make the diagnosis of equine sarcoids (ES) on clinical assessment alone, without histopathological confirmation. However, the accuracy of the clinical diagnosis of ES has not been critically assessed. To assess sensitivity, specificity, positive and negative predictive values of the clinical diagnosis of ES, 40 clinical cases with histologically confirmed equine skin lesions (26 ES and 14 non-ES) were compiled in a representative online examination. For each case and lesion, at least one photograph and all relevant information were presented in a standar...
The clinical diagnosis of equine sarcoids-Part 2: Assessment of case features typical of equine sarcoids and validation of a diagnostic protocol to guide equine clinicians in the diagnosis of equine sarcoids.
Veterinary journal (London, England : 1997)    September 1, 2018   Volume 240 14-18 doi: 10.1016/j.tvjl.2018.08.010
Haspeslagh M, Gerber V, Knottenbelt DC, Schüpbach G, Martens A, Koch C.Research has shown that the accuracy of the clinical diagnosis of equine sarcoids (ES) can be improved. Particularly, less experienced veterinarians are often mistaken in their clinical judgement despite a high level of diagnostic confidence. The aim of this study was to develop and assess the performance of a diagnostic protocol (DP) to improve diagnostic accuracy and identify diagnostically challenging cases. The design of the DP was based on typical clinical features of ES and its algorithm was optimised through repeated tests on clinical cases prior to validating its performance in a repre...
DNA methylation patterns of the S100A14, POU2F3 and SFN genes in equine sarcoid tissues.
Research in veterinary science    July 24, 2018   Volume 119 302-307 doi: 10.1016/j.rvsc.2018.07.006
Semik-Gurgul E, Ząbek T, Fornal A, Wnuk M, Pawlina-Tyszko K, Gurgul A, Klukowska-Rötzler J, Koch C, Mählmann K, Bugno-Poniewierska M.Genetic and epigenetic alterations in the equine sarcoid, a locally invasive skin tumour of equids, are still poorly characterized. Numerous studies have provided reliable evidence for the relationship between the development of cancer and the loss of function of a number of tumour suppressor genes. In the present study, we assessed methylation levels in the promoter region of SFN, S100A14 and POU2F3 genes in sarcoid samples to clarify whether DNA methylation may be associated with previously identified changes in the expression level of these genes during the course of tumour progression. Usi...
The possible role of Stomoxys calcitrans in equine sarcoid transmission.
Veterinary journal (London, England : 1997)    November 22, 2017   Volume 231 8-12 doi: 10.1016/j.tvjl.2017.11.009
Haspeslagh M, Vlaminck L, Martens A.The association between bovine papillomavirus (BPV) and equine sarcoids is well established, but it is unclear how the virus spreads. Although evidence in support of viral spread through direct animal contact exists, this does not explain sarcoid development in isolated equids. BPV DNA has been detected in flies, which could indicate that these insects serve as a vector. This study aimed to investigate whether BPV-negative stable flies (Stomoxys calcitrans) become positive for BPV DNA after exposure to equine sarcoid or bovine papilloma tissue under experimental conditions and, if so, for how ...
Topical use of 5% acyclovir cream for the treatment of occult and verrucous equine sarcoids: a double-blinded placebo-controlled study.
BMC veterinary research    October 6, 2017   Volume 13, Issue 1 296 doi: 10.1186/s12917-017-1215-0
Haspeslagh M, Jordana Garcia M, Vlaminck LEM, Martens AM.Previous studies mention the use of topical acyclovir for the treatment of equine sarcoids. Success rates vary and since the bovine papillomavirus (BPV) lacks the presence of a kinase necessary to activate acyclovir, there is no proof of its activity against equine sarcoids. Results: Twenty-four equine sarcoids were topically treated with acyclovir cream and 25 with a placebo. Both creams were applied twice daily during 6 months. Before the start of the treatment and further on a monthly basis, photographs and swabs were obtained. On the photographs, sarcoid diameter and surface area were meas...
Genomic landscape of copy number variation and copy neutral loss of heterozygosity events in equine sarcoids reveals increased instability of the sarcoid genome.
Biochimie    July 23, 2017   Volume 140 122-132 doi: 10.1016/j.biochi.2017.07.006
Pawlina-Tyszko K, Gurgul A, Szmatoła T, Ropka-Molik K, Semik-Gurgul E, Klukowska-Rötzler J, Koch C, Mählmann K, Bugno-Poniewierska M.Although they are the most common neoplasms in equids, sarcoids are not fully characterized at the molecular level. Therefore, the objective of this study was to characterize the landscape of structural rearrangements, such as copy number variation (CNV) and copy neutral loss of heterozygosity (cnLOH), in the genomes of sarcoid tumor cells. This information will not only broaden our understanding of the characteristics of this genome but will also improve the general knowledge of this tumor and the mechanisms involved in its generation. To this end, Equine SNP64K Illumina microarrays were appl...
Type-specific L1 virus-like particle-mediated protection of horses from experimental bovine papillomavirus 1-induced pseudo-sarcoid formation is long-lasting.
The Journal of general virology    June 21, 2017   Volume 98, Issue 6 1329-1333 doi: 10.1099/jgv.0.000791
Harnacker J, Hainisch EK, Shafti-Keramat S, Kirnbauer R, Brandt S.Equine sarcoids are common therapy-resistant skin tumours induced by bovine papillomavirus type 1 or 2 (BPV1, BPV2) infection. We have previously shown that prophylactic vaccination with BPV1 L1 virus-like particles (VLPs) efficiently protects horses from experimental BPV1-induced pseudo-sarcoid development. Here, we assessed BPV1 L1 VLP vaccine-mediated long-term protection from experimental tumour formation in seven horses 5 years after immunization with three different doses of BPV1 L1 VLPs, and three unvaccinated control animals. Horses were challenged by intradermal inoculation with infec...
Potential of a BPV1 L1 VLP vaccine to prevent BPV1- or BPV2-induced pseudo-sarcoid formation and safety and immunogenicity of EcPV2 L1 VLPs in horse.
The Journal of general virology    March 13, 2017   Volume 98, Issue 2 230-241 doi: 10.1099/jgv.0.000673
Hainisch EK, Abel-Reichwald H, Shafti-Keramat S, Pratscher B, Corteggio A, Borzacchiello G, Wetzig M, Jindra C, Tichy A, Kirnbauer R, Brandt S.We have previously shown that immunization of horses with bovine papillomavirus type 1 (BPV1) L1 virus-like particles (VLPs) is safe and highly immunogenic and that BPV1 and bovine papillomavirus type 2 (BPV2) are closely related serotypes. Here we evaluated the protective potential of a BPV1 L1 VLP vaccine against experimental BPV1 and BPV2 challenge and studied the safety and immunogenicity of a bivalent equine papillomavirus type 2 (EcPV2)/BPV1 L1 VLP vaccine. Fourteen healthy horses were immunized with BPV1 L1 VLPs (100 µg per injection) plus adjuvant on days 0 and 28, while seven remai...
Comprehensive characteristics of microRNA expression profile of equine sarcoids.
Biochimie    March 1, 2017   Volume 137 20-28 doi: 10.1016/j.biochi.2017.02.017
Pawlina K, Gurgul A, Szmatoła T, Koch C, Mählmann K, Witkowski M, Bugno-Poniewierska M.Equine sarcoids are the most common neoplasms occurring in horses. Despite frequent occurrence, they are still not well described at the molecular level. Thus, in the present study, we performed a comprehensive comparative analysis of sarcoid miRNAome profile to identify aberrantly expressed microRNAs, along with their structural variants, potentially useful as biomarkers and, in a wider perspective, broaden the knowledge about this tumor and underlying mechanisms. To this end, we conducted next generation sequencing and as a result we identified both known and potentially novel miRNAs. Differ...
Comparative analysis of DNA methylation patterns of equine sarcoid and healthy skin samples.
Veterinary and comparative oncology    February 21, 2017   Volume 16, Issue 1 37-46 doi: 10.1111/vco.12308
Semik E, Ząbek T, Gurgul A, Fornal A, Szmatoła T, Pawlina K, Wnuk M, Klukowska-Rötzler J, Koch C, Mählmann K, Bugno-Poniewierska M.In this study, for the first time we report the genome-wide DNA methylation profile of skin tumour in horses and describe differentially methylated genomic regions (DMRs) with respect to healthy skin. Methods: The comparative analysis of DNA methylation patterns detected using Reduced Representation Bisulfite Sequencing (RRBS) technique, allowed identification of 136 regions showing differential methylation between sarcoid and normal skin tissue. Results: Most of the identified DMRs were short fragments, less than 1 kb in size, located in the intergenic regions. Among identified DMRs there wer...
Glycolysis inhibition improves photodynamic therapy response rates for equine sarcoids.
Veterinary and comparative oncology    January 27, 2017   Volume 15, Issue 4 1543-1552 doi: 10.1111/vco.12299
Golding JP, Kemp-Symonds JG, Dobson JM.Photodynamic therapy (PDT) holds great promise in treating veterinary and human dermatological neoplasms, including equine sarcoids, but is currently hindered by the amount of photosensitiser and light that can be delivered to lesions thicker than around 2 mm, and by the intrinsic antioxidant defences of tumour cells. We have developed a new PDT technique that combines an efficient transdermal penetration enhancer solution, for topical delivery of 5-aminolevulinic acid (ALA) photosensitiser, with acute topical post-PDT application of the glycolysis inhibitor lonidamine. We show that the new ...