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Aminolevulinic acid (ALA) is a naturally occurring metabolic precursor of heme that is converted intracellularly into the potent photosensitizer protoporphyrin IX (PpIX). When administered either topically or systemically, ALA preferentially accumulates in rapidly proliferating cells, such as tumor cells or psoriatic plaques. Upon activation by specific wavelengths of light (photodynamic therapy, PDT) or ultrasound (sonodynamic therapy, SDT), PpIX generates reactive oxygen species, primarily singlet oxygen, which induce selective tissue necrosis or apoptosis. Additionally, the fluorescence of PpIX under blue light allows for photodynamic diagnosis (PDD) and intraoperative visualization of malignant tissues. ALA is FDA-approved for the treatment of actinic keratosis and for the visualization of malignant gliomas during surgery, and it is being investigated for various other oncological and dermatological indications.
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