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It also contributes to a well-functioning immune system and supports mental clarity and mood balance

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This process consumes cellular methyl donors and, critically, prevents nicotinamide from being recycled into NAD+

However, in reality, this may not be the case, particularly when treating vital organs and sensitive tissue volumes or those with baseline high healthy tissue photosensitizer accumulation even with higher accumulation in adjacent diseased tissue, this healthy tissue would remain susceptible to PDT.[ 34 , 35 ] For example, a phase II/III clinical trial of PhotofrinPDT for malignant pleural mesothelioma reported frequent and serious cardiac and respiratory adverse events, including mortality 3/73 (4 %) caused by stroke and myocardial infarction with cardiac tamponade, atrial fibrillation 21/73 (28 %), respiratory failure 14/73 (19 %), deep venous thrombosis 17/73 (23 %), and persistent air leak 17/73 (23 %), likely due to offtarget Photofrin PDT sensitivity.[ 34 , 35 , 36 , 37 ] This tumouradjacent phototoxicity was also evidenced in a phase I trial testing Visudyne PDT in vertebral bone metastases, where 10 % of the 30 patients experienced vertebral collapse after imageguided PDT treatment