Irreversible electroporation attenuates neointimal formation after angioplasty

Restenosis following coronary angioplasty represents a major clinical problem. Irreversible electroporation (IRE) is a nonthermal, nonpharmacological cell ablation method. IRE utilizes a sequence of electrical pulses that produce permanent damage to tissue within a few seconds.

METHODS AND RESULTS

The left carotid arteries of eight rats underwent in vivo intimal damage using two Fogarty angioplasty catheters. The procedure was immediately followed by IRE ablation in four rats, while the remaining four were used as the control group. The IRE ablation was performed using a sequence of ten dc pulses of 3800 V/cm, 100 micros each, at a frequency of ten pulses per second, applied across the blood vessel between two parallel electrodes. The electrical conductance of the treated tissue was measured during the electroporation to provide real-time feedback of the process. Left carotid arteries were excised and fixated after a 28-day follow-up period. Neointimal formation was evaluated histologically. The use of IRE was successful in three out of four animals in a way that is consistent with the measurements of blood vessel electrical properties. The integrity of the endothelial layer was recovered in the IRE-treated animals, compared with control. Successful IRE reduced neointima to media ratio (0.57 +/-0.4 versus 1.88 +/-1.0, P = 0.02).

CONCLUSIONS

We report for the first time the in vivo results of attenuation of neointimal formation using IRE. Our study shows that IRE might be able to attenuate neointimal formation after angioplasty damage in a rodent model of restenosis. This approach may open new venues in the treatment of coronary artery restenosis after balloon angioplasty.

Imaging cryosurgery with EIT: tracking the ice front and post-thaw tissue viability

Cryosurgery employs freezing for targeted destruction of undesirable tissues such as cancer. Ice front imaging has made controlled treatment of deep body tumors possible. One promising method, recently explored for this task, is EIT, which recovers images of electrical impedance from measurements made at boundary electrodes. However, since frozen tissue near the ice front survives, ice front imaging is insufficient. Monitoring treatment effect would enable iterative cryosurgery, where extents of ablation and need for further treatment are assessed upon thawing. Since lipid bilayers are strong barriers to low frequency electrical current and cell destruction implies impaired membranes, EIT should be able to detect the desired effect of cryosurgery: cell death. Previous work has tested EIT for ice front imaging with tank studies while others have simulated EIT in detecting cryoablation, but in vivo tests have not been reported in either case. To address this, we report 3D images of differential conductivity throughout the freeze-thaw cycle in a rat liver model in vivo with histological validation, first testing our system for ice front imaging in a gel and for viability imaging post-thaw in a raw potato slice.

A new concept for medical imaging centered on cellular phone technology

According to World Health Organization reports, some three quarters of the world population does not have access to medical imaging. In addition, in developing countries over 50% of medical equipment that is available is not being used because it is too sophisticated or in disrepair or because the health personnel are not trained to use it. The goal of this study is to introduce and demonstrate the feasibility of a new concept in medical imaging that is centered on cellular phone technology and which may provide a solution to medical imaging in underserved areas. The new system replaces the conventional stand-alone medical imaging device with a new medical imaging system made of two independent components connected through cellular phone technology. The independent units are: a) a data acquisition device (DAD) at a remote patient site that is simple, with limited controls and no image display capability and b) an advanced image reconstruction and hardware control multiserver unit at a central site. The cellular phone technology transmits unprocessed raw data from the patient site DAD and receives and displays the processed image from the central site. (This is different from conventional telemedicine where the image reconstruction and control is at the patient site and telecommunication is used to transmit processed images from the patient site). The primary goal of this study is to demonstrate that the cellular phone technology can function in the proposed mode. The feasibility of the concept is demonstrated using a new frequency division multiplexing electrical impedance tomography system, which we have developed for dynamic medical imaging, as the medical imaging modality. The system is used to image through a cellular phone a simulation of breast cancer tumors in a medical imaging diagnostic mode and to image minimally invasive tissue ablation with irreversible electroporation in a medical imaging interventional mode.

Minimally obtrusive wearable device for continuous interactive cognitive and neurological assessment

This study demonstrates the feasibility of a minimally obtrusive wearable system that can assess cognitive performance continuously throughout normal life activities by excitation of the peripheral nervous system and detection of the central nervous system response. The new concept was tested with one possible implementation as a device the size of a wristwatch which interrogates the subject by means of haptic excitation (vibration) and records the responses (subtle hand movements detected by accelerometers). The system was programmed to perform simple reaction time trials and was tested with ten volunteers during 8 h of their normal daytime activities. Results indicate that the volunteers responded properly to most of the interrogations (>95%) and that the impact of the device on everyday activities was not significant. The ability to assess cognitive capabilities of individuals continuously during everyday activities could have far-reaching implications for diagnostics and treatment of many different neurological conditions.

Intravascular irreversible electroporation: theoretical and experimental feasibility study

Irreversible electroporation (IRE) employs microsecond scale, mega-volt/m electric field pulses to impair the cell membrane. IRE is emerging as a valuable new minimally invasive technique. Of central importance in using IRE is the existence of electric fields, which while impairing the cell membrane, do not cause thermal Joule heating induced damage to the tissue. Our recent studies suggest that IRE could become an important technique to ablate vascular smooth muscle cells of the arterial wall and attenuate restenosis following angioplasty. This study was done to support the use of IRE in treatment of restenosis and is a fundamental investigation on the electric field parameters that can produce non-thermal IRE ablation of cells on the arterial wall. The study combines time-dependant finite-element models of the electric field equation and of the bio-heat equation with Henriques and Moritz thermal damage integral to evaluate the range of non-thermal IRE fields for use in blood vessels. The theoretical analysis is supported by temperature measurements during intravascular IRE of rodent carotid arteries, showing no significant temperature rise.

The effect of irreversible electroporation on blood vessels

We present a pilot study on the long term effects of irreversible electroporation (IRE) on a large blood vessel. The study was motivated by the anticipated use of IRE for treatment of cancer tumors abutting large blood vessels. A sequence of 10 direct current IRE pulses of 3800 V/cm, 100 micros each, at a frequency of 10 pulses per second, were applied directly to the carotid artery in six rats. Measuring tissue conductivity during the procedure showed, as predicted, an increase in conductivity during the application of the pulse, which suggests that this measurement can be used to control the application of IRE. All the animals survived the procedure and showed no side effects. Histology performed 28 days after the procedure showed that the connective matrix of the blood vessels remained intact and the number of vascular smooth muscle cells (VSMC) in the arterial wall decreased with no evidence of aneurysm, thrombus formation or necrosis. Average VSMC density was significantly lower following IRE ablation compared with control (24 +/- 11 vs. 139 +/- 14, P<0.001), with no apparent damage to extra cellular matrix components and structure. In addition to the relevance of this study to treatment of cancer near large blood vessels these findings tentatively suggest that IRE has possible applications to treatment of pathological processes in which it is desired to reduce the proliferation of VSMC population, such as restenosis and for attenuating atherosclerotic processes in clinical important locations such as coronary, carotid and renal arteries.

In vivodetection of liver steatosis in rats based on impedance spectroscopy

Hepatic steatosis is a widespread condition of high prevalence in Western populations, and its asymptomatic nature represents a hefty problem in liver surgery and transplantation. Current diagnostic methods rely mainly on biopsy and blood tests, and are thus time consuming and expensive. Here we report the use of direct impedance measurements on liver tissue as a promising alternative to conventional diagnostic methods in surgery and transplantation. Working on a dual Zucker Fat (ZF), Zucker Lean (ZL) rat experimental model, we show that certain parameters extracted from multi-frequency impedance measurements correlate well with the presence of steatosis and that these results can be adequately approximated with bi-frequency measurements extracting the impedance modulus at 1 kHz and the impedance phase angle at 5.7 kHz. We further support our findings on a theoretical model of tissue impedance, and the simulations carried out suggest a possible mechanism to expound the negative effect of steatosis in post-transplant graft function.

A SiC microdevice for the minimally invasive monitoring of ischemia in living tissues

Monitoring of ischemia in living tissues is a field of increasing interest in many clinical settings. In this work we report for the first time anywhere the development of needle-shaped, minimally-invasive impedance probes based on silicon carbide (SiC) substrates. An in-vitro comparison of these new devices with Si-based impedance probes demonstrates that their effective operation range extends up to the 100 kHz range, thus allowing a wide-spectrum multi-frequency analysis of impedance modulus and phase angle. Furthermore, we show that, when applied to in-vivo settings, this kind of analysis yields to an accurate monitoring of ischemia, while making possible the application of more robust mathematical methods for the study of impedance in living tissues.

Impedance analyzer for in vivo electroporation studies

Electroporation, the permeabilization of the cell membrane with electrical pulses, is being used for in vivo gene therapy, drug therapy and minimally invasive tissue ablation. Applying electrical pulses across cells can have a variety of outcomes; from no effect to reversible electroporation to irreversible electroporation. For reliable in vivo use of electroporation it is important to have real time feedback on the outcome of the application of the electrical pulse. Recently, it has been proposed that measuring the electrical properties of electroporated tissues in temporal relation to the applied pulses could provide this feedback. To generate fundamental data on the in vivo electrical properties of electroporated tissues we have developed a fast spectroscopic impedance analyzer that measures electrical properties of tissues in vivo in conjunction with commercial electroporation pulse generators. Here we describe the apparatus and illustrate its use with an experiment on reversible electroporation in a rat liver.

Bioimpedance dispersion width as a parameter to monitor living tissues

In the case of living tissues, the spectral width of the electrical bioimpedance dispersions (closely related with the alpha parameter in the Cole equation) evolves during the ischemic periods. This parameter is often ignored in favor of other bioimpedance parameters such as the central frequency or the resistivity at low frequencies. The object of this paper is to analyze the significance of this parameter through computer simulations (in the alpha and beta dispersion regions) and to demonstrate its practical importance through experimental studies performed in rat kidneys during cold preservation. The simulations indicate that the dispersion width could be determined by the morphology of the extra-cellular spaces. The experimental studies show that it is a unique parameter able to detect certain conditions such as a warm ischemia period prior to cold preservation or the effect of a drug (Swinholide A) able to disrupt the cytoskeleton. The main conclusion is that, thanks to the alpha parameter in the Cole equation, the bioimpedance is not only useful to monitor the intra/extra-cellular volume imbalances or the inter-cellular junctions resistance but also to detect tissue structural alterations.

Electrical bioimpedance measurement during hypothermic rat kidney preservation for assessing ischemic injury

Non-heart-beating donors sustain an ischemic insult of unknown severity and duration, which can compromise the viability of the graft. This preliminary study aimed to assess whether electrical bioimpedance monitoring of cold preserved organs could be useful to identify kidneys that have suffered previous warm ischemia (WI). Two rat groups were studied during 24 h of preservation in University of Wisconsin solution (UW): a control cold ischemia group and another group subjected previously to 45 min of WI. Multi-frequency bioimpedance was monitored during preservation by means of a miniaturized silicon probe and the results were modeled according to the Cole equation. Tissular ATP content, lactate dehydrogenase in UW solution and histological injury were assessed. Renal function and cell injury, evaluated during 3 h of ex vivo reperfusion using the isolated perfused rat kidney model, demonstrated differences between groups. Bioimpedance results showed that the time constant and the high frequency resistivity parameters derived from the Cole equation were able to discriminate between groups at the beginning of the preservation (Deltatau approximately 78%, DeltaRinfinity approximately 36%), but these differences tended to converge as preservation time advanced. Nevertheless, another of the Cole parameters, alpha, showed increasing significant differences until 24 h of preservation (Deltaalpha approximately 15%).

Minimally invasive silicon probe for electrical impedance measurements in small animals

It is commonly accepted that electrical impedance provides relevant information about the physiological condition of living tissues. Currently, impedance measurements are performed with relatively large electrodes not suitable for studies in small animals due to their poor spatial resolution and to the damage that they cause to the tissue. A minimally invasive needle shaped probe for electrical impedance measurements of living tissues is presented in this paper. This micro-probe consists of four square platinum electrodes (300 microm x 300 microm) on a silicon substrate (9 mm x 0.6 mm x 0.5 mm) and has been fabricated by using standard Si microelectronic techniques. The electrodes are not equally spaced in order to optimise the signal strength and the spatial resolution. Characterisation data obtained indicate that these probes provide high spatial resolution (measurement radius <4 mm) with a useful wide frequency band going from 100 Hz to 100 kHz. A series of in vivo experiments in rat kidneys subjected to ischemia was performed to demonstrate the feasibility of the probes and the measurement system. The impedance modulus and phase were measured at 1 kHz since this frequency is sufficiently low to permit the study of the extracellular medium. The extracellular pH and K+ were also simultaneously measured by using commercial miniaturised Ion Selective Electrodes. The induced ischemia period (45 min) resulted in significant changes of all measured parameters (Delta/Z/ approximately 65%; DeltapH approximately 0.8; DeltaK+ approximately 30 mM).

Multiparametric monitoring of ischemia-reperfusion in rat kidney: effect of ischemic preconditioning

BACKGROUND

Microelectrode technology is a promising tool for monitoring kidney ischemia and the changes induced by its therapeutic management. Ischemic preconditioning, that is, brief ischemic periods before sustained ischemia, has been shown to protect several organs, including the kidney, from ischemia-reperfusion injury. We tested whether the effect of preconditioning could be appraised by real-time measurement of parameters representative of tissue hypoxia.

METHODS

In a sample of pentobarbital-anesthetized and mechanically ventilated rats, we studied the effect of renal ischemic preconditioning (10-min ischemia and 10-min reflow interval) on subsequent ischemia-reperfusion (45 min and 60 min). Renal tissue electrical impedance, extracellular pH, and potassium concentration [K+] were measured continuously by implanted microelectrodes.

RESULTS

Ischemia induced an early, rapid rise in extracellular potassium and impedance module, followed by a phase of slower increase, whereas pH decreased rapidly, reaching a plateau. Preconditioning treatment did not cause significant changes in interstitial pH and [K+] but increased ischemic tissue impedance. During reperfusion, the three variables recovered progressively; however, after a decline, electrical impedance showed a clear postischemic increase. This rise was suppressed by preconditioning.

CONCLUSIONS

Real-time measurement of any of the three parameters showed capability for early detection of ischemia. In contrast with findings in myocardial tissue, preconditioning in the kidney did not increase potassium cell loss during ischemia or improve ischemic acidosis or tissue impedance. Electrical impedance increased for a second time during reperfusion, indicating the presence of a postischemic cellular edema; concealing this episode was the most noticeable effect of the preconditioning treatment.