Fiberoptic microneedles: novel optical diffusers for interstitial delivery of therapeutic light

Simple Characterization of Cylindrical Diffuser Fibers With a Fluorescent Layer

OBJECTIVES

A fast, simple, versatile, and reliable method to record light emission intensity profiles of cylindrical light diffusers (CDFs) in air and transparent liquids has been developed.

METHODS

A fluorescent color glass filter (RG695) converts red light emitted by a cylindrical diffuser fiber into near-infrared light in an emission angle-independent manner. The red light was provided from a diode laser system at 635 nm. Near-infrared fluorescence from the RG695 was imaged with a camera. Images from this camera were processed to obtain emission intensity profiles. Cylindrical diffuser fiber profiles of four different manufacturers were compared.

RESULTS

The proposed method provides angle-independent intensity profiles of cylindrical diffuser fibers with a single camera shot. It could be demonstrated that dependent on the underlying principle of how the diffuser fiber tips emit light, the emission profile can change significantly in media with different refractive indices.

CONCLUSIONS

By converting the light emitted by a diffuser fiber tip into fluorescence light one can eliminate the dependence of the recorded profile on the emission angle from the diffusor. This approach allows for easily taking into account refraction-index (mis)matching by placing the equipment into a suitable liquid. The proposed measurement principle bears potential for quality assurance measurements of CDFs used for interstitial laser thermotherapy or photodynamic therapy.

Enhanced light focusing inside scattering media with shaped ultrasound

Light focusing is the primary enabler of various scientific and industrial processes including laser materials processing and microscopy. However, the scattering of light limits the depth at which current methods can operate inside heterogeneous media such as biological tissue, liquid emulsions, and composite materials. Several approaches have been developed to address this issue, but they typically come at the cost of losing spatial or temporal resolution, or increased invasiveness. Here, we show that ultrasound waves featuring a Bessel-like profile can locally modulate the optical properties of a turbid medium to facilitate light guiding. Supported by wave optics and Monte Carlo simulations, we demonstrate how ultrasound enhances light focusing a factor of 7 compared to conventional methods based on placing optical elements outside the complex medium. Combined with point-by-point scanning, images of samples immersed in turbid media with an optical density up to 15, similar to that of weakly scattering biological tissue, can be reconstructed. The quasi-instantaneous generation of the shaped-ultrasound waves, together with the possibility to use transmission and reflection architectures, can pave the way for the real-time control of light inside living tissue.

Potential surgical therapies for drug-resistant focal epilepsy

Drug-resistant focal epilepsy (DRFE), defined by failure of two antiepileptic drugs, affects 30% of epileptic patients. Epilepsy surgeries are alternative options for this population. Preoperative evaluation is critical to include potential candidates, and to choose the most appropriate procedure to maximize efficacy and simultaneously minimize side effects. Traditional procedures involve open skull surgeries and epileptic focus resection. Alternatively, neuromodulation surgeries use peripheral nerve or deep brain stimulation to reduce the activities of epileptogenic focus. With the advanced improvement of laser-induced thermal therapy (LITT) technique and its utilization in neurosurgery, magnetic resonance-guided LITT (MRgLITT) emerges as a minimal invasive approach for drug-resistant focal epilepsy. In the present review, we first introduce drug-resistant focal epilepsy and summarize the indications, pros and cons of traditional surgical procedures and neuromodulation procedures. And then, focusing on MRgLITT, we thoroughly discuss its history, its technical details, its safety issues, and current evidence on its clinical applications. A case report on MRgLITT is also included to illustrate the preoperational evaluation. We believe that MRgLITT is a promising approach in selected patients with drug-resistant focal epilepsy, although large prospective studies are required to evaluate its efficacy and side effects, as well as to implement a standardized protocol for its application.

Internal-Illumination Photoacoustic Tomography Enhanced by a Graded-Scattering Fiber Diffuser

The penetration depth of photoacoustic imaging in biological tissues has been fundamentally limited by the strong optical attenuation when light is delivered externally through the tissue surface. To address this issue, we previously reported internal-illumination photoacoustic imaging using a customized radial-emission optical fiber diffuser, which, however, has complex fabrication, high cost, and non-uniform light emission. To overcome these shortcomings, we have developed a new type of low-cost fiber diffusers based on a graded-scattering method in which the optical scattering of the fiber diffuser is gradually increased as the light travels. The graded scattering can compensate for the optical attenuation and provide relatively uniform light emission along the diffuser. We performed Monte Carlo numerical simulations to optimize several key design parameters, including the number of scattering segments, scattering anisotropy factor, divergence angle of the optical fiber, and reflective index of the surrounding medium. These optimized parameters collectively result in uniform light emission along the fiber diffuser and can be flexibly adjusted to accommodate different applications. We fabricated and characterized the prototype fiber diffuser made of agarose gel and intralipid. Equipped with the new fiber diffuser, we performed thorough proof-of-concept studies on ex vivo tissue phantoms and an in vivo swine model to demonstrate the deep-imaging capability (~10 cm achieved ex vivo) of photoacoustic tomography. We believe that the internal light delivery via the optimized fiber diffuser is an effective strategy to image deep targets (e.g., kidney) in large animals or humans.

Sound Out the Deep Colors: Photoacoustic Molecular Imaging at New Depths

Photoacoustic tomography (PAT) has become increasingly popular for molecular imaging due to its unique optical absorption contrast, high spatial resolution, deep imaging depth, and high imaging speed. Yet, the strong optical attenuation of biological tissues has traditionally prevented PAT from penetrating more than a few centimeters and limited its application for studying deeply seated targets. A variety of PAT technologies have been developed to extend the imaging depth, including employing deep-penetrating microwaves and X-ray photons as excitation sources, delivering the light to the inside of the organ, reshaping the light wavefront to better focus into scattering medium, as well as improving the sensitivity of ultrasonic transducers. At the same time, novel optical fluence mapping algorithms and image reconstruction methods have been developed to improve the quantitative accuracy of PAT, which is crucial to recover weak molecular signals at larger depths. The development of highly-absorbing near-infrared PA molecular probes has also flourished to provide high sensitivity and specificity in studying cellular processes. This review aims to introduce the recent developments in deep PA molecular imaging, including novel imaging systems, image processing methods and molecular probes, as well as their representative biomedical applications. Existing challenges and future directions are also discussed.

Mechanical characterization of a fiberoptic microneedle device for controlled delivery of fluids and photothermal excitation

Current clinical approaches for treating pancreatic cancer have been demonstrated as ineffective at improving midterm survival. A primary obstacle to local drug delivery is the desmoplastic nature of the peritumoral environment, which acts as a significant barrier to circulating macromolecules. To address this need, our group presents a sharp fiberoptic microcatheter capable of accessing the pancreas through transduodenal endoscope and penetrating a tumor to locally co-deliver photothermal and fluid-based therapies. Experiments sought to characterize the mechanical penetration capabilities and fluid mechanics of the fiberoptic microneedle design. A refined off-center fusion splicing technique was developed for joining a multimode fiber to the annular core of a light-guiding capillary, allowing light transmission with minimal optical loss. A novel and frugal technique for assessing the penetration force of the microneedle was conducted in a bovine gelatin tissue phantom with a Young's modulus stiffer than the high range for pancratic tissue or tumor. Buckling forces for different microneedle lengths were measured and compared against theoretical values obtained from Euler's Critical Load equation under fixed-pinned column conditions. Hydraulic resistance of different capillary lengths was evaluated and compared against the theoretical values from Hagen-Poiseuille's law, allowing assessment of contributions from different segments of the device. The results demonstrated that the microcatheter can robustly and repeatably penetrate a soft tissue phantom chosen to be a conservative model of pancreatic tissue for penetration properties. Experiments showed that a 1.5 N insertion force was required for phantom penetration with a 45° beveled needle at a 5 mm unsupported length, while the critical buckling load was measured to be approximately 4 N. In addition, the design was demonstrated to efficiently transport 1064 nm light and aqueous fluids with a 70-75% light coupling efficiency and 12,200 Pa.s/μl hydraulic resistance, respectively. These findings motivate the FMD's further development as a treatment platform for pancreatic cancer.

Photoacoustic tomography for imaging the prostate: a transurethral illumination probe design and application

In vivo imaging of prostate cancer with photoacoustic tomography is currently limited by the lack of sufficient local fluence for deep tissue penetration and the risk of over-irradiation near the laser-tissue contact surface. We propose the design of a transurethral illumination probe that addresses those limitations. A high energy of 50 mJ/pulse is coupled into a 1000-µm-core diameter multimode fiber. A 2 cm diffusing end is fabricated, which delivers light in radial illumination. The radial illumination is then reflected and reshaped by a parabolic cylindrical mirror to obtain nearly parallel side illumination with a doubled fluence. The fiber assembly is housed in a 25 Fr cystoscope sheath to provide protection of the fiber and maintain a minimal laser-tissue contact distance of 5 mm. A large laser-tissue contact surface area of 4 cm² is obtained and the fluence on the tissue surface is kept below the maximum permissible exposure. By imaging a prostate mimicking phantom, a penetration depth of 3.5 cm at 10 mJ/cm² fluence and 700 nm wavelength is demonstrated. The results indicate that photoacoustic tomography with the proposed transurethral probe has the potential to image the entire prostate while satisfying the fluence maximum permissible exposure and delivering a high power to the tissue.

Polyethersulfone optical fibers with thermally induced microbubbles for custom side-scattering profiles

Polyethersulfone (PES) optical fibers are drawn and thermally processed in order to generate variable side-illumination profiles. The thermal treatment allows microbubbles to be formed in an outer layer of the PES fiber, providing light scattering with controllable amplitudes (0.25-2.5 cm^-1). Several fibers with different scattering profiles, such as uniform axial irradiation and multiple irradiation spots, are demonstrated. A small microbubble-induced scattering spot on the surface may be used for side-coupling of ambient light into the fiber. These mechanically flexible all-PES fibers with custom-designable scattering profiles may be useful for spatially tuned delivery of light for various applications, including phototherapy.

Spatial effect of conical angle on optical-thermal distribution for circumferential photocoagulation

A uniformly diffusing applicator can be advantageous for laser treatment of tubular tissue. The current study investigated various conical angles for diffuser tips as a critical factor for achieving radially uniform light emission. A customized goniometer was employed to characterize the spatial uniformity of the light propagation. An ex vivo model was developed to quantitatively compare the temperature development and irreversible tissue coagulation. The 10-mm diffuser tip with angle at 25° achieved a uniform longitudinal intensity profile (i.e., 0.90 ± 0.07) as well as a consistent thermal denaturation on the tissue. The proposed conical angle can be instrumental in determining the uniformity of light distribution for the photothermal treatment of tubular tissue.

Antimicrobial blue light inactivation of pathogenic microbes: State of the art

As an innovative non-antibiotic approach, antimicrobial blue light in the spectrum of 400-470nm has demonstrated its intrinsic antimicrobial properties resulting from the presence of endogenous photosensitizing chromophores in pathogenic microbes and, subsequently, its promise as a counteracter of antibiotic resistance. Since we published our last review of antimicrobial blue light in 2012, there have been a substantial number of new studies reported in this area. Here we provide an updated overview of the findings from the new studies over the past 5 years, including the efficacy of antimicrobial blue light inactivation of different microbes, its mechanism of action, synergism of antimicrobial blue light with other angents, its effect on host cells and tissues, the potential development of resistance to antimicrobial blue light by microbes, and a novel interstitial delivery approach of antimicrobial blue light. The potential new applications of antimicrobial blue light are also discussed.

Optical lens-microneedle array for percutaneous light delivery

The limited penetration depth of light in skin tissues is a practical bottleneck in dermatologic applications of light-induced therapies, including anti-microbial blue light therapy and photodynamic skin cancer therapy. Here, we demonstrate a novel device, termed optical microneedle array (OMNA), for percutaneous light delivery. A prototype device with a 11 by 11 array of needles at a spacing of 1 mm and a length of 1.6 mm was fabricated by press-molding poly-(lactic acid) (PLA) polymers. The device also incorporates a matched microlens array that focuses the light through the needle tips at specific points to achieve an optimal intensity profile in the tissue. In experiments done with bovine tissues, the OMNA enabled us to deliver a total of 7.5% of the input photons at a wavelength of 491 nm, compared to only 0.85% without the device. This 9-fold enhancement of light delivery was close to the prediction of 10.8 dB by ray-tracing simulation and is expected to increase the effective treatment depth of anti-microbial blue light therapy significantly from 1.3 to 2.5 mm in human skin.

Diffusing, Side-Firing, and Radial Delivery Laser Balloon Catheters for Creating Subsurface Thermal Lesions in Tissue

Infrared lasers have been used in combination with applied cooling methods to preserve superficial skin layers during cosmetic surgery. Similarly, combined laser irradiation and tissue cooling may also allow development of minimally invasive laser therapies beyond dermatology. This study compares diffusing, side-firing, and radial delivery laser balloon catheter designs for creation of subsurface lesions in tissue, ex vivo, using a near-IR laser and applied contact cooling. An Ytterbium fiber laser with 1075 nm wavelength delivered energy through custom built 18 Fr (6-mm-OD) balloon catheters incorporating either 10-mm-long diffusing fiber tip, 90 degree side-firing fiber, or radial delivery cone mirror, through a central lumen. A chilled solution was flowed through a separate lumen into 9-mm-diameter balloon to keep probe cooled at 7°C. Porcine liver tissue samples were used as preliminary tissue model for immediate observation of thermal lesion creation. The diffusing fiber produced subsurface thermal lesions measuring 49.3 ± 10.0 mm² and preserved 0.8 ± 0.1 mm of surface tissue. The side-firing fiber produced subsurface thermal lesions of 2.4 ± 0.9 mm² diameter and preserved 0.5 ± 0.1 mm of surface tissue. The radial delivery probe assembly failed to produce subsurface thermal lesions, presumably due to the small effective spot diameter at the tissue surface, which limited optical penetration depth. Optimal laser power and irradiation time measured 15 W and 100 s for diffusing fiber and 1.4 W and 20 s, for side-firing fiber, respectively. Diffusing and side-firing laser balloon catheter designs provided subsurface thermal lesions in tissue. However, the divergent laser beam in both designs limited the ability to preserve a thicker layer of tissue surface. Further optimization of laser and cooling parameters may be necessary to preserve thicker surface tissue layers.

Circumferential irradiation for interstitial coagulation of urethral stricture

An optical diffuser was developed to achieve radially uniform light irradiation by micro-machining helical patterns on the fiber surface for endoscopically treating urethral stricture. Spatial emission from the diffuser was evaluated by goniometric measurements. A computational model was developed to predict spatio-temporal heat distribution during the interstitial coagulation. The fabricated diffuser yielded circumferential light distribution with slightly concentrated energy at the proximal end. Both simulation and tissue testing demonstrated approximately 1-mm coagulation thickness at 6 W for 10 sec with 1470 nm. The proposed optical diffuser may be a feasible tool to treat the urethral stricture in a uniform manner.

Microneedle applications in improving skin appearance

Microneedles (MNs) are micron-sized, minimally invasive devices that breach the outermost layer of the skin, the stratum corneum (SC), creating transient, aqueous pores in the skin and facilitating the transport of therapeutic molecules into the epidermis. Following many years of extensive research in the area of MN-mediated trans- and intra-dermal drug delivery, MNs are now being exploited in the cosmeceutical industry as a means of disrupting skin cell architecture, inducing elastin and collagen expression and deposition. They are also being used as vehicles to deliver cosmeceutic molecules across the skin, in addition to their use in combinatorial treatments with topical agents or light sources. This review explores the chronology of microneedling methodologies, which has led to the emergence of MN devices, now extensively used in cosmeceutical applications. Recent developments in therapeutic molecule and peptide delivery to the skin via MN platforms are addressed and some commercially available MN devices are described. Important safety and regulatory considerations relating to MN usage are addressed, as are studies relating to public perception of MN, as these will undoubtedly influence the acceptance of MN products as they progress towards commercialisation.

Devitrite-based optical diffusers

Devitrite is a novel material produced by heat treatment of commercial soda-lime-silica glass. It consists of fans of needle-like crystals which can extend up to several millimeters and have interspacings of up to a few hundred nanometers. To date, only the material properties of devitrite have been reported, and there has been a distinct lack of research on using it for optical applications. In this study, we demonstrate that randomly oriented fans of devitrite crystals can act as highly efficient diffusers for visible light. Devitrite crystals produce phase modulation of light because of their relatively high anisotropy. The nanoscale spacings between these needles enable light to be diffused to large scattering angles. Experimentally measured results suggest that light diffusion patterns with beam widths of up to 120° are produced. Since devitrite is an inexpensive material to produce, it has the potential to be used in a variety of commercial applications.

Fiberoptic microneedle device facilitates volumetric infusate dispersion during convection-enhanced delivery in the brain

BACKGROUND AND OBJECTIVES

A fiberoptic microneedle device (FMD) was designed and fabricated for the purpose of enhancing the volumetric dispersal of macromolecules delivered to the brain through convection-enhanced delivery (CED) by concurrent delivery of sub-lethal photothermal hyperthermia. This study's objective was to demonstrate enhanced dispersal of fluid tracer molecules through co-delivery of 1,064  nm laser energy in an in vivo rodent model.

MATERIALS AND METHODS

FMDs capable of co-delivering fluids and laser energy through a single light-guiding capillary tube were fabricated. FMDs were stereotactically inserted symmetrically into both cerebral hemispheres of 16 anesthetized rats to a depth of 1.5  mm. Laser irradiation (1,064 nm) at 0 (control), 100, and 200 mW was administered concurrently with CED infusions of liposomal rhodamine (LR) or gadolinium-Evans blue-serum albumin conjugated complex (Gd-EBA) at a flow rate of 0.1 µl/min for 1 hour. Line pressures were monitored during the infusions. Rodents were sacrificed immediately following infusion and their brains were harvested, frozen, and serially cryosectioned for histopathologic and volumetric analyses.

RESULTS

Analysis by ANOVA methods demonstrated that co-delivery enhanced volumetric dispersal significantly, with measured volumes of 15.8  ±  0.6 mm(3) for 100 mW compared to 10.0  ±  0.4 mm(3) for its fluid only control and 18.0  ±  0.3 mm(3) for 200 mW compared to 10.3  ±  0.7 mm(3) for its fluid only control. Brains treated with 200 mW co-delivery exhibited thermal lesions, while 100 mW co-deliveries were associated with preservation of brain cytoarchitecture.

CONCLUSION

Both lethal and sub-lethal photothermal hyperthermia substantially increase the rate of volumetric dispersal in a 1 hour CED infusion. This suggests that the FMD co-delivery method could reduce infusion times and the number of catheter insertions into the brain during CED procedures.

Comparison of laser-induced damage with forward-firing and diffusing optical fiber during laser-assisted lipoplasty

BACKGROUND AND OBJECTIVES

Laser-assisted lipoplasty is made possible by using an optical fiber that delivers light endoscopically to subcutaneous fat tissue. Most optical fibers for laser-assisted lipoplasty are designed to be irradiated in a forward direction. In this study, we compared forward-firing fiber and diffusing fiber for use in laser-assisted lipoplasty. The effective parameters of the ablation pattern which resulted from the laser-induced damage are discussed for both systems. In particular, we note the effect resulting from the different beam emission patterns and the contours of laser fluence.

METHODS

We used two different laser delivery systems (a forward-firing fiber and a diffusing fiber) to examine how the beam emission pattern affects the laser-assisted coagulation and damage pattern of in vitro fat tissues. A porcine liver tissue (water-rich tissue) was used as a secondary laser target to investigate how the laser-assisted coagulation pattern depends on both the type of tissue (water-rich and lipid-rich tissue) as well as the delivery system. An evaluation using a digital camera and a thermal camera was conducted for the tissue ablation processes in order to observe the generated heat transfer in fat and liver.

RESULTS

The overall shape of the laser-assisted coagulation zone was different from the beam emission pattern in the case where a forward-firing fiber was used within fat tissue. The center of the laser-affected zone is characterized by the formation of a reservoir of melted fat. In the thermal image analysis, there existed a discrepancy between the temperature distribution of the fat tissue and the liver tissue during the forward-firing fiber irradiation. In the liver tissue ablation process, the temperature distribution during the laser ablation also demonstrated an elongated ellipse that matches well with the laser-induced damage zone. The temperature distribution in fat tissue adhered to a more discoid pattern that corresponded to the laser-induced damage zone.

CONCLUSIONS

Based on our findings, we have proposed mechanisms that can explain the laser-induced damage in both tissues when a forward firing fiber is employed as the delivery system. In the case of fat tissue, the ablation mechanism can be characterized by the reservoir formation of melted lipids while the ablation is characterized as the well-known drilling effect for liver tissue.

Ultraviolet C light for Acinetobacter baumannii wound infections in mice: potential use for battlefield wound decontamination?

BACKGROUND

Since the beginning of the conflicts in the Middle East, US Army physicians have noted a high rate of multidrug-resistant Acinetobacter baumannii infections among US soldiers wounded and initially treated in Iraq. In this study, we investigated the use of ultraviolet C (UVC) light for prevention of multidrug-resistant A. baumannii wound infections using mouse models.

METHODS

Partial-thickness skin abrasions and full-thickness burns in mice were infected with a multidrug-resistant A. baumannii isolate recovered from a wounded US soldier deployed to Iraq. The luxCDABE operon, which was contained in plasmid pMF 385, was cloned into the A. baumannii strain. This allowed real-time monitoring of the extent of infection in mice using bioluminescence imaging. UVC light was delivered to the mouse wounds at 30 minutes after the inoculation of A. baumannii. Groups of infected mouse wounds without being exposed to UVC served as the controls.

RESULTS

In vitro studies demonstrated that A. baumannii cells were inactivated at UVC exposures much lower than those needed for a similar effect on mammalian cells. It was observed in animal studies that UVC (3.24 J/cm(2) for abrasions and 2.59 J/cm(2) for burns) significantly reduced the bacterial burdens in UVC-treated wounds by approximately 10-fold compared with nontreated controls (p = 0.004 for abrasions, p = 0.019 for burns). DNA lesions were observed by immunofluorescence in mouse skin abrasions immediately after a UVC exposure of 3.24 J/cm(2); however, the lesions were extensively repaired within 72 hours.

CONCLUSION

These results suggested that UVC may be useful in preventing combat-related wound infections.