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3-T magnetic resonance-guided high-intensity focused ultrasound (3 T-MR-HIFU) for the treatment of pain from bone metastases of solid tumors. Support Care Cancer 2022; 30:5737-5745. [PMID: 35332373 DOI: 10.1007/s00520-022-06990-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Bone metastases (BM) are still the main cause of morbidity and mortality in cancer patients, not only because of their complications, defined as skeletal-related events (SREs), but also because of the negative impact bone pain has on quality of life (QoL) and survival, especially when opioid analgesics and locoregional treatments fail. MATERIALS AND METHODS A single-center prospective study was carried out on 12 patients with symptomatic BM treated with MRI-guided focused ultrasound (MR-HIFU). The primary endpoint was the effectiveness of MR-HIFU in reducing current and breakthrough cancer pain (BTCP) scores. The main secondary aims were the evaluation of circulating markers at different time-points and their relation to pain and procedure efficacy. Other secondary objectives included temporal evolution of pain response, evaluation of QoL, and side effects of the treatment. Descriptive statistics were used to evaluate primary and secondary endpoints. Questionnaires on pain and QoL completed at baseline and at 30 days were compared using appropriate statistical tests with exploratory intent. RESULTS MR-HIFU was successfully completed in all 12 patients enrolled between September 2015 and December 2018. On day 30, 6 (50.0%) patients showed a complete response of current pain and 6 a partial response, while 5 (41.7%) obtained a complete BTCP response. A partial response of BM evaluated by MD Anderson criteria was obtained in 9 (81.8%) patients. Only one patient progressed in the target lesion after MR-HIFU. No treatment-related adverse events were recorded. Bone turnover markers CTX/RANK-L (P) do not demonstrate any significant change with the pain or BM response. CONCLUSION In our patients, targeted therapy of painful BM with MRI-guided focused ultrasound ablation was safe and showed encouraging early-onset and functional results.
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Giantulli S, Tortorella E, Brasili F, Scarpa S, Cerroni B, Paradossi G, Bedini A, Morrone S, Silvestri I, Domenici F. Effect of 1-MHz ultrasound on the proinflammatory interleukin-6 secretion in human keratinocytes. Sci Rep 2021; 11:19033. [PMID: 34561481 PMCID: PMC8463532 DOI: 10.1038/s41598-021-98141-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/02/2021] [Indexed: 02/08/2023] Open
Abstract
Keratinocytes, the main cell type of the skin, are one of the most exposed cells to environmental factors, providing a first defence barrier for the host and actively participating in immune response. In fact, keratinocytes express pattern recognition receptors that interact with pathogen associated molecular patterns and damage associated molecular patterns, leading to the production of cytokines and chemokines, including interleukin (IL)-6. Herein, we investigated whether mechanical energy transported by low intensity ultrasound (US) could generate a mechanical stress able to induce the release of inflammatory cytokine such IL-6 in the human keratinocyte cell line, HaCaT. The extensive clinical application of US in both diagnosis and therapy suggests the need to better understand the related biological effects. Our results point out that US promotes the overexpression and secretion of IL-6, associated with the activation of nuclear factor-κB (NF-κB). Furthermore, we observed a reduced cell viability dependent on exposure parameters together with alterations in membrane permeability, paving the way for further investigating the molecular mechanisms related to US exposure.
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Affiliation(s)
- Sabrina Giantulli
- grid.7841.aDepartment of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Elisabetta Tortorella
- grid.7841.aDepartment of Molecular Medicine, Sapienza University of Rome, Rome, Italy ,grid.6530.00000 0001 2300 0941Department of Chemical Sciences and Technologies, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Brasili
- grid.6530.00000 0001 2300 0941Department of Chemical Sciences and Technologies, University of Rome Tor Vergata, Rome, Italy ,grid.7841.aDepartment of Physics, Sapienza University of Rome, Rome, Italy ,grid.5326.20000 0001 1940 4177CNR-NANOTEC, Institute of Nanotechnology, Soft and Living Matter Laboratory, Rome, Italy
| | - Susanna Scarpa
- grid.7841.aDepartment of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Barbara Cerroni
- grid.6530.00000 0001 2300 0941Department of Chemical Sciences and Technologies, University of Rome Tor Vergata, Rome, Italy
| | - Gaio Paradossi
- grid.6530.00000 0001 2300 0941Department of Chemical Sciences and Technologies, University of Rome Tor Vergata, Rome, Italy
| | - Angelico Bedini
- grid.425425.00000 0001 2218 2472INAIL, Italian Worker’s Compensation Authority, Rome, Italy
| | - Stefania Morrone
- grid.7841.aDepartment of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Ida Silvestri
- grid.7841.aDepartment of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabio Domenici
- grid.6530.00000 0001 2300 0941Department of Chemical Sciences and Technologies, University of Rome Tor Vergata, Rome, Italy
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Huerta TS, Devarajan A, Tsaava T, Rishi A, Cotero V, Puleo C, Ashe J, Coleman TR, Chang EH, Tracey KJ, Chavan SS. Targeted peripheral focused ultrasound stimulation attenuates obesity-induced metabolic and inflammatory dysfunctions. Sci Rep 2021; 11:5083. [PMID: 33658532 PMCID: PMC7930257 DOI: 10.1038/s41598-021-84330-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/05/2021] [Indexed: 02/06/2023] Open
Abstract
Obesity, a growing health concern, is associated with an increased risk of morbidity and mortality. Chronic low-grade inflammation is implicated in obesity-driven metabolic complications. Peripheral focused ultrasound stimulation (pFUS) is an emerging non-invasive technology that modulates inflammation. Here, we reasoned that focused ultrasound stimulation of the liver may alleviate obesity-related inflammation and other comorbidities. After 8 weeks on a high-fat high-carbohydrate "Western" diet, C57BL/6J mice were subjected to either sham stimulation or focused ultrasound stimulation at the porta hepatis. Daily liver-focused ultrasound stimulation for 8 weeks significantly decreased body weight, circulating lipids and mitigated dysregulation of adipokines. In addition, liver-focused ultrasound stimulation significantly reduced hepatic cytokine levels and leukocyte infiltration. Our findings demonstrate the efficacy of hepatic focused ultrasound for alleviating obesity and obesity-associated complications in mice. These findings suggest a previously unrecognized potential of hepatic focused ultrasound as a possible novel noninvasive approach in the context of obesity.
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Affiliation(s)
- Tomás S Huerta
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA
| | - Alex Devarajan
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Tea Tsaava
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Arvind Rishi
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | | | - Jeffrey Ashe
- GE Research, 1 Research Circle, Niskayuna, NY, 12309, USA
| | - Thomas R Coleman
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Eric H Chang
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA.
- The Elmezzi Graduate School of Molecular Medicine, 350 Community Drive, Manhasset, NY, 11030, USA.
| | - Sangeeta S Chavan
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA.
- The Elmezzi Graduate School of Molecular Medicine, 350 Community Drive, Manhasset, NY, 11030, USA.
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Yu K, Niu X, He B. Neuromodulation Management of Chronic Neuropathic Pain in The Central Nervous system. ADVANCED FUNCTIONAL MATERIALS 2020; 30:1908999. [PMID: 34335132 PMCID: PMC8323399 DOI: 10.1002/adfm.201908999] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Indexed: 05/05/2023]
Abstract
Neuromodulation is becoming one of the clinical tools for treating chronic neuropathic pain by transmitting controlled physical energy to the pre-identified neural targets in the central nervous system. Its nature of drug-free, non-addictive and improved targeting have attracted increasing attention among neuroscience research and clinical practices. This article provides a brief overview of the neuropathic pain and pharmacological routines for treatment, summarizes both the invasive and non-invasive neuromodulation modalities for pain management, and highlights an emerging brain stimulation technology, transcranial focused ultrasound (tFUS) with a focus on ultrasound transducer devices and the achieved neuromodulation effects and applications on pain management. Practical considerations of spatial guidance for tFUS are discussed for clinical applications. The safety of transcranial ultrasound neuromodulation and its future prospectives on pain management are also discussed.
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Affiliation(s)
| | | | - Bin He
- Department of Biomedical Engineering, Carnegie Mellon University
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Todd N, McDannold N, Borsook D. Targeted manipulation of pain neural networks: The potential of focused ultrasound for treatment of chronic pain. Neurosci Biobehav Rev 2020; 115:238-250. [PMID: 32534900 PMCID: PMC7483565 DOI: 10.1016/j.neubiorev.2020.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/24/2020] [Accepted: 06/04/2020] [Indexed: 12/29/2022]
Abstract
Focused ultrasound (FUS) is a promising technology for facilitating treatment of brain diseases including chronic pain. Focused ultrasound is a unique modality for delivering therapeutic levels of energy into the body, including the central nervous system (CNS). It is non-invasive and can target spatially localized effects through the intact skull to cortical or subcortical regions of the brain. FUS can achieve three different mechanisms of action in the brain that are relevant for chronic pain treatment: (1) localized thermal ablation of neural tissue; (2) localized and transient disruption of the blood-brain barrier for targeted drug delivery to CNS structures; and (3) inhibition or stimulation of neuronal activity in targeted regions. This review provides an in-depth look at the technology of FUS with emphasis placed on applications to CNS-based treatments of chronic pain. While still in the early stages of clinical translation and with some technical challenges remaining, we suggest that FUS has great potential as a novel approach for manipulating CNS networks involved in pain treatment.
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Affiliation(s)
- Nick Todd
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Center for Pain and the Brain, 1 Autumn Street, Boston Children's Hospital, Boston, MA, 02115, United States.
| | - Nathan McDannold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - David Borsook
- Center for Pain and the Brain, 1 Autumn Street, Boston Children's Hospital, Boston, MA, 02115, United States; Department of Anesthesia, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, United States
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Ezeokeke CK, Bobola MS, Selby M, Ko JH, Friedly JL, Mourad PD. Case study of an amputee regaining sensation and muscle function in a residual limb after peripheral nerve stimulation by intense focused ultrasound. Brain Stimul 2020; 13:527-529. [PMID: 32289669 PMCID: PMC7195996 DOI: 10.1016/j.brs.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- C K Ezeokeke
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - M S Bobola
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - M Selby
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - J H Ko
- Department of Plastic Surgery, Northwestern University, Chicago, IL, USA
| | - J L Friedly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - P D Mourad
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA; Division of Engineering and Mathematics, University of Washington, Bothell, WA, USA.
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Bobola MS, Chen L, Ezeokeke CK, Olmstead TA, Nguyen C, Sahota A, Williams RG, Mourad PD. Transcranial focused ultrasound, pulsed at 40 Hz, activates microglia acutely and reduces Aβ load chronically, as demonstrated in vivo. Brain Stimul 2020; 13:1014-1023. [PMID: 32388044 DOI: 10.1016/j.brs.2020.03.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/18/2020] [Accepted: 03/26/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Iaccarino et al. (2016) [1] exposed 1 h of light flickering at 40 Hz to awake 5XFAD Alzheimer's Disease (AD) mouse models, generating action potentials at 40 Hz, activating ∼54% of microglia to colocalize with Aβ plaque, acutely, and clearing ∼ 50% of Aβ plaque after seven days, but only in the visual cortex. HYPOTHESIS Transcranially delivered, focused ultrasound (tFUS) can replicate the results of Iaccarino et al. (2016) [1] but throughout its area of application. METHODS We exposed sedated 5XFAD mice to tFUS (2.0 MHz carrier frequency, 40 Hz pulse repetition frequency, 400 μs-long pulses, spatial peak pulse average value of 190 W/cm2). Acute studies targeted tFUS into one hemisphere of brain centered on its hippocampus for 1 h. Chronic studies targeted comparable brain in each hemisphere for 1 h/day for five days. RESULTS Acute application of tFUS activated more microglia that colocalized with Aβ plaque relative to sham ultrasound (36.0 ± 4.6% versus 14.2 ± 2.6% [mean ± standard error], z = 2.45, p < 0.014) and relative to the contralateral hemisphere of treated brain (36.0 ± 4.6% versus 14.3 ± 4.0%, z = 2.61, p < 0.009). Chronic application over five days reduced their Aβ plaque burden by nearly half relative to paired sham animals (47.4 ± 5.8%, z = - 2.79, p < 0.005). CONCLUSION Our results compare to those of Iaccarino et al. (2016) [1] but throughout the area of ultrasound-exposed brain. Our results also compare to those achieved by medications that target Aβ, but over a substantially shorter period of time. The proximity of our ultrasound protocol to those shown safe for non-human primates and humans may motivate its rapid translation to human studies.
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Affiliation(s)
- M S Bobola
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - L Chen
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - C K Ezeokeke
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - T A Olmstead
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - C Nguyen
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - A Sahota
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - R G Williams
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - P D Mourad
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA; Division of Engineering and Mathematics, University of Washington, Bothell, WA, USA.
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8
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Schimek N, Burke-Conte Z, Abernethy J, Schimek M, Burke-Conte C, Bobola M, Stocco A, Mourad PD. Repeated Application of Transcranial Diagnostic Ultrasound Towards the Visual Cortex Induced Illusory Visual Percepts in Healthy Participants. Front Hum Neurosci 2020; 14:66. [PMID: 32194387 PMCID: PMC7062642 DOI: 10.3389/fnhum.2020.00066] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/12/2020] [Indexed: 11/24/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) of the visual cortex can induce phosphenes as participants look at a visual target. So can non-diagnostic ultrasound (nDU), delivered in a transcranial fashion, while participants have closed their eyes during stimulation. Here, we sought to determine if DU, aimed at the visual cortex, could alter the perception of a visual target. We applied a randomized series of actual or sham DU, transcranially and towards the visual cortex of healthy participants while they stared at a visual target (a white crosshair on a light-blue background), with the ultrasound device placed where TMS elicited phosphenes. These participants observed percepts seven out of ten times, which consisted of extra or extensions of lines relative to the original crosshair, and additional colors, an average of 53.7 ± 2.6% of the time over the course of the experiment. Seven out of ten different participants exposed to sham-only DU observed comparable percepts, but only an average of 36.3 ± 1.9% of the time, a statistically significant difference (p < 0.00001). Moreover, on average, participants exposed to a combination of sham and actual ultrasound reported a net increase of 47.9 percentage points in the likelihood that they would report a percept by the end of the experiment. Our results are consistent with the hypothesis that a random combination of sham-only and actual DU, applied directly over the visual cortex of participants, increased the likelihood that they would observe visual effects, but not the type of effects, with that likelihood increasing over the course of the experiment. From this, we conclude that repeated exposures by DU may make the visual cortex more responsive to stimulation of their visual cortex by the visual target itself. Future studies should identify the biophysical mechanism(s) and neural pathways by which DU, in our hands and others, can generate its observed effects on brain function. These observations, consistent with other’s observation of effects of DU stimulation of the human motor cortex and amygdala, as well as the FDA approved nature of DU, may lead to increased use of DU as a means of altering brain function.
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Affiliation(s)
- Nels Schimek
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Zeb Burke-Conte
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Justin Abernethy
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Maren Schimek
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Celeste Burke-Conte
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Michael Bobola
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Andrea Stocco
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Pierre D Mourad
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States.,Division of Engineering and Mathematics, University of Washington, Seattle, WA, United States
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Kaye AD, Motejunas MW, Bonneval LA, Ehrhardt KP, Latimer DR, Trescot A, Wilson KE, Ibrahim IN, Cornett EM, Urman RD, Candido KD. Ultrasound practice for chronic pain procedures: A comprehensive review. Best Pract Res Clin Anaesthesiol 2019; 33:465-486. [PMID: 31791564 DOI: 10.1016/j.bpa.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/09/2019] [Indexed: 12/11/2022]
Abstract
Chronic pain management techniques have evolved in recent years. With regard to this, ultrasound (US) technology has become a standard for most acute pain procedures and essential for postsurgical pain relief and enhanced recovery after surgery protocols. This manuscript summarizes clinical studies evaluating US use for chronic pain management and compares efficacy with standard techniques including fluoroscopy (FL). US possesses several unique benefits when compared with FL, including elimination of radiation exposure while providing similar clinical outcomes. In summary, US use for chronic pain procedures is emerging as a viable, safe, and effective modality. Additional studies are needed to best appreciate US and its role in chronic pain management.
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Affiliation(s)
- Alan David Kaye
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Mark W Motejunas
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Lauren A Bonneval
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Ken P Ehrhardt
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Dustin R Latimer
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | | | - Kyle E Wilson
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Ibraham N Ibrahim
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
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Bobola MS, Ezeokeke CK, Kuznetslova K, Lahti AC, Loeser JD, Olmstead TA, Friedly JL, Mourad PD. A Pre-clinical Study of the Response Threshold of Intact and Transected Nerves to Stimulation by Transcutaneous Intense Focused Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2094-2103. [PMID: 31153718 DOI: 10.1016/j.ultrasmedbio.2019.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 03/02/2019] [Accepted: 04/09/2019] [Indexed: 06/09/2023]
Abstract
We used diagnostic ultrasound imaging to guide individual bursts (0.1 s) of 2 MHz intense focused ultrasound (iFU) to determine the sensitivity of intact and transected nerves. We found that all nerves had greater sensitivity to iFU stimulation than surrounding muscle. Intact nerves from healthy volunteers had less sensitivity to iFU stimulation (272 ± 35 W/cm2 [median ± standard error]) than transected nerves (19 ± 37 W/cm2). Intact, contralateral nerves of amputees dichotomized naturally into two groups-one very sensitive to iFU stimulation (6 ± 2 W/cm2) and one relatively insensitive (539 ± 19 W/cm2), compared with the intact nerves of healthy volunteers. Our study demonstrates the ability of iFU under ultrasound image guidance to stimulate deep, intact and transected peripheral nerves. It also highlights differences in the receptivity to ultrasound stimulation of the peripheral nerves of amputees versus healthy volunteers.
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Affiliation(s)
- M S Bobola
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - C K Ezeokeke
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - K Kuznetslova
- Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - A C Lahti
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - J D Loeser
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - T A Olmstead
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - J L Friedly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - P D Mourad
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA; Applied Physics Laboratory, University of Washington, Seattle, WA, USA; Division of Engineering and Mathematics, University of Washington, Bothell, WA, USA.
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11
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Olmstead TA, Chiarelli PA, Griggs DJ, McClintic AM, Myroniv AN, Mourad PD. Transcranial and pulsed focused ultrasound that activates brain can accelerate remyelination in a mouse model of multiple sclerosis. J Ther Ultrasound 2018; 6:11. [PMID: 30555696 PMCID: PMC6287362 DOI: 10.1186/s40349-018-0119-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/15/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) impacts approximately 400,000 in the United States and is the leading cause of disability among young to middle aged people in the developed world. Characteristic of this disease, myelin within generally focal volumes of brain tissue wastes away under an autoimmune assault, either inexorably or through a cycle of demyelination and remyelination. This centrally located damage produces central and peripheral symptoms tied to the portion of brain within the MS lesion site. Interestingly, Gibson and colleagues noted that optical activation of transgenically tagged central neurons increased the thickness of the myelin sheath around those neurons. Since ultrasound, delivered transcranially, can also activate brain focally, we hypothesized that ultrasound stimulation that followed the temporal pattern of Gibson et al. applied to MS lesions in a mouse model might either decelerate the demyelination phase or accelerate its remyelination phase. METHODS We created a temporal pattern of ultrasound delivery that conformed to that of Gibson et al. and capable of activating mouse brain. We then applied ultrasound, transcranially, following that temporal pattern to separate cohorts of a mouse model of multiple sclerosis, using three different ultrasound carrier frequencies (0.625 MHz, 1.09 MHz, 2.0 MHz), during each of the demyelinating and remyelinating phases. After identifying the most promising protocol and MS brain state through qualitative analysis of myelin content, we performed additional studies for that condition then assayed for change in myelin content via quantitative analysis. RESULTS We identified one ultrasound protocol that significantly accelerated remyelination, without damage, as demonstrated with histological analysis. CONCLUSION MRI-guided focused ultrasound systems exist that can, in principle, deliver the ultrasound protocol we successfully tested here. In addition, MRI, as the clinical gold standard, can readily identify MS lesions. Given the relatively low intensity values of our ultrasound protocol - close to FDA limits - we anticipate that future success with this approach to MS therapy as tested using more realistic MS mouse models may one day translate to clinical trials that help address this devastating disease.
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Affiliation(s)
- T. A. Olmstead
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195 USA
| | - P. A. Chiarelli
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195 USA
| | - D. J. Griggs
- Division of Engineering and Mathematics, University of Washington, Bothell, WA 98011 USA
| | - A. M. McClintic
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195 USA
| | - A. N. Myroniv
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195 USA
| | - P. D. Mourad
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195 USA
- Division of Engineering and Mathematics, University of Washington, Bothell, WA 98011 USA
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