Hydrogen peroxide contrast echocardiography

Thermal and Acoustic Stabilization Of Volatile Phase-Change Contrast Agents Via Layer-By-Layer Assembly

OBJECTIVE

Phase-change contrast agents (PCCAs) are perfluorocarbon nanodroplets (NDs) that have been widely studied for ultrasound imaging in vitro, pre-clinical studies, and most recently incorporated a variant of PCCAs, namely a microbubble-conjugated microdroplet emulsion, into the first clinical studies. Their properties also make them attractive candidates for a variety of diagnostic and therapeutic applications including drug-delivery, diagnosis and treatment of cancerous and inflammatory diseases, as well as tumor-growth tracking. However, control over the thermal and acoustic stability of PCCAs both in vivo and in vitro has remained a challenge for expanding the potential utility of these agents in novel clinical applications. As such, our objective was to determine the stabilizing effects of layer-by-layer assemblies and its effect on both thermal and acoustic stability.

METHODS

We utilized layer-by-layer (LBL) assemblies to coat the outer PCCA membrane and characterized layering by measuring zeta potential and particle size. Stability studies were conducted by; 1) incubating the LBL-PCCAs at atmospheric pressure at 37∘C and 45∘C followed by; 2) ultrasound-mediated activation at 7.24 MHz and peak-negative pressures ranging from 0.71 - 5.48 MPa to ascertain nanodroplet activation and resultant microbubble persistence. The thermal and acoustic properties of decafluorobutane gas-condensed nanodroplets (DFB-NDs) layered with 6 and 10 layers of charge-alternating biopolymers, (LBL6NDs and LBL10NDs) respectively, were studied and compared to non-layered DFB-NDs. Half-life determinations were conducted at both 37∘C and 45∘C with acoustic droplet vaporization (ADV) measurements occurring at 23∘C.

DISCUSSION

Successful application of up to 10 layers of alternating positive and negatively charged biopolymers onto the surface membrane of DFB-NDs was demonstrated. Two major claims were substantiated in this study; namely, (1) biopolymeric layering of DFB-NDs imparts a thermal stability up to an extent; and, (2) both LBL6NDs and LBL10NDs did not appear to alter particle acoustic vaporization thresholds, suggesting that the thermal stability of the particle may not necessarily be coupled with particle acoustic vaporization thresholds.

CONCLUSION

Results demonstrate that the layered PCCAs had higher thermal stability, where the half-lifes of the LBLxNDs are significantly increased after incubation at 37∘C and 45∘C. Furthermore, the acoustic vaporization profiles the DFB-NDs, LBL6NDs, and LBL10NDs show that there is no statistically significant difference between the acoustic vaporization energy required to initiate acoustic droplet vaporization.

Catalase-Loaded Silica Nanoparticles Formulated via Direct Surface Modification as Potential Oxygen Generators for Hypoxia Relief

Enzymes are biological catalysts that have many potential industrial and biomedical applications. However, the widespread use of enzymes in the industry has been limited by their instability and poor recovery. In biomedical applications, systemic administration of enzymes has faced two main challenges: limited bioactivity mostly due to rapid degradation by proteases and immunogenic activity, since most enzymes are from nonhuman sources. Herein, we propose a robust enzyme-encapsulation strategy to mitigate these limitations. Catalase (CAT) was encapsulated in nanoporous silica nanoparticles (CAT-SiNPs) by first chemically modifying the enzyme surface with a silica precursor, followed by silica growth and finally poly(ethylene glycol) (PEG) conjugation. The formulation was carried out in mild aqueous conditions and yielded nanoparticles (NPs) with a mean diameter of 230 ± 10 nm and a concentration of 1.3 ± 0.8 × 10¹² NPs/mL. CAT-SiNPs demonstrated high enzyme activity, optimal protection from proteolysis by proteinase K and trypsin, and excellent stability over time. In addition, a new electrochemical assay was developed to measure CAT activity in a rapid, simple, and accurate manner without interference from chromophore usually present in biological samples. Concentrations of 2.5 × 10¹⁰ to 80 × 10¹⁰ CAT-SiNPs/mL not only proved to be nontoxic in cell cultures using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay but also conferred cell protection when cells were exposed to 1 mM hydrogen peroxide (H₂O₂). Finally, the ability of CAT-SiNPs to release oxygen (O₂) when exposed to H₂O₂ was demonstrated in vivo using a rat model. Following the direct injection of CAT-SiNPs in the left kidney, partial pressure of oxygen (pO₂) increased by more than 30 mmHg compared to the contralateral control kidney during the systemic infusion of safe levels of H₂O₂. This pilot study highlights the potential of CAT-SiNPs to generate O₂ to relieve hypoxia in tissues and potentially sensitize tumors against radiation therapy.

Toward in vivo detection of hydrogen peroxide with ultrasound molecular imaging

We present a new class of ultrasound molecular imaging agents that extend upon the design of micromotors that are designed to move through fluids by catalyzing hydrogen peroxide (H₂O₂) and propelling forward by escaping oxygen microbubbles. Micromotor converters require 62 mm of H₂O₂ to move - 1000-fold higher than is expected in vivo. Here, we aim to prove that ultrasound can detect the expelled microbubbles, to determine the minimum H₂O₂ concentration needed for microbubble detection, explore alternate designs to detect the H₂O₂ produced by activated neutrophils and perform preliminary in vivo testing. Oxygen microbubbles were detected by ultrasound at 2.5 mm H₂O₂. Best results were achieved with a 400-500 nm spherical design with alternating surface coatings of catalase and PSS over a silica core. The lowest detection limit of 10-100 μm was achieved when assays were done in plasma. Using this design, we detected the H₂O₂ produced by freshly isolated PMA-activated neutrophils allowing their distinction from naïve neutrophils. Finally, we were also able to show that direct injection of these nanospheres into an abscess in vivo enhanced ultrasound signal only when they contained catalase, and only when injected into an abscess, likely because of the elevated levels of H₂O₂ produced by inflammatory mediators.

The development of echocardiography in China: the pioneering role of Xin-fang Wang

I cannot discuss the history of the development of echocardiography in China without describing the pioneering role of Xin-fang Wang (王新房) from Wuhan, China, who is the "father of modern echocardiography."(1) Although Inge Edler from Sweden(2-5) and Harvey Feigenbaum from the United States(6) were also oftentimes referred to as the fathers of echocardiography, both Edler(7) and Feigenbaum(8) recognized that the Chinese used cardiac ultrasonography in the very early years (Figure 1).

Is there increased sympathetic activity in patients with mitral valve prolapse?

The aim of this study was to investigate autonomic nervous system tone in patients with mitral valve prolapse (MVP). Heart rate variability (HRV) was assessed from 24-hour ambulatory Holter recordings in 28 patients with primary MVP and in 28 age and sex matched normal control subjects in a drug-free state. Sixteen of the MVP patients were symptomatic and 12 asymptomatic. Spectral HRV was calculated in terms of low (LF: 0.06-0.15 Hz) and high (HF: 0.15-0.40 Hz) frequency components using fast Fourier transform analysis, and the ratio LF/HF was calculated. Spectral analysis of HRV showed that the MVP patients, taken as a single group, had lower HF and LF and a higher LF/HF ratio than the controls. No significant difference in HRV was found between the 16 symptomatic and the 12 asymptomatic patients, but the symptomatic patients had a significantly higher LF/HF ratio than the controls. Our observations suggest that, during normal daily activities, patients with MVP experience a significant deviation in autonomic nervous system tone with predominance of the sympathetic branch. This predominance is more marked in symptomatic patients.

The phenomenon of dysautonomia and mitral valve prolapse

In recent years research has shown that subsets of patients with mitral valve prolapse also have associated autonomic or neuroendocrine dysfunction that can result in a number of related symptoms, including fatigue, palpitations, chest pain, exercise intolerance, dyspnea, dizziness, headache, sleep disorders, gastrointestinal disturbances, cold extremities, and panic attacks. These patients have been classified as having mitral valve prolapse syndrome. This article discusses the pathogenesis and management of mitral valve prolapse syndrome and serves to make clinicians aware of newer developments in the study of autonomic function and dysfunction.

Quantitative echo contrast concentration measurement by Doppler sonography

The hypothesis investigated in this study is that Doppler ultrasound can be used to make quantitative echo contrast concentration measurements in flow systems. Our motivation was to demonstrate the utility and some of the pitfalls of using scattered ultrasound intensity to quantify echo contrast in chambers and vessels. Doppler ultrasound was used rather than conventional imaging techniques because of its natural association with the assessment of flow in chambers and vessels. We compared the intensity of audio Doppler to various steady-state concentrations echo contrast in a carefully controlled in vitro flow system. A total of 62 paired audio Doppler intensity and echo contrast concentration measurements were made. A weak positive correlation was found between the absolute echo contrast concentration and audio Doppler intensity (r = 0.510, p = 0.001). The correlation was weak because of the many unknowns and effervescent nature of microbubble echo contrast agents. However, audio Doppler intensity was shown to correlate strongly with the relative concentration of echo contrast over short time periods (r = 0.958, p = 0.0001). The results show that Doppler intensity can be used to quantitatively measure the relative, but not the absolute concentration of echo contrast in in vitro flow systems.

Air microbubbles as a contrast medium in transcranial Doppler sonography. A pilot study

An insufficient signal-to-noise ratio is a significant limiting factor in assessing intracranial hemodynamic parameters by transcranial Doppler sonography. To establish the feasibility and validity of signal enhancement in transcranial Doppler sonography, stabilized air microbubbles bound to galactose microparticles as a carrier (SHU 454) were used in an animal model. The disadvantage of a short-lasting effect is caused by instability of the contrast medium and a consequent reduced capacity to pass through the lung. Eight pigs received SHU 454 intraarterially in various concentrations and forms of application during transcranial monitoring of the middle cerebral artery with a 2 MHz pulsed ultrasound device. The effect was reproducible, dependent on the dose and application modalities. The best results were obtained with low concentrations (100 mg of microparticles/ml of suspension) and low injection speeds (0.5-1.0 ml/sec) into the common carotid artery by injection pump, reaching a homogeneous average enhancement of 6 to 12 dB over at least 5 minutes. Histological examination of the brain showed no evidence of air embolization. Further development requires a stable solution with similar properties and an ability to pass through the lung, therefore being suitable for intravenous application in humans.

In vivo prediction of the transmural extent of experimental acute myocardial infarction using contrast echocardiography

Acute myocardial infarction progresses radially from endocardium to epicardium within the ischemic area. The amount of progression is highly variable, but depends largely on the transmural distribution of myocardial blood flow. Recent contrast echocardiographic observations indicate that slowly appearing low levels of contrast enhancement are often seen in the ischemic region, particularly in the epicardial level, and that ischemic regions which show these low levels of contrast have significantly more blood flow than those that do not. This study was designed to determine whether the transmural distribution of this delayed contrast enhancement can sufficiently discriminate between regions of high and low flow to serve as an in vivo predictor of the transmural extent of acute infarction. Twenty-four dogs had acute circumflex coronary ligation which was maintained for 6 hours. Contrast echocardiographic studies were performed at the level of the mitral chordae 2 hours after occlusion using a dilute hydrogen peroxide and blood solution as a contrast agent. Comparison was made with the pathologic infarct measured by triphenyltetrazolium chloride staining. The mean transmural extent of infarction ranged from 0 to 89% and was predicted in vivo by the transmural extent of the delayed contrast defect (r = 0.92; infarction [percent transmural] = 0.74 contrast [percent transmural] + 11%; SEE = 10%). Reproducibility for the transmural extent of delayed contrast defects was good (r = 0.89 to 0.98.) These data further support the concept that the transmural distribution of delayed contrast enhancement parallels blood flow and indicate that the mean transmural extent of acute infarction can be predicted in vivo 2 hours after coronary occlusion from the residual contrast defect.

Contrast echocardiographic estimation of regional myocardial blood flow after acute coronary occlusion

Contrast echocardiography can predict pathologic area at risk during acute coronary occlusion. In this study we evaluated (1) whether the intensity and timing of contrast appearance in ischemic regions can provide a quantitative measure of residual myocardial perfusion, and (2) whether changes in these parameters observed after serial injections reflect changes in blood flow to acutely ischemic tissue. Supra-aortic hydrogen peroxide contrast echocardiography was performed in 12 consecutive dogs at 1, 20, and 120 min after acute circumflex coronary occlusion. Contrast enhancement was determined qualitatively with a segmental four-point scoring system based on the appearance time and peak perceived intensity of contrast enhancement and quantitatively with a computer algorithm designed to reflect these parameters. Comparison was made in each segment to concomitant radioactive microsphere blood flow. Qualitative scoring related systematically to normalized segmental blood flow (3+ = 93%; 2+ = 61%; 1+ = 32%; 0 = 18%; p less than .01 for each vs adjacent value), as did quantitative analysis including all segments (r = .78; p less than .01) and isolated to the ischemic region (flow = 1.13 intensity change +6.8%; r = .83, p less than .001). Changes in microsphere flow in ischemic regions between sequential observations were correlated with changes in qualitative score (r = .88, p less than .001) and results of quantitative analysis (r = 0.70, p less than .01). The amount of contrast enhancement can provide quantitative information about residual myocardial blood flow in ischemic regions and can also be used to track changing patterns of flow in vivo after acute coronary occlusion.

Artifactual regional gray level variability in contrast-enhanced two-dimensional echocardiographic images: effect on measurement of the coronary perfusion bed

The purpose of this study was to determine the extent of regional variability of image echocardiographic amplitude (expressed as gray level variability) in contrast-enhanced two-dimensional echocardiographic images, and to assess the effect of such baseline gray level variability on quantitation of the coronary perfusion bed. In 10 anesthetized closed chest dogs, short-axis papillary muscle echocardiographic images were obtained during control preinjection conditions and during injection of three contrast agents into the left main coronary artery with and without circumflex artery occlusion. Regional echocardiographic amplitude variation was measured by computer-based videodensitometric analysis of mean gray levels in four myocardial regions after cavity (background) gray level subtraction. To determine the effect of regional gray level variability on quantitation of the coronary perfusion bed, the contrast-enhanced left anterior descending artery perfusion bed was measured by two methods. The circumferential method ignored myocardial contrast inhomogeneity by measuring the circumferential extent of contrast enhancement, whether or not the enhancement by contrast medium extended transmurally. The exact method measured only the area of myocardium actually enhanced by contrast medium, which often did not extend transmurally. The perfusion beds determined by the two echocardiographic methods were compared with the anatomic perfusion bed determined by postmortem barium-gelatin coronary arteriography. Regional gray levels varied qualitatively and quantitatively in the control state (before contrast injection), with lateral regions being less bright than axial regions. After injection of contrast medium, brightness increased in all regions, the axial regions brightening most.(ABSTRACT TRUNCATED AT 250 WORDS)

Hydrogen peroxide contrast echocardiography: quantification in vivo of myocardial risk area during coronary occlusion and of the necrotic area remaining after myocardial reperfusion

During sustained coronary occlusion in canine preparations, the extent of regions that fail to show contrast enhancement when imaged by supra-aortic hydrogen peroxide contrast echocardiography (SHPCE) has been shown to correlate well for single cross sections with the extent of malperfused myocardium "at risk" of infarction. In the present study, SHPCE was investigated as a means of determining the fraction of total left ventricular mass at risk during occlusion. Since necrotic tissue has low blood flow even when reperfused, we also investigated the potential of quantitating the extent of infarcted myocardium by measuring the extent of contrast defects seen with SHPCE performed during reperfusion. In 20 dogs the fraction of the left ventricle showing a contrast defect during coronary occlusion correlated well with the fraction of the left ventricular mass "at risk" by an autoradiographic technique (autoradiography = 0.83 echocardiography + 8.6%; r = .89, SEE = 4.5%). SHPCE was also performed after 3 hr of reperfusion following occlusions varying in duration from 60 to 150 min. The fraction of the ventricle showing a contrast defect during reperfusion predicted the infarcted portion of the left ventricle as shown by triphenyl tetrazolium chloride staining (% left ventricle infarcted = 0.81 echocardiography + 3.3%; r = .84, SEE = 5.3%). Observer variability for the fraction of the ventricle showing a contrast defect was excellent during both occlusion and reperfusion. The ratio of the left ventricular extent of contrast-negative regions during reperfusion and occlusion was used to calculate a necrosis-to-risk index in vivo that correlated relatively well with the myocardial necrosis-to-risk ratio determined morphologically (r = .77, SEE = 16%).(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of location and size of myocardial infarction with contrast-enhanced echocardiography. II. Application of digital imaging techniques

Contrast echocardiography can be used to identify nonperfused regions of myocardium and localize and quantify infarcted myocardium. Analysis is usually undertaken by visual inspection of an analog two-dimensional echocardiographic image. The purpose of our study was to apply digital imaging techniques to contrast-enhanced echocardiograms for the determination of myocardial infarct size. Myocardial contrast was produced by an injection into the aortic root of a mixture of hydrogen peroxide and blood. Sixteen open chest dogs were studied 4 hours after coronary artery occlusion. Echocardiograms were evaluated by two independent observers. The results were compared with infarct location and size determined with nitro-blue tetrazolium staining of the corresponding slice of the left ventricle. Both the routine analog echocardiographic image and the digital subtraction image were analyzed. For the latter, three precontrast and three postcontrast echocardiographic enddiastolic fields were digitized in a 256 X 256 X 6 bit matrix and then averaged. Average pre- and postcontrast images were mathematically subtracted to form the digital subtraction image. There was excellent correlation between the percent of infarct determined with digital subtraction contrast echocardiography and results of nitro-blue tetrazolium staining (r = 0.97, SEE = 0.04, p less than 0.001). Using linear regression, the relation between infarct size by the two studies was best described by the equation DSI = 0.92 NBT + 0.03, where DSI = digital subtraction image and NBT = infarct size by nitro-blue tetrazolium. Inter- and intraobserver variability were also excellent (r = 0.93 and 0.96, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)