Enhancement of cell killing of HL-60 cells by ultrasound in the presence of the photosensitizing drug Photofrin II

Towards overcoming obstacles of type II photodynamic therapy: Endogenous production of light, photosensitizer, and oxygen

Conventional photodynamic therapy (PDT) approaches face challenges including limited light penetration, low uptake of photosensitizers by tumors, and lack of oxygen in tumor microenvironments. One promising solution is to internally generate light, photosensitizers, and oxygen. This can be accomplished through endogenous production, such as using bioluminescence as an endogenous light source, synthesizing genetically encodable photosensitizers in situ, and modifying cells genetically to express catalase enzymes. Furthermore, these strategies have been reinforced by the recent rapid advancements in synthetic biology. In this review, we summarize and discuss the approaches to overcome PDT obstacles by means of endogenous production of excitation light, photosensitizers, and oxygen. We envision that as synthetic biology advances, genetically engineered cells could act as precise and targeted "living factories" to produce PDT components, leading to enhanced performance of PDT.

Spotlight on porphyrins: Classifications, mechanisms and medical applications

Photodynamic therapy (PDT) and sonodynamic therapy (SDT) are non-invasive treatment methods with obvious inhibitory effect on tumors and have few side effects, which have been widely concerned and explored by researchers. Sensitizer is the main factor in determining the therapeutic effect of PDT and SDT. Porphyrins, a group of organic compounds widespread in nature, can be activated by light or ultrasound and produce reactive oxygen species. Therefore, porphyrins as sensitizers in PDT have been widely explored and investigated for many years. Herein, we summarize the classical porphyrin compounds and their applications and mechanisms in PDT and SDT. The application of porphyrin in clinical diagnosis and imaging is also discussed. In conclusion, porphyrins have good application prospects in disease treatment as an important part of PDT or SDT, and in clinical diagnosis and imaging.

Antibacterial Sonodynamic Therapy: Current Status and Future Perspectives

Multidrug-resistant bacteria have emerged in both community and hospital settings, partly due to the misuse of antibiotics. The inventory of viable antibiotics is rapidly declining, and efforts toward discovering newer antibiotics are not yielding the desired outcomes. Therefore, alternate antibacterial therapies based on physical mechanisms such as light and ultrasound are being explored. Sonodynamic therapy (SDT) is an emerging therapeutic approach that involves exposing target tissues to a nontoxic sensitizing chemical and low-intensity ultrasound. SDT can enable site-specific cytotoxicity by producing reactive oxygen species (ROS) in response to ultrasound, which can be harnessed for treating bacterial infections. This approach can potentially be used for both superficial and deep-seated microbial infections. The majority of the sonosensitizers reported are nonpolar, exhibiting limited bioavailability and a high clearance rate in the body. Therefore, targeted delivery agents such as nanoparticle composites, liposomes, and microbubbles are being investigated. This article reviews recent developments in antibacterial sonodynamic therapy, emphasizing biophysical and chemical mechanisms, novel delivery agents, ultrasound exposure and image guidance strategies, and the challenges in the pathway to clinical translation.

5-Aminolevulinic Acid Triggered by Ultrasound Halts Tumor Proliferation in a Syngeneic Model of Breast Cancer

Sonodynamic therapy is a bimodal therapeutic approach in which a chemical compound and ultrasound (US) synergistically act to elicit oxidative damage, triggering cancer cell death. Despite encouraging results, mainly for anticancer treatment, sonodynamics is still far from having a clinical application. Therefore, to close the gap between the bench and bedside, more in vivo studies are needed. In this investigation, the combined effect of 5-aminolevulinic acid (Ala), a natural porphyrin precursor, plus exposure to US, was investigated in vivo on a syngeneic breast cancer model. Real-time RT-PCR, Western blotting, and immunohistochemistry assays were performed to evaluate the effect of sonodynamic treatment on the main cancer hallmarks. The sonodynamic-treated group had a significant reduction (p ≤ 0.0001) in tumor size compared to the untreated group, and the Ala- and US-only treated groups, where a strong decrease (p ≤ 0.0001) in Ki67 protein expression was the most relevant feature of sonodynamic-treated cancer tissues. Moreover, oxidative stress was confirmed as the pivotal driver of the anticancer effect through cell cycle arrest, apoptosis, and autophagy; thus, sonodynamics should be explored further for cancer treatment.

Photo- and Sono-Dynamic Therapy: A Review of Mechanisms and Considerations for Pharmacological Agents Used in Therapy Incorporating Light and Sound

As irreplaceable energy sources of minimally invasive treatment, light and sound have, separately, laid solid foundations in their clinic applications. Constrained by the relatively shallow penetration depth of light, photodynamic therapy (PDT) typically involves involves superficial targets such as shallow seated skin conditions, head and neck cancers, eye disorders, early-stage cancer of esophagus, etc. For ultrasound-driven sonodynamic therapy (SDT), however, to various organs is facilitated by the superior... transmission and focusing ability of ultrasound in biological tissues, enabling multiple therapeutic applications including treating glioma, breast cancer, hematologic tumor and opening blood-brain-barrier (BBB). Considering the emergence of theranostics and precision therapy, these two classic energy sources and corresponding sensitizers are worth reevaluating. In this review, three typical therapies using light and sound as a trigger, PDT, SDT, and combined PDT and SDT are introduced. The therapeutic dynamics and current designs of pharmacological sensitizers involved in these therapies are presented. By introducing both the history of the field and the most up-to-date design strategies, this review provides a systemic summary on the development of PDT and SDT and fosters inspiration for researchers working on 'multi-modal' therapies involving light and sound.

Spectroscopic investigation on the sonodynamic damage to protein in the presence of eosine B

In this work, bovine serum albumin (BSA) and eosine B (EB) were selected as a model protein and sonosensitizer, respectively. The sonodynamic damage to protein in the presence of EB and its mechanism were studied by means of absorption and fluorescence spectra. The results indicated that the synergistic effects of ultrasound and EB can efficiently damage the BSA molecules, and the damage of protein could be mainly due to the generation of reactive oxygen species (ROS). The damage degree of protein increased with the increase of ultrasonic time and EB concentration because of the increased quantities of ROS. Hydroxyl free radical (OH) was the major mediators of the ultrasound-inducing proteins damage in the presence of EB. In addition, the quantities of ROS from the diphenylcarbazide (DPCI)-EB solutions and the DPCI-fluorescein (FS) solutions with or without ROS scavengers were contrasted, respectively. The results show that FS mainly produce OH, but the quantities of ROS in the presence of FS were lower than those of EB, which indicates that the nitro and bromine substituent groups on the benzene ring of FS increase the quantity of ROS, but do not change the kinds of ROS.

Sonodynamic and sonocatalytic damage of BSA molecules by Cresol Red, Cresol Red-DA and Cresol Red-DA-Fe under ultrasonic irradiation

The interaction of Cresol Red derivatives (Cresol Red (o-Cresolsulfonphthalein), Cresol Red-DA (3,3'-Bis [N,N-di (carboxymethyl) aminomethyl]-o-cresolsulfonphthalein) and Cresol Red-DA-Fe(III) (3,3'-Bis [N,N-di (carboxymethyl) aminomethyl]-o-cresolsulfonphthalein-Ferrous(III)) with bovine serum albumin (BSA) were studied by the combination of ultraviolet spectroscopy, circular dichroism (CD) spectroscopy, fluorescence spectroscopy and synchronous fluorescence spectroscopy. On that basis, the sonodynamic and sonocatalytic damages of Cresol Red derivatives to BSA under ultrasonic irradiation were also investigated by means of corresponding spectrum technology. Meanwhile, some influenced factors such as ultrasonic irradiation time, Cresol Red derivatives concentration and ionic strength on the damage degree of BSA molecules were also reviewed. In addition, the binding site and damage site of BSA molecules were estimated by synchronous fluorescence spectra. Finally, the results of oxidation-extraction photometry (OEP) using several reactive oxygen species (ROS) scavengers indicated that the damage of BSA molecules is mainly due to the generation of ROS. Perhaps, this paper may offer some important subjects for broadening the application of Cresol Red derivatives in sonodynamic therapy (SDT) and sonocatalytic therapy (SCT) technologies for tumor treatment.

Spectrometry researches on interaction and sonodynamic damage of riboflavin (RF) to bovine serum albumin (BSA)

In this paper, the riboflavin (RF) was used to study the interaction and sonodynamic damage to bovine serum albumin (BSA) by fluorescence and UV-vis spectroscopy. The results showed that the RF could efficiently bind to BSA in aqueous solution. Under ultrasonic irradiation, the RF could obviously damage the BSA. In addition, synchronous fluorescence spectroscopy revealed that the RF showed more accessible to tryptophan (Trp) residues than to tyrosine (Tyr) residues. Also, it damaged Trp residues more seriously than Tyr residues under ultrasonic irradiation. At last, the generation of reactive oxygen species (ROS) in sonodynamic process was estimated by the method of Oxidation-Extraction Spectrometry (OES). And then, several radical scavengers were used to determine the kind of ROS. It was found that at least the singlet oxygen ((1)O(2)) and hydroxyl radicals (*OH) were generated.

Oxidation-extraction spectrometry of reactive oxygen species (ROS) generated by chlorophyllin magnesium (Chl-Mg) under ultrasonic irradiation

In order to examine the mechanism and process of sonodynamic reaction, the chlorophyllin magnesium (Chl-Mg) acting as a sonosensitizer was irradiated by ultrasound, and the generation of reactive oxygen species (ROS) were detected by the method of oxidation-extraction spectrometry (OES). That is, under ultrasonic irradiation in the presence of Chl-Mg, the 1,5-diphenyl carbazide (DPCI) is oxidized by generated ROS into 1,5-diphenyl carbazone (DPCO), which can be extracted by mixed organic solvent and display a obvious visible absorption at 563 nm wavelength. Besides, the generation conditions of ROS were also reviewed. The results demonstrated that the quantities of generated ROS increased with the increase of ultrasonic irradiation time, Chl-Mg concentration and DPCI concentration. Finally, several radical scavengers (l-Histidine (His), 2,6-Di-tert-butyl-methylphenol (BHT) and Vitamin C (VC)) were used to determine the kind of the generated ROS. It was found that at least the hydroxyl radical (OH) and singlet oxygen (1O2) were generated in the presence of Chl-Mg under ultrasonic irradiation. It is wish that this paper might offer some valuable references for the study on the mechanism of SDT and the application of Chl-Mg in tumor treatment.

Detection and comparison of reactive oxygen species (ROS) generated by chlorophyllin metal (Fe, Mg and Cu) complexes under ultrasonic and visible-light irradiation

In this paper, in order to examine the mechanisms of sonodynamic and photodynamic reactions, the chlorophyllin metal (Chl-M (M=Fe, Mg and Cu)) complexes were irradiated by ultrasound (US) and visible-light (VL), respectively, and the generation of reactive oxygen species (ROS) were detected by the method of Oxidation-Extraction Spectrometry (OES). That is, the 1,5-diphenyl carbazide (DPCI) is oxidized by the generated ROS into 1,5-diphenyl carbazone (DPCO), which can display a various visible absorption around 563 nm wavelength. Besides, some influence parameters on the generation of ROS were also reviewed. The results demonstrated an apparent synergistic effect of Chl-M and ultrasonic or visible-light irradiation for the generation of ROS. Moreover, the quantities of generated ROS increase with the increase of (ultrasonic or visible-light) irradiation time and Chl-M (M=Fe, Mg and Cu) concentration. Finally, several quenchers were used to determine the kind of the generated ROS. It is wished that this paper might offer some valuable references for the study on the sonodynamic therapy (SDT) and photodynamic therapy (PDT) mechanisms and the application of Chl-M in tumor treatment.

Sonodynamic therapy using water-dispersed TiO2-polyethylene glycol compound on glioma cells: comparison of cytotoxic mechanism with photodynamic therapy

Sonodynamic therapy is expected to be a novel therapeutic strategy for malignant gliomas. The titanium dioxide (TiO(2)) nanoparticle, a photosensitizer, can be activated by ultrasound. In this study, by using water-dispersed TiO(2) nanoparticles, an in vitro comparison was made between the photodynamic and sonodynamic damages on U251 human glioblastoma cell lines. Water-dispersed TiO(2) nanoparticles were constructed by the adsorption of chemically modified polyethylene glycole (PEG) on the TiO(2) surface (TiO(2)/PEG). To evaluate cytotoxicity, U251 monolayer cells were incubated in culture medium including 100 μg/ml of TiO(2)/PEG for 3h and subsequently irradiated by ultraviolet light (5.0 mW/cm(2)) or 1.0MHz ultrasound (1.0 W/cm(2)). Cell survival was estimated by MTT assay 24h after irradiation. In the presence of TiO(2)/PEG, the photodynamic cytotoxic effect was not observed after 20 min of an ultraviolet light exposure, while the sonodynamic cytotoxicity effect was almost proportional to the time of sonication. In addition, photodynamic cytotoxicity of TiO(2)/PEG was almost completely inhibited by radical scavenger, while suppression of the sonodynamic cytotoxic effect was not significant. Results of various fluorescent stains showed that ultrasound-treated cells lost their viability immediately after irradiation, and cell membranes were especially damaged in comparison with ultraviolet-treated cells. These findings showed a potential application of TiO(2)/PEG to sonodynamic therapy as a new treatment of malignant gliomas and suggested that the mechanism of TiO(2)/PEG mediated sonodynamic cytotoxicity differs from that of photodynamic cytotoxicity.

Spectroscopic studies on interaction and sonodynamic damage of metallochlorophyllin (Chl-M (M=Fe, Zn and Cu)) to protein under ultrasonic irradiation

In this paper, the chlorophyll derivatives, metallochlorophyllin (Chl-M) (M=Fe, Zn and Cu) including chlorophyllin iron (Chl-Fe), chlorophyllin zinc (Chl-Zn) and chlorophyllin copper (Chl-Cu), were adopted as sonosensitizers to combine with ultrasonic irradiation, and the sonodynamic damage of bovine serum albumin (BSA) was investigated. At first, the interaction of Chl-M with BSA was studied by fluorescence spectroscopy. The results show that the quenching mechanism belongs to a static process and among them the affinity of Chl-Fe to BSA is the most obvious. Then, some influence factors on the sonodynamic damage of BSA molecules in the presence of Chl-M under ultrasonic irradiation were also studied. Synchronous fluorescence spectra show that the binding and damage sites of Chl-M to BSA molecule are mainly on the tryptophan (Trp) residues. The generation of ROS in Chl-M sonodynamic process is estimated by the method of Oxidation-Extraction Spectrometry (OEP). This paper may offer some valuable references for the study of the sonodynamic activity of Chl-M and the effect of the central metals. Synchronously, it contributes to the application of Chl-M in SDT for tumor treatment.

Toxicity and Cytopathogenic Properties Toward Human Melanoma Cells of Activated Cancer Therapeutics in Zebra Fish

There is an increasing body of data showing that activated cancer therapy—the synergistic effect of “preloaded” molecules and a tuned energy source to produce cytopathogenic moieties—is a promising new modality for cancer treatment.The key activated therapies are photodynamic therapy (PDT), which involves the synergy between light and photosensitizer molecules, and ultrasound activated therapy (USAT; also referred to as sonodynamic therapy), which involves the synergy between ultrasound and sonosensitizer molecules. PDT is a well-known activated therapy with roots dating back to 1900. However, minimal data exist on USAT. One reason is the lack of suitable sonosensitizers for clinical USAT use. The authors present both LC50 toxicity and cancer cell cytotoxicity studies on 2 dual activation agents. These compounds function as both sonosensitizers and photosensitizers, and are referred to as SonneLux agents, designated SF1 and SF2. The sensitizers are derived from chlorophyll and are metal centered porphyrins known to specifically accumulate in hyperproliferating tissue. LC50 studies on both SF1 and SF2 as determined in zebra fish reveal that both are essentially nontoxic to zebra fish. In the worst case, 5% zebra fish death is noted at the maximum soluble concentration of the sensitizer. In the cytotoxicity studies, melanoma cell line WM-266-4, derived from a metastatic site of a malignant melanoma, was tested against SF1 and SF2. Both sensitizer systems showed marked efficacy in the destruction of the implanted melanoma cells. They show great promise for clinical use in the future.

Spectroscopic study on interaction of bovine serum albumin with sodium magnesium chlorophyllin and its sonodynamic damage under ultrasonic irradiation

Sonodynamic therapy (SDT) is an attractive antitumor treatment for recent years. In this paper, sodium magnesium chlorophyllin (SMC) as a sonosensitizer combining with ultrasonic (US) irradiation to damage bovine serum albumin (BSA) has been investigated by fluorescence and UV-vis spectroscopy. The interaction of BSA with SMC was studied by the quenching of intrinsic fluorescence at varying temperature. The quenching constants (K(SV)), effective binding constants (K(A)), apparent association constants (K(a)) and binding site numbers were determined. The results indicated the quenching mechanism is a static procedure. Thermodynamic parameters show that the interactions involve hydrogen bonds, hydrophobic interactions, electrostatic interactions and complexations. The binding distance is 3.533 nm. The synergistic effect of SMC and ultrasound was estimated including the study of damage conditions. Synchronous fluorescence spectra indicate the damage to Trp residues is more serious. This paper may offer some valuable references for using spectroscopy method to study the application of chlorophyll derivatives in antitumor treatment.

Investigation on damage of BSA molecules under irradiation of low frequency ultrasound in the presence of FeIII-tartrate complexes

The interaction between bovine serum albumin (BSA) and Fe(III)-tartrate complexes ([Fe(III)(tar)(H(2)O)(3)](-) and [Fe(III)(tar)(2)](5-)) as well as the damage of BSA in the presence of Fe(III)-tartrate complexes under ultrasonic irradiation was studied by UV-vis and fluorescence spectra. In addition, the influences of ultrasonic irradiation time, Fe(III)-tartrate complex concentration, ionic strength and solution acidity (pH value) were also examined on the damage of BSA. The results showed that the fluorescence quenching of BSA caused by the Fe(III)-tartrate complexes belonged to the static quenching. The BSA and Fe(III)-tartrate complexes interacted with each other mainly through weak interaction and coordinate actions. The corresponding binding association constants (K) and the binding site numbers (n) were calculated. The results were as follows: K(1)=1.67 x 10(3) L mol(-1) and n(1)=0.9699 for [Fe(III)(tar)(H(2)O)(3)](-), K(2)=1.54 x 10(3) L mol(-1) and n(2)=0.8754 for [Fe(III)(tar)(2)](5-). Otherwise, under ultrasonic irradiation the BSA molecules were obviously damaged by the Fe(III)-tartrate complexes. The damage degree rose up with the increase of ultrasonic irradiation time, Fe(III)-tartrate complex concentration, pH value and ionic strength. And that, [Fe(III)(tar)(H(2)O)(3)](-) exhibited higher sonocatalytic activity in a way than [Fe(III)(tar)(2)](5-).

Investigation on damage of DNA molecules under irradiation of low frequency ultrasound in the presence of hematoporphyrin-gallium (HP-Ga) complex

The interaction of deoxyribonucleic acid (DNA) and hematoporphyrin-gallium (HP-Ga) complex and the damage of DNA under ultrasonic irradiation in the presence of HP-Ga complex were studied by means of UV-vis spectrum, fluorescence spectrum and gelatin electrophoresis. In addition, some influence factors such as ultrasonic irradiation time, HP-Ga complex concentration, ionic strength and solution acidity on the damage of DNA were also considered. Under a certain condition, the damage degree of DNA was enhanced with increasing ultrasonic irradiation time, HP-Ga complex concentration and ionic strength. Whether the pH value was too high or too low, it would be disadvantage to the damage of DNA. Perhaps, these results would be significant for driving sonodynamic treatment (SDT) to the clinic application in the future.

Comparison between sonodynamic effect with protoporphyrin IX and hematoporphyrin on sarcoma 180

PURPOSE

The comparison between sonodynamic antitumor effect with protoporphyrin IX (PPIX) and hematoporphyrin (Hp) at a concentration of 5 mg/kg on Sarcoma 180 (S180) cells was studied in vivo, and the potential cell damage mechanism was also investigated.

METHODS

The sonodynamically induced anti-tumor effect of PPIX was studied in mice bearing S180 solid tumors. In order to determine the optimum timing of ultrasound exposure after administration of PPIX, the PPIX concentrations in plasma, skin, muscle and tumor were determined by the fluorescence intensity of tissue extractions with a fluorescence spectrophotometer based on the standard curve. Anti-tumor effects were estimated by measuring the tumor size and the tumor weight. Additionally, the morphological changes of S180 cells were evaluated by transmission electron microscope (TEM) observation immediately after sonodynamic therapy (SDT) treatment.

RESULTS

A time of 24 h after the intravenous administration of PPIX was chosen as the best time for ultrasound exposure. The antitumor effect induced by PPIX mediated sonodynamic therapy (PPIX-SDT) was in a dose dependent manner when ultrasound intensity was at or above the inertial cavitation threshold (5 W/cm(2)). A significant tumor growth delay was observed both in PPIX mediated sonodynamic therapy and in Hp mediated sonodynamic therapy treatments (Hp-SDT), and the tumor weight inhibition ratios after the synergistic treatments were 42.82 +/- 0.03 and 35.22 +/- 0.03%, respectively, this difference was significant at P < 0.05. While ultrasound alone (5 W/cm(2)) showed a slight tumor growth inhibitory effect compared with the control group, and PPIX or Hp alone showed almost no significant effect. Furthermore, TEM observation indicated cell damage was more serious in PPIX-SDT treatment group than in Hp-SDT treatment group. After sonication, the cell ultra-structure such as cell membrane destruction, mitochondria swelling, chromatin condensation might be important factors that inhibited the tumor growth and even induced cell death.

CONCLUSIONS

The comparative results suggested that PPIX as a sonosensitizer might have more potential cytotoxicity than Hp when irradiated with ultrasound, and the ultra-structural changes may account for cell destruction induced by sonodynamic therapy in our experiment mode.

Comparison between sonodynamic effect and photodynamic effect with photosensitizers on free radical formation and cell killing

Although enhancement of ultrasound-induced cell killing by photodynamic reagents has been shown, the sonochemical mechanism in detail is still not clear. Here, comparison between sonodynamic effect and photodynamic effect with photosensitizers at a concentration of 10 microM on free radical formation and cell killing was made. When electron paramagnetic-resonance spectroscopy (EPR) was used to detect 2,2,6,6-tetramethyl-4-piperidone-N-oxyl (TAN) after photo-irradiation or sonication with 2,2,6,6-tetramethyl-4-piperidone (TMPD), the order of TAN formation in the photo-irradiated samples was as follows: rhodamine 6G (R6) > sulforhodamine B (SR) > hematoporphyrin (Hp) > rhodamine 123 (R123) > rose bengal (RB)>erythrosine B (Er) = 0; although there was time-dependent TAN formation when the samples were sonicated, no significant difference among these agents were observed. All these agents suppressed ultrasound-induced OH radical formation detected by EPR-spin trapping. Sensitizer-derived free radicals were markedly observed in SR, RB and Er, while trace level of radicals derived from R6 and R123 were observed. Enhancement of ultrasound-induced decrease of survival in human lymphoma U937 cells was observed at 1.5 W/cm(2) (less than inertial cavitation threshold) for R6, R123, SR and Er, and at 2.3 W/cm(2) for R6, R123, Er, RB and SR. On the other hand, photo-induced decrease of survival was observed for R6, Hp and RB at the same concentration (10 microM). These comparative results suggest that (1) (1)O(2) is not involved in the enhancement of ultrasound-induced loss of cell survival, (2) OH radicals and sensitizer-derived free radicals do not take part in the enhancement, and (3) the mechanism is mainly due to certain mechanical stress such as augmentation of physical disruption of cellular membrane by sensitizers in the close vicinity of cells and/or cavitation bubbles.

Effects of low-intensity focused ultrasound on the mouse submandibular gland

Ultrasound is expected to make a considerable contribution to drug delivery systems (DDSs). We tested the hypothesis that low-intensity focused ultrasound (LIFU) increases vessel permeability in the mouse submandibular gland without causing parenchymal damage. In a preliminary study, LIFU at 3 W/cm2 with a 50% duty cycle for 2 minutes did not cause histologic damage. We therefore applied LIFU to mouse submandibular gland at these conditions before and after injecting horseradish peroxidase. Single labeling laser scanning confocal microscopy revealed positive horseradish peroxidase staining around the excretory ducts in the mucous-producing part of the gland, but absence of staining in control glands. Immunostaining for fibrinogen was positive in the same region. Fibrinogen is an intravascular protein that does not pass through intact vessels. These findings suggest that LIFU increases vessel permeability and disruption without destruction. It is anticipated that this process will be useful in establishing a DDS that uses LIFU.

Effect of ultrasound on enzymatic activity of selected plasminogen activators

INTRODUCTION

Ultrasound has been shown to accelerate enzymatic fibrinolysis with adjunctive plasminogen activators. Additionally, ultrasound is known for interaction with biological substances on molecular level in sonodynamic therapy and sonochemistry. Therefore, we investigated the possibility of ultrasound affecting the biological activity of plasminogen activators used in thrombolysis treatment.

MATERIALS AND METHODS

Four currently marketed plasminogen activators were evaluated: urokinase, streptokinase, alteplase, and reteplase. The tests were conducted in reconstituted, undiluted plasminogen activator. Each test contained a control and a test sample. The test sample was incubated in a water bath at temperatures of approximately 34 degrees C and exposed to ultrasound for 1h. The control was incubated in the same water bath as the test sample for the same duration but was not exposed to ultrasound. The ultrasound frequency and intensity used for this experiment were 1 MHz and 2.5-3.1W/cm2, respectively. For quantitative measurement of biological activity of the test and control samples of each plasminogen activator either specific chromogenic substrates or the fibrin clot liquefaction time was used.

RESULTS

Student t-test was applied to compare treated vs. control group for each plasminogen activator. The p-value for urokinase, streptokinase, alteplase, and reteplase are 0.43, 0.76, 0.70, and 0.30, respectively.

CONCLUSION

Ultrasound with a frequency of 1 MHz and intensities of 2.5-3.1W/cm2 had no statistically significant impact on biological activity of selected plasminogen activators.

Sonodynamic therapy--a review of the synergistic effects of drugs and ultrasound

Sonodynamic therapy, the ultrasound dependent enhancement of cytotoxic activities of certain compounds (sonosensitizers) in studies with cells in vitro and in tumor bearing animals, is reviewed. The attractive features of this modality for cancer treatment emerges from the ability to focus the ultrasound energy on malignancy sites buried deep in tissues and to locally activate a preloaded sonosensitizer. Possible mechanisms of sonodynamic therapy include generation of sonosensitizer derived radicals which initiate chain peroxidation of membrane lipids via peroxyl and/or alkoxyl radicals, the physical destabilization of the cell membrane by the sonosensitizer thereby rendering the cell more susceptible to shear forces or ultrasound enhanced drug transport across the cell membrane (sonoporation). Evidence against the role of singlet oxygen in sonodynamic therapy is discussed. The mechanism of sonodynamic therapy is probably not governed by a universal mechanism, but may be influenced by multiple factors including the nature of the biological model, the sonosensitizer and the ultrasound parameters. The current review emphasizes the effect of ultrasound induced free radicals in sonodynamic therapy.

Effect of polymer surface activity on cavitation nuclei stability against dissolution

The persistence of acoustic cavitation in a pulsed wave ultrasound regime depends upon the ability of cavitation nuclei, i.e., bubbles, to survive the off time between pulses. Due to the dependence of bubble dissolution on surface tension, surface-active agents may affect the stability of bubbles against dissolution. In this study, measurements of bubble dissolution rates in solutions of the surface-active polymer poly(propyl acrylic acid) (PPAA) were conducted to test this premise. The surface activity of PPAA varies with solution pH and concentration of dissolved polymer molecules. The surface tension of PPAA solutions (55-72 dynes/cm) that associated with the polymer surface activity was measured using the Wilhelmy plate technique. Samples of these polymer solutions then were exposed to 1.1 MHz high intensity focused ultrasound, and the dissolution of bubbles created by inertial cavitation was monitored using an active cavitation detection scheme. Analysis of the pulse echo data demonstrated that bubble dissolution time was inversely proportional to the surface tension of the solution. Finally, comparison of the experimental results with dissolution times computed from the Epstein-Plesset equation suggests that the radii of residual bubbles from inertial cavitation increase as the surface tension decreases.

A review of research into the uses of low level ultrasound in cancer therapy

The use of low power ultrasound in therapeutic medicine is a developing field and this review will concentrate on the applications of this technology in cancer therapy. The effects of low power ultrasound have been evaluated in terms of the biological changes induced in the structure and function of tissue. The main fields of study have been in sonodynamic therapy, improving chemotherapy, gene therapy and apoptosis therapy. The range of ultrasonic power levels that can be effectively employed in therapy appears to be narrow and this may have hindered past research in the applications in cancer treatment.

Sonodynamic effect of erythrosin B on sarcoma 180 cells in vitro

The ultrasonically induced cytotoxic effect of erythrosin B (EB) on isolated sarcoma 180 cells was investigated. The tumor cells were suspended in an air-saturated phosphate buffered saline and exposed to ultrasound at 1.93 MHz in a standing-wave mode for up to 60 s in the presence and absence of EB. The rate of cell damage induction by ultrasound was enhanced by 4-5 times with 160-microM EB, while no cell damage was observed with EB alone. This enhancement was significantly inhibited by histidine. Sonochemical generation of active oxygen species in the presence of EB, measured by ESR spectroscopy, was also inhibited by histidine. These results indicate the involvement of a sonochemical mechanism.

Free radical intermediates in sonodynamic therapy

Current understanding of the mechanism of sonodynamic action (i.e. the ultrasound-dependent enhancement of the cytotoxic action of certain drugs--sonosensitizers) with potential applications for cancer therapy is presented. The experimental evidence suggests that sonosensitization is due to the chemical activation of sonosensitizers inside or in the close vicinity of hot collapsing cavitation bubbles to form sensitizer-derived free radicals either by direct pyrolysis or due to reactions with .H and .OH radicals, formed by pyrolysis of water. These free radicals (mostly carbon-centered) react with oxygen to form peroxyl and alkoxyl radicals. Unlike .OH and .H, which are also formed by pyrolysis inside cavitation bubbles, the reactivity of alkoxyl and peroxyl radicals with organic components dissolved in biological media is lower and hence have higher probability of reaching critical cellular sites. Sonodynamic therapy appears to be a promising modality for cancer treatment since ultrasound can penetrate deep within the tissue and can be focused in a small region of tumor to chemically activate relatively non-toxic molecules (e.g. porphyrins) thus minimizing undesirable side effects.

Combination effect of photodynamic and sonodynamic therapy on experimental skin squamous cell carcinoma in C3H/HeN mice

We studied a combination of photodynamic therapy (PDT) and sonodynamic therapy (SDT) for improving tumoricidal effects in a transplantable mouse squamous cell carcinoma (SCC) model. Two sensitizers were utilized: the pheophorbide-a derivative PH-1126, which is a newly developed photosensitizer, and the gallium porphyrin analogue ATX-70, a commonly used sonosensitizer. Mice were injected with either PH-1126 or ATX-70 i.p. at doses of 5 or 10 mg/kg.bw. At 24 (ATX-70) or 36 hr (PH-1126) (time of optimum drug concentration in the tumor) after injection, SCCs underwent laser light irradiation (88 J/cm2 of 575 nm for ATX-70; 44J/cm2 of 650 nm for PH-1126) (PDT), ultrasound irradiation (0.51 W/cm2 at 1.0 MHz for 10 minutes) (SDT), or a combination of the two treatments. The combination of PDT and SDT using either PH-1126 or ATX-70 as a sensitizer resulted in significantly improved inhibition of tumor growth (92-98%) (additive effect) as compared to either single treatment (27-77%). The combination using PH-1126 resulted in 25% of the treated mice being tumor free at 20 days after treatment. Moreover, the median survival period (from irradiation to death) of PDT + SDT-treated mice (> 120 days) was significantly greater than that in single treatment groups (77-95 days). Histological changes revealed that combination therapy could induce tumor necrosis 2-3 times as deep as in either of the single modalities. The combination of PDT and SDT could be very useful for treatment of non-superficial or nodular tumors.

Enhanced cytotoxic effect of Ara-C by low intensity ultrasound to HL-60 cells

A clonogenic assay was tested in order to determine the effects of low intensity ultrasound on HL-60 cells in the presence of cytosine arabinoside (Ara-C). HL-60 cells were exposed to ultrasound at an intensity of 0.3 W/cm2 (48 kHz). Cells were then cultured for 8 days and the number of colonies was statistically analyzed (ANOVA). Ultrasound exposure alone for 120 s resulted in no significant decrease of colonies compared to non-treated cells (P0 = 0.1426). Significant differences (P0 < 0.005) were obtained between ultrasound treated and untreated cells in the presence of various concentrations of Ara-C (2 x 10(-9), 1 x 10(-8), 2 x 10(-8), 5 x 10(-8), 1 x 10(-7) M). Morphological evaluation of ultrasound irradiated cells with scanning electron microscopy showed minor disruption of cell surface and disappearance of microvilli. These observations suggests that low intensity ultrasound altered the cell membrane thus resulting in change in Ara-C uptake into HL-60 cells.

Sonodynamically induced antitumor effect of 4-formyloximethylidene-3-hydroxy-2-vinyl-deuterio-porphynyl(IX)-6,7-dia spartic acid (ATX-S10)

The sonodynamically induced antitumor effect of 4-formyloximethylidene-3-hydroxy-2-vinyl-deuterio-porphyn yl(IX)-6,7-diaspartic acid (ATX-S10) was investigated. Both in vitro and in vivo antitumor effects were tested in combination with ultrasound at 2 MHz. The rate of ultrasonically induced damage to isolated sarcoma 180 cells in air-saturated suspension was enhanced two-fold with 80 microM ATX-S10. This enhancement was significantly inhibited by histidine, which may suggest that it was mediated by ultrasonically induced oxidation. The coadministraion of 25 mg/kg ATX-S10 followed by ultrasonic exposure at 2 MHz stopped the growth of implanted colon 26 tumors at an intensity at which ultrasound alone showed only a slight antitumor effect.

Sonodynamically-induced cell damage with fluorinated anthracycline derivative, FAD104

The ultrasonically-induced in vitro cell damaging effect of fluorine-containing anthracycline derivative (FAD104) was investigated. Sarcoma 180 cells suspended in air-saturated PBS were exposed to ultrasound for up to 60 s in the presence and absence of FAD104. The rate of inducing cell damage with ultrasound was doubled with 80 microM FAD104, while no cell damage was observed with FAD104 alone. This enhancement was significantly inhibited by histidine, which may suggest a sonochemical mechanism.

Sonodynamically-induced in vitro cell damage enhanced by adriamycin

Sonodynamically-induced cell damage and active oxygen generation enhanced by adriamycin (ADM) were compared in the same in vitro insonation set-up. Significant enhancement of the rates of both ultrasonically-induced cell damage and nitroxide generation was demonstrated with 40-160 microM ADM. Both rates correlated very well resulting in a correlation coefficient of more than 0.99. The enhancement of both rates was suppressed by 10 mM histidine. These results are consistent with the hypothesis that ultrasonically-generated active oxygen plays a major role in the sonodynamically-induced cell damage enhanced by ADM.

Sonodynamically induced antitumor effect of pheophorbide a

The sonodynamically induced antitumor effect of pheophorbide a (Ph-a) was investigated. Both in vitro and in vivo effects on sarcoma 180 were tested in combination with ultrasound at 2 MHz. The rate of ultrasonically induced cell damage in air-saturated suspension was enhanced by twice with 80 microM Ph-a. This enhancement was significantly inhibited by histidine, which may suggest it was mediated by ultrasonically induced oxidation. For mice, 5 mg/kg Ph-a was administered before the insonation, and ultrasound stopped the tumor growth at an intensity with which ultrasound alone showed only a slight antitumor effect.

Effects of sonodynamic and photodynamic treatment on cellular thiol levels

Exposure of murine leukemia L1210 cells to ultrasound in vitro resulted in cell fragmentation; cells which survived this treatment were 100% viable and showed a transient decrease in intracellular thiol pools (expressed as glutathione equivalents). Depletion of thiol pools became progressively greater with increasing exposure of cells to ultrasound; this was not associated with leakage of thiols into the medium. Biochemically elevating glutathione levels or sonication in the presence of the anti-oxidant trolox offered only a minor degree of protection against sonotoxicity. Photodynamic therapy also resulted in depletion of intracellular thiol levels, and loss of cell viability. In the presence of trolox, both effects were reversed, although elevation of intracellular thiol levels did not protect cell from phototoxicity.

Modes of photodynamic vs. sonodynamic cytotoxicity

We compared effects of ultrasound-induced vs. photodynamic cytotoxicity in cell culture. The photodynamic effects mediated by mesoporphyrin caused a delayed toxic reaction, the presence of a "shoulder" on the dose-response curve, indicating the capacity for limited repair of photodamage. In contrast, ultrasound-induced loss of viability resulted from rapid cell destruction and was proportional to the time of sonication. Photodynamic damage to cells before exposure to ultrasound potentiated cell breakage but did not affect the clonogenicity of the surviving cell population. Photodamage after exposure to ultrasound decreased the viability of cells which had survived ultrasonic treatment.

Liver tissue damage by ultrasound in combination with the photosensitizing drug, Photofrin II

We have investigated whether ablation of normal rat liver by ultrasound can be enhanced after administration of a photosensitizing agent (Photofrin II). After laparotomy and administration of Photofrin II (30 mg/kg), ultrasound (210 kHz, 1.3 W/cm2) was directed directly to the surface of the liver for a total duration of 3 min by a plane type unfocused transducer (6 mm x 6 mm). The depth of tissue damage was histologically compared to rats exposed to ultrasound alone. The mean maximum lesion depth on rats applied with ultrasound and Photofrin II was 5.7 +/- 0.9 mm (mean +/- SD) whereas in rats treated with ultrasound alone this was 3.0 +/- 0.4 mm. There was a significant difference between the two groups (P < 0.05). The present study suggests the possible use of a photosensitizing agent as an enhancer for the treatment of liver tumors by ultrasound.