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

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.

Optimization of enhancement of therapeutic efficacy of ultrasound: Frequency-dependent effects on iodine formation from KI-starch solutions and ultrasound-induced killing of rat thymocytes

We investigated liberation of iodine from solutions of KI-starch and cell lysis of rat thymocytes in argon-and nitrous oxide-saturated aqueous solutions induced by ultrasound at frequencies of 38 and 500 kHz and 1 and 2 MHz. Iodine was liberated in argon-saturated solutions exposed to ultrasound at 38 kHz, 500 kHz, and 1 MHz but not at 2 MHz. Lysis occurred in argon-saturated solutions at all four frequencies, but only at 38 kHz in nitrous oxide-saturated cell suspensions. No iodine was liberated in the other nitrous oxide-saturated samples. Relative ratio of the chemical effect versus 70-percent cell survival (an example of the physical effect) was, in order of frequency, 500 kHz>1.0 MHz>38 kHz>2.0 MHz. Partial protection was observed for cell lysis and cell viability after sonication with 500 kHz in argon-saturated solution containing cysteamine, a free radical scavenger. These results suggest that the chemical effects of ultrasound are prominent at specific frequencies, and that free radicals induced by ultrasonic cavitation partially affect lysis and the loss of viability of rat thymocytes.

Magnetic resonance thermal imaging combined with SMASH navigators in the presence of motion

This study develops and tests an MR thermometry method combined with SMASH navigators in phantom experiments mimicking human liver motion with the purpose of detecting and correcting motion artifacts in thermal MR images. Experimental data were acquired on a 3T MRI scanner. Motion artifacts of mobile phantoms mimicking human liver motion were detected and corrected using the SMASH navigators and then MR temperature maps were obtained using a proton resonant frequency (PRF) shift method with complex image subtraction. Temperature acquired by MR thermal imaging was compared to that measured via thermocouples. MR thermal imaging combined with the SMASH navigator technique resulted in accurate temperature maps of the mobile phantoms compared to temperatures measured using the thermocouples. The differences between the obtained and measured temperatures varied from 8.2°C to 14.2°C and 2.2°C to 4.9°C without and with motion correction, respectively. Motion correction improved the temperature acquired by MR thermal imaging by >55%. The combination of the MR thermal imaging and SMASH navigator technique will enable monitoring and controlling heat distribution and temperature change in tissues during thermal therapies and will be a very important tool for cancer treatment in mobile organs.

PACS number: 87.57.‐s

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.

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-).

Experimental study on killing tumor cells by activation of hematoporphyrin derivatives by bi-frequency focal ultrasound in vitro

Tumor cells K562 were killed by the hematoporphyrin derivatives (HpD) activated by bi-frequency focal ultrasound in which a choice of irradiating parameter of ultrasound was tested by experiment. The effect of killing tumor cells was investigated by MTT method and compared with the contrast group. The results showed that the bi-frequency ultrasound exhibited an improved effect of killing tumor cells than single frequency ultrasound. It was 2-3 times higher than the single frequency ultrasound for the killing effect of tumor cells. After the irradiation of ultrasound, the cell-killing effect of hatching 16 h is better than that of hatching 4 h in the hatching tank. This might be due to delay of cell apoptosis.

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.

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 on chemically induced mammary tumor: pharmacokinetics, tissue distribution and sonodynamically induced antitumor effect of porfimer sodium

The sonodynamically induced antitumor effect of porfimer sodium (PF) was evaluated on a chemically induced mammary tumor in Sprague-Dawley rats. The timing of 24 h after the administration of PF was chosen for the ultrasonic exposure, based on pharmacokinetic analysis of the PF concentrations in the tumor, plasma, skin and muscle. At a PF dose not less than 2.5 mg/kg and at a free-field ultrasonic intensity not less than 3 W/cm2, the synergistic effect between PF administration and ultrasonic exposure on the tumor growth inhibition was significant. The ultrasonic intensity showed a relatively sharp threshold for the synergistic antitumor effect, which is typical of an ultrasonic effect mediated by acoustic cavitation. These results suggest that PF is a potentially useful as a sonosensitizer for sonodynamic treatment of chemically induced tumors.

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.

Sonodynamic treatment of murine tumor through second-harmonic superimposition

Acoustic cavitation is the primary mechanism of sonochemical reaction and has potential use for tumor treatment in combination with a certain sonodynamically active agent. It has been known that inducing cavitation with progressive waves is more difficult than with standing waves. This may have been limiting the sonodynamic treatment of tumors. We found that ultrasonically induced chemical reactions are greatly accelerated when the second harmonic is superimposed onto the fundamental. Experimental murine tumors were treated with progressive waves in combination with administration of a gallium-porphyrin complex (ATX-70). The tumors treated with second-harmonic superimposition stopped growing for about 2 days and then gradually started growing again. When only 0.5 MHz was used, tumor growth was not significantly different from that in untreated tumors. It was significantly slower than the untreated when only 1.0 MHz was used, but it was significantly further slowed when second-harmonic superimposition was used. The tumor-bearing mice treated with second-harmonic superimposition after ATX-70 administration survived 5 days longer on average than those untreated.

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.

Effects of dissolved gases and an echo contrast agent on apoptosis induced by ultrasound and its mechanism via the mitochondria-caspase pathway

Human histiocytic lymphoma U937 cells were exposed to continuous 1-MHz ultrasound (US) for therapeutic use, (0 approximately 6.5 W/cm(2) (I(SPTA)). Apoptosis and its related end points were examined by flow cytometry. Fraction of cells with low mitochondria membrane potential were observed after sonication and significant superoxide and peroxide formation, increased activity of caspase-3, and DNA fragmentation revealed biochemically, were also found. The fraction of early apoptosis and secondary necrosis increased with the incubation time after sonication. Early apoptosis observed at 6 h after sonication reached its maximum at 2 min of sonication and gradually decreased. On the other hand, secondary necrosis increased with the duration of sonication. When the effects of dissolved gases, Ar, N(2), O(2), air, N(2)O and CO(2), on free radical formation due to inertial cavitation were investigated by electron spin resonance (ESR) spin trapping, formation of hydroxyl radicals and hydrogen atoms was found in solutions saturated with Ar, N(2), O(2) and air, but not with N(2)O and CO(2). Apoptosis induced by US was also dependent on the dissolved gases in the order Ar = N(2) = O(2) = air >> N(2)O = CO(2) approximately 0. These results suggest that US-induced apoptosis, which is mitochondria-caspase dependent, was linked to inertial cavitation. However, quantities of free radicals did not influence the fraction of early apoptosis and secondary necrosis. When the cells were sonicated in the presence of an echo contrast agent, Levovist; synergistic enhancement of secondary necrosis induced by US was observed at concentrations of more than 20 mg/mL. In contrast, an additive increase of early apoptosis was observed in the combined treatments. These results suggest that Levovist; acting as cavitation nuclei, enhances secondary necrosis induced by US due to an increase in the membrane damage.