Focused ultrasound ablation of the epididymis with use of thermal measurements in a canine model

Enhancement of antitumor vaccine in ablated hepatocellular carcinoma by high-intensity focused ultrasound

AIM: To investigate whether tumor debris created by high-intensity focused ultrasound (HIFU) could trigger antitumor immunity in a mouse hepatocellular carcinoma model.

METHODS: Twenty C57BL/6J mice bearing H22 hepatocellular carcinoma were used to generate antitumor vaccines. Ten mice underwent HIFU ablation, and the remaining 10 mice received a sham-HIFU procedure with no ultrasound irradiation. Sixty normal mice were randomly divided into HIFU vaccine, tumor vaccine and control groups. These mice were immunized with HIFU-generated vaccine, tumor-generated vaccine, and saline, respectively. In addition, 20 mice bearing H22 tumors were successfully treated with HIFU ablation. The protective immunity of the vaccinated mice was investigated before and after a subsequent H22 tumor challenge. Using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, the cytotoxicity of splenic lymphocytes co-cultured with H22 cells was determined in vitro before the tumor challenge, and tumor volume and survival were measured in vivo after the challenge in each group. The mechanism was also explored by loading the vaccines with bone marrow-derived dendritic cells (DCs).

RESULTS: Compared to the control, HIFU therapy, tumor-generated and HIFU-generated vaccines significantly increased cytolytic activity against H22 cells in the splenocytes of the vaccinated mice (P < 0.001). The tumor volume was significantly smaller in the HIFU vaccine group than in the tumor vaccine group (P < 0.05) and control group (P < 0.01). However, there was no tumor growth after H22 rechallenge in the HIFU therapy group. Forty-eight-day survival rate was 100% in mice in the HIFU therapy group, 30% in both the HIFU vaccine and tumor vaccine groups, and 20% in the control group, indicating that the HIFU-treated mice displayed significantly longer survival than the vaccinated mice in the remaining three groups (P < 0.001). After bone marrow-derived DCs were incubated with HIFU-generated and tumor-generated vaccines, the number of mature DCs expressing MHC-II⁺, CD80⁺ and CD86⁺ molecules was significantly increased, and interleukin-12 and interferon-γ levels were significantly higher in the supernatants when compared with immature DCs incubated with mouse serum (P < 0.001). However, no differences of the number of mature DCs and cytokine levels were observed between the HIFU-generated and tumor-generated vaccines (P > 0.05).

CONCLUSION: Tumor debris remaining after HIFU can improve tumor immunogenicity. This debris releases tumor antigens as an effective vaccine to develop host antitumor immune response after HIFU ablation.

Dendritic cells loaded with ultrasound-ablated tumour induce in vivo specific antitumour immune responses

Previous studies have shown that high-intensity focused ultrasound (HIFU) ablation can induce a local inflammation with marked infiltration of dendritic cells (DCs). The purpose of this study was to investigate whether DCs could capture and present activating signals delivered by necrotic tumour cells that remain in situ after HIFU, thus initiating specific antitumour immunity. Tumour debris was derived from a mouse H22 tumour model after HIFU ablation. Bone marrow-derived DCs were loaded with HIFU-treated tumour, tumour lysate and mouse serum. Syngeneic naïve C57BL/6J mice were immunised with three loaded DCs followed by a subsequent H22 tumour challenge. Tumour size and survival were then recorded in each vaccinated mouse. The results showed that both HIFU-ablated tumour and tumour lysate could significantly increase the number of mature DCs and the secretion of IL-12 and IFN-gamma (p<0.001). The proliferation of splenic lymphocytes co-incubated with the loaded-DCs was significantly higher in both HIFU-ablated tumour and tumour lysate groups (p<0.01). Cytotoxocity and TNF-alpha and IFN-gamma secretion of cytotoxic T lymphocytes against H22 cells were significantly higher in HIFU-ablated tumour group than that in tumour lysate group (p<0.01). After the H22 tumour challenge, a significant decrease of tumour volume was observed in HIFU-ablated tumour group (p<0.01). However, there was no statistical difference of long-term survival rates among three groups (p>0.05). It is concluded that DCs can be activated by HIFU-ablated tumour debris and, thus, initiate host specific antitumour immune response after HIFU therapy.

Increased infiltration of activated tumor-infiltrating lymphocytes after high intensity focused ultrasound ablation of human breast cancer

BACKGROUND

Previous studies have shown that high intensity focused ultrasound (HIFU) ablation can induce a distinct inflammatory reaction with marked infiltration of lymphocytes after direct tumor destruction. In this study, we investigated the status of tumor-infiltrating lymphocytes (TILs) after HIFU ablation of human breast cancer and explored mechanisms that may be involved in HIFU-triggered, antitumor immune response.

METHODS

A total of 48 female patients with biopsy-proven breast cancer were divided randomly into 1 of 2 groups: control group (n = 25), in which only modified radical mastectomy was performed, or HIFU group (n = 23), in which HIFU ablation of the primary breast cancer was performed prior to modified radical mastectomy. Using semiquantitative immunohistochemical analysis, tumor-infiltrating T lymphocytes and subsets, B lymphocytes, and natural killer (NK) cells were assessed in all patients. Expression of Fas ligand (FasL), granzyme, and perforin on TILs was also studied in both groups.

RESULTS

TILs infiltrated along the margins of the ablated region in all HIFU-treated neoplasms, and the numbers of tumor-infiltrating CD3, CD4, CD8, CD4/CD8, B lymphocytes, and NK cells was increased significantly in the HIFU group. The number of FasL(+), granzyme(+), and perforin(+) TILs was significantly greater in the HIFU group than in the control group.

CONCLUSION

HIFU ablation induced marked infiltration of CD3, CD4, CD8, B lymphocytes, and NK cells in the treated breast lesions. The number of FasL(+), granzyme(+), and perforin(+) TILs was significantly increased after HIFU treatment.

Non-surgical methods of contraception and sterilization

The Humane Society of the United States estimates that each year between 8 and 10 million dogs and cats enter shelters and 4-5 million of these animals are euthanized due to lack of homes. Many veterinarians within the United States recommend surgical sterilization for population control in dogs and cats. However, there are non-surgical methods to control reproduction. Pharmacologic methods of contraception and sterilization can be safe, reliable and reversible. Hormonal treatments using progestins, androgens, or gonadotropin releasing hormone (GnRH) analogs act to either directly block reproductive hormone receptor-mediated events, or indirectly block conception via negative feedback mechanisms. Immunocontraception, via vaccination against GnRH, the luteinizing hormone receptor or zona pellucida proteins, is also possible. Intratesticular or intraepididymal injections provide a method for non-surgical sterilization of the male dog and cat. Additional methods have been employed for mechanical disruption of fertility including intravaginal and intrauterine devices and ultrasound testicular ablation. Alternative approaches to surgical sterilization will be reviewed.

Experimental studies of the thermal effects associated with radiation force imaging of soft tissue

Many groups are studying acoustic radiation force-based imaging modalities to determine the mechanical properties of tissue. Acoustic Radiation Force Impulse (ARFI) imaging is one of these modalities that uses standard diagnostic ultrasound scanners to generate localized, impulsive, acoustic radiation force in tissue. This radiation force generates tissue displacements that are tracked using conventional correlation-based ultrasound methods. The dynamic response of tissue to this impulsive radiation force provides information about the mechanical properties of the tissue. The generation of micron-scale displacements using acoustic radiation force in tissue requires the use of high-intensity acoustic beams, and the soft tissue heating associated with these high-intensity beams must be evaluated to ensure safety when performing ARFI imaging in vivo. Experimental studies using thermocouples have validated Finite Element Method (FEM) models that simulate the heating of soft tissue during ARFI imaging. Spatial maps of heating measured with the thermocouples are in good agreement with FEM model predictions, with cooling time constants measured and modeled to be on the order of several seconds. Transducer heating during ARFI imaging has been measured to be less than 1 degrees C for current clinical implementations. These validated FEM models can now be used to simulate soft tissue heating associated with different transducers, beam spacing, focal configurations and thermal material properties. These experiments confirm that ARFI imaging of soft tissue is safe, although thermal response must be monitored when developing ARFI beam sequences for specific tissue types and organsystems.

Subsurface tissue lesions created using an Nd:YAG laser and a sapphire contact cooling probe

BACKGROUND AND OBJECTIVES

This study investigates deep laser coagulation of tissue in combination with contact cooling of the tissue surface for potential use in noninvasive procedures in urology.

STUDY DESIGN/MATERIALS AND METHODS

A laser probe was designed and tested for simultaneous Nd:YAG laser irradiation and sapphire contact cooling of liver and skin tissue samples, ex vivo. Gross and histologic examination was used to quantify thermal lesion dimensions.

RESULTS

Liver lesions measured 5.5 +/- 0.3 mm in diameter, while preserving the tissue surface to a depth of 2.1 +/- 0.2 mm (n = 5). Skin lesions measured 4.3 +/- 0.9 mm in diameter, while preserving the skin surface to a depth of 1.1 +/- 0.2 mm (n = 6). There were no statistical differences in lesion diameter and layer of preserved tissue between contact (sapphire) cooling and prior non-contact (cryogen spray) cooling results for a given tissue type (P > 0.05).

CONCLUSIONS

Noninvasive laser procedures targeting tissue structures for thermal coagulation within a few millimeters of the tissue surface are feasible and may expand the use of combined laser/cooling techniques for applications in urology and general surgery. In vivo animal studies are currently in development to optimize the laser and cooling parameters for potential clinical applications.

Subsurface Tissue Lesions Created Using an Nd:YAG Laser and Cryogen Cooling

BACKGROUND AND PURPOSE

Cooling methods are commonly used in dermatology to protect the skin surface during cosmetic laser procedures. This study investigated deep laser heating of tissue in combination with cryogen cooling of the surface for potential noninvasive targeting of subsurface tissue structures in urology.

MATERIALS AND METHODS

Porcine liver and skin were studied because they represent simple and difficult tissue models, respectively, for subsurface lesion production. Gross and histologic methods were used to measure lesion dimensions.

RESULTS

Liver lesions measured 4.9 +/- 1.2 mm in diameter, while preserving the tissue surface to a depth of 2.1 +/- 0.4 mm (N = 5). Surface temperatures remained below 40 degrees C, while lesion temperatures ranged from 60 to 70 degrees C. Skin lesions measured 4.1 +/- 0.6 mm, while preserving the skin surface to a depth of 1.2 +/- 0.2 mm (N = 4).

CONCLUSION

This technique may prove useful to target subsurface anatomic structures in urology.