Frequency and thermal effects on the enhancement of transdermal transport by sonophoresis

Mechanisms underlying the influence of skin properties on a single cavitation bubble in low-frequency sonophoresis

As a safe and effective method for systemic transdermal drug delivery (TDD), sonophoresis has drawn much attention from researchers. Despite numerous studies confirming cavitation as the main reason for sonophoresis, the effect skin has on cavitation bubble dynamics remains elusive due to the difficulty of experimental challenges. For a start, we reveal how single cavitation bubble (SCB) dynamics are affected by skin properties, including elasticity, hydrophilicity and texture. We use polydimethylsiloxane (PDMS) to simulate human skin and record the temporary evolution of SCBs with synchronous ultrafast photography. The influences of skin properties on SCBs are concluded: 1) SCBs collapse later near walls with better elasticities and generate microjets with higher speed; 2) SCBs collapse later near hydrophilic walls with slower microjets; and 3) the existence of a texture structure on walls also delays the time of bubble collapse near them and slows the velocities of microjets (v) during collapses.

Development of a Microfluidic Formatted Ultrasound-Controlled Monodisperse Lipid Vesicles' Hydrogel Dressing Combined with Ultrasound for Transdermal Drug Delivery System

Transdermal drug delivery system (TDDS) has attracted much attention in the pharmaceutical technology area. However, the current methods are difficult to ensure penetration efficiency, controllability, and safety in the dermis, so its widespread clinical use has been limited. This work proposes an ultrasound-controlled monodisperse lipid vesicles (U-CMLVs) hydrogel dressing, which combines with ultrasound to form TDDS. Using microfluidic technology, prepare size controllable U-CMLVs with high drug encapsulation efficiency and quantitative encapsulation of ultrasonic response materials, and even uniform mix them with hydrogel to prepare the required thickness of dressings. The high encapsulation efficiency can ensure sufficient dosage of the drugs and further realize the control of ultrasonic response through quantitative encapsulation of ultrasound-responsive materials. Using high frequency (5 MHz, 0.4 W cm-2 ) and low frequency (60 kHz, 1 W cm-2 ) ultrasound to control the movement and rupture of U-CMLVs, the contents not only penetrate the stratum corneum into the epidermis but also break through the bottleneck of penetration efficiency, and deep into the dermis. These findings provide the groundwork for deep, controllable, efficient, and safe drug delivery through TDDS and lay a foundation for further expanding its application.

A Conformable Ultrasound Patch for Cavitation-Enhanced Transdermal Cosmeceutical Delivery

Increased consumer interest in healthy-looking skin demands a safe and effective method to increase transdermal absorption of innovative therapeutic cosmeceuticals. However, permeation of small-molecule drugs is limited by the innate barrier function of the stratum corneum. Here, a conformable ultrasound patch (cUSP) that enhances transdermal transport of niacinamide by inducing intermediate-frequency sonophoresis in the fluid coupling medium between the patch and the skin is reported. The cUSP consists of piezoelectric transducers embedded in a soft elastomer to create localized cavitation pockets (0.8 cm² , 1 mm deep) over larger areas of conformal contact (20 cm² ). Multiphysics simulation models, acoustic spectrum analysis, and high-speed videography are used to characterize transducer deflection, acoustic pressure fields, and resulting cavitation bubble dynamics in the coupling medium. The final system demonstrates a 26.2-fold enhancement in niacinamide transport in a porcine model in vitro with a 10 min ultrasound application, demonstrating the suitability of the device for short-exposure, large-area application of sonophoresis for patients and consumers suffering from skin conditions and premature skin aging.

Research progress of physical transdermal enhancement techniques in tumor therapy

The advancement and popularity of transdermal drug delivery (TDD) based on the physical transdermal enhancement technique (PTET) has opened a new paradigm for local tumor treatment. The drug can be directly delivered to the tumor site through the skin, thus avoiding the toxic side effects caused by the first-pass effect and achieving high patient compliance. Further development of PTETs has provided many options for antitumor drugs and laid the foundation for future applications of wearable closed-loop targeting drug delivery systems. In this highlight, the different types of PTETs and related mechanisms, and applications of PTET-related tumor detection and therapy are highlighted. According to their type and characteristics, PTETs are categorized as follows: (1) iontophoresis, (2) electroporation, (3) ultrasound, (4) thermal ablation, and (5) microneedles. PTET-related applications in the local treatment of tumors are categorized as follows: (1) melanoma, (2) breast tumor, (3) squamous cell carcinoma, (4) cervical tumor, and (5) others. The challenges and future prospects of existing PTETs are also discussed. This highlight will provide guidance for the design of PTET-based wearable closed-loop targeting drug delivery systems and personalized therapy for tumors.

Quantitative Analysis of Acoustic Pressure for Sonophoresis and Its Effect on Transdermal Penetration

Ultrasound facilitates the penetration of macromolecular compounds through the skin and offers a promising non-invasive technique for transdermal delivery. However, technical difficulties in quantifying ultrasound-related parameters have restricted further analysis of the sonophoresis mechanism. In this study, we devise a bolt-clamped Langevin transducer-based sonophoresis device that enables us to measure with a thin lead zirconate titanate (PZT) sensor. One-dimensional acoustic theory accounting for wave interaction at the skin interface indicates that the acoustic pressure and cavitation onset on the skin during sonophoresis are sensitive to the subcutaneous support, meaning that there is a strong need to perform the pressure measurement in an experimental environment replacing the human body. From a series of the experiments with our new device, the transdermal penetration of polystyrene, silica and gold nanoparticles is found to depend on the size and material of the particles, as well as the hardness of the subcutaneous support material. We speculate from the acoustic pressure measurement that the particles' penetration results from the mechanical action of cavitation.

Transdermal delivery of heparin using low-frequency sonophoresis in combination with sponge spicules for venous thrombosis treatment

This study reports that the use of low-frequency sonophoresis (LFS) in combination with sponge Haliclona sp. spicules (SHS), referred to as cSoSp (combined Sonophoresis and Spicules), can enhance the transdermal drug delivery in a synergistic manner. The topical application of cSoSp in vitro significantly enhanced the skin absorption of Fluorescent-Dextrans (4000 Da, FD-4K), a model drug of low-molecular-weight heparin (LMWH). The utilization of cSoSp dramatically increased the transdermal flux of FD-4K (188.6 ± 93.7 ng cm^-2 h^-1) compared to LFS (5.8 ± 3.1 ng cm^-2 h^-1) and SHS (3.2 ± 1.2 ng cm^-2 h^-1) among others. The mechanism of action of cSoSp could be attributed to the synergism between plenty of long-lasting nano-channels created by SHS and the disorders of SC lipids made by shock waves of LFS, which improves the homogeneity of the cavitation effects. Furthermore, LMWH (3000 Da) was transdermally delivered by using cSoSp to treat both superficial venous thrombosis (SVT) and deep venous thrombosis (DVT) in the marginal ear vein of rabbits with a good therapeutic effect. Furthermore, skin irritation and toxicity studies using guinea pigs indicated that cSoSp was nonirritating without any morphological changes in the keratinocytes. cSoSp offers a promising strategy to enhance the transdermal delivery of hydrophilic macromolecules such as heparin.

Wearable patch delivery system for artificial pancreas health diagnostic-therapeutic application: A review

The advanced stimuli-responsive approaches for on-demand drug delivery systems have received tremendous attention as they have great potential to be integrated with sensing and multi-functional electronics on a flexible and stretchable single platform (all-in-one concept) in order to develop skin-integration with close-loop sensation for personalized diagnostic and therapeutic application. The wearable patch pumps have evolved from reservoir-based to matrix patch and drug-in-adhesive (single-layer or multi-layer) type. In this review, we presented the basic requirements of an artificial pancreas, surveyed the design and technologies used in commercial patch pumps available on the market and provided general information about the latest wearable patch pump. We summarized the various advanced delivery strategies with their mechanisms that have been developed to date and representative examples. Mechanical, electrical, light, thermal, acoustic and glucose-responsive approaches on patch form have been successfully utilized in the controllable transdermal drug delivery manner. We highlighted key challenges associated with wearable transdermal delivery systems, their research direction and future development trends.

Piezoelectric Single Crystal Ultrasonic Transducer for Endoscopic Drug Release in Gastric Mucosa

Modern advanced minimally invasive surgery has been implemented for most of the significant gastrointestinal diseases. However, patients with coagulopathy or unresectable tumors cannot be cured by current treatment methods. Moreover, other existing medical devices for targeted drug release are too large to be applied in gastric endoscope because the diameter of the biopsy channel is smaller than 3 mm. To address it, in this work, we developed a piezoelectric single crystal ultrasonic transducer (the diameter was only 2.2 mm and the mass was 0.076 g) to produce acoustic waves, which could promote the drug release in the designed position of the digestive tract through an endoscope. It exhibited the electromechanical coupling coefficient of 0.36 and the center frequency of 6.9 MHz with the -6-dB bandwidth of 23%. In in vitro sonophoresis experiment, the gastric mucosa permeability to Bovine Serum Albumin increased about 5.6 times when the ultrasonic transducer was activated at 40 [Formula: see text] and 60% duty ratio, proving that employment of this transducer could facilitate drug penetration in the gastric mucosa. Meanwhile, the permeability could be adjusted by tuning the duty ratio of the ultrasonic transducer. The corresponding sonophoresis mechanism was related to the acoustic streaming and the thermal effect produced by the transducer. In addition, the measured maximum power density was 128 mW/cm² and the mechanical index of the ultrasonic transducer was 0.02. The results held a great implication for applications of the transducer for targeted drug release in the gastrointestinal tract.

Advances in Ultrasound Mediated Transdermal Drug Delivery

Low frequency ultrasound-assisted drug delivery has been widely investigated as a non-invasive method to enhance the transdermal penetration of drugs. Using this technique, a brief application of ultrasound is used to permeabilize skin for a prolonged time. In this review, an overview on ultrasound is detailed to help explain the parameters that could be modulated to obtain the desired ultrasound parameters for enhanced transdermal drug delivery. The mechanisms of enhancement and the latest developments in the area of ultrasound-assisted transdermal drug delivery are discussed. Special emphasis is placed on the effects of ultrasound when used in combination with microneedles, electroporation and iontophoresis, and penetration enhancers. Further, this review summarizes the effect of ultrasound on skin integrity and the regulatory requirements for commercialization of the ultrasound based transdermal delivery instruments.

Effect of physical stimuli on hair follicle deposition of clobetasol-loaded Lipid Nanocarriers

Clobetasol propionate (CLO) is a potent glucocorticoid used to treat inflammation-based skin, scalp, and hair disorders. In such conditions, hair follicles (HF) are not only the target site but can also act as drug reservoirs when certain formulations are topically applied. Recently, we have demonstrated nanostructured lipid carriers (NLC) containing CLO presenting epidermal-targeting potential. Here, the focus was evaluating the HF uptake provided by such nanoparticles in comparison to a commercial cream and investigating the influence of different physical stimuli [i.e., infrared (IR) irradiation (with and without metallic nanoparticles-MNP), ultrasound (US) (with and without vibration) and mechanical massage] on their follicular targeting potential. Nanosystems presented sizes around 180 nm (PdI < 0.2) and negative zeta potential. The formulation did not alter skin water loss measurements and was stable for at least 30 days at 5 °C. Nanoparticles released the drug in a sustained fashion for more than 3 days and increased passively about 40 times CLO follicular uptake compared to the commercial cream. Confocal images confirmed the enhanced follicular delivery. On the one hand, NLC application followed by IR for heat generation showed no benefit in terms of HF targeting even at higher temperatures generated by metallic nanoparticle heating. On the other hand, upon US treatment, CLO retention was significantly increased in deeper skin layers. The addition of mechanical vibration to the US treatment led to higher follicular accumulation compared to passive exposure to NLC without stimuli. However, from all evaluated stimuli, manual massage presented the highest follicular targeting potential, driving more than double the amount of CLO into the HF than NLC passive application. In conclusion, NLC showed great potential for delivering CLO to HF, and a simple massage was capable of doubling follicular retention.

Analyses of the Temperature Field of a Piezoelectric Micro Actuator in the Endoscopic Biopsy Channel

Micro actuators have been used to realize the arrival of digestive tract lesions for the local targeted application of drugs in endoscopes. However, there still exists a key safety issue that casts a shadow over the practical and safe implementation of actuators in the human body, namely an overheated environment caused by actuators’ operation. Herein, with the aim of solving the temperature rising problem of a piezoelectric micro actuator operating in an endoscopic biopsy channel (OLYMPUS, Tokyo, Japan), a thermal finite element method (FEM) based on COMSOL Multiphysics software is proposed. The temperature distribution and its rising curves are obtained by the FEM method. Both the simulated and experimental maximum temperatures are larger than the safety value (e.g., 42 °C for human tissues) when the driving voltage of the actuator is 200 Vpp, which proves that the overheating problem really exists in the actuator. Furthermore, the results show that the calculated temperature rising curves correspond to the experimental results, proving the effectiveness of this FEM method. Therefore, we introduce a temperature control method through optimizing the duty ratio of the actuator. In comparison with a 100% duty ratio operation condition, it is found that a 60% duty ratio with a driving voltage of 200 Vpp can more effectively prevent the temperature rising issue in the first 3 min, as revealed by the corresponding temperatures of 44.4 and 41.4 °C, respectively. When the duty ratio is adjusted to 30% or less, the temperature rise of the actuator can be significantly reduced to only 36.6 °C, which is close to the initial temperature (36.4 °C). Meanwhile, the speed of the actuator can be well-maintained at a certain level, demonstrating its great applicability for safe operation in the human body.

Controlled Ultrasound Erosion for Transdermal Delivery and Hepatitis B Immunization

Although ultrasound is effective for transdermal delivery, it remains difficult to control the position, shape and size of localized skin transport regions. We developed an ultrasound erosion protocol to generate a single-site, circular delivery region with controlled size at the center of patched skin. We found that (i) shorter ultrasound pulses (25 cycles) with higher pulse repetition frequency (4 kHz) and higher peak negative pressure (17.0 MPa) resulted in larger (0.995 mm²) and deeper (∼300 µm) skin delivery regions with a higher success rate (94.44%); and (ii) temperature elevation of the skin increased with ultrasound exposure time, with a 30-s safety threshold. Furthermore, we found that hair follicles decreased the delivery controllability of ultrasound erosion. Therefore, we selected the skin of the hind legs of mice without dense hair follicles to deliver more than 1 μL of vaccine solution and successfully elicit immune responses against hepatitis B surface antigen.

A Thermoelectric Device for Coupling Fluid Temperature Regulation During Continuous Skin Sonoporation or Sonophoresis

During skin sonoporation and sonophoresis, time-consuming duty cycles or fluid replacement is often required to mitigate coupling fluid temperature increases. This study demonstrates an alternative method for temperature regulation: a circulating, thermoelectric system. Porcine skin samples were sonoporated continuously for 10 min at one of three intensities (23.8, 34.2, 39.4 W/m²). A caffeine solution was then applied to the skin and left to diffuse for 20 h. During sonoporation, the system was able to maintain the temperature between 10 and 16°C regardless of the intensity. No increase in transdermal transport was achieved with an intensity of 23.8 W/m². Intensities of 34.2 and 39.4 W/m² resulted in 3.5-fold (p < 0.05) and 3.7-fold (p < 0.05) increases in mean transport, relative to a control case with no ultrasound. From these results, it is concluded that a significant transport increase can be achieved with a system that circulates and cools the coupling fluid during ultrasound application. Relative to the previous methods of temperature control (duty cycles and fluid replacement), use of this circulation system will lead to significant time savings in future experimental studies.

Application of low-frequency sonophoresis and reduction of antibiotics in the aquatic systems

A major concern in aquaculture is the use of chemical therapeutics, such as antibiotics, because of their impact on the environment as well as on the fish product. As a potential tool for reducing antibiotic use, we tested the application of low-frequency ultrasound as a method for enhancing antibiotic uptake. Rainbow trout juveniles (Oncorhynchus mykiss) were exposed to two different concentrations of oxytetracycline (OTC), flumequine (FLU) and florfenicol (FLO), administered by bath after the application of ultrasound. After exposure, concentrations of these substances were measured in the liver and blood of treated fish. Results showed that the ultrasound treatment can significantly increase the uptake for all three antibiotics. The uptake of OTC for example, in fish exposed to an OTC concentration of 20 mg L^-1 after prior treatment with ultrasound, was similar to the OTC concentrations in their liver and blood to fish exposed to 100 mg L^-1 without sonication. For FLU and FLO, the use of ultrasound caused significant differences of uptake in the liver at high antibiotic concentrations. This suggests that the use of ultrasound as a technique to deliver antibiotics to fish can ultimately reduce the amount of antibiotics discharged into the aquatic environment.

Hydrogel increases localized transport regions and skin permeability during low frequency ultrasound treatment

Low frequency ultrasound (LFU) enhances skin permeability via the formation of heterogeneous localized transport regions (LTRs). In this work, hydrogels with different zeta potentials were used as the coupling medium for LFU to investigate their contribution to LTR patterns and to the skin penetration of two model drugs, calcein and doxorubicin (DOX). When hydrogels were used, LTRs covering at least a 3-fold greater skin area were observed compared to those resulting from traditional LFU treatment and sodium lauryl sulfate. More LTRs resulted in an enhancement of calcein skin permeation. The zeta potential of the hydrogels affected the skin penetration of the positively charged DOX; the cationic coupling medium decreased the DOX recovered from the viable epidermis by 2.8-fold, whereas the anionic coupling medium increased the DOX accumulation in the stratum corneum by 4.4-fold. Therefore, LFU/hydrogel treatment increases LTRs areas and can target ionized drugs to specific skin layers depending on the zeta potential of the coupling medium.

Mechanistic study of decreased skin penetration using a combination of sonophoresis with sodium fluorescein-loaded PEGylated liposomes with d-limonene

The effect of low frequency sonophoresis (SN, 20 kHz) on the skin transport of sodium fluorescein (NaFI)-loaded liposomes was investigated. An in vitro skin penetration study in open and blocked hair follicles was performed, and confocal laser scanning microscopy and scanning electron microscopy were used to visualize the penetration pathways. The results showed that SN significantly increased the flux of NaFI solution, whereas it significantly decreased the flux of NaFI-loaded polyethylene glycol-coated (PEGylated) liposomes with D-limonene (PL-LI). SN did not significantly affect the flux of NaFI-loaded conventional liposomes and PEGylated liposomes. In the blocked follicles, the flux of NaFI-loaded PL-LI both with and without SN decreased, indicating that NaFI-loaded PL-LI penetrated the skin via the transfollicular pathway. A confocal laser scanning microscopy image showed that in the skin without SN, the fluorescence intensity of NaFI-loaded PL-LI was observed in the skin and along the length of hair inside the skin, whereas in the skin with applied SN, the fluorescence intensity was detected only on the top of hair outside the skin. From scanning electron microscopy images, SN dislocated the corneocytes and reduced the deposition of PL-LI around hair follicles. These results revealed that SN may partially plug hair follicle orifices and reduce percutaneous absorption through the follicular pathway.

Dendrimer-coupled sonophoresis-mediated transdermal drug-delivery system for diclofenac

The purpose of the present study was to develop a novel transdermal drug-delivery system comprising a polyamidoamine dendrimer coupled with sonophoresis to enhance the permeation of diclofenac (DF) through the skin. The novel transdermal drug-delivery system was developed by using a statistical Plackett–Burman design. Hairless male Wistar rat skin was used for the DF-permeation study. Coupling media concentration, ultrasound-application time, duty cycle, distance from probe to skin, and a third-generation polyamidoamine-dendrimer concentration were selected as independent variables, while in vitro drug release was selected as a dependent variable. Independent variables were found to be statistically significant (P<0.05). DF gel without dendrimer and ultrasound treatment to skin (passive delivery, run 13) showed 56.69 µg/cm² cumulative drug permeated through the skin, while the DF-dendrimer gel without sonophoresis treatment (run 14) showed 257.3 µg/cm² cumulative drug permeated through the skin after 24 hours. However, when the same gel was applied to sonophoresis-treated skin, drastic permeation enhancement was observed. In the case of run 3, the cumulative drug that permeated through the skin was 935.21 µg/cm². It was concluded that dendrimer-coupled sonophoresis-mediated transdermal drug delivery system has the potential to enhance the permeation of DF through the skin.

Quantitative evaluation of sonophoresis efficiency and its dependence on sonication parameters and particle size

Transdermal drug delivery makes a critical contribution to medical practice and some advantages over conventional oral administration and hypodermic injection. Enhancement of percutaneous absorption or penetration of therapeutic agents (ie, drugs and macromolecules) by ultrasound, termed sonophoresis, has been applied and studied for decades. In this study, the penetration percentage through porcine ear skin specimens was determined quantitatively by measuring the fluorescence from nanoparticles of 60, 220, and 840 nm in size in a receptor chamber at different sonication parameters (ie, duty cycle, 20%-100%; acoustic intensity, 0.3-1.0 W/cm(2); duration, 7-30 minutes; and frequency, 1 MHz). In general, the sonophoresis efficiency increased with the acoustic intensity, duty cycle, and sonication duration but decreased with the particle size (mean ± SD, 62.6% ± 5.4% for 60-nm versus 11.9% ± 1.1% for 840-nm polystyrene nanospheres after 30 minutes of sonication at 0.5 W/cm(2) and a 100% duty cycle; P < .05). On scanning electron microscopy the pore size remained the same (≈100 μm), but more flakes were observed with the progress of sonication. In summary, sonophoresis efficiency is dependent on the ultrasound parameters and particle size. Sufficient sonication would lead to satisfactory penetration of even submicrometer objects through the pores.

Investigating the sonophoresis effect on the permeation of diclofenac sodium using 3D skin equivalent

Ultrasound temporally increases skin permeability by altering stratum corneum SC function (sonophoresis). The objective of this study was to evaluate the effect of variable ultrasound conditions on the permeation of diclofenac sodium DS with range of physicochemical properties through EpiDerm™. Permeation studies were carried out in vitro using Franz diffusion cell. HPLC method was used for the determination of the concentration of diclofenac sodium in receiving compartment. Parameters like ultrasound frequency, application time, amplitude, and mode of sonication and distance of ultrasound horn from skin were investigated, and the conditions where the maximum enhancement rate obtained were determined. Application of ultrasound enhanced permeation of diclofenac sodium across EpiDerm™ by fivefolds. The most effective enhancing parameters were power sonication of 20kHz frequency, 20% amplitude at continuous mode for 5min.

Potential of combined ultrasound and microneedles for enhanced transdermal drug permeation: a review

Transdermal drug delivery (TDD) is limited by the outer layer of the skin, i.e., the stratum corneum. Research on TDD has become very active in the recent years and various technologies have been developed to overcome the resistance of the stratum corneum to molecular diffusion. In particular, researchers have started to consider the possibility of combining the TDD technologies in order to have further increase in drug permeability. Both microneedles (MNs) and ultrasound are promising technologies. They achieve enhancement in drug permeation via different mechanisms and therefore give a good potential for combining with each other. This review will focus on discussing the potential of this combinational technique along with other important issues, e.g., the mechanisms of ultrasound and MNs as it is and these mechanisms which are coupled via the two systems (i.e. MNs and ultrasound). We discuss the possible ways to achieve this combination as well as how this combination would increase the permeability. Some of the undeveloped (weaker) research areas of MNs and sonophoresis are also discussed in order to understand the true potential of combining the two technologies when they are developed further in the future. We propose several hypothetical combinations based on the possible mechanisms involved in MNs and ultrasound. Furthermore, we carry out a cluster analysis by which we determine the significance of this combinational method in comparison with some other selected combinational methods for TDD (e.g., MNs and iontophoresis). Using a time series analysis tool (ARIMA model), the current trend and the future development of combined MNs and ultrasound are also analysed. Overall, the review in this paper indicates that combining MNs and ultrasound is a promising TDD method for the future.

Fetal membrane transport enhancement using ultrasound for drug delivery and noninvasive detection

PURPOSE

The purpose of this research was to evaluate the effect of ultrasound on mass transport across fetal membrane for direct fetal drug delivery and sensing of the amniotic fluid in a noninvasive manner.

METHODS

Post-delivery human fetal membranes (chorioamnion) were used for in vitro experiments, in which the effect of ultrasound on transport across fetal membrane of fluorescent model molecule (250 kDa) was evaluated. Ex vivo experiments were carried out on a whole rat amniotic sac. The model molecule or alpha-fetoprotein was injected into the amniotic sac through the placenta. Transport of these molecules across pre- and post-insonation of the amniotic sac was evaluated. The ultrasound enhancement's mechanism was also assessed.

RESULTS

The greatest enhancement in mass transport (43-fold) in vitro was achieved for 5 min of insonation (20 kHz, 4.6 W/cm(2), 5 mm distance). Ex vivo results showed a rapid increase (23-fold) in mass transport of the model molecule and also for alphafetoprotein following 30 s of insonation (20 kHz, 4.6 W/cm(2), 5 mm distance).

CONCLUSIONS

Mass transport across fetal membranes was enhanced post-insonation both in vitro and ex vivo in a reversible and transient manner. We suggest that exterior (to the amniotic sac) ultrasound-induced cavitation is the main mechanism of action.

Ultrasound mediated transdermal drug delivery

Transdermal drug delivery offers an attractive alternative to the conventional drug delivery methods of oral administration and injections. However, the stratum corneum serves as a barrier that limits the penetration of substances to the skin. Application of ultrasound (US) irradiation to the skin increases its permeability (sonophoresis) and enables the delivery of various substances into and through the skin. This review presents the main findings in the field of sonophoresis in transdermal drug delivery as well as transdermal monitoring and the mathematical models associated with this field. Particular attention is paid to the proposed enhancement mechanisms and future trends in the fields of cutaneous vaccination and gene therapy.

Sonophoresis in transdermal drug deliverys

Transdermal drug delivery (TDD) has several significant advantages compared to oral drug delivery, including elimination of pain and sustained drug release. However, the use of TDD is limited by low skin permeability due to the stratum corneum (SC), the outermost layer of the skin. Sonophoresis is a technique that temporarily increases skin permeability such that various medications can be delivered noninvasively. For the past several decades, various studies of sonophoresis in TDD have been performed focusing on parameter optimization, delivery mechanism, transport pathway, or delivery of several drug categories including hydrophilic and high molecular weight compounds. Based on these various studies, several possible mechanisms of sonophoresis have been suggested. For example, cavitation is believed to be the predominant mechanism responsible for drug delivery in sonophoresis. This review presents details of various studies on sonophoresis including the latest trends, delivery of various therapeutic drugs, sonophoresis pathways and mechanisms, and outlook of future studies.

Enhanced topical delivery of tetrandrine by ethosomes for treatment of arthritis

The purpose of this work was to explore the feasibility of ethosomes for improving the antiarthritic efficacy of tetrandrine by topical application. It was found that tetrandrine was a weak base (pK(a) = 7.06) with pH-dependent partition coefficient. The spherical-shaped ethosomes were prepared by pH gradient loading method. Ex vivo permeation and deposition behavior demonstrated that the drug flux across rat skin and deposition of the drug in rat skin for ethosomes was 2.1- and 1.7-fold higher than that of liposomes, respectively. Confocal laser scanning microscopy confirmed that ethosomes could enhance the topical delivery of the drug in terms of depth and quantity compared with liposomes. The ethosomes were shown to generate substantial enhancement of therapeutic efficacy of tetrandrine on Freund's complete adjuvant-induced arthritis with regard to liposomes. These results indicated that ethosomes would be a promising carrier for topical delivery of tetrandrine into and across the skin.

Ultrasound-mediated transdermal drug delivery: mechanisms, scope, and emerging trends

The use of ultrasound for the delivery of drugs to, or through, the skin is commonly known as sonophoresis or phonophoresis. The use of therapeutic and high frequencies of ultrasound (≥0.7MHz) for sonophoresis (HFS) dates back to as early as the 1950s, while low-frequency sonophoresis (LFS, 20-100kHz) has only been investigated significantly during the past two decades. Although HFS and LFS are similar because they both utilize ultrasound to increase the skin penetration of permeants, the mechanisms associated with each physical enhancer are different. Specifically, the location of cavitation and the extent to which each process can increase skin permeability are quite dissimilar. Although the applications of both technologies are different, they each have strengths that could allow them to improve current methods of local, regional, and systemic drug delivery. In this review, we will discuss the mechanisms associated with both HFS and LFS, specifically concentrating on the key mechanistic differences between these two skin treatment methods. Background on the relevant physics associated with ultrasound transmitted through aqueous media will also be discussed, along with implications of these phenomena on sonophoresis. Finally, a thorough review of the literature is included, dating back to the first published reports of sonophoresis, including a discussion of emerging trends in the field.

The importance of microjet vs shock wave formation in sonophoresis

Low-frequency ultrasound application has been shown to greatly enhance transdermal drug delivery. Skin exposed to ultrasound is affected in a heterogeneous manner, thus mass transport through the stratum corneum occurs mainly through highly permeable localized transport regions (LTRs). Shock waves and microjets generated during inertial cavitations are responsible for the transdermal permeability enhancement. In this study, we evaluated the effect of these two phenomena using direct and indirect methods, and demonstrated that the contribution of microjets to skin permeability enhancement is significantly higher than shock waves.

Evaluation of the ultrasound influence in the cutaneous penetration of d-panthenol: test in vitro

BACKGROUND

d-panthenol is a popular additive in cosmetic and pharmaceutical preparations. However, in order for this vitamin to provide skin benefits, it must penetrate the stratum corneum.

OBJECTIVE

To verify the penetrability of d-panthenol in the skin and evaluate the effect of ultrasound on the cutaneous penetration of this vitamin.

METHODS

The diffusion cell technique with pig skin as the membrane, distilled water as the receptor solution, and a hydrophilic d-panthenol gel were used for the research. The experimental groups were gel + d-panthenol (10%) and gel + d-panthenol (10%) + ultrasound. The receptor solution was collected at predetermined times and the amount of d-panthenol was determined by using a spectrophotometer at 406 nm.

RESULTS

Ultrasound resulted in a statistically significant increase (P < 0.05) in the penetration of d-panthenol at 2, 60, and 240 min.

CONCLUSION

d-panthenol penetration through the pig's skin is enhanced through the use of ultrasound.

Penetration pathways induced by low-frequency sonophoresis with physical and chemical enhancers: iron oxide nanoparticles versus lanthanum nitrates

Low-frequency sonophoresis (LFS) has been shown to disrupt the structure of stratum corneum (SC) lipid bilayers and enhance SC permeability. In this study, we examined the penetration pathway of lanthanum nitrate (LaNO(3)) tracer in viable epidermis after combined treatment of LFS and tape stripping (TS), as a physical enhancer, or oleic acid (OA) application, as a chemical enhancer, using transmission electron microscopy (TEM). As a positive control, we visualized the passive diffusion pathway of LaNO(3) and iron oxide (Fe(3)O(4)) nanoparticles after the incision of hairless mouse skin. Next, we applied LFS immediately after TS or OA application and visualized the penetration pathway of LaNO(3). Each treatment showed restricted penetration to the SC-stratum granulosum (SG) interface or upper SG layer. However, the additional application of LFS induced diffuse intracellular distribution of LaNO(3) throughout the viable epidermis. Quantitative analysis also revealed that combined treatment significantly increases LaNO(3) penetration into viable epidermis when compared with each treatment. Our ultrastructural findings show the synergistic effect of LFS and TS or OA application on transdermal drug delivery. We also found that this combined treatment enhances the penetration of LaNO(3) through the viable epidermis through an intracellular pathway.

Sonophoresis: recent advancements and future trends

OBJECTIVES

Use of ultrasound in therapeutics and drug delivery has gained importance in recent years, evident by the increase in patents filed and new commercial devices launched. The present review discusses new advancements in sonophoretic drug delivery in the last two decades, and highlights important challenges still to be met to make this technology of more use in the alleviation of diseases.

KEY FINDINGS

Phonophoretic research often suffers from poor calibration in terms of the amount of ultrasound energy emitted, and therefore current research must focus on safety of exposure to ultrasound and miniaturization of devices in order to make this technology a commercial reality. More research is needed to identify the role of various parameters influencing sonophoresis so that the process can be optimized. Establishment of long-term safety issues, broadening the range of drugs that can be delivered through this system, and reduction in the cost of delivery are issues still to be addressed.

SUMMARY

Sonophoresis (phonophoresis) has been shown to increase skin permeability to various low and high molecular weight drugs, including insulin and heparin. However, its therapeutic value is still being evaluated. Some obstacles in transdermal sonophoresis can be overcome by combination with other physical and chemical enhancement techniques. This review describes recent advancements in equipment and devices for phonophoresis, new formulations tried in sonophoresis, synergistic effects with techniques such as chemical enhancers, iontophoresis and electroporation, as well as the growing use of ultrasound in areas such as cancer therapy, cardiovascular disorders, temporary modification of the blood-brain barrier for delivery of imaging and therapeutic agents, hormone replacement therapy, sports medicine, gene therapy and nanotechnology. This review also lists patents pertaining to the formulations and techniques used in sonophoretic drug delivery.

Thermal effect of sonophoresis for accelerating the analgesic effect of local anesthetics on rat tail nerve

Sonophoresis is an ultrasound transdermal drugs delivery system. The eutectic mixture of local anesthetics (EMLA) has been used clinically for anesthesia but requires at least one hour to take effect and lacks of analgesia's objective assessment. We proposed that sonophoresis could reduce the duration of EMLA analgesia effect onset and be assessed by sensory conduction studies. Thirty Wistar adult rats were randomized into normal, control, ultrasound-, and heat-treatment groups. Normal group was received no EMLA cream or ultrasound and heat treatment. The control group received the EMLA cream on the rat tail at 3.5 cm distal to the rat tail base for local anesthesia of tail nerve. Ultrasound- and heat-treatment groups were received ultrasound with different parameters and heat treatment, respectively, before EMLA cream applied. Sensory conduction studies of tail nerve were made before and after treatment every 5 min at least for 60 min in all rats. There was no significant difference between the EMLA control group and heat treatment group. All rats in ultrasound-treatment group exhibit significant difference with EMLA control group and heat-treatment group in time for decreased 20% SNCV except for the 2 W/cm(2), 25 min, 20% in ultrasound-treatment group having no significant difference with heat-treatment group. There was no significant difference between ultrasound-treatment subgroups. In the decrease of amplitude, only the 2 W/cm(2), 5 min, 100% and the 2 W/cm(2), 10 min, 50% in ultrasound-treatment group had significant difference between EMLA control and heat-treatment groups. We have objectively examined the sonophoresis effect of ultrasound by investigating the effects of EMLA. Applying ultrasound for 5 min reduces the onset time of EMLA analgesia from 60 min to less than 20 min. Ultrasound sonophoresis of analgesic drugs is potentially useful in the treatment of carpal tunnel syndrome, tooth extraction, and other applications of analgesia.

Heterogeneity in skin treated with low-frequency ultrasound

Recent experimental evidence using colored, fluorescent permeants suggests that skin treated with low-frequency sonophoresis (LFS) is perturbed in a heterogeneous manner. Macroscopic and microscopic visualization studies, topical penetration studies, transdermal permeability studies, and skin electrical resistivity measurements have shown that discrete domains, referred to as localized transport regions (LTRs), which are formed during LFS treatment of the skin, possess greatly reduced barrier properties, and therefore exhibit increased permeant skin penetration, compared to the surrounding regions of LFS-treated skin. The transformation of LTR formation from a heterogeneous to a homogeneous phenomenon has the potential benefit of increasing the maximum level of transdermal permeability or of reducing the area of skin required to deliver a desired dose of drug transdermally. Future studies, aimed at elucidating both the mechanisms of LTR formation and the limits of nondamaging formation of LTRs in the skin, are required to incorporate these proposed improvements to enhance the efficacy and practical utility of low-frequency sonophoresis.

Applications of ultrasonic skin permeation in transdermal drug delivery

Transdermal ultrasound-mediated drug delivery has been studied as a method for needle-less, non-invasive drug administration. Potential obstacles include the stratum corneum, which is not sufficiently passively permeable to allow effective transfer of many medications into the bloodstream without active methods. A general review of the transdermal ultrasound drug delivery literature has shown that this technology offers promising potential for non-invasive drug administration. Included in this review are the reported acoustic parameters used for achieving delivery, along with the known intensities and exposure times. Ultrasound mechanisms are discussed as well as spatial field characteristics. Accurate and precise quantification of the acoustic field used in drug delivery experiments is essential to ensure safety versus efficacy and to avoid potentially harmful bioeffects.

Dose comparison of ultrasonic transdermal insulin delivery to subcutaneous insulin injection

Prior studies have demonstrated the effectiveness of noninvasive transdermal insulin delivery using a cymbal transducer array. In this study the physiologic response to ultrasound mediated transdermal insulin delivery is compared to that of subcutaneously administered insulin. Anesthetized rats (350–550 g) were divided into four groups of four animals; one group representing ultrasound mediated insulin delivery and three representing subcutaneously administered insulin (0.15, 0.20, and 0.25 U/kg). The cymbal array was operated for 60 minutes at 20 kHz with 100 mW/cm² spatial-peak temporal-peak intensity and a 20% duty cycle. The blood glucose level was determined at the beginning of the experiment and, following insulin administration, every 15 minutes for 90 minutes for both the ultrasound and injection groups. The change in blood glucose from baseline was compared between groups. When administered by subcutaneous injection at insulin doses of 0.15 and 0.20 U/kg, there was little change in the blood glucose levels over the 90 minute experiment. Following subcutaneous administration of insulin at a dose of 0.25 U/kg, blood glucose decreased by 190 ± 96 mg/dl (mean ± SD) at 90 minutes. The change in blood glucose following ultrasound mediated insulin delivery was −262 ± 40 mg/dl at 90 minutes. As expected, the magnitude of change in blood glucose between the three injection groups was dependant on the dose of insulin administered. The change in blood glucose in the ultrasound group was greater than that observed in the injection groups suggesting that a higher effective dose of insulin was delivered.

Low-frequency sonophoresis: current status and future prospects

Application of ultrasound enhances skin permeability to drugs, a phenomenon referred to as sonophoresis. Significant strides have been made in sonophoresis research in recent years, especially under low-frequency conditions (20 kHz<f<100 kHz). This article reviews the mechanistic principles and current status of sonophoresis under low-frequency conditions. Several therapeutic macromolecules including insulin, low-molecular weight heparin, and vaccines have been delivered using low-frequency sonophoresis in vivo. Clinical trials have been performed with several drugs including lidocaine and cyclosporin. Novel theoretical and experimental approaches have provided insights into the mechanisms of low-frequency sonophoresis. Current understanding of these mechanisms is presented.

Mechanotransduction pathways of low-intensity ultrasound in C-28/I2 human chondrocyte cell line

Low-intensity ultrasound (LIUS) has recently been considered to be an effective method to induce cartilage repair and/or regeneration after injury. Nevertheless, there is no study to provide a cellular mechanism or signal pathways of LIUS stimulation. The current study is designed to investigate the effects of LIUS on the mechanotransduction pathways in C-28/I2, an immortalized human chondrocyte cell line. C-28/I2 cells were treated with LIUS at an intensity of 200 mW/cm2 using Noblelife™ from Duplogen. The role of stretch-activated channels (SAC) and integrins that are most well-known mechanoreceptors on the chondrocyte cell surface was first examined in mediating the LIUS effects on the expression of type II collagen and aggrecan. When analysed by reverse transcriptase polymerase chain reaction (RT-PCR) and immunohistochemistry, gadolinium (a specific inhibitor of SACs) or GRGDSP (a peptide inhibitor of integrins) specifically reduced the LIUS-induced elevation of type II collagen and aggrecan expressions depending on the incubation time. In addition, the LIUS treatment of C-28/I2 cells induced the phosphorylation of c-Jun N-terminal kinase (JNK) and extracellular signal-regulated kinase (ERK) but not p38 kinase among the members of the mitogen-activated protein kinases (MAPKs). The phosphorylation of ERK by LIUS was repressed by a specific inhibitor of the ERK pathway and integrin function. These results suggest that the LIUS signal might be mediated via canonical mechanoreceptors of SACs and integrins and subsequently through JNK and ERK pathways. The present study provides the first evidence for the activation of the mechanotransduction pathways by LIUS in human chondrocytes.