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Huang H, Zheng Y, Chang M, Song J, Xia L, Wu C, Jia W, Ren H, Feng W, Chen Y. Ultrasound-Based Micro-/Nanosystems for Biomedical Applications. Chem Rev 2024. [PMID: 38924776 DOI: 10.1021/acs.chemrev.4c00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Due to the intrinsic non-invasive nature, cost-effectiveness, high safety, and real-time capabilities, besides diagnostic imaging, ultrasound as a typical mechanical wave has been extensively developed as a physical tool for versatile biomedical applications. Especially, the prosperity of nanotechnology and nanomedicine invigorates the landscape of ultrasound-based medicine. The unprecedented surge in research enthusiasm and dedicated efforts have led to a mass of multifunctional micro-/nanosystems being applied in ultrasound biomedicine, facilitating precise diagnosis, effective treatment, and personalized theranostics. The effective deployment of versatile ultrasound-based micro-/nanosystems in biomedical applications is rooted in a profound understanding of the relationship among composition, structure, property, bioactivity, application, and performance. In this comprehensive review, we elaborate on the general principles regarding the design, synthesis, functionalization, and optimization of ultrasound-based micro-/nanosystems for abundant biomedical applications. In particular, recent advancements in ultrasound-based micro-/nanosystems for diagnostic imaging are meticulously summarized. Furthermore, we systematically elucidate state-of-the-art studies concerning recent progress in ultrasound-based micro-/nanosystems for therapeutic applications targeting various pathological abnormalities including cancer, bacterial infection, brain diseases, cardiovascular diseases, and metabolic diseases. Finally, we conclude and provide an outlook on this research field with an in-depth discussion of the challenges faced and future developments for further extensive clinical translation and application.
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Affiliation(s)
- Hui Huang
- School of Environmental and Chemical Engineering, Shanghai University, Shanghai 200444, P. R. China
- Materdicine Lab, School of Life Sciences, Shanghai University, Shanghai 200444, P. R. China
| | - Yi Zheng
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, P. R. China
| | - Meiqi Chang
- Laboratory Center, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P. R. China
| | - Jun Song
- Materdicine Lab, School of Life Sciences, Shanghai University, Shanghai 200444, P. R. China
| | - Lili Xia
- Materdicine Lab, School of Life Sciences, Shanghai University, Shanghai 200444, P. R. China
| | - Chenyao Wu
- Materdicine Lab, School of Life Sciences, Shanghai University, Shanghai 200444, P. R. China
| | - Wencong Jia
- Materdicine Lab, School of Life Sciences, Shanghai University, Shanghai 200444, P. R. China
| | - Hongze Ren
- Materdicine Lab, School of Life Sciences, Shanghai University, Shanghai 200444, P. R. China
| | - Wei Feng
- School of Environmental and Chemical Engineering, Shanghai University, Shanghai 200444, P. R. China
- Materdicine Lab, School of Life Sciences, Shanghai University, Shanghai 200444, P. R. China
| | - Yu Chen
- School of Environmental and Chemical Engineering, Shanghai University, Shanghai 200444, P. R. China
- Materdicine Lab, School of Life Sciences, Shanghai University, Shanghai 200444, P. R. China
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Loskutova K, Torras M, Zhao Y, Svagan AJ, Grishenkov D. Cellulose Nanofiber-Coated Perfluoropentane Droplets: Fabrication and Biocompatibility Study. Int J Nanomedicine 2023; 18:1835-1847. [PMID: 37051314 PMCID: PMC10085006 DOI: 10.2147/ijn.s397626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/10/2023] [Indexed: 04/14/2023] Open
Abstract
Purpose To study the effect of cellulose nanofiber (CNF)-shelled perfluoropentane (PFP) droplets on the cell viability of 4T1 breast cancer cells with or without the addition of non-encapsulated paclitaxel. Methods The CNF-shelled PFP droplets were produced by mixing a CNF suspension and PFP using a homogenizer. The volume size distribution and concentration of CNF-shelled PFP droplets were estimated from images taken with an optical microscope and analyzed using Fiji software and an in-house Matlab script. The thermal stability was qualitatively assessed by comparing the size distribution and concentration of CNF-shelled PFP droplets at room temperature (~22°) and 37°C. The cell viability of 4T1 cells was measured using a 3-[4,5-dimethylthiazol-2yl]-2,5-diphenyltetrazolium bromide (MTT) assay. Additionally, a hemolysis assay was performed to assess blood compatibility of CNF-shelled PFP droplets. Results The droplet diameter and concentration of CNF-shelled PFP droplets decreased after 48 hours at both room temperature and 37°C. In addition, the decrease in concentration was more significant at 37°C, from 3.50 ± 0.64×106 droplets/mL to 1.94 ± 0.10×106 droplets/mL, than at room temperature, from 3.65 ± 0.29×106 droplets/mL to 2.56 ± 0.22×106 droplets/mL. The 4T1 cell viability decreased with increased exposure time and concentration of paclitaxel, but it was not affected by the presence of CNF-shelled PFP droplets. No hemolysis was observed at any concentration of CNF-shelled PFP droplets. Conclusion CNF-shelled PFP droplets have the potential to be applied as drug carriers in ultrasound-mediated therapy.
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Affiliation(s)
- Ksenia Loskutova
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, SE-141 57, Sweden
- Correspondence: Ksenia Loskutova, Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11C, Huddinge, SE-14157, Sweden, Tel +46 707 26 76 77, Email
| | - Mar Torras
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, SE-141 57, Sweden
| | - Ying Zhao
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, SE-141 57, Sweden
| | - Anna J Svagan
- Department of Fibre and Polymer Technology, KTH Royal Institute of Technology, Stockholm, SE-100 44, Sweden
| | - Dmitry Grishenkov
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, SE-141 57, Sweden
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Liu M, Lai W, Chen M, Wang P, Liu J, Fang X, Yang Y, Wang C. Prominent Enhancement of Peptide-mediated Targeting Efficiency for Human Hepatocellular Carcinomas With Composition-engineered Protein Corona on Gold Nanoparticles. Colloids Surf A Physicochem Eng Asp 2023. [DOI: 10.1016/j.colsurfa.2023.131016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Wen Y, Guo D, Zhang J, Liu X, Liu T, Li L, Jiang S, Wu D, Jiang H. Clinical photoacoustic/ultrasound dual-modal imaging: Current status and future trends. Front Physiol 2022; 13:1036621. [PMID: 36388111 PMCID: PMC9651137 DOI: 10.3389/fphys.2022.1036621] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/05/2022] [Indexed: 08/24/2023] Open
Abstract
Photoacoustic tomography (PAT) is an emerging biomedical imaging modality that combines optical and ultrasonic imaging, providing overlapping fields of view. This hybrid approach allows for a natural integration of PAT and ultrasound (US) imaging in a single platform. Due to the similarities in signal acquisition and processing, the combination of PAT and US imaging creates a new hybrid imaging for novel clinical applications. Over the recent years, particular attention is paid to the development of PAT/US dual-modal systems highlighting mutual benefits in clinical cases, with an aim of substantially improving the specificity and sensitivity for diagnosis of diseases. The demonstrated feasibility and accuracy in these efforts open an avenue of translating PAT/US imaging to practical clinical applications. In this review, the current PAT/US dual-modal imaging systems are discussed in detail, and their promising clinical applications are presented and compared systematically. Finally, this review describes the potential impacts of these combined systems in the coming future.
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Affiliation(s)
- Yanting Wen
- Department of Ultrasound Imaging, The Fifth People’s Hospital of Chengdu, Chengdu, China
- School of Computer Science and Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Dan Guo
- Department of Ultrasound Imaging, The Fifth People’s Hospital of Chengdu, Chengdu, China
| | - Jing Zhang
- Department of Ultrasound Imaging, The Fifth People’s Hospital of Chengdu, Chengdu, China
- School of Computer Science and Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Xiaotian Liu
- Department of Ultrasound Imaging, The Fifth People’s Hospital of Chengdu, Chengdu, China
| | - Ting Liu
- Department of Ultrasound Imaging, The Fifth People’s Hospital of Chengdu, Chengdu, China
| | - Lu Li
- Department of Ultrasound Imaging, The Fifth People’s Hospital of Chengdu, Chengdu, China
| | - Shixie Jiang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Dan Wu
- School of Computer Science and Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Huabei Jiang
- Department of Medical Engineering, University of South Florida, Tampa, FL, United States
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Kikuchi Y, Kanagawa T, Ayukai T. Physico-mathematical model for multiple ultrasound-contrast-agent microbubbles encapsulated by a visco-elastic shell: Effect of shell compressibility on ultrasound attenuation. Chem Eng Sci 2022. [DOI: 10.1016/j.ces.2022.117541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Furtado RG, Rassi DDC, Melato LH, Oliveira ACRD, Nunes PM, Baccelli PE, Santos SCDO, Santos VE, Rassi Junior L, Nunes CG. Safety of SF6(SonoVue®) Contrast Agent on Pharmacological Stress Echocardiogram. Arq Bras Cardiol 2021; 117:1170-1178. [PMID: 34644784 PMCID: PMC8757146 DOI: 10.36660/abc.20200475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 01/27/2021] [Indexed: 11/18/2022] Open
Abstract
Fundamento Em 2007, a Food and Drug Administration (FDA) determinou revisões sobre segurança dos agentes de contraste ecocardiográfico (ACE) disponíveis no mercado após relatos de mortes. Ao longo desses anos, diversos estudos comprovaram a segurança dos ACE, porém com poucos estudos relacionados ao SonoVue®. Objetivos Avaliar a segurança do SonoVue® durante o ecocardiograma sob estresse farmacológico (EEF) por meio da análise da incidência de reações alérgicas e da comparação entre os grupos quanto ao surgimento de arritmia, efeitos colaterais menores e eventos adversos. Métodos Estudo observacional, prospectivo, no qual 2.346 pacientes foram submetidos ao EEF e divididos em dois grupos: grupo 1 com ACE (n=1.099) e grupo 2 sem ACE (n=1.247). Os pacientes foram avaliados durante o EEF – 24 horas e 30 dias. Foi definido p significativo quando <0,05. Resultados O grupo 1 apresentou efeitos colaterais mais leves, como cefaleia (5/0,5% vs. 19/1,5%, p=0,012) e hipertensão reativa (3/0,3% vs . 19/1,5%, p=0,002), menos arritmias como extrassístoles ventriculares (180/16,4% vs . 247/19,8%, p=0,032) e taquicardia paroxística supraventricular (2/0,2% vs . 15/1,2%, p=0,003), assim como nenhum evento adverso como infarto agudo do miocárdio (IAM) e óbito. No grupo 2, um paciente apresentou IAM <24h (1/01%) e dois óbitos <30 dias (2/0,1%). Urticária relacionada ao SonoVue® foi observada em 3 (0,3%) pacientes sem reação anafilática. Conclusão SonoVue® demonstrou segurança durante o EEF, não sendo observados morte, IAM ou reação anafilática. Observou-se menor incidência de efeitos colaterais mais leves e arritmias no grupo que utilizou o ACE, assim como baixa incidência de reações alérgicas leves.
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Affiliation(s)
- Rogerio Gomes Furtado
- Centro de Diagnóstico por Imagem (CDI), Goiânia, GO - Brasil.,Universidade Federal de Goiás, Goiânia, GO - Brasil
| | - Daniela do Carmo Rassi
- Centro de Diagnóstico por Imagem (CDI), Goiânia, GO - Brasil.,Universidade Federal de Goiás, Goiânia, GO - Brasil
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Campos C, Turck P, Tavares AMV, Corssac G, Lacerda D, Araujo A, Llesuy S, Klein AB. Effects of Copaiba Oil in Peripheral Markers of Oxidative Stress in a Model of Cor Pulmonale in Rats. Arq Bras Cardiol 2021; 117:1106-1112. [PMID: 34644790 PMCID: PMC8757149 DOI: 10.36660/abc.20200929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/27/2021] [Indexed: 11/27/2022] Open
Abstract
Fundamento Até o presente momento, os efeitos sistêmicos do óleo de copaíba jamais foram documentados no Cor pulmonale induzido por monocrotalina. Objetivos Investigar os efeitos do óleo de copaíba nos marcadores periféricos de stress oxidativo em ratos com Cor pulmonale. Métodos Ratos Wistar machos (170±20g, n=7/grupo) foram divididos em quatro grupos: controle (CO), monocrotalina (MCT), óleo de copaíba (O), e monocrotalina + óleo de copaíba (MCT-O). Foi administrada a MCT (60 mg/kg i.p.) e, depois de uma semana, foi iniciado o tratamento com óleo de copaíba (400 mg/kg/day-gavagem-14 dias). Foi realizado o ecocardiograma e, depois disso, foi coletado sangue do tronco para a realização de avaliações de stress oxidativo. Análise estatística: ANOVA de duas vias com teste Student-Newman-Keuls post hoc. P-valores <0,05 foram considerados significativos. Resultados O óleo de copaíba reduziu a resistência vascular pulmonar e a hipertrofia do ventrículo direito (VD) hipertrofia (Índice de Fulton (mg/mg)): MCT-O= 0,39±0,03; MCT= 0,49±0,01), e função sistólica melhorada (fração de encurtamento do VD, %) no grupo MCT-O (17,8±8,2) em comparação com o grupo de MCT (9,4±3,1; p<0,05). Além disso, no grupo MCT-O, espécies reativas do oxigênio e os níveis de carbonila foram reduzidos, e os parâmetros antioxidantes aumentaram no sangue periférico (p <0,05). Conclusões Os resultados deste estudo sugerem que o óleo de copaíba tem um efeito antioxidante sistêmico interessante, que se reflete na melhoria da função e na morfometria do VD nesse modelo de Cor pulmonale . A atenuação do Cor pulmonale promovida pelo óleo de copaíba coincidiu com uma redução no stress oxidativo sistêmico.
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Affiliation(s)
- Cristina Campos
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Patrick Turck
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | - Giana Corssac
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Denise Lacerda
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Alex Araujo
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Susana Llesuy
- Hospital Italiano de Buenos Aires, Buenos Aires - Argentina
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Optimizing contrast-enhanced echocardiography by employing a sonographer driven protocol. J Echocardiogr 2021; 19:173-178. [PMID: 33797745 PMCID: PMC8352799 DOI: 10.1007/s12574-021-00523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/04/2021] [Accepted: 03/13/2021] [Indexed: 11/11/2022]
Abstract
Background The use of enhancing agents in echocardiography has been shown to facilitate improved study quality. Despite the known benefits, its use remains limited by institutional policies. Methods We aimed to retrospectively evaluate if allowing sonographers to place a peripheral intravenous catheter and administer enhancing agent led to a decrease in time to complete outpatient transthoracic echocardiograms in comparison to using nursing personnel. Three separate protocols were employed. The ‘nurse driven protocol’ utilized nurses to place a peripheral intravenous catheter and inject enhancing agent. In a ‘mixed protocol,’ a nurse placed a peripheral intravenous catheter and the sonographer gave the enhancing agent. The ‘sonographer driven protocol’ involved the sonographer placing the peripheral intravenous catheter and delivering enhancing agent. Results A total of 232 echocardiograms were included for analysis. Patient characteristics across the three protocols were not statistically significant. The ‘mixed protocol’ had an average study time that was significantly less than the ‘nurse driven protocol’ (49.4 min ± 11.4 vs 54.6 min ± 12.9; p = 0.024). The ‘sonographer driven protocol’ also showed a significant reduction in study time (50.3 min ± 12.6) when compared to the ‘nurse driven protocol’ (p = 0.017). The additional task for the sonographer to place the peripheral intravenous catheter did not significantly increase the time to complete the study. Conclusion Allowing sonographers to administer enhancing agent reduced individual echocardiogram study times by approximately 5 min, supporting that a ‘sonographer driven protocol’ is more efficient with potential downstream economic benefits.
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Peng S, Song R, Lin Q, Zhang Y, Yang Y, Luo M, Zhong Z, Xu X, Lu L, Yao S, Zhang F. A Robust Oxygen Microbubble Radiosensitizer for Iodine-125 Brachytherapy. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:2002567. [PMID: 33854878 PMCID: PMC8025033 DOI: 10.1002/advs.202002567] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/15/2020] [Indexed: 05/04/2023]
Abstract
Iodine-125 (125I) brachytherapy, a promising form of radiotherapy, is increasingly applied in the clinical treatment of a wide range of solid tumors. However, the extremely hypoxic microenvironment in solid tumors can cause hypoxia-induced radioresistance to 125I brachytherapy, resulting in therapeutic inefficacy. In this study, the aim is to sensitize hypoxic areas in solid tumors using ultrasound-activated oxygen microbubbles for 125I brachytherapy. A modified emulsion freeze-drying method is developed to prepare microbubbles that can be lyophilized for storage and easily reconstituted in situ before administration. The filling gas of the microbubbles is modified by the addition of sulfur hexafluoride to oxygen such that the obtained O2/SF6 microbubbles (OS MBs) achieve a much longer half-life (>3×) than that of oxygen microbubbles. The OS MBs are tested in nasopharyngeal carcinoma (CNE2) tumor-bearing mice and oxygen delivery by the OS MBs induced by ultrasound irradiation relieve hypoxia instantly. The post-treatment results of brachytherapy combined with the ultrasound-triggered OS MBs show a greatly improved therapeutic efficacy compared with brachytherapy alone, illustrating ultrasound-mediated oxygen delivery with the developed OS MBs as a promising strategy to improve the therapeutic outcome of 125I brachytherapy in hypoxic tumors.
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Affiliation(s)
- Sheng Peng
- Department of UltrasoundSun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060P. R. China
| | - Ruyuan Song
- Bioengineering Graduate ProgramDepartment of Chemical and Biological EngineeringThe Hong Kong University of Science and TechnologyHong Kong999077P. R. China
| | - Qingguang Lin
- Department of UltrasoundSun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060P. R. China
| | - Yanling Zhang
- Department of Imaging and Interventional RadiologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060P. R. China
| | - Yuanzhong Yang
- Department of PathologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060P. R. China
| | - Ma Luo
- Department of Imaging and Interventional RadiologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060P. R. China
| | - Zhihui Zhong
- Department of Imaging and Interventional RadiologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060P. R. China
| | - Xiaonan Xu
- Department of Mechanical and Aerospace EngineeringThe Hong Kong University of Science and TechnologyHong Kong999077P. R. China
| | - Ligong Lu
- Zhuhai Interventional Medical CenterZhuhai Precision Medical CenterZhuhai People's HospitalZhuhai Hospital of Jinan UniversityZhuhai519000P. R. China
| | - Shuhuai Yao
- Bioengineering Graduate ProgramDepartment of Chemical and Biological EngineeringThe Hong Kong University of Science and TechnologyHong Kong999077P. R. China
- Department of Mechanical and Aerospace EngineeringThe Hong Kong University of Science and TechnologyHong Kong999077P. R. China
| | - Fujun Zhang
- Department of Imaging and Interventional RadiologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060P. R. China
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Functional micro/nanobubbles for ultrasound medicine and visualizable guidance. Sci China Chem 2021; 64:899-914. [PMID: 33679901 PMCID: PMC7921288 DOI: 10.1007/s11426-020-9945-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/18/2021] [Indexed: 12/28/2022]
Abstract
Chemically functionalized gas-filled bubbles with a versatile micro/nano-sized scale have witnessed a long history of developments and emerging applications in disease diagnosis and treatments. In combination with ultrasound and image-guidance, micro/nanobubbles have been endowed with the capabilities of biomedical imaging, drug delivery, gene transfection and disease-oriented therapy. As an external stimulus, ultrasound (US)-mediated targeting treatments have been achieving unprecedented efficiency. Nowadays, US is playing a crucial role in visualizing biological/pathological changes in lives as a reliable imaging technique and a powerful therapeutic tool. This review retrospects the history of ultrasound, the chemistry of functionalized agents and summarizes recent advancements of functional micro/nanobubbles as US contrast agents in preclinical and trans-clinical research. Latest ultrasound-based treatment modalities in association with functional micro/nanobubbles have been highlighted as their great potentials for disease precision therapy. It is believed that these state-of-the-art micro/nanobubbles will become a booster for ultrasound medicine and visualizable guidance to serve future human healthcare in a more comprehensive and practical manner.
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Borden MA, Shakya G, Upadhyay A, Song KH. Acoustic Nanodrops for Biomedical Applications. Curr Opin Colloid Interface Sci 2020; 50:101383. [PMID: 33100885 PMCID: PMC7581261 DOI: 10.1016/j.cocis.2020.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Acoustic nanodrops are designed to vaporize into ultrasound-responsive microbubbles, which presents certain challenges nonexistent for conventional nano-emulsions. The requirements of biocompatibility, vaporizability and colloidal stability has focused research on perfluorocarbons (PFCs). Shorter PFCs yield better vaporizability via their lower critical temperature, but they also dissolve more easily owing to their higher vapor pressure and solubility. Thus, acoustic nanodrops have required a tradeoff between vaporizability and colloidal stability in vivo. The recent advent of vaporizable endoskeletal droplets, which are both stable and vaporizable, may have solved this problem. The purpose of this review is to justify this premise by pointing out the beneficial properties of acoustic nanodrops, providing an analysis of vaporization and dissolution mechanisms, and reviewing current biomedical applications.
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Affiliation(s)
- Mark A. Borden
- Biomedical Engineering, Mechanical Engineering, University of Colorado, Boulder, USA
| | - Gazendra Shakya
- Biomedical Engineering, Mechanical Engineering, University of Colorado, Boulder, USA
| | - Awaneesh Upadhyay
- Biomedical Engineering, Mechanical Engineering, University of Colorado, Boulder, USA
| | - Kang-Ho Song
- Biomedical Engineering, Mechanical Engineering, University of Colorado, Boulder, USA
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Versluis M, Stride E, Lajoinie G, Dollet B, Segers T. Ultrasound Contrast Agent Modeling: A Review. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2117-2144. [PMID: 32546411 DOI: 10.1016/j.ultrasmedbio.2020.04.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 05/21/2023]
Abstract
Ultrasound is extensively used in medical imaging, being safe and inexpensive and operating in real time. Its scope of applications has been widely broadened by the use of ultrasound contrast agents (UCAs) in the form of microscopic bubbles coated by a biocompatible shell. Their increased use has motivated a large amount of research to understand and characterize their physical properties as well as their interaction with the ultrasound field and their surrounding environment. Here we review the theoretical models that have been proposed to study and predict the behavior of UCAs. We begin with a brief introduction on the development of UCAs. We then present the basics of free-gas-bubble dynamics upon which UCA modeling is based. We review extensively the linear and non-linear models for shell elasticity and viscosity and present models for non-spherical and asymmetric bubble oscillations, especially in the presence of surrounding walls or tissue. Then, higher-order effects such as microstreaming, shedding and acoustic radiation forces are considered. We conclude this review with promising directions for the modeling and development of novel agents.
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Affiliation(s)
- Michel Versluis
- Physics of Fluids Group, MESA+ Institute for Nanotechnology, Technical Medical (TechMed) Center, University of Twente, Enschede, the Netherlands.
| | - Eleanor Stride
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Guillaume Lajoinie
- Physics of Fluids Group, MESA+ Institute for Nanotechnology, Technical Medical (TechMed) Center, University of Twente, Enschede, the Netherlands
| | - Benjamin Dollet
- Centre National de la Recherche Scientifique (CNRS), Laboratoire Interdisciplinaire de Physique (LIPhy), Université Grenoble Alpes, Grenoble, France
| | - Tim Segers
- Physics of Fluids Group, MESA+ Institute for Nanotechnology, Technical Medical (TechMed) Center, University of Twente, Enschede, the Netherlands
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Abstract
Ultrasound and magneto-responsive nanosized drug delivery systems have been designed as novel carriers for controlled release. Colloidal bubbles (CBs) could be designed to incorporate different materials, such as protein, lipid, polymer, surfactants, and even nanoparticles in their shell, which makes them suitable for a wide range of drug delivery applications. The interior of CBs may be filled with different gases, which is essential for conferring the characteristics of an ultrasounds contrasting agent. Manipulating the core of CBs enhances features such as stability and duration of the echogenic effect. Thus CBs derivatized with nanoparticles combine functional properties of CBs and NPs to yield a versatile theranostics platform technology.
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Chai SC, Tan PJ, Tong KL. A review of the safety and clinical utility of contrast echocardiography. Singapore Med J 2019; 61:181-183. [PMID: 31820006 DOI: 10.11622/smedj.2019169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There are limitations to the sensitivity and specificity of conventional two-dimensional echocardiograms in making an accurate diagnosis in certain patient populations. This led to the development of specific contrast-enhancing agents with the following characteristics: small enough to cross the pulmonary capillary bed, remain stable throughout the length of the procedure, do not dissolve in blood, and rapidly cleared from the body with low toxicity. Unfortunately, the use of contrast echocardiography has not taken off as expected. The low take-up rate among clinicians can largely be attributed to the black box warning by the United States Food and Drug Administration in 2007, after the coincidental occurrence of four patient deaths and about 190 severe cardiopulmonary reactions shortly after contrast agent administration. In this article, we address the clinical safety of contrast agents, share our institution's experience in using it and elaborate on the clinical indications of contrast echocardiography.
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Affiliation(s)
- Siang Chew Chai
- Department of Cardiology, Changi General Hospital, Singapore
| | - Puay Joo Tan
- Department of Cardiology, Changi General Hospital, Singapore
| | - Khim Leng Tong
- Department of Cardiology, Changi General Hospital, Singapore
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15
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Platts DG, Shiino K, Chan J, Burstow DJ, Scalia GM, Fraser JF. Echocardiographic assessment of myocardial function and mechanics during veno-venous extracorporeal membrane oxygenation. Echo Res Pract 2019; 6:25-35. [PMID: 30959479 PMCID: PMC6499935 DOI: 10.1530/erp-18-0071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/03/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Transthoracic echocardiography (TTE) plays a fundamental role in the management of patients supported with extra-corporeal membrane oxygenation (ECMO). In light of fluctuating clinical states, serial monitoring of cardiac function is required. Formal quantification of ventricular parameters and myocardial mechanics offer benefit over qualitative assessment. The aim of this research was to compare unenhanced (UE) versus contrast-enhanced (CE) quantification of myocardial function and mechanics during ECMO in a validated ovine model. METHODS Twenty-four sheep were commenced on peripheral veno-venous ECMO. Acute smoke-induced lung injury was induced in 21 sheep (3 controls). CE-TTE with Definity using Cadence Pulse Sequencing was performed. Two readers performed image analysis with TomTec Arena. End diastolic area (EDA, cm2), end systolic area (ESA, cm2), fractional area change (FAC, %), endocardial global circumferential strain (EGCS, %), myocardial global circumferential strain (MGCS, %), endocardial rotation (ER, degrees) and global radial strain (GRD, %) were evaluated for UE-TTE and CE-TTE. RESULTS Full data sets are available in 22 sheep (92%). Mean CE EDA and ESA were significantly larger than in unenhanced images. Mean FAC was almost identical between the two techniques. There was no significant difference between UE and CE EGCS, MGCS and ER. There was significant difference in GRS between imaging techniques. Unenhanced inter-observer variability was from 0.48-0.70 but significantly improved to 0.71-0.89 for contrast imaging in all echocardiographic parameters. CONCLUSION Semi-automated methods of myocardial function and mechanics using CE-TTE during ECMO was feasible and similar to UE-TTE for all parameters except ventricular areas and global radial strain. Addition of contrast significantly decreased inter-observer variability of all measurements.
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Affiliation(s)
- David G Platts
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Kenji Shiino
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Fujita Health University, Toyoake, Japan
| | - Jonathan Chan
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Darryl J Burstow
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Gregory M Scalia
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
- Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
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16
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Wu G, Xie T, Dimaano MM, Alghrouz MI, Ahmad M. High-definition blood flow imaging in the assessment of left ventricular function: Initial experience and comparison with contrast echocardiography. Echocardiography 2019; 36:546-557. [PMID: 30786059 DOI: 10.1111/echo.14282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/26/2018] [Accepted: 01/17/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The study aimed to assess the accuracy and reproducibility of the high-definition blood flow imaging (HD-Flow) in evaluation of left ventricular (LV) function by comparison with contrast echocardiography (Contrast). BACKGROUND Contrast improves endocardial border visualization and assists in precise assessment of LV function. HD-Flow, a novel ultrasound technique that enhances blood flow discrimination in LV, could possibly be used for improving endocardial border definition without contrast. METHODS Eighty patients with technically limited transthoracic echocardiograms had HD-Flow, and contrast performed sequentially. LV endocardial visualization, image acquisition time, wall motion, volumes, ejection fraction (EF), stroke volume (SV), and stroke volume index (SVI) were compared. Inter- and intra-observer agreements were examined in a randomly selected subgroup. RESULTS Both HD-Flow and contrast significantly improved the percentage of the well-defined endocardial border segments (71% at baseline vs 94.1% by HD-Flow vs 94.9% by contrast, X2 = 401, P < 0.001). The acquisition time for HD-Flow was significantly less when compared to contrast (2.13 ± 1.18 minutes vs 10.96 ± 3.51 minutes, P < 0.001). LV end-diastolic volume (EDV), end-systolic volume (ESV), EF, SV, and SVI measured by the two methods correlated well (EDVr = 0.97, ESVr = 0.96, EFr = 0.90, SVr = 0.77, SVIr = 0.74, all P < 0.001). In comparison, HD-Flow was neither significantly different in detecting LV wall motion abnormality nor in EF, SV, and SVI measurements, but slightly underestimated LV volumes. CONCLUSIONS HD-Flow imaging is feasible and user-friendly in enhancing LV endocardial definition. This technique is useful in both qualitative and quantitative assessment of LV function.
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Affiliation(s)
- Geru Wu
- Division of Cardiology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Tianrong Xie
- Division of Cardiology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Meneleo M Dimaano
- Division of Cardiology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Mohammad I Alghrouz
- Division of Cardiology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Masood Ahmad
- Division of Cardiology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
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17
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Senior R, Becher H, Monaghan M, Agati L, Zamorano J, Vanoverschelde JL, Nihoyannopoulos P, Edvardsen T, Lancellotti P. Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017. Eur Heart J Cardiovasc Imaging 2018; 18:1205-1205af. [PMID: 28950366 DOI: 10.1093/ehjci/jex182] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022] Open
Abstract
Contrast echocardiography is widely used in cardiology. It is applied to improve image quality, reader confidence and reproducibility both for assessing left ventricular (LV) structure and function at rest and for assessing global and regional function in stress echocardiography. The use of contrast in echocardiography has now extended beyond cardiac structure and function assessment to evaluation of perfusion both of the myocardium and of the intracardiac structures. Safety of contrast agents have now been addressed in large patient population and these studies clearly established its excellent safety profile. This document, based on clinical trials, randomized and multicentre studies and published clinical experience, has established clear recommendations for the use of contrast in various clinical conditions with evidence-based protocols.
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Affiliation(s)
- Roxy Senior
- Department of Cardiology, Royal Brompton Hospital, Imperial College, Sydney Street, London SW3 6NP, UK
| | | | | | | | - Jose Zamorano
- CIBERCV, University Hospital Ramón y Cajal, Madrid, Spain
| | | | | | | | - Patrizio Lancellotti
- University of Liege Hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liege, Belgium
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18
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Jin C, Zhang H, Zou J, Liu Y, Zhang L, Li F, Wang R, Xuan W, Ye M, Tan W. Floxuridine Homomeric Oligonucleotides "Hitchhike" with Albumin In Situ for Cancer Chemotherapy. Angew Chem Int Ed Engl 2018; 57:8994-8997. [PMID: 29923269 DOI: 10.1002/anie.201804156] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/08/2018] [Indexed: 12/14/2022]
Abstract
Automated attachment of chemotherapeutic drugs to oligonucleotides through phosphoramidite chemistry and DNA synthesis has emerged as a powerful technology in constructing structure-defined and payload-tunable oligonucleotide-drug conjugates. In practice, however, in vivo delivery of these oligonucleotides remains a challenge. Inspired by the systemic transport of hydrophobic payloads by serum albumin in nature, we report the development of a lipid-conjugated floxuridine homomeric oligonucleotide (LFU20) that "hitchhikes" with endogenous serum albumin for cancer chemotherapy. Upon intravenous injection, LFU20 immediately inserts into the hydrophobic cave of albumin to form an LFU20/albumin complex, which accumulates in the tumor by the enhanced permeability and retention (EPR) effect and internalizes into the lysosomes of cancer cells. After degradation, cytotoxic floxuridine monophosphate is released to inhibit cell proliferation.
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Affiliation(s)
- Cheng Jin
- Molecular Science and Biomedicine Laboratory, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Life Sciences, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan, 410082, China
| | - Hui Zhang
- Molecular Science and Biomedicine Laboratory, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Life Sciences, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan, 410082, China
| | - Jianmei Zou
- Molecular Science and Biomedicine Laboratory, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Life Sciences, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan, 410082, China
| | - Yan Liu
- Molecular Science and Biomedicine Laboratory, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Life Sciences, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan, 410082, China
| | - Lin Zhang
- Molecular Science and Biomedicine Laboratory, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Life Sciences, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan, 410082, China
| | - Fengjie Li
- Molecular Science and Biomedicine Laboratory, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Life Sciences, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan, 410082, China
| | - Ruowen Wang
- Institute of Molecular Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, and College of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Department of Chemistry and Department of Physiology and Functional Genomics, Center for Research at the Bio/Nano Interface, Health Cancer Center, UF Genetics Institute and McKnight Brain Institute, University of Florida, Gainesville, FL, 32611-7200, USA
| | - Wenjing Xuan
- Molecular Science and Biomedicine Laboratory, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Life Sciences, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan, 410082, China
| | - Mao Ye
- Molecular Science and Biomedicine Laboratory, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Life Sciences, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan, 410082, China
| | - Weihong Tan
- Molecular Science and Biomedicine Laboratory, State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Life Sciences, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan, 410082, China.,Institute of Molecular Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, and College of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Department of Chemistry and Department of Physiology and Functional Genomics, Center for Research at the Bio/Nano Interface, Health Cancer Center, UF Genetics Institute and McKnight Brain Institute, University of Florida, Gainesville, FL, 32611-7200, USA
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19
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Jin C, Zhang H, Zou J, Liu Y, Zhang L, Li F, Wang R, Xuan W, Ye M, Tan W. Floxuridine Homomeric Oligonucleotides “Hitchhike” with Albumin In Situ for Cancer Chemotherapy. Angew Chem Int Ed Engl 2018. [DOI: 10.1002/ange.201804156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Cheng Jin
- Molecular Science and Biomedicine Laboratory State Key Laboratory of Chemo/Biosensing and Chemometrics College of Chemistry and Chemical Engineering College of Life Sciences Aptamer Engineering Center of Hunan Province Hunan University Changsha Hunan 410082 China
| | - Hui Zhang
- Molecular Science and Biomedicine Laboratory State Key Laboratory of Chemo/Biosensing and Chemometrics College of Chemistry and Chemical Engineering College of Life Sciences Aptamer Engineering Center of Hunan Province Hunan University Changsha Hunan 410082 China
| | - Jianmei Zou
- Molecular Science and Biomedicine Laboratory State Key Laboratory of Chemo/Biosensing and Chemometrics College of Chemistry and Chemical Engineering College of Life Sciences Aptamer Engineering Center of Hunan Province Hunan University Changsha Hunan 410082 China
| | - Yan Liu
- Molecular Science and Biomedicine Laboratory State Key Laboratory of Chemo/Biosensing and Chemometrics College of Chemistry and Chemical Engineering College of Life Sciences Aptamer Engineering Center of Hunan Province Hunan University Changsha Hunan 410082 China
| | - Lin Zhang
- Molecular Science and Biomedicine Laboratory State Key Laboratory of Chemo/Biosensing and Chemometrics College of Chemistry and Chemical Engineering College of Life Sciences Aptamer Engineering Center of Hunan Province Hunan University Changsha Hunan 410082 China
| | - Fengjie Li
- Molecular Science and Biomedicine Laboratory State Key Laboratory of Chemo/Biosensing and Chemometrics College of Chemistry and Chemical Engineering College of Life Sciences Aptamer Engineering Center of Hunan Province Hunan University Changsha Hunan 410082 China
| | - Ruowen Wang
- Institute of Molecular Medicine, Renji Hospital Shanghai Jiao Tong University School of Medicine, and College of Chemistry and Chemical Engineering Shanghai Jiao Tong University Shanghai China
- Department of Chemistry and Department of Physiology and Functional Genomics Center for Research at the Bio/Nano Interface Health Cancer Center UF Genetics Institute and McKnight Brain Institute University of Florida Gainesville FL 32611-7200 USA
| | - Wenjing Xuan
- Molecular Science and Biomedicine Laboratory State Key Laboratory of Chemo/Biosensing and Chemometrics College of Chemistry and Chemical Engineering College of Life Sciences Aptamer Engineering Center of Hunan Province Hunan University Changsha Hunan 410082 China
| | - Mao Ye
- Molecular Science and Biomedicine Laboratory State Key Laboratory of Chemo/Biosensing and Chemometrics College of Chemistry and Chemical Engineering College of Life Sciences Aptamer Engineering Center of Hunan Province Hunan University Changsha Hunan 410082 China
| | - Weihong Tan
- Molecular Science and Biomedicine Laboratory State Key Laboratory of Chemo/Biosensing and Chemometrics College of Chemistry and Chemical Engineering College of Life Sciences Aptamer Engineering Center of Hunan Province Hunan University Changsha Hunan 410082 China
- Institute of Molecular Medicine, Renji Hospital Shanghai Jiao Tong University School of Medicine, and College of Chemistry and Chemical Engineering Shanghai Jiao Tong University Shanghai China
- Department of Chemistry and Department of Physiology and Functional Genomics Center for Research at the Bio/Nano Interface Health Cancer Center UF Genetics Institute and McKnight Brain Institute University of Florida Gainesville FL 32611-7200 USA
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20
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Abstract
Contrast-enhanced ultrasound imaging is a recently approved technique in the United States that uses a specific contrast agent, namely, microbubbles, consisting mainly of a gas core and a stabilized biological shell. These compounds allow for the visualization of small vascular beds and improve characterization of anatomic structures and lesions. They have a relatively safe profile and are primarily excreted through the lungs.
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Affiliation(s)
- David Hunt
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Javier Romero
- Department of Radiology, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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21
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Wang S, Hossack JA, Klibanov AL. Targeting of microbubbles: contrast agents for ultrasound molecular imaging. J Drug Target 2018; 26:420-434. [PMID: 29258335 DOI: 10.1080/1061186x.2017.1419362] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
For contrast ultrasound imaging, the most efficient contrast agents comprise highly compressible gas-filled microbubbles. These micrometer-sized particles are typically filled with low-solubility perfluorocarbon gases, and coated with a thin shell, often a lipid monolayer. These particles circulate in the bloodstream for several minutes; they demonstrate good safety and are already in widespread clinical use as blood pool agents with very low dosage necessary (sub-mg per injection). As ultrasound is an ubiquitous medical imaging modality, with tens of millions of exams conducted annually, its use for molecular/targeted imaging of biomarkers of disease may enable wider implementation of personalised medicine applications, precision medicine, non-invasive quantification of biomarkers, targeted guidance of biopsy and therapy in real time. To achieve this capability, microbubbles are decorated with targeting ligands, possessing specific affinity towards vascular biomarkers of disease, such as tumour neovasculature or areas of inflammation, ischaemia-reperfusion injury or ischaemic memory. Once bound to the target, microbubbles can be selectively visualised to delineate disease location by ultrasound imaging. This review discusses the general design trends and approaches for such molecular ultrasound imaging agents, which are currently at the advanced stages of development, and are evolving towards widespread clinical trials.
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Affiliation(s)
- Shiying Wang
- a Department of Biomedical Engineering , University of Virginia , Charlottesville , VA , USA
| | - John A Hossack
- a Department of Biomedical Engineering , University of Virginia , Charlottesville , VA , USA
| | - Alexander L Klibanov
- a Department of Biomedical Engineering , University of Virginia , Charlottesville , VA , USA.,b Cardiovascular Division (Department of Medicine), Robert M Berne Cardiovascular Research Center , University of Virginia , Charlottesville , VA , USA
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22
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Lipophilic siRNA targets albumin in situ and promotes bioavailability, tumor penetration, and carrier-free gene silencing. Proc Natl Acad Sci U S A 2017; 114:E6490-E6497. [PMID: 28739942 DOI: 10.1073/pnas.1621240114] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Clinical translation of therapies based on small interfering RNA (siRNA) is hampered by siRNA's comprehensively poor pharmacokinetic properties, which necessitate molecule modifications and complex delivery strategies. We sought an alternative approach to commonly used nanoparticle carriers by leveraging the long-lived endogenous serum protein albumin as an siRNA carrier. We synthesized siRNA conjugated to a diacyl lipid moiety (siRNA-L2), which rapidly binds albumin in situ. siRNA-L2, in comparison with unmodified siRNA, exhibited a 5.7-fold increase in circulation half-life, an 8.6-fold increase in bioavailability, and reduced renal accumulation. Benchmarked against leading commercial siRNA nanocarrier in vivo jetPEI, siRNA-L2 achieved 19-fold greater tumor accumulation and 46-fold increase in per-tumor-cell uptake in a mouse orthotopic model of human triple-negative breast cancer. siRNA-L2 penetrated tumor tissue rapidly and homogeneously; 30 min after i.v. injection, siRNA-L2 achieved uptake in 99% of tumor cells, compared with 60% for jetPEI. Remarkably, siRNA-L2 achieved a tumor:liver accumulation ratio >40:1 vs. <3:1 for jetPEI. The improved pharmacokinetic properties of siRNA-L2 facilitated significant tumor gene silencing for 7 d after two i.v. doses. Proof-of-concept was extended to a patient-derived xenograft model, in which jetPEI tumor accumulation was reduced fourfold relative to the same formulation in the orthotopic model. The siRNA-L2 tumor accumulation diminished only twofold, suggesting that the superior tumor distribution of the conjugate over nanoparticles will be accentuated in clinical situations. These data reveal the immense promise of in situ albumin targeting for development of translational, carrier-free RNAi-based cancer therapies.
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23
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Postema AW, Scheltema MJV, Mannaerts CK, Van Sloun RJG, Idzenga T, Mischi M, Engelbrecht MRE, De la Rosette JJMCH, Wijkstra H. The prostate cancer detection rates of CEUS-targeted versus MRI-targeted versus systematic TRUS-guided biopsies in biopsy-naïve men: a prospective, comparative clinical trial using the same patients. BMC Urol 2017; 17:27. [PMID: 28381220 PMCID: PMC5382402 DOI: 10.1186/s12894-017-0213-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current standard for Prostate Cancer (PCa) detection in biopsy-naïve men consists of 10-12 systematic biopsies under ultrasound guidance. This approach leads to underdiagnosis and undergrading of significant PCa while insignificant PCa may be overdiagnosed. The recent developments in MRI and Contrast Enhanced Ultrasound (CEUS) imaging have sparked an increasing interest in PCa imaging with the ultimate goal of replacing these "blind" systematic biopsies with reliable imaging-based targeted biopsies. METHODS/DESIGN In this trial, we evaluate and compare the PCa detection rates of multiparametric (mp)MRI-targeted biopsies, CEUS-targeted biopsies and systematic biopsies under ultrasound guidance in the same patients. After informed consent, 299 biopsy-naïve men will undergo mpMRI scanning and CEUS imaging 1 week prior to the prostate biopsy procedure. During the biopsy procedure, a systematic transrectal 12-core biopsy will be performed by one operator blinded for the imaging results and targeted biopsy procedure. Subsequently a maximum of 4 CEUS-targeted biopsies and/or 4 mpMRI-targeted biopsies of predefined locations determined by an expert CEUS reader using quantification techniques and an expert radiologist, respectively, will be taken by a second operator using an MRI-US fusion device. The primary outcome is the detection rate of PCa (all grades) and clinically significant PCa (defined as Gleason score ≥7) compared between the three biopsy protocols. DISCUSSION This trial compares the detection rate of (clinically significant) PCa, between both traditional systematic biopsies and targeted biopsies based on predefined regions of interest identified by two promising imaging technologies. It follows published recommendations on study design for the evaluation of imaging guided prostate biopsy techniques, minimizing bias and allowing data pooling. It is the first trial to combine mpMRI imaging and advanced CEUS imaging with quantification. TRIAL REGISTRATION The Dutch Central Committee on Research Involving Human Subjects registration number NL52851.018.15, registered on 3 Nov 2015. Clinicaltrials.gov database registration number NCT02831920 , retrospectively registered on 5 July 2016.
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Affiliation(s)
- A. W. Postema
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - M. J. V. Scheltema
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - C. K. Mannaerts
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - R. J. G. Van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - T. Idzenga
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - M. Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | | | - H. Wijkstra
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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24
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Abstract
In October 2007, the Food and Drug Administration mandated significant revisions to product labeling for the commercially available echocardiographic contrast agents (ECA) Definity and Optison after spontaneous healthcare provider reports of 4 patient deaths and ≈190 severe cardiopulmonary reactions occurring in close temporal relationship to ECA administration. Since then, multiple large ECA safety studies have been published and have included outpatients, hospitalized patients (including the critically ill), patients undergoing stress echocardiography, and patients with pulmonary hypertension. In addition, the Food and Drug Administration has convened 2 Advisory Committee meetings and the product labels for Optison and Definity have been substantially revised with a softening of safety restrictions. In this review, we will address the safety of ECA use in patients with serious cardiopulmonary conditions, patients with intracardiac shunts, and special patient populations including pulmonary hypertension, pediatrics, and pregnancy. In addition, we will discuss the confounding role of pseudocomplication in attribution of adverse events during diagnostic testing, the current status of the ECA Black Box Warning, and recommended safety precautions during ECA administration.
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Affiliation(s)
| | - Michael L. Main
- From Saint Luke’s Mid America Heart Institute, Kansas City, MO
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25
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Kim DY, Choi JH, Hong GR, Rim SJ, Kim JY, Lee SC, Sohn IS, Chung WJ, Seo HS, Yoon SJ, Cho KI, Choi SW, Lee KJ. Impact of Contrast Echocardiography on Assessment of Ventricular Function and Clinical Diagnosis in Routine Clinical Echocardiography: Korean Multicenter Study. J Cardiovasc Ultrasound 2017; 25:28-33. [PMID: 28400933 PMCID: PMC5385314 DOI: 10.4250/jcu.2017.25.1.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 03/21/2017] [Accepted: 03/21/2017] [Indexed: 11/29/2022] Open
Abstract
Background Fundamental echocardiography has some drawbacks in patients with difficult-to-image echocardiograms. The aim of this study is to evaluate impact of contrast echocardiography (CE) on ventricular function assessment and clinical diagnosis in routine clinical echocardiography. Methods Two hundred sixty patients were prospectively enrolled over 3 years in 12 medical centers in Korea. General image quality, the number of distinguishable segments, ability to assess regional wall motion, left ventricular (LV) apex and right ventricle (RV) visualization, LV ejection fraction, changes in diagnostic or treatment plan were documented after echocardiography with and without ultrasound contrast agent. Results Poor or uninterpretable general image was 31% before contrast use, and decreased to 2% (p<0.05) after contrast use. The average number of visualized LV segments was 9.53 before contrast use, and increased to 14.46 (p<0.001) after contrast use. The percentage of poor or not seen LV regional wall motion was decreased from 28.4% to 3.5% (p<0.001). The percentage of poor or not seen LV apex and RV was decreased from 49.4% to 2.4% (p<0.001), from 30.5% to 10.5% (p<0.001), respectively. Changes in diagnostic procedure and treatment plan after CE were 30% and 29.6%, respectively. Conclusion Compared to fundamental echocardiography, CE impacted LV function assessment and clinical decision making in Korean patients who undergo routine echocardiography.
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Affiliation(s)
- Doo-Youp Kim
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Jung-Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Joong Rim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jang-Young Kim
- Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Il-Suk Sohn
- Department of Cardiology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Heart Center, Gachon University Gil Hospital, Gachon University School of Medicine, Incheon, Korea
| | - Hye-Sun Seo
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, Korea
| | - Se-Jung Yoon
- Division of Cardiology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kyoung-Im Cho
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Si-Wan Choi
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung-Jin Lee
- Division of Cardiology, Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea
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Ignee A, Atkinson NSS, Schuessler G, Dietrich CF. Ultrasound contrast agents. Endosc Ultrasound 2016; 5:355-362. [PMID: 27824024 PMCID: PMC5206822 DOI: 10.4103/2303-9027.193594] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/15/2016] [Indexed: 02/07/2023] Open
Abstract
Endoscopic ultrasound (EUS) plays an important role in imaging of the mediastinum and abdominal organs. Since the introduction of US contrast agents (UCA) for transabdominal US, attempts have been made to apply contrast-enhanced US techniques also to EUS. Since 2003, specific contrast-enhanced imaging was possible using EUS. Important studies have been published regarding contrast-enhanced EUS and the characterization of focal pancreatic lesions, lymph nodes, and subepithelial tumors. In this manuscript, we describe the relevant UCA, their application, and specific image acquisition as well as the principles of image tissue characterization using contrast-enhanced EUS. Safety issues, potential future developments, and EUS-specific issues are reviewed.
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Affiliation(s)
- Andre Ignee
- Department of Medical, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | | | - Gudrun Schuessler
- Department of Medical, Caritas-Krankenhaus, Bad Mergentheim, Germany
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Zhang C, Wang Z, Wang C, Li X, Liu J, Xu M, Xu S, Xie X, Jiang Q, Wang W, Cao Z. Highly Uniform Perfluoropropane-Loaded Cerasomal Microbubbles As a Novel Ultrasound Contrast Agent. ACS APPLIED MATERIALS & INTERFACES 2016; 8:15024-15032. [PMID: 26114237 DOI: 10.1021/acsami.5b03668] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Microbubbles are widely used as ultrasound contrast agents owing to their excellent echoing characteristics under ultrasound radiation. However, their short sonographic duration and wide size distribution still hinder their application. Herein, we present a hard-template approach to produce perfluoropropane-loaded cerasomal microbubbles (PLCMs) with uniform size and long sonographic duration. The preparation of PLCMs includes deposition of Si-lipids onto functionalized CaCO3 microspheres, removal of their CaCO3 cores and mild infusion of perfluoropropane. In vitro and in vivo experiments showed that PLCMs had excellent echoing characteristics under different ultrasound conditions. More importantly, PLCMs could be imaged for much longer than SonoVue (commercially used microbubbles) under the same ultrasound parameters and concentrations. Our results demonstrated that PLCMs have great potential for use as a novel contrast agent in ultrasound imaging.
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Affiliation(s)
- Chunyang Zhang
- Department of Biomedical Engineering, School of Engineering, Sun Yat-sen University , Guangzhou, Guangdong 510006, China
| | - Zhu Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong 510080, China
| | - Chunan Wang
- Department of Biomedical Engineering, School of Engineering, Sun Yat-sen University , Guangzhou, Guangdong 510006, China
| | - Xiongjun Li
- Department of Biomedical Engineering, School of Engineering, Sun Yat-sen University , Guangzhou, Guangdong 510006, China
| | - Jie Liu
- Department of Biomedical Engineering, School of Engineering, Sun Yat-sen University , Guangzhou, Guangdong 510006, China
| | - Ming Xu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong 510080, China
| | - Shuyu Xu
- Department of Biomedical Engineering, School of Engineering, Sun Yat-sen University , Guangzhou, Guangdong 510006, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong 510080, China
| | - Qing Jiang
- Department of Biomedical Engineering, School of Engineering, Sun Yat-sen University , Guangzhou, Guangdong 510006, China
| | - Wei Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong 510080, China
| | - Zhong Cao
- Department of Biomedical Engineering, School of Engineering, Sun Yat-sen University , Guangzhou, Guangdong 510006, China
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Härmark J, Hebert H, Koeck PJB. Shell thickness determination of polymer-shelled microbubbles using transmission electron microscopy. Micron 2016; 85:39-43. [PMID: 27077316 DOI: 10.1016/j.micron.2016.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 10/22/2022]
Abstract
Intravenously injected microbubbles (MBs) can be utilized as ultrasound contrast agent (CA) resulting in enhanced image quality. A novel CA, consisting of air filled MBs stabilized with a shell of polyvinyl alcohol (PVA) has been developed. These spherical MBs have been decorated with superparamagnetic iron oxide nanoparticles (SPIONs) in order to serve as both ultrasound and magnetic resonance imaging (MRI) CA. In this study, a mathematical model was introduced that determined the shell thickness of two types of SPIONs decorated MBs (Type A and Type B). The shell thickness of MBs is important to determine, as it affects the acoustical properties. In order to investigate the shell thickness, thin sections of plastic embedded MBs were prepared and imaged using transmission electron microscopy (TEM). However, the sections were cut at random distances from the MB center, which affected the observed shell thickness. Hence, the model determined the average shell thickness of the MBs from corrected mean values of the outer and inner radii observed in the TEM sections. The model was validated using simulated slices of MBs with known shell thickness and radius. The average shell thickness of Type A and Type B MBs were 651nm and 637nm, respectively.
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Affiliation(s)
- Johan Härmark
- School of Technology and Health, KTH Royal Institute of Technology and Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
| | - Hans Hebert
- School of Technology and Health, KTH Royal Institute of Technology and Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
| | - Philip J B Koeck
- School of Technology and Health, KTH Royal Institute of Technology and Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
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Paefgen V, Doleschel D, Kiessling F. Evolution of contrast agents for ultrasound imaging and ultrasound-mediated drug delivery. Front Pharmacol 2015; 6:197. [PMID: 26441654 PMCID: PMC4584939 DOI: 10.3389/fphar.2015.00197] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/31/2015] [Indexed: 12/21/2022] Open
Abstract
Ultrasound (US) is one of the most frequently used diagnostic methods. It is a non-invasive, comparably inexpensive imaging method with a broad spectrum of applications, which can be increased even more by using bubbles as contrast agents (CAs). There are various different types of bubbles: filled with different gases, composed of soft- or hard-shell materials, and ranging in size from nano- to micrometers. These intravascular CAs enable functional analyses, e.g., to acquire organ perfusion in real-time. Molecular analyses are achieved by coupling specific ligands to the bubbles' shell, which bind to marker molecules in the area of interest. Bubbles can also be loaded with or attached to drugs, peptides or genes and can be destroyed by US pulses to locally release the entrapped agent. Recent studies show that US CAs are also valuable tools in hyperthermia-induced ablation therapy of tumors, or can increase cellular uptake of locally released drugs by enhancing membrane permeability. This review summarizes important steps in the development of US CAs and introduces the current clinical applications of contrast-enhanced US. Additionally, an overview of the recent developments in US probe design for functional and molecular diagnosis as well as for drug delivery is given.
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Affiliation(s)
| | | | - Fabian Kiessling
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, AachenGermany
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Grishenkov D, Gonon A, Weitzberg E, Lundberg JO, Harmark J, Cerroni B, Paradossi G, Janerot-Sjoberg B. Ultrasound contrast agent loaded with nitric oxide as a theranostic microdevice. Drug Des Devel Ther 2015; 9:2409-19. [PMID: 25995614 PMCID: PMC4425237 DOI: 10.2147/dddt.s77790] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The current study describes novel multifunctional polymer-shelled microbubbles (MBs) loaded with nitric oxide (NO) for integrated therapeutic and diagnostic applications (ie, theranostics) of myocardial ischemia. We used gas-filled MBs with an average diameter of 4 μm stabilized by a biocompatible shell of polyvinyl alcohol. In vitro acoustic tests showed sufficient enhancement of the backscattered power (20 dB) acquired from the MBs' suspension. The values of attenuation coefficient (0.8 dB/cm MHz) and phase velocities (1,517 m/s) were comparable with those reported for the soft tissue. Moreover, polymer MBs demonstrate increased stability compared with clinically approved contrast agents with a fracture threshold of about 900 kPa. In vitro chemiluminescence measurements demonstrated that dry powder of NO-loaded MBs releases its gas content in about 2 hours following an exponential decay profile with an exponential time constant equal to 36 minutes. The application of high-power ultrasound pulse (mechanical index =1.2) on the MBs resuspended in saline decreases the exponential time constant from 55 to 4 minutes in air-saturated solution and from 17 to 10 minutes in degassed solution. Thus, ultrasound-triggered release of NO is achieved. Cytotoxicity tests indicate that phagocytosis of the MBs by macrophages starts within 6-8 hours. This is a suitable time for initial diagnostics, treatment, and monitoring of the therapeutic effect using a single injection of the proposed multifunctional MBs.
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Affiliation(s)
- Dmitry Grishenkov
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Engineering, KTH, Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Adrian Gonon
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eddie Weitzberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Jon O Lundberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Harmark
- Department of Biosciences and Nutrition, Karolinska Institutet, KTH, Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden
| | - Barbara Cerroni
- Department of Chemical Sciences and Technologies, University of Rome Tor Vergata, Rome, Italy
| | - Gaio Paradossi
- Department of Chemical Sciences and Technologies, University of Rome Tor Vergata, Rome, Italy
| | - Birgitta Janerot-Sjoberg
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Engineering, KTH, Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
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Appis AW, Tracy MJ, Feinstein SB. Update on the safety and efficacy of commercial ultrasound contrast agents in cardiac applications. Echo Res Pract 2015; 2:R55-62. [PMID: 26693339 PMCID: PMC4676450 DOI: 10.1530/erp-15-0018] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/22/2015] [Indexed: 12/27/2022] Open
Abstract
Ultrasound contrast agents (UCAs) are currently used throughout the world in both clinical and research settings. The concept of contrast-enhanced ultrasound imaging originated in the late 1960s, and the first commercially available agents were initially developed in the 1980s. Today's microbubbles are designed for greater utility and are used for both approved and off-label indications. In October 2007, the US Food and Drug Administration (FDA) imposed additional product label warnings that included serious cardiopulmonary reactions, several new disease-state contraindications, and a mandated 30 min post-procedure monitoring period for the agents Optison and Definity. These additional warnings were prompted by reports of cardiopulmonary reactions that were temporally related but were not clearly attributable to these UCAs. Subsequent published reports over the following months established not only the safety but also the improved efficacy of clinical ultrasound applications with UCAs. The FDA consequently updated the product labeling in June 2008 and reduced contraindications, although it continued to monitor select patients. In addition, a post-marketing program was proposed to the sponsors for a series of safety studies to further assess the risk of UCAs. Then in October 2011, the FDA leadership further downgraded the warnings after hearing the results of the post-marketing data, which revealed continued safety and improved efficacy. The present review focuses on the use of UCAs in today's clinical practice, including the approved indications, a variety of off-label uses, and the most recent data, which affirms the safety and efficacy of UCAs.
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Affiliation(s)
- Andrew W Appis
- Division of Cardiology, Rush University Medical Center , 1653 West Congress Parkway, Chicago, Illinois, 60612 , USA
| | - Melissa J Tracy
- Division of Cardiology, Rush University Medical Center , 1653 West Congress Parkway, Chicago, Illinois, 60612 , USA
| | - Steven B Feinstein
- Division of Cardiology, Rush University Medical Center , 1653 West Congress Parkway, Chicago, Illinois, 60612 , USA
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Weidemann F, Liu D, Niemann M, Herrmann S, Hu H, Gaudron P, Ertl G, Hu K. Abschätzung der linksventrikulären systolischen Funktion bei Patienten mit schlechter Bildqualität. Herz 2015; 40:240-9. [DOI: 10.1007/s00059-013-3924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 11/28/2022]
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Platts DG, Diab S, Dunster KR, Shekar K, Burstow DJ, Sim B, Tunbridge M, McDonald C, Chemonges S, Chan J, Fraser JF. Feasibility of perflutren microsphere contrast transthoracic echocardiography in the visualization of ventricular endocardium during venovenous extracorporeal membrane oxygenation in a validated ovine model. Echocardiography 2014; 32:548-56. [PMID: 25059883 DOI: 10.1111/echo.12695] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Transthoracic echocardiography (TTE) during extra corporeal membrane oxygenation (ECMO) is important but can be technically challenging. Contrast-specific TTE can improve imaging in suboptimal studies. These contrast microspheres are hydrodynamically labile structures. This study assessed the feasibility of contrast echocardiography (CE) during venovenous (VV) ECMO in a validated ovine model. METHOD Twenty-four sheep were commenced on VV ECMO. Parasternal long-axis (Plax) and short-axis (Psax) views were obtained pre- and postcontrast while on VV ECMO. Endocardial definition scores (EDS) per segment were graded: 1 = good, 2 = suboptimal 3 = not seen. Endocardial border definition score index (EBDSI) was calculated for each view. Endocardial length (EL) in the Plax view for the left ventricle (LV) and right ventricle (RV) was measured. RESULTS Summation EDS data for the LV and RV for unenhanced TTE (UE) versus CE TTE imaging: EDS 1 = 289 versus 346, EDS 2 = 38 versus 10, EDS 3 = 33 versus 4, respectively. Wilcoxon matched-pairs rank-sign tests showed a significant ranking difference (improvement) pre- and postcontrast for the LV (P < 0.0001), RV (P < 0.0001) and combined ventricular data (P < 0.0001). EBDSI for CE TTE was significantly lower than UE TTE for the LV (1.05 ± 0.17 vs. 1.22 ± 0.38, P = 0.0004) and RV (1.06 ± 0.22 vs. 1.42 ± 0.47, P = 0.0.0006) respectively. Visualized EL was significantly longer in CE versus UE for both the LV (58.6 ± 11.0 mm vs. 47.4 ± 11.7 mm, P < 0.0001) and the RV (52.3 ± 8.6 mm vs. 36.0 ± 13.1 mm, P < 0.0001), respectively. CONCLUSIONS Despite exposure to destructive hydrodynamic forces, CE is a feasible technique in an ovine ECMO model. CE results in significantly improved EDS and increased EL.
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Affiliation(s)
- David G Platts
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia
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Safety of ultrasound contrast agents in the pediatric oncologic population: a single-institution experience. AJR Am J Roentgenol 2014; 202:966-70. [PMID: 24758648 DOI: 10.2214/ajr.13.12010] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Little information is available regarding the safety of ultrasound contrast agents in children. The purpose of this article was to assess the safety profile of the i.v. administration of ultrasound contrast agents in the pediatric oncology population. MATERIALS AND METHODS Patients with pediatric solid malignancies who were enrolled on institutional clinical trials conducted between June 2003 and January 2013 and who met our institutional screening criteria for contrast-enhanced ultrasound (CEUS) were eligible. After providing informed consent or assent for CEUS, subjects received i.v. bolus injections of one of two contrast agents for imaging of the primary tumor or a metastatic target lesion. Hemodynamic parameters, including heart rate, cardiac rhythm, and oxygen saturation, were monitored immediately before and for 30 minutes after the administration of the contrast agent. Interviews with the subject or a guardian were conducted by the principal investigator or a radiologist coinvestigator before and after the examination to assess for any adverse effects. RESULTS Thirty-four subjects (21 male and 13 female) ranging in age from 8 months to 20.7 years (median, 8.7 years) underwent 134 CEUS. No detrimental change in hemodynamic status occurred in any subject. Three subjects (3/134, 2.2%) reported mild transient side effects on one occasion each, two (2/134, 1.5%) had taste alteration, and one (1/134, 0.8%) reported mild transient tinnitus and lightheadedness. These reactions did not recur in these subjects on subsequent CEUS examinations. CONCLUSION The i.v. administration of ultrasound contrast agents is safe and well tolerated in the pediatric oncology population. Further studies in children are needed to confirm our findings.
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Wei K, Shah S, Jaber WA, DeMaria A. An observational study of the occurrence of serious adverse reactions among patients who receive optison in routine medical practice. J Am Soc Echocardiogr 2014; 27:1006-10. [PMID: 24930121 DOI: 10.1016/j.echo.2014.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Reports of ultrasound contrast agent safety have been derived mainly from retrospective databases rather than from studies specifically designed to assess safety. The purpose of this study was to prospectively determine the safety of Optison (GE Healthcare, Princeton, NJ) in routine medical practice. METHODS Patients referred for routine rest or stress two-dimensional echocardiography who had indications for contrast were enrolled. Vital signs were obtained at baseline and at intervals up to 1 hour after dosing of Optison. Patients were followed for the development of any serious adverse event (SAE), defined as an event that causes death, is life threatening, requires or prolongs hospitalization, or causes another important event, for 24 hours after Optison administration. RESULTS A total of 1,039 patients were enrolled, and 76% had 24-hour follow-up. The median age was 60 years (range, 20-97 years), and 62% were men. The mean body mass index was 33 ± 9 kg/m(2). Patient comorbidities included hypertension (73%), hyperlipidemia (64%), smoking (52%), and diabetes (37%). There were significant increases in systolic blood pressure, heart rate, and respiratory rate between the baseline, 5- to 15-min, 30-min, and 60-min time points after the administration of Optison in patients undergoing stress studies but none in those undergoing rest studies. There was a total of six SAEs during the study, which were felt to be related not to Optison but rather to the stress test itself or to the patient's underlying pathology. Although two events were classified as SAEs because of hospitalization, the hospitalizations were appropriate for pathology that would have been missed without Optison use. CONCLUSIONS In this large, prospective safety study of Optison during routine resting and stress echocardiography, no SAEs related to Optison developed. Optison helped define abnormalities that required appropriate hospitalization for further management.
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Affiliation(s)
- Kevin Wei
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
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Glassy MS, Groves EM. Analysis of the quantitative improvements in resting echocardiographic image sharpness through the use of contrast enhanced echocardiography. Int J Cardiovasc Imaging 2014; 30:867-73. [PMID: 24647916 DOI: 10.1007/s10554-014-0401-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/12/2014] [Indexed: 10/25/2022]
Abstract
Contrast enhanced echocardiography (CEE) is a technique for the improvement of suboptimal echocardiographic studies. While commonly performed at selected institutions, its value has only been shown qualitatively, and to this point no study has been directed at establishing a quantitative improvement in image quality compared with non-contrast enhanced echocardiography (non-CEE). The purpose of this study was to quantitatively measure the effect of contrast on the quality of images obtained during non-CEE versus CEE. Thirty consecutive patients underwent CEE. In all subjects a non-CEE was obtained prior to administering any contrast, allowing for a direct comparison and an internal control group. Sharpness of the septal, apical and lateral myocardial walls in the apical 4-chamber view was calculated with and without contrast. Three signal intensity levels were obtained for each wall then averaged to compare the images with and without contrast for a statistically significant difference in sharpness. Quantitative analysis showed a significant difference in sharpness between CEE and non-CEE in the left ventricular septal myocardial wall, p < 0.01. A more drastic significant increase in image sharpness was observed between non-CEE and CEE in the apical and lateral left ventricular myocardial walls, both p < 0.000001. CEE significantly increases the sharpness at all left ventricular myocardial walls thus allowing higher quality images with presumably more accurate diagnosis of regional wall motion abnormalities, left ventricular endocardial border detection, left ventricular dimensions, ejection fraction and apical pathology.
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Affiliation(s)
- Matthew S Glassy
- Department of Internal Medicine, University of California, Irvine, 2141 Engineering Hall, Irvine, CA, 92697, USA
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Abdelmoneim SS, Bernier M, Hagen ME, Eifert-Rain S, Bott-Kitslaar D, Wilansky S, Castello R, Bhat G, Pellikka PA, Best PJM, Hayes SN, Mulvagh SL. A multicenter, prospective study to evaluate the use of contrast stress echocardiography in early menopausal women at risk for coronary artery disease: trial design and baseline findings. J Womens Health (Larchmt) 2013; 22:173-83. [PMID: 23398128 DOI: 10.1089/jwh.2012.3714] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS This multisite prospective trial, Stress Echocardiography in Menopausal Women At Risk for Coronary Artery Disease (SMART), aimed to evaluate the prognostic value of contrast stress echocardiography (CSE), coronary artery calcification (CAC), and cardiac biomarkers for prediction of cardiovascular events after 2 and 5 years in early menopausal women experiencing chest pain symptoms or risk factors. This report describes the study design, population, and initial test results at study entry. METHODS From January 2004 through September 2007, 366 early menopausal women (age 54±5 years, Framingham risk score 6.51%±4.4 %, range 1%-27%) referred for stress echocardiography were prospectively enrolled. Image quality was enhanced with an ultrasound contrast agent. Tests for cardiac biomarkers [high-sensitivity C-reactive protein (hsCRP), atrial natriuretic protein (ANP), brain natriuretic protein (BNP), endothelin (ET-1)] and cardiac computed tomography (CT) for CAC were performed. RESULTS CSE (76% exercise, 24% dobutamine) was abnormal in 42 women (11.5%), and stress electrocardiogram (ECG) was positive in 22 women (6%). Rest BNP correlated weakly with stress wall motion score index (WMSI) (r=0.189, p<0.001). Neither hsCRP, ANP, endothelin, nor CAC correlated with stress WMSI. Predictors of abnormal CSE were body mass index (BMI), diabetes mellitus, family history of premature coronary artery disease (CAD), and positive stress ECG. Twenty-four women underwent clinically indicated coronary angiography (CA); 5 had obstructive (≥50%), 15 had nonobstructive (10%-49%), and 4 had no epicardial CAD. CONCLUSIONS The SMART trial is designed to assess the prognostic value of CSE in early menopausal women. Independent predictors of positive CSE were BMI, diabetes mellitus, family history of premature CAD, and positive stress ECG. CAC scores and biomarkers (with the exception of rest BNP) were not correlated with CSE results. We await the follow-up data.
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Affiliation(s)
- Sahar S Abdelmoneim
- Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Hu K, Liu D, Niemann M, Herrmann S, Gaudron PD, Ertl G, Weidemann F. Methods for Assessment of Left Ventricular Systolic Function in Technically Difficult Patients with Poor Imaging Quality. J Am Soc Echocardiogr 2013; 26:105-13. [DOI: 10.1016/j.echo.2012.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 12/14/2022]
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Liao AH, Wu SY, Wang HE, Weng CH, Wu MF, Li PC. Evaluation of 18F-labeled targeted perfluorocarbon-filled albumin microbubbles as a probe for microUS and microPET in tumor-bearing mice. ULTRASONICS 2013; 53:320-327. [PMID: 22832082 DOI: 10.1016/j.ultras.2012.06.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 06/04/2012] [Accepted: 06/09/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE In this study, albumin-shelled, targeted MBs (tMBs) were first demonstrated with the expectation of visualization of biodistribution of albumin-shelled tMBs. The actual biodistribution of albumin-shelled tMBs is of vital importance either for molecular imaging or for drug delivery. MOTIVATION Recently, albumin microbubbles (MBs) have been studied for drug and gene delivery in vitro and in vivo through cavitation. Targeted lipid-shelled MBs have been applied for ultrasound molecular imaging and conjugated with radiolabeled antibodies for whole-body biodistribution evaluations. The novelty of the work is that, in addition to the lipid tMBs, the albumin tMBs was also applied in biodistribution detection. METHODS Multimodality albumin-shelled, (18)F-SFB-labeled VEGFR2 tMBs were synthesized, and their characteristics in mice bearing MDA-MB-231 human breast cancer were investigated with micro-positron-emission tomography (microPET) and high-frequency ultrasound (microUS). RESULTS Albumin-shelled MBs can be labeled with (18)F-SFB directly and conjugated with antibodies for dual molecular imaging. The albumin-shelled tMBs show a lifetime in 30min in the blood pool and a highly specific adherence to tumor vessels in mice bearing human breast cancer. CONCLUSIONS From the evaluations of whole-body biodistribution, the potential of the dual molecular imaging probe for drug or gene delivery in animal experiments with albumin shelled MBs has been investigated.
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Affiliation(s)
- Ai-Ho Liao
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
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Morbid obesity: obscuring the diagnosis of aortic stenosis in a patient with cardiogenic wheezing. J Gen Intern Med 2013; 28:155-9. [PMID: 22810357 PMCID: PMC3539027 DOI: 10.1007/s11606-012-2155-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 06/16/2012] [Accepted: 06/19/2012] [Indexed: 10/28/2022]
Abstract
We report the case of a morbidly obese 65-year-old female who presented with repeated hypotensive episodes following dialysis. She was misdiagnosed as suffering from asthma, and eventually was found to have severe aortic stenosis. Obesity has become a common and formidable obstacle to gathering important diagnostic information in patients. Modern diagnostic lab tests and imaging modalities such as transthoracic echocardiography (TTE) can provide spurious data in the morbidly obese population, which can ultimately lead to misdiagnosis. In this clinical vignette, we discuss the relationship between the basic pathophysiologic mechanisms underlying aortic stenosis and patient clinical presentation. We also review the relevant literature and discuss the impact of obesity on the diagnosis of this condition.
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41
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Perry R, Joseph M. Advanced echocardiographic techniques. Australas J Ultrasound Med 2012; 15:126-142. [PMID: 28191159 PMCID: PMC5024913 DOI: 10.1002/j.2205-0140.2012.tb00196.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Echocardiography has advanced significantly since its first clinical use. The move towards more accurate imaging and quantification has driven this advancement. In this review, we will briefly focus on three distinct but important recent advances, three‐dimensional (3D) echocardiography, contrast echocardiography and myocardial tissue imaging. The basic principles of these techniques will be discussed as well as current and future clinical applications.
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Affiliation(s)
- Rebecca Perry
- Flinders Clinical Research; South Australian Health and Medical Research Institute; Adelaide South Australia Australia
- Department of Cardiovascular Medicine; Flinders Medical Centre; Bedford Park South Australia Australia
- Discipline of Medicine Flinders University; Bedford Park South Australia Australia
| | - Majo Joseph
- Flinders Clinical Research; South Australian Health and Medical Research Institute; Adelaide South Australia Australia
- Department of Cardiovascular Medicine; Flinders Medical Centre; Bedford Park South Australia Australia
- Discipline of Medicine Flinders University; Bedford Park South Australia Australia
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42
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Liao AH, Li YK, Lee WJ, Wu MF, Liu HL, Kuo ML. Estimating the delivery efficiency of drug-loaded microbubbles in cancer cells with ultrasound and bioluminescence imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1938-1948. [PMID: 22929655 DOI: 10.1016/j.ultrasmedbio.2012.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 07/17/2012] [Accepted: 07/18/2012] [Indexed: 06/01/2023]
Abstract
The application of drug-loaded microbubbles (MBs) in combination with ultrasound (US), which results in an increase in capillary permeability at the site of US-sonication-induced MB destruction, may be an efficient method of localized drug delivery. This study investigated the mechanism underlying the US-mediated release of luciferin-loaded MBs through the blood vessels to targeted cells using an in vivo bioluminescence imaging (BLI) system. The luciferin-loaded MBs comprised an albumin shell with a diameter of 1234 ± 394 nm (mean ± SD) and contained 2.48 × 10⁹ bubbles/mL; within each MB, the concentration of encapsulated luciferin was 1.48 × 10⁻¹⁰ mg/bubble. The loading efficiency of luciferin in MBs was only about 19.8%, while maintaining both the bioluminescence and acoustic properties. In vitro and in vivo BLI experiments were performed to evaluate the US-mediated release of luciferin-loaded MBs. For in vitro results, the increase in light emission of luciferin-loaded albumin-shelled MBs after destruction via US sonication (6.24 ± 0.72 × 10⁷ photons/s) was significantly higher than that in the luciferin-loaded albumin-shelled MBs (3.11 ± 0.33 × 10⁷ photons/s) (p < 0.05). The efficiency of the US-mediated release of luciferin-loaded MBs in 4T1-luc2 tumor-bearing mice was also estimated. The signal intensity of the tumor with US destruction at 3 W/cm² for 30 s was significantly higher than without US destruction at 3 (p = 0.025), 5 (p = 0.013), 7 (p = 0.012) and 10 (p = 0.032) min after injecting luciferin-loaded albumin-shelled MBs. The delivery efficiency was, thus, improved with US-mediated release, allowing reduction of the total injection dose of luciferin.
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Affiliation(s)
- Ai-Ho Liao
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan.
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43
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Boolani H, Main ML. Update on Contrast Echocardiography: Safety and Utility. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9162-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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44
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Goldberg YH, Ginelli P, Siegel R, Ostfeld RJ, Schaefer M, Spevack DM. Administration of perflutren contrast agents during transthoracic echocardiography is not associated with a significant increase in acute mortality risk. Cardiology 2012; 122:119-25. [PMID: 22813648 DOI: 10.1159/000338731] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 03/26/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite the 2008 revision of a previously issued black box warning of the US Food and Drug Administration against the use of perflutren ultrasound contrast agents, the warning still reports fatalities having occurred following their administration. We sought to assess 1-day mortality associated with contrast use across a wide range of clinical settings and co-morbidities. METHODS We conducted a retrospective study involving 96,705 transthoracic echocardiograms (TTE) in 63,189 adults at our institution between July 2003 and June 2008. A contrast agent was used in 2,518 TTE during this time. The primary outcome was total mortality within 1 day of TTE. RESULTS Death occurred in 10 patients (0.44%) in the contrast group and in 421 patients (0.69%) in the non-contrast group (p = 0.14). In a multivariate model, use of contrast enhancement was not associated with increased mortality (p = 0.67) after adjustment for age, gender, race, patient location, ejection fraction, and the presence of various co-morbidities. Cause of death analysis did not identify any cases where contrast played a likely role. CONCLUSION Definity contrast use during TTE was not associated with increased acute mortality risk. Contrast administration during TTE should not be withheld when the additional information obtained could potentially improve patient management.
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45
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McCarville MB, Kaste SC, Hoffer FA, Khan RB, Walton RC, Alpert BS, Furman WL, Li C, Xiong X. Contrast-enhanced sonography of malignant pediatric abdominal and pelvic solid tumors: preliminary safety and feasibility data. Pediatr Radiol 2012; 42:824-33. [PMID: 22249601 PMCID: PMC3400719 DOI: 10.1007/s00247-011-2338-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 12/12/2011] [Accepted: 12/14/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND Little information exists regarding pediatric contrast-enhanced US. OBJECTIVE To assess the safety and feasibility of contrast-enhanced US of pediatric abdominal and pelvic tumors. MATERIALS AND METHODS This prospective study included eight boys and five girls (mean age, 10.8 years) with abdominal or pelvic tumors. Cohorts of three subjects underwent US with perflutren contrast agent at escalating dose levels. Neurological and funduscopic examination, electrocardiography and continuous pulse oximetry were performed before and after contrast administration. Three radiologists independently scored six imaging parameters on pre- and postcontrast sonography. Inter-reviewer agreement was measured by the Kappa statistic. RESULTS No neurological, retinal, electrocardiographical or pulse oximetry changes were attributable to the contrast agent. Two subjects reported minor, transient symptoms. Postcontrast US parameter scores improved slightly in 8 of 12 subjects. Postcontrast ultrasound inter-reviewer agreement improved slightly for detection of tumor margins (precontrast = 0.20, postcontrast = 0.26), local tumor invasion (precontrast = -0.01, postcontrast = 0.10) and adenopathy (precontrast = 0.35, postcontrast = 0.44). CONCLUSIONS Although our sample size is small, perflutren contrast agents appear to be safe and well tolerated in children. Contrast-enhanced sonography of pediatric abdominal and pelvic tumors is feasible, but larger studies are needed to define their safety and efficacy in children.
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Affiliation(s)
- M. Beth McCarville
- Department of Radiological Sciences, St Jude Children’s Research Hospital, Memphis, TN,Department of Radiology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | - Sue C Kaste
- Department of Radiological Sciences, St Jude Children’s Research Hospital, Memphis, TN,Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN,Department of Radiology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | - Fredric A Hoffer
- Department of Radiological Sciences, St Jude Children’s Research Hospital, Memphis, TN,Department of Radiology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | - Raja B. Khan
- Division of Neurology, St Jude Children’s Research Hospital, Memphis, TN
| | - R. Christopher Walton
- Division of Ophthalmology, St Jude Children’s Research Hospital, Memphis, TN,Department of Ophthalmology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | - Bruce S. Alpert
- Division of Cardiology, St Jude Children’s Research Hospital, Memphis, TN,Department of Cardiology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | - Wayne L. Furman
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN,Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | - Chenghong Li
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, TN
| | - Xiaoping Xiong
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, TN
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46
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Abdelmoneim SS, Mulvagh SL. Perflutren lipid microsphere injectable suspension for cardiac ultrasound. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/iim.12.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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47
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Park Y, Luce AC, Whitaker RD, Amin B, Cabodi M, Nap RJ, Szleifer I, Cleveland RO, Nagy JO, Wong JY. Tunable diacetylene polymerized shell microbubbles as ultrasound contrast agents. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2012; 28:3766-72. [PMID: 22260537 PMCID: PMC3302155 DOI: 10.1021/la204510h] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Monodisperse gas microbubbles, encapsulated with a shell of photopolymerizable diacetylene lipids and phospholipids, were produced by microfluidic flow focusing, for use as ultrasound contrast agents. The stability of the polymerized shell microbubbles against both aggregation and gas dissolution under physiological conditions was studied. Polyethylene glycol (PEG) 5000, which was attached to the diacetylene lipids, was predicted by molecular theory to provide more steric hindrance against aggregation than PEG 2000, and this was confirmed experimentally. The polymerized shell microbubbles were found to have higher shell-resistance than nonpolymerizable shell microbubbles and commercially available microbubbles (Vevo MicroMarker). The acoustic stability under 7.5 MHz ultrasound insonation was significantly greater than that for the two comparison microbubbles. The acoustic stability was tunable by varying the amount of diacetylene lipid. Thus, our polymerized shell microbubbles are a promising platform for ultrasound contrast agents.
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Affiliation(s)
- Yoonjee Park
- Department of Biomedical Engineering, Boston University, 44 Cummington St, Boston, MA 02215, USA
| | - Adam C. Luce
- Department of Biomedical Engineering, Boston University, 44 Cummington St, Boston, MA 02215, USA
| | - Ragnhild D. Whitaker
- Department of Biomedical Engineering, Boston University, 44 Cummington St, Boston, MA 02215, USA
| | - Bhumica Amin
- Department of Biomedical Engineering, Boston University, 44 Cummington St, Boston, MA 02215, USA
| | - Mario Cabodi
- Department of Biomedical Engineering, Boston University, 44 Cummington St, Boston, MA 02215, USA
| | - Rikkert J. Nap
- Department of Biomedical Engineering and Chemistry of Life Processes Institute, Northwestern University, Sheridan Road, Evanston, IL 60208, USA
| | - Igal Szleifer
- Department of Biomedical Engineering and Chemistry of Life Processes Institute, Northwestern University, Sheridan Road, Evanston, IL 60208, USA
| | - Robin O. Cleveland
- Department of Mechanical Engineering, Boston University, 110 Cummington St, Boston, MA 02215, USA
| | - Jon O. Nagy
- NanoValent Pharmaceuticals, Inc., 910 Technology Blvd. STE G, Bozeman, MT 59718, USA
| | - Joyce Y. Wong
- Department of Biomedical Engineering, Boston University, 44 Cummington St, Boston, MA 02215, USA
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Platts DG, Sedgwick JF, Burstow DJ, Mullany DV, Fraser JF. The Role of Echocardiography in the Management of Patients Supported by Extracorporeal Membrane Oxygenation. J Am Soc Echocardiogr 2012; 25:131-41. [DOI: 10.1016/j.echo.2011.11.009] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Indexed: 01/08/2023]
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49
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Fine NM, Pellikka PA. Stress echocardiography for the detection and assessment of coronary artery disease. J Nucl Cardiol 2011; 18:501-15. [PMID: 21431999 DOI: 10.1007/s12350-011-9365-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nowell M Fine
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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50
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Forsberg F, Ro RJ, Fox TB, Liu JB, Chiou SY, Potoczek M, Goldberg BB. Contrast enhanced maximum intensity projection ultrasound imaging for assessing angiogenesis in murine glioma and breast tumor models: A comparative study. ULTRASONICS 2011; 51:382-9. [PMID: 21144542 PMCID: PMC3030198 DOI: 10.1016/j.ultras.2010.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 11/10/2010] [Accepted: 11/12/2010] [Indexed: 05/21/2023]
Abstract
The purpose of this study was to prospectively compare noninvasive, quantitative measures of vascularity obtained from four contrast enhanced ultrasound (US) techniques to four invasive immunohistochemical markers of tumor angiogenesis in a large group of murine xenografts. Glioma (C6) or breast cancer (NMU) cells were implanted in 144 rats. The contrast agent Optison (GE Healthcare, Princeton, NJ) was injected in a tail vein (dose: 0.4ml/kg). Power Doppler imaging (PDI), pulse-subtraction harmonic imaging (PSHI), flash-echo imaging (FEI), and Microflow imaging (MFI; a technique creating maximum intensity projection images over time) was performed with an Aplio scanner (Toshiba America Medical Systems, Tustin, CA) and a 7.5MHz linear array. Fractional tumor neovascularity was calculated from digital clips of contrast US, while the relative area stained was calculated from specimens. Results were compared using a factorial, repeated measures ANOVA, linear regression and z-tests. The tortuous morphology of tumor neovessels was visualized better with MFI than with the other US modes. Cell line, implantation method and contrast US imaging technique were significant parameters in the ANOVA model (p<0.05). The strongest correlation determined by linear regression in the C6 model was between PSHI and percent area stained with CD31 (r=0.37, p<0.0001). In the NMU model the strongest correlation was between FEI and COX-2 (r=0.46, p<0.0001). There were no statistically significant differences between correlations obtained with the various US methods (p>0.05). In conclusion, the largest study of contrast US of murine xenografts to date has been conducted and quantitative contrast enhanced US measures of tumor neovascularity in glioma and breast cancer xenograft models appear to provide a noninvasive marker for angiogenesis; although the best method for monitoring angiogenesis was not conclusively established.
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Affiliation(s)
- Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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