Enhancement of hyperthermic cell killing by non-thermal effect of ultrasound

The crosstalk between sonodynamic therapy and autophagy in cancer

As a noninvasive treatment approach for cancer and other diseases, sonodynamic therapy (SDT) has attracted extensive attention due to the deep penetration of ultrasound, good focusing, and selective irradiation sites. However, intrinsic limitations of traditional sonosensitizers hinder the widespread application of SDT. With the development of nanotechnology, nanoparticles as sonosensitizers or as a vehicle to deliver sonosensitizers have been designed and used to target tissues or tumor cells with high specificity and accuracy. Autophagy is a common metabolic alteration in both normal cells and tumor cells. When autophagy happens, a double-membrane autophagosome with sequestrated intracellular components is delivered and fused with lysosomes for degradation. Recycling these cell materials can promote survival under a variety of stress conditions. Numerous studies have revealed that both apoptosis and autophagy occur after SDT. This review summarizes recent progress in autophagy activation by SDT through multiple mechanisms in tumor therapies, drug resistance, and lipid catabolism. A promising tumor therapy, which combines SDT with autophagy inhibition using a nanoparticle delivering system, is presented and investigated.

Ultrasound-Induced DNA Damage and Cellular Response: Historical Review, Mechanisms Analysis, and Therapeutic Implications

The biological effects of ultrasound may be classified into thermal and nonthermal mechanisms. The nonthermal effects may be further classified into cavitational and noncavitational mechanisms. DNA damage induced by ultrasound is considered to be related to nonthermal cavitations. For this aspect, many in vitro studies on DNA have been conducted for evaluating the safety of diagnostic ultrasound, particularly in fetal imaging. Technological advancement in detecting DNA damage both in vitro and in vivo have elucidated the mechanism of DNA damage formation and their cellular response. Damage to DNA, and the residual damages after DNA repair are implicated in the biological effects. Here, we discuss the historical evidence of ultrasound on DNA damage and the mechanism of DNA damage formation both in vitro and in vivo, compared with those induced by ionizing radiation. We also offer a commentary on the safety of ultrasound over X-ray-based imaging. Also, understanding the various mechanisms involved in the bioeffects of ultrasound will lead us to alternative strategies for use of ultrasound for therapy.

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

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

Recent advances of sonodynamic therapy in cancer treatment

Sonodynamic therapy (SDT) is an emerging approach that involves a combination of low-intensity ultrasound and specialized chemical agents known as sonosensitizers. Ultrasound can penetrate deeply into tissues and can be focused into a small region of a tumor to activate a sonosensitizer which offers the possibility of non-invasively eradicating solid tumors in a site-directed manner. In this article, we critically reviewed the currently accepted mechanisms of sonodynamic action and summarized the classification of sonosensitizers. At the same time, the breath of evidence from SDT-based studies suggests that SDT is promising for cancer treatment.

The effects of power on–off durations of pulsed ultrasound on the destruction of cancer cells

PURPOSE

Low-intensity ultrasound irradiation is a potential method for suppressing cancer cell proliferation, inducing apoptosis and delivering specific cytotoxic genes or drugs into tumors topographically in future cancer therapies. However, ultrasound attenuates rapidly in tissue and produces heat. Pulsed ultrasound is frequently used to minimize pain and possible thermal damage to the surrounding normal tissue during therapy, since it results in smaller temperature increases. This study compared three pulsed-ultrasound strategies for destroying cancer cells, measuring their induced temperature increases to determine the optimal pulsing parameters.

MATERIALS AND METHODS

We performed three types of experiment, involving ultrasound with (1) a fixed duty cycle of 50% with variable on- and off-times, (2) a fixed off-time with variable on-times, and (3) a fixed on-time with variable off-times.

RESULTS

The results show that for different types of cultured cells (HeLa, HT-29, Ca9-22 and fibroblast) exposed to ultrasound of the same frequency (1 MHz) and energy, long pulses combined with off-times that are 5-10 times longer (on-/-off-times pairs of 5/25, 25/250, or 250/2500 ms/ms) cause significant cell destruction whilst avoiding temperature increases of more than 1.5 degrees C. Furthermore, the correlation between the temperature increase and the percentage of surviving cells is low.

CONCLUSIONS

Pulsed ultrasound with a long on-time and an even longer off-time exerts a high cytotoxic effect but a smaller temperature increase compared with non-pulsed ultrasound. This indicates that the cytotoxic effects observed in the current study were not purely due to the thermal effects of the ultrasound.

Ultrasound-mediated gene transfection

Ultrasound-mediated gene transfection (sonotransfection) has been shown to be a promising physical method for gene therapy, especially for cancer gene therapy. The procedure being done in vitro uses several ultrasound exposure (sonication) setups. Although high transfection rates have been attained in some of these setups in vitro, replicating similar levels of transfection in vivo has been difficult. In vivo-simulated setups offer hope for a more consistent outcome in vivo. Presented in this chapter are typical methods of sonotransfection in vitro, methods when using a novel in vivo-simulated in vitro sonication setup and also sonotransfection methods when doing in vivo experiments. Factors that could potentially influence the outcome of an ultrasound experiment are cited. Several advantages of sonotransfection are recognized, although a low transfection rate is still considered a disadvantage of this method. To improve the transfection rate and the efficiency of sonotransfection, several studies are currently being undertaken. Particularly promising are studies using engineered microbubbles to carry the therapeutic genes into a particular target tissue in the body, then using ultrasound to release or deliver the genes directly into target cells, e.g., cancer cells.

Quantitative relations of acoustic inertial cavitation with sonoporation and cell viability

Ultrasound-induced acoustic cavitation assists gene delivery, possibly by increasing the permeability of the cell membranes. How the cavitation dose is related to the sonoporation rate and the cell viability is still unknown and so this in vitro study quantitatively investigated the effects of cavitation induced by 1-MHz pulsed ultrasound waves and the contrast agent Levovist (containing microbubbles when reconstituted by adding saline and shaken) on the delivery of short DNA-FITC molecules into HeLa cells. The concentrations of cells and DNA-FITC were 2 x 10(5) cells/mL and 40 microg/mL, respectively. The cavitation was quantified as the inertial cavitation dose (ICD), corresponding to the spectral broadband signal enhancement during microbubble destruction. The relations of ICD with sonoporation and cell viability were examined for various acoustic pressures (0.48-1.32 MPa), Levovist concentrations (1.12 x 10(5)-1.12 x 10(7) bubbles/mL) and pulse durations (1-10 cycles). The linear regressions of the sonoporation rate versus ICD and the cell viability versus ICD were y = 28.67x + 10.71 (R(2) = 0.95) and z = -62.83x + 91.18 (R(2) = 0.84), respectively, where x is ICD, y is the sonoporation rate and z is the cell viability. These results show that the sonoporation rate and the cell viability are highly correlated with the ICD, indicating that sonoporation results may be potentially predicted using ICD.

Biological and environmental factors affecting ultrasound-induced hemolysis in vitro: 2. Medium dissolved gas (pO2) content

The data collected in this project supported the a priori hypothesis that the concentration of dissolved oxygen in whole human blood in vitro affected the extent of ultrasound (US)-induced hemolysis under conditions conducive to the occurrence of inertial cavitation. Aliquots of whole human blood in vitro with a relatively high O(2) level had statistically significantly more 1-MHz US-induced hemolysis than aliquots with a relatively low O(2) level in the presence of controlled gas nucleation (Albunex or ALX, supplementation), with US-induced hemolytic yields being substantially less at 2.2- and 3.5-MHz exposures or in the absence of ALX-supplementation at otherwise comparable acoustic pressures, pulse lengths and duty factors. Passive cavitation detection (pcd) measures indicated a linear relationship for hemolysis up to about 70% and pcd values (R(2) = 0.99).

Enhancement of hyperthermia-induced apoptosis by non-thermal effects of ultrasound

To determine the effect of ultrasound on hyperthermia-induced apoptosis, we exposed U937 cells (in air-saturated suspension) to continuous 1 MHz ultrasound at intensities 0.5 or 1.0 W/cm(2), considered non-thermal and sub-threshold for inertial cavitation, while at 44.0 degrees C for 10 min. We found that 0.5 W/cm(2), in combination with hyperthermia, synergistically induced apoptosis. On the other hand, 1.0 W/cm(2) in combination with hyperthermia showed an augmented instant cell lysis but no significant change in the ratio of apoptosis. This result might be useful when apoptosis induction is desired over instant cell killing in cancer therapy.

DNA microarray analyses of genes elicited by ultrasound in human U937 cells

The gene expression of human histiocytic lymphoma cell line U937 at 6 h after 1 MHz ultrasound treatment in the presence of Ar or N(2)O gas was examined by DNA microarrays. Of the 9,182 genes analyzed, only the keratin gene was identified as down-regulated in the cells exposed to ultrasound in the presence of N(2)O where no internal cavitation was observed. In contrast, five up-regulated and two down-regulated genes were identified in the cells exposed to ultrasound in the presence of Ar where internal cavitation was apparently observed. Six changes of the gene expression were confirmed by the semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR). Gene expression of heme oxygenase was augmented by a factor of 6.6 in microarray and by 4.0 by RT-PCR. These results indicate that internal cavitation increased the expression of genes responsive to oxidative stress in sonicated cells but non-inertial cavitation had minimal effects on gene expression.

Mathematical description of combined action of ultrasound and hyperthermia on yeast cells

The inactivation of diploid yeast cells of Saccharomyces cerevisiae was studied after simultaneous treatment of ultrasound and hyperthermia. The existence of a definite temperature range was proved within which a synergistic interaction was determined. An optimal temperature that maximized the synergy could be identified. A simple mathematical model of synergistic interaction of damages produced by ultrasound and high temperature has been proposed. The model suggests that synergism is expected from the additional lethal damage arising from the interaction of sub-lesions induced by both agents. The model allows quantitative analysis of the combined action of two agents used to be performed, and predicts the greatest value of the synergistic effect and conditions under which it can be achieved.

Temporality in Ultrasound-Induced Cell Lysis In Vitro

To test the hypothesis that the full extent of in vitro cell lysis due to ultrasound becomes evident with time lapse following insonation, human erythrocytes (2% hematocrit) in autologous plasma were mixed with Albunex(R), a pulse echo contrast agent, and exposed to 1-MHz, continuous-wave ultrasound (US) (5 W/cm(2) SPTA intensity) for 60 seconds while in a rotating (200 rpm) dialysis membrane vessel. Exposed and sham-exposed samples were subsequently assayed for hemolysis colorimetrically, either immediately or after a delay of 3 hours. Hemolysis was dependent on the interval between US exposure and assay, with significantly greater lysis evident with delayed assay. There was also temporality in lytic yield with sample number, i.e., with time postpreparation of the blood sample, US-induced cell lysis decreased. The temporality of lytic yield was eliminated by maintenance at ice water temperatures, or by waiting about 1 hour before beginning treatments. The collective data indicate that the full extent of US-induced cell lysis is not evident upon assay immediately after insonation, and that with time postpreparation and preinsonation, erythrocytes may undergo changes in sensitivity to US. (ECHOCARDIOGRAPHY, Volume 13, January 1996)

Lysis of erythrocytes by exposure to CW ultrasound

The threshold for lysis of erythrocytes suspended at concentrations of 0.5-1% in saline or plasma in rotating cylindrical exposure vessels is approximately spatial peak intensities of 2 W/cm2 at 1 MHz continuous wave (CW). Results of a series of experiments in which cell concentration, viscosity and gas composition of the suspending medium and rotation speed of the exposure vessel were varied combined with observations of sonoluminescence are all consistent with a hypothesis that cells are lysed by inertial (transient) acoustic cavitation. For the proposed mechanism to operate in cell suspensions, it is necessary that bubbles be brought into contact with the cells. Rotation of the chamber recycles bubbles that are driven by radiation forces to the far wall of the chamber in a matter of milliseconds. The physical and chemical properties of the wall of the chamber appear to be important as stabilizing sites for nuclei that serve as seeds for cavitation events.

Cell density dependence of the ultrasonic degassing of fixed erythrocyte suspensions

Ultrasonic cell lysis in vitro shows a strong dependence on the cell density of the suspensions. The major determinant in this phenomenon appears to be the suspended particle density per se. Reported are the results of experiments designed to test the hypothesis that the majority of the cell density effect arises as a consequence of the cell density-dependent formation of cellular aggregates around oscillating bubbles in an ultrasound field (Nyborg and Miller 1982), which in turn diminishes the potential for the occurrence and sustenance of destructive cavitational events in the bulk suspension fluid. The hypothesis was tested indirectly using manometric methods to measure ultrasound-induced release of dissolved gas from saline solutions and fixed erythrocyte suspensions. Ultrasonic degassing of the fluids in excess of that attributable to thermal effects was observed, and was suppressed by the presence of fixed erythrocytes when the cell density was greater than 5 x 10(6) cells/mL. At higher cell densities, the inhibition of ultrasonic degassing by fixed cells increased monotonically with increasing cell density, attaining complete suppression at a cell density of 5 x 10(8) cells/mL. The data thus support the hypothesis.

Bioeffects in echocardiography

Two mechanisms have been identified through which ultrasound as it is used clinically could produce biologically significant effects. One is heating that results from the absorption of ultrasonic energy by tissues. The other is cavitation, the ultrasonic activation of gas bodies including the potentially violent collapse of small gas bodies in or near tissue that is sometimes called transient or inertial cavitation. The heart, itself, is well perfused and the likelihood of significant heating of the heart tissues in the most extreme conditions known today is negligible. Lung also appears to be relatively immune to heating under diagnostic exposure conditions. In normal echocardiographic procedures, the only tissues that need serious consideration are the ribs. Under extreme conditions, ultrasonic heating of the bone might be as great as 6 degrees C. Nonthermal action of ultrasound has been demonstrated to cause lung hemorrhage at pressure levels on the order of 1 MPa. Although many diagnostic devices produce focal pressures greater than this amount, it appears unlikely that hemorrhage will occur in normal echocardiographic applications. Under certain conditions, pulsed ultrasound can either stimulate or modify the contraction of the heart but the exposures required are not used in normal echocardiographic applications. Since specific devices have been identified who's outputs approach levels required to produce thermal and nonthermal effects, the user should be aware of potential biological effects, particularly in pediatric or obstetric applications, as output levels increase.

Effect of shear stress and free radicals induced by ultrasound on erythrocytes

The present study was undertaken to elucidate the mechanism of hemolysis induced by ultrasound. Ar or N2O gas was used to distinguish between cavitation with or without free radical formation (hydroxyl radicals and hydrogen atoms). Free radical formation was examined by the method of spin trapping combined with ESR. After sonication of erythrocyte suspensions, several structural and functional parameters of the erythrocyte membrane--hemolysis, membrane fluidity, membrane permeability, and membrane deformability--were examined. Although free radical formation was observed in the erythrocyte suspensions sonicated in the presence of Ar, no free radical formation was observed in the presence of N2O. However, the hemolysis behavior induced by ultrasound was similar in the presence of Ar or N2O. The membrane fluidity, permeability, and deformability of the remaining unlysed erythrocytes after sonication in the presence of Ar or N2O were unchanged and identical to those of the control cells. On the other hand, after gamma irradiation (700 Gy), the hemolysis behavior was quite different from that after sonication, and the membrane properties were significantly changed. These results suggest that hemolysis induced by sonication was due to mechanical shearing stress arising from cavitation, and that the membrane integrity of the remaining erythrocytes after sonication was the same as that of control cells without sonication. The triatomic gas, N2O, may be useful for ultrasonically disrupting cells without accompanying free radical formation.