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Kim HB, Baik KY, Sung CK. Histological Response to 5 kHz Irreversible Electroporation in a Porcine Liver Model. Technol Cancer Res Treat 2023; 22:15330338231171767. [PMID: 37125478 PMCID: PMC10134162 DOI: 10.1177/15330338231171767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Unlike necrosis by thermal ablation, irreversible electroporation (IRE) is known to induce apoptosis by disrupting plasma membrane integrity with electric pulses while preserving the structure of blood vessels and bile ducts in liver tissue without a heat sink effect. This study aimed to investigate thermal damage and histopathological effects in the porcine liver by high-frequency electric pulses (5 kHz) which is much higher than the widely used 1 Hz. The electric field and thermal distributions of 5 kHz electric pulses were compared with those of 1 Hz in numerical simulations. 5 kHz-IRE was applied on pigs under ultrasound imaging to guide the electrode placement. The animals underwent computed tomography (CT) examination immediately and 1 day after IRE. After CT, IRE-treated tissues were taken and analyzed histologically. CT revealed that hepatic veins were intact for 1-day post-IRE. Histopathologically, the structure of the portal vein was intact, but endothelial cells were partially removed. In addition, the hepatic artery structure from which endothelial cells were removed were not damaged, while the bile duct structure and cholangiocytes were intact. The thermal injury was observed only in the vicinity of the electrodes as simulated in silico. 5 kHz-IRE generated high heat due to its short pulse interval, but the thermal damage was limited to the tissue around the electrodes. The histopathological damage caused by 5 kHz-IRE was close to that caused by 1 Hz-IRE. If a short-time treatment is required for reasons such as anesthesia, high-frequency IRE treatment is worth considering. Our observations will contribute to a better understanding of the IRE phenomena and search for advanced therapeutic conditions.
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Affiliation(s)
- Hong Bae Kim
- Medical Engineering Research Center, The Standard Co. Ltd, Gunpo-si, Republic of Korea
| | - Ku Youn Baik
- Electrical and Biological Physics, Kwangwoon University, Seoul, Republic of Korea
| | - Chang Kyu Sung
- Department of Radiology, Seoul National University College of Medicine and Boramae Medical Center, Seoul, Republic of Korea
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Modification of a Ready-Made High-Voltage Pulse Generator for Non-Thermal Irreversible Electroporation. Bull Exp Biol Med 2022; 173:276-280. [DOI: 10.1007/s10517-022-05533-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 10/17/2022]
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Rai ZL, Feakins R, Pallett LJ, Manas D, Davidson BR. Irreversible Electroporation (IRE) in Locally Advanced Pancreatic Cancer: A Review of Current Clinical Outcomes, Mechanism of Action and Opportunities for Synergistic Therapy. J Clin Med 2021; 10:1609. [PMID: 33920118 PMCID: PMC8068938 DOI: 10.3390/jcm10081609] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/04/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022] Open
Abstract
Locally advanced pancreatic cancer (LAPC) accounts for 30% of patients with pancreatic cancer. Irreversible electroporation (IRE) is a novel cancer treatment that may improve survival and quality of life in LAPC. This narrative review will provide a perspective on the clinical experience of pancreas IRE therapy, explore the evidence for the mode of action, assess treatment complications, and propose strategies for augmenting IRE response. A systematic search was performed using PubMed regarding the clinical use and safety profile of IRE on pancreatic cancer, post-IRE sequential histological changes, associated immune response, and synergistic therapies. Animal data demonstrate that IRE induces both apoptosis and necrosis followed by fibrosis. Major complications may result from IRE; procedure related mortality is up to 2%, with an average morbidity as high as 36%. Nevertheless, prospective and retrospective studies suggest that IRE treatment may increase median overall survival of LAPC to as much as 30 months and provide preliminary data justifying the well-designed trials currently underway, comparing IRE to the standard of care treatment. The mechanism of action of IRE remains unknown, and there is a lack of data on treatment variables and efficiency in humans. There is emerging data suggesting that IRE can be augmented with synergistic therapies such as immunotherapy.
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Affiliation(s)
- Zainab L. Rai
- Centre of Surgical Innovation, Organ Regeneration and Transplantation, University College London (UCL), London NW3 2QG, UK;
- Wellcome/EPSRC Center for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK
- Royal Free NHS Foundation Trust, London NW3 2QG, UK;
| | - Roger Feakins
- Royal Free NHS Foundation Trust, London NW3 2QG, UK;
| | - Laura J. Pallett
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London WC1E 6BT, UK;
| | - Derek Manas
- Newcastle Upon Tyne NHS Foundation Trust, Newcastle-Upon-Tyne NE7 7DN, UK;
| | - Brian R. Davidson
- Centre of Surgical Innovation, Organ Regeneration and Transplantation, University College London (UCL), London NW3 2QG, UK;
- Royal Free NHS Foundation Trust, London NW3 2QG, UK;
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Kim HB, Chung JH. Incorporation of Reversible Electroporation Into Electrolysis Accelerates Apoptosis for Rat Liver Tissue. Technol Cancer Res Treat 2020; 19:1533033820948051. [PMID: 32985353 PMCID: PMC7534095 DOI: 10.1177/1533033820948051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Tissue electrolysis is an alternative modality that uses a low intensity direct electric current passing through at least 2 electrodes within the tissue and resulting electrochemical products including chlorine and hydrogen. These products induce changes in pH around electrodes and cause dehydration resulting from electroosmotic pressure, leading to changes in microenvironment and thus metabolism of the tissues, yielding apoptosis. The procedure requires adequate time for electrochemical reactions to yield products sufficient to induce apoptosis of the tissues. Incorporation of electroporation into electrolysis can decrease the treatment time and enhance the efficiency of electrolytic ablation. Electroporation causes permeabilization in the cell membrane allowing the efflux of potassium ions and extension of the electrochemical area, facilitating the electrolysis process. However, little is known about the combined effects on apoptosis in liver ablation. In this study, we performed an immunohistochemical evaluation of apoptosis for the incorporation of electroporation into electrolysis in liver tissues. To do so, the study was performed with microelectrodes for fixed treatment time while the applied voltage varied to increase the applied total energy for electrolysis. The apoptotic rate for electrolytic ablation increased with enhanced applied energy. The apoptotic rate was 4.31 ± 1.73 times that of control in the synergistic combination compared to 1.49 ± 0.33 times that of the control in electrolytic ablation alone. Additionally, tissue structure was better preserved in synergistic combination ablation compared to electrolysis with an increment of 3.8 mA. Thus, synergistic ablation may accelerate apoptosis and be a promising modality for the treatment of liver tumors.
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Affiliation(s)
- Hong Bae Kim
- Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Jong Hoon Chung
- Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea.,Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, Republic of Korea
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Effects of Actin Cytoskeleton Disruption on Electroporation In Vitro. Appl Biochem Biotechnol 2020; 191:1545-1561. [PMID: 32157625 DOI: 10.1007/s12010-020-03271-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/13/2020] [Indexed: 01/26/2023]
Abstract
The role of actin fibers in cellular responses to external electric pulses is not clear yet. In this study, we utilized the blocker of actin polymerization, cytochalasin D (cytoD), and investigated its effects on the electropore generation. Eight 100 μs electric pulses of sub-kilovolt per centimeter voltage with 100 ms intervals were applied to adhered cells in vitro, and the membrane permeability was quantified using membrane-impermeable propidium iodide (PI) dye. With cytoD application, the transfer of PI dye decreased significantly in all the applied voltages. At the same time, the roughness of cells increased, the membrane stiffness decreased, and the transmembrane resting potential decreased. Our result supports that actin fibers have clear effects on electroporation through modulating membrane properties including transmembrane resting potential.
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Lee JM, Choi HS, Kim ES, Keum B, Seo YS, Jeen YT, Lee HS, Chun HJ, Um SH, Kim CD, Kim HB. Characterization of irreversible electroporation on the stomach: A feasibility study in rats. Sci Rep 2019; 9:9094. [PMID: 31235753 PMCID: PMC6591231 DOI: 10.1038/s41598-019-45659-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/11/2019] [Indexed: 12/12/2022] Open
Abstract
Irreversible electroporation (IRE) is a newly developed non-thermal ablative therapy. During the IRE procedure, the permeability of the cell membrane is irreversibly changed by application of high-energy pulses across the tissue. This induces the breakdown of cell homeostasis, and thereby cell death. Here, we present an in vivo study to demonstrate IRE ablation of gastric tissue and characterize the changes that occur with time therein. No significant complications were observed in the test rats during the experiment. The electroporated tissues exhibited apoptosis at 10, 24 and 48 h after IRE ablation. The apoptosis peaked at 10 h after IRE and then declined, suggesting that the ablated tissue rapidly recovered owing to intense metabolic activity. In addition, the electroporated tissues exhibited morphological changes such as pyknosis and karyorrhexis, while histological analysis showed that the blood vessels were preserved. Interestingly, electroporation greatly affected the mucosa and muscularis propria, but not the submucosa and serosa. This study suggests that IRE could potentially be used as a minimally invasive treatment for early gastric cancer that does not exhibit lymph node metastasis or dysplasia.
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Affiliation(s)
- Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea.
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Yeon Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Soon Ho Um
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Chang Duck Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Hong Bae Kim
- Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, 08826, Republic of Korea
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Sugrue A, Maor E, Ivorra A, Vaidya V, Witt C, Kapa S, Asirvatham S. Irreversible electroporation for the treatment of cardiac arrhythmias. Expert Rev Cardiovasc Ther 2018; 16:349-360. [DOI: 10.1080/14779072.2018.1459185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Alan Sugrue
- Department of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elad Maor
- Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Antoni Ivorra
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Vaibhav Vaidya
- Department of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chance Witt
- Department of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Suraj Kapa
- Department of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Samuel Asirvatham
- Department of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Vogel JA, van Veldhuisen E, Agnass P, Crezee J, Dijk F, Verheij J, van Gulik TM, Meijerink MR, Vroomen LG, van Lienden KP, Besselink MG. Time-Dependent Impact of Irreversible Electroporation on Pancreas, Liver, Blood Vessels and Nerves: A Systematic Review of Experimental Studies. PLoS One 2016; 11:e0166987. [PMID: 27870918 PMCID: PMC5117758 DOI: 10.1371/journal.pone.0166987] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/07/2016] [Indexed: 12/12/2022] Open
Abstract
Introduction Irreversible electroporation (IRE) is a novel ablation technique in the treatment of unresectable cancer. The non-thermal mechanism is thought to cause mostly apoptosis compared to necrosis in thermal techniques. Both in experimental and clinical studies, a waiting time between ablation and tissue or imaging analysis to allow for cell death through apoptosis, is often reported. However, the dynamics of the IRE effect over time remain unknown. Therefore, this study aims to summarize these effects in relation to the time between treatment and evaluation. Methods A systematic search was performed in Pubmed, Embase and the Cochrane Library for original articles using IRE on pancreas, liver or surrounding structures in animal or human studies. Data on pathology and time between IRE and evaluation were extracted. Results Of 2602 screened studies, 36 could be included, regarding IRE in liver (n = 24), pancreas (n = 4), blood vessels (n = 4) and nerves (n = 4) in over 440 animals (pig, rat, goat and rabbit). No eligible human studies were found. In liver and pancreas, the first signs of apoptosis and haemorrhage were observed 1–2 hours after treatment, and remained visible until 24 hours in liver and 7 days in pancreas after which the damaged tissue was replaced by fibrosis. In solitary blood vessels, the tunica media, intima and lumen remained unchanged for 24 hours. After 7 days, inflammation, fibrosis and loss of smooth muscle cells were demonstrated, which persisted until 35 days. In nerves, the median time until demonstrable histological changes was 7 days. Conclusions Tissue damage after IRE is a dynamic process with remarkable time differences between tissues in animals. Whereas pancreas and liver showed the first damages after 1–2 hours, this took 24 hours in blood vessels and 7 days in nerves.
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Affiliation(s)
- J. A. Vogel
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - E van Veldhuisen
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - P. Agnass
- Department of Radiation Therapy, Academic Medical Center, Amsterdam, the Netherlands
| | - J. Crezee
- Department of Radiation Therapy, Academic Medical Center, Amsterdam, the Netherlands
| | - F. Dijk
- Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands
| | - J. Verheij
- Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands
| | - T. M. van Gulik
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
- Department of Experimental Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - M. R. Meijerink
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - L. G. Vroomen
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - K. P. van Lienden
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - M. G. Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail:
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Phillips M, Krishnan H, Raju N, Rubinsky B. Tissue Ablation by a Synergistic Combination of Electroporation and Electrolysis Delivered by a Single Pulse. Ann Biomed Eng 2016; 44:3144-3154. [DOI: 10.1007/s10439-016-1624-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/20/2016] [Indexed: 01/20/2023]
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Sung CK, Kim HB, Jung JH, Baik KY, Moon KW, Kim HS, Yi JH, Chung JH. Histological and Mathematical Analysis of the Irreversibly Electroporated Liver Tissue. Technol Cancer Res Treat 2016; 16:488-496. [PMID: 27079209 DOI: 10.1177/1533034616640642] [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] [Indexed: 12/14/2022] Open
Abstract
Irreversible electroporation has clinically been used to treat various types of cancer. A plan on how to apply irreversible electroporation before practicing is very important to increase the ablation area and reduce the side effects. Several electrical models have been developed to predict the ablation area with applied electric energy. In this experiment, the static relationship between applied electric energy and ablated area was mathematically and experimentally investigated at 10 hours after applying irreversible electroporation. We performed the irreversible electroporation on the liver tissue of Sprague Dawley rats (male, 8 weeks, weighing 250-350 g). The ablated area was measured based on histological analysis and compared with the mathematical calculation from the electric energy, assuming that the tissue is homogeneous. The ablated area increased with the increase in applied electric energy. The numerically calculated contour lines of electric energy density overlapped well with the apoptotic area induced by the irreversible electroporation. The overlapped area clearly showed that the destructive threshold of apoptosis between electrodes is electric energy density level of 5.9 × 105 J/m3. The results of the present study suggested that the clinical results of the irreversible electroporation on a liver tissue could be predicted through mathematical calculation.
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Affiliation(s)
- Chang Kyu Sung
- 1 Department of Radiology, Seoul National University Cancer Research Institute, SNU-SMG Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong Bae Kim
- 2 Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Jong Hyun Jung
- 3 Department of Physics and Astronomy, Seoul National University, Seoul, Republic of Korea
| | - Ku Youn Baik
- 4 Department of Electrical and Biological Physics, Kwangwoon University, Seoul, Republic of Korea
| | - Kee Wook Moon
- 5 Quality Management Team, Infopia Co Ltd, Anyang-si, Republic of Korea
| | - Hyung-Sik Kim
- 6 Department of Biomedical Engineering, Research Institute of Biomedical Engineering, College of Biomedical & Health Science, Konkuk University, Chungcheongbuk-do, Republic of Korea
| | - Jeong-Han Yi
- 6 Department of Biomedical Engineering, Research Institute of Biomedical Engineering, College of Biomedical & Health Science, Konkuk University, Chungcheongbuk-do, Republic of Korea
| | - Jong Hoon Chung
- 2 Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea.,7 Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, Republic of Korea
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Kim HB, Sung CK, Baik KY, Moon KW, Kim HS, Yi JH, Jung JH, Moon MH, Choi OK. Changes of apoptosis in tumor tissues with time after irreversible electroporation. Biochem Biophys Res Commun 2013; 435:651-6. [PMID: 23688425 DOI: 10.1016/j.bbrc.2013.05.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/09/2013] [Indexed: 12/18/2022]
Abstract
Irreversible electroporation is a novel method of ablating living tissues through its non-thermal effects, unlike radiofrequency ablation which has a severe problem of heat sink. It is due to high-energy direct current which leads to permanent disruption of lipid bilayer integrity in terms of exchanges between intra- and extracellular components via nano-sized pores. That finally causes irreversible damage to cellular homeostasis. Irreversibly damaged cells may undergo apoptosis followed by necrosis with time after electroporation. This damage can make it possible to monitor the ablated area with time post-IRE through MR imaging and an ultrasound system. Most previous studies have investigated the immediate response of undesired tissue to IRE. In our study, we showed changes of tumor tissues with time post-IRE by histological analysis and MR imaging. Tissues under IRE ablation showed a peak apoptotic rate at 24 h after IRE ablation with viable tissues at the peripheral rim of treated tissues in histological analysis. This phenomenon was also observed with no enhancement on contrast-enhanced MR images due to devascularization of IRE ablated zones.
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Affiliation(s)
- Hong-Bae Kim
- Department of Radiology and Seoul National University Cancer Research Institute, Seoul National University College of Medicine, SNU-SMG Boramae Medical Center, 39 Boramae-Gil, Dongjak-Gu, Seoul 156-707, Republic of Korea
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Golberg A, Yarmush ML. Nonthermal irreversible electroporation: fundamentals, applications, and challenges. IEEE Trans Biomed Eng 2013; 60:707-14. [PMID: 23314769 DOI: 10.1109/tbme.2013.2238672] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tissue ablation is an essential procedure for the treatment of many diseases. In the last decade, a nonthermal tissue ablation using intensive pulsed electric fields, called nonthermal irreversible electroporation (NTIRE), has rapidly emerged. The exact mechanisms responsible for cell death by NTIRE, however, are currently unknown. Nevertheless, the technique's remarkable ability to ablate tissue in the proximity of larger blood vessels, to preserve tissue architecture, short procedure duration, and shortened postoperative recovery period rapidly moved NTIRE from bench to bed side. This work provides an overview on the development of NTIRE, its current state-of-the-art, challenges, and future needs.
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Affiliation(s)
- Alexander Golberg
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Li W, Fan Q, Ji Z, Qiu X, Li Z. The effects of irreversible electroporation (IRE) on nerves. PLoS One 2011; 6:e18831. [PMID: 21533143 PMCID: PMC3077412 DOI: 10.1371/journal.pone.0018831] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 03/10/2011] [Indexed: 02/07/2023] Open
Abstract
Background If a critical nerve is circumferentially involved with tumor, radical surgery intended to cure the cancer must sacrifice the nerve. Loss of critical nerves may lead to serious consequences. In spite of the impressive technical advancements in nerve reconstruction, complete recovery and normalization of nerve function is difficult to achieve. Though irreversible electroporation (IRE) might be a promising choice to treat tumors near or involved critical nerve, the pathophysiology of the nerve after IRE treatment has not be clearly defined. Methods We applied IRE directly to a rat sciatic nerve to study the long term effects of IRE on the nerve. A sequence of 10 square pulses of 3800 V/cm, each 100 µs long was applied directly to rat sciatic nerves. In each animal of group I (IRE) the procedure was applied to produce a treated length of about 10 mm. In each animal of group II (Control) the electrodes were only applied directly on the sciatic nerve for the same time. Electrophysiological, histological, and functional studies were performed on immediately after and 3 days, 1 week, 3, 5, 7 and 10 weeks following surgery. Findings Electrophysiological, histological, and functional results show the nerve treated with IRE can attain full recovery after 7 weeks. Conclusion This finding is indicative of the preservation of nerve involving malignant tumors with respect to the application of IRE pulses to ablate tumors completely. In summary, IRE may be a promising treatment tool for any tumor involving nerves.
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Affiliation(s)
- Wei Li
- Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, The Fourth Military Medical University, Xi’an, Shanxi, China
| | - Qingyu Fan
- Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, The Fourth Military Medical University, Xi’an, Shanxi, China
| | - Zhenwei Ji
- Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, The Fourth Military Medical University, Xi’an, Shanxi, China
| | - Xiuchun Qiu
- Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, The Fourth Military Medical University, Xi’an, Shanxi, China
| | - Zhao Li
- Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, The Fourth Military Medical University, Xi’an, Shanxi, China
- * E-mail:
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Abstract
Irreversible electroporation (IRE) is a novel tumor ablation technique using a non-thermal energy to create innumerable permanent nanopores in the cell membrane to disrupt cellular homeostasis. This disruption of cellular homeostasis initiates apoptosis which leads to permanent cell death. In our translational research, we have demonstrated that IRE can be a safe, fast and powerful method of tumor treatment. In this review, we present an overview of IRE ablation including a brief history of IRE, advantages and disadvantages of IRE and clinical and research implications of IRE.
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Affiliation(s)
- Edward W Lee
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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