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Ward RE, Martinez-Correa S, Tierradentro-García LO, Hwang M, Sehgal CM. Sonothrombolysis: State-of-the-Art and Potential Applications in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 11:57. [PMID: 38255371 PMCID: PMC10814591 DOI: 10.3390/children11010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
In recent years, advances in ultrasound therapeutics have been implemented into treatment algorithms for the adult population; however, the use of therapeutic ultrasound in the pediatric population still needs to be further elucidated. In order to better characterize the utilization and practicality of sonothrombolysis in the juvenile population, the authors conducted a literature review of current pediatric research in therapeutic ultrasound. The PubMed database was used to search for all clinical and preclinical studies detailing the use and applications of sonothrombolysis, with a focus on the pediatric population. As illustrated by various review articles, case studies, and original research, sonothrombolysis demonstrates efficacy and safety in clot dissolution in vitro and in animal studies, particularly when combined with microbubbles, with potential applications in conditions such as deep venous thrombosis, peripheral vascular disease, ischemic stroke, myocardial infarction, and pulmonary embolism. Although there is limited literature on the use of therapeutic ultrasound in children, mainly due to the lower prevalence of thrombotic events, sonothrombolysis shows potential as a noninvasive thrombolytic treatment. However, more pediatric sonothrombolysis research needs to be conducted to quantify the safety and ethical considerations specific to this vulnerable population.
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Affiliation(s)
- Rebecca E. Ward
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (R.E.W.); (S.M.-C.); (L.O.T.-G.); (M.H.)
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Santiago Martinez-Correa
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (R.E.W.); (S.M.-C.); (L.O.T.-G.); (M.H.)
| | - Luis Octavio Tierradentro-García
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (R.E.W.); (S.M.-C.); (L.O.T.-G.); (M.H.)
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Misun Hwang
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (R.E.W.); (S.M.-C.); (L.O.T.-G.); (M.H.)
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Chandra M. Sehgal
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Liu WS, Zhu SF, Guo YL, Huang R, Yang X. Effect of microbubbles on transcranial doppler ultrasound-assisted intracranial recombinant tissue-type plasminogen activator thrombolysis. Vascular 2023; 31:1194-1200. [PMID: 35799413 DOI: 10.1177/17085381221079109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of microbubbles on the efficacy of transcranial doppler (TCD) ultrasound-assisted thrombolytic therapy of recombinant tissue-type plasminogen activator (rt-PA). METHODS Male New Zealand white rabbits (n = 36) were randomly divided into an rt-PA group (n = 18) and an rt-PA plus microbubble group (n = 18). After the cerebral infarction model was constructed with autologous blood clots, rt-PA and rt-PA plus microbubble intervention were performed, respectively. The hemodynamic changes and infarct size of the two groups were recorded. In addition, the ELISA method was used to detect the level of nitric oxide (NO), superoxide dismutase (SOD), and malondialdehyde (MDA) in the brain tissue of the two-group graph model and high-sensitivity C-reactive protein (hs-CRP) in the serum. RESULTS In the rt-PA group, the recanalization rate was 38.9% and the average infarct size was 11.8%. In the rt-PA plus microbubble group, the recanalization rate was 66.7% and the average infarct size was 8.2%. In addition, the average values for NO, SOD, MDA, and hs-CRP were 16.48 ± 5.39 μmol/L, 730.2 ± 9.86 U/mg, 0.92 ± 0.43 nmol/mg, and 8.56 ± 1.64 mg/L in the rt-PA group, respectively, and the average values were 9.18 ± 3.37 μmol/L, 426.2 ± 6.39 U/mg, 0.73 ± 0.44 nmol/mg, and 5.23 ± 0.94 mg/L in the rt-PA plus microbubble group, respectively. CONCLUSIONS The addition of microbubbles enhanced the effects of TCD-assisted rrt-PA thrombolysis.
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Affiliation(s)
- Wei-Song Liu
- Department of Internal Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Shao-Fen Zhu
- Department of Internal Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yuan-Ling Guo
- Department of Internal Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Rong Huang
- Department of Internal Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xue Yang
- Department of Internal Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Parker P, Pynn H, Haldane AG, Ballard M, König TC, Johnston AM. UK Field Medical Care 2032: one Military Vision. BMJ Mil Health 2023; 169:485-487. [PMID: 35091495 DOI: 10.1136/bmjmilitary-2021-002056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Paul Parker
- 16 Medical Regiment, Merville Barracks, Colchester, UK
- Senior Lecturer in Special Operations Medicine, University College, Cork, Eire
| | - H Pynn
- Bristol Royal Infirmary, Emergency Department, Bristol, UK
| | - A G Haldane
- 16 Medical Regiment, Merville Barracks, Colchester, UK
| | - M Ballard
- Radiology Department, RCDM Birmingham, Birmingham, UK
| | - T C König
- 16 Medical Regiment, Merville Barracks, Colchester, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - A M Johnston
- Department of Anaesthesia and Intensive Care Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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Tsivgoulis G, Safouris A, Alexandrov AV. Ultrasonography. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Shin Low S, Nong Lim C, Yew M, Siong Chai W, Low LE, Manickam S, Ti Tey B, Show PL. Recent ultrasound advancements for the manipulation of nanobiomaterials and nanoformulations for drug delivery. ULTRASONICS SONOCHEMISTRY 2021; 80:105805. [PMID: 34706321 PMCID: PMC8555278 DOI: 10.1016/j.ultsonch.2021.105805] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/08/2021] [Accepted: 10/20/2021] [Indexed: 05/04/2023]
Abstract
Recent advances in ultrasound (US) have shown its great potential in biomedical applications as diagnostic and therapeutic tools. The coupling of US-assisted drug delivery systems with nanobiomaterials possessing tailor-made functions has been shown to remove the limitations of conventional drug delivery systems. The low-frequency US has significantly enhanced the targeted drug delivery effect and efficacy, reducing limitations posed by conventional treatments such as a limited therapeutic window. The acoustic cavitation effect induced by the US-mediated microbubbles (MBs) has been reported to replace drugs in certain acute diseases such as ischemic stroke. This review briefly discusses the US principles, with particular attention to the recent advancements in drug delivery applications. Furthermore, US-assisted drug delivery coupled with nanobiomaterials to treat different diseases (cancer, neurodegenerative disease, diabetes, thrombosis, and COVID-19) are discussed in detail. Finally, this review covers the future perspectives and challenges on the applications of US-mediated nanobiomaterials.
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Affiliation(s)
- Sze Shin Low
- Continental-NTU Corporate Lab, Nanyang Technological University, 50 Nanyang Drive, Singapore 637553, Singapore; Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, Semenyih 43500, Selangor Darul Ehsan, Malaysia
| | - Chang Nong Lim
- School of Engineering and Physical Sciences, Heriot-Watt University Malaysia, No. 1, Jalan Venna P5/2, Precinct 5, Putrajaya 62200, Malaysia
| | - Maxine Yew
- Department of Mechanical, Materials and Manufacturing Engineering, University of Nottingham Ningbo China, 199 Taikang East Road, Ningbo 315100, Zhejiang, China
| | - Wai Siong Chai
- School of Mechanical Engineering and Automation, Harbin Institute of Technology, Shenzhen, Shenzhen 518055, Guangdong, China
| | - Liang Ee Low
- Biofunctional Molecule Exploratory (BMEX) Research Group, School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, China.
| | - Sivakumar Manickam
- Petroleum and Chemical Engineering, Faculty of Engineering, Universiti Teknologi Brunei, Jalan Tungku Link Gadong, Bandar Seri Begawan, BE1410, Brunei Darussalam.
| | - Beng Ti Tey
- Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; Chemical Engineering Discipline, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia
| | - Pau Loke Show
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, Semenyih 43500, Selangor Darul Ehsan, Malaysia.
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Refaat A, del Rosal B, Palasubramaniam J, Pietersz G, Wang X, Peter K, Moulton SE. Smart Delivery of Plasminogen Activators for Efficient Thrombolysis; Recent Trends and Future Perspectives. ADVANCED THERAPEUTICS 2021. [DOI: 10.1002/adtp.202100047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ahmed Refaat
- Department of Telecommunications, Electrical, Robotics and Biomedical Engineering, Faculty of Science, Engineering and Technology Swinburne University of Technology John St Melbourne VIC 3122 Australia
- Atherothrombosis and Vascular Biology Laboratory Baker Heart and Diabetes Institute 75 Commercial Road Melbourne VIC 3004 Australia
- Molecular Imaging and Theranostics Laboratory Baker Heart and Diabetes Institute 75 Commercial Road Melbourne VIC 3004 Australia
- Pharmaceutics Department Faculty of Pharmacy ‐ Alexandria University 1 El‐Khartoum Square Azarita Alexandria 21521 Egypt
| | - Blanca del Rosal
- ARC Centre of Excellence for Nanoscale BioPhotonics School of Science RMIT University 124 La Trobe St Melbourne VIC 3000 Australia
| | - Jathushan Palasubramaniam
- Atherothrombosis and Vascular Biology Laboratory Baker Heart and Diabetes Institute 75 Commercial Road Melbourne VIC 3004 Australia
- Molecular Imaging and Theranostics Laboratory Baker Heart and Diabetes Institute 75 Commercial Road Melbourne VIC 3004 Australia
- Department of Medicine Monash University 27 Rainforest Walk Melbourne VIC 3800 Australia
- Department of Cardiology Alfred Hospital 55 Commercial Rd Melbourne VIC 3004 Australia
| | - Geoffrey Pietersz
- Atherothrombosis and Vascular Biology Laboratory Baker Heart and Diabetes Institute 75 Commercial Road Melbourne VIC 3004 Australia
- Burnet Institute 85 Commercial Road Melbourne VIC 3004 Australia
| | - Xiaowei Wang
- Atherothrombosis and Vascular Biology Laboratory Baker Heart and Diabetes Institute 75 Commercial Road Melbourne VIC 3004 Australia
- Molecular Imaging and Theranostics Laboratory Baker Heart and Diabetes Institute 75 Commercial Road Melbourne VIC 3004 Australia
- Department of Medicine Monash University 27 Rainforest Walk Melbourne VIC 3800 Australia
- Department of Cardiometabolic Health University of Melbourne Melbourne VIC 3010 Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology Laboratory Baker Heart and Diabetes Institute 75 Commercial Road Melbourne VIC 3004 Australia
- Department of Medicine Monash University 27 Rainforest Walk Melbourne VIC 3800 Australia
- Department of Cardiology Alfred Hospital 55 Commercial Rd Melbourne VIC 3004 Australia
- Department of Cardiometabolic Health University of Melbourne Melbourne VIC 3010 Australia
| | - Simon E. Moulton
- Department of Telecommunications, Electrical, Robotics and Biomedical Engineering, Faculty of Science, Engineering and Technology Swinburne University of Technology John St Melbourne VIC 3122 Australia
- ARC Centre of Excellence for Electromaterials Science Swinburne University of Technology John St Melbourne VIC 3122 Australia
- Aikenhead Centre for Medical Discovery (ACMD) St Vincent's Hospital Melbourne VIC 3065 Australia
- Iverson Health Innovation Research Institute Swinburne University of Technology John St Melbourne VIC 3122 Australia
- Australian Institute for Innovative Materials, Intelligent Polymer Research Institute University of Wollongong Wollongong NSW 2500 Australia
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Kleven RT, Karani KB, Hilvert N, Ford SM, Mercado-Shekhar KP, Racadio JM, Rao MB, Abruzzo TA, Holland CK. Accelerated sonothrombolysis with Definity in a xenographic porcine cerebral thromboembolism model. Sci Rep 2021; 11:3987. [PMID: 33597659 PMCID: PMC7889614 DOI: 10.1038/s41598-021-83442-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/29/2021] [Indexed: 01/31/2023] Open
Abstract
Adjuvant ultrasound at 2 MHz with or without an ultrasound contrast agent improves the rate of thrombus resolution by recombinant tissue plasminogen activator (rt-PA) in laboratory and clinical studies. A sub-megahertz approach can further expand this therapy to a subset of patients with an insufficient temporal bone window, improving efficacy in unselected patient populations. The aim of this study was to determine if a clinical ultrasound contrast agent (UCA), Definity, and 220 kHz pulsed ultrasound accelerated rt-PA thrombolysis in a preclinical animal model of vascular occlusion. The effect of Definity and ultrasound on thrombus clearance was first investigated in vitro and subsequently tested in a xenographic porcine cerebral thromboembolism model in vivo. Two different microcatheter designs (end-hole, multi-side-hole) were used to infuse rt-PA and Definity at the proximal edge or directly into clots, respectively. Sonothrombolysis with Definity increased clot mass loss relative to saline or rt-PA alone in vitro, only when rt-PA was administered directly into clots via a multi-side-hole microcatheter. Combined treatment with rt-PA, Definity, and ultrasound in vivo increased the rate of reperfusion up to 45 min faster than clots treated with rt-PA or saline. In this porcine cerebral thromboembolism model employing retracted human clots, 220 kHz ultrasound, in conjunction with Definity increased the probability of early successful reperfusion with rt-PA.
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Affiliation(s)
- Robert T Kleven
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, University of Cincinnati, CVC 3921, 0586, 231 Albert Sabin Way, Cincinnati, OH, 45267-0586, USA.
| | - Kunal B Karani
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nicole Hilvert
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Samantha M Ford
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Karla P Mercado-Shekhar
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - John M Racadio
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marepalli B Rao
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, University of Cincinnati, CVC 3921, 0586, 231 Albert Sabin Way, Cincinnati, OH, 45267-0586, USA
| | - Todd A Abruzzo
- Division of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
- Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Christy K Holland
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, University of Cincinnati, CVC 3921, 0586, 231 Albert Sabin Way, Cincinnati, OH, 45267-0586, USA
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
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Ultrasound combined with microbubbles enhances the renoprotective effects of methylprednisolone in rats with adriamycin-induced nephropathy. Eur J Pharm Sci 2021; 159:105714. [PMID: 33453390 DOI: 10.1016/j.ejps.2021.105714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/24/2020] [Accepted: 01/07/2021] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to investigate the effect of ultrasound combined with microbbules (SonoVueTM) on the potency of methylprednisolone in attenuating the renal injury induced by adriamycin in rats. Animal model was established by two intravenous injections of 4 mg/kg adriamycin with a 2-week interval in rats. One week later, the adriamycin injected rats were randomly divided into 7 groups, receiving various treatments daily for 2 weeks. Two doses of methylprednisolone (20 or 40 mg/kg) were administrated alone or 20 mg/kg methylprednisolone and 100 µL SonoVueTM microbbules (1-5 × 108 bubbles/mL; mean diameter of bubbles: 2.5 µm) was co-administrated by intravenous injections from the tail vein. The ultrasound was applied at a frequency of 0.8 MHz and a spatial average temporal average intensity of 2.79 W/cm2 for 5 min at a 50% duty cycle (1 s on 1 s off) on the back skin of the anatomic position of the kidney in rats of two groups combined with ultrasound. Renal injury were analyzed using immunohistochemical staining, real-time PCR, light and transmission electron microcopies. The kidney function related biochemical indexes were measured by automatic biochemistry analyzer. The results showed that adriamycin induced a typical renal injury and 40 mg/kg methylprednisolone injection significantly ameliorated the abnormality of key parameters such as proteinuria, renal mRNA and protein expression levels of nephrin, collagens III and IV as well as podocyte impairment, glomerulosclerosis and tubulointerstitial injury indexes. However, a sub-dose of methylprednisolone at 20 mg/kg was ineffective when administered intravenously, but its potency at this dosage was enhanced by co-administration with 100 µL SonoVueTM microbubbles plus ultrasound irradiation. In conclusion, ultrasound combined with microbubbles can significantly increase local renal drug delivery leading to enhanced therapeutic effect of low dose methylprednisolone in ameliorating adriamycin-induced nephropathy in rats.
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Su M, Dai Q, Chen C, Zeng Y, Chu C, Liu G. Nano-Medicine for Thrombosis: A Precise Diagnosis and Treatment Strategy. NANO-MICRO LETTERS 2020; 12:96. [PMID: 34138079 PMCID: PMC7770919 DOI: 10.1007/s40820-020-00434-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/13/2020] [Indexed: 05/11/2023]
Abstract
Thrombosis is a global health issue and one of the leading factors of death. However, its diagnosis has been limited to the late stages, and its therapeutic window is too narrow to provide reasonable and effective treatment. In addition, clinical thrombolytics suffer from a short half-life, allergic reactions, inactivation, and unwanted tissue hemorrhage. Nano-medicines have gained extensive attention in diagnosis, drug delivery, and photo/sound/magnetic-theranostics due to their convertible properties. Furthermore, diagnosis and treatment of thrombosis using nano-medicines have also been widely studied. This review summarizes the recent advances in this area, which revealed six types of nanoparticle approaches: (1) in vitro diagnostic kits using "synthetic biomarkers"; (2) in vivo imaging using nano-contrast agents; (3) targeted drug delivery systems using artificial nanoparticles; (4) microenvironment responsive drug delivery systems; (5) drug delivery systems using biological nanostructures; and (6) treatments with external irradiation. The investigations of nano-medicines are believed to be of great significance, and some of the advanced drug delivery systems show potential applications in clinical theranotics.
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Affiliation(s)
- Min Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine School of Public Health, Xiamen University, Xiamen, 361102, People's Republic of China
- State Key Laboratory of Physical Chemistry of Solid Surfaces, The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, People's Republic of China
| | - Qixuan Dai
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine School of Public Health, Xiamen University, Xiamen, 361102, People's Republic of China
| | - Chuan Chen
- Department of Pharmacy, Xiamen Medical College, Xiamen, 361023, People's Republic of China
| | - Yun Zeng
- Department of Pharmacy, Xiamen Medical College, Xiamen, 361023, People's Republic of China
| | - Chengchao Chu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine School of Public Health, Xiamen University, Xiamen, 361102, People's Republic of China.
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, 361102, People's Republic of China.
| | - Gang Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine School of Public Health, Xiamen University, Xiamen, 361102, People's Republic of China.
- State Key Laboratory of Physical Chemistry of Solid Surfaces, The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, People's Republic of China.
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Zhong Y, Zhang Y, Xu J, Zhou J, Liu J, Ye M, Zhang L, Qiao B, Wang ZG, Ran HT, Guo D. Low-Intensity Focused Ultrasound-Responsive Phase-Transitional Nanoparticles for Thrombolysis without Vascular Damage: A Synergistic Nonpharmaceutical Strategy. ACS NANO 2019; 13:3387-3403. [PMID: 30855938 DOI: 10.1021/acsnano.8b09277] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Multimodal molecular imaging has shown promise as a complementary approach to thrombus detection. However, the simultaneous noninvasive detection and lysis of thrombi for cardiovascular diseases remain challenging. Herein, a perfluorohexane (PFH)-based biocompatible nanostructure was fabricated, namely, as-prepared Fe3O4-poly(lactic- co-glycolic acid)-PFH-CREKA nanoparticles (NPs), which combine phase transition (PT) thrombolysis capabilities with properties conducive to multimodal imaging. This well-developed PT agent responded effectively to low-intensity focused ultrasound (LIFU) by triggering the vaporization of liquid PFH to achieve thrombolysis. The presence of the CREKA peptide, which binds to the fibrin of the thrombus, allows targeted imaging and efficacious thrombolysis. Then, we found that, compared with thrombolysis using a non-phase-transition agent, PT thrombolysis can produce a robust decrease in the thrombus burden regardless of the acoustic power density of LIFU. In particular, the reduced energy for LIFU-responsive PT during the lysis process guarantees the superior safety of PT thrombolysis. After injecting the NPs intravenously, we demonstrated that this lysis process can be monitored with ultrasound and photoacoustic imaging in vivo to evaluate its efficacy. Therefore, this nonpharmaceutical strategy departs from routine methods and reveals the potential use of PT thrombolysis as an effective and noninvasive alternative to current thrombolytic therapy.
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Affiliation(s)
- Yixin Zhong
- Department of Radiology , Second Affiliated Hospital of Chongqing Medical University , No. 74 Linjiang Road , Yuzhong District, Chongqing , 400010 , People's Republic of China
- Chongqing Key Laboratory of Ultrasound Molecular Imaging & Department of Ultrasound , Second Affiliated Hospital of Chongqing Medical University , No. 74 Linjiang Road , Yuzhong District, Chongqing , 400010 , People's Republic of China
| | - Yu Zhang
- Department of Radiology , Second Affiliated Hospital of Chongqing Medical University , No. 74 Linjiang Road , Yuzhong District, Chongqing , 400010 , People's Republic of China
- Chongqing Key Laboratory of Ultrasound Molecular Imaging & Department of Ultrasound , Second Affiliated Hospital of Chongqing Medical University , No. 74 Linjiang Road , Yuzhong District, Chongqing , 400010 , People's Republic of China
| | - Jie Xu
- Department of Radiology , Second Affiliated Hospital of Chongqing Medical University , No. 74 Linjiang Road , Yuzhong District, Chongqing , 400010 , People's Republic of China
| | - Jun Zhou
- Department of Radiology , Second Affiliated Hospital of Chongqing Medical University , No. 74 Linjiang Road , Yuzhong District, Chongqing , 400010 , People's Republic of China
| | - Jia Liu
- Department of Radiology , Second Affiliated Hospital of Chongqing Medical University , No. 74 Linjiang Road , Yuzhong District, Chongqing , 400010 , People's Republic of China
| | - Man Ye
- Department of Radiology , Second Affiliated Hospital of Chongqing Medical University , No. 74 Linjiang Road , Yuzhong District, Chongqing , 400010 , People's Republic of China
| | - Liang Zhang
- Chongqing Key Laboratory of Ultrasound Molecular Imaging & Department of Ultrasound , Second Affiliated Hospital of Chongqing Medical University , No. 74 Linjiang Road , Yuzhong District, Chongqing , 400010 , People's Republic of China
| | - Bin Qiao
- Chongqing Key Laboratory of Ultrasound Molecular Imaging & Department of Ultrasound , Second Affiliated Hospital of Chongqing Medical University , No. 74 Linjiang Road , Yuzhong District, Chongqing , 400010 , People's Republic of China
| | - Zhi-Gang Wang
- Chongqing Key Laboratory of Ultrasound Molecular Imaging & Department of Ultrasound , Second Affiliated Hospital of Chongqing Medical University , No. 74 Linjiang Road , Yuzhong District, Chongqing , 400010 , People's Republic of China
| | - Hai-Tao Ran
- Chongqing Key Laboratory of Ultrasound Molecular Imaging & Department of Ultrasound , Second Affiliated Hospital of Chongqing Medical University , No. 74 Linjiang Road , Yuzhong District, Chongqing , 400010 , People's Republic of China
| | - Dajing Guo
- Department of Radiology , Second Affiliated Hospital of Chongqing Medical University , No. 74 Linjiang Road , Yuzhong District, Chongqing , 400010 , People's Republic of China
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Jahan R, Villablanca JP, Harris RJ, Duarte-Vogel S, Williams CK, Vinters HV, Rao N, Enzmann DR, Ellingson BM. Selective middle cerebral artery occlusion in the rabbit: Technique and characterization with pathologic findings and multimodal MRI. J Neurosci Methods 2018; 313:6-12. [PMID: 30529458 DOI: 10.1016/j.jneumeth.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/29/2018] [Accepted: 12/04/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND A reliable animal model of ischemic stroke is vital for pre-clinical evaluation of stroke therapies. We describe a reproducible middle cerebral artery (MCA) embolic occlusion in the French Lop rabbit characterized with multimodal MRI and histopathologic tissue analysis. NEW METHOD Fluoroscopic-guided microcatheter placement was performed in five consecutive subjects with angiographic confirmation of MCA occlusion with autologous clot. Multimodal MRI was obtained prior to occlusion and up to six hours post after which repeat angiography confirmed sustained occlusion. The brain was harvested for histopathologic examination. RESULTS Angiography confirmed successful MCA catheterization and durable (>6 h) MCA occlusion in all animals. There was increase of ADC volume over time and variable final core volume presumably related to individual variation in collateral flow. FLAIR hyperintensity indicative of cytotoxic edema and parenchymal contrast enhancement reflective of blood brain barrier disruption was observed over time. Tissue staining of the ischemic brain showed edema and structural alterations consistent with infarction. COMPARISON WITH EXISTING METHODS This study describes a technique of selective catheterization and embolic occlusion of the MCA in the rabbit with MRI characterization of evolution of ischemia in the model. CONCLUSIONS We demonstrate the feasibility of a rabbit model of embolic MCA occlusion with angiographic documentation. Serial MR imaging demonstrated changes comparable to those observed in human ischemic stroke, confirmed histopathologically.
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Affiliation(s)
- Reza Jahan
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
| | - J Pablo Villablanca
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Robert J Harris
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Sandra Duarte-Vogel
- Division of Laboratory Animal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Christopher K Williams
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Harry V Vinters
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Neal Rao
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Dieter R Enzmann
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Benjamin M Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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12
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Zafar A, Quadri SA, Farooqui M, Ortega-Gutiérrez S, Hariri OR, Zulfiqar M, Ikram A, Khan MA, Suriya SS, Nunez-Gonzalez JR, Posse S, Mortazavi MM, Yonas H. MRI-Guided High-Intensity Focused Ultrasound as an Emerging Therapy for Stroke: A Review. J Neuroimaging 2018; 29:5-13. [PMID: 30295987 DOI: 10.1111/jon.12568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/21/2018] [Indexed: 01/23/2023] Open
Abstract
Stroke, either ischemic or hemorrhagic, accounts for significantly high morbidity and mortality rates around the globe effecting millions of lives annually. For the past few decades, ultrasound has been extensively investigated to promote clot lysis for the treatment of stroke, myocardial infarction, and acute peripheral arterial occlusions, with or without the use of tPA or contrast agents. In the age of modern minimal invasive techniques, magnetic resonance imaging-guided high-intensity focused ultrasound is a new emerging modality that seems to promise therapeutic utilities for both ischemic and hemorrhagic stroke. High-intensity focused ultrasound causes thermal heating as the tissue absorbs the mechanical energy transmitted by the ultrasonic waves leading to tissue denaturation and coagulation. Several in-vitro and in-vivo studies have demonstrated the viability of this technology for sonothrombolysis in both types of stroke and have warranted clinical trials. Apart from safety and efficacy, initiation of trials would further enable answers regarding its practical application in a clinical setup. Though this technology has been under study for treatment of various brain diseases for some decades now, relatively very few neurologists and even neurosurgeons seem to be acquainted with it. The aim of this review is to provide basic understanding of this powerful technology and discuss its clinical application and potential role as an emerging viable therapeutic option for the future management of stroke.
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Affiliation(s)
- Atif Zafar
- Department of Neurology, University of New Mexico Hospitals, Albuquerque, NM
| | - Syed A Quadri
- Department of Neurology, University of New Mexico Hospitals, Albuquerque, NM.,California Institute of Neuroscience, Thousand Oaks, CA.,National Skull Base Center, Thousand Oaks, CA
| | - Mudassir Farooqui
- Department of Neurology, University of New Mexico Hospitals, Albuquerque, NM
| | | | - Omid R Hariri
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Maryam Zulfiqar
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Asad Ikram
- Department of Neurology, University of New Mexico Hospitals, Albuquerque, NM
| | - Muhammad Adnan Khan
- Department of Neurology, University of New Mexico Hospitals, Albuquerque, NM.,California Institute of Neuroscience, Thousand Oaks, CA.,National Skull Base Center, Thousand Oaks, CA
| | - Sajid S Suriya
- Department of Neurology, University of New Mexico Hospitals, Albuquerque, NM.,California Institute of Neuroscience, Thousand Oaks, CA.,National Skull Base Center, Thousand Oaks, CA
| | | | - Stefan Posse
- Department of Neurology, University of New Mexico Hospitals, Albuquerque, NM
| | - Martin M Mortazavi
- California Institute of Neuroscience, Thousand Oaks, CA.,National Skull Base Center, Thousand Oaks, CA
| | - Howard Yonas
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM
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13
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Auboire L, Sennoga CA, Hyvelin JM, Ossant F, Escoffre JM, Tranquart F, Bouakaz A. Microbubbles combined with ultrasound therapy in ischemic stroke: A systematic review of in-vivo preclinical studies. PLoS One 2018; 13:e0191788. [PMID: 29420546 PMCID: PMC5805249 DOI: 10.1371/journal.pone.0191788] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/29/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Microbubbles (MBs) combined with ultrasound sonothrombolysis (STL) appears to be an alternative therapeutic strategy for acute ischemic stroke (IS), but clinical results remain controversial. OBJECTIVE The aim of this systematic review is to identify the parameters tested; to assess evidence on the safety and efficacy on preclinical data on STL; and to assess the validity and publication bias. METHODS Pubmed® and Web of ScienceTM databases were systematically searched from January 1995 to April 2017 in French and English. We included studies evaluating STL on animal stroke model. This systematic review was conducted in accordance with the PRISMA guidelines. Data were extracted following a pre-defined schedule by two of the authors. The CAMARADES criteria were used for quality assessment. A narrative synthesis was conducted. RESULTS Sixteen studies met the inclusion criteria. The result showed that ultrasound parameters and types of MBs were heterogeneous among studies. Numerous positive outcomes on efficacy were found, but only four studies demonstrated superiority of STL versus recombinant tissue-type plasminogen activator on clinical criteria. Data available on safety are limited. LIMITATIONS Quality assessment of the studies reviewed revealed a number of biases. CONCLUSION Further in vivo studies are needed to demonstrate a better efficacy and safety of STL compared to currently approved therapeutic options. SYSTEMATIC REVIEW REGISTRATION http://syrf.org.uk/protocols/.
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Affiliation(s)
- Laurent Auboire
- UMR Imagerie et Cerveau, Inserm U930, Université François-Rabelais de Tours, France
- CHRU de Tours, Service d’échographie-Doppler, Tours, France
| | - Charles A. Sennoga
- UMR Imagerie et Cerveau, Inserm U930, Université François-Rabelais de Tours, France
| | | | - Fréderic Ossant
- UMR Imagerie et Cerveau, Inserm U930, Université François-Rabelais de Tours, France
- CHRU de Tours, CIC-IT, Tours, France
| | - Jean-Michel Escoffre
- UMR Imagerie et Cerveau, Inserm U930, Université François-Rabelais de Tours, France
| | | | - Ayache Bouakaz
- UMR Imagerie et Cerveau, Inserm U930, Université François-Rabelais de Tours, France
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14
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Quadri SA, Waqas M, Khan I, Khan MA, Suriya SS, Farooqui M, Fiani B. High-intensity focused ultrasound: past, present, and future in neurosurgery. Neurosurg Focus 2018; 44:E16. [DOI: 10.3171/2017.11.focus17610] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Since Lynn and colleagues first described the use of focused ultrasound (FUS) waves for intracranial ablation in 1942, many strides have been made toward the treatment of several brain pathologies using this novel technology. In the modern era of minimal invasiveness, high-intensity focused ultrasound (HIFU) promises therapeutic utility for multiple neurosurgical applications, including treatment of tumors, stroke, epilepsy, and functional disorders. Although the use of HIFU as a potential therapeutic modality in the brain has been under study for several decades, relatively few neuroscientists, neurologists, or even neurosurgeons are familiar with it. In this extensive review, the authors intend to shed light on the current use of HIFU in different neurosurgical avenues and its mechanism of action, as well as provide an update on the outcome of various trials and advances expected from various preclinical studies in the near future. Although the initial technical challenges have been overcome and the technology has been improved, only very few clinical trials have thus far been carried out. The number of clinical trials related to neurological disorders is expected to increase in the coming years, as this novel therapeutic device appears to have a substantial expansive potential. There is great opportunity to expand the use of HIFU across various medical and surgical disciplines for the treatment of different pathologies. As this technology gains recognition, it will open the door for further research opportunities and innovation.
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Affiliation(s)
- Syed A. Quadri
- 1California Institute of Neuroscience, Thousand Oaks, California
| | - Muhammad Waqas
- 1California Institute of Neuroscience, Thousand Oaks, California
- 2Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Inamullah Khan
- 2Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Sajid S. Suriya
- 1California Institute of Neuroscience, Thousand Oaks, California
| | - Mudassir Farooqui
- 3University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and
| | - Brian Fiani
- 4Department of Neurosurgery, Institute of Clinical Orthopedic and Neurosciences, Desert Regional Medical Center, Palm Springs, California
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15
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Papadopoulos N, Kyriacou PA, Damianou C. Review of Protocols Used in Ultrasound Thrombolysis. J Stroke Cerebrovasc Dis 2017; 26:2447-2469. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 07/01/2017] [Accepted: 07/30/2017] [Indexed: 01/01/2023] Open
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Ultrasound Mediated Microbubbles Destruction Augmented Sonolysis: An In Vitro and In Vivo Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7021929. [PMID: 28900624 PMCID: PMC5576396 DOI: 10.1155/2017/7021929] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/08/2017] [Accepted: 07/05/2017] [Indexed: 01/07/2023]
Abstract
Objective This study was aimed at exploring ultrasound mediated microbubbles destruction (UMMD) assisted sonolysis in both the in vitro and in vivo clots. Methods Therapeutic ultrasound (TUS) and lipid microbubbles (MBs) were used in whole blood clots and divided into the control, TUS group, and TUS + MB group. Thrombolytic rates and microscopy were performed. Color Doppler flow imaging (CDFI) and angiography were performed to evaluate the recanalization rates and flow scores in femoral arterial thrombus (FAT) in rabbits. FAT were dyed with H&E. Results The average thrombolytic ratios of TUS + MB group were significantly higher than those of TUS group and the control group (both P < 0.05). Clots had different pathological changes. Recanalization rates and flow scores in TUS + MB group were significantly higher than the control and TUS group. Flow scores and recanalization ratios were grade 0 in 0% of the control group, grade I in 25% of TUS group, and grade II or higher in 87.5% of TUS + MB group after 30 min sonolysis. Conclusions Both the in vitro and in vivo sonolysis can be significantly augmented by the introduction of MBs without thrombolytic agents, which might be induced by the enhanced cavitation via UMMD.
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17
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Jin Q, Lin CY, Kang ST, Chang YC, Zheng H, Yang CM, Yeh CK. Superhydrophobic silica nanoparticles as ultrasound contrast agents. ULTRASONICS SONOCHEMISTRY 2017; 36:262-269. [PMID: 28069209 DOI: 10.1016/j.ultsonch.2016.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 06/06/2023]
Abstract
Microbubbles have been widely studied as ultrasound contrast agents for diagnosis and as drug/gene carriers for therapy. However, their size and stability (lifetime of 5-12min) limited their applications. The development of stable nanoscale ultrasound contrast agents would therefore benefit both. Generating bubbles persistently in situ would be one of the promising solutions to the problem of short lifetime. We hypothesized that bubbles could be generated in situ by providing stable air nuclei since it has been found that the interfacial nanobubbles on a hydrophobic surface have a much longer lifetime (orders of days). Mesoporous silica nanoparticles (MSNs) with large surface areas and different levels of hydrophobicity were prepared to test our hypothesis. It is clear that the superhydrophobic and porous nanoparticles exhibited a significant and strong contrast intensity compared with other nanoparticles. The bubbles generated from superhydrophobic nanoparticles sustained for at least 30min at a MI of 1.0, while lipid microbubble lasted for about 5min at the same settings. In summary MSNs have been transformed into reliable bubble precursors by making simple superhydrophobic modification, and made into a promising contrast agent with the potentials to serve as theranostic agents that are sensitive to ultrasound stimulation.
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Affiliation(s)
- Qiaofeng Jin
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Chih-Yu Lin
- Department of Chemistry, National Tsing Hua University, Hsinchu, Taiwan
| | - Shih-Tsung Kang
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Yuan-Chih Chang
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen China
| | - Chia-Min Yang
- Department of Chemistry, National Tsing Hua University, Hsinchu, Taiwan.
| | - Chih-Kuang Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan.
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18
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Yang W, Zhou Y. Effect of pulse repetition frequency of high-intensity focused ultrasound on in vitro thrombolysis. ULTRASONICS SONOCHEMISTRY 2017; 35:152-160. [PMID: 27666197 DOI: 10.1016/j.ultsonch.2016.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/18/2016] [Accepted: 09/18/2016] [Indexed: 06/06/2023]
Abstract
Vascular occlusion by the thrombi is the main reason for ischemic stroke and deep vein thrombosis. High-intensity focused ultrasound (HIFU) and histotripsy or microtripsy pulses can effectively dissolve the blood clot with no use of thrombolytic agent and ultrasound contrast agent (microbubbles). In this study, HIFU bursts at the same duty cycle (2%) but varied pulse repetition frequency (PRF) from 1Hz to 1000Hz were delivered to in vitro porcine blood clot for 30s. Thrombolysis efficiency initially increases slightly with the PRF, 86.4±10.3%, 89.9±11.9, and 92.9±12.8% at the PRF of 1Hz, 10Hz, and 100Hz, respectively, without significant difference (p>0.05), but then drops dramatically to 37.9±6.9% at the PRF of 1000Hz (p<0.05). The particle size in the supernatant of dissolution is 547.1±129.5nm, which suggests the disruption of thrombi into the subcellular level. Thrombi motion during HIFU exposure shows violent motion and significant curling at the low PRF, rotation about its axis with occasional curling at the moderate PRF, and localized vibration at the high PRF due to the generation of acoustic radiation force and streaming. Quantitative analysis of recorded motion shows the axial displacement decreases with the PRF of delivered HIFU bursts, from 3.9±1.5mm at 1Hz to 0.7±0.4mm at 1000Hz. Bubble cavitation during HIFU exposure to the blood clot was also monitored. The increase of PRF led to the increase of inertial cavitation but the decrease of stable cavitation. In summary, the PRF of delivered HIFU bursts at the same output energy has a significant effect on the thrombi motion, bubble cavitation activities, and subsequently thrombolysis efficiencies.
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Affiliation(s)
- Wenjing Yang
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Yufeng Zhou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore.
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19
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Papadopoulos N, Damianou C. Microbubble-Based Sonothrombolysis Using a Planar Rectangular Ultrasonic Transducer. J Stroke Cerebrovasc Dis 2017; 26:1287-1296. [PMID: 28236599 DOI: 10.1016/j.jstrokecerebrovasdis.2017.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/13/2016] [Accepted: 01/24/2017] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The aim of the proposed study was to evaluate in an in vitro flow model the ability of small planar rectangular (2 × 10 mm2) ultrasonic transducer to enhance thrombolysis induced by the thrombolytic agent tenecteplase (TNK-tPA). METHODS To provide a more realistic clinical environment of stroke, the study was conducted under realistic flow conditions and TNK-tPA concentrations. Fully retracted porcine blood clots were used to determine the thrombolytic efficacy of ultrasound (US) waves as an adjunct to TNK-tPA or in combination with microbubbles (MBs). Two ultrasonic flat rectangular transducers were used in the experiments, operating at 3.7 and 5.2 MHz respectively. A pulsed US protocol that maintained temperature elevation at the target of 1°C was applied. Thrombolysis efficacy was measured in milligrams of mass clot removed. RESULTS The effect of experimental parameters, such as power, frequency, and MBs administration, on thrombolysis efficacy was explored. CONCLUSIONS The results revealed that thrombolysis efficacy decreases at higher frequency, and therefore, the possibility of using lower frequency to improve efficacy should be further investigated. Additionally, study findings demonstrated that the combination of 3.7 MHz with MBs as an adjunct to TNK-tPA strongly enhanced thrombolysis efficacy, because with 30 minutes of treatment, 700 mg of clot was removed through nonthermal mechanisms. As a final point, this study has shown that MBs dose influences thrombolysis enhancement, because higher thrombolytic efficacy was observed with higher doses of MBs.
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Affiliation(s)
| | - Christakis Damianou
- Electrical Engineering Department, Cyprus University of Technology, Limassol, Cyprus.
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20
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Arthur MC, Brown A, Carlson K, Lowery J, Skinner RD, Culp WC. Dodecafluoropentane Improves Neurological Function Following Anterior Ischemic Stroke. Mol Neurobiol 2016; 54:4764-4770. [PMID: 27501802 DOI: 10.1007/s12035-016-0019-8] [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: 01/27/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Abstract
Dodecafluoropentane emulsion (DDFPe), an advanced oxygen transport drug, given IV at 90-min intervals maintains viability in the penumbra during cerebral ischemia in the standard rabbit anterior stroke model (STND). This study investigated shortened dosage schedules of DDFPe in nonstandard posterior (NSTND) strokes following occlusions of the posterior cerebral arteries. DDFPe given at shortened schedules of 30 or 60-min injection intervals will reduce neurological deficits, percent stroke volume (%SV), and serum glutamate levels in NSTND ischemic strokes. New Zealand White rabbits (N = 26) were randomly placed into three groups: A (n = 9) controls given saline injections every 60 min, B (n = 9) 2 % DDFPe given IV every 30 min, and C (n = 8) DDFPe every 60 min. Injections began 1 h after embolization. Groups were subdivided into STND and NSTND based on angiographically verified embolization of the cerebral arteries. Neurological assessments and blood samples were done at 0.5-1-h intervals. Rabbits were euthanized at 7 h following embolization. Stained brain slices were measured for %SV. The 30 and 60-min subgroups did not differ and were combined as DDFPe-STND or DDFPe-NSTND groups. In the DDFPe-STND stroke group, the %SV, neurological assessment scores (NAS), and serum glutamate were decreased vs. STND controls (p = 0.0016, 0.008, and 0.016, respectively). In the DDFPe-NSTND stroke group, %SV, NAS, and serum glutamate did not differ statistically compared to NSTND controls (p = 0.82, 0.097, and 0.06, respectively). More frequent dosage schedules provided no additional improvement. In anterior strokes, DDFPe improves recovery but not in the more severe NSTND strokes.
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Affiliation(s)
- M Christine Arthur
- Department of Radiology, University of Arkansas for Medical Sciences, Slot 556, 4301 West Markham St, Little Rock, AR, 72205, USA
| | - Aliza Brown
- Department of Radiology, University of Arkansas for Medical Sciences, Slot 556, 4301 West Markham St, Little Rock, AR, 72205, USA.
| | - Kristen Carlson
- College of Medicine, Medical School, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - John Lowery
- Department of Laboratory Animal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Robert D Skinner
- Department of Radiology, University of Arkansas for Medical Sciences, Slot 556, 4301 West Markham St, Little Rock, AR, 72205, USA.,Department of Neurobiology and Developmental Sciences and Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - William C Culp
- Department of Radiology, University of Arkansas for Medical Sciences, Slot 556, 4301 West Markham St, Little Rock, AR, 72205, USA
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Haršány M, Tsivgoulis G, Alexandrov AV. Ultrasonography. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Petit B, Bohren Y, Gaud E, Bussat P, Arditi M, Yan F, Tranquart F, Allémann E. Sonothrombolysis: the contribution of stable and inertial cavitation to clot lysis. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1402-1410. [PMID: 25601463 DOI: 10.1016/j.ultrasmedbio.2014.12.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 12/04/2014] [Accepted: 12/10/2014] [Indexed: 06/04/2023]
Abstract
Microbubble-mediated sonothrombolysis (STL) is a remarkable approach to vascular occlusion therapy. However, STL remains a complex process with multiple interactions between clot, ultrasound (US), microbubbles (MB) and thrombolytic drug. The aim of this study was to evaluate the ability of combining US and MB to degrade fibrin and, more specifically, to assess the roles of both stable (SC) and inertial (IC) cavitation. Human blood clots containing radiolabeled fibrin were exposed to different combinations of recombinant tissue plasminogen activator (rtPA), US (1 MHz) and phospholipid MB. Three acoustic pressures were tested: 200, 350 and 1,300 kPa (peak-negative pressure). Clot lysis was assessed by diameter loss and release of radioactive fibrin degradation products. The combination rtPA + US + MB clearly revealed that IC (1,300 kPa) was able to enhance fibrin degradation significantly (66.3 ± 1.8%) compared with rtPA alone (51.7 ± 2.0%, p < 0.001). However, SC failed to enhance fibrin degradation at an acoustic pressure of 200 kPa. At 350 kPa, a synergistic effect between rtPA and US + MB was observed with an absolute increase of 6% compared to rtPA alone (p < 0.001). Conversely, without rtPA, the combination of US + MB was unable to degrade the fibrin network (0.3 ± 0.1%, p > 0.05 vs. control), but induced a distinct loss of red blood cells throughout the entire thickness of the clot, implying that MB were able to penetrate and cavitate inside the clot.
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Affiliation(s)
- B Petit
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Y Bohren
- Bracco Suisse S.A., Plan-les-Ouates, Geneva, Switzerland
| | - E Gaud
- Bracco Suisse S.A., Plan-les-Ouates, Geneva, Switzerland
| | - P Bussat
- Bracco Suisse S.A., Plan-les-Ouates, Geneva, Switzerland
| | - M Arditi
- Bracco Suisse S.A., Plan-les-Ouates, Geneva, Switzerland
| | - F Yan
- Bracco Suisse S.A., Plan-les-Ouates, Geneva, Switzerland
| | - F Tranquart
- Bracco Suisse S.A., Plan-les-Ouates, Geneva, Switzerland
| | - E Allémann
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
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23
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Ren ST, Kang XN, Liao YR, Wang W, Ai H, Chen LN, Luo HT, Fu RG, Tan LF, Shen XL, Wang B. The ultrasound contrast imaging properties of lipid microbubbles loaded with urokinase in dog livers and their thrombolytic effects when combined with low-frequency ultrasound in vitro. J Thromb Thrombolysis 2015; 37:303-9. [PMID: 23943336 DOI: 10.1007/s11239-013-0950-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A new microbubble loaded with urokinase (uPA-MB) was explored in a previous study. However, its zeta potential and ultrasound contrast imaging properties and its thrombolytic effects when combined with low-frequency ultrasound (LFUS) were unclear. The zeta potential and ultrasound contrast imaging property of 5 uPA-MBs loading with 50,000 IU uPA was respectively detected using a Malvern laser particle analyzer and a Logiq 9 digital premium ultrasound system. Its ultrasound contrast imaging property was performed on the livers of two healthy dogs to compare with SonoVue. And the clot mass loss rate, D-dimer concentration and surface morphology of the clot residues were measured to evaluate the thrombolytic effect after treatment with three doses of 5 uPA-MBs combined with LFUS in vitro. The zeta potential of 5 uPA-MBs (-27.0 ± 2.40 mV) was higher than that of normal microbubbles (-36.95 ± 1.77 mV). Contrast-enhanced imaging of the hepatic vessels using 5 uPA-MBs was similar to SonoVue, while the imaging duration of 5 uPA-MBs (10 min) was longer than SonoVue (6 min). The thrombolytic effect of three doses of uPA-MBs combined with LFUS was significantly better than that of the control group and showed dose dependence. The 5 uPA-MBs have a negative charge on their surface and good echogenicity as ultrasound contrast agents. The 5 uPA-MBs combined with LFUS can promote thrombolysis in a dose-dependent manner.
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Affiliation(s)
- Shu-Ting Ren
- Department of Pathology, School of Medicine, Xi'an Jiaotong University, Xi'an, 710061, China
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Petit B, Yan F, Bussat P, Bohren Y, Gaud E, Fontana P, Tranquart F, Allémann E. Fibrin degradation during sonothrombolysis – Effect of ultrasound, microbubbles and tissue plasminogen activator. J Drug Deliv Sci Technol 2015. [DOI: 10.1016/j.jddst.2014.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Comparison of Sonothrombolysis Efficiencies of Different Ultrasound Systems. J Stroke Cerebrovasc Dis 2014; 23:2730-2735. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/11/2014] [Accepted: 06/20/2014] [Indexed: 11/23/2022] Open
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26
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Improvements in Cerebral Blood Flow and Recanalization Rates With Transcranial Diagnostic Ultrasound and Intravenous Microbubbles After Acute Cerebral Emboli. Invest Radiol 2014; 49:593-600. [DOI: 10.1097/rli.0000000000000059] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Unger E, Porter T, Lindner J, Grayburn P. Cardiovascular drug delivery with ultrasound and microbubbles. Adv Drug Deliv Rev 2014; 72:110-26. [PMID: 24524934 DOI: 10.1016/j.addr.2014.01.012] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 01/23/2014] [Accepted: 01/29/2014] [Indexed: 01/14/2023]
Abstract
Microbubbles lower the threshold for cavitation of ultrasound and have multiple potential therapeutic applications in the cardiovascular system. One of the first therapeutic applications to enter into clinical trials has been microbubble-enhanced sonothrombolysis. Trials were conducted in acute ischemic stroke and clinical trials are currently underway for sonothrombolysis in treatment of acute myocardial infarction. Microbubbles can be targeted to epitopes expressed on endothelial cells and thrombi by incorporating targeting ligands onto the surface of the microbubbles. Targeted microbubbles have applications as molecular imaging contrast agents and also for drug and gene delivery. A number of groups have shown that ultrasound with microbubbles can be used for gene delivery yielding robust gene expression in the target tissue. Work has progressed to primate studies showing delivery of therapeutic genes to generate islet cells in the pancreas to potentially cure diabetes. Microbubbles also hold potential as oxygen therapeutics and have shown promising results as a neuroprotectant in an ischemic stroke model. Regulatory considerations impact the successful clinical development of therapeutic applications of microbubbles with ultrasound. This paper briefly reviews the field and suggests avenues for further development.
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Porter TR, Xie F. Can transcranial ultrasound and microbubble therapy ever enter the mainstream in acute stroke therapy? Expert Rev Cardiovasc Ther 2014; 10:549-51. [DOI: 10.1586/erc.12.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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de Saint Victor M, Crake C, Coussios CC, Stride E. Properties, characteristics and applications of microbubbles for sonothrombolysis. Expert Opin Drug Deliv 2014; 11:187-209. [DOI: 10.1517/17425247.2014.868434] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Lapchak PA, Kikuchi K, Butte P, Hölscher T. Development of transcranial sonothrombolysis as an alternative stroke therapy: incremental scientific advances toward overcoming substantial barriers. Expert Rev Med Devices 2014; 10:201-13. [DOI: 10.1586/erd.12.88] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Brown A, Woods S, Skinner R, Hatton J, Lowery J, Roberson P, Hennings L, Culp WC. Neurological assessment scores in rabbit embolic stroke models. Open Neurol J 2013; 7:38-43. [PMID: 24265650 PMCID: PMC3831307 DOI: 10.2174/1874205x01307010038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/06/2013] [Accepted: 09/08/2013] [Indexed: 11/22/2022] Open
Abstract
Background: Neurological outcomes and behavioral assessments are widely used in animal models of stroke, but assessments in rabbit models are not fully validated. The wryneck model of neurological assessment scores (NAS) was compared to percent infarct volume (%IV) values (infarct volume is a proven clinical indicator of stroke severity) and arterial occlusion localization in three rabbit angiographic stroke models. Hypothesis: NAS values will correlate with percent infarct volume values. Methods: Anesthetized New Zealand White rabbits (N=131, 4-5 kg) received internal carotid artery emboli by angiographic catheter introduced into the femoral artery and occlusions were characterized. Rabbits were evaluated at 24 hours post embolism using the NAS test of 0 (normal) to 10 (death). Deficit criteria included neck twist, righting reflex, extension reflex in hind paw and forepaw, and posture. Brain sections stained with triphenyltetrazolium chloride (TTC) were analyzed for %IV. Volume of the infarct was measured and calculated as a percent of the total brain volume. Results: The aggregate correlation for NAS values vs. %IV values was R=0.61, p<0.0001, a strong positive relationship, while correlations of the NAS components ranged from R=0.28-0.46. Occlusionsof the posterior cerebral artery vs. the middle cerebral artery alone produced significantly greater deficit scores at p<0.0001. Conclusions: These positive results validate the NAS system in the rabbit angiographic embolic stroke model.
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Affiliation(s)
- Aliza Brown
- Department of Radiology, 4301 West Markham Street, University of Arkansas for Medical Sciences, Little Rock, AR 72205-7199, USA
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Xie F, Gao S, Wu J, Lof J, Radio S, Vignon F, Shi W, Powers J, Unger E, Everbach EC, Liu J, Porter TR. Diagnostic ultrasound induced inertial cavitation to non-invasively restore coronary and microvascular flow in acute myocardial infarction. PLoS One 2013; 8:e69780. [PMID: 23922797 PMCID: PMC3726756 DOI: 10.1371/journal.pone.0069780] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 06/07/2013] [Indexed: 12/19/2022] Open
Abstract
Ultrasound induced cavitation has been explored as a method of dissolving intravascular and microvascular thrombi in acute myocardial infarction. The purpose of this study was to determine the type of cavitation required for success, and whether longer pulse duration therapeutic impulses (sustaining the duration of cavitation) could restore both microvascular and epicardial flow with this technique. Accordingly, in 36 hyperlipidemic atherosclerotic pigs, thrombotic occlusions were induced in the mid-left anterior descending artery. Pigs were then randomized to either a) ½ dose tissue plasminogen activator (0.5 mg/kg) alone; or same dose plasminogen activator and an intravenous microbubble infusion with either b) guided high mechanical index short pulse (2.0 MI; 5 usec) therapeutic ultrasound impulses; or c) guided 1.0 mechanical index long pulse (20 usec) impulses. Passive cavitation detectors indicated the high mechanical index impulses (both long and short pulse duration) induced inertial cavitation within the microvasculature. Epicardial recanalization rates following randomized treatments were highest in pigs treated with the long pulse duration therapeutic impulses (83% versus 59% for short pulse, and 49% for tissue plasminogen activator alone; p<0.05). Even without epicardial recanalization, however, early microvascular recovery occurred with both short and long pulse therapeutic impulses (p<0.005 compared to tissue plasminogen activator alone), and wall thickening improved within the risk area only in pigs treated with ultrasound and microbubbles. We conclude that although short pulse duration guided therapeutic impulses from a diagnostic transducer transiently improve microvascular flow, long pulse duration therapeutic impulses produce sustained epicardial and microvascular re-flow in acute myocardial infarction.
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Affiliation(s)
- Feng Xie
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Shunji Gao
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Juefei Wu
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - John Lof
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Stanley Radio
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Francois Vignon
- Philips Research North America, Briarcliff, New York, United States of America
| | - William Shi
- Philips Research North America, Briarcliff, New York, United States of America
| | - Jeffry Powers
- Philips Medical Systems Inc, Bothell, Washington, United States of America
| | - Evan Unger
- NuvOx Pharma, Inc, Tuscan, Arizona, United States of America
| | - E. Carr Everbach
- Swarthmore College, Swarthmore, Pennsylvania, United States of America
| | - Jinjin Liu
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Thomas R. Porter
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- * E-mail:
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Hölscher T, Dunford JV, Schlachetzki F, Boy S, Hemmen T, Meyer BC, Serra J, Powers J, Voie A. Prehospital stroke diagnosis and treatment in ambulances and helicopters-a concept paper. Am J Emerg Med 2013; 31:743-7. [PMID: 23415600 DOI: 10.1016/j.ajem.2012.12.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 12/18/2012] [Accepted: 12/28/2012] [Indexed: 01/25/2023] Open
Abstract
Stroke is the second common cause of death and the primary cause of early invalidity worldwide. Different from other diseases is the time sensitivity related to stroke. In case of an ischemic event occluding a brain artery, 2000000 neurons die every minute. Stroke diagnosis and treatment should be initiated at the earliest time point possible, preferably at the site or during patient transport. Portable ultrasound has been used for prehospital diagnosis for applications other than stroke, and its acceptance as a valuable diagnostic tool "in the field" is growing. The intrahospital use of transcranial ultrasound for stroke diagnosis has been described extensively in the literature. Beyond its diagnostic use, first clinical trials as well as numerous preclinical work demonstrate that ultrasound can be used to accelerate clot lysis (sonothrombolysis) in presence as well as in absence of tissue plasminogen activator. Hence, the use of transcranial ultrasound for diagnosis and possibly treatment of stroke bares the potential to add to current stroke care paradigms significantly. The purpose of this concept article is to describe the opportunities presented by recent advances in transcranial ultrasound to diagnose and potentially treat large vessel embolic stroke in the prehospital environment.
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Affiliation(s)
- Thilo Hölscher
- Department of Radiology, Brain Ultrasound Research Laboratory (BURL), University of California, San Diego, CA, USA.
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Culp WC, Woods SD, Brown AT, Lowery JD, Hennings LJ, Skinner RD, Borrelli MJ, Roberson PK. Three variations in rabbit angiographic stroke models. J Neurosci Methods 2012; 212:322-8. [PMID: 23142182 DOI: 10.1016/j.jneumeth.2012.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 09/24/2012] [Accepted: 10/25/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE To develop angiographic models of embolic stroke in the rabbit using pre-formed clot or microspheres to model clinical situations ranging from transient ischemic events to severe ischemic stroke. MATERIALS AND METHODS New Zealand White rabbits (N=151) received angiographic access to the internal carotid artery (ICA) from a femoral approach. Variations of emboli type and quantity of emboli were tested by injection into the ICA. These included fresh clots (1.0-mm length, 3-6h), larger aged clots (4.0-mm length, 3 days), and 2 or 3 insoluble microspheres (700-900 μm). Neurological assessment scores (NAS) were based on motor, sensory, balance, and reflex measures. Rabbits were euthanized at 4, 7, or 24h after embolization, and infarct volume was measured as a percent of total brain volume using 2,3,5-triphenyltetrazolium chloride (TTC). RESULTS Infarct volume percent at 24 h after stroke was lower for rabbits embolized with fresh clot (0.45±0.14%), compared with aged clot (3.52±1.31%) and insoluble microspheres (3.39±1.04%). Overall NAS (including posterior vessel occlusions) were positively correlated to infarct volume percent measurements in the fresh clot (r=0.50), aged clot (r=0.65) and microsphere (r=0.62) models (p<0.001). CONCLUSION The three basic angiographic stroke models may be similar to human transient ischemic attacks (TIA) (fresh clot), major strokes that can be thrombolysed (aged clot), or major strokes with insoluble emboli such as atheromata (microspheres). Model selection can be tailored to specific research needs.
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Affiliation(s)
- William C Culp
- Department of Radiology, 4301 West Markham Street, University of Arkansas for Medical Sciences, Little Rock, AR 72205-7199, USA.
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Effects of microbubbles on transcranial Doppler ultrasound-assisted intracranial urokinase thrombolysis. Thromb Res 2012; 130:547-51. [DOI: 10.1016/j.thromres.2012.06.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 06/20/2012] [Accepted: 06/21/2012] [Indexed: 11/18/2022]
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High-intensity focused ultrasound (HIFU) for dissolution of clots in a rabbit model of embolic stroke. PLoS One 2012; 7:e42311. [PMID: 22870315 PMCID: PMC3411660 DOI: 10.1371/journal.pone.0042311] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 07/06/2012] [Indexed: 11/19/2022] Open
Abstract
It is estimated that only 2-6% of patients receive thrombolytic therapy for acute ischemic stroke suggesting that alternative therapies are necessary. In this study, we investigate the potential for high intensity focused ultrasound (HIFU) to initiate thrombolysis in an embolic model of stroke. Iron-loaded blood clots were injected into the middle cerebral artery (MCA) of New Zealand White rabbits, through the internal carotid artery and blockages were confirmed by angiography. MRI was used to localize the iron-loaded clot and target the HIFU beam for treatment. HIFU pulses (1.5 MHz, 1 ms bursts, 1 Hz pulse repetition frequency, 20 s duration) were applied to initiate thrombolysis. Repeat angiograms and histology were used to assess reperfusion and vessel damage. Using 275 W of acoustic power, there was no evidence of reperfusion in post-treatment angiograms of 3 rabbits tested. In a separate group of animals, 415 W of acoustic power was applied and reperfusion was observed in 2 of the 4 (50%) animals treated. In the last group of animals, acoustic power was further increased to 550 W, which led to the reperfusion in 5 of 7 (∼70%) animals tested. Histological analysis confirmed that the sonicated vessels remained intact after HIFU treatment. Hemorrhage was detected outside of the sonication site, likely due to the proximity of the target vessel with the base of the rabbit skull. These results demonstrate the feasibility of using HIFU, as a stand-alone method, to cause effective thrombolysis without immediate damage to the targeted vessels. HIFU, combined with imaging modalities used to identify and assess stroke patients, could dramatically reduce the time to achieve flow restoration in patients thereby significantly increasing the number of patients which benefit from thrombolysis treatments.
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Abstract
OBJECTIVES To characterize the ability of high-intensity focused ultrasound to achieve thrombolysis in vitro and investigate the feasibility of this approach as a means of restoring blood flow in thrombus-occluded arteries in vivo. MATERIALS AND METHODS All experiments were approved by the Institutional Animal Care Committee. Thrombolysis was performed with a 1.51-MHz focused ultrasound transducer with pulse lengths of 0.1 to 10 milliseconds and acoustic powers up to 300 W. In vitro experiments were performed with blood clots formed from rabbit arterial blood and situated in 2-mm diameter tubing. Both single location and flow bypass recanalization experiments were conducted. In vitro clot erosion was assessed with 30-MHz ultrasound, with debris size measured with filters and a Coulter counter. In vivo clots were initiated in the femoral arteries of rabbits (n = 26). Cavitation signals from bubbles formed during exposure were monitored. In vivo flow restoration was assessed with 23-MHz Doppler ultrasound. RESULTS At a single location, in vitro clot erosion volumes increased with exposure power and pulse length, with debris size reducing with increasing pulse length. Flow bypass experiments achieved 99.2% clot erosion with 1.1% of debris above 0.5 mm in size. In vivo, 10 milliseconds pulses were associated with bleeding, but at 1 millisecond, it was feasible to achieve partial flow restoration in 6 of the 10 clots with only 1 of the 10 showing evidence of bleeding. In all cases, thrombolysis occurred only in the presence of cavitation. CONCLUSION High-intensity focused ultrasound thrombolysis is feasible as a means of restoring partial blood flow in thrombus-occluded arteries in the absence of thrombolytic agents. The potential for bleeding with this approach requires further investigation.
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Abstract
The goal of this study was to develop an in vivo sonothrombolysis model for stroke research. The rabbit carotid artery has average vessel diameters similar to human M1/M2 segments and allows generation of a thrombotic occlusion using various kinds of thrombus material as well as thrombus placement under visual control. It further allows real-time monitoring of flow and clot mechanics during the sonothrombolysis procedure using high-frequency diagnostic ultrasound. In the present study, the model will be introduced and first results to show feasibility using diagnostic as well as high-intensity focused ultrasound will be presented.
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Meairs S, Alonso A, Hennerici MG. Progress in Sonothrombolysis for the Treatment of Stroke. Stroke 2012; 43:1706-10. [DOI: 10.1161/strokeaha.111.636332] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stephen Meairs
- From the Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Angelika Alonso
- From the Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael G. Hennerici
- From the Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
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Petit B, Yan F, Tranquart F, Allémann E. Microbubbles and ultrasound-mediated thrombolysis: a review of recent in vitro studies. J Drug Deliv Sci Technol 2012. [DOI: 10.1016/s1773-2247(12)50065-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dodecafluoropentane emulsion decreases infarct volume in a rabbit ischemic stroke model. J Vasc Interv Radiol 2011; 23:116-21. [PMID: 22079515 DOI: 10.1016/j.jvir.2011.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 09/30/2011] [Accepted: 10/05/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To assess the efficacy of dodecafluoropentane emulsion (DDFPe), a nanodroplet emulsion with significant oxygen transport potential, in decreasing infarct volume in an insoluble-emboli rabbit stroke model. MATERIALS AND METHODS New Zealand White rabbits (N = 64; weight, 5.1 ± 0.50 kg) underwent angiography and received embolic spheres in occluded internal carotid artery branches. Rabbits were randomly assigned to groups in 4-hour and 7-hour studies. Four-hour groups included control (n = 7, embolized without treatment) and DDFPe treatment 30 minutes before stroke (n = 7), at stroke onset (n = 8), and 30 minutes (n = 5), 1 hour (n = 7), 2 hours (n = 5), or 3 hours after stroke (n = 6). Seven-hour groups included control (n = 6) and DDFPe at 1 hour (n = 8) and 6 hours after stroke (n = 5). DDFPe dose was a 2% weight/volume intravenous injection (0.6 mL/kg) repeated every 90 minutes as time allowed. After euthanasia, infarct volume was determined by vital stains on brain sections. RESULTS At 4 hours, median infarct volume decreased for all DDFPe treatment times (pretreatment, 0.30% [P = .004]; onset, 0.20% [P = .004]; 30 min, 0.35% [P = .009]; 1 h, 0.30% [P = .01]; 2 h, 0.40% [P = .009]; and 3 h, 0.25% [P = .003]) compared with controls (3.20%). At 7 hours, median infarct volume decreased with treatment at 1 hour (0.25%; P = .007) but not at 6 hours (1.4%; P = .49) compared with controls (2.2%). CONCLUSIONS Intravenous DDFPe in an animal model decreases infarct volumes and protects brain tissue from ischemia, justifying further investigation.
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Ren ST, Long LH, Wang M, Li YP, Qin H, Zhang H, Jing BB, Li YX, Zang WJ, Wang B, Shen XL. Thrombolytic effects of a combined therapy with targeted microbubbles and ultrasound in a 6 h cerebral thrombosis rabbit model. J Thromb Thrombolysis 2011; 33:74-81. [DOI: 10.1007/s11239-011-0644-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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