1
|
Li Y, Gao Z, Zheng X, Pan Y, Xu J, Li Y, Chen H. Interventional Removal of Travelling Microthrombi Using Targeted Magnetic Microbubble. Adv Healthc Mater 2024:e2401631. [PMID: 38938195 DOI: 10.1002/adhm.202401631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/17/2024] [Indexed: 06/29/2024]
Abstract
Microthrombus is one of the major causes of the sequelae of Corona Virus Disease 2019 (COVID-19 and leads to subsequent embolism and necrosis. Due to their small size and irregular movements, the early detection and efficient removal of microthrombi in vivo remain a great challenge. In this work, an interventional method is developed to identify and remove the traveling microthrombi using targeted-magnetic-microbubbles (TMMBs) and an interventional magnetic catheter. The thrombus-targeted drugs are coated on the TMMBs and magnetic nanoparticles are shelled inside, which allow not only targeted adhesion onto the traveling microthrombi, but also the effective capture by the magnetic catheter in the vessel. In the proof-of-concept experiments in the rat models, the concentration of microthrombus is reduced by more than 60% in 3 min, without damaging the organs. It is a promising method for treating microthrombus issues.
Collapse
Affiliation(s)
- Yongjian Li
- The State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, P. R. China
| | - Zujie Gao
- The State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, P. R. China
| | - Xiaobing Zheng
- The State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, P. R. China
| | - Yunfan Pan
- The State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, P. R. China
| | - Jinlong Xu
- The State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, P. R. China
| | - Yan Li
- The State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, P. R. China
| | - Haosheng Chen
- The State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, P. R. China
| |
Collapse
|
2
|
Goudot G, Nazer B. Editorial: Therapeutic ultrasound in cardiovascular disease. Front Cardiovasc Med 2024; 11:1428155. [PMID: 38887454 PMCID: PMC11180833 DOI: 10.3389/fcvm.2024.1428155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Affiliation(s)
- Guillaume Goudot
- Université Paris Cité, INSERM U970 PARCC, Paris, France
- Vascular Medicine Department, Georges Pompidou European Hospital, APHP, Paris, France
| | - Babak Nazer
- Division of Cardiology, University of Washington, Seattle, WA, United States
| |
Collapse
|
3
|
Zhou S, Li J, Chen X, Huang B, Lu D, Zhang T. Mediation of long-pulsed ultrasound enhanced microbubble recombinant tissue plasminogen activator thrombolysis in a rat model of platelet-rich thrombus. Cardiovasc Diagn Ther 2024; 14:51-58. [PMID: 38434566 PMCID: PMC10904306 DOI: 10.21037/cdt-23-356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/29/2023] [Indexed: 03/05/2024]
Abstract
Background Ultrasound (US)-enhanced microbubble (MB) therapy has been investigated as a therapeutic technique to facilitate the thrombolysis for the treatment of pericardial and microvascular obstruction. This study sought to assess the therapeutic effects of long-pulsed US-assisted MB-mediated recombinant tissue plasminogen activator (rt-PA) thrombolysis in a rat model of platelet-rich thrombus. Methods Ferric chloride (10%) was used to induce total arterial occlusion before formation of platelet-rich thrombi. Therapeutic long-tone-burst US (1 MHz, 0.6 MPa, 1,000-µs pulse length) was used, and 2.9×109/mL of lipid MBs and 1 mg/mL of rt-PA were infused. Subsequently, 42 Sprague-Dawley (SD) male rats were randomly divided into seven groups: (I) control; (II) rt-PA; (III) high duty cycle US + MB; (IV) low duty cycle US + rt-PA; (V) high duty cycle US + rt-PA; (VI) low duty cycle US + rt-PA + MB; and (VII) high duty cycle US + rt-PA + MB. The recanalization grades were evaluated after 20 minutes' treatment. Results Compared to the control, there was significant improvement in recanalization in the US + rt-PA groups (P=0.01 vs. control), US (low duty cycle) + rt-PA + MB (P=0.003 vs. control) and US (high duty cycle) + rt-PA + MB (P<0.001 vs. control) groups, in which recanalization was successfully achieved in all rats. Conclusions Long-pulsed US-enhanced MB-mediated rt-PA thrombolysis offered a powerful approach in the treatment of platelet-rich thrombus.
Collapse
Affiliation(s)
- Shuxuan Zhou
- Department of Cardiology, the First Affiliated Hospital of Jinan University, Guangzhou, China
- Cardiovascular Center, Hospital of Changan Dongguan, Dongguan, China
| | - Jinhua Li
- Department of Ultrasound, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xianghui Chen
- Department of Cardiology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Bihan Huang
- Department of Cardiology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Dan Lu
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tao Zhang
- Department of Cardiology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| |
Collapse
|
4
|
Goncin U, Curiel L, Geyer CR, Machtaler S. Aptamer-Functionalized Microbubbles Targeted to P-selectin for Ultrasound Molecular Imaging of Murine Bowel Inflammation. Mol Imaging Biol 2023; 25:283-293. [PMID: 35851673 DOI: 10.1007/s11307-022-01755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/01/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Our objectives were to develop a targeted microbubble with an anti-P-selectin aptamer and assess its ability to detect bowel inflammation in two murine models of acute colitis. PROCEDURES Lipid-shelled microbubbles were prepared using mechanical agitation. A rapid copper-free click chemistry approach (azide-DBCO) was used to conjugate the fluorescent anti-P-selectin aptamer (Fluor-P-Ap) to the microbubble surface. Bowel inflammation was chemically induced using 2,4,6-trinitrobenzenesulfonic acid (TNBS) in both Balb/C and interleukin-10-deficient (IL-10 KO) mice. Mouse bowels were imaged using non-linear contrast mode following an i.v. bolus of 1 × 108 microbubbles. Each mouse received a bolus of aptamer-functionalized and non-targeted microbubbles. Mouse phenotypes and the presence of P-selectin were validated using histology and immunostaining, respectively. RESULTS Microbubble labelling of Fluor-P-Ap was complete after 20 min at 37 ̊C. We estimate approximately 300,000 Fluor-P-Ap per microbubble and confirmed fluorescence using confocal microscopy. There was a significant increase in ultrasound molecular imaging signal from both Balb/C (p = 0.003) and IL-10 KO (p = 0.02) mice with inflamed bowels using aptamer-functionalized microbubbles in comparison to non-targeted microbubbles. There was no signal in healthy mice (p = 0.4051) using either microbubble. CONCLUSIONS We constructed an aptamer-functionalized microbubble specific for P-selectin using a clinically relevant azide-DBCO click reaction, which could detect bowel inflammation in vivo. Aptamers have potential as a next generation targeting agent for developing cost-efficient and clinically translatable targeted microbubbles.
Collapse
Affiliation(s)
- Una Goncin
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada
| | - Laura Curiel
- Department of Electrical and Software Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, T2N 4V8, Canada
| | - C Ronald Geyer
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada
| | - Steven Machtaler
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada.
| |
Collapse
|
5
|
Chen X, Chen X, Wang J, Yu FTH, Villanueva FS, Pacella JJ. Dynamic Behavior of Polymer Microbubbles During Long Ultrasound Tone-Burst Excitation and Its Application for Sonoreperfusion Therapy. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:996-1006. [PMID: 36697268 PMCID: PMC9974862 DOI: 10.1016/j.ultrasmedbio.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Ultrasound (US)-targeted microbubble (MB) cavitation (UTMC)-mediated therapies have been found to restore perfusion and enhance drug/gene delivery. Because of the potentially longer circulation time and relative ease of storage and reconstitution of polymer-shelled MBs compared with lipid MBs, we investigated the dynamic behavior of polymer microbubbles and their therapeutic potential for sonoreperfusion (SRP) therapy. METHODS The fate of polymer MBs during a single long tone-burst exposure (1 MHz, 5 ms) at various acoustic pressures and MB concentrations was recorded via high-speed microscopy and passive cavitation detection (PCD). SRP efficacy of the polymer MBs was investigated in an in vitro flow system and compared with that of lipid MBs. DISCUSSION Microscopy videos indicated that polymer MBs formed gas-filled clusters that continued to oscillate, fragment and form new gas-filled clusters during the single US burst. PCD confirmed continued acoustic activity throughout the 5-ms US excitation. SRP efficacy with polymer MBs increased with pulse duration and acoustic pressure similarly to that with lipid MBs but no significant differences were found between polymer and lipid MBs. CONCLUSION These data suggest that persistent cavitation activity from polymer MBs during long tone-burst US excitation confers excellent reperfusion efficacy.
Collapse
Affiliation(s)
- Xianghui Chen
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xucai Chen
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jianjun Wang
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Francois T H Yu
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Flordeliza S Villanueva
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John J Pacella
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| |
Collapse
|
6
|
Microbubbles for human diagnosis and therapy. Biomaterials 2023; 294:122025. [PMID: 36716588 DOI: 10.1016/j.biomaterials.2023.122025] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 01/26/2023]
Abstract
Microbubbles (MBs) were observed for the first time in vivo as a curious consequence of quick saline injection during ultrasound (US) imaging of the aortic root, more than 50 years ago. From this serendipitous event, MBs are now widely used as contrast enhancers for US imaging. Their intrinsic properties described in this review, allow a multitude of designs, from shell to gas composition but also from grafting targeting agents to drug payload encapsulation. Indeed, the versatile MBs are deeply studied for their dual potential in imaging and therapy. As presented in this paper, new generations of MBs now opens perspectives for targeted molecular imaging along with the development of new US imaging systems. This review also presents an overview of the different therapeutic strategies with US and MBs for cancer, cardiovascular diseases, and inflammation. The overall aim is to overlap those fields in order to find similarities in the MBs application for treatment enhancement associated with US. To conclude, this review explores the new scales of MBs technologies with nanobubbles development, and along concurrent advances in the US imaging field. This review ends by discussing perspectives for the booming future uses of MBs.
Collapse
|
7
|
Zhou NQ, Song YT, Liu WZ, Yue RZ, Tian XQ, Yang SC, Yin YL, Li P. Diagnostic ultrasound-mediated microbubble cavitation dose-dependently improves diabetic cardiomyopathy through angiogenesis. Cell Biol Int 2023; 47:178-187. [PMID: 36183368 DOI: 10.1002/cbin.11918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 01/19/2023]
Abstract
Ultrasound-mediated microbubble cavitation (UMMC) induces therapeutic angiogenesis to treat ischemic diseases. This study aimed to investigate whether diagnostic UMMC alleviates diabetic cardiomyopathy (DCM) and, if so, through which mechanisms. DCM model was established by injecting streptozocin into rats to induce hyperglycemia, followed by a high-fat diet. The combined therapy of cation microbubble with low-intensity diagnostic ultrasound (frequency = 4 MHz), with a pulse frequency of 20 Hz and pulse length (PL) of 8, 18, 26, or 36 cycles, was given to rats twice a week for 8 consecutive weeks. Diagnostic UMMC therapy with PL at 8, 18, and 26 cycles, but not 36 cycles, dramatically prevented myocardial fibrosis, improved heart functions, and increased angiogenesis, accompanied by increased levels of PI3K, Akt, and eNOS proteins in the DCM model of rats. In cultured endothelial cells, low-intensity UMMC treatment (PL = 3 cycles, sound pressure level = 50%, mechanical index = 0.82) increased cell viability and activated PI3K-Akt-eNOS signaling. The combination of diagnostic ultrasound with microbubble destruction dose-dependently promoted angiogenesis, thus improving heart function through PI3K-Akt-eNOS signaling in diabetes. Accordingly, diagnostic UMMC therapy should be considered to protect the heart in patients with diabetes.
Collapse
Affiliation(s)
- Nan-Qian Zhou
- Department of Ultrasonography, Henan Provincial People's Hospital (People's Hospital of Zhengzhou University), Zhengzhou, Henan, China
| | - Yu-Ting Song
- Henan International Joint Laboratory of Cardiovascular Remodeling and Drug Intervention, Xinxiang Key Laboratory of Vascular Remodeling Intervention and Molecular Targeted Therapy Drug Development, College of Pharmacy, Xinxiang, Henan, China.,Department of Neurology, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Wei-Zhen Liu
- Department of Physiology and Pathophysiology, Sino-UK Joint Laboratory of Brain Function and Injury of Henan Province, School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, Henan, China
| | - Rui-Zhu Yue
- Department of Physiology and Pathophysiology, Sino-UK Joint Laboratory of Brain Function and Injury of Henan Province, School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, Henan, China
| | - Xin-Qiao Tian
- Department of Ultrasonography, Henan Provincial People's Hospital (People's Hospital of Zhengzhou University), Zhengzhou, Henan, China
| | - Shi-Chang Yang
- Department of Neurology, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Ya-Ling Yin
- Department of Physiology and Pathophysiology, Sino-UK Joint Laboratory of Brain Function and Injury of Henan Province, School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, Henan, China
| | - Peng Li
- Henan International Joint Laboratory of Cardiovascular Remodeling and Drug Intervention, Xinxiang Key Laboratory of Vascular Remodeling Intervention and Molecular Targeted Therapy Drug Development, College of Pharmacy, Xinxiang, Henan, China
| |
Collapse
|
8
|
Chiang HP, Aguiar MOD, Tavares BG, Rosa VEE, Gomes SB, Oliveira MT, Soeiro A, Nicolau JC, Ribeiro HB, Sbano JC, Rochitte CE, Filho RK, Ramires JAF, Porter TR, Mathias W, Tsutsui JM. The Impact of Sonothrombolysis on Left Ventricular Diastolic Function and Left Atrial Mechanics Preventing Left Atrial Remodeling in Patients With ST Elevation Acute Myocardial Infarction. J Am Soc Echocardiogr 2022; 36:504-513. [PMID: 36535625 DOI: 10.1016/j.echo.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The diagnostic ultrasound-guided high mechanical index impulses during an intravenous microbubble infusion (sonothrombolysis) improve myocardial perfusion in acute ST segment elevation myocardial infarction, but its effect on left ventricular diastolic dysfunction (DD), left atrial (LA) mechanics and remodeling is unknown. We assessed the effect of sonothrombolysis on DD grade and LA mechanics. METHODS One hundred patients (59 ± 10 years; 34% women) were randomized to receive either high mechanical index impulses plus percutaneous coronary intervention (PCI) (therapy group) or PCI only (control group) (n = 50 in each group). Diastolic dysfunction grade and LA mechanics were assessed immediately before and after PCI and at 48 to 72 hours, 1 month, and 6 months of follow-up. Diastolic dysfunction grades were classified as grades I, II, and III. The LA mechanics was obtained by two-dimensional speckle-tracking echocardiography-derived global longitudinal strain (GLS). RESULTS As follow-up time progressed, increased DD grade was observed more frequently in the control group than in the therapy group at 1 month and 6 months of follow-up (all P < .05). The LA-GLS values were incrementally higher in the therapy group when compared with the control group at 48 to 72 hours, 24.0% ± 7.3% in the therapy group versus 19.6% ± 7.2% in the control group, P = .005; at 1 month, 25.3% ± 6.3% in the therapy group versus 21.5% ± 8.3% in the control group, P = .020; and at 6 months, 26.2% ± 8.7% in the therapy group versus 21.6% ± 8.5% in the control group, P = .015. The therapy group was less likely to experience LA remodeling (odds ratio, 2.91 [1.10-7.73]; P = .03). LA-GLS was the sole predictor of LA remodeling (odds ratio, 0.79 [0.67-0.94]; P = .006). CONCLUSION Sonothrombolysis is associated with better DD grade and LA mechanics, reducing LA remodeling.
Collapse
Affiliation(s)
- Hsu Po Chiang
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil.
| | - Miguel O D Aguiar
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
| | - Bruno G Tavares
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
| | - Vitor E E Rosa
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Sergio Barros Gomes
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Mucio T Oliveira
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Alexandre Soeiro
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Jose C Nicolau
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Henrique B Ribeiro
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - João C Sbano
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
| | - Carlos E Rochitte
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Roberto Kalil Filho
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Jose A F Ramires
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | - Wilson Mathias
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
| | - Jeane M Tsutsui
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
| |
Collapse
|
9
|
Guo S, Zhang S, Chen K, Chen X, Hu F. Effects of diagnostic ultrasound with cRGD-microbubbles on simultaneous detection and treatment of atherosclerotic plaque in ApoE−/− mice. Front Cardiovasc Med 2022; 9:946557. [PMID: 35935617 PMCID: PMC9354833 DOI: 10.3389/fcvm.2022.946557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Atherosclerotic vulnerable plaque is the leading cause of acute fatal cardiovascular events. Thus, early rapid identification and appropriate treatment of atherosclerotic plaque maybe can prevent fatal cardiovascular events. However, few non–invasive molecular imaging techniques are currently available for the simultaneous detection and targeted treatment of atherosclerotic plaques. We hypothesized that diagnostic ultrasound (DU) combined with cyclic Arg-Gly-Asp-modified microbubbles (MBR) could provide targeted imaging and dissolution of activated platelets to identify advanced atherosclerotic plaques and improve plaque instability. Methods Three mouse models, apolipoprotein E-deficient mice on a hypercholesterolemic diet (HCD) or normal chow diet and wild-type mice on an HCD were used. The most appropriate ultrasonic mechanical index (MI) was determined based on the expression of GP IIb/IIIa in sham, DU alone and DUMBR-treated groups at MI values of 0.5, 1.5, and 1.9. The video intensity (VI) values, activated platelets and plaque instability were analyzed by ultrasound molecular imaging, scanning electron microscopy and histopathological methods. Results We found that the VI values of ultrasound molecular imaging of MBR were positively correlated with plaque GP IIb/IIIa expression, vulnerability index and necrotic center / fiber cap ratio. 24 h after treatment at different MIs, compared with those of the other groups, both the VI values and GP IIb/IIIa expression were significantly reduced in MI 1.5 and MI 1.9 DUMBR-treated groups. The plaque vulnerability index and necrotic center / fiber cap ratio were significantly decreased in MI 1.5-treated group, which may be due to targeted dissolution of activated platelets, with a reduction in von Willebrand factor expression. Conclusion DUMBR targeting GP IIb/IIIa receptors could rapidly detect advanced atherosclerotic plaques and simultaneously give targeted therapy by dissolving activated and aggregated platelets. This technology may represent a novel approach for the simultaneous identification and treatment of atherosclerotic plaques.
Collapse
|
10
|
Zhan J, Zhong L, Wu J. Assessment and Treatment for Coronary Microvascular Dysfunction by Contrast Enhanced Ultrasound. Front Cardiovasc Med 2022; 9:899099. [PMID: 35795368 PMCID: PMC9251174 DOI: 10.3389/fcvm.2022.899099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022] Open
Abstract
With growing evidence in clinical practice, the understanding of coronary syndromes has gradually evolved out of focusing on the well-established link between stenosis of epicardial coronary artery and myocardial ischemia to the structural and functional abnormalities at the level of coronary microcirculation, known as coronary microvascular dysfunction (CMD). CMD encompasses several pathophysiological mechanisms of coronary microcirculation and is considered as an important cause of myocardial ischemia in patients with angina symptoms without obstructive coronary artery disease (CAD). As a result of growing knowledge of the understanding of CMD assessed by multiple non-invasive modalities, CMD has also been found to be involved in other cardiovascular diseases, including primary cardiomyopathies as well as heart failure with preserved ejection fraction (HFpEF). In the past 2 decades, almost all the imaging modalities have been used to non-invasively quantify myocardial blood flow (MBF) and promote a better understanding of CMD. Myocardial contrast echocardiography (MCE) is a breakthrough as a non-invasive technique, which enables assessment of myocardial perfusion and quantification of MBF, exhibiting promising diagnostic performances that were comparable to other non-invasive techniques. With unique advantages over other non-invasive techniques, MCE has gradually developed into a novel modality for assessment of the coronary microvasculature, which may provide novel insights into the pathophysiological role of CMD in different clinical conditions. Moreover, the sonothrombolysis and the application of artificial intelligence (AI) will offer the opportunity to extend the use of contrast ultrasound theragnostics.
Collapse
|
11
|
Tavares BG, Aguiar MO, Tsutsui J, Oliveira M, Soeiro ADM, Nicolau J, Ribeiro H, PoChiang H, Sbano J, Rochitte CE, Lopes B, Ramirez J, Kalil R, Mathias W. A Sonotrombólise Promove Melhora dos Índices de Motilidade e Perfusão do Ventrículo Esquerdo após o Infarto Agudo do Miocárdio. Arq Bras Cardiol 2022; 118:756-765. [PMID: 35508053 PMCID: PMC9007009 DOI: 10.36660/abc.20200651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 03/24/2021] [Indexed: 12/31/2022] Open
Abstract
Fundamento Demonstrou-se recentemente que a aplicação de ultrassom de alta energia com microbolhas, técnica conhecida como sonotrombólise, causa a dissolução de trombos intravasculares e aumenta a taxa de recanalização angiográfica no infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM-CSST). Objetivo Avaliar o efeito da sonotrombólise nos índices de motilidade e perfusão miocárdicas em pacientes com IAM-CSST, utilizando a ecocardiografia com perfusão miocárdica em tempo real (EPMTR). Método Uma centena de pacientes com IAM-CSST foram randomizados em dois grupos: Terapia (50 pacientes tratados com sonotrombólise e angioplastia coronária primária) e Controle (50 pacientes tratados com angioplastia coronária primária). Os pacientes realizaram EPMTR para analisar a fração de ejeção do ventrículo esquerdo (FEVE), o índice de escore de motilidade segmentar (IEMS) e o número de segmentos com defeito de perfusão miocárdica, 72 horas após o IAM-CSST e com 6 meses de acompanhamento. Foi considerado significativo p < 0,05. Resultados Pacientes tratados com sonotrombólise apresentaram FEVE mais alta que o grupo Controle em 72 horas (50 ± 10%
vs.
44 ± 10%; p = 0,006), e essa melhora foi mantida em seis meses (53 ± 10%
vs.
48 ± 12%; p = 0,008). O IEMS foi similar nos grupos Terapia e Controle em 72 horas (1,62 ± 0,39
vs.
1,75 ± 0,40; p = 0,09), mas tornou-se menor no grupo Terapia em 6 meses (1,46 ± 0,36
vs.
1,64 ± 0,44; p = 0,02). O número de segmentos com defeito de perfusão não foi diferente entre os grupos em 72 horas (5,92 ± 3,47
vs.
6,94 ± 3,39; p = 0,15), mas ficou menor no grupo Terapia em 6 meses (4,64 ± 3,31
vs.
6,57 ± 4,29; p = 0,01). Conclusão A sonotrombólise em pacientes com IAM-CSST resulta na melhora dos índices de motilidade e perfusão ventricular ao longo do tempo.
Collapse
|
12
|
Contrast Ultrasound, Sonothrombolysis and Sonoperfusion in Cardiovascular Disease: Shifting to Theragnostic Clinical Trials. JACC Cardiovasc Imaging 2022; 15:345-360. [PMID: 34656483 PMCID: PMC8837667 DOI: 10.1016/j.jcmg.2021.07.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/23/2021] [Indexed: 02/03/2023]
Abstract
Contrast ultrasound has a variety of applications in cardiovascular medicine, both in diagnosing cardiovascular disease as well as providing prognostic information. Visualization of intravascular contrast microbubbles is based on acoustic cavitation, the characteristic oscillation that results in changes in the reflected ultrasound waves. At high power, this acoustic response generates sufficient shear that is capable of enhancing endothelium-dependent perfusion in atherothrombotic cardiovascular disease (sonoperfusion). The oscillation and collapse of microbubbles in response to ultrasound also induces microstreaming and jetting that can fragment thrombus (sonothrombolysis). Several preclinical studies have focused on identifying optimal diagnostic ultrasound settings and treatment regimens. Clinical trials have been performed in acute myocardial infarction, stroke, and peripheral arterial disease often with improved outcome. In the coming years, results of ongoing clinical trials along with innovation and improvements in sonothrombolysis and sonoperfusion will determine whether this theragnostic technique will become a valuable addition to reperfusion therapy.
Collapse
|
13
|
Nederhoed JH, Tjaberinga M, Otten RHJ, Evers JM, Musters RJP, Wisselink W, Yeung KK. Therapeutic Use of Microbubbles and Ultrasound in Acute Peripheral Arterial Thrombosis: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2821-2838. [PMID: 34272082 DOI: 10.1016/j.ultrasmedbio.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/15/2021] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Abstract
Catheter-directed thrombolysis (CDT) for acute peripheral arterial occlusion is time consuming and carries a risk of major hemorrhage. Contrast-enhanced sonothrombolysis (CEST) might enhance outcomes compared with standard CDT. In the study described here, we systematically reviewed all in vivo studies on contrast-enhanced sonothrombolysis in a setting of arterial thrombosis. A systematic search of the PubMed, Embase, Cochrane Library and Web of Science databases was conducted. Two reviewers independently performed the study selection, quality assessment and data extraction. Primary outcomes were recanalization rate and thrombus weight. Secondary outcome was any possible adverse event. The 35 studies included in this review were conducted in four different (pre)clinical settings: ischemic stroke, myocardial infarction, (peripheral) arterial thrombosis and arteriovenous graft occlusion. Because of the high heterogeneity among the studies, it was not possible to conduct a meta-analysis. In almost all studies, recanalization rates were higher in the group that underwent a form of CEST. One study was terminated early because of a higher incidence of intracranial hemorrhage. Studies on CEST suggest that adding microbubbles and ultrasound to standard intra-arterial CDT is safe and might improve outcomes in acute peripheral arterial thrombosis. Further research is needed before CEST can be implemented in daily practice.
Collapse
Affiliation(s)
- Johanna H Nederhoed
- Department of Surgery, Amsterdam University Medical Centers (VUmc), Amsterdam, The Netherlands.
| | - Meike Tjaberinga
- Department of Surgery, Amsterdam University Medical Centers (VUmc), Amsterdam, The Netherlands
| | - René H J Otten
- Medical Library Vrije Universiteit, Amsterdam University Medical Centers (VUmc), Amsterdam, The Netherlands
| | - Josje M Evers
- Department of Surgery, Amsterdam University Medical Centers (VUmc), Amsterdam, The Netherlands
| | - René J P Musters
- Department of Physiology, Amsterdam University Medical Centers (VUmc), Amsterdam, The Netherlands
| | - Willem Wisselink
- Department of Surgery, Amsterdam University Medical Centers (VUmc), Amsterdam, The Netherlands
| | - Kak K Yeung
- Department of Surgery, Amsterdam University Medical Centers (VUmc), Amsterdam, The Netherlands; Department of Physiology, Amsterdam University Medical Centers (VUmc), Amsterdam, The Netherlands
| |
Collapse
|
14
|
Vidal-Calés P, Cepas-Guillén PL, Brugaletta S, Sabaté M. New Interventional Therapies beyond Stenting to Treat ST-Segment Elevation Acute Myocardial Infarction. J Cardiovasc Dev Dis 2021; 8:jcdd8090100. [PMID: 34564118 PMCID: PMC8469769 DOI: 10.3390/jcdd8090100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022] Open
Abstract
Myocardial infarction remains the principal cause of death in Europe. In patients with ST-segment-elevation myocardial infarction (STEMI), a promptly revascularization with primary percutaneous intervention (PCI) has transformed prognosis in the last decades. However, despite increasing successful PCI procedures, mortality has remained unchanged in recent years. Also, due to an unsatisfactory reperfusion, some patients have significant myocardial damage and suffer left ventricular adverse remodeling with reduced function—all that resulting in the onset of heart failure with all its inherent clinical and socioeconomic burden. As a consequence of longer ischemic times, distal thrombotic embolization, ischemia-reperfusion injury and microvascular dysfunction, the resultant myocardial infarct size is the major prognostic determinant in STEMI patients. The improved understanding of all the pathophysiology underlying these events has derived to the development of several novel therapies aiming to reduce infarct size and to improve clinical outcomes in these patients. In this article, based on the mechanisms involved in myocardial infarction prognosis, we review the new interventional strategies beyond stenting that may solve the suboptimal results that STEMI patients still experience.
Collapse
Affiliation(s)
- Pablo Vidal-Calés
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.V.-C.); (P.L.C.-G.); (S.B.)
| | - Pedro L. Cepas-Guillén
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.V.-C.); (P.L.C.-G.); (S.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Salvatore Brugaletta
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.V.-C.); (P.L.C.-G.); (S.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Manel Sabaté
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.V.-C.); (P.L.C.-G.); (S.B.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV) CB16/11/00411, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-932-275-519
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW High mechanical index impulses from a diagnostic transducer are utilized in myocardial perfusion imaging, but can also be utilized therapeutically in three cardiovascular applications: (a) thrombus dissolution (sonothrombolysis), (b) improving microvascular flow in ischemic territories (sonoperfusion), and (c) targeted drug and nucleic acid delivery. The targeted therapeutic effect appears to be based on acoustic cavitation of the intravascular microbubbles which results in endothelial shear and pore formation, as well as mechanical destruction of thrombi. RECENT FINDINGS Within the last 5 years, clinical trials have been performed in acute myocardial infarction demonstrating successful reductions in myocardial infarct size with sonothrombolysis added to current guideline-based treatment. In patients with severe peripheral arterial disease, brief improvements in calf microvascular blood flow have been observed for 1 h after 10 min of sonoperfusion therapy. Targeted ultrasound therapies are developing for prevention of microvascular obstruction in acute coronary syndromes and peripheral vascular disease.
Collapse
|
16
|
Abstract
With the increasing insight into molecular mechanisms of cardiovascular disease, a promising solution involves directly delivering genes, cells, and chemicals to the infarcted myocardium or impaired endothelium. However, the limited delivery efficiency after administration fails to reach the therapeutic dose and the adverse off-target effect even causes serious safety concerns. Controlled drug release via external stimuli seems to be a promising method to overcome the drawbacks of conventional drug delivery systems (DDSs). Microbubbles and magnetic nanoparticles responding to ultrasound and magnetic fields respectively have been developed as an important component of novel DDSs. In particular, several attempts have also been made for the design and fabrication of dual-responsive DDS. This review presents the recent advances in the ultrasound and magnetic fields responsive DDSs in cardiovascular application, followed by their current problems and future reformation.
Collapse
|
17
|
Zhang L, Li Z, Ye X, Chen Z, Chen ZS. Mechanisms of thrombosis and research progress on targeted antithrombotic drugs. Drug Discov Today 2021; 26:2282-2302. [PMID: 33895314 DOI: 10.1016/j.drudis.2021.04.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/26/2022]
Abstract
Globally, the incidence of thromboembolic diseases has increased in recent years, accompanied by an increase in patient mortality. Currently, several targeting delivery strategies have been developed to treat thromboembolic diseases. In this review, we discuss the mechanisms of thrombolysis and current anticoagulant drugs, particularly those with targeting capability, highlighting advances in the accurate treatment of thrombolysis with fewer adverse effects. Such approaches include magnetic drug-loading systems combined with molecular imaging to recanalize blood vessels and systems based on chimeric Arg-Gly-Asp (RGD) sequences that can target platelet glycoprotein receptor. With such progress in targeted antithrombotic drugs, targeted thrombolysis treatment shows significant potential benefit for patients.
Collapse
Affiliation(s)
- Lei Zhang
- State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, Fuzhou 350002, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhen Li
- Fujian Cancer Hospital, Fujian Provincial Cancer Hospital of Fujian Medical University, Fuzhou 350014, China
| | - Xianren Ye
- Fujian Cancer Hospital, Fujian Provincial Cancer Hospital of Fujian Medical University, Fuzhou 350014, China.
| | - Zhuo Chen
- State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, Fuzhou 350002, China; University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Zhe-Sheng Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, NY 11439, USA.
| |
Collapse
|
18
|
Hinds MT, Ammi AY, Johnson J, Kaul S. Quantification of microbubble-induced sonothrombolysis in an ex vivo non-human primate model. J Thromb Haemost 2021; 19:502-512. [PMID: 33205492 PMCID: PMC8591990 DOI: 10.1111/jth.15180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In vitro studies with ultrasound (US) and microbubbles (MB) have reported that sono-thrombolysis can be achieved at high peak rarefactional acoustic pressure amplitudes (PRAPAs) using 0.25 and 1.05 MHz US frequencies. OBJECTIVE The aim of the current study was to determine if these parameters work on an ex vivo physiological model of thrombosis. METHODS A thrombogenic device was placed in an ex vivo chronic arteriovenous shunt in juvenile baboons. Platelet accumulation was measured by dynamic imaging of the device and the 10 cm thrombus tail with 111 In-labeled platelets. After 15 minutes of thrombus formation, treatment with either low-dose recombinant tissue plasminogen activator (rtPA) or low-dose rtPA + MB+US was performed for 20 minutes. Four US settings at 0.25% duty cycle were used: 0.25 MHz at PRAPAs of 1.20 and 2.20 MPa, and 1.05 MHz at 1.75 and 4.75 MPa. RESULTS Platelet accumulation was not inhibited by low-dose rtPA or MB with US alone. Platelet accumulation was significantly reduced with 0.25 MHz US at 2.20 PRAPA (P < .001) and with 1.05 MHz at 1.75 MPa and 4.75 MPa (P < .05) when used with MB and low-dose rtPA. Although this approach prevented platelet accumulation it did not cause thrombolysis on the device. CONCLUSIONS rtPA + MB + US (0.25 and 1.05 MHz) resulted in inhibition of platelet accumulation on the thrombogenic device when moderately high PRAPAs (≥1.75 MPa) were used. These results taken in context with lytic effects of US on myocardial microthrombi and direct effect on myocardial blood flow and function provide direction for the use of therapeutic US in acute coronary syndromes.
Collapse
Affiliation(s)
- Monica T. Hinds
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Azzdine Y. Ammi
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer Johnson
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Sanjiv Kaul
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
19
|
Xu J, Zhang Y, Nie G. Intelligent antithrombotic nanomedicines: Progress, opportunities, and challenges. VIEW 2021. [DOI: 10.1002/viw.20200145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Junchao Xu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety CAS Center for Excellence in Nanoscience National Center for Nanoscience and Technology Beijing China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing China
| | - Yinlong Zhang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety CAS Center for Excellence in Nanoscience National Center for Nanoscience and Technology Beijing China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing China
| | - Guangjun Nie
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety CAS Center for Excellence in Nanoscience National Center for Nanoscience and Technology Beijing China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing China
- GBA Research Innovation Institute for Nanotechnology Guangdong China
- Henan Institute of Advanced Technology Zhengzhou University Zhengzhou China
| |
Collapse
|
20
|
El Kadi S, Porter TR, van Rossum AC, Kamp O. Sonothrombolysis in the ambulance for ST-elevation myocardial infarction: rationale and protocol. Neth Heart J 2020; 29:330-337. [PMID: 33184756 PMCID: PMC8160072 DOI: 10.1007/s12471-020-01516-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 01/01/2023] Open
Abstract
Background Treatment of ST-elevation myocardial infarction (STEMI) has improved over the years. Current challenges in the management of STEMI are achievement of early reperfusion and the prevention of microvascular injury. Sonothrombolysis has emerged as a potential treatment for acute myocardial infarction, both for epicardial recanalisation as well as improving microvascular perfusion. This study aims to determine safety and feasibility of sonothrombolysis application in STEMI patients in the ambulance. Methods Ten patients with STEMI will be included and treated with sonothrombolysis in the ambulance during transfer to the PCI centre. Safety will be assessed by the occurrence of ventricular arrhythmias and shock during sonothrombolysis intervention. Feasibility will be assessed by the extent of protocol completion and myocardial visibility. Efficacy will be determined by angiographic patency rate, ST-elevation resolution, infarct size and left ventricular volumes, and function measured with cardiovascular magnetic resonance imaging, and contrast and strain echocardiography. A comparison will be made with matched controls using an existing STEMI database. Discussion Sonothrombolysis is a novel technique for the treatment of cardiovascular thromboembolic disease. The first clinical trials on its use for STEMI have demonstrated promising results. This study will be the first to examine the feasibility of in-ambulance sonothrombolysis for STEMI. Trial registration EU Clinical Trials Register (identifier: 2019-001883-31), registered 2020-02-25.
Collapse
Affiliation(s)
- S El Kadi
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands.
| | - T R Porter
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - A C van Rossum
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - O Kamp
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| |
Collapse
|
21
|
Guan L, Wang C, Yan X, Liu L, Li Y, Mu Y. A thrombolytic therapy using diagnostic ultrasound combined with RGDS-targeted microbubbles and urokinase in a rabbit model. Sci Rep 2020; 10:12511. [PMID: 32719362 PMCID: PMC7385658 DOI: 10.1038/s41598-020-69202-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 04/10/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to explore thrombolysis therapy based on ultrasound combined with urokinase and Arg–Gly–Asp sequence (RGDS)-targeted microbubbles by evaluating the histological changes in a thrombotic rabbit model. Forty-two New Zealand rabbits featuring platelet-rich thrombi in the femoral artery were randomized to (n = 6/group): ultrasound alone (US); urokinase alone (UK); ultrasound plus non-targeted microbubbles (US + M); ultrasound plus RGDS-targeted microbubbles (US + R); RGDS-targeted microbubbles plus urokinase (R + UK); ultrasound, non-targeted microbubbles and urokinase (US + M + UK); and ultrasound, RGDS-targeted microbubbles and urokinase (US + R + UK) groups. Diagnostic ultrasound was used transcutaneously over the thrombus for 30 min. We evaluated the thrombolytic effect based on ultrasound thrombi detection, blood flow, and histological observations. Among all study groups, complete recanalization was achieved in the US + R + UK group. Hematoxylin and eosin staining showed that the thrombi were completely dissolved. Scanning electron microscopy examination demonstrated that the fiber network structure of the thrombi was damaged. Transmission electron microscopy showed that the thrombus was decomposed into high electron-dense particles. Histology for von Willebrand factor and tissue factor were both negative in the US + R + UK group. This study revealed that a thrombolytic therapy consisting of diagnostic ultrasound together with RGDS-targeted and urokinase coupled microbubbles.
Collapse
Affiliation(s)
- Lina Guan
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Chunmei Wang
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Xue Yan
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Liyun Liu
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Yanhong Li
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Yuming Mu
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China.
| |
Collapse
|
22
|
Flow Augmentation in the Myocardium by Ultrasound Cavitation of Microbubbles: Role of Shear-Mediated Purinergic Signaling. J Am Soc Echocardiogr 2020; 33:1023-1031.e2. [PMID: 32532642 DOI: 10.1016/j.echo.2020.03.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Ultrasound-mediated cavitation of microbubble contrast agents produces high intravascular shear. We hypothesized that microbubble cavitation increases myocardial microvascular perfusion through shear-dependent purinergic pathways downstream from ATP release that is immediate and sustained through cellular ATP channels such as Pannexin-1. METHODS Quantitative myocardial contrast echocardiography perfusion imaging and in vivo optical imaging of ATP was performed in wild-type and Pannexin-1-deficient (Panx1-/-) mice before and 5 and 30 minutes after 10 minutes of ultrasound-mediated (1.3 MHz, mechanical index 1.3) myocardial microbubble cavitation. Flow augmentation in a preclinical model closer to humans was evaluated in rhesus macaques undergoing myocardial contrast echocardiography perfusion imaging after high-power cavitation in the apical four-chamber plane for 10 minutes. RESULTS Microbubble cavitation in wild-type mice (n = 7) increased myocardial perfusion by 64% ± 25% at 5 minutes and 95% ± 55% at 30 minutes compared with baseline (P < .05). In Panx1-/- mice (n = 5), perfusion increased by 28% ± 26% at 5 minutes (P = .04) but returned to baseline at 30 minutes. Myocardial ATP signal in wild-type (n = 7) mice undergoing cavitation compared with sham-treated controls (n = 3) was 450-fold higher at 5 minutes and 90-fold higher at 30 minutes after cavitation (P < .001). The ATP signal in Panx1-/- mice (n = 4) was consistently 10-fold lower than that in wild-type mice and was similar to sham controls at 30 minutes. In macaques (n = 8), myocardial perfusion increased twofold in the cavitation-exposed four-chamber plane, similar in degree to that produced by adenosine, but did not increase in the control two-chamber plane. CONCLUSIONS Cavitation of microbubbles in the myocardial microcirculation produces an immediate release of ATP, likely from cell microporation, as well as sustained release, which is channel dependent and responsible for persistent flow augmentation. These findings provide mechanistic insight by which cavitation improves perfusion and reduces infarct size in patients with myocardial infarction.
Collapse
|
23
|
Molecular imaging of inflammation - Current and emerging technologies for diagnosis and treatment. Pharmacol Ther 2020; 211:107550. [PMID: 32325067 DOI: 10.1016/j.pharmthera.2020.107550] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/07/2019] [Indexed: 12/12/2022]
Abstract
Inflammation is a key factor in multiple diseases including primary immune-mediated inflammatory diseases e.g. rheumatoid arthritis but also, less obviously, in many other common conditions, e.g. cardiovascular disease and diabetes. Together, chronic inflammatory diseases contribute to the majority of global morbidity and mortality. However, our understanding of the underlying processes by which the immune response is activated and sustained is limited by a lack of cellular and molecular information obtained in situ. Molecular imaging is the visualization, detection and quantification of molecules in the body. The ability to reveal information on inflammatory biomarkers, pathways and cells can improve disease diagnosis, guide and monitor therapeutic intervention and identify new targets for research. The optimum molecular imaging modality will possess high sensitivity and high resolution and be capable of non-invasive quantitative imaging of multiple disease biomarkers while maintaining an acceptable safety profile. The mainstays of current clinical imaging are computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US) and nuclear imaging such as positron emission tomography (PET). However, none of these have yet progressed to routine clinical use in the molecular imaging of inflammation, therefore new approaches are required to meet this goal. This review sets out the respective merits and limitations of both established and emerging imaging modalities as clinically useful molecular imaging tools in addition to potential theranostic applications.
Collapse
|
24
|
Aguiar MO, Tavares BG, Tsutsui JM, Fava AM, Borges BC, Oliveira MT, Soeiro A, Nicolau JC, Ribeiro HB, Chiang HP, Sbano JC, Goldsweig A, Rochitte CE, Lopes BB, Ramirez JA, Kalil Filho R, Porter TR, Mathias W. Sonothrombolysis Improves Myocardial Dynamics and Microvascular Obstruction Preventing Left Ventricular Remodeling in Patients With ST Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2020; 13:e009536. [DOI: 10.1161/circimaging.119.009536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background:
It has recently been demonstrated that high-energy diagnostic transthoracic ultrasound and intravenous microbubbles dissolve thrombi (sonothrombolysis) and increase angiographic recanalization rates in patients with ST-segment–elevation myocardial infarction. We aimed to study the effect of sonothrombolysis on the myocardial dynamics and infarct size obtained by real-time myocardial perfusion echocardiography and their value in preventing left ventricular remodeling.
Methods:
One hundred patients with ST-segment–elevation myocardial infarction were randomized to therapy (50 patients treated with sonothrombolysis and percutaneous coronary intervention) or control (50 patients treated with percutaneous coronary intervention only). Left ventricular volumes, ejection fraction, risk area (before treatment), myocardial perfusion defect over time (infarct size), and global longitudinal strain were determined by quantitative real-time myocardial perfusion echocardiography and speckle tracking echocardiography imaging.
Results:
Risk area was similar in the control and therapy groups (19.2±10.1% versus 20.7±8.9%;
P
=0.56) before treatment. The therapy group presented a behavior significantly different than control group over time (
P
<0.001). The perfusion defect was smaller in the therapy at 48 to 72 hours even in the subgroup of patients with no recanalization at first angiography (12.9±6.5% therapy versus 18.8±9.9% control;
P
=0.015). The left ventricular global longitudinal strain was higher in the therapy than control immediately after percutaneous coronary intervention (14.1±4.1% versus 12.0±3.3%;
P
=0.012), and this difference was maintained until 6 months (17.1±3.5% versus 13.6±3.6%;
P
<0.001). The only predictor of left ventricular remodeling was treatment with sonothrombolysis: the control group was more likely to exhibit left ventricular remodeling with an odds ratio of 2.79 ([95% CI, 0.13–6.86];
P
=0.026).
Conclusions:
Sonothrombolysis reduces microvascular obstruction and improves myocardial dynamics in patients with ST-segment–elevation myocardial infarction and is an independent predictor of left ventricular remodeling over time.
Collapse
Affiliation(s)
- Miguel O.D. Aguiar
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Bruno G. Tavares
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Jeane M. Tsutsui
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Agostina M. Fava
- University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.)
| | - Bruno C. Borges
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Mucio T. Oliveira
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Alexandre Soeiro
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Jose C. Nicolau
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Henrique B. Ribeiro
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Hsu P. Chiang
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - João C.N. Sbano
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Andrew Goldsweig
- University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.)
| | - Carlos E. Rochitte
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Bernardo B.C. Lopes
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - José A.F. Ramirez
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Roberto Kalil Filho
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Thomas R. Porter
- University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.)
| | - Wilson Mathias
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| |
Collapse
|
25
|
Kosareva A, Abou-Elkacem L, Chowdhury S, Lindner JR, Kaufmann BA. Seeing the Invisible-Ultrasound Molecular Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:479-497. [PMID: 31899040 DOI: 10.1016/j.ultrasmedbio.2019.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
Ultrasound molecular imaging has been developed in the past two decades with the goal of non-invasively imaging disease phenotypes on a cellular level not depicted on anatomic imaging. Such techniques already play a role in pre-clinical research for the assessment of disease mechanisms and drug effects, and are thought to in the future contribute to earlier diagnosis of disease, assessment of therapeutic effects and patient-tailored therapy in the clinical field. In this review, we first describe the chemical composition and structure as well as the in vivo behavior of the ultrasound contrast agents that have been developed for molecular imaging. We then discuss the strategies that are used for targeting of contrast agents to specific cellular targets and protocols used for imaging. Next we describe pre-clinical data on imaging of thrombosis, atherosclerosis and microvascular inflammation and in oncology, including the pathophysiological principles underlying the selection of targets in each area. Where applicable, we also discuss efforts that are currently underway for translation of this technique into the clinical arena.
Collapse
Affiliation(s)
- Alexandra Kosareva
- Cardiovascular Molecular Imaging, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Lotfi Abou-Elkacem
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford, California, USA
| | - Sayan Chowdhury
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford, California, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Portland, Oregon, USA; Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Beat A Kaufmann
- Cardiovascular Molecular Imaging, Department of Biomedicine, University of Basel, Basel, Switzerland; Department of Cardiology, University Hospital and University of Basel, Basel, Switzerland.
| |
Collapse
|
26
|
Ultrasound molecular imaging: insights into cardiovascular pathology. J Echocardiogr 2020; 18:86-93. [PMID: 32056137 PMCID: PMC7244457 DOI: 10.1007/s12574-020-00463-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/16/2020] [Accepted: 01/27/2020] [Indexed: 01/06/2023]
Abstract
Similar to what has already occurred in cancer medicine, the management of cardiovascular conditions will likely be improved by non-invasive molecular imaging technologies that can provide earlier or more accurate diagnosis. These techniques are already having a positive impact in pre-clinical research by providing insight into pathophysiology or efficacy of new therapies. Contrast enhanced ultrasound (CEU) molecular imaging is a technique that relies on the ultrasound detection of targeted microbubble contrast agents to examine molecular or cellular events that occur at the blood pool-endothelial interface. CEU molecular imaging techniques have been developed that are able to provide unique information on atherosclerosis, ischemia reperfusion injury, angiogenesis, vascular inflammation, and thrombus formation. Accordingly, CEU has the potential to be used in a wide variety of circumstances to detect disease early or at the bedside, and to guide appropriate therapy based on vascular phenotype. This review will describe the physical basis for CEU molecular imaging, and the specific disease processes for the pre-clinical translational research experience.
Collapse
|
27
|
Yadava M, Le DE, Dykan IV, Grafe MR, Nugent M, Ammi AY, Giraud D, Zhao Y, Minnier J, Kaul S. Therapeutic Ultrasound Improves Myocardial Blood Flow and Reduces Infarct Size in a Canine Model of Coronary Microthromboembolism. J Am Soc Echocardiogr 2019; 33:234-246. [PMID: 31812549 DOI: 10.1016/j.echo.2019.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Therapeutic ultrasound (TUS) has been used to lyse infarct-related coronary artery thrombus. There has been no study examining the effect of TUS specifically on myocardial microthromboemboli seen in acute myocardial infarction and acute coronary syndromes. The aim of this study was to test the hypothesis that TUS improves myocardial blood flow (MBF) and reduces infarct size (IS) in this situation by dissolving myocardial microthrombi. METHODS An open-chest canine model of myocardial microthromboembolism was created by disrupting a thrombus in the left anterior descending coronary artery, and 1.05- and 0.25-MHz TUS (n = 7 each) delivered epicardially for 30 min was compared with control (n = 6). MBF and IS (as a percentage of left anterior descending coronary artery perfusion bed size) were measured 60 min after treatment. In addition, immunohistochemistry was performed to assess microthrombi, and histopathology was performed to define inflammation. RESULTS Transmural, epicardial, and endocardial myocardial blood volume and MBF (measured using myocardial contrast echocardiography) and percentage wall thickening were significantly higher 60 min after receiving TUS compared with control. The ratio of IS to left anterior descending coronary artery perfusion bed size was significantly smaller (P = .03) in the 1.05-MHz TUS group (0.14 ± 0.04) compared with the control (0.31 ± 0.06, P = .04) and 0.25-MHz (0.36 ± 0.08) groups. MBF versus percentage wall thickening exhibited a linear relation (r = 0.65) in the control and 1.05-MHz TUS groups but not in the 0.25-MHz TUS group (r = 0.29). The presence of myocardial microemboli in vessels >10 μm in diameter was significantly reduced in the 1.05-MHz TUS group compared with the other two groups. The distribution and intensity of inflammation was higher in the 0.25-MHz TUS group compared with the other groups. CONCLUSIONS TUS at 1.05 MHz is effective in restoring myocardial blood volume and MBF, thus reducing IS by clearing the microcirculation of microthrombi. IS reduction is not seen at 0.25 MHz, despite improvement in MBF, which may be related to the increased inflammation noted at this frequency. Because both acute myocardial infarction and acute coronary syndromes are associated with microthromboembolism, these results suggest that TUS could have a potential adjunctive role in the treatment of both conditions.
Collapse
Affiliation(s)
- Mrinal Yadava
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon; Portland Veterans Administration Medical Center, Portland, Oregon
| | - D Elizabeth Le
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon; Portland Veterans Administration Medical Center, Portland, Oregon
| | - Igor V Dykan
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Marjorie R Grafe
- Department of Pathology, Oregon Health and Science University, Portland, Oregon
| | - Matthew Nugent
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon; Portland Veterans Administration Medical Center, Portland, Oregon
| | - Azzdine Y Ammi
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - David Giraud
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Yan Zhao
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Jessica Minnier
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon; Department of Biostatistics, Oregon Health and Science University, Portland, Oregon
| | - Sanjiv Kaul
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon.
| |
Collapse
|
28
|
Diagnostic Ultrasound and Microbubbles Treatment Improves Outcomes of Coronary No-Reflow in Canine Models by Sonothrombolysis. Crit Care Med 2019; 46:e912-e920. [PMID: 29965834 PMCID: PMC6110622 DOI: 10.1097/ccm.0000000000003255] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Supplemental Digital Content is available in the text. Objectives: Effective treatment for microvascular thrombosis-induced coronary no-reflow remains an unmet clinical need. This study sought to evaluate whether diagnostic ultrasound and microbubbles treatment could improve outcomes of coronary no-reflow by dissolving platelet- and erythrocyte-rich microthrombi. Design: Randomized controlled laboratory investigation. Setting: Research laboratory. Subjects: Mongrel dogs. Interventions: Coronary no-reflow models induced by platelet- or erythrocyte-rich microthrombi were established and randomly assigned to control, ultrasound, recombinant tissue-type plasminogen activator, ultrasound + microbubbles, or ultrasound + microbubbles + recombinant tissue-type plasminogen activator group. All treatments lasted for 30 minutes. Measurements and Main Results: Percentage of microemboli-obstructed coronary arterioles was lower in ultrasound + microbubbles group than that in control group for platelet- (> 50% obstruction: 10.20% ± 3.56% vs 31.80% ± 3.96%; < 50% obstruction: 14.80% ± 4.15% vs 28.20% ± 3.56%) and erythrocyte-rich microthrombi (> 50% obstruction: 8.20% ± 3.11% vs 30.60% ± 4.83%; < 50% obstruction: 12.80% ± 4.15% vs 25.80% ± 3.70%) (p < 0.001). Percentage change of myocardial blood flow in left anterior descending artery-dominated region, left ventricular ejection fraction, fractional shortening, and ST-segment resolution were higher, whereas infarcted area, troponin I, and creatine kinase MB isoenzyme were lower in ultrasound + microbubbles group than that in control group for both types of microthrombi (p < 0.001). Percentage change of myocardial blood flow, ejection fraction, fractional shortening, and ST-segment resolution were higher, whereas infarcted area, troponin I, and creatine kinase MB isoenzyme were lower in ultrasound + microbubbles and ultrasound + microbubbles + recombinant tissue-type plasminogen activator groups than that in recombinant tissue-type plasminogen activator group for platelet-rich microthrombi (p < 0.05). Conclusions: Ultrasound + microbubbles treatment could dissolve platelet- and erythrocyte-rich microthrombi, thereby improving outcomes of coronary no-reflow, making it a promising supplement to current reperfusion therapy for acute ST-segment elevation myocardial infarction.
Collapse
|
29
|
Zhang B, Kim H, Wu H, Gao Y, Jiang X. Sonothrombolysis with magnetic microbubbles under a rotational magnetic field. ULTRASONICS 2019; 98:62-71. [PMID: 31202970 PMCID: PMC6710138 DOI: 10.1016/j.ultras.2019.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/28/2019] [Accepted: 06/09/2019] [Indexed: 05/06/2023]
Abstract
Thrombosis is an extremely critical clinical condition where a clot forms inside a blood vessel which blocks the blood flow through the cardiovascular system. Previous sonothrombolysis methods using ultrasound and microbubbles (MBs) often have a relatively low lysis rate due to the low microbubbles concentration at clot region caused by blood flow in the vessel. To solve this problem, the magnetic microbubbles (MMBs) that can be retained by an outer magnetic field against blood flow are used in this study. Here we report the development of a new method using the rotational magnetic field to trap and vibrate magnetic microbubbles at target clot region and then using an intravascular forward-looking ultrasound transducer to activate them acoustically. In this study, we investigated the influence of different blood flow conditions, vessel occlusion conditions (partial and fully occluded), clot ages (fresh, retracted), ultrasound parameters (input voltage, duty cycle) and rotational magnetic field parameters (amplitude, frequency) on the thrombolysis rate. The results showed that the additional use of magnetic microbubbles significantly enhances in vitro lysis of blood clot.
Collapse
Affiliation(s)
- Bohua Zhang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh 27695, NC, USA
| | - Howuk Kim
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh 27695, NC, USA
| | - Huaiyu Wu
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh 27695, NC, USA
| | - Yu Gao
- Institute of Advanced Materials, Nanjing University of Posts and Telecommunications, Nanjing 210023, China
| | - Xiaoning Jiang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh 27695, NC, USA.
| |
Collapse
|
30
|
Mason OR, Davidson BP, Sheeran P, Muller M, Hodovan JM, Sutton J, Powers J, Lindner JR. Augmentation of Tissue Perfusion in Patients With Peripheral Artery Disease Using Microbubble Cavitation. JACC Cardiovasc Imaging 2019; 13:641-651. [PMID: 31422129 DOI: 10.1016/j.jcmg.2019.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/20/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The authors investigated ideal acoustic conditions on a clinical scanner custom-programmed for ultrasound (US) cavitation-mediated flow augmentation in preclinical models. We then applied these conditions in a first-in-human study to test the hypothesis that contrast US can increase limb perfusion in normal subjects and patients with peripheral artery disease (PAD). BACKGROUND US-induced cavitation of microbubble contrast agents augments tissue perfusion by convective shear and secondary purinergic signaling that mediates release of endogenous vasodilators. METHODS In mice, unilateral exposure of the proximal hindlimb to therapeutic US (1.3 MHz, mechanical index 1.3) was performed for 10 min after intravenous injection of lipid microbubbles. US varied according to line density (17, 37, 65 lines) and pulse duration. Microvascular perfusion was evaluated by US perfusion imaging, and in vivo adenosine triphosphate (ATP) release was assessed using in vivo optical imaging. Optimal parameters were then used in healthy volunteers and patients with PAD where calf US alone or in combination with intravenous microbubble contrast infusion was performed for 10 min. RESULTS In mice, flow was augmented in the US-exposed limb for all acoustic conditions. Only at the lowest line density was there a stepwise increase in perfusion for longer (40-cycle) versus shorter (5-cycle) pulse duration. For higher line densities, blood flow consistently increased by 3-fold to 4-fold in the US-exposed limb irrespective of pulse duration. High line density and long pulse duration resulted in the greatest release of ATP in the cavitation zone. Application of these optimized conditions in humans together with intravenous contrast increased calf muscle blood flow by >2-fold in both healthy subjects and patients with PAD, whereas US alone had no effect. CONCLUSIONS US of microbubbles when using optimized acoustic environments can increase perfusion in limb skeletal muscle, raising the possibility of a therapy for patients with PAD. (Augmentation of Limb Perfusion With Contrast Ultrasound; NCT03195556).
Collapse
Affiliation(s)
| | | | - Paul Sheeran
- Philips Ultrasound, Bothell, Washington; and Philips Research, Cambridge, Massachusetts
| | | | | | - Jonathan Sutton
- Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon
| | - Jeffry Powers
- Philips Ultrasound, Bothell, Washington; and Philips Research, Cambridge, Massachusetts
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Portland, Oregon; Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon.
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW This review will provide recent pre-clinical and initial clinical trials exploring the efficacy of sonothrombolysis as an adjunct to current emergent therapies in acute coronary syndromes. RECENT FINDINGS The initial clinical trials examining the efficacy of short pulse duration diagnostic ultrasound (DUS) high mechanical index impulses in patients with ST segment elevation myocardial infarction (STEMI) have demonstrated that there is improved patency of the infarct vessel, and improved microvascular flow following percutaneous coronary intervention. Subsequent randomized prospective trials have confirmed that in patients with acute STEMI receiving an intravenous microbubble infusion, diagnostic high mechanical index impulses applied in the apical windows pre- and post-percutaneous coronary intervention have reduced myocardial infarction size, as assessed by magnetic resonance imaging at 72 h following presentation, and have been associated with better left ventricular systolic function at 6 month follow-up. Sonothrombolysis has potential for improving early epicardial coronary artery patency and reduce left ventricular remodeling when added to current interventional strategies in STEMI.
Collapse
Affiliation(s)
- Thomas R Porter
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Wilson Mathias
- Departamento de Cardiopneumologia da Faculdade de Medicina, University of Sao Paulo School of Medicine, Sao Paulo, State of Sao Paulo, 03178-200, Brazil
| |
Collapse
|
32
|
Otani K, Kamiya A, Miyazaki T, Koga A, Inatomi A, Harada-Shiba M. Surface Modification with Lactadherin Augments the Attachment of Sonazoid Microbubbles to Glycoprotein IIb/IIIa. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1455-1465. [PMID: 30857759 DOI: 10.1016/j.ultrasmedbio.2019.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/07/2018] [Accepted: 01/25/2019] [Indexed: 06/09/2023]
Abstract
Arginine-glycine-aspartate (RGD)-carrying microbubbles (MBs) have been utilized as a specific contrast agent for glycoprotein IIb/IIIa (αIIbβ3 integrin)-expressing activated platelets in ultrasound molecular imaging. Recently, we found that surface modification with lactadherin provides the RGD motif on the surface of phosphatidylserine-containing clinically available MBs, Sonazoid. Here, we examined the potential of lactadherin-bearing Sonazoid MBs to be targeted MBs for glycoprotein IIb/IIIa using the custom-designed in vitro settings with recombinant αIIbβ3 integrin, activated platelets or erythrocyte-rich human clots. By modification of the surface with lactadherin, a large number of Sonazoid MBs were attached to the αIIbβ3 integrin-coated and platelet-immobilized plate. Additionally, the video intensity of clots after incubation with lactadherin-bearing Sonazoid MBs was significantly higher than that with unmodified Sonazoid MBs, implying the number of attached Sonazoid MBs was increased by the modification with lactadherin. Our results suggest that the lactadherin-bearing Sonazoid MBs have the potential to be thrombus-targeted MBs.
Collapse
Affiliation(s)
- Kentaro Otani
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan.
| | - Atsunori Kamiya
- Department of Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takahiro Miyazaki
- Department of Cell Biology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Ayumi Koga
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ayako Inatomi
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Mariko Harada-Shiba
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan; Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| |
Collapse
|
33
|
Cattaneo M, Froio A, Gallino A. Cardiovascular Imaging and Theranostics in Cardiovascular Pharmacotherapy. Eur Cardiol 2019; 14:62-64. [PMID: 31131039 PMCID: PMC6523052 DOI: 10.15420/ecr.2019.6.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Imaging plays a pivotal role in the diagnostic and prognostic assessment of cardiovascular diseases. During the past two decades, there has been an expansion of the available imaging techniques, some of which are now part of routine clinical practice. Cardiovascular imaging of atherosclerosis is a useful instrument, and it can corroborate and expand pathophysiological evidence on cardiovascular disease, providing proof of concept for medical therapy and can predict its responsiveness, and it may be able to be used as surrogate endpoints for clinical trials. Theranostics is an emerging therapy that combines imaging and therapeutic functions, using imaging-based therapeutic delivery systems. Theranostics could partially overcome current imaging limitations and translate experimental evidence and large-scale trials assessing clinical endpoints, rationalising cardiovascular drug development and paving the way to personalised medicine. The medical community cannot overlook the use of cardiovascular imaging as a complementary and supportive adjunct to trials investigating clinical endpoints, which remain the mainstay for investigating the efficacy and safety of cardiovascular pharmacotherapy.
Collapse
Affiliation(s)
- Mattia Cattaneo
- Cardiovascular Research Unit, Ospedale Regionale di Bellinzona e Valli Bellinzona, Switzerland.,Department of Cardiovascular Intensive Care, Cardiocentro Ticino Lugano, Switzerland
| | - Alberto Froio
- Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca Milan, Italy
| | - Augusto Gallino
- Cardiovascular Research Unit, Ospedale Regionale di Bellinzona e Valli Bellinzona, Switzerland.,University of Zurich Zurich, Switzerland
| |
Collapse
|
34
|
de Saint Victor M, Barnsley LC, Carugo D, Owen J, Coussios CC, Stride E. Sonothrombolysis with Magnetically Targeted Microbubbles. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1151-1163. [PMID: 30773375 DOI: 10.1016/j.ultrasmedbio.2018.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 12/18/2018] [Accepted: 12/22/2018] [Indexed: 05/13/2023]
Abstract
Microbubble-enhanced sonothrombolysis is a promising approach to increasing the tolerability and efficacy of current pharmacological treatments for ischemic stroke. Maintaining therapeutic concentrations of microbubbles and drugs at the clot site, however, poses a challenge. The objective of this study was to investigate the effect of magnetic microbubble targeting upon clot lysis rates in vitro. Retracted whole porcine blood clots were placed in a flow phantom of a partially occluded middle cerebral artery. The clots were treated with a combination of tissue plasminogen activator (0.75 µg/mL), magnetic microbubbles (∼107 microbubbles/mL) and ultrasound (0.5 MHz, 630-kPa peak rarefactional pressure, 0.2-Hz pulse repetition frequency, 2% duty cycle). Magnetic targeting was achieved using a single permanent magnet (0.08-0.38 T and 12-140 T/m in the region of the clot). The change in clot diameter was measured optically over the course of the experiment. Magnetic targeting produced a threefold average increase in lysis rates, and linear correlation was observed between lysis rate and total energy of acoustic emissions.
Collapse
Affiliation(s)
- Marie de Saint Victor
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Lester C Barnsley
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Dario Carugo
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Joshua Owen
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Constantin C Coussios
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Eleanor Stride
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.
| |
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW Non-invasive molecular imaging is currently used as a research technique to better understand disease pathophysiology. There are also many potential clinical applications where molecular imaging may provide unique information that allows either earlier or more definitive diagnosis, or can guide precision medicine-based decisions on therapy. Contrast-enhanced ultrasound (CEU) with targeted microbubble contrast agents is one such technique that has been developed that has the unique properties of providing rapid information and revealing information only on events that occur within the vascular space. RECENT FINDINGS CEU molecular probes have been developed for a wide variety of disease states including atherosclerosis, vascular inflammation, thrombosis, tumor neovascularization, and ischemic injury. While the technique has not yet been adapted to clinical use, it has been used to reveal pathological processes, to identify new therapeutic targets, and to test the efficacy of novel treatments. This review will explore the physical basis for CEU molecular imaging, its strengths and limitations compared to other molecular imaging modalities, and the pre-clinical translational research experience.
Collapse
Affiliation(s)
- Eran Brown
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.,Knight Cardiovascular Institute, UHN-62, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, UHN-62, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA. .,Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland, OR, USA.
| |
Collapse
|
36
|
Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. J Am Coll Cardiol 2019; 73:2832-2842. [PMID: 30894317 DOI: 10.1016/j.jacc.2019.03.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Preclinical studies have demonstrated that high mechanical index (MI) impulses from a diagnostic ultrasound transducer during an intravenous microbubble infusion (sonothrombolysis) can restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI). OBJECTIVES This study tested the clinical effectiveness of sonothrombolysis in patients with STEMI. METHODS Patients with their first STEMI were prospectively randomized to either diagnostic ultrasound-guided high MI impulses during an intravenous Definity (Lantheus Medical Imaging, North Billerica, Massachusetts) infusion before, and following, emergent percutaneous coronary intervention (PCI), or to a control group that received PCI only (n = 50 in each group). A reference first STEMI group (n = 203) who arrived outside the randomization window was also analyzed. Angiographic recanalization before PCI, ST-segment resolution, infarct size by magnetic resonance imaging, and systolic function (LVEF) at 6 months were compared. RESULTS ST-segment resolution occurred in 16 (32%) high MI PCI versus 2 (4%) PCI-only patients before PCI, and angiographic recanalization was 48% in high MI/PCI versus 20% in PCI only and 21% in the reference group (p < 0.001). Infarct size was reduced (29 ± 22 g high MI/PCI vs. 40 ± 20 g PCI only; p = 0.026). LVEF was not different between groups before treatment (44 ± 11% vs. 43 ± 10%), but increased immediately after PCI in the high MI/PCI group (p = 0.03), and remained higher at 6 months (p = 0.015). Need for implantable defibrillator (LVEF ≤30%) was reduced in the high MI/PCI group (5% vs. 18% PCI only; p = 0.045). CONCLUSIONS Sonothrombolysis added to PCI improves recanalization rates and reduces infarct size, resulting in sustained improvements in systolic function after STEMI. (Therapeutic Use of Ultrasound in Acute Coronary Artery Disease; NCT02410330).
Collapse
|
37
|
彭 晓, 李 海, 陈 晓, 钟 佳, 刘 俭, 曹 世. [Efficacy of combined ultrasound and microbubble treatment for thrombolysis for rescuing ischemic tissues in rats at different time after thrombosis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:1089-1094. [PMID: 30377102 PMCID: PMC6744185 DOI: 10.12122/j.issn.1673-4254.2018.09.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the relationship between the time after thrombosis and the efficacy of combined ultrasound and microbubble treatment for rescuing the ischemic tissues. METHODS Rat models of thrombosis in the right common iliac artery were established and received combined ultrasound and microbubble treatment at 3, 6 and 12 h after thrombosis. The recanalization rate of the right common iliac artery was assessed using both 2-dimensional and Doppler ultrasound. The plateau acoustic intensity (AI) was quantified for estimating the skeletal microvascular blood volume, and skeletal muscle injury markers including myoglobin (Mb) and creatinine kinase (CK) were measured using ELISA. Postmortem TUNEL staining was used to detect the apoptotic rate of skeletal muscle cells in the hind limb of the rats. RESULTS Compared with those in 3 h group, the recanalization rate and AI were significantly lower, and the levels of Mb and CK and the apoptotic rate of the skeletal muscle cells were significantly higher in both 6 h group and 12 h group (P < 0.05). Compared with those in 6 h group, the rats receiving treatment at 12 h after thrombosis showed significantly lowered AI and increased Mb, CK and apoptotic rate of the skeletal muscle cells (P < 0.05). CONCLUSIONS The efficacy of combined ultrasound and microbubble treatment for rescuing ischemic tissues tends to be attenuated as the time after thrombosis prolongs in rats.
Collapse
Affiliation(s)
- 晓红 彭
- 南方医科大学南方医院 医务科,广东 广州 510515Department of Medical Services Administration, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 海瑞 李
- 南方医科大学南方医院 心内科,广东 广州 510515Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 晓强 陈
- 南方医科大学南方医院 心内科,广东 广州 510515Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 佳源 钟
- 南方医科大学南方医院 心内科,广东 广州 510515Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 俭 刘
- 南方医科大学南方医院 心内科,广东 广州 510515Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 世平 曹
- 南方医科大学南方医院 心内科,广东 广州 510515Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| |
Collapse
|
38
|
Porter TR, Mulvagh SL, Abdelmoneim SS, Becher H, Belcik JT, Bierig M, Choy J, Gaibazzi N, Gillam LD, Janardhanan R, Kutty S, Leong-Poi H, Lindner JR, Main ML, Mathias W, Park MM, Senior R, Villanueva F. Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr 2018; 31:241-274. [DOI: 10.1016/j.echo.2017.11.013] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
39
|
Nederhoed JH, Ebben HP, Slikkerveer J, Hoksbergen AW, Kamp O, Tangelder GJ, Wisselink W, Musters RJ, Yeung KK. Intravenous Targeted Microbubbles Carrying Urokinase versus Urokinase Alone in Acute Peripheral Arterial Thrombosis in a Porcine Model. Ann Vasc Surg 2017; 44:400-407. [DOI: 10.1016/j.avsg.2017.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 11/27/2022]
|
40
|
Slikkerveer J, Juffermans LJ, van Royen N, Appelman Y, Porter TR, Kamp O. Therapeutic application of contrast ultrasound in ST elevation myocardial infarction: Role in coronary thrombosis and microvascular obstruction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 8:45-53. [PMID: 28868906 PMCID: PMC6376593 DOI: 10.1177/2048872617728559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In the past few decades, cardiac ultrasound has become a widely available, easy-to-use diagnostic tool in many scenarios in acute cardiac care. The introduction of microbubbles extended its diagnostic value. Not long thereafter, several investigators explored the therapeutic potential of contrast ultrasound on thrombus dissolution. Despite large improvements in therapeutic options, acute ST elevation myocardial infarction remains one of the main causes of mortality and morbidity in the western world. The therapeutic effect of contrast ultrasound on thrombus dissolution might prove to be a new, effective treatment strategy in this group of patients. With the recent publication of human studies scrutinising the therapeutic options of ultrasound and microbubbles in ST elevation myocardial infarction, we have entered a new stage in this area of research. This therapeutic effect is based on biochemical effects both at macrovascular and microvascular levels, of which the exact working mechanisms remain to be elucidated in full. This review will give an up-to-date summary of our current knowledge of the therapeutic effects of contrast ultrasound and its potential application in the field of ST elevation myocardial infarction, along with its future developments.
Collapse
Affiliation(s)
- Jeroen Slikkerveer
- 1 Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.,2 Institute of Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Lynda Jm Juffermans
- 1 Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.,2 Institute of Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.,3 Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels van Royen
- 1 Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.,2 Institute of Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande Appelman
- 1 Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.,2 Institute of Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Thomas R Porter
- 4 University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Otto Kamp
- 1 Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.,2 Institute of Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
41
|
Yu FT, Chen X, Straub AC, Pacella JJ. The Role of Nitric Oxide during Sonoreperfusion of Microvascular Obstruction. Theranostics 2017; 7:3527-3538. [PMID: 28912893 PMCID: PMC5596441 DOI: 10.7150/thno.19422] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 07/10/2017] [Indexed: 11/17/2022] Open
Abstract
Rationale: Microembolization during PCI for acute myocardial infarction can cause microvascular obstruction (MVO). MVO severely limits the success of reperfusion therapies, is associated with additional myonecrosis, and is linked to worse prognosis, including death. We have shown, both in in vitro and in vivo models, that ultrasound (US) and microbubble (MB) therapy (termed “sonoreperfusion” or “SRP”) is a theranostic approach that relieves MVO and restores perfusion, but the underlying mechanisms remain to be established. Objective: In this study, we investigated the role of nitric oxide (NO) during SRP. Methods and results: We first demonstrated in plated cells that US-stimulated MB oscillations induced a 6-fold increase in endothelial nitric oxide synthase (eNOS) phosphorylation in vitro. We then monitored the kinetics of intramuscular NO and perfusion flow rate responses following 2-min of SRP therapy in the rat hindlimb muscle, with and without blockade of eNOS with LNAME. Following SRP, we found that starting at 6 minutes, intramuscular NO increased significantly over 30 min and was higher than baseline after 13 min. Concomitant contrast enhanced burst reperfusion imaging confirmed that there was a marked increase in perfusion flow rate at 6 and 10 min post SRP compared to baseline (>2.5 fold). The increases in intramuscular NO and perfusion rate were blunted with LNAME. Finally, we tested the hypothesis that NO plays a role in SRP by assessing reperfusion efficacy in a previously described rat hindlimb model of MVO during blockade of eNOS. After US treatment 1, microvascular blood volume was restored to baseline in the MB+US group, but remained low in the LNAME group. Perfusion rates increased in the MB+US group after US treatment 2 but not in the MB+US+LNAME group. Conclusions: These data strongly support that MB oscillations can activate the eNOS pathway leading to increased blood perfusion and that NO plays a significant role in SRP efficacy.
Collapse
|
42
|
Gao S, Zhu Q, Guo M, Gao Y, Dong X, Chen Z, Liu Z, Xie F. Ultrasound and Intra-Clot Microbubbles Enhanced Catheter-Directed Thrombolysis in Vitro and in Vivo. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1671-1678. [PMID: 28479088 DOI: 10.1016/j.ultrasmedbio.2017.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/03/2017] [Accepted: 03/27/2017] [Indexed: 06/07/2023]
Abstract
Insufficient penetration of microbubbles (MBs) into the vessel-obstructing thrombi significantly reduces the effectiveness of ultrasound thrombolysis (UT). The widely performed catheter-directed therapy (CDT) makes it possible to increase the local concentration of MBs in the clot. In an occluded vessel with a bypass, treatment of fresh human whole blood clots with CDT-based UT (intra-clot injection of MBs and urokinase, with ultrasound exposure) resulted in a significantly higher percentage of weight loss (35.32 ± 15.42%), compared with CDT alone (19.64 ± 4.71%), non-CDT-based UT (systemic administration of urokinase and MBs, with ultrasound exposure, 8.79 ± 3.02%) and systemic thrombolysis (7.90 ± 2.14). Ultrasound and intra-clot MB enhancement of CDT was further confirmed by a rabbit IVC thrombolysis study, where CDT-based UT resulted in significantly more effective thrombolysis compared with CDT alone. In summary, combining CDT with intra-clot MB-induced acoustic cavitation can improve thrombolysis.
Collapse
Affiliation(s)
- Shunji Gao
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Qiong Zhu
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - MengJiao Guo
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yuan Gao
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xiaoxiao Dong
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zhong Chen
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zheng Liu
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
| | - Feng Xie
- Internal Medicine Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
43
|
Translational initiatives in thrombolytic therapy. Front Med 2017; 11:1-19. [DOI: 10.1007/s11684-017-0497-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 10/10/2016] [Indexed: 01/26/2023]
|
44
|
Zhang J, Liu H, Du X, Guo Y, Chen X, Wang S, Fang J, Cao P, Zhang B, Liu Z, Zhang W. Increasing of Blood-Brain Tumor Barrier Permeability through Transcellular and Paracellular Pathways by Microbubble-Enhanced Diagnostic Ultrasound in a C6 Glioma Model. Front Neurosci 2017; 11:86. [PMID: 28280455 PMCID: PMC5322268 DOI: 10.3389/fnins.2017.00086] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 02/09/2017] [Indexed: 11/13/2022] Open
Abstract
Most of the anticancer agents cannot be efficiently delivered into the brain tumor because of the existence of blood-brain tumor barrier (BTB). The objective of this study was to explore the effect of microbubble-enhanced diagnostic ultrasound (MEUS) on the BTB permeability and the possible mechanism. Glioma-bearing rats were randomized into three groups as follows: the microbubble-enhanced continued diagnostic ultrasound (MECUS) group; the microbubble-enhanced intermittent diagnostic ultrasound (MEIUS) group and the control group. The gliomas were insonicated through the skull with a diagnostic ultrasound and injected with microbubbles through the tail veins. Evans Blue (EB) and dynamic contrast-enhanced-MRI were used to test changes in the BTB permeability. Confocal laser scanning microscopy was used to observe the deposition of the EB in the tumor tissues. The distribution and expression of junctional adhesion molecule-A (JAM-A) and calcium-activated potassium channels (KCa channels) were detected by a Western blot, qRT-PCR, and immunohistochemical staining. In the MEUS groups, the EB extravasation (11.0 ± 2.2 μg/g in MECUS group and 17.9 ± 2.3 μg/g in MEIUS group) exhibited a significant increase compared with the control group (5.3 ± 0.9 μg/g). The MEIUS group had more EB extravasation than the MECUS group. The Ktrans value of the dynamic contrast-enhanced-MRI in the MEUS groups was higher than that of the control group and correlated strongly with the EB extravasation in the tumor (R2 = 0.97). This showed that the Ktrans value might be a non-invasive method to evaluate the BTB permeability in rat glioma after microbubble-enhanced ultrasound treatment.Western blot, qRT-PCR and immunohistochemical staining revealed that MEUS increased the KCa channels expression and reduced JAM-A expression in glioma. This change was more obvious in the MEIUS group than in the MECUS group. The results demonstrated that MEUS effectively increased the BTB permeability in glioma. The mechanisms might involve the up-regulation of KCa channels expression and affecting the formation of tight junctions in the BTB by a reduction of JAM-A expression. These findings might provide some new guidance for glioma drug therapy.
Collapse
Affiliation(s)
- Jinlong Zhang
- Department of Radiology, Research Institute of Surgery, Daping Hospital, Third Military Medical University Chongqing, China
| | - Heng Liu
- Department of Radiology, Research Institute of Surgery, Daping Hospital, Third Military Medical University Chongqing, China
| | - Xuesong Du
- Department of Radiology, Research Institute of Surgery, Daping Hospital, Third Military Medical University Chongqing, China
| | - Yu Guo
- Department of Radiology, Research Institute of Surgery, Daping Hospital, Third Military Medical University Chongqing, China
| | - Xiao Chen
- Department of Radiology, Research Institute of Surgery, Daping Hospital, Third Military Medical University Chongqing, China
| | - Shunan Wang
- Department of Radiology, Research Institute of Surgery, Daping Hospital, Third Military Medical University Chongqing, China
| | - Jingqin Fang
- Department of Radiology, Research Institute of Surgery, Daping Hospital, Third Military Medical University Chongqing, China
| | | | - Bo Zhang
- Four and the State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Third Military Medical University Chongqing, China
| | - Zheng Liu
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University Chongqing, China
| | - Weiguo Zhang
- Department of Radiology, Research Institute of Surgery, Daping Hospital, Third Military Medical UniversityChongqing, China; Chongqing Clinical Research Center for Imaging and Nuclear MedicineChongqing, China
| |
Collapse
|
45
|
Belcik JT, Davidson BP, Xie A, Wu MD, Yadava M, Qi Y, Liang S, Chon CR, Ammi AY, Field J, Harmann L, Chilian WM, Linden J, Lindner JR. Augmentation of Muscle Blood Flow by Ultrasound Cavitation Is Mediated by ATP and Purinergic Signaling. Circulation 2017; 135:1240-1252. [PMID: 28174191 DOI: 10.1161/circulationaha.116.024826] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/23/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Augmentation of tissue blood flow by therapeutic ultrasound is thought to rely on convective shear. Microbubble contrast agents that undergo ultrasound-mediated cavitation markedly amplify these effects. We hypothesized that purinergic signaling is responsible for shear-dependent increases in muscle perfusion during therapeutic cavitation. METHODS Unilateral exposure of the proximal hindlimb of mice (with or without ischemia produced by iliac ligation) to therapeutic ultrasound (1.3 MHz, mechanical index 1.3) was performed for 10 minutes after intravenous injection of 2×108 lipid microbubbles. Microvascular perfusion was evaluated by low-power contrast ultrasound perfusion imaging. In vivo muscle ATP release and in vitro ATP release from endothelial cells or erythrocytes were assessed by a luciferin-luciferase assay. Purinergic signaling pathways were assessed by studying interventions that (1) accelerated ATP degradation; (2) inhibited P2Y receptors, adenosine receptors, or KATP channels; or (3) inhibited downstream signaling pathways involving endothelial nitric oxide synthase or prostanoid production (indomethacin). Augmentation in muscle perfusion by ultrasound cavitation was assessed in a proof-of-concept clinical trial in 12 subjects with stable sickle cell disease. RESULTS Therapeutic ultrasound cavitation increased muscle perfusion by 7-fold in normal mice, reversed tissue ischemia for up to 24 hours in the murine model of peripheral artery disease, and doubled muscle perfusion in patients with sickle cell disease. Augmentation in flow extended well beyond the region of ultrasound exposure. Ultrasound cavitation produced an ≈40-fold focal and sustained increase in ATP, the source of which included both endothelial cells and erythrocytes. Inhibitory studies indicated that ATP was a critical mediator of flow augmentation that acts primarily through either P2Y receptors or adenosine produced by ectonucleotidase activity. Combined indomethacin and inhibition of endothelial nitric oxide synthase abolished the effects of therapeutic ultrasound, indicating downstream signaling through both nitric oxide and prostaglandins. CONCLUSIONS Therapeutic ultrasound using microbubble cavitation to increase muscle perfusion relies on shear-dependent increases in ATP, which can act through a diverse portfolio of purinergic signaling pathways. These events can reverse hindlimb ischemia in mice for >24 hours and increase muscle blood flow in patients with sickle cell disease. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov. Unique identifier: NCT01566890.
Collapse
Affiliation(s)
- J Todd Belcik
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Brian P Davidson
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Aris Xie
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Melinda D Wu
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Mrinal Yadava
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Yue Qi
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Sherry Liang
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Chae Ryung Chon
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Azzdine Y Ammi
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Joshua Field
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Leanne Harmann
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - William M Chilian
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Joel Linden
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Jonathan R Lindner
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.).
| |
Collapse
|
46
|
Zhang J, Wu S, Liu Y, Qiao L, Gao W, Zhang W, Liu Z. Disruption of Prostate Microvasculature by Combining Microbubble-Enhanced Ultrasound and Prothrombin. PLoS One 2016; 11:e0162398. [PMID: 27643992 PMCID: PMC5028116 DOI: 10.1371/journal.pone.0162398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/26/2016] [Indexed: 11/18/2022] Open
Abstract
Previous studies have shown a unique method to disrupt tumor vasculature using pulsed, high-pressure amplitude therapeutic ultrasound combined with microbubbles. In this study, we attempted to destroy the prostate vasculature of canine prostates using microbubble-enhanced ultrasound (MEUS) and prothrombin. The prostates of 43 male mongrel canines were surgically exposed. Twenty-two prostates were treated using MEUS (n = 11) or MEUS and prothrombin (PMEUS, n = 11). The other 21 prostates, which were treated using microbubbles (n = 7), ultrasound (n = 7) or prothrombin (n = 7) only, served as the controls. Prothrombin was intravenously infused at 20 IU/kg. MEUS was induced using a therapeutic ultrasound device at a peak negative pressure of 4.47 MPa and a microbubble injection. Contrast-enhanced ultrasound was performed to assess the blood perfusion of the prostates. Then, the prostate tissue was harvested immediately after treatment and at 48 hours later for pathological examination. The contrast-enhanced ultrasound peak value of the prostate decreased significantly from 36.2 ± 5.6 to 27.1 ± 6.3 after treatment in the PMEUS group, but it remained unchanged in the other groups. Histological examination found severe microvascular rupture, hemorrhage and thrombosis in both MEUS- and PMEUS-treated prostates immediately after treatment, while disruption in the PMEUS group was more severe than in the MEUS group. Forty-eight hours after treatment, massive necrosis and infiltration of white blood cells occurred in the PMEUS group. This study demonstrated that PMEUS disrupted the normal microvasculature of canine prostates and induced massive necrosis. PMEUS could potentially become a new noninvasive method used for the treatment of benign prostatic hyperplasia.
Collapse
Affiliation(s)
- Jinlong Zhang
- Department of Radiology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Shengzheng Wu
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yongliang Liu
- Department of Urology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Lu Qiao
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Wenhong Gao
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Weiguo Zhang
- Department of Radiology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
- State key laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
- * E-mail: (ZL); (WZ)
| | - Zheng Liu
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing, China
- * E-mail: (ZL); (WZ)
| |
Collapse
|
47
|
Black JJ, Yu FTH, Schnatz RG, Chen X, Villanueva FS, Pacella JJ. Effect of Thrombus Composition and Viscosity on Sonoreperfusion Efficacy in a Model of Micro-Vascular Obstruction. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2220-31. [PMID: 27207018 PMCID: PMC4983511 DOI: 10.1016/j.ultrasmedbio.2016.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/28/2016] [Accepted: 04/06/2016] [Indexed: 05/11/2023]
Abstract
Distal embolization of micro-thrombi during stenting for myocardial infarction causes micro-vascular obstruction (MVO). We have previously shown that sonoreperfusion (SRP), a microbubble (MB)-mediated ultrasound (US) therapy, resolves MVO from venous micro-thrombi in vitro in saline. However, blood is more viscous than saline, and arterial thrombi that embolize during stenting are mechanically distinct from venous clot. Therefore, we tested the hypothesis that MVO created with arterial micro-thrombi are more resistant to SRP therapy compared with venous micro-thrombi, and higher viscosity further increases the US requirement for effective SRP in an in vitro model of MVO. Lipid MBs suspended in plasma with adjusted viscosity (1.1 cP or 4.0 cP) were passed through tubing bearing a mesh with 40-μm pores to simulate a micro-vascular cross-section; upstream pressure reflected thrombus burden. To simulate MVO, the mesh was occluded with either arterial or venous micro-thrombi to increase upstream pressure to 40 mmHg ± 5 mmHg. Therapeutic long-tone-burst US was delivered to the occluded area for 20 min. MB activity was recorded with a passive cavitation detector. MVO caused by arterial micro-thrombi at either blood or plasma viscosity resulted in less effective SRP therapy compared to venous thrombi. Higher viscosity further reduced the effectiveness of SRP therapy. The passive cavitation detector showed a decrease in inertial cavitation when viscosity was increased, while stable cavitation was affected in a more complex manner. Overall, these data suggest that arterial thrombi may require higher acoustic pressure US than venous thrombi to achieve similar SRP efficacy; increased viscosity decreases SRP efficacy; and both inertial and stable cavitation are implicated in observed SRP efficacy.
Collapse
Affiliation(s)
- John J Black
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Francois T H Yu
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rick G Schnatz
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Xucai Chen
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Flordeliza S Villanueva
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John J Pacella
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| |
Collapse
|
48
|
Roos ST, Juffermans LJM, van Royen N, van Rossum AC, Xie F, Appelman Y, Porter TR, Kamp O. Unexpected High Incidence of Coronary Vasoconstriction in the Reduction of Microvascular Injury Using Sonolysis (ROMIUS) Trial. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1919-1928. [PMID: 27160847 DOI: 10.1016/j.ultrasmedbio.2016.03.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 06/05/2023]
Abstract
High-mechanical-index ultrasound and intravenous microbubbles might prove beneficial in treating microvascular obstruction caused by microthrombi after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). Experiments in animals have revealed that longer-pulse-duration ultrasound is associated with an improvement in microvascular recovery. This trial tested long-pulse-duration, high-mechanical-index ultrasound in STEMI patients. Non-randomly assigned, non-blinded patients were included in this phase 2 trial. The primary endpoint was any side effect possibly related to the ultrasound treatment. The study was aborted after six patients were included; three patients experienced coronary vasoconstriction of the culprit artery, unresponsive to nitroglycerin. Therefore, coronary artery diameter was measured in five pigs. Coronary artery diameters distal to the injury site decreased after application of ultrasound, after balloon injury plus thrombus injection (from 1.89 ± 0.24 mm before to 1.78 ± 0.17 after ultrasound, p = 0.05). Long-pulse-duration ultrasound might cause coronary vasoconstriction distal to the culprit vessel location.
Collapse
Affiliation(s)
- Sebastiaan T Roos
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands.
| | - Lynda J M Juffermans
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - Feng Xie
- University of Nebraska Medical Centre, Omaha, Nebraska, USA
| | - Yolande Appelman
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | | | - Otto Kamp
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| |
Collapse
|
49
|
Porter TR, Choudhury SA, Xie F. Utilization of diagnostic ultrasound and intravenous lipid-encapsulated perfluorocarbons in non-invasive targeted cardiovascular therapeutics. J Ther Ultrasound 2016; 4:18. [PMID: 27429753 PMCID: PMC4946285 DOI: 10.1186/s40349-016-0062-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 07/04/2016] [Indexed: 02/06/2023] Open
Abstract
Diagnostic ultrasound (DUS) pressures have the ability to induce inertial cavitation (IC) of systemically administered microbubbles; this bioeffect has many diagnostic and therapeutic implications in cardiovascular care. Diagnostically, commercially available lipid-encapsulated perfluorocarbons (LEP) can be utilized to improve endocardial and vascular border delineation as well as assess myocardial perfusion. Therapeutically, the liquid jets induced by IC can alter endothelial function and dissolve thrombi within the immediate vicinity of the cavitating microbubbles. The cavitating LEP can also result in the localized release of any bound therapeutic substance at the site of insonation. DUS-induced IC has been tested in pre-clinical studies to determine what effect it has on acute vascular and microvascular thrombosis as well as nitric oxide (NO) release. These pre-clinical studies have consistently shown that DUS-induced IC of LEP is effective in restoring coronary vascular and microvascular flow in acute ST segment elevation myocardial infarction (STEMI), with microvascular flow improving even if upstream large vessel flow has not been achieved. The initial clinical trials examining the efficacy of short pulse duration DUS high mechanical index impulses in patients with STEMI are underway, and preliminary studies have suggested that earlier epicardial vessel recanalization can be achieved prior to arriving in the cardiac catheterization laboratory. DUS high mechanical index impulses have also been effective in pre-clinical studies for targeting DNA delivery that has restored islet cell function in type I diabetes and restored vascular flow in the extremities downstream from a peripheral vascular occlusion. Improvements in this technique will come from three dimensional arrays for therapeutic applications, more automated delivery techniques that can be applied in the field, and use of submicron-sized acoustically activated LEP droplets that may better permeate the clot prior to DUS activation and cavitation. This article will focus on these newer developments for DUS therapeutic applications.
Collapse
Affiliation(s)
- Thomas R Porter
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, 68198 Omaha, NE USA
| | - Songita A Choudhury
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, 68198 Omaha, NE USA
| | - Feng Xie
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, 68198 Omaha, NE USA
| |
Collapse
|
50
|
Porter TR, Radio S, Lof J, Everbach C, Powers JE, Vignon F, Shi WT, Xie F. Diagnostic Ultrasound High Mechanical Index Impulses Restore Microvascular Flow in Peripheral Arterial Thromboembolism. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1531-40. [PMID: 27083977 PMCID: PMC4899265 DOI: 10.1016/j.ultrasmedbio.2016.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/18/2016] [Accepted: 02/03/2016] [Indexed: 05/25/2023]
Abstract
We sought to explore mechanistically how intermittent high-mechanical-index (MI) diagnostic ultrasound impulses restore microvascular flow. Thrombotic microvascular obstruction was created in the rat hindlimb muscle of 36 rats. A diagnostic transducer confirmed occlusion with low-MI imaging during an intravenous microbubble infusion. This same transducer was used to intermittently apply ultrasound with an MI that produced stable or inertial cavitation (IC) for 10 min through a tissue-mimicking phantom. A nitric oxide inhibitor, L-Nω-nitroarginine methyl ester (L-NAME), was pre-administered to six rats. Plateau microvascular contrast intensity quantified skeletal microvascular blood volume, and postmortem staining was used to detect perivascular hemorrhage. Intermittent IC impulses produced the greatest recovery of microvascular blood volume (p < 0.0001, analysis of variance). Nitric oxide inhibition did not affect the skeletal microvascular blood volume improvement, but did result in more perivascular hemorrhage. IC inducing pulses from a diagnostic transducer can reverse microvascular obstruction after acute arterial thromboembolism. Nitric oxide may prevent unwanted bio-effects of these IC pulses.
Collapse
Affiliation(s)
- Thomas R Porter
- University of Nebraska Medical Center, Omaha, Nebraska, USA.
| | - Stanley Radio
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - John Lof
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | | | - Francois Vignon
- Philips Research North America, Briarcliff Manor, New York, USA
| | - William T Shi
- Philips Research North America, Briarcliff Manor, New York, USA
| | - Feng Xie
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|