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Ward RE, Martinez-Correa S, Tierradentro-García LO, Hwang M, Sehgal CM. Sonothrombolysis: State-of-the-Art and Potential Applications in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 11:57. [PMID: 38255371 PMCID: PMC10814591 DOI: 10.3390/children11010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
In recent years, advances in ultrasound therapeutics have been implemented into treatment algorithms for the adult population; however, the use of therapeutic ultrasound in the pediatric population still needs to be further elucidated. In order to better characterize the utilization and practicality of sonothrombolysis in the juvenile population, the authors conducted a literature review of current pediatric research in therapeutic ultrasound. The PubMed database was used to search for all clinical and preclinical studies detailing the use and applications of sonothrombolysis, with a focus on the pediatric population. As illustrated by various review articles, case studies, and original research, sonothrombolysis demonstrates efficacy and safety in clot dissolution in vitro and in animal studies, particularly when combined with microbubbles, with potential applications in conditions such as deep venous thrombosis, peripheral vascular disease, ischemic stroke, myocardial infarction, and pulmonary embolism. Although there is limited literature on the use of therapeutic ultrasound in children, mainly due to the lower prevalence of thrombotic events, sonothrombolysis shows potential as a noninvasive thrombolytic treatment. However, more pediatric sonothrombolysis research needs to be conducted to quantify the safety and ethical considerations specific to this vulnerable population.
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Affiliation(s)
- Rebecca E. Ward
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (R.E.W.); (S.M.-C.); (L.O.T.-G.); (M.H.)
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Santiago Martinez-Correa
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (R.E.W.); (S.M.-C.); (L.O.T.-G.); (M.H.)
| | - Luis Octavio Tierradentro-García
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (R.E.W.); (S.M.-C.); (L.O.T.-G.); (M.H.)
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Misun Hwang
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (R.E.W.); (S.M.-C.); (L.O.T.-G.); (M.H.)
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Chandra M. Sehgal
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Kutty S. The 21st Annual Feigenbaum Lecture: Beyond Artificial: Echocardiography from Elegant Images to Analytic Intelligence. J Am Soc Echocardiogr 2020; 33:1163-1171. [DOI: 10.1016/j.echo.2020.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 02/02/2023]
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Kutty S, Liu N, Zhou J, Xiao Y, Wu J, Danford D, Lof J, Xie F, Porter TR. ULTRASOUND INDUCED MICROBUBBLE CAVITATION FOR THE TREATMENT OF CATHETERIZATION INDUCED VASOSPASM. ACTA ACUST UNITED AC 2017; 2:748-756. [PMID: 29349360 PMCID: PMC5769697 DOI: 10.1016/j.jacbts.2017.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shelby Kutty
- Division of Pediatric Cardiology, University of Nebraska College of Medicine/Children's Hospital & Medical Center, Omaha, NE
| | - Na Liu
- Division of Pediatric Cardiology, University of Nebraska College of Medicine/Children's Hospital & Medical Center, Omaha, NE.,Department of Cardiology and Cardiac Catheterization Lab, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jia Zhou
- Division of Pediatric Cardiology, University of Nebraska College of Medicine/Children's Hospital & Medical Center, Omaha, NE.,Department of Ultrasonography, the First Affiliated Hospital of University of South China, Hengyang, China
| | - Yunbin Xiao
- Division of Pediatric Cardiology, University of Nebraska College of Medicine/Children's Hospital & Medical Center, Omaha, NE
| | - Juefei Wu
- Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, NE
| | - David Danford
- Division of Pediatric Cardiology, University of Nebraska College of Medicine/Children's Hospital & Medical Center, Omaha, NE
| | - John Lof
- Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, NE
| | - Feng Xie
- Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, NE
| | - Thomas R Porter
- Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, NE
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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.
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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
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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.
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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)
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