1
|
Kotani K, Ngako Kadji FM, Mandai Y, Hiraoka Y. Backflow reduction in local injection therapy with gelatin formulations. Drug Deliv 2024; 31:2329100. [PMID: 38515401 PMCID: PMC10962293 DOI: 10.1080/10717544.2024.2329100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
The local injection of therapeutic drugs, including cells, oncolytic viruses and nucleic acids, into different organs is an administrative route used to achieve high drug exposure at the site of action. However, after local injection, material backflow and side effect reactions can occur. Hence, this study was carried out to investigate the effect of gelatin on backflow reduction in local injection. Gelatin particles (GPs) and hydrolyzed gelatin (HG) were injected into tissue models, including versatile training tissue (VTT), versatile training tissue tumor-in type (VTT-T), and broiler chicken muscles (BCM), using needle gauges between 23 G and 33 G. The backflow material fluid was collected with filter paper, and the backflow fluid rate was determined. The backflow rate was significantly reduced with 35 μm GPs (p value < .0001) at different concentrations up to 5% and with 75 μm GPs (p value < .01) up to 2% in the tissue models. The reduction in backflow with HG of different molecular weights showed that lower-molecular-weight HG required a higher-concentration dose (5% to 30%) and that higher-molecular-weight HG required a lower-concentration dose (7% to 8%). The backflow rate was significantly reduced with the gelatin-based formulation, in regard to the injection volumes, which varied from 10 μL to 100 μL with VTT or VTT-T and from 10 μL to 200 μL with BCM. The 35 μm GPs were injectable with needles of small gauges, which included 33 G, and the 75 μm GPs and HG were injectable with 27 G needles. The backflow rate was dependent on an optimal viscosity of the gelatin solutions. An optimal concentration of GPs or HG can prevent material backflow in local injection, and further studies with active drugs are necessary to investigate the applicability in tumor and organ injections.
Collapse
Affiliation(s)
- Kazuki Kotani
- Department of Biomedical, R&D C-enter, Nitta Gelatin, Inc, Yao City, Osaka, Japan
| | | | - Yoshinobu Mandai
- Department of Biomedical, R&D C-enter, Nitta Gelatin, Inc, Yao City, Osaka, Japan
| | - Yosuke Hiraoka
- Department of Biomedical, R&D C-enter, Nitta Gelatin, Inc, Yao City, Osaka, Japan
| |
Collapse
|
2
|
Yang Y, Yuan T, Rodriguez Y Baena F, Dini D, Zhan W. Effect of infusion direction on convection-enhanced drug delivery to anisotropic tissue. J R Soc Interface 2024; 21:20240378. [PMID: 39353562 PMCID: PMC11444765 DOI: 10.1098/rsif.2024.0378] [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: 03/08/2024] [Revised: 08/12/2024] [Accepted: 08/13/2024] [Indexed: 10/04/2024] Open
Abstract
Convection-enhanced delivery (CED) can effectively overcome the blood-brain barrier by infusing drugs directly into diseased sites in the brain using a catheter, but its clinical performance still needs to be improved. This is strongly related to the highly anisotropic characteristics of brain white matter, which results in difficulties in controlling drug transport and distribution in space. In this study, the potential to improve the delivery of six drugs by adjusting the placement of the infusion catheter is examined using a mathematical model and accurate numerical simulations that account simultaneously for the interstitial fluid (ISF) flow and drug transport processes in CED. The results demonstrate the ability of this direct infusion to enhance ISF flow and therefore facilitate drug transport. However, this enhancement is highly anisotropic, subject to the orientation of local axon bundles and is limited within a small region close to the infusion site. Drugs respond in different ways to infusion direction: the results of our simulations show that while some drugs are almost insensitive to infusion direction, this strongly affects other compounds in terms of isotropy of drug distribution from the catheter. These findings can serve as a reference for planning treatments using CED.
Collapse
Affiliation(s)
- Yi Yang
- School of Engineering, University of Aberdeen, Aberdeen, UK
| | - Tian Yuan
- Department of Mechanical Engineering, Imperial College London, London, UK
| | | | - Daniele Dini
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Wenbo Zhan
- School of Engineering, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
3
|
Chen R, Rey JA, Tuna IS, Tran DD, Sarntinoranont M. A Spatial Interpolation Approach to Assign Magnetic Resonance Imaging-Derived Material Properties for Finite Element Models of Adeno-Associated Virus Infusion Into a Recurrent Brain Tumor. J Biomech Eng 2024; 146:101001. [PMID: 38581376 PMCID: PMC11110824 DOI: 10.1115/1.4064966] [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: 04/18/2023] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 04/08/2024]
Abstract
Adeno-associated virus (AAV) is a clinically useful gene delivery vehicle for treating neurological diseases. To deliver AAV to focal targets, direct infusion into brain tissue by convection-enhanced delivery (CED) is often needed due to AAV's limited penetration across the blood-brain-barrier and its low diffusivity in tissue. In this study, computational models that predict the spatial distribution of AAV in brain tissue during CED were developed to guide future placement of infusion catheters in recurrent brain tumors following primary tumor resection. The brain was modeled as a porous medium, and material property fields that account for magnetic resonance imaging (MRI)-derived anatomical regions were interpolated and directly assigned to an unstructured finite element mesh. By eliminating the need to mesh complex surfaces between fluid regions and tissue, mesh preparation was expedited, increasing the model's clinical feasibility. The infusion model predicted preferential fluid diversion into open fluid regions such as the ventricles and subarachnoid space (SAS). Additionally, a sensitivity analysis of AAV delivery demonstrated that improved AAV distribution in the tumor was achieved at higher tumor hydraulic conductivity or lower tumor porosity. Depending on the tumor infusion site, the AAV distribution covered 3.67-70.25% of the tumor volume (using a 10% AAV concentration threshold), demonstrating the model's potential to inform the selection of infusion sites for maximal tumor coverage.
Collapse
Affiliation(s)
- Reed Chen
- Department of Biomedical Engineering, Duke University, 407 Towerview Rd, Box 97756, Durham, NC 27708
| | - Julian A. Rey
- Department of Mechanical & Aerospace Engineering, University of Florida, 142 New Engineering Building, P.O. Box 116250, Gainesville, FL 32611
- University of Florida
| | - Ibrahim S. Tuna
- Department of Radiology, University of Florida College of Medicine, P.O. Box 100374, Gainesville, FL 32610-0374
- University of Florida
| | - David D. Tran
- Division of Neuro-Oncology, Department of Neurological Surgery and Neurology USC Brain Tumor Center, University of Southern California Keck School of Medicine, Los Angeles, CA 90033
- University of Southern California
| | - Malisa Sarntinoranont
- Department of Mechanical & Aerospace Engineering, University of Florida, 497 Wertheim, P.O. Box 116250, Gainesville, FL 32611
| |
Collapse
|
4
|
Mandalawatta HP, Rajendra K, Fairfax K, Hewitt AW. Emerging trends in virus and virus-like particle gene therapy delivery to the brain. MOLECULAR THERAPY. NUCLEIC ACIDS 2024; 35:102280. [PMID: 39206077 PMCID: PMC11350507 DOI: 10.1016/j.omtn.2024.102280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Recent advances in gene therapy and gene-editing techniques offer the very real potential for successful treatment of neurological diseases. However, drug delivery constraints continue to impede viable therapeutic interventions targeting the brain due to its anatomical complexity and highly restrictive microvasculature that is impervious to many molecules. Realizing the therapeutic potential of gene-based therapies requires robust encapsulation and safe and efficient delivery to the target cells. Although viral vectors have been widely used for targeted delivery of gene-based therapies, drawbacks such as host genome integration, prolonged expression, undesired off-target mutations, and immunogenicity have led to the development of alternative strategies. Engineered virus-like particles (eVLPs) are an emerging, promising platform that can be engineered to achieve neurotropism through pseudotyping. This review outlines strategies to improve eVLP neurotropism for therapeutic brain delivery of gene-editing agents.
Collapse
Affiliation(s)
| | - K.C. Rajendra
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Kirsten Fairfax
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Alex W. Hewitt
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| |
Collapse
|
5
|
Yuan T, Zhan W, Terzano M, Holzapfel GA, Dini D. A comprehensive review on modeling aspects of infusion-based drug delivery in the brain. Acta Biomater 2024; 185:1-23. [PMID: 39032668 DOI: 10.1016/j.actbio.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024]
Abstract
Brain disorders represent an ever-increasing health challenge worldwide. While conventional drug therapies are less effective due to the presence of the blood-brain barrier, infusion-based methods of drug delivery to the brain represent a promising option. Since these methods are mechanically controlled and involve multiple physical phases ranging from the neural and molecular scales to the brain scale, highly efficient and precise delivery procedures can significantly benefit from a comprehensive understanding of drug-brain and device-brain interactions. Behind these interactions are principles of biophysics and biomechanics that can be described and captured using mathematical models. Although biomechanics and biophysics have received considerable attention, a comprehensive mechanistic model for modeling infusion-based drug delivery in the brain has yet to be developed. Therefore, this article reviews the state-of-the-art mechanistic studies that can support the development of next-generation models for infusion-based brain drug delivery from the perspective of fluid mechanics, solid mechanics, and mathematical modeling. The supporting techniques and database are also summarized to provide further insights. Finally, the challenges are highlighted and perspectives on future research directions are provided. STATEMENT OF SIGNIFICANCE: Despite the immense potential of infusion-based drug delivery methods for bypassing the blood-brain barrier and efficiently delivering drugs to the brain, achieving optimal drug distribution remains a significant challenge. This is primarily due to our limited understanding of the complex interactions between drugs and the brain that are governed by principles of biophysics and biomechanics, and can be described using mathematical models. This article provides a comprehensive review of state-of-the-art mechanistic studies that can help to unravel the mechanism of drug transport in the brain across the scales, which underpins the development of next-generation models for infusion-based brain drug delivery. More broadly, this review will serve as a starting point for developing more effective treatments for brain diseases and mechanistic models that can be used to study other soft tissue and biomaterials.
Collapse
Affiliation(s)
- Tian Yuan
- Department of Mechanical Engineering, Imperial College London, SW7 2AZ, UK.
| | - Wenbo Zhan
- School of Engineering, University of Aberdeen, Aberdeen, AB24 3UE, UK
| | - Michele Terzano
- Institute of Biomechanics, Graz University of Technology, Austria
| | - Gerhard A Holzapfel
- Institute of Biomechanics, Graz University of Technology, Austria; Department of Structural Engineering, NTNU, Trondheim, Norway
| | - Daniele Dini
- Department of Mechanical Engineering, Imperial College London, SW7 2AZ, UK.
| |
Collapse
|
6
|
Choi SJ, Lee S, Choi H, Ko MJ, Kim D, Kim DH. Development of injectable colloidal solution forming an in situ hydrogel for tumor ablation. Biomater Sci 2024; 12:4483-4492. [PMID: 39073039 PMCID: PMC11334955 DOI: 10.1039/d4bm00598h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
Ablation cancer therapy using percutaneous intra-tumoral injection of ethanol is a promising method for targeted and effective locoregional cancer therapy. Magnetic gelatin microsphere (MGM) colloidal ethanol solution is developed as a potential injectable tumor ablation agent. The MGM was fabricated by electrostatic interactions among gelatin, acrylic acid, and acrylic acid-coated iron oxide nanoparticles. The fabricated MGM was dispersed in ethanol solution to form injectable MGM colloidal ethanol solution. The MGM colloidal ethanol solution can be easily infused and undergo in situ gelation via solvent exchange from ethanol to water in an artificial tissue. Furthermore, the MGM colloidal ethanol solution allowed doxorubicin (Dox) chemo-agent loading and its sustained release upon the formation of a drug depot by in situ gelation in artificial tissues. Our in vitro study demonstrated that locally delivered ethanol and Dox with MGM colloidal ethanol solution promoted the anti-cancer therapeutic efficacy with a significantly suppressed cancer cell recovery rate. Overall, our developed injectable MGM colloidal ethanol solution that can be transformed to a hydrogel drug depot at the injection site holds clinical potential for a new class of chemo-ablation agents.
Collapse
Affiliation(s)
- Seong Jin Choi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon 16419, Korea
| | - Sanghee Lee
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| | - Hyunjun Choi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| | - Min Jun Ko
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| | - Donghwan Kim
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon 16419, Korea
| | - Dong-Hyun Kim
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, University of Illinois, Chicago, IL 60607, USA
| |
Collapse
|
7
|
O'Sullivan KP, Coats B. Coupled Eulerian-Lagrangian model prediction of neural tissue strain during microelectrode insertion. J Neural Eng 2024; 21:046055. [PMID: 39074496 DOI: 10.1088/1741-2552/ad68a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/29/2024] [Indexed: 07/31/2024]
Abstract
Objective.Implanted neural microelectrodes are an important tool for recording from and stimulating the cerebral cortex. The performance of chronically implanted devices, however, is often hindered by the development of a reactive tissue response. Previous computational models have investigated brain strain from micromotions of neural electrodes after they have been inserted, to investigate design parameters that might minimize triggers to the reactive tissue response. However, these models ignore tissue damage created during device insertion, an important contributing factor to the severity of inflammation. The objective of this study was to evaluate the effect of electrode geometry, insertion speed, and surface friction on brain tissue strain during insertion.Approach. Using a coupled Eulerian-Lagrangian approach, we developed a 3D finite element model (FEM) that simulates the dynamic insertion of a neural microelectrode in brain tissue. Geometry was varied to investigate tip bluntness, cross-sectional shape, and shank thickness. Insertion velocities were varied from 1 to 8 m s-1. Friction was varied from frictionless to 0.4. Tissue strain and potential microvasculature hemorrhage radius were evaluated for brain regions along the electrode shank and near its tip.Main results. Sharper tips resulted in higher mean max principal strains near the tip except for the bluntest tip on the square cross-section electrode, which exhibited high compressive strain values due to stress concentrations at the corners. The potential vascular damage radius around the electrode was primarily a function of the shank diameter, with smaller shank diameters resulting in smaller distributions of radial strain around the electrode. However, the square shank interaction with the tip taper length caused unique strain distributions that increased the damage radius in some cases. Faster insertion velocities created more strain near the tip but less strain along the shank. Increased friction between the brain and electrode created more strain near the electrode tip and along the shank, but frictionless interactions resulted in increased tearing of brain tissue near the tip.Significance. These results demonstrate the first dynamic FEM study of neural electrode insertion, identifying design factors that can reduce tissue strain and potentially mitigate initial reactive tissue responses due to traumatic microelectrode array insertion.
Collapse
Affiliation(s)
- K P O'Sullivan
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States of America
| | - B Coats
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, United States of America
| |
Collapse
|
8
|
Malekoshoaraie MH, Wu B, Krahe DD, Ahmed Z, Pupa S, Jain V, Cui XT, Chamanzar M. Fully flexible implantable neural probes for electrophysiology recording and controlled neurochemical modulation. MICROSYSTEMS & NANOENGINEERING 2024; 10:91. [PMID: 38947533 PMCID: PMC11211464 DOI: 10.1038/s41378-024-00685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/01/2024] [Accepted: 02/28/2024] [Indexed: 07/02/2024]
Abstract
Targeted delivery of neurochemicals and biomolecules for neuromodulation of brain activity is a powerful technique that, in addition to electrical recording and stimulation, enables a more thorough investigation of neural circuit dynamics. We have designed a novel, flexible, implantable neural probe capable of controlled, localized chemical stimulation and electrophysiology recording. The neural probe was implemented using planar micromachining processes on Parylene C, a mechanically flexible, biocompatible substrate. The probe shank features two large microelectrodes (chemical sites) for drug loading and sixteen small microelectrodes for electrophysiology recording to monitor neuronal response to drug release. To reduce the impedance while keeping the size of the microelectrodes small, poly(3,4-ethylenedioxythiophene) (PEDOT) was electrochemically coated on recording microelectrodes. In addition, PEDOT doped with mesoporous sulfonated silica nanoparticles (SNPs) was used on chemical sites to achieve controlled, electrically-actuated drug loading and releasing. Different neurotransmitters, including glutamate (Glu) and gamma-aminobutyric acid (GABA), were incorporated into the SNPs and electrically triggered to release repeatedly. An in vitro experiment was conducted to quantify the stimulated release profile by applying a sinusoidal voltage (0.5 V, 2 Hz). The flexible neural probe was implanted in the barrel cortex of the wild-type Sprague Dawley rats. As expected, due to their excitatory and inhibitory effects, Glu and GABA release caused a significant increase and decrease in neural activity, respectively, which was recorded by the recording microelectrodes. This novel flexible neural probe technology, combining on-demand chemical release and high-resolution electrophysiology recording, is an important addition to the neuroscience toolset used to dissect neural circuitry and investigate neural network connectivity.
Collapse
Affiliation(s)
| | - Bingchen Wu
- Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260 USA
- Center for Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittburgh, 15213 USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, 15219 USA
| | - Daniela D. Krahe
- Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260 USA
| | - Zabir Ahmed
- Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA 15213 USA
| | - Stephen Pupa
- Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA 15213 USA
| | - Vishal Jain
- Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA 15213 USA
| | - Xinyan Tracy Cui
- Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260 USA
- Center for Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittburgh, 15213 USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, 15219 USA
| | - Maysamreza Chamanzar
- Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA 15213 USA
- Carnegie Mellon Neuroscience Institute, Carnegie Mellon University, Pittsburgh, 15213 USA
| |
Collapse
|
9
|
Noh DH, Zadeh AH, Zhang H, Wang F, Ryu S, Zhang C, Kim S. Convection-Enhanced Drug Delivery: Experimental and Analytical Studies of Infusion Behavior in an In Vitro Brain Surrogate. Ann Biomed Eng 2024; 52:1693-1705. [PMID: 38502430 DOI: 10.1007/s10439-024-03482-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
Convection-enhanced drug delivery (CED) directly infuses drugs with a large molecular weight toward target cells as a therapeutic strategy for neurodegenerative diseases and brain cancers. Despite the success of many previous in vitro experiments on CED, challenges still remain. In particular, a theoretical predictive model is needed to form a basis for treatment planning, and developing such a model requires well-controlled injection tests that can rigorously capture the convective (advective) and diffusive transport of an infusate. For this purpose, we investigated the advection-diffusion transport of an infusate (bromophenol blue solution) in the brain surrogate (0.2% w/w agarose gel) at different injection rates, ranging from 0.25 to 4 μL/min, by closely monitoring changes in the color intensity, propagation distance, and injection pressures. One dimensional closed-form solution was examined with two variable sets, such as the mathematically calculated coefficient of molecular diffusion and average velocity, and the hydraulic dispersion coefficient and seepage velocity by the least squared method. As a result, the seepage velocity was greater than the average velocity to some extent, particularly for the later infusion times. The poroelastic deformation in the brain surrogate might lead to changes in porosity, and consequently, slight increases in the actual flow velocity as infusion continues. The limitation of efficiency of the single catheter was analyzed by dimensionless analysis. Lastly, this study suggests a simple but robust approach that can properly capture the convective (advective) and diffusive transport of an infusate in an in vitro brain surrogate via well-controlled injection tests.
Collapse
Affiliation(s)
- Dong-Hwa Noh
- Department of Civil and Environmental Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Amin Hosseini Zadeh
- Department of Civil and Environmental Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
- Alfred Benesch & Company, Lincoln, Nebraska, USA
| | - Haipeng Zhang
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Fei Wang
- Department of Radiation Oncology, University of Nebraska-Medical Center, Omaha, Nebraska, USA
| | - Sangjin Ryu
- Department of Mechanical and Materials Engineering; Nebraska Center for Materials and Nanoscience, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Chi Zhang
- Department of Radiation Oncology, University of Nebraska-Medical Center, Omaha, Nebraska, USA
| | - Seunghee Kim
- Department of Civil and Environmental Engineering; Nebraska Center for Materials and Nanoscience, University of Nebraska-Lincoln, Lincoln, Nebraska, USA.
| |
Collapse
|
10
|
Adhikari G, Sarojasamhita VP, Richardson-Powell V, Farooqui A, Budzinski M, Garvey DT, Yang J, Katz D, Crouch B, Ramanujam N, Mueller JL. Impact of Injection-Based Delivery Parameters on Local Distribution Volume of Ethyl-Cellulose Ethanol Gel in Tissue and Tissue Mimicking Phantoms. IEEE Trans Biomed Eng 2024; 71:1488-1498. [PMID: 38060363 PMCID: PMC11086015 DOI: 10.1109/tbme.2023.3340613] [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] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Local drug delivery aims to minimize systemic toxicity by preventing off-target effects; however, injection parameters influencing depot formation of injectable gels have yet to be thoroughly studied. We explored the effects of needle characteristics, injection depth, rate, volume, and polymer concentration on gel ethanol distribution in both tissue and phantoms. METHODS The polymer ethyl cellulose (EC) was added to ethanol to form an injectable gel to ablate cervical precancer and cancer. Tissue mimicking phantoms composed of 1% agarose dissolved in deionized water were used to establish overall trends between various injection parameters and the resulting gel distribution. Additional experiments were performed in excised swine cervices with a CT-imageable injectate formulation, which enabled visualization of the distribution without tissue sectioning. RESULTS Needle type and injection rate had minimal impact on gel distribution, while needle depths ≥13 mm yielded significantly larger distributions. Needle gauge and EC concentration impacted injection pressure with maximum gel distribution achieved when the pressure was 70-250 kPa. Injection volumes ≤3 mL of 6% EC-ethanol minimized fluid leakage away from the injection site. Results guided the development of a speculum-compatible hand-held injector to deliver gel ethanol into the cervix. CONCLUSION Needle depth, gauge, and polymer concentration are critical to consider when delivering injectable gels. SIGNIFICANCE This study addressed key questions related to the impact of injection-based parameters on gel distribution at a scale relevant to human applications including: 1) how best to deliver EC-ethanol into the cervix and 2) general insights about injection protocols relevant to the delivery of injectable gels in tissue.
Collapse
Affiliation(s)
- Gatha Adhikari
- Department of Bioengineering, University of Maryland, College Park, MD, USA
| | | | | | - Asma Farooqui
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Maya Budzinski
- Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - David T. Garvey
- Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Jeffrey Yang
- Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - David Katz
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Brian Crouch
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Nimmi Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina, USA
| | - Jenna L. Mueller
- Department of Bioengineering, University of Maryland, College Park, MD, USA
- Department of OB-GYN & Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
11
|
Romanishin A, Vasilev A, Khasanshin E, Evtekhov A, Pusynin E, Rubina K, Kakotkin V, Agapov M, Semina E. Oncolytic viral therapy for gliomas: Advances in the mechanisms and approaches to delivery. Virology 2024; 593:110033. [PMID: 38442508 DOI: 10.1016/j.virol.2024.110033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/04/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
Glioma is a diverse category of tumors originating from glial cells encompasses various subtypes, based on the specific type of glial cells involved. The most aggressive is glioblastoma multiforme (GBM), which stands as the predominant primary malignant tumor within the central nervous system in adults. Despite the application of treatment strategy, the median survival rate for GBM patients still hovers around 15 months. Oncolytic viruses (OVs) are artificially engineered viruses designed to selectively target and induce apoptosis in cancer cells. While clinical trials have demonstrated encouraging results with intratumoral OV injections for some cancers, applying this approach to GBM presents unique challenges. Here we elaborate on current trends in oncolytic viral therapy and their delivery methods. We delve into the various methods of delivering OVs for therapy, exploring their respective advantages and disadvantages and discussing how selecting the optimal delivery method can enhance the efficacy of this innovative treatment approach.
Collapse
Affiliation(s)
- A Romanishin
- Institute of Medicine and Life Science, Immanuel Kant Baltic Federal University, Kaliningrad, 236041, Russia.
| | - A Vasilev
- Institute of Medicine and Life Science, Immanuel Kant Baltic Federal University, Kaliningrad, 236041, Russia
| | - E Khasanshin
- Kaliningrad Regional Hospital, Kaliningrad, 236016, Russia
| | - A Evtekhov
- Kaliningrad Regional Hospital, Kaliningrad, 236016, Russia
| | - E Pusynin
- Kaliningrad Regional Hospital, Kaliningrad, 236016, Russia
| | - K Rubina
- Faculty of Medicine, Lomonosov Moscow State University, Lomonosovsky Ave., 27/1, 119991, Moscow, Russia
| | - V Kakotkin
- Institute of Medicine and Life Science, Immanuel Kant Baltic Federal University, Kaliningrad, 236041, Russia
| | - M Agapov
- Institute of Medicine and Life Science, Immanuel Kant Baltic Federal University, Kaliningrad, 236041, Russia; Faculty of Medicine, Lomonosov Moscow State University, Lomonosovsky Ave., 27/1, 119991, Moscow, Russia
| | - E Semina
- Institute of Medicine and Life Science, Immanuel Kant Baltic Federal University, Kaliningrad, 236041, Russia; Faculty of Medicine, Lomonosov Moscow State University, Lomonosovsky Ave., 27/1, 119991, Moscow, Russia
| |
Collapse
|
12
|
Fernando D, Ahmed AU, Williams BRG. Therapeutically targeting the unique disease landscape of pediatric high-grade gliomas. Front Oncol 2024; 14:1347694. [PMID: 38525424 PMCID: PMC10957575 DOI: 10.3389/fonc.2024.1347694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Pediatric high-grade gliomas (pHGG) are a rare yet devastating malignancy of the central nervous system's glial support cells, affecting children, adolescents, and young adults. Tumors of the central nervous system account for the leading cause of pediatric mortality of which high-grade gliomas present a significantly grim prognosis. While the past few decades have seen many pediatric cancers experiencing significant improvements in overall survival, the prospect of survival for patients diagnosed with pHGGs has conversely remained unchanged. This can be attributed in part to tumor heterogeneity and the existence of the blood-brain barrier. Advances in discovery research have substantiated the existence of unique subgroups of pHGGs displaying alternate responses to different therapeutics and varying degrees of overall survival. This highlights a necessity to approach discovery research and clinical management of the disease in an alternative subtype-dependent manner. This review covers traditional approaches to the therapeutic management of pHGGs, limitations of such methods and emerging alternatives. Novel mutations which predominate the pHGG landscape are highlighted and the therapeutic potential of targeting them in a subtype specific manner discussed. Collectively, this provides an insight into issues in need of transformative progress which arise during the management of pHGGs.
Collapse
Affiliation(s)
- Dasun Fernando
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
- Department of Molecular and Translational Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Afsar U. Ahmed
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
- Department of Molecular and Translational Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Bryan R. G. Williams
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
- Department of Molecular and Translational Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| |
Collapse
|
13
|
Abdoun OT, Yim M. Assessing Tissue Damage Around a Tape Spring Steerable Needle With Sharp Turn Radii. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2024; 5:45-49. [PMID: 38445241 PMCID: PMC10914145 DOI: 10.1109/ojemb.2024.3355286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/15/2023] [Accepted: 12/14/2023] [Indexed: 03/07/2024] Open
Abstract
Steerable needles are a novel technology that offers a wide range of uses in medical diagnostics and therapeutics. Currently, there exist several steerable needle designs in the literature, however, they are limited in their use by the number of possible turns, turn radius, and tissue damage. We introduce a novel design of a tape spring steerable needle, capable of multiple turns, that minimizes tissue damage. In this study, we measure the turning radius of our steerable needle in porcine liver tissue in vitro with ultrasound and estimate tissue damage in gel blocks using image analysis and 3D plaster casting. We were able to demonstrate our steerable needle's ability to steer through biological tissue, as well as introduce a novel method for estimating tissue damage. Our findings show that our needle design showed lower damage compared to similar designs in literature, as well as tissue stiffness being a protective factor against tissue damage.
Collapse
Affiliation(s)
- Omar T. Abdoun
- Department of Bioengineering and The Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA19104USA
| | - Mark Yim
- Department of Mechanical Engineering and Applied MechanicsUniversity of PennsylvaniaPhiladelphiaPA19104USA
| |
Collapse
|
14
|
Patel K, Hutapea P. Study of Tissue Damage Induced by Insertion of Composite-Coated Needle. Med Eng Phys 2024; 123:104094. [PMID: 38365334 DOI: 10.1016/j.medengphy.2023.104094] [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: 07/30/2023] [Revised: 11/15/2023] [Accepted: 12/21/2023] [Indexed: 02/18/2024]
Abstract
Medical interventions have significantly progressed in developing minimally invasive techniques like percutaneous procedures. These procedures include biopsy and internal radiation therapy, where a needle or needle-like medical device is inserted through the skin to access a target inside the body. Ensuring accurate needle insertion and minimizing tissue-damage or cracks are critical in these procedures. This research aims to examine the coated needle effect on the force required to insert the needle (i.e., insertion force) and on tissue-damage during needle insertion into the bovine kidney. Reducing the needle insertion force, which is influenced by needle surface friction, generally results in a reduction in tissue-damage. Surgical needles were coated with a composite material, combining Polytetrafluoroethylene, Polydopamine, and Activated Carbon. Force measurement during needle insertion and a histological study to determine tissue-damage were conducted to evaluate the effectiveness of the coating. The insertion force was reduced by 49 % in the case of the coated needles. Furthermore, a histological analysis comparing tissue-damage resulting from coated and uncoated needles revealed an average 39 % reduction in tissue-damage with the use of coated needles. The results of this study demonstrate the potential of coated needles to enhance needle insertion and safety during percutaneous procedures.
Collapse
Affiliation(s)
- Kavi Patel
- Department of Mechanical Engineering, Temple University, Philadelphia, PA 19122, United States of America
| | - Parsaoran Hutapea
- Department of Mechanical Engineering, Temple University, Philadelphia, PA 19122, United States of America.
| |
Collapse
|
15
|
Dhanawat M, Garima, Wilson K, Gupta S, Chalotra R, Gupta N. Convection-enhanced Diffusion: A Novel Tactics to Crack the BBB. Curr Drug Deliv 2024; 21:1515-1528. [PMID: 38275045 DOI: 10.2174/0115672018266501231207095127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 01/27/2024]
Abstract
Although the brain is very accessible to nutrition and oxygen, it can be difficult to deliver medications to malignant brain tumours. To get around some of these issues and enable the use of therapeutic pharmacological substances that wouldn't typically cross the blood-brain barrier (BBB), convection-enhanced delivery (CED) has been developed. It is a cutting-edge strategy that gets beyond the blood-brain barrier and enables targeted drug administration to treat different neurological conditions such as brain tumours, Parkinson's disease, and epilepsy. Utilizing pressure gradients to spread the medicine across the target area is the main idea behind this diffusion mechanism. Through one to several catheters positioned stereotactically directly within the tumour mass, around the tumour, or in the cavity created by the resection, drugs are given. This method can be used in a variety of drug classes, including traditional chemotherapeutics and cutting-edge investigational targeted medications by using positive-pressure techniques. The drug delivery volume must be optimized for an effective infusion while minimizing backflow, which causes side effects and lowers therapeutic efficacy. Therefore, this technique provides a promising approach for treating disorders of the central nervous system (CNS).
Collapse
Affiliation(s)
- Meenakshi Dhanawat
- Amity Institute of Pharmacy, Amity University Haryana, Amity Education Valley, Panchgaon, Manesar, Gurugram, Haryana, 122413, India
| | - Garima
- M.M College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana- Ambala, Haryana, 133207, India
| | - Kashish Wilson
- M.M College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana- Ambala, Haryana, 133207, India
| | - Sumeet Gupta
- M.M College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana- Ambala, Haryana, 133207, India
| | - Rishabh Chalotra
- Department of Pharmacology, Central University of Punjab, Bathinda, India
| | - Nidhi Gupta
- M.M College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana- Ambala, Haryana, 133207, India
| |
Collapse
|
16
|
Michiels J, Vitale F. Design and Characterization of Pressure Monitoring and Insertion system for Intraparenchymal Convection Enhanced Delivery. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082745 DOI: 10.1109/embc40787.2023.10341013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Neurological disorders are a significant societal and economic burden. Common pharmacological therapies often can only manage symptoms and have limited efficacy. Intraparenchymal convection enhanced delivery (IP CED) is a neurosurgical technique for direct brain delivery of therapeutics. Currently, the main applications of IP CED are targeted chemotherapy for glioblastoma and gene therapy. While IP CED has advantages over systemic approaches, its benefits can be drastically reduced by inadequate coverage as low as 21% of target anatomy, excessive infusion durations greater than 2 hours, and off-target effects. Addressing the limitations of IP CED requires thorough investigation and optimization of the relevant fluid dynamic and operational parameters. In this work, we present the design, fabrication, and characterization of low-cost, open-source, and fully automated CED cannula insertion control and pressure-monitoring systems. Using these automated CED control systems, we investigate the effects of pressure, insertion velocity, and flow rates on several outcome variables, including reflux, volume distribution, and infusion cloud morphology during CED infusions in brain phantoms.Clinical Relevance- CED pressure properties may be able to implicate reflux incidents and could provide clinicians with valuable, real-time information regarding ongoing infusions without the need for costly medical imaging modalities.
Collapse
|
17
|
Sree V, Zhong X, Bilionis I, Ardekani A, Tepole AB. Optimizing autoinjector devices using physics-based simulations and Gaussian processes. J Mech Behav Biomed Mater 2023; 140:105695. [PMID: 36739826 DOI: 10.1016/j.jmbbm.2023.105695] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/06/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
Autoinjectors are becoming a primary drug delivery option to the subcutaneous space. These devices need to work robustly and autonomously to maximize drug bio-availability. However, current designs ignore the coupling between autoinjector dynamics and tissue biomechanics. Here we present a Bayesian framework for optimization of autoinjector devices that can account for the coupled autoinjector-tissue biomechanics and uncertainty in tissue mechanical behavior. The framework relies on replacing the high fidelity model of tissue insertion with a Gaussian process (GP). The GP model is accurate yet computationally affordable, enabling a thorough sensitivity analysis that identified tissue properties, which are not part of the autoinjector design space, as important variables for the injection process. Higher fracture toughness decreases the crack depth, while tissue shear modulus has the opposite effect. The sensitivity analysis also shows that drug viscosity and spring force, which are part of the design space, affect the location and timing of drug delivery. Low viscosity could lead to premature delivery, but can be prevented with smaller spring forces, while higher viscosity could prevent premature delivery while demanding larger spring forces and increasing the time of injection. Increasing the spring force guarantees penetration to the desired depth, but it can result in undesirably high accelerations. The Bayesian optimization framework tackles the challenge of designing devices with performance metrics coupled to uncertain tissue properties. This work is important for the design of other medical devices for which optimization in the presence of material behavior uncertainty is needed.
Collapse
Affiliation(s)
- Vivek Sree
- School of Mechanical Engineering, Purdue University, West Lafayette, USA
| | - Xiaoxu Zhong
- School of Mechanical Engineering, Purdue University, West Lafayette, USA
| | - Ilias Bilionis
- School of Mechanical Engineering, Purdue University, West Lafayette, USA
| | - Arezoo Ardekani
- School of Mechanical Engineering, Purdue University, West Lafayette, USA
| | - Adrian Buganza Tepole
- School of Mechanical Engineering, Purdue University, West Lafayette, USA; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, USA.
| |
Collapse
|
18
|
Kumosa LS. Commonly Overlooked Factors in Biocompatibility Studies of Neural Implants. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2205095. [PMID: 36596702 PMCID: PMC9951391 DOI: 10.1002/advs.202205095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/16/2022] [Indexed: 06/17/2023]
Abstract
Biocompatibility of cutting-edge neural implants, surgical tools and techniques, and therapeutic technologies is a challenging concept that can be easily misjudged. For example, neural interfaces are routinely gauged on how effectively they determine active neurons near their recording sites. Tissue integration and toxicity of neural interfaces are frequently assessed histologically in animal models to determine tissue morphological and cellular changes in response to surgical implantation and chronic presence. A disconnect between histological and efficacious biocompatibility exists, however, as neuronal numbers frequently observed near electrodes do not match recorded neuronal spiking activity. The downstream effects of the myriad surgical and experimental factors involved in such studies are rarely examined when deciding whether a technology or surgical process is biocompatible. Such surgical factors as anesthesia, temperature excursions, bleed incidence, mechanical forces generated, and metabolic conditions are known to have strong systemic and thus local cellular and extracellular consequences. Many tissue markers are extremely sensitive to the physiological state of cells and tissues, thus significantly impacting histological accuracy. This review aims to shed light on commonly overlooked factors that can have a strong impact on the assessment of neural biocompatibility and to address the mismatch between results stemming from functional and histological methods.
Collapse
Affiliation(s)
- Lucas S. Kumosa
- Neuronano Research CenterDepartment of Experimental Medical ScienceMedical FacultyLund UniversityMedicon Village, Byggnad 404 A2, Scheelevägen 8Lund223 81Sweden
| |
Collapse
|
19
|
Sperring CP, Argenziano MG, Savage WM, Teasley DE, Upadhyayula PS, Winans NJ, Canoll P, Bruce JN. Convection-enhanced delivery of immunomodulatory therapy for high-grade glioma. Neurooncol Adv 2023; 5:vdad044. [PMID: 37215957 PMCID: PMC10195574 DOI: 10.1093/noajnl/vdad044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
The prognosis for glioblastoma has remained poor despite multimodal standard of care treatment, including temozolomide, radiation, and surgical resection. Further, the addition of immunotherapies, while promising in a number of other solid tumors, has overwhelmingly failed in the treatment of gliomas, in part due to the immunosuppressive microenvironment and poor drug penetrance to the brain. Local delivery of immunomodulatory therapies circumvents some of these challenges and has led to long-term remission in select patients. Many of these approaches utilize convection-enhanced delivery (CED) for immunological drug delivery, allowing high doses to be delivered directly to the brain parenchyma, avoiding systemic toxicity. Here, we review the literature encompassing immunotherapies delivered via CED-from preclinical model systems to clinical trials-and explore how their unique combination elicits an antitumor response by the immune system, decreases toxicity, and improves survival among select high-grade glioma patients.
Collapse
Affiliation(s)
- Colin P Sperring
- Department of Neurological Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital, New York, New York, USA
| | - Michael G Argenziano
- Department of Neurological Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital, New York, New York, USA
| | - William M Savage
- Department of Neurological Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital, New York, New York, USA
| | - Damian E Teasley
- Department of Neurological Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital, New York, New York, USA
| | - Pavan S Upadhyayula
- Department of Neurological Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital, New York, New York, USA
| | - Nathan J Winans
- Department of Neurological Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital, New York, New York, USA
| | - Peter Canoll
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center/NY-Presbyterian Hospital, New York, New York, USA
| | - Jeffrey N Bruce
- Department of Neurological Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital, New York, New York, USA
| |
Collapse
|
20
|
Mehta JN, Morales BE, Hsu FC, Rossmeisl JH, Rylander CG. Constant Pressure Convection-Enhanced Delivery Increases Volume Dispersed With Catheter Movement in Agarose. J Biomech Eng 2022; 144:111003. [PMID: 35656789 PMCID: PMC9254693 DOI: 10.1115/1.4054729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/27/2022] [Indexed: 11/08/2022]
Abstract
Convection-enhanced delivery (CED) has been extensively studied for drug delivery to the brain due to its inherent ability to bypass the blood-brain barrier. Unfortunately, CED has also been shown to inadequately distribute therapeutic agents over a large enough targeted tissue volume to be clinically beneficial. In this study, we explore the use of constant pressure infusions in addition to controlled catheter movement as a means to increase volume dispersed (Vd) in an agarose gel brain tissue phantom. Constant flow rate and constant pressure infusions were conducted with a stationary catheter, a catheter retracting at a rate of 0.25 mm/min, and a catheter retracting at a rate of 0.5 mm/min. The 0.25 mm/min and 0.5 mm/min retracting constant pressure catheters resulted in significantly larger Vd compared to any other group, with a 105% increase and a 155% increase compared to the stationary constant flow rate catheter, respectively. These same constant pressure retracting infusions resulted in a 42% and 45% increase in Vd compared to their constant flow rate counterparts. Using constant pressure infusions coupled with controlled catheter movement appears to have a beneficial effect on Vd in agarose gel. Furthermore, constant pressure infusions reveal the fundamental limitation of flow-driven infusions in both controlled catheter movement protocols as well as in stationary protocols where maximum infusion volume can never be reliably obtained.
Collapse
Affiliation(s)
- Jason N. Mehta
- Walker Department of Mechanical Engineering, University of Texas at Austin, 204 E. Dean Keeton Street, Stop C2200, Austin, TX, 78712-1591
| | - Brianna E. Morales
- Department of Biomedical Engineering, University of Texas at Austin, 301 E. Dean Keeton St. C2100, Austin, TX, 78712-2100
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine Medical, Center Boulevard, Winston-Salem, NC 27157
| | - John H. Rossmeisl
- Department of Small Animal Clinical Sciences, VA-MD College of Veterinary Medicine, Virginia Tech, 205 Duckpond Drive, Blacksburg, VA 24061
| | - Christopher G. Rylander
- Walker Department of Mechanical Engineering, University of Texas at Austin, 204 E. Dean Keeton Street, Stop C2200, Austin, TX, 78712-1591
| |
Collapse
|
21
|
Kofoed RH, Dibia CL, Noseworthy K, Xhima K, Vacaresse N, Hynynen K, Aubert I. Efficacy of gene delivery to the brain using AAV and ultrasound depends on serotypes and brain areas. J Control Release 2022; 351:667-680. [DOI: 10.1016/j.jconrel.2022.09.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023]
|
22
|
Allen JK, Sutherland TC, Prater AR, Geoffroy CG, Pellois JP. In vivo peptide-based delivery of a gene-modifying enzyme into cells of the central nervous system. SCIENCE ADVANCES 2022; 8:eabo2954. [PMID: 36170360 PMCID: PMC9519033 DOI: 10.1126/sciadv.abo2954] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/10/2022] [Indexed: 06/16/2023]
Abstract
We report on the successful delivery of the Cre recombinase enzyme in the neural cells of mice in vivo by simple coinjection with peptides derived from HIV-TAT. Cre delivery activates the expression of a reporter gene in both neurons and astrocytes of the cortex without tissue damage and with a transduction efficiency that parallels or exceeds that of a commonly used adeno-associated virus. Our data indicate that the delivery peptides mediate efficient endosomal leakage and cytosolic escape in cells that have endocytosed Cre. The peptides, therefore, act in trans and do not require conjugation to the payload, greatly simplifying sample preparation. Moreover, the delivery peptides are exclusively composed of natural amino acids and are consequently readily degradable and processed by cells. We envision that this approach will be beneficial to applications that require the transient introduction of proteins into cells in vivo.
Collapse
Affiliation(s)
- Jason K. Allen
- Department of Biochemistry and Biophysics, and Department of Chemistry, Texas A&M University, College Station, TX 77843, USA
| | - Theresa C. Sutherland
- Department of Neuroscience and Experimental Therapeutics, School of Medicine, Texas A&M University, Bryan, TX 77807, USA
| | - Austin R. Prater
- Department of Biochemistry and Biophysics, and Department of Chemistry, Texas A&M University, College Station, TX 77843, USA
| | - Cédric G. Geoffroy
- Department of Neuroscience and Experimental Therapeutics, School of Medicine, Texas A&M University, Bryan, TX 77807, USA
| | - Jean-Philippe Pellois
- Department of Biochemistry and Biophysics, and Department of Chemistry, Texas A&M University, College Station, TX 77843, USA
| |
Collapse
|
23
|
Coles L, Oluwasanya PW, Karam N, Proctor CM. Fluidic enabled bioelectronic implants: opportunities and challenges. J Mater Chem B 2022; 10:7122-7131. [PMID: 35959561 PMCID: PMC9518646 DOI: 10.1039/d2tb00942k] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022]
Abstract
Bioelectronic implants are increasingly facilitating novel strategies for clinical diagnosis and treatment. The integration of fluidic technologies into such implants enables new complementary routes for sensing and therapy alongside electrical interaction. Indeed, these two technologies, electrical and fluidic, can work synergistically in a bioelectronics implant towards the fabrication of a complete therapeutic platform. In this perspective article, the leading applications of fluidic enabled bioelectronic implants are highlighted and methods of operation and material choices are discussed. Furthermore, a forward-looking perspective is offered on emerging opportunities as well as critical materials and technological challenges.
Collapse
Affiliation(s)
- Lawrence Coles
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, UK.
| | - Pelumi W Oluwasanya
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, UK.
| | - Nuzli Karam
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, UK.
| | - Christopher M Proctor
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, UK.
| |
Collapse
|
24
|
Mehta JN, Rausch MK, Rylander CG. Convection-enhanced delivery with controlled catheter movement: A parametric finite element analysis. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3635. [PMID: 35763587 PMCID: PMC9516958 DOI: 10.1002/cnm.3635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 05/12/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
Convection-enhanced delivery (CED) is an investigational method for delivering therapeutics directly to the brain for the treatment of glioblastoma. However, it has not become a common clinical therapy due to an inability of CED treatments to deliver therapeutics in a large enough tissue volume to fully saturate the target region. We have recently shown that the combination of controlled catheter movement and constant pressure infusions can be used to significantly increase volume dispersed (Vd ) in an agarose gel brain tissue phantom. In the present study, we develop a computational model to predict Vd achieved by various retraction rates with both constant pressure and constant flow rate infusions. An increase in Vd is achieved with any movement rate, but increase in Vd between successive movement rates drops off at rates above 0.3-0.35 mm/min. Finally, we found that infusions with retraction result in a more even distribution in concentration level compared to the stationary catheter, suggesting a potential increased ability for moving catheters to have a therapeutic impact regardless of the required therapeutic concentration level.
Collapse
Affiliation(s)
- Jason N. Mehta
- Department of Mechanical Engineering, University of Texas at Austin, Austin, Texas, USA
| | - Manuel K. Rausch
- Department of Aerospace Engineering and Engineering Mechanics, University of Texas at Austin, Austin, Texas, USA
| | | |
Collapse
|
25
|
Hall MB, Habash NM, Haas NA, Schwarz JM. A method for the selective depletion of microglia in the dorsal hippocampus in the juvenile rat brain. J Neurosci Methods 2022; 374:109567. [PMID: 35306037 PMCID: PMC9070732 DOI: 10.1016/j.jneumeth.2022.109567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/10/2022] [Accepted: 03/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND To understand the role of microglia in brain function and development, methods have emerged to deplete microglia throughout the brain. Liposome-encapsulated clodronate (LEC) can be infused into the brain to deplete microglia in a brain-region and time-specific manner. NEW METHOD This study validates methodology to deplete microglia in the rat dorsal hippocampus (dHP) during a specific period of juvenile development. Stereotaxic surgery was performed to infuse LEC at postnatal day (P) 16 or 19 into dHP. Rat brains were harvested at various ages to determine specificity of infusion and duration of depletion. RESULTS P19 infusion of LEC into dHP with a 27G syringe depleted microglia in dHP subregions CA1, dentate gyrus (DG), and CA3 from P24-P30. There was also evidence of depletion in parietal cortex above the infusion site. P16 infusion of LEC with a 32 G syringe depleted microglia only in dHP subregions CA1 and DG from P21-P40. COMPARISON WITH EXISTING METHOD(S) Previous methods have infused LEC intra-hippocampally in adult rats or intra-cerebroventricularly in neonatal rats. This study is the first to publish methodology to deplete microglia in a brain-region specific manner during juvenile rat development. CONCLUSIONS The timing of LEC infusion during the juvenile period can be adjusted to achieve maximal microglia depletion by a specific postnatal day. A 27G needle results in LEC backflow during the infusion, but also allows LEC to reach all subregions of dHP. Infusion with a 32 G needle prevents backflow during infusion, but results in a more local spread of LEC within dHP.
Collapse
Affiliation(s)
- Mary Beth Hall
- University of Delaware, Department of Psychological and Brain Sciences, 108 Wolf Hall, Newark, DE 19716, USA.
| | - Nicola M Habash
- University of Delaware, Department of Psychological and Brain Sciences, 108 Wolf Hall, Newark, DE 19716, USA.
| | - Nicole A Haas
- University of Delaware, Department of Psychological and Brain Sciences, 108 Wolf Hall, Newark, DE 19716, USA.
| | - Jaclyn M Schwarz
- University of Delaware, Department of Psychological and Brain Sciences, 108 Wolf Hall, Newark, DE 19716, USA.
| |
Collapse
|
26
|
Sree VD, Ardekani A, Vlachos P, Tepole AB. The biomechanics of autoinjector — Skin interactions during dynamic needle insertion. J Biomech 2022; 134:110995. [DOI: 10.1016/j.jbiomech.2022.110995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/25/2022]
|
27
|
Ohline SM, Chan C, Schoderboeck L, Wicky HE, Tate WP, Hughes SM, Abraham WC. Effect of soluble amyloid precursor protein-alpha on adult hippocampal neurogenesis in a mouse model of Alzheimer's disease. Mol Brain 2022; 15:5. [PMID: 34980189 PMCID: PMC8721980 DOI: 10.1186/s13041-021-00889-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/19/2021] [Indexed: 01/08/2023] Open
Abstract
Soluble amyloid precursor protein-alpha (sAPPα) is a regulator of neuronal and memory mechanisms, while also having neurogenic and neuroprotective effects in the brain. As adult hippocampal neurogenesis is impaired in Alzheimer’s disease, we tested the hypothesis that sAPPα delivery would rescue adult hippocampal neurogenesis in an APP/PS1 mouse model of Alzheimer’s disease. An adeno-associated virus-9 (AAV9) encoding murine sAPPα was injected into the hippocampus of 8-month-old wild-type and APP/PS1 mice, and later two different thymidine analogues (XdU) were systemically injected to label adult-born cells at different time points after viral transduction. The proliferation of adult-born cells, cell survival after eight weeks, and cell differentiation into either neurons or astrocytes was studied. Proliferation was impaired in APP/PS1 mice but was restored to wild-type levels by viral expression of sAPPα. In contrast, sAPPα overexpression failed to rescue the survival of XdU+-labelled cells that was impaired in APP/PS1 mice, although it did cause a significant increase in the area density of astrocytes in the granule cell layer across both genotypes. Finally, viral expression of sAPPα reduced amyloid-beta plaque load in APP/PS1 mice in the dentate gyrus and somatosensory cortex. These data add further evidence that increased levels of sAPPα could be therapeutic for the cognitive decline in AD, in part through restoration of the proliferation of neural progenitor cells in adults.
Collapse
Affiliation(s)
- Shane M Ohline
- Department of Psychology, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand.,Department of Physiology, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Connie Chan
- Department of Psychology, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Lucia Schoderboeck
- Department of Biochemistry, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Hollie E Wicky
- Department of Biochemistry, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Warren P Tate
- Department of Biochemistry, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Stephanie M Hughes
- Department of Biochemistry, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Wickliffe C Abraham
- Department of Psychology, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand.
| |
Collapse
|
28
|
Interrelation between Spectral Online Monitoring and Postoperative T1-Weighted MRI in Interstitial Photodynamic Therapy of Malignant Gliomas. Cancers (Basel) 2021; 14:cancers14010120. [PMID: 35008284 PMCID: PMC8749816 DOI: 10.3390/cancers14010120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Treatment monitoring is highly important for the delivery and control of brain tumor therapy. For interstitial photodynamic therapy (iPDT), an intraoperative spectral online monitoring (SOM) setup was established in former studies to monitor photosensitizer fluorescence and treatment light transmission during therapy. In this work, data from patients treated with iPDT as the initial treatment for newly diagnosed glioblastoma (n = 11) were retrospectively analyzed. Observed changes in treatment light transmission were assessed, and changes in optical tissue absorption were calculated out of these. In addition, magnetic resonance imaging (MRI) data were recorded within 48 h after therapy and showed intrinsic T1 hyperintensity in the treated area in non-contrast-enhanced T1-weighted sequences. A 3D co-registration of intrinsic T1 hyperintensity lesions and the light transmission zones between cylindrical diffuser fiber pairs showed that reduction in treatment light transmission corresponding to increased light absorption had a spatial correlation with post-therapeutic intrinsic T1 hyperintensity (p ≤ 0.003). Abstract In a former study, interstitial photodynamic therapy (iPDT) was performed on patients suffering from newly diagnosed glioblastoma (n = 11; 8/3 male/female; median age: 68, range: 40–76). The procedure includes the application of 5-ALA to selectively metabolize protoporphyrin IX (PpIX) in tumor cells and illumination utilizing interstitially positioned optical cylindrical diffuser fibers (CDF) (2–10 CDFs, 2–3 cm diffusor length, 200 mW/cm, 635 nm, 60 min irradiation). Intraoperative spectral online monitoring (SOM) was employed to monitor treatment light transmission and PpIX fluorescence during iPDT. MRI was used for treatment planning and outcome assessment. Case-dependent observations included intraoperative reduction of treatment light transmission and local intrinsic T1 hyperintensity in non-contrast-enhanced T1-weighted MRI acquired within one day after iPDT. Intrinsic T1 hyperintensity was observed and found to be associated with the treatment volume, which indicates the presence of methemoglobin, possibly induced by iPDT. Based on SOM data, the optical absorption coefficient and its change during iPDT were estimated for the target tissue volumes interjacent between evaluable CDF-pairs at the treatment wavelength of 635 nm. By spatial comparison and statistical analysis, it was found that observed increases of the absorption coefficient during iPDT were larger in or near regions of intrinsic T1 hyperintensity (p = 0.003). In cases where PpIX-fluorescence was undetectable before iPDT, the increase in optical absorption and intrinsic T1 hyperintensity tended to be less. The observations are consistent with in vitro experiments and indicate PDT-induced deoxygenation of hemoglobin and methemoglobin formation. Further investigations are needed to provide more data on the time course of the observed changes, thus paving the way for optimized iPDT irradiation protocols.
Collapse
|
29
|
Kumosa LS, Schouenborg J. Profound alterations in brain tissue linked to hypoxic episode after device implantation. Biomaterials 2021; 278:121143. [PMID: 34653937 DOI: 10.1016/j.biomaterials.2021.121143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/20/2021] [Indexed: 12/17/2022]
Abstract
To enable authentic interfacing with neuronal structures in the brain, preventing alterations of tissue during implantation of devices is critical. By transiently implanting oxygen microsensors into rat cortex cerebri for 2 h, substantial and long lasting (>1 h) hypoxia is routinely generated in surrounding tissues; this hypoxia is linked to implantation generated compressive forces. Preferential loss of larger neurons and reduced metabolic components in surviving neurons indicates decreased viability one week after such hypoxic, compressive implantations. By devising an implantation method that relaxes compressive forces; magnitude and duration of hypoxia generated following such an implantation are ameliorated and neurons appear similar to naïve tissues. In line with these observations, astrocyte proliferation was significantly more pronounced for more hypoxic, compressive implantations. Surprisingly, astrocyte processes were frequently found to traverse cellular boundaries into nearby neuronal nuclei, indicating injury induction of a previously not described astrocyte-neuron interaction. Found more frequently in less hypoxic, force-relaxed insertions and thus correlating to a more beneficial outcome, this finding may suggest a novel protective mechanism. In conclusion, substantial and long lasting insertion induced hypoxia around brain implants, a previously overlooked factor, is linked to significant adverse alterations in nervous tissue.
Collapse
Affiliation(s)
- Lucas S Kumosa
- Neuronano Research Center, Faculty of Medicine, Lund University, Scheelevägen 2, Medicon Village 404A2, 223 81, Lund, Sweden.
| | - Jens Schouenborg
- Neuronano Research Center, Faculty of Medicine, Lund University, Scheelevägen 2, Medicon Village 404A2, 223 81, Lund, Sweden; NanoLund, Lund University, Professorsgatan 1, 223 63, Lund, Sweden.
| |
Collapse
|
30
|
Mueller JL, Morhard R, DeSoto M, Chelales E, Yang J, Nief C, Crouch B, Everitt J, Previs R, Katz D, Ramanujam N. Optimizing ethyl cellulose-ethanol delivery towards enabling ablation of cervical dysplasia. Sci Rep 2021; 11:16869. [PMID: 34413378 PMCID: PMC8376953 DOI: 10.1038/s41598-021-96223-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/05/2021] [Indexed: 11/08/2022] Open
Abstract
In low-income countries, up to 80% of women diagnosed with cervical dysplasia do not return for follow-up care, primarily due to treatment being inaccessible. Here, we describe development of a low-cost, portable treatment suitable for such settings. It is based on injection of ethyl cellulose (EC)-ethanol to ablate the transformation zone around the os, the site most impacted by dysplasia. EC is a polymer that sequesters the ethanol within a prescribed volume when injected into tissue, and this is modulated by the injected volume and delivery parameters (needle gauge, bevel orientation, insertion rate, depth, and infusion rate). Salient injection-based delivery parameters were varied in excised swine cervices. The resulting injection distribution volume was imaged with a wide-field fluorescence imaging device or computed tomography. A 27G needle and insertion rate of 10 mm/s achieved the desired insertion depth in tissue. Orienting the needle bevel towards the outer edge of the cervix and keeping infusion volumes ≤ 500 µL minimized leakage into off-target tissue. These results guided development of a custom hand-held injector, which was used to locate and ablate the upper quadrant of a swine cervix in vivo with no adverse events or changes in host temperature or heart rate. After 24 h, a distinct region of necrosis was detected that covered a majority (> 75%) of the upper quadrant of the cervix, indicating four injections could effectively cover the full cervix. The work here informs follow up large animal in vivo studies, e.g. in swine, to further assess safety and efficacy of EC-ethanol ablation in the cervix.
Collapse
Affiliation(s)
- Jenna L Mueller
- Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, 8278 Paint Branch Drive, College Park, MD, 20742, USA.
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Robert Morhard
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Michael DeSoto
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Erika Chelales
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Jeffrey Yang
- Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, 8278 Paint Branch Drive, College Park, MD, 20742, USA
| | - Corrine Nief
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Brian Crouch
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Jeffrey Everitt
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca Previs
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, USA
| | - David Katz
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, USA
| | - Nimmi Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
| |
Collapse
|
31
|
Finite Element Model to Reproduce the Effect of Pre-Stress and Needle Insertion Velocity During Infusions into Brain Phantom Gel. Ing Rech Biomed 2021. [DOI: 10.1016/j.irbm.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
32
|
Khalifa A, Eisape A, Coughlin B, Cash S. A simple method for implanting free-floating microdevices into the nervous tissue. J Neural Eng 2021; 18. [PMID: 33827069 DOI: 10.1088/1741-2552/abf590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/07/2021] [Indexed: 12/20/2022]
Abstract
Objective. Free-floating implantable neural interfaces are an emerging powerful paradigm for mapping and modulation of brain activity. Minuscule wirelessly-powered devices have the potential to provide minimally-invasive interactions with neurons in chronic research and medical applications. However, these devices face a seemingly simple problem-how can they be placed into nervous tissue rapidly, efficiently and in an essentially arbitrary location?Approach. We introduce a novel injection tool and describe a controlled injection approach that minimizes damage to the tissue.Main results.To validate the needle injectable tool and the presented delivery approach, we evaluate the spatial precision and rotational alignment of the microdevices injected into agarose, brain, and sciatic nerve with the aid of tissue clearing and MRI imaging. In this research, we limited the number of injections into the brain to four per rat as we are using microdevices that are designed for an adult head size on a rat model. We then present immunohistology data to assess the damage caused by the needle.Significance. By virtue of its simplicity, the proposed injection method can be used to inject microdevices of all sizes and shapes and will do so in a fast, minimally-invasive, and cost-effective manner. As a result, the introduced technique can be broadly used to accelerate the validation of these next-generation types of electrodes in animal models.
Collapse
Affiliation(s)
- Adam Khalifa
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States of America
| | - Adebayo Eisape
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, United States of America
| | - Brian Coughlin
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States of America
| | - Sydney Cash
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States of America
| |
Collapse
|
33
|
Duarte Azevedo M, Sander S, Jeanneret C, Olfat S, Tenenbaum L. Selective targeting of striatal parvalbumin-expressing interneurons for transgene delivery. J Neurosci Methods 2021; 354:109105. [PMID: 33652020 DOI: 10.1016/j.jneumeth.2021.109105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 01/17/2023]
Abstract
PVCre mice--> combined with AAV-FLEX vectors allowed efficient and specific targeting of PV+ interneurons in the striatum. However, diffusion of viral particles to the globus pallidus caused massive transduction of PV+ projection neurons and subsequent anterograde transport of the transgene product to the subthalamic nucleus and the substantia nigra pars reticulata. Different AAV serotypes (1 and 9) and promoters (CBA and human synapsin) were evaluated. The combination of AAV1, a moderate expression level (human synapsin promoter) and a precise adjustment of the stereotaxic coordinates in the anterior and dorsolateral part of the striatum were necessary to avoid transduction of PV+ GP projection neurons. Even in the absence of direct transduction due to diffusion of viral particles, GP PV+ projection neurons could be retrogradely transduced via their terminals present in the dorsal striatum. However, in the absence of diffusion, GP-Str PV+ projection neurons were poorly or not transduced suggesting that retrograde transduction did not significantly impair the selective targeting of striatal PV+ neurons. Finally, a prominent reduction of the number of striatal PV+ interneurons (about 50 %) was evidenced in the presence of the Cre recombinase suggesting that functional effects of AAV-mediated transgene expression in PV+ striatal interneurons in PVCre mice should be analyzed with caution.
Collapse
Affiliation(s)
- Marcelo Duarte Azevedo
- Laboratory of Cellular and Molecular Neurotherapies, Center for Neuroscience Research, Clinical Neurosciences Department, Lausanne University Hospital, Switzerland
| | - Sibilla Sander
- Laboratory of Cellular and Molecular Neurotherapies, Center for Neuroscience Research, Clinical Neurosciences Department, Lausanne University Hospital, Switzerland
| | - Cheryl Jeanneret
- Laboratory of Cellular and Molecular Neurotherapies, Center for Neuroscience Research, Clinical Neurosciences Department, Lausanne University Hospital, Switzerland
| | - Soophie Olfat
- Laboratory of Cellular and Molecular Neurotherapies, Center for Neuroscience Research, Clinical Neurosciences Department, Lausanne University Hospital, Switzerland
| | - Liliane Tenenbaum
- Laboratory of Cellular and Molecular Neurotherapies, Center for Neuroscience Research, Clinical Neurosciences Department, Lausanne University Hospital, Switzerland.
| |
Collapse
|
34
|
D'Amico RS, Aghi MK, Vogelbaum MA, Bruce JN. Convection-enhanced drug delivery for glioblastoma: a review. J Neurooncol 2021; 151:415-427. [PMID: 33611708 DOI: 10.1007/s11060-020-03408-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/18/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Convection-enhanced delivery (CED) is a method of targeted, local drug delivery to the central nervous system (CNS) that bypasses the blood-brain barrier (BBB) and permits the delivery of high-dose therapeutics to large volumes of interest while limiting associated systemic toxicities. Since its inception, CED has undergone considerable preclinical and clinical study as a safe method for treating glioblastoma (GBM). However, the heterogeneity of both, the surgical procedure and the mechanisms of action of the agents studied-combined with the additional costs of performing a trial evaluating CED-has limited the field's ability to adequately assess the durability of any potential anti-tumor responses. As a result, the long-term efficacy of the agents studied to date remains difficult to assess. MATERIALS AND METHODS We searched PubMed using the phrase "convection-enhanced delivery and glioblastoma". The references of significant systematic reviews were also reviewed for additional sources. Articles focusing on physiological and physical mechanisms of CED were included as well as technological CED advances. RESULTS We review the history and principles of CED, procedural advancements and characteristics, and outcomes from key clinical trials, as well as discuss the potential future of this promising technique for the treatment of GBM. CONCLUSION While the long-term efficacy of the agents studied to date remains difficult to assess, CED remains a promising technique for the treatment of GBM.
Collapse
Affiliation(s)
- Randy S D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA.
| | - Manish K Aghi
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | - Jeffrey N Bruce
- Department of Neurological Surgery, New York Presbyterian/Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| |
Collapse
|
35
|
Weber-Adrian D, Kofoed RH, Silburt J, Noroozian Z, Shah K, Burgess A, Rideout S, Kügler S, Hynynen K, Aubert I. Systemic AAV6-synapsin-GFP administration results in lower liver biodistribution, compared to AAV1&2 and AAV9, with neuronal expression following ultrasound-mediated brain delivery. Sci Rep 2021; 11:1934. [PMID: 33479314 PMCID: PMC7820310 DOI: 10.1038/s41598-021-81046-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/20/2020] [Indexed: 02/06/2023] Open
Abstract
Non-surgical gene delivery to the brain can be achieved following intravenous injection of viral vectors coupled with transcranial MRI-guided focused ultrasound (MRIgFUS) to temporarily and locally permeabilize the blood-brain barrier. Vector and promoter selection can provide neuronal expression in the brain, while limiting biodistribution and expression in peripheral organs. To date, the biodistribution of adeno-associated viruses (AAVs) within peripheral organs had not been quantified following intravenous injection and MRIgFUS delivery to the brain. We evaluated the quantity of viral DNA from the serotypes AAV9, AAV6, and a mosaic AAV1&2, expressing green fluorescent protein (GFP) under the neuron-specific synapsin promoter (syn). AAVs were administered intravenously during MRIgFUS targeting to the striatum and hippocampus in mice. The syn promoter led to undetectable levels of GFP expression in peripheral organs. In the liver, the biodistribution of AAV9 and AAV1&2 was 12.9- and 4.4-fold higher, respectively, compared to AAV6. The percentage of GFP-positive neurons in the FUS-targeted areas of the brain was comparable for AAV6-syn-GFP and AAV1&2-syn-GFP. In summary, MRIgFUS-mediated gene delivery with AAV6-syn-GFP had lower off-target biodistribution in the liver compared to AAV9 and AAV1&2, while providing neuronal GFP expression in the striatum and hippocampus.
Collapse
Affiliation(s)
- Danielle Weber-Adrian
- grid.410356.50000 0004 1936 8331Present Address: Faculty of Health Sciences, School of Medicine, Queen′s University, Kingston, ON Canada ,grid.17063.330000 0001 2157 2938Biological Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Rikke Hahn Kofoed
- grid.17063.330000 0001 2157 2938Biological Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Joseph Silburt
- grid.17063.330000 0001 2157 2938Biological Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Zeinab Noroozian
- grid.17063.330000 0001 2157 2938Biological Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Kairavi Shah
- grid.17063.330000 0001 2157 2938Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Alison Burgess
- grid.17063.330000 0001 2157 2938Physical Sciences, Sunnybrook Research Institute, Toronto, ON Canada
| | - Shawna Rideout
- grid.17063.330000 0001 2157 2938Physical Sciences, Sunnybrook Research Institute, Toronto, ON Canada
| | - Sebastian Kügler
- grid.411984.10000 0001 0482 5331Department of Neurology, Center Nanoscale Microscopy and Physiology of the Brain (CNMPB) at University Medical Center Göttingen, Göttingen, Germany
| | - Kullervo Hynynen
- grid.17063.330000 0001 2157 2938Physical Sciences, Sunnybrook Research Institute, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Isabelle Aubert
- grid.17063.330000 0001 2157 2938Biological Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| |
Collapse
|
36
|
Kara E, Rahman A, Aulisa E, Ghosh S. Tumor ablation due to inhomogeneous anisotropic diffusion in generic three-dimensional topologies. Phys Rev E 2020; 102:062425. [PMID: 33466110 DOI: 10.1103/physreve.102.062425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 11/23/2020] [Indexed: 11/07/2022]
Abstract
In recent decades computer-aided technologies have become prevalent in medicine, however, cancer drugs are often only tested on in vitro cell lines from biopsies. We derive a full three-dimensional model of inhomogeneous -anisotropic diffusion in a tumor region coupled to a binary population model, which simulates in vivo scenarios faster than traditional cell-line tests. The diffusion tensors are acquired using diffusion tensor magnetic resonance imaging from a patient diagnosed with glioblastoma multiform. Then we numerically simulate the full model with finite element methods and produce drug concentration heat maps, apoptosis hotspots, and dose-response curves. Finally, predictions are made about optimal injection locations and volumes, which are presented in a form that can be employed by doctors and oncologists.
Collapse
Affiliation(s)
- Erdi Kara
- Department of Mathematics and Statistics, Texas Tech University, Lubbock TX
| | - Aminur Rahman
- Department of Applied Mathematics, University of Washington, Seattle WA
| | - Eugenio Aulisa
- Department of Mathematics and Statistics, Texas Tech University, Lubbock TX
| | - Souparno Ghosh
- Department of Statistics, University of Nebraska - Lincoln, Lincoln NB
| |
Collapse
|
37
|
Belanger MC, Anbaei P, Dunn AF, Kinman AW, Pompano RR. Spatially Resolved Analytical Chemistry in Intact, Living Tissues. Anal Chem 2020; 92:15255-15262. [PMID: 33201681 PMCID: PMC7864589 DOI: 10.1021/acs.analchem.0c03625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tissues are an exciting frontier for bioanalytical chemistry, one in which spatial distribution is just as important as total content. Intact tissue preserves the native cellular and molecular organization and the cell-cell contacts found in vivo. Live tissue, in particular, offers the potential to analyze dynamic events in a spatially resolved manner, leading to fundamental biological insights and translational discoveries. In this Perspective, we provide a tutorial on the four fundamental challenges for the bioanalytical chemist working in living tissue samples as well as best practices for mitigating them. The challenges include (i) the complexity of the sample matrix, which contributes myriad interfering species and causes nonspecific binding of reagents; (ii) hindered delivery and mixing; (iii) the need to maintain physiological conditions; and (iv) tissue reactivity. This framework is relevant to a variety of methods for spatially resolved chemical analysis, including optical imaging, inserted sensors and probes such as electrodes, and surface analyses such as sensing arrays. The discussion focuses primarily on ex vivo tissues, though many considerations are relevant in vivo as well. Our goal is to convey the exciting potential of analytical chemistry to contribute to understanding the functions of live, intact tissues.
Collapse
Affiliation(s)
- Maura C. Belanger
- Department of Chemistry, University of Virginia, PO BOX 400319, Charlottesville, VA 22904
| | - Parastoo Anbaei
- Department of Chemistry, University of Virginia, PO BOX 400319, Charlottesville, VA 22904
| | - Austin F. Dunn
- Department of Chemistry, University of Virginia, PO BOX 400319, Charlottesville, VA 22904
| | - Andrew W.L. Kinman
- Department of Chemistry, University of Virginia, PO BOX 400319, Charlottesville, VA 22904
| | - Rebecca R. Pompano
- Department of Chemistry, University of Virginia, PO BOX 400319, Charlottesville, VA 22904
| |
Collapse
|
38
|
Mehta JN, McRoberts GR, Rylander CG. Controlled Catheter Movement Affects Dye Dispersal Volume in Agarose Gel Brain Phantoms. Pharmaceutics 2020; 12:E753. [PMID: 32796527 PMCID: PMC7464141 DOI: 10.3390/pharmaceutics12080753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/21/2020] [Accepted: 08/06/2020] [Indexed: 01/24/2023] Open
Abstract
The standard of care for treatment of glioblastoma results in a mean survival of only 12 to 15 months. Convection-enhanced delivery (CED) is an investigational therapy to treat glioblastoma that utilizes locoregional drug delivery via a small-caliber catheter placed into the brain parenchyma. Clinical trials have failed to reach their endpoints due to an inability of standard catheters to fully saturate the entire brain tumor and its margins. In this study, we examine the effects of controlled catheter movement on dye dispersal volume in agarose gel brain tissue phantoms. Four different catheter movement control protocols (stationary, continuous retraction, continuous insertion, and intermittent insertion) were applied for a single-port stepped catheter capable of intrainfusion movement. Infusions of indigo carmine dye into agarose gel brain tissue phantoms were conducted during the controlled catheter movement. The dispersal volume (Vd), forward dispersal volume (Vdf), infusion radius, backflow distance, and forward flow distance were quantified for each catheter movement protocol using optical images recorded throughout the experiment. Vd and Vdf for the retraction and intermittent insertion groups were significantly higher than the stationary group. The stationary group had a small but significantly larger infusion radius than either the retracting or the intermittent insertion groups. The stationary group had a greater backflow distance and lower forward flow distance than either the retraction or the intermittent insertion groups. Continuous retraction of catheters during CED treatments can result in larger Vd than traditional stationary catheters, which may be useful for improving the outcomes of CED treatment of glioblastoma. However, catheter design will be crucial in preventing backflow of infusate up the needle tract, which could significantly alter both the Vd and shape of the infusion.
Collapse
Affiliation(s)
- Jason N. Mehta
- Walker Department of Mechanical Engineering, The University of Texas at Austin, 204 E. Dean Keeton Street, Stop C2200, Austin, TX 78712-1591, USA;
| | - Gabrielle R. McRoberts
- Department of Neuroscience, The University of Texas at Austin, Austin, TX 78712-1591, USA;
| | - Christopher G. Rylander
- Walker Department of Mechanical Engineering, The University of Texas at Austin, 204 E. Dean Keeton Street, Stop C2200, Austin, TX 78712-1591, USA;
| |
Collapse
|
39
|
Morhard R, Mueller JL, Tang Q, Nief C, Chelales E, Lam CT, Alvarez DA, Rubinstein M, Katz DF, Ramanujam N. Understanding Factors Governing Distribution Volume of Ethyl Cellulose-Ethanol to Optimize Ablative Therapy in the Liver. IEEE Trans Biomed Eng 2020; 67:2337-2348. [PMID: 31841399 PMCID: PMC7295656 DOI: 10.1109/tbme.2019.2960049] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Ethanol ablation, the injection of ethanol to induce necrosis, was originally used to treat hepatocellular carcinoma, with survival rates comparable to surgery. However, efficacy is limited due to leakage into surrounding tissue. To reduce leakage, we previously reported incorporating ethyl cellulose (EC) with ethanol as this mixture forms a gel when injected into tissue. To further develop EC-ethanol injection as an ablative therapy, the present study evaluates the extent to which salient injection parameters govern the injected fluid distribution. METHODS Utilizing ex vivo swine liver, injection parameters (infusion rate, EC%, infusion volume) were examined with fluorescein added to each solution. After injection, tissue samples were frozen, sectioned, and imaged. RESULTS While leakage was higher for ethanol and 3%EC-ethanol at a rate of 10 mL/hr compared to 1 mL/hr, leakage remained low for 6%EC-ethanol regardless of infusion rate. The impact of infusion volume and pressure were also investigated first in tissue-mimicking surrogates and then in tissue. Results indicated that there is a critical infusion pressure beyond which crack formation occurs leading to fluid leakage. At a rate of 10 mL/hr, a volume of 50 μL remained below the critical pressure. CONCLUSIONS Although increasing the infusion rate increases stress on the tissue and the risk of crack formation, injections of 6%EC-ethanol were localized regardless of infusion rate. To further limit leakage, multiple low-volume infusions may be employed. SIGNIFICANCE These results, and the experimental framework developed to obtain them, can inform optimizing EC-ethanol to treat a range of medical conditions.
Collapse
|
40
|
Development and Characterization of a Benchtop Corneal Puncture Injury Model. Sci Rep 2020; 10:4218. [PMID: 32144320 PMCID: PMC7060308 DOI: 10.1038/s41598-020-61079-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/11/2020] [Indexed: 12/13/2022] Open
Abstract
During recent military operations, eye-related injuries have risen in frequency due to increased use of explosive weaponry which often result in corneal puncture injuries. These have one of the poorest visual outcomes for wounded soldiers, often resulting in blindness due to the large variations in injury shape, size, and severity. As a result, improved therapeutics are needed which can stabilize the injury site and promote wound healing. Unfortunately, current corneal puncture injury models are not capable of producing irregularly shaped, large, high-speed injuries as seen on the battlefield, making relevant therapeutic development challenging. Here, we present a benchtop corneal puncture injury model for use with enucleated eyes that utilizes a high-speed solenoid device suitable for creating military-relevant injuries. We first established system baselines and ocular performance metrics, standardizing the different aspects of the benchtop model to ensure consistent results and properly account for tissue variability. The benchtop model was evaluated with corneal puncture injury objects up to 4.2 mm in diameter which generated intraocular pressure levels exceeding 1500 mmHg. Overall, the created benchtop model provides an initial platform for better characterizing corneal puncture injuries as seen in a military relevant clinical setting and a realistic approach for assessing potential therapeutics.
Collapse
|
41
|
Chung K, Ullah I, Kim N, Lim J, Shin J, Lee SC, Jeon S, Kim SH, Kumar P, Lee SK. Intranasal delivery of cancer-targeting doxorubicin-loaded PLGA nanoparticles arrests glioblastoma growth. J Drug Target 2020; 28:617-626. [PMID: 31852284 DOI: 10.1080/1061186x.2019.1706095] [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] [Indexed: 12/13/2022]
Abstract
Glioblastoma multiforme (GBM) is the most aggressive form of brain tumour and treatment is very challenging. Despite the recent advances in drug delivery systems, various approaches that allow sufficient deposition of anti-cancer drugs within the brain remain unsuccessful due to limited drug delivery throughout the brain. In this study, we utilised an intranasal (IN) approach to allow delivery of anti-cancer drug, encapsulated in PLGA nanoparticles (NPs). PLGA NPs were modified with the RGD ligand to enable Avβ3 expressing tumour-specific delivery. IN delivery of RGD-conjugated-doxorubicin (DOX)-loaded-PLGA-nanoparticles (RGD-DOX-NP) showed cancer-specific delivery of NP and inhibition of brain tumour growth compared to the free-DOX or non-modified DOX-NP in the C6-implanted GBM model. Further, IN treatment with RGD-DOX-NP induces apoptosis in the tumour region without affecting normal brain cells. Our study provides therapeutic evidence to treat GBM using a non-invasive IN approach, which may further be translated to other brain-associated diseases.
Collapse
Affiliation(s)
- Kunho Chung
- Department of Bioengineering and Institute of Nanoscience and Technology, Hanyang University, Seoul, Korea
| | - Irfan Ullah
- Department of Bioengineering and Institute of Nanoscience and Technology, Hanyang University, Seoul, Korea.,Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Nahyeon Kim
- Department of Bioengineering and Institute of Nanoscience and Technology, Hanyang University, Seoul, Korea.,Samsung Bioepis, Incheon, Korea
| | - Jaeyeoung Lim
- Department of Bioengineering and Institute of Nanoscience and Technology, Hanyang University, Seoul, Korea.,Celltrion, Incheon, Korea
| | - Jungah Shin
- Department of Bioengineering and Institute of Nanoscience and Technology, Hanyang University, Seoul, Korea.,Chong Kun Dang Pharmaceutics, Seoul, Korea
| | - Sangah C Lee
- Department of Bioengineering and Institute of Nanoscience and Technology, Hanyang University, Seoul, Korea.,Department of Health Services, Policy, and Practice, Brown University, Providence, RI, USA
| | - Sangmin Jeon
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, Korea
| | - Sun Hwa Kim
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, Korea
| | - Priti Kumar
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Sang-Kyung Lee
- Department of Bioengineering and Institute of Nanoscience and Technology, Hanyang University, Seoul, Korea
| |
Collapse
|
42
|
Weber-Adrian D, Kofoed RH, Chan JWY, Silburt J, Noroozian Z, Kügler S, Hynynen K, Aubert I. Strategy to enhance transgene expression in proximity of amyloid plaques in a mouse model of Alzheimer's disease. Theranostics 2019; 9:8127-8137. [PMID: 31754385 PMCID: PMC6857057 DOI: 10.7150/thno.36718] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/29/2019] [Indexed: 12/26/2022] Open
Abstract
Gene therapy can be designed to efficiently counter pathological features characteristic of neurodegenerative disorders. Here, we took advantage of the glial fibrillary acidic protein (GFAP) promoter to preferentially enhance transgene expression near plaques composed of amyloid-beta peptides (Aβ), a hallmark of Alzheimer's disease (AD), in the TgCRND8 mouse model of amyloidosis. Methods: The delivery of intravenously injected recombinant adeno-associated virus mosaic serotype 1/2 (rAAV1/2) to the cortex and hippocampus of TgCRND8 mice was facilitated using transcranial MRI-guided focused ultrasound in combination with microbubbles (MRIgFUS), which transiently and locally increases the permeability of the blood-brain barrier (BBB). rAAV1/2 expression of the reporter green fluorescent protein (GFP) under a GFAP promoter was compared to GFP expression driven by the constitutive human beta actin (HBA) promoter. Results: MRIgFUS targeting the cortex and hippocampus facilitated the entry of rAAV1/2 and GFP expression under the GFAP promoter was localized to GFAP-positive astrocytes. Adjacent to Aβ plaques where GFAP is upregulated, the volume, surface area, and fluorescence intensity of the transgene GFP were greater in rAAV1/2-GFAP-GFP compared to rAAV1/2-HBA-GFP treated animals. In peripheral organs, GFP expression was particularly strong in the liver, irrespective of the promoter. Conclusion: The GFAP promoter enhanced transgene expression in proximity of Aβ plaques in the brain of TgCRND8 mice, and it also resulted in significant expression in the liver. Future gene therapies for neurological disorders could benefit from using a GFAP promoter to regulate transgene expression in response to disease-induced astrocytic reactivity.
Collapse
Affiliation(s)
- Danielle Weber-Adrian
- Biological Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Rikke Hahn Kofoed
- Biological Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Josephine Wing Yee Chan
- Biological Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Joseph Silburt
- Biological Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Zeinab Noroozian
- Biological Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Sebastian Kügler
- Department of Neurology, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Kullervo Hynynen
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Isabelle Aubert
- Biological Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| |
Collapse
|
43
|
Kumosa LS, Zetterberg V, Schouenborg J. Gelatin promotes rapid restoration of the blood brain barrier after acute brain injury. Acta Biomater 2018; 65:137-149. [PMID: 29037893 DOI: 10.1016/j.actbio.2017.10.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/27/2017] [Accepted: 10/10/2017] [Indexed: 12/25/2022]
Abstract
Gelatin coating of brain implants is known to provide considerable benefits in terms of reduced inflammatory sequalae and long-term neuroprotective effects. However, the mechanisms for gelatin's protective role in brain injury are still unknown. To address this question, cellular and molecular markers were studied with quantitative immunohistochemical microscopy at acute (<2hours, 1, 3days), intermediate (1-2 weeks) and long-term time points (6 weeks) after transient insertion of stainless steel needles into female rat cortex cerebri with or without gelatin coating. Compared to non-coated controls, injuries caused by gelatin coated needles showed a significantly faster resolution of post-stab bleeding/leakage and differential effects on different groups of microglia cells. While similar levels of matrix metalloproteinase (MMP-2 and MMP-9, two gelatinases) was found for coated and noncoated needle stabs during the first week, markedly increased levels of both MMPs was seen for gelatin-coated but not non-coated needle stabs after 2weeks. Neuronal populations and activated astrocytes were largely unaffected. In conclusion, the beneficial effects of gelatin may be the combined results of faster healing of the blood brain barrier curtailing leakage of blood borne molecules/cells into brain parenchyma and to a modulation of the microglial population response favoring restitution of the injured tissue. These findings present an important therapeutic potential for gelatin coatings in various disease, injury and surgical conditions. STATEMENT OF SIGNIFICANCE The neural interfaces field holds great promise to enable elucidation of neural information processing and to develop new implantable devices for stimulation based therapy. Currently, this field is struggling to find solutions for reducing tissue reactions to implanted micro and nanotechnology. Prior studies have recently shown that gelatin coatings lower activation of digestive microglia and mitigate the ubiquitous loss of neurons adjacent to implanted probes, both of which impede implant function. The underlying mechanisms remain to be elucidated, however. Our findings demonstrate for the first time that gelatin has a significant effect on the BBB by promoting rapid restoration of integrity after injury. Moreover, gelatin alters microglia phenotypes and modulates gelatinase activity for up to 2weeks favoring anti-inflammation and restoration of the tissue. Given the key importance of the BBB for normal brain functions, we believe our findings have substantial significance and will be highly interesting to researchers in the biomaterial field.
Collapse
|
44
|
Apollo NV, Jiang J, Cheung W, Baquier S, Lai A, Mirebedini A, Foroughi J, Wallace GG, Shivdasani MN, Prawer S, Chen S, Williams R, Cook MJ, Nayagam DAX, Garrett DJ. Development and Characterization of a Sucrose Microneedle Neural Electrode Delivery System. ACTA ACUST UNITED AC 2017. [DOI: 10.1002/adbi.201700187] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Nicholas V. Apollo
- School of Physics; University of Melbourne; Parkville Victoria 3010 Australia
- The Bionics Institute; 384-388 Albert St. East Melbourne Victoria 3002 Australia
| | - Jonathan Jiang
- Department of Medicine; University of Melbourne; Parkville Victoria 3010 Australia
| | - Warwick Cheung
- Department of Medicine; University of Melbourne; Parkville Victoria 3010 Australia
| | - Sebastien Baquier
- Department of Medicine; University of Melbourne; Parkville Victoria 3010 Australia
- Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Parkville Victoria 3010 Australia
| | - Alan Lai
- Department of Medicine; University of Melbourne; Parkville Victoria 3010 Australia
| | - Azadeh Mirebedini
- Intelligent Polymer Research Institute (IPRI); AIIM Facility; Innovation Campus; University of Wollongong; Wollongong New South Wales 2522 Australia
| | - Javad Foroughi
- Intelligent Polymer Research Institute (IPRI); AIIM Facility; Innovation Campus; University of Wollongong; Wollongong New South Wales 2522 Australia
| | - Gordon G. Wallace
- Intelligent Polymer Research Institute (IPRI); AIIM Facility; Innovation Campus; University of Wollongong; Wollongong New South Wales 2522 Australia
| | - Mohit N. Shivdasani
- The Bionics Institute; 384-388 Albert St. East Melbourne Victoria 3002 Australia
- Department of Medical Bionics; University of Melbourne; Parkville Victoria 3010 Australia
| | - Steven Prawer
- School of Physics; University of Melbourne; Parkville Victoria 3010 Australia
| | - Shou Chen
- Department of Anatomical Pathology; St Vincent's Hospital Melbourne; Fitzroy Victoria 3065 Australia
| | - Richard Williams
- Department of Anatomical Pathology; St Vincent's Hospital Melbourne; Fitzroy Victoria 3065 Australia
- Department of Pathology; University of Melbourne; Parkville Victoria 3010 Australia
| | - Mark J. Cook
- Department of Medicine; University of Melbourne; Parkville Victoria 3010 Australia
| | - David A. X. Nayagam
- The Bionics Institute; 384-388 Albert St. East Melbourne Victoria 3002 Australia
- Department of Pathology; University of Melbourne; Parkville Victoria 3010 Australia
| | - David J. Garrett
- School of Physics; University of Melbourne; Parkville Victoria 3010 Australia
- The Bionics Institute; 384-388 Albert St. East Melbourne Victoria 3002 Australia
| |
Collapse
|
45
|
Lehocky CA, Fellows-Mayle W, Engh JA, Riviere CN. Tip Design for Safety of Steerable Needles for Robot-Controlled Brain Insertion. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:107-114. [PMID: 29170740 PMCID: PMC5695876 DOI: 10.2147/rsrr.s141085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Current practice in neurosurgical needle insertion is limited by the straight trajectories inherent with rigid probes. One technique allowing curvilinear trajectories involves flexible bevel-tipped needles, which bend during insertion due to their asymmetry. In the brain, safety will require avoidance of the sharp tips often used in laboratory studies, in favor of a more rounded profile. Steering performance, on the other hand, requires maximal asymmetry. Design of safe bevel-tipped brain needles thus involves management of this tradeoff by adjusting needle gauge, bevel angle, and fillet (or tip) radius to arrive at a design that is suitably asymmetrical while producing strain, strain rate, and stress below the levels that would damage brain tissue. Methods Designs with a variety of values of needle radius, bevel angle, and fillet radius were evaluated in finite-element simulations of simultaneous insertion and rotation. Brain tissue was modeled as a hyperelastic, linear viscoelastic material. Based on the literature available, safety thresholds of 0.19 strain, 10 s-1 strain rate, and 120 kPa stress were used. Safe values of needle radius, bevel angle, and fillet radius were selected, along with an appropriate velocity envelope for safe operation. The resulting needle was fabricated and compared with a Sedan side-cutting brain biopsy needle in a study in the porcine model in vivo (N=3). Results The prototype needle selected was 1.66 mm in diameter, with bevel angle of 10° and fillet radius of 0.25 mm. Upon examination of postoperative CT and histological images, no differences in tissue trauma or hemorrhage were noted between the prototype needle and the Sedan needle. Conclusions The study indicates a general design technique for safe bevel-tipped brain needles based on comparison with relevant damage thresholds for strain, strain rate, and stress. The full potential of the technique awaits the determination of more exact safety thresholds.
Collapse
Affiliation(s)
- Craig A Lehocky
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Wendy Fellows-Mayle
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Johnathan A Engh
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Cameron N Riviere
- The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
46
|
Brain Tissue Responses to Guide Cannula Insertion and Replacement of a Microrecording Electrode with a Definitive DBS Electrode. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0328-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
47
|
Chiu HT, Su CK, Sun YC, Chiang CS, Huang YF. Albumin-Gold Nanorod Nanoplatform for Cell-Mediated Tumoritropic Delivery with Homogenous ChemoDrug Distribution and Enhanced Retention Ability. Am J Cancer Res 2017; 7:3034-3052. [PMID: 28839462 PMCID: PMC5566104 DOI: 10.7150/thno.19279] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 06/05/2017] [Indexed: 11/30/2022] Open
Abstract
Recently, living cells with tumor-homing properties have provided an exciting opportunity to achieve optimal delivery of nanotherapeutic agents. However, premature payload leakage may impair the host cells, often leading to inadequate in vivo investigations or therapeutic efficacy. Therefore, a nanoplatform that provides a high drug-loading capacity and the precise control of drug release is required. In the present study, a robust one-step synthesis of a doxorubicin (DOX)-loaded gold nanorod/albumin core-shell nanoplatform (NR@DOX:SA) was designed for effective macrophage-mediated delivery to demonstrate how nanoparticle-loaded macrophages improve photothermal/chemodrug distribution and retention ability to achieve enhanced antitumor effects. The serum albumin shell of these nanoagents served as a drug reservoir to delay the intracellular DOX release and drug-related toxicity that impairs the host cell carriers. Near-infrared laser irradiation enabled on-demand payload release to destroy neighboring tumor cells. A series of in vivo quantitative analyses demonstrated that the nanoengineered macrophages delivered the nanodrugs through tumor-tropic migration to tumor tissues, resulting in the twice homogenous and efficient photothermal activations of drug release to treat prostate cancer. By contrast, localized pristine NR@DOX:SAs exhibit limited photothermal drug delivery that further reduces their retention ability and therapeutic efficacy after second combinational treatment, leading to a failure of cancer therapy. Moreover, the resultant unhealable wounds impair quality of life. Free DOX has rapid clearance and therefore exhibits limited antitumor effects. Our findings suggest that in comparison with pristine nanoparticles or free DOX, the nanoengineered macrophages effectively demonstrate the importance and effect of homogeneous drug distribution and retention ability in cancer therapy.
Collapse
|
48
|
Abstract
Convection-enhanced delivery (CED) is a promising technique that generates a pressure gradient at the tip of an infusion catheter to deliver therapeutics directly through the interstitial spaces of the central nervous system. It addresses and offers solutions to many limitations of conventional techniques, allowing for delivery past the blood-brain barrier in a targeted and safe manner that can achieve therapeutic drug concentrations. CED is a broadly applicable technique that can be used to deliver a variety of therapeutic compounds for a diversity of diseases, including malignant gliomas, Parkinson's disease, and Alzheimer's disease. While a number of technological advances have been made since its development in the early 1990s, clinical trials with CED have been largely unsuccessful, and have illuminated a number of parameters that still need to be addressed for successful clinical application. This review addresses the physical principles behind CED, limitations in the technique, as well as means to overcome these limitations, clinical trials that have been performed, and future developments.
Collapse
Affiliation(s)
- A M Mehta
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, 10032, USA
| | - A M Sonabend
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, 10032, USA
| | - J N Bruce
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, 10032, USA.
| |
Collapse
|
49
|
Mathematical Modelling of Convection Enhanced Delivery of Carmustine and Paclitaxel for Brain Tumour Therapy. Pharm Res 2017; 34:860-873. [PMID: 28155074 DOI: 10.1007/s11095-017-2114-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Convection enhanced delivery (CED) is a promising method of anticancer treatment to bypass the blood-brain barrier. This paper is aimed to study drug transport under different CED operating conditions. METHODS The convection enhanced delivery of chemotherapeutics to an intact and a remnant brain tumour after resection is investigated by means of mathematical modelling of the key physical and physiological processes of drug transport. Realistic models of brain tumour and its holding tissue are reconstructed from magnetic resonance images. Mathematical modelling is performed for the delivery of carmustine and paclitaxel with different infusion rates, solution concentrations and locations of infusion site. RESULTS Modelling predications show that drug penetration can be improved by raising the infusion rate and the infusion solution concentration. The delivery of carmustine with CED is highly localised. High drug concentration only can be achieved around the infusion site. The transport of paclitaxel is more sensitive to CED-enhanced interstitial fluid as compared to carmustine, with deeper penetration into tumour interior. Infusing paclitaxel in the upstream of interstitial fluid flow leads to high spatial averaged concentration and relatively uniform distribution. CONCLUSION Results obtained in this study can be used to guide the design and optimisation of CED treatment regimens.
Collapse
|
50
|
Song J, Li N, Xia Y, Gao Z, Zou SF, Kong L, Yao YJ, Jiao YN, Yan YH, Li SH, Tao ZY, Lian G, Yang JX, Kang TG. Arctigenin Treatment Protects against Brain Damage through an Anti-Inflammatory and Anti-Apoptotic Mechanism after Needle Insertion. Front Pharmacol 2016; 7:182. [PMID: 27445818 PMCID: PMC4916177 DOI: 10.3389/fphar.2016.00182] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/10/2016] [Indexed: 12/31/2022] Open
Abstract
Convection enhanced delivery (CED) infuses drugs directly into brain tissue. Needle insertion is required and results in a stab wound injury (SWI). Subsequent secondary injury involves the release of inflammatory and apoptotic cytokines, which have dramatic consequences on the integrity of damaged tissue, leading to the evolution of a pericontusional-damaged area minutes to days after in the initial injury. The present study investigated the capacity for arctigenin (ARC) to prevent secondary brain injury and the determination of the underlying mechanism of action in a mouse model of SWI that mimics the process of CED. After CED, mice received a gavage of ARC from 30 min to 14 days. Neurological severity scores (NSS) and wound closure degree were assessed after the injury. Histological analysis and immunocytochemistry were used to evaluated the extent of brain damage and neuroinflammation. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) was used to detect universal apoptosis. Enzyme-linked immunosorbent assays (ELISA) was used to test the inflammatory cytokines (tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10) and lactate dehydrogenase (LDH) content. Gene levels of inflammation (TNF-α, IL-6, and IL-10) and apoptosis (Caspase-3, Bax and Bcl-2) were detected by reverse transcription-polymerase chain reaction (RT-PCR). Using these, we analyzed ARC’s efficacy and mechanism of action. Results: ARC treatment improved neurological function by reducing brain water content and hematoma and accelerating wound closure relative to untreated mice. ARC treatment reduced the levels of TNF-α and IL-6 and the number of allograft inflammatory factor (IBA)- and myeloperoxidase (MPO)-positive cells and increased the levels of IL-10. ARC-treated mice had fewer TUNEL+ apoptotic neurons and activated caspase-3-positive neurons surrounding the lesion than controls, indicating increased neuronal survival. Conclusions: ARC treatment confers neuroprotection of brain tissue through anti-inflammatory and anti-apoptotic effects in a mouse model of SWI. These results suggest a new strategy for promoting neuronal survival and function after CED to improve long-term patient outcome.
Collapse
Affiliation(s)
- Jie Song
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine Dalian, China
| | - Na Li
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine Dalian, China
| | - Yang Xia
- Department of Engineering, St. Cross College, University of Oxford Oxford, UK
| | - Zhong Gao
- Department of Interventional Therapy, Department of Rehabilitation, Dalian Municipal Central Hospital Dalian, China
| | - Sa-Feng Zou
- Department of Interventional Therapy, Department of Rehabilitation, Dalian Municipal Central Hospital Dalian, China
| | - Liang Kong
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine Dalian, China
| | - Ying-Jia Yao
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine Dalian, China
| | - Ya-Nan Jiao
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine Dalian, China
| | - Yu-Hui Yan
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine Dalian, China
| | - Shao-Heng Li
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine Dalian, China
| | - Zhen-Yu Tao
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine Dalian, China
| | - Guan Lian
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine Dalian, China
| | - Jing-Xian Yang
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine Dalian, China
| | - Ting-Guo Kang
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine Dalian, China
| |
Collapse
|