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Verma Y, Perera Molligoda Arachchige AS. Advances in Tumor Management: Harnessing the Potential of Histotripsy. Radiol Imaging Cancer 2024; 6:e230159. [PMID: 38639585 DOI: 10.1148/rycan.230159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Tissue ablation techniques have long been used in clinical settings to treat various oncologic diseases. However, many of these techniques are invasive and can cause substantial adverse effects. Histotripsy is a noninvasive, nonionizing, nonthermal tissue ablation technique that has the potential to replace surgical interventions in various clinical settings. Histotripsy works by delivering high-intensity focused ultrasound waves to target tissue. These waves create cavitation bubbles within tissues that rapidly expand and collapse, thereby mechanically fractionating the tissue into acellular debris that is subsequently absorbed by the body's immune system. Preclinical and clinical studies have demonstrated the efficacy of histotripsy in treating a range of diseases, including liver, pancreatic, renal, and prostate tumors. Safety outcomes of histotripsy have been generally favorable, with minimal adverse effects reported. However, further studies are needed to optimize the technique and understand its long-term effects. This review aims to discuss the importance of histotripsy as a noninvasive tissue ablation technique, the preclinical and clinical literature on histotripsy and its safety, and the potential applications of histotripsy in clinical practice. Keywords: Tumor Microenvironment, Ultrasound-High-Intensity Focused (HIFU), Ablation Techniques, Abdomen/GI, Genital/Reproductive, Nonthermal Tissue Ablation, Histotripsy, Clinical Trials, Preclinical Applications, Focused Ultrasound © RSNA, 2024.
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Affiliation(s)
- Yash Verma
- From the Norfolk and Norwich University Hospital, Colney Ln, Norwich NR4 7UY, England (Y.V.); and Faculty of Medicine, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Milan, Italy (A.S.P.M.A.)
| | - Arosh S Perera Molligoda Arachchige
- From the Norfolk and Norwich University Hospital, Colney Ln, Norwich NR4 7UY, England (Y.V.); and Faculty of Medicine, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Milan, Italy (A.S.P.M.A.)
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Aurup C, Bendig J, Blackman SG, McCune EP, Bae S, Jimenez-Gambin S, Ji R, Konofagou EE. Transcranial Functional Ultrasound Imaging Detects Focused Ultrasound Neuromodulation Induced Hemodynamic Changes in Mouse and Nonhuman Primate Brains In Vivo. bioRxiv 2024:2024.03.08.583971. [PMID: 38559149 PMCID: PMC10979885 DOI: 10.1101/2024.03.08.583971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Focused ultrasound (FUS) is an emerging noinvasive technique for neuromodulation in the central nervous system (CNS). To evaluate the effects of FUS-induced neuromodulation, many studies used behavioral changes, functional magnetic resonance imaging (fMRI) or electroencephalography (EEG). However, behavioral readouts are often not easily mapped to specific brain activity, EEG has low spatial resolution limited to the surface of the brain and fMRI requires a large importable scanner that limits additional readouts and manipulations. In this context, functional ultrasound imaging (fUSI) holds promise to directly monitor the effects of FUS neuromodulation with high spatiotemporal resolution in a large field of view, with a comparatively simple and flexible setup. fUSI uses ultrafast Power Doppler Imaging (PDI) to measure changes in cerebral blood volume, which correlates well with neuronal activity and local field potentials. We designed a setup that aligns a FUS transducer with a linear array to allow immediate subsequent monitoring of the hemodynamic response with fUSI during and after FUS neuromodulation. We established a positive correlation between FUS pressure and the size of the activated area, as well as changes in cerebral blood volume (CBV) and found that unilateral sonications produce bilateral hemodynamic changes with ipsilateral accentuation in mice. We further demonstrated the ability to perform fully noninvasive, transcranial FUS-fUSI in nonhuman primates for the first time by using a lower-frequency transducer configuration.
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Affiliation(s)
- Christian Aurup
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Jonas Bendig
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Samuel G. Blackman
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Erica P. McCune
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Sua Bae
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | | | - Robin Ji
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Elisa E. Konofagou
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
- Department of Radiology, Columbia University, New York, NY, USA
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Karakatsani ME, Ji R, Murillo MF, Kugelman T, Kwon N, Lao YH, Liu K, Pouliopoulos AN, Honig LS, Duff KE, Konofagou EE. Focused ultrasound mitigates pathology and improves spatial memory in Alzheimer's mice and patients. Theranostics 2023; 13:4102-4120. [PMID: 37554284 PMCID: PMC10405840 DOI: 10.7150/thno.79898] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/12/2023] [Indexed: 08/10/2023] Open
Abstract
Rationale: Bilateral sonication with focused ultrasound (FUS) in conjunction with microbubbles has been shown to separately reduce amyloid plaques and hyperphosphorylated tau protein in the hippocampal formation and the entorhinal cortex in different mouse models of Alzheimer's disease (AD) without any therapeutic agents. However, the two pathologies are expressed concurrently in human disease. Therefore, the objective of this study is to investigate the effects of repeated bilateral sonications in the presence of both pathologies. Methods: Herein, we investigate its functional and morphological outcomes on brains bearing both pathologies simultaneously. Eleven transgenic mice of the 3xTg-AD line (14 months old) expressing human amyloid beta and human tau and eleven age-matched wild-type littermates received four weekly bilateral sonications covering the hippocampus followed by working memory testing. Afterwards, immunohistochemistry and immunoassays (western blot and ELISA) were employed to assess any changes in amyloid beta and human tau. Furthermore, we present preliminary data from our clinical trial using a neuronavigation-guided FUS system for sonications in AD patients (NCT04118764). Results: Interestingly, both wild-type and transgenic animals that received FUS experienced improved working memory and spent significantly more time in the escape platform-quadrant, with wild-type animals spending 43.2% (sham: 37.7%) and transgenic animals spending 35.3% (sham: 31.0%) of the trial in the target quadrant. Furthermore, this behavioral amelioration in the transgenic animals correlated with a 58.3% decrease in the neuronal length affected by tau and a 27.2% reduction in total tau levels. Amyloid plaque population, volume and overall load were also reduced overall. Consistently, preliminary data from a clinical trial involving AD patients showed a 1.8% decrease of amyloid PET signal 3-weeks after treatment in the treated hemisphere compared to baseline. Conclusion: For the first time, it is shown that bilateral FUS-induced BBB opening significantly and simultaneously ameliorates both coexistent pathologies, which translated to improvements in spatial memory of transgenic animals with complex AD, the human mimicking phenotype. The level of cognitive improvement was significantly correlated with the volume of BBB opening. Non-transgenic animals were also shown to exhibit similar memory amelioration for the first time, indicating that BBB opening results into benefits in the neuronal function regardless of the existence of AD pathology. A potential mechanism of action for the reduction of the both pathologies investigated was the cholesterol metabolism, specifically the LRP1b receptor, which exhibited increased expression levels in transgenic mice following FUS-induced BBB opening. Initial clinical evidence supported that the beta amyloid reduction shown in rodents could be translatable to humans with significant amyloid reduction shown in the treated hemisphere.
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Affiliation(s)
| | - Robin Ji
- Department of Biomedical Engineering, Columbia University, New York, USA
| | - Maria F. Murillo
- Department of Biomedical Engineering, Columbia University, New York, USA
| | - Tara Kugelman
- Department of Biomedical Engineering, Columbia University, New York, USA
| | - Nancy Kwon
- Department of Biomedical Engineering, Columbia University, New York, USA
| | - Yeh-Hsing Lao
- Department of Biomedical Engineering, Columbia University, New York, USA
| | - Keyu Liu
- Department of Biomedical Engineering, Columbia University, New York, USA
| | | | - Lawrence S. Honig
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, USA
| | - Karen E. Duff
- UK Dementia Research Institute, University College London, London, UK
| | - Elisa E. Konofagou
- Department of Radiology, Columbia University Irving Medical Center, New York, USA
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Leong KX, Yang W, Sharma D, Liu S, Czarnota GJ. Ultrasound-stimulated microbubbles enhanced vascular disruption in fractionated radiotherapy via ASMase activation. Dis Model Mech 2023:307309. [PMID: 37186003 DOI: 10.1242/dmm.049531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/20/2023] [Indexed: 05/17/2023] Open
Abstract
Recent studies have indicated that radiotherapy affects tumour vasculature as well as tumour cells. The use of ultrasound-stimulated microbubbles (USMB) can potentially enhance the effects of radiotherapy through the activation of the acid sphingomyelinase (ASMase) - ceramide pathway. ASMase knockout (ASMase -/-) and wild type (WT) mice bearing fibrosarcoma (MCA/129 tumour line) were treated with 10 Gy or 20 Gy in 5 fractions alongside or independently of USMB treatments. Results indicated that tumour responses to fXRT were enhanced when fXRT was coupled with USMB as part of the treatment regimen. Sphingosine-1-Phosphate (S1P) treated and ASMase -/- mice demonstrated radioresistance against fractionated radiotherapy (fXRT) alone while the combination treatment only showed radioresistance in ASMase -/- mice. Results indicated that in WT and S1P cohorts, the use of USMB+fXRT was capable of enhancing tumour response compared to USMB or fXRT alone. While in WT and S1P cohorts there was enhanced vascular disruption, ASMase -/- cohorts demonstrated no significant vascular disruption, indicating the importance of ASMase in facilitating vascular changes in response to fXRT and USMB.
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Affiliation(s)
- Kai Xuan Leong
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Wenyi Yang
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Deepa Sharma
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Stanley Liu
- Biological Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Gregory J Czarnota
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Field RD, Jakus MA, Chen X, Human K, Zhao X, Chitnis PV, Sia SK. Ultrasound-Responsive Aqueous Two-Phase Microcapsules for On-Demand Drug Release. Angew Chem Int Ed Engl 2022; 61:e202116515. [PMID: 35233907 DOI: 10.1002/anie.202116515] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Indexed: 12/21/2022]
Abstract
Traditional implanted drug delivery systems cannot easily change their release profile in real time to respond to physiological changes. Here we present a microfluidic aqueous two-phase system to generate microcapsules that can release drugs on demand as triggered by focused ultrasound (FUS). The biphasic microcapsules are made of hydrogels with an outer phase of mixed molecular weight (MW) poly(ethylene glycol) diacrylate that mitigates premature payload release and an inner phase of high MW dextran with payload that breaks down in response to FUS. Compound release from microcapsules could be triggered as desired; 0.4 μg of payload was released across 16 on-demand steps over days. We detected broadband acoustic signals amidst low heating, suggesting inertial cavitation as a key mechanism for payload release. Overall, FUS-responsive microcapsules are a biocompatible and wirelessly triggerable structure for on-demand drug delivery over days to weeks.
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Affiliation(s)
- Rachel D Field
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Margaret A Jakus
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Xiaoyu Chen
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Kelia Human
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Parag V Chitnis
- Department of Bioengineering, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA
| | - Samuel K Sia
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
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Rincon-Torroella J, Khela H, Bettegowda A, Bettegowda C. Biomarkers and focused ultrasound: the future of liquid biopsy for brain tumor patients. J Neurooncol 2021; 156:33-48. [PMID: 34613580 PMCID: PMC8714625 DOI: 10.1007/s11060-021-03837-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/28/2021] [Indexed: 01/12/2023]
Abstract
Introduction Despite advances in modern medicine, brain tumor patients are still monitored purely by clinical evaluation and imaging. Traditionally, invasive strategies such as open or stereotactic biopsies have been used to confirm the etiology of clinical and imaging changes. Liquid biopsies can enable physicians to noninvasively analyze the evolution of a tumor and a patient’s response to specific treatments. However, as a consequence of biology and the current limitations in detection methods, no blood or cerebrospinal fluid (CSF) brain tumor-derived biomarkers are used in routine clinical practice. Enhancing the presence of tumor biomarkers in blood and CSF via brain-blood barrier (BBB) disruption with MRI-guided focused ultrasound (MRgFUS) is a very compelling strategy for future management of brain tumor patients. Methods A literature review on MRgFUS-enabled brain tumor liquid biopsy was performed using Medline/Pubmed databases and clinical trial registries. Results The therapeutic applications of MRgFUS to target brain tumors have been under intense investigation. At high-intensity, MRgFUS can ablate brain tumors and target tissues, which needs to be balanced with the increased risk for damage to surrounding normal structures. At lower-intensity and pulsed-frequency, MRgFUS may be able to disrupt the BBB transiently. Thus, while facilitating intratumoral or parenchymal access to standard or novel therapeutics, BBB disruption with MRgFUS has opened the possibility of enhanced detection of brain tumor-derived biomarkers. Conclusions In this review, we describe the concept of MRgFUS-enabled brain tumor liquid biopsy and present the available preclinical evidence, ongoing clinical trials, limitations, and future directions of this application.
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Affiliation(s)
- Jordina Rincon-Torroella
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 118, Baltimore, MD, 21128, USA
| | - Harmon Khela
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 118, Baltimore, MD, 21128, USA
| | - Anya Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 118, Baltimore, MD, 21128, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 118, Baltimore, MD, 21128, USA.
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Stern JM, Spivak NM, Becerra SA, Kuhn TP, Korb AS, Kronemyer D, Khanlou N, Reyes SD, Monti MM, Schnakers C, Walshaw P, Keselman I, Cohen MS, Yong W, Fried I, Jordan SE, Schafer ME, Engel J, Bystritsky A. Safety of focused ultrasound neuromodulation in humans with temporal lobe epilepsy. Brain Stimul 2021; 14:1022-1031. [PMID: 34198105 DOI: 10.1016/j.brs.2021.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Transcranial Focused Ultrasound (tFUS) is a promising new potential neuromodulation tool. However, the safety of tFUS neuromodulation has not yet been assessed adequately. Patients with refractory temporal lobe epilepsy electing to undergo an anterior temporal lobe resection present a unique opportunity to evaluate the safety and efficacy of tFUS neuromodulation. Histological changes in tissue after tFUS can be examined after surgical resection, while further potential safety concerns can be assessed using neuropsychological testing. METHODS Neuropsychological functions were assessed in eight patients before and after focused ultrasound sonication of the temporal lobe at intensities up to 5760 mW/cm2. Using the BrainSonix Pulsar 1002, tFUS was delivered under MR guidance, using the Siemens Magnetom 3T Prisma scanner. Neuropsychological changes were assessed using various batteries. Histological changes were assessed using hematoxylin and eosin staining, among others. RESULTS With respect to safety, the histological analysis did not reveal any detectable damage to the tissue, except for one subject for whom the histology findings were inconclusive. In addition, neuropsychological testing did not show any statistically significant changes in any test, except for a slight decrease in performance on one of the tests after tFUS. SIGNIFICANCE This study supports the hypothesis that low-intensity Transcranial Focused Ultrasound (tFUS) used for neuromodulation of brain circuits at intensities up to 5760 mW/cm2 may be safe for use in human research. However, due to methodological limitations in this study and inconclusive findings, more work is warranted to establish the safety. Future directions include greater number of sonications as well as longer exposure at higher intensity levels to further assess the safety of tFUS for modulation of neuronal circuits.
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Affiliation(s)
- John M Stern
- Department of Neurology, UCLA School of Medicine, USA
| | - Norman M Spivak
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; Department of Neurosurgery, UCLA School of Medicine, USA
| | - Sergio A Becerra
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA
| | - Taylor P Kuhn
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA
| | - Alexander S Korb
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; BrainSonix Inc., Los Angeles, CA, USA
| | - David Kronemyer
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA
| | - Négar Khanlou
- Department of Pathology and Laboratory Medicine, UCLA School of Medicine, USA
| | - Samuel D Reyes
- Department of Neurosurgery, UCLA School of Medicine, USA
| | - Martin M Monti
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; Department of Neurosurgery, UCLA School of Medicine, USA; Department of Psychology, UCLA College of Letters and Science, USA; Brain Research Institute, UCLA, USA
| | | | - Patricia Walshaw
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA
| | - Inna Keselman
- Department of Neurology, UCLA School of Medicine, USA
| | - Mark S Cohen
- Department of Neurology, UCLA School of Medicine, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; Department of Psychology, UCLA College of Letters and Science, USA; Department of Radiology, UCLA School of Medicine, USA; Department of Biomedical Physics, UCLA School of Medicine, USA; Department of Bioengineering, UCLA School of Engineering, USA; California Nanosystems Institute, UCLA, USA; Brain Research Institute, UCLA, USA
| | - William Yong
- Department of Pathology and Laboratory Medicine, UCLA School of Medicine, USA
| | - Itzhak Fried
- Department of Neurosurgery, UCLA School of Medicine, USA; Brain Research Institute, UCLA, USA
| | - Sheldon E Jordan
- Neurology Management Associates- Los Angeles, Santa Monica, CA, USA
| | - Mark E Schafer
- BrainSonix Inc., Los Angeles, CA, USA; School of Biomedical Engineering, Drexel University, Philadelphia, PA, USA
| | - Jerome Engel
- Department of Neurology, UCLA School of Medicine, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; Department of Neurobiology, UCLA School of Medicine, USA; Brain Research Institute, UCLA, USA
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; BrainSonix Inc., Los Angeles, CA, USA.
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Zeng Y, Acord M, Kaovasia TP, Miao P, Sun J, Senarathna J, Theodore N, Thakor N, Manbachi A. A MINIATURE LASER SPECKLE CONTRAST IMAGER FOR MONITORING OF THE NEURO-MODULATORY EFFECT OF TRANSCRANIAL FOCUSED ULTRASOUND STIMULATION. Proc Des Med Devices Conf 2021; 2021:V001T09A001. [PMID: 35224565 PMCID: PMC8875282 DOI: 10.1115/dmd2021-1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Transcranial focused ultrasound stimulation is a neuromodulation technique that is capable of exciting or suppressing the neural network. Such neuro-modulatory effects enable the treatment of brain diseases non-invasively, such as treating stroke. The neuro-modulatory effect on cerebral hemodynamics has been monitored using laser speckle contrast imaging in animal studies. However, the bulky size and stationary nature of the imaging system constrains the application of this imaging technique on research that requires the animal to have different body positions or to be awake. We present the design of a system that combines a miniature microscope for laser speckle contrast imaging and transcranial focused ultrasound stimulation, as well as, test its capability to monitor cerebral hemodynamics during stimulation and compare the result with a benchtop imaging system.
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Affiliation(s)
- Yinuo Zeng
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Molly Acord
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Peng Miao
- Department of Biomedical Engineering, Shanghai Jiaotong University, Shanghai, China
| | - Junfeng Sun
- Department of Biomedical Engineering, Shanghai Jiaotong University, Shanghai, China
| | - Janaka Senarathna
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Nitish Thakor
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Amir Manbachi
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
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Acord M, Kaovasia TP, Gamo NJ, Xiong T, Morrison K, Tyler B, Luciano M, Manbachi A. DESIGN AND FABRICATION OF A FOCUSED ULTRASOUND DEVICE FOR MINIMALLY-INVASIVE NEUROSURGERY: REPORTING A SECOND, MINIATURIZED AND MR-COMPATIBLE PROTOTYPE WITH STEERING CAPABILITIES. Proc Des Med Devices Conf 2021; 2021:V001T13A009. [PMID: 35237771 PMCID: PMC8884717 DOI: 10.1115/dmd2021-1062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many surgeons are faced with inoperable or only partially operable brain lesions, such as tumors. Even when surgery is feasible, patient outcome is greatly affected by blood loss or infection. This has led many physicians toward non- or minimally-invasive surgery, which demands specialized toolkits. Focused ultrasound has great potential for assisting in such procedures due to its ability to focus a few cm away from the surface of the transducer. In a prior study, we developed a focused ultrasound prototype that could fit within a BrainPath trocar, specifically made for minimally invasive brain surgery. Here, we present the design and fabrication of a second prototype that reduces size, is MR-compatible, and has electronic steering capabilities.
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Affiliation(s)
| | | | - Nao J Gamo
- NeuroSonics Medical, Inc., Baltimore, MD
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Matula TJ, Wang YN, Khokhlova T, Leotta DF, Kucewicz J, Brayman AA, Bruce M, Maxwell AD, MacConaghy BE, Thomas G, Chernikov VP, Buravkov SV, Khokhlova VA, Richmond K, Chan K, Monsky W. Treating Porcine Abscesses with Histotripsy: A Pilot Study. Ultrasound Med Biol 2021; 47:603-619. [PMID: 33250219 PMCID: PMC7855811 DOI: 10.1016/j.ultrasmedbio.2020.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/18/2020] [Accepted: 10/19/2020] [Indexed: 06/12/2023]
Abstract
Infected abscesses are walled-off collections of pus and bacteria. They are a common sequela of complications in the setting of surgery, trauma, systemic infections and other disease states. Current treatment is typically limited to antibiotics with long-term catheter drainage, or surgical washout when inaccessible to percutaneous drainage or unresponsive to initial care efforts. Antibiotic resistance is also a growing concern. Although bacteria can develop drug resistance, they remain susceptible to thermal and mechanical damage. In particular, short pulses of focused ultrasound (i.e., histotripsy) generate mechanical damage through localized cavitation, representing a potential new paradigm for treating abscesses non-invasively, without the need for long-term catheterization and antibiotics. In this pilot study, boiling and cavitation histotripsy treatments were applied to subcutaneous and intramuscular abscesses developed in a novel porcine model. Ultrasound imaging was used to evaluate abscess maturity for treatment monitoring and assessment of post-treatment outcomes. Disinfection was quantified by counting bacteria colonies from samples aspirated before and after treatment. Histopathological evaluation of the abscesses was performed to identify changes resulting from histotripsy treatment and potential collateral damage. Cavitation histotripsy was more successful in reducing the bacterial load while having a smaller treatment volume compared with boiling histotripsy. The results of this pilot study suggest focused ultrasound may lead to a technology for in situ treatment of acoustically accessible abscesses.
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Affiliation(s)
- Thomas J Matula
- Applied Physics Laboratory, University of Washington, Seattle, Washington, USA.
| | - Yak-Nam Wang
- Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Tatiana Khokhlova
- Department of Gastroenterology, University of Washington, Seattle, Washington, USA
| | - Daniel F Leotta
- Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - John Kucewicz
- Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Andrew A Brayman
- Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Matthew Bruce
- Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Adam D Maxwell
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Brian E MacConaghy
- Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Gilles Thomas
- Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Valery P Chernikov
- Research Institute of Human Morphology, Laboratory of Cell Pathology, Moscow, Russia
| | - Sergey V Buravkov
- Faculty of Fundamental Medicine, M. V. Lomonosov Moscow State University, Moscow, Russia
| | - Vera A Khokhlova
- Applied Physics Laboratory, University of Washington, Seattle, Washington, USA; Department of Acoustics, Physics Faculty, M. V. Lomonosov Moscow State University, Moscow, Russia
| | | | - Keith Chan
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Wayne Monsky
- Department of Radiology, University of Washington, Seattle, Washington, USA
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11
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Kim J, Shin J, Kong C, Lee SH, Chang WS, Han SH. The synergistic effect of focused ultrasound and biophotonics to overcome the barrier of light transmittance in biological tissue. Photodiagnosis Photodyn Ther 2021; 33:102173. [PMID: 33529746 DOI: 10.1016/j.pdpdt.2020.102173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/09/2020] [Accepted: 12/23/2020] [Indexed: 11/28/2022]
Abstract
Optical technology is a tool to diagnose and treat human diseases. Shallow penetration depth caused by the high optical scattering nature of biological tissues is a significant obstacle to utilizing light in the biomedical field. In this paper, light transmission enhancement in the rat brain induced by focused ultrasound (FUS) was observed and the cause of observed enhancement was analyzed. Both air bubbles and mechanical deformation generated by FUS were cited as the cause. The Monte Carlo simulation was performed to investigate effects on transmission by air bubbles and finite element method was also used to describe mechanical deformation induced by motions of acoustic particles. As a result, it was found that the mechanical deformation was more suitable to describe the transmission change according to the FUS pulse observed in the experiment.
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Affiliation(s)
- Jaehyuk Kim
- Molecular Imaging, Princess Margaret Cancer Centre, Toronto, ON, Canada; Health and Medical Equipment, Samsung Electronics Co. Ltd., Suwon, Republic of Korea
| | - Jaewoo Shin
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chanho Kong
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Ho Lee
- Molecular Imaging, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hee Han
- Molecular Imaging, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
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12
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Aryal M, Papademetriou I, Zhang YZ, Power C, McDannold N, Porter T. MRI Monitoring and Quantification of Ultrasound-Mediated Delivery of Liposomes Dually Labeled with Gadolinium and Fluorophore through the Blood-Brain Barrier. Ultrasound Med Biol 2019; 45:1733-1742. [PMID: 31010598 PMCID: PMC6555669 DOI: 10.1016/j.ultrasmedbio.2019.02.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/11/2019] [Accepted: 02/28/2019] [Indexed: 05/15/2023]
Abstract
Magnetic resonance image-guided focused ultrasound has emerged as a viable non-invasive technique for the treatment of central nervous system-related diseases/disorders. Application of mechanical and thermal effects associated with focused transcranial ultrasound has been studied extensively in pre-clinical models, which has paved the way for clinical trials. However, in vivo treatment evaluation techniques on drug delivery application via blood-brain barrier opening has not been fully explored. Current treatment evaluation techniques via magnetic resonance imaging are hindered by systemic toxicity resulting from free gadolinium delivery. Here we propose a novel treatment evaluation strategy to overcome limitations by (i) synthesizing liposomes that are dually labeled with gadolinium, a magnetic resonance imaging (MRI) contrast agent, and rhodamine, a fluorophore; (ii) applying a focused ultrasound (FUS)-mediated BBB opening technique to deliver the liposomes across vascular barriers, achieving local gadolinium enhancement while reducing systemic and unwanted regional toxic effects associated with free gadolinium; and (iii) utilizing the MRI modality to confirm the delivery as it is already included in the FUS treatment in clinic. Liposomes were secondarily labeled with a fluorescent marker to confirm results obtained by MRI quantification postmortem. Two different sizes, 77.5 nm (group A) and 140 nm (group B), of gadolinium- and fluorescence-labeled liposomes were fabricated using thin-film hydration followed by extrusion methods and determined their stability up to 6 h under physiologic conditions. Gadolinium signal was detected on contrast-enhanced T1-weighted MRI 5 h after the delivery of liposomes via the BBB opening approach with an ultrasound pulse of 0.42 MPa (estimate in water) combined with microbubbles. MRI contrast was enhanced significantly in sonicated regions compared with non-sonicated regions of the brain. This was due to the accumulation of labeled liposomes, which was confirmed by detection of rhodamine fluorescence in histologic sections. The relative increase in MRI signal intensity was greater for smaller liposomes (mean diameter = 77.5 nm) than larger liposomes (mean diameter = 140 nm), which suggested a greater accumulation of the smaller liposomes in the brain after ultrasound-mediated opening of the BBB. Our findings suggest that the dual-labeled nanocarrier platform can be established, the FUS-mediated BBB opening approach can be used to deliver it through vascular barriers and MRI can be used to evaluate the extent of nanocarrier delivery.
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Affiliation(s)
- Muna Aryal
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Iason Papademetriou
- Department of Mechanical Engineering, Boston University, Boston, Massachusetts, USA
| | - Yong-Zhi Zhang
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chanikarn Power
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathan McDannold
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tyrone Porter
- Department of Mechanical Engineering, Boston University, Boston, Massachusetts, USA; Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
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13
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Abstract
Stereotactic surgery is an increasingly popular option for disabling tremors whenever it is insufficiently improved by drug treatment. Surgical approaches are expanding. Thalamic deep brain stimulation is one of the most efficacious treatments. Its recent technological advances with adaptive stimulation and new electrodes configuration will allow a more physiological stimulation. However, a reappraisal of less invasive, new lesioning procedures is underway. Gamma Knife thalamotomy and magnetic resonance-guided focused ultrasounds encounter very few contraindications. Recent studies reported their efficacy on tremor control and safety profile. Besides the ventralis intermedius nucleus of the thalamus, alternative targets are also emerging. The effectiveness of surgical therapies on essential tremor and Parkinson's disease tremor is well established. For more uncommon tremors, preliminary studies are encouraging. All these surgical therapies can be proposed as treatment option for medically refractory tremors.
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Affiliation(s)
- T Witjas-Slucki
- Service de neurologie et pathologie du mouvement, UMR 7289 CNRS Aix-Marseille université, institut de neurosciences de la Timone, CHU Timone, Marseille, boulevard, Jean-Moulin, 13005 Marseille, France.
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14
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O'Reilly MA, Jones RM, Barrett E, Schwab A, Head E, Hynynen K. Investigation of the Safety of Focused Ultrasound-Induced Blood-Brain Barrier Opening in a Natural Canine Model of Aging. Theranostics 2017; 7:3573-3584. [PMID: 28912896 PMCID: PMC5596444 DOI: 10.7150/thno.20621] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/06/2017] [Indexed: 01/25/2023] Open
Abstract
Rationale: Ultrasound-mediated opening of the Blood-Brain Barrier(BBB) has shown exciting potential for the treatment of Alzheimer's disease(AD). Studies in transgenic mouse models have shown that this approach can reduce plaque pathology and improve spatial memory. Before clinical translation can occur the safety of the method needs to be tested in a larger brain that allows lower frequencies be used to treat larger tissue volumes, simulating clinical situations. Here we investigate the safety of opening the BBB in half of the brain in a large aged animal model with naturally occurring amyloid deposits. Methods: Aged dogs naturally accumulate plaques and show associated cognitive declines. Low-frequency ultrasound was used to open the BBB unilaterally in aged beagles (9-11yrs, n=10) in accordance with institutionally approved protocols. Animals received either a single treatment or four weekly treatments. Magnetic resonance imaging(MRI) was used to guide the treatments and assess the tissue effects. The animals underwent neurological testing during treatment follow-up, and a follow-up MRI exam 1 week following the final treatment. Results: The permeability of the BBB was successfully increased in all animals (mean enhancement: 19±11% relative to untreated hemisphere). There was a single adverse event in the chronic treatment group that resolved within 24 hrs. Follow-up MRI showed the BBB to be intact with no evidence of tissue damage in all animals. Histological analysis showed comparable levels of microhemorrhage between the treated and control hemispheres in the prefrontal cortex (single/repeat treatment: 1.0±1.4 vs 0.4±0.5/5.2±1.8 vs. 4.0±2.0). No significant differences were observed in beta-amyloid load (single/repeat: p=0.31/p=0.98) although 3/5 animals in each group showed lower Aβ loads in the treated hemisphere. Conclusion: Whole-hemisphere opening of the BBB was well tolerated in the aged large animal brain. The treatment volumes and frequencies used are clinically relevant and indicate safety for clinical translation. Further study is warranted to determine if FUS has positive effects on naturally occurring amyloid pathology.
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Abstract
Shock wave lithotripsy has generally been a first choice for kidney stone removal. The shock wave lithotripter uses an order of microsecond pulse durations and up to a 100 MPa pressure spike triggered at approximately 0.5-2 Hz to fragment kidney stones through mechanical mechanisms. One important mechanism is cavitation. We proposed an alternative type of lithotripsy method that maximizes cavitation activity to disintegrate kidney stones using high-intensity focused ultrasound (HIFU). Here we outline the method according to the previously published literature (Matsumoto et al., Dynamics of bubble cloud in focused ultrasound. Proceedings of the second international symposium on therapeutic ultrasound, pp 290-299, 2002; Ikeda et al., Ultrasound Med Biol 32:1383-1397, 2006; Yoshizawa et al., Med Biol Eng Comput 47:851-860, 2009; Koizumi et al., A control framework for the non-invasive ultrasound the ragnostic system. Proceedings of 2009 IEEE/RSJ International Conference on Intelligent Robotics and Systems (IROS), pp 4511-4516, 2009; Koizumi et al., IEEE Trans Robot 25:522-538, 2009). Cavitation activity is highly unpredictable; thus, a precise control system is needed. The proposed method comprises three steps of control in kidney stone treatment. The first step is control of localized high pressure fluctuation on the stone. The second step is monitoring of cavitation activity and giving feedback on the optimized ultrasound conditions. The third step is stone tracking and precise ultrasound focusing on the stone. For the high pressure control we designed a two-frequency wave (cavitation control (C-C) waveform); a high frequency ultrasound pulse (1-4 MHz) to create a cavitation cloud, and a low frequency trailing pulse (0.5 MHz) following the high frequency pulse to force the cloud into collapse. High speed photography showed cavitation collapse on a kidney stone and shock wave emission from the cloud. We also conducted in-vitro erosion tests of model and natural kidney stones. For the model stones, the erosion rate of the C-C waveform showed a distinct advantage with the combined high and low frequency waves over either wave alone. For optimization of the high frequency ultrasound intensity, we investigated the relationship between subharmonic emission from cavitation bubbles and stone erosion volume. For stone tracking we have also developed a non-invasive ultrasound theragnostic system (NIUTS) that compensates for kidney motion. Natural stones were eroded and most of the resulting fragments were less than 1 mm in diameter. The small fragments were small enough to pass through the urethra. The results demonstrate that, with the precise control of cavitation activity, focused ultrasound has the potential to be used to develop a less invasive and more controllable lithotripsy system.
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Affiliation(s)
| | - Shin Yoshizawa
- Department of Communications Engineering, Tohoku University, Sendai, Miyagi, Japan
| | - Norihiro Koizumi
- Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan
| | - Mamoru Mitsuishi
- Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan
| | - Yoichiro Matsumoto
- Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan.
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16
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Shen Y, Zhang A, Guo J, Dan G, Chen S, Yu H. Fluorescence imaging of Evans blue extravasation into mouse brain induced by low frequency ultrasound with microbubble. Biomed Mater Eng 2015; 24:2831-8. [PMID: 25226988 DOI: 10.3233/bme-141101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Blood-Brain Barrier (BBB) can be opened locally, noninvasively and reversibly by low frequency focused ultra-sound (FUS) in the presence of microbubbles. In this study, Evans blue (EB) dye extravasation across BBB was enhanced by 1 MHz FUS at acoustic pressure of 0.35 MPa in the presence of microbubbles at clinically comparable dosage. The spatial distribution of EB extravasation was visualized using fluorescence imaging method. The center region of BBB disruption area showed more enhanced fluorescence signal than the surrounding region in general. However, EB dye deposition was heterogeneous in the center region. The findings in this study indicated potential use of fluorescence imaging to evaluate large molecules delivery across BBB.
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Affiliation(s)
- Yuanyuan Shen
- Department of Biomedical Engineering, Shenzhen University, Shenzhen 518060, China Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen 518060, China National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Shenzhen 518060, China
| | - Aili Zhang
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200240 , China
| | - Jinxuan Guo
- Department of Biomedical Engineering, Shenzhen University, Shenzhen 518060, China
| | - Guo Dan
- Department of Biomedical Engineering, Shenzhen University, Shenzhen 518060, China Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen 518060, China National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Shenzhen 518060, China
| | - Siping Chen
- Department of Biomedical Engineering, Shenzhen University, Shenzhen 518060, China Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen 518060, China National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Shenzhen 518060, China
| | - Hao Yu
- Department of Biomedical Engineering, Shenzhen Polytechnic, Shenzhen 518055, China
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Saha S, Bhanja P, Partanen A, Zhang W, Liu L, Tomé W, Guha C. Low intensity focused ultrasound (LOFU) modulates unfolded protein response and sensitizes prostate cancer to 17AAG. Oncoscience 2014; 1:434-45. [PMID: 25594042 PMCID: PMC4284617 DOI: 10.18632/oncoscience.48] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/02/2014] [Indexed: 01/08/2023] Open
Abstract
The hypoxic tumor microenvironment generates oxidative Endoplasmic Reticulum (ER) stress, resulting in protein misfolding and unfolded protein response (UPR). UPR induces several molecular chaperones including heat-shock protein 90 (HSP90), which corrects protein misfolding and improves survival of cancer cells and resistance to tumoricidal therapy although prolonged activation of UPR induces cell death. The HSP90 inhibitor, 17AAG, has shown promise against various solid tumors, including prostate cancer (PC). However, therapeutic doses of 17AAG elicit systemic toxicity. In this manuscript, we describe a new paradigm where the combination therapy of a non-ablative and non-invasive low energy focused ultrasound (LOFU) and a non-toxic, low dose 17AAG causes synthetic lethality and significant tumoricidal effects in mouse and human PC xenografts. LOFU induces ER stress and UPR in tumor cells without inducing cell death. Treatment with a non-toxic dose of 17AAG further increased ER stress in LOFU treated PC and switch UPR from a cytoprotective to an apoptotic response in tumors resulting significant induction of apoptosis and tumor growth retardation. These observations suggest that LOFU-induced ER stress makes the ultrasound-treated tumors more susceptible to chemotherapeutic agents, such as 17AAG. Thus, a novel therapy of LOFU-induced chemosensitization may be designed for locally advanced and recurrent tumors.
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Affiliation(s)
- Subhrajit Saha
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Payel Bhanja
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Wei Zhang
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Laibin Liu
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Wolfgang Tomé
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, USA ; Montefiore Medical Center, New York, NY, USA
| | - Chandan Guha
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, USA ; Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA ; Montefiore Medical Center, New York, NY, USA
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