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Raspagliesi L, D'Ammando A, Gionso M, Sheybani ND, Lopes MB, Moore D, Allen S, Gatesman J, Porto E, Timbie K, Franzini A, Di Meco F, Sheehan J, Xu Z, Prada F. Intracranial Sonodynamic Therapy With 5-Aminolevulinic Acid and Sodium Fluorescein: Safety Study in a Porcine Model. Front Oncol 2021; 11:679989. [PMID: 34235081 PMCID: PMC8256685 DOI: 10.3389/fonc.2021.679989] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/25/2021] [Indexed: 02/02/2023] Open
Abstract
Background Sonodynamic therapy (SDT) is an emerging ultrasound-based treatment modality for malignant gliomas which combines ultrasound with sonosensitizers to produce a localized cytotoxic and modulatory effect. Tumor-specificity of the treatment is achieved by the selective extravasation and accumulation of sonosensitizers in the tumor-bearing regions. The aim of this study is to demonstrate the safety of low-intensity ultrasonic irradiation of healthy brain tissue after the administration of FDA-approved sonosensitizers used for SDT in experimental studies in an in vivo large animal model. Methods In vivo safety of fluorescein (Na-Fl)- and 5 aminolevulinic acid (5-ALA)-mediated low-intensity ultrasound irradiation of healthy brain parenchyma was assessed in two sets of four healthy swine brains, using the magnetic resonance imaging (MRI)-guided Insightec ExAblate 4000 220 kHz system. After administration of the sonosensitizers, a wide fronto-parietal craniotomy was performed in pig skulls to allow transmission of ultrasonic beams. Sonication was performed on different spots within the thalamus and periventricular white matter with continuous thermal monitoring. Sonication-related effects were investigated with MRI and histological analysis. Results Post-treatment MRI images acquired within one hour following the last sonication, on day one, and day seven did not visualize any sign of brain damage. On histopathology, no signs of necrosis or apoptosis attributable to the ultrasonic treatments were shown in target areas. Conclusions The results of the present study suggest that either Na-FL or 5-ALA-mediated sonodynamic therapies under MRI-guidance with the current acoustic parameters are safe towards healthy brain tissue in a large in vivo model. These results further support growing interest in clinical translation of sonodynamic therapy for intracranial gliomas and other brain tumors.
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Affiliation(s)
- Luca Raspagliesi
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio D'Ammando
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Natasha D Sheybani
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, United States
| | - Maria-Beatriz Lopes
- Department of Pathology, University of Virginia, Charlottesville, VA, United States
| | - David Moore
- Focused Ultrasound Foundation, Charlottesville, VA, United States
| | - Steven Allen
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Jeremy Gatesman
- Center for Comparative Medicine, University of Virginia, Charlottesville, VA, United States
| | - Edoardo Porto
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Kelsie Timbie
- Focused Ultrasound Foundation, Charlottesville, VA, United States
| | - Andrea Franzini
- Department of Neurosurgery, Humanitas Clinical and Research Center, Milan, Italy
| | - Francesco Di Meco
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy.,Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, United States
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Francesco Prada
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Focused Ultrasound Foundation, Charlottesville, VA, United States.,Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States.,Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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