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Fesmire CC, Williamson RH, Petrella RA, Kaufman JD, Topasna N, Sano MB. Integrated Time Nanosecond Pulse Irreversible Electroporation (INSPIRE): Assessment of Dose, Temperature, and Voltage on Experimental and Clinical Treatment Outcomes. IEEE Trans Biomed Eng 2024; 71:1511-1520. [PMID: 38145519 PMCID: PMC11035095 DOI: 10.1109/tbme.2023.3340718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
OBJECTIVE This study sought to investigate a novel strategy using temperature-controlled delivery of nanosecond pulsed electric fields as an alternative to the 50-100 microsecond pulses used for irreversible electroporation. METHODS INSPIRE treatments were carried out at two temperatures in 3D tumor models using doses between 0.001 s and 0.1 s. The resulting treatment zones were quantified using viability staining and lethal electric field intensities were determined numerically. Computational modeling was then used to determine parameters necessary for INSPIRE treatments to achieve equivalent treatment zones to clinical electroporation treatments and evaluate the potential for these treatments to induce deleterious thermal damage. RESULTS Lethal thresholds between 1109 and 709 V/cm were found for nominal 0.01 s treatments with pulses between 350 ns and 2000 ns at physiological temperatures. Further increases in dose resulted in significant decreases in lethal thresholds. Given these experimental results, treatment zones comparable to clinical electroporation are possible by increasing the dose and voltage used with nanosecond duration pulses. Temperature-controlled simulations indicate minimal thermal cell death while achieving equivalent treatment volumes to clinical electroporation. CONCLUSION Nanosecond electrical pulses can achieve comparable outcomes to traditional electroporation provided sufficient electrical doses or voltages are applied. The use of temperature-controlled delivery may minimize thermal damage during treatment. SIGNIFICANCE Intense muscle stimulation and the need for cardiac gating have limited irreversible electroporation. Nanosecond pulses can alleviate these challenges, but traditionally have produced significantly smaller treatment zones. This study suggests that larger ablation volumes may be possible with the INSPIRE approach and that future in vivo studies are warranted.
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Scuderi M, Dermol-Cerne J, Scancar J, Markovic S, Rems L, Miklavcic D. The equivalence of different types of electric pulses for electrochemotherapy with cisplatin - an in vitro study. Radiol Oncol 2024; 58:51-66. [PMID: 38378034 PMCID: PMC10878774 DOI: 10.2478/raon-2024-0005] [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] [Received: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Electrochemotherapy (ECT) is a treatment involving the administration of chemotherapeutics drugs followed by the application of 8 square monopolar pulses of 100 μs duration at a repetition frequency of 1 Hz or 5000 Hz. However, there is increasing interest in using alternative types of pulses for ECT. The use of high-frequency short bipolar pulses has been shown to mitigate pain and muscle contractions. Conversely, the use of millisecond pulses is interesting when combining ECT with gene electrotransfer for the uptake of DNA-encoding proteins that stimulate the immune response with the aim of converting ECT from a local to systemic treatment. Therefore, the aim of this study was to investigate how alternative types of pulses affect the efficiency of the ECT. MATERIALS AND METHODS We performed in vitro experiments, exposing Chinese hamster ovary (CHO) cells to conventional ECT pulses, high-frequency bipolar pulses, and millisecond pulses in the presence of different concentrations of cisplatin. We determined cisplatin uptake by inductively coupled plasma mass spectrometry and cisplatin cytotoxicity by the clonogenic assay. RESULTS We observed that the three tested types of pulses potentiate the uptake and cytotoxicity of cisplatin in an equivalent manner, provided that the electric field is properly adjusted for each pulse type. Furthermore, we quantified that the number of cisplatin molecules, resulting in the eradication of most cells, was 2-7 × 107 per cell. CONCLUSIONS High-frequency bipolar pulses and millisecond pulses can potentially be used in ECT to reduce pain and muscle contraction and increase the effect of the immune response in combination with gene electrotransfer, respectively.
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Affiliation(s)
- Maria Scuderi
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Janja Dermol-Cerne
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Janez Scancar
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Stefan Markovic
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Lea Rems
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Damijan Miklavcic
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
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Čebron Ž, Djokić M, Petrič M, Čemažar M, Bošnjak M, Serša G, Trotovšek B. Intraoperative electrochemotherapy of the posterior resection surface after pancreaticoduodenectomy: Preliminary results of a hybrid approach treatment of pancreatic cancer. Bioelectrochemistry 2024; 155:108576. [PMID: 37748261 DOI: 10.1016/j.bioelechem.2023.108576] [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] [Received: 06/11/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Despite extensive research in recent decades, pancreatic cancer continues to be among the most lethal forms of cancer, with no substantial increase in survival rates. Local recurrences account for approximately 30 per cent of all disease recurrences. With the intent to improve survival, we designed a novel, hybrid treatment strategy consisting of surgical resection and additional intraoperative electrochemotherapy of the posterior resection surface. We present the study protocols and preliminary findings of a prospective pilot study investigating this treatment approach. METHODS Consenting patients with resectable pancreatic head ductal adenocarcinoma who met the inclusion criteria were enrolled in the study. After surgical resection, electrochemotherapy with bleomycin was performed using plate electrodes to cover the area between anatomical landmarks. RESULTS Electrochemotherapy of the posterior resection surface was feasible in all 7 patients. We observed pancreatic fistula grade B in only one patient; all other noted complications were Clavien-Dindo grade 2 or less. The hospital mortality was 0%. CONCLUSIONS Our preliminary results suggest that a hybrid approach combining surgery with intraoperative electrochemotherapy is safe and feasible.
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Affiliation(s)
- Žan Čebron
- University Medical Centre Ljubljana, Department of Abdominal Surgery, Zaloska 7, SI-1000 Ljubljana, Slovenia; University of Ljubljana, Medical Faculty, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Mihajlo Djokić
- University Medical Centre Ljubljana, Department of Abdominal Surgery, Zaloska 7, SI-1000 Ljubljana, Slovenia; University of Ljubljana, Medical Faculty, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Miha Petrič
- University Medical Centre Ljubljana, Department of Abdominal Surgery, Zaloska 7, SI-1000 Ljubljana, Slovenia; University of Ljubljana, Medical Faculty, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Maja Čemažar
- Institute of Oncology Ljubljana, Department of Experimental Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia; University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia
| | - Maša Bošnjak
- Institute of Oncology Ljubljana, Department of Experimental Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia
| | - Gregor Serša
- Institute of Oncology Ljubljana, Department of Experimental Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia; University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, SI-1000 Ljubljana, Slovenia.
| | - Blaž Trotovšek
- University Medical Centre Ljubljana, Department of Abdominal Surgery, Zaloska 7, SI-1000 Ljubljana, Slovenia; University of Ljubljana, Medical Faculty, Vrazov trg 2, 1000 Ljubljana, Slovenia.
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Radzevičiūtė-Valčiukė E, Malyško-Ptašinskė V, Mickevičiūtė E, Kulbacka J, Rembiałkowska N, Zinkevičienė A, Novickij J, Novickij V. Calcium electroporation causes ATP depletion in cells and is effective both in microsecond and nanosecond pulse range as a modality of electrochemotherapy. Bioelectrochemistry 2024; 155:108574. [PMID: 37738862 DOI: 10.1016/j.bioelechem.2023.108574] [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] [Received: 04/07/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023]
Abstract
Calcium electroporation is a modality of electrochemotherapy (ECT), which is based on intracellular electric field-mediated delivery of cytotoxic doses of calcium into the cells resulting in rapid cell death. In this work, we have developed a CHO-K1 luminescent cell line, which allowed the estimation of cell membrane permeabilization, ATP depletion and cytotoxicity evaluation without the use of additional markers and methodologies. We have shown the high efficiency of nanosecond pulses compressed into a MHz burst for application in calcium ECT treatments. The 5 kV/cm and 10 kV/cm nanosecond (100 and 600 ns) pulses were delivered in bursts of 10, 50 and 100 pulses (a total of 12 parametric protocols) and then compared to standard microsecond range sequences (100 µs × 8) of 0.4-1.4 kV/cm. The effects of calcium-free, 2 mM and 5 mM calcium electroporation treatments were characterized. It was shown that reversible electroporation is accompanied by ATP depletion associated with membrane damage, while during calcium ECT the ATP depletion is several-fold higher, which results in cell death. Finally, efficacy-wise equivalent pulse parameters from nanosecond and microsecond ranges were established, which can be used for calcium nano-ECT as a better alternative to ESOPE (European Standard Operating Procedures on Electrochemotherapy) protocols.
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Affiliation(s)
- Eivina Radzevičiūtė-Valčiukė
- State Research Institute Centre for Innovative Medicine, Department of Immunology, Vilnius, Lithuania; Faculty of Electronics, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | | | - Eglė Mickevičiūtė
- State Research Institute Centre for Innovative Medicine, Department of Immunology, Vilnius, Lithuania
| | - Julita Kulbacka
- State Research Institute Centre for Innovative Medicine, Department of Immunology, Vilnius, Lithuania; Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Nina Rembiałkowska
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Auksė Zinkevičienė
- State Research Institute Centre for Innovative Medicine, Department of Immunology, Vilnius, Lithuania
| | - Jurij Novickij
- Faculty of Electronics, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Vitalij Novickij
- State Research Institute Centre for Innovative Medicine, Department of Immunology, Vilnius, Lithuania; Faculty of Electronics, Vilnius Gediminas Technical University, Vilnius, Lithuania.
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Rembiałkowska N, Szlasa W, Radzevičiūtė-Valčiukė E, Kulbacka J, Novickij V. Negative effects of cancellation during nanosecond range High-Frequency calcium based electrochemotherapy in vitro. Int J Pharm 2023; 648:123611. [PMID: 37977287 DOI: 10.1016/j.ijpharm.2023.123611] [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] [Received: 06/22/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
Drug delivery using nanosecond pulsed electric fields is a new branch of electroporation-based treatments, which potentially can substitute European standard operating procedures for electrochemotherapy. In this work, for the first time, we characterize the effects of ultra-fast repetition frequency (1-2.5 MHz) nanosecond pulses (5-9 kV/cm, 200 and 400 ns) in the context of nano-electrochemotherapy with calcium. Additionally, we investigate the feasibility of bipolar symmetric (↑200 ns + ↓200 ns) and asymmetric (↑200 ns + ↓400 ns) nanosecond protocols for calcium delivery. The effects of bipolar cancellation and the influence of interphase delay (200 ns) are overviewed. Human lung cancer cell lines A549 and H69AR were used as a model. It was shown that unipolar pulses delivered at high frequency are effective for electrochemotherapy with a significant improvement in efficiency when the delay between separate pulses is reduced. Bipolar symmetric pulses trigger the cancellation phenomenon limiting applications for drug delivery and can be compensated by the asymmetry of the pulse (↑200 ns + ↓400 ns or ↑400 ns + ↓200 ns). The results of this study can be successfully used to derive a new generation of nsPEF protocols for successful electrochemotherapy treatments.
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Affiliation(s)
- Nina Rembiałkowska
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Wojciech Szlasa
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Eivina Radzevičiūtė-Valčiukė
- Faculty of Electronics, Vilnius Gediminas Technical University, Vilnius, Lithuania; State Research Institute Centre for Innovative Medicine, Department of Immunology and Bioelectrochemistry, Vilnius, Lithuania
| | - Julita Kulbacka
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland; State Research Institute Centre for Innovative Medicine, Department of Immunology and Bioelectrochemistry, Vilnius, Lithuania.
| | - Vitalij Novickij
- Faculty of Electronics, Vilnius Gediminas Technical University, Vilnius, Lithuania; State Research Institute Centre for Innovative Medicine, Department of Immunology and Bioelectrochemistry, Vilnius, Lithuania.
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Rangel MMM, Linhares LCM, de Oliveira KD, Suzuki DOH, Maglietti FH, de Nardi AB. Evaluation of the safety and feasibility of electrochemotherapy with intravenous bleomycin as local treatment of bladder cancer in dogs. Sci Rep 2023; 13:21078. [PMID: 38030630 PMCID: PMC10687251 DOI: 10.1038/s41598-023-45433-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Local treatment of canine urothelial carcinoma (UC) of the bladder is a challenge. More than 90% of the cases invade the muscular layer, more than 50% develop on bladder sites with a difficult surgical approach and often requiring radical surgical procedures. This study aims to evaluate the safety and feasibility of electrochemotherapy (ECT) with intravenous bleomycin (BLM) as a local therapy for bladder UC. This prospective study included 21 dogs with spontaneous bladder UC. Regional/distant metastases and neoplastic infiltration of the serosa was considered the main exclusion criteria. We had no deaths during ECT or in the immediate postoperative period, and no suture dehiscence. Most dogs (19/21) developed mild adverse effects, whereas two dogs developed ureteral stenosis. Complete response (CR) was achieved in 62% of the cases (13/21), while partial response (PR) was achieved in 24% (5/21). The median survival and disease-free survival times were 284 and 270 days, respectively. Overall survival was significantly better in the dogs who achieved a CR. In conclusion, ECT was well-tolerated in dogs with UC, demonstrating its safety and feasibility. These data pave the way for new studies aimed at evaluating the effectiveness of ECT in canine bladder UC as a translational model for human disease.
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Affiliation(s)
| | - Laís Calazans Menescal Linhares
- School of Agricultural and Veterinary Sciences, São Paulo State University (UNESP) "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil.
| | | | - Daniela Ota Hisayasu Suzuki
- Institute of Biomedical Engineering, Federal University of Santa Catarina (UFSC), Florianopolis, Santa Catarina, Brazil
| | - Felipe Horacio Maglietti
- Instituto Universitario de Ciencias de la Salud. Fundación Barceló-CONICET, Buenos Aires, Argentina
| | - Andrigo Barboza de Nardi
- School of Agricultural and Veterinary Sciences, São Paulo State University (UNESP) "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
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Qian K, Zhong Z. Research frontiers of electroporation-based applications in cancer treatment: a bibliometric analysis. BIOMED ENG-BIOMED TE 2023; 68:445-456. [PMID: 37185096 DOI: 10.1515/bmt-2023-0113] [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] [Received: 03/17/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Electroporation, the breakdown of the biomembrane induced by external electric fields, has increasingly become a research hotspot for its promising related methods in various kinds of cancers. CONTENT In this article, we utilized CiteSpace 6.1.R2 to perform a bibliometric analysis on the research foundation and frontier of electroporation-based applications in cancer therapy. A total of 3,966 bibliographic records were retrieved from the Web of Science Core Collection for the bibliometric analysis. Sersa G. and Mir L. M. are the most indispensable researchers in this field, and the University of Ljubljana of Slovenia is a prominent institution. By analyzing references and keywords, we found that, with a lower recurrence rate, fewer severe adverse events, and a higher success rate, irreversible electroporation, gene electrotransfer, and electrochemotherapy are the three main research directions that may influence the future treatment protocol of cancers. SUMMARY This article visualized relevant data to synthesize scientific research on electroporation-based cancer therapy, providing helpful suggestions for further investigations on electroporation. OUTLOOK Although electroporation-based technologies have been proven as promising tools for cancer treatment, its radical mechanism is still opaque and their commercialization and universalization need further efforts from peers.
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Affiliation(s)
- Kun Qian
- Department of High-voltage and Insulation, School of Electrical Engineering, Chongqing University, Chongqing, China
| | - Zilong Zhong
- Research Institute of Foreign Languages, Beijing Foreign Studies University, Beijing, China
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Vélez Salazar FM, Patiño Arcila ID. Influence of electric field, blood velocity, and pharmacokinetics on electrochemotherapy efficiency. Biophys J 2023; 122:3268-3298. [PMID: 37421133 PMCID: PMC10465711 DOI: 10.1016/j.bpj.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/13/2023] [Accepted: 07/05/2023] [Indexed: 07/09/2023] Open
Abstract
The convective delivery of chemotherapeutic drugs in cancerous tissues is directly proportional to the blood perfusion rate, which in turns can be transiently reduced by the application of high-voltage and short-duration electric pulses due to vessel vasoconstriction. However, electric pulses can also increase vessel wall and cell membrane permeabilities, boosting the extravasation and cell internalization of drug. These opposite effects, as well as possible adverse impacts on the viability of tissues and endothelial cells, suggest the importance of conducting in silico studies about the influence of physical parameters involved in electric-mediated drug transport. In the present work, the global method of approximate particular solutions for axisymmetric domains, together with two solution schemes (Gauss-Seidel iterative and linearization+successive over-relaxation), is applied for the simulation of drug transport in electroporated cancer tissues, using a continuum tumor cord approach and considering both the electropermeabilization and vasoconstriction phenomena. The developed global method of approximate particular solutions algorithm is validated with numerical and experimental results previously published, obtaining a satisfactory accuracy and convergence. Then, a parametric study about the influence of electric field magnitude and inlet blood velocity on the internalization efficacy, drug distribution uniformity, and cell-kill capacity of the treatment, as expressed by the number of internalized moles into viable cells, homogeneity of exposure to bound intracellular drug, and cell survival fraction, respectively, is analyzed for three pharmacokinetic profiles, namely one-short tri-exponential, mono-exponential, and uniform. According to numerical results, the trade-off between vasoconstriction and electropermeabilization effects and, consequently, the influence of electric field magnitude and inlet blood velocity on the assessment parameters considered here (efficacy, uniformity, and cell-kill capacity) is different for each pharmacokinetic profile deemed.
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Affiliation(s)
| | - Iván David Patiño Arcila
- Grupo de Investigación e Innovación Ambiental (GIIAM), Institución Universitaria Pascual Bravo, Medellín, Colombia.
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Perera-Bel E, Aycock KN, Salameh ZS, Gomez-Barea M, Davalos RV, Ivorra A, Ballester MAG. PIRET-A Platform for Treatment Planning in Electroporation-Based Therapies. IEEE Trans Biomed Eng 2023; 70:1902-1910. [PMID: 37015676 PMCID: PMC10281020 DOI: 10.1109/tbme.2022.3232038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Tissue electroporation is the basis of several therapies. Electroporation is performed by briefly exposing tissues to high electric fields. It is generally accepted that electroporation is effective where an electric field magnitude threshold is overreached. However, it is difficult to preoperatively estimate the field distribution because it is highly dependent on anatomy and treatment parameters. OBJECTIVE We developed PIRET, a platform to predict the treatment volume in electroporation-based therapies. METHODS The platform seamlessly integrates tools to build patient-specific models where the electric field is simulated to predict the treatment volume. Patient anatomy is segmented from medical images and 3D reconstruction aids in placing the electrodes and setting up treatment parameters. RESULTS Four canine patients that had been treated with high-frequency irreversible electroporation were retrospectively planned with PIRET and with a workflow commonly used in previous studies, which uses different general-purpose segmentation (3D Slicer) and modeling software (3Matic and COMSOL Multiphysics). PIRET outperformed the other workflow by 65 minutes (× 1.7 faster), thanks to the improved user experience during treatment setup and model building. Both approaches computed similarly accurate electric field distributions, with average Dice scores higher than 0.93. CONCLUSION A platform which integrates all the required tools for electroporation treatment planning is presented. Treatment plan can be performed rapidly with minimal user interaction in a stand-alone platform. SIGNIFICANCE This platform is, to the best of our knowledge, the most complete software for treatment planning of irreversible electroporation. It can potentially be used for other electroporation applications.
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Barca I, Ferragina F, Kallaverja E, Arrotta A, Cristofaro MG. Electrochemotherapy as an Effective Alternative in the Treatment of Local Advanced Oral Squamous Cell Carcinoma: A Retrospective Analysis of Treated Cases. Int J Environ Res Public Health 2023; 20:5170. [PMID: 36982078 PMCID: PMC10049161 DOI: 10.3390/ijerph20065170] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
Advanced oral squamous cell carcinomas represent a major challenge for maxillofacial surgeons, oncologists and radiation therapists. They also account for a large share of healthcare costs. They respond little and/or poorly to conventional therapies (surgery, radiotherapy and chemotherapy). Electrochemotherapy is a new method used as a palliative treatment in patients with advanced cancer of the neck/head region who are not eligible for standard therapies. It combines the use of cytotoxic drugs with the physical principle of electroporation; it effectively controls the tumour locally and preserves organ function. To date, ECT has been little used for oral mucosal tumours, as this is difficult to access for electrodes. We report six cases of advanced oral squamous cell carcinoma treated with electrochemotherapy. This study aims to assess the debulking effect of cancer via ECT in patients with advanced oral squamous cell carcinoma. It also aims to assess the safety and tolerability of this treatment.
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Affiliation(s)
- Ida Barca
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Francesco Ferragina
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Elvis Kallaverja
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Antonella Arrotta
- Department of Medical and Surgical Sciences, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Maria Giulia Cristofaro
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
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Bertino G, Muir T, Odili J, Groselj A, Marconato R, Curatolo P, Kis E, Lonkvist CK, Clover J, Quaglino P, Kunte C, Spina R, Seccia V, de Terlizzi F, Campana LG. Treatment of Basal Cell Carcinoma with Electrochemotherapy: Insights from the InspECT Registry (2008–2019). Curr Oncol 2022; 29:5324-5337. [PMID: 36005161 PMCID: PMC9406883 DOI: 10.3390/curroncol29080423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
This prospective registry-based study aims to describe electrochemotherapy (ECT) modalities in basal cell carcinoma (BCC) patients and evaluate its efficacy, safety, and predictive factors. The International Network for Sharing Practices of Electrochemotherapy (InspECT) multicentre database was queried for BCC cases treated with bleomycin-ECT between 2008 and 2019 (n = 330 patients from seven countries, with 623 BCCs [median number: 1/patient; range: 1–7; size: 13 mm, range: 5–350; 85% were primary, and 80% located in the head and neck]). The procedure was carried out under local anaesthesia in 68% of cases, with the adjunct of mild sedation in the remaining 32%. Of 300 evaluable patients, 242 (81%) achieved a complete response (CR) after a single ECT course. Treatment naïvety (odds ratio [OR] 0.35, 95% confidence interval [C.I.] 0.19–0.67, p = 0.001) and coverage of deep tumour margin with electric pulses (O.R. 5.55, 95% C.I. 1.37–21.69, p = 0.016) predicted CR, whereas previous radiation was inversely correlated (O.R. 0.25, p = 0.0051). Toxicity included skin ulceration (overall, 16%; G3, 1%) and hyperpigmentation (overall, 8.1%; G3, 2.5%). At a 17-month follow-up, 28 (9.3%) patients experienced local recurrence/progression. Despite no convincing evidence that ECT confers improved outcomes compared with standard surgical excision, it can still be considered an opportunity to avoid major resection in patients unsuitable for more demanding treatment. Treatment naïvety and coverage of the deep margin predict tumour clearance and may inform current patient selection and management.
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Affiliation(s)
- Giulia Bertino
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy;
| | - Tobian Muir
- South Tees NHS Foundation Trust, Middlesbrough TS4 3BW, UK;
| | - Joy Odili
- Department of Plastic Surgery, St. George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK;
| | - Ales Groselj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia;
| | | | - Pietro Curatolo
- Dermatology Unit, Department of Internal Medicine and Medical Specialties, University “La Sapienza”, 00042 Rome, Italy;
| | - Erika Kis
- Department of Dermatology and Allergology, Albert Szent-Györgyi Clinical Centre, University of Szeged, 6700 Szeged, Hungary;
| | - Camilla Kjaer Lonkvist
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark;
| | - James Clover
- Cork Cancer Research Centre, University College Cork, T12 YN60 Cork, Ireland;
- Department of Plastic Surgery, Cork University Hospital, T12 DC4A Cork, Ireland
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10094 Turin, Italy;
| | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Fachklinik München, 81379 Munich, Germany;
- Department of Dermatology and Allergology, Ludwig-Maximillian University, 80539 Munich, Germany
| | - Romina Spina
- Psychology Unit, University Hospital of Padova, 35100 Padova, Italy;
| | - Veronica Seccia
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy;
| | - Francesca de Terlizzi
- IGEA Clinical Biophysics Department, Via Parmenide 10/A, Carpi, 41012 Modena, Italy;
| | - Luca Giovanni Campana
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, UK
- Correspondence:
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12
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Tamra A, Zedek A, Rols MP, Dubuc D, Grenier K. Single cell microwave biosensor for monitoring cellular response to electrochemotherapy. IEEE Trans Biomed Eng 2022; 69:3407-3414. [PMID: 35471894 DOI: 10.1109/tbme.2022.3170267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper presents a 40 GHz microwave biosensor used to monitor and characterize single cells (THP-1) subjected to electrochemotherapy and obtain an electronic signature of the treatment efficiency. This biosensor proposes a non-destructive and label-free technique that first allows, with the rapid measurement of single untreated cells in their culture medium, the extraction of two frequency-dependent dielectric parameters, the capacitance (C (f)) and the conductance (G (f)). Second, this technique can powerfully reveal the effects of a chemical membrane permeabilizing treatment (Saponin). At last, it permits us to detect, and predict, the potentiation of a molecule classically used in chemotherapy (Bleomycin) when combined with the application of electric pulses (principle of electrochemotherapy). Treatment-affected cells show a decrease in the capacitive and conductive contrasts, indicating damages at the cellular levels. Along with these results, classical biological tests are conducted. Statistical analysis points out a high correlation rate (R2>0.97), which clearly reveals the reliability and efficacy of our technique and makes it an attractive technique for biology related researches and personalized medicine.
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13
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Bosnjak M, Jesenko T, Markelc B, Cerovsek A, Sersa G, Cemazar M. Sunitinib potentiates the cytotoxic effect of electrochemotherapy in pancreatic carcinoma cells. Radiol Oncol 2022; 56:164-172. [PMID: 35344644 PMCID: PMC9122288 DOI: 10.2478/raon-2022-0009] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/02/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND One of the new treatment options for unresectable locally advanced pancreatic cancer is electrochemotherapy (ECT), a local ablative therapy that potentiates the entry of chemotherapeutic drugs into the cells, by the application of an electric field to the tumor. Its feasibility and safety were demonstrated in preclinical and clinical studies; however, there is a lack of preclinical studies assessing the actions of different drugs used in ECT, their mechanisms and interactions with other target drugs that are used in clinical practice. MATERIALS AND METHODS The aim of the study was to determine the cytotoxicity of two chemotherapeutic drugs usually used in ECT (bleomycin and cisplatin) in the BxPC-3 human pancreatic carcinoma cell line and evaluate the interactions of ECT with the targeted drug sunitinib. First, the cytotoxicity of ECT using both chemotherapeutics was determined. In the next part, the interactions of ECT and sunitinib were evaluated through determination of combined cytotoxicity, sunitinib targets and kinetics of cell death. RESULTS The results demonstrate that ECT is effective in pancreatic cancer cell line, especially when bleomycin is used, with the onset of cell death in the first hours after the treatment, reaching a plateau at 20 hours after the treatment. Furthermore, we provide the rationale for combining ECT with bleomycin and the targeted drug sunitinib to potentiate cytotoxicity. The combined treatment of sunitinib and ECT was synergistic for bleomycin only at the highest used concentration of bleomycin 0.14 μM, whereas with lower doses of bleomycin, this effect was not observed. The interaction of ECT and treatment with sunitinib was confirmed by course of the cell death, also indicating on synergism. CONCLUSIONS ECT and sunitinib combined treatment has clinical potential, and further studies are warranted.
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Affiliation(s)
- Masa Bosnjak
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Jesenko
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bostjan Markelc
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Anja Cerovsek
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
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Rembiałkowska N, Novickij V, Baczyńska D, Dubińska-Magiera M, Saczko J, Rudno-Rudzińska J, Maciejewska M, Kulbacka J. Micro- and Nanosecond Pulses Used in Doxorubicin Electrochemotherapy in Human Breast and Colon Cancer Cells with Drug Resistance. Molecules 2022; 27:molecules27072052. [PMID: 35408450 PMCID: PMC9000361 DOI: 10.3390/molecules27072052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/30/2022] Open
Abstract
(1) Background: Pulsed electric field (PEF) techniques are commonly used to support the delivery of various molecules. A PEF seems a promising method for low permeability drugs or when cells demonstrate therapy resistance and the cell membrane becomes an impermeable barrier. (2) Methods: In this study, we have used doxorubicin-resistant and sensitive models of human breast cancer (MCF-7/DX, MCF-7/WT) and colon cancer cells (LoVo, LoVoDX). The study aimed to investigate the susceptibility of the cells to doxorubicin (DOX) and electric fields in the 20–900 ns pulse duration range. The viability assay was utilized to evaluate the PEF protocols’ efficacy. Cell confluency and reduced glutathione were measured after PEF protocols. (3) Results: The obtained results showed that PEFs significantly supported doxorubicin delivery and cytotoxicity after 48 and 72 h. The 60 kV/cm ultrashort pulses × 20 ns × 400 had the most significant cytotoxic anticancer effect. The increase in DOX concentration provokes a decrease in cell viability, affected cell confluency, and reduced GSSH when combined with the ESOPE (European Standard Operating Procedures of Electrochemotherapy) protocol. Additionally, reactive oxygen species after PEF and PEF-DOX were detected. (4) Conclusions: Ultrashort electric pulses with low DOX content or ESOPE with higher DOX content seem the most promising in colon and breast cancer treatment.
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Affiliation(s)
- Nina Rembiałkowska
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211A, 50-556 Wroclaw, Poland; (N.R.); (D.B.); (J.S.)
| | - Vitalij Novickij
- Institute of High Magnetic Fields, Vilnius Gediminas Technical University, LT-03227 Vilnius, Lithuania;
| | - Dagmara Baczyńska
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211A, 50-556 Wroclaw, Poland; (N.R.); (D.B.); (J.S.)
| | - Magda Dubińska-Magiera
- Department of Animal Developmental Biology, Faculty of Biological Science, University of Wroclaw, Sienkiewicza 21, 50-335 Wroclaw, Poland;
| | - Jolanta Saczko
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211A, 50-556 Wroclaw, Poland; (N.R.); (D.B.); (J.S.)
| | - Julia Rudno-Rudzińska
- Department of General and Oncological Surgery, Medical University Hospital, Borowska 211, 50-556 Wroclaw, Poland;
| | - Magdalena Maciejewska
- Laboratory of Experimental Anticancer Therapy, Hirszfeld Institute of Immunology and Experimental Therapy, Rudolfa Weigla 12, 53-114 Wroclaw, Poland;
| | - Julita Kulbacka
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211A, 50-556 Wroclaw, Poland; (N.R.); (D.B.); (J.S.)
- Correspondence:
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Spugnini EP, Menditti D, De Luca A, Baldi A. Electrochemotherapy in translational medicine: from veterinary experience to human oncology. Crit Rev Eukaryot Gene Expr 2022; 33:79-90. [PMID: 36374813 DOI: 10.1615/critreveukaryotgeneexpr.2022043966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Electrochemotherapy (ECT) is a tumor treatment that, through the application of electric pulses with suitable amplitude and waveforms, favors the systemic or local delivery of chemotherapy agents. This procedure significantly increases the permeability of cancer cells to anticancer drugs, making them more effective and allowing their use at lower doses with less morbidity for patients. Its use in veterinary oncology is consolidated and it is currently adopted as first-line treatment for different cancers with successful results. In human oncology, ECT use is mainly in the treatment of cutaneous tumors and for the palliation of cutaneous metastases of malignant tumors. A standard operating procedure has been formulated. Currently, several preclinical and phase I and II studies are under way involving various cancers in humans to better define the efficacy and tolerability of this therapy. This review summarizes the state of the art of ECT in veterinary and human oncology, describing the most significant results achieved to date.
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Affiliation(s)
| | - Dardo Menditti
- Department of Dentistry, Orthodontics and Oral Surgery, University of Campania, Naples, Italy
| | - Antonio De Luca
- Department of Mental Health and Physics, Preventive Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Alfonso Baldi
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies Campania University "Luigi Vanvitelli," Caserta, Italy
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16
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Novickij V, Baleviciute A, Malysko V, Zelvys A, Radzeviciute E, Kos B, Zinkeviciene A, Miklavcic D, Novickij J, Girkontaite I. Effects of Time Delay Between Unipolar Pulses in High Frequency Nano-Electrochemotherapy. IEEE Trans Biomed Eng 2021; 69:1726-1732. [PMID: 34797759 DOI: 10.1109/tbme.2021.3129176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This work focuses on bleomycin electrochemotherapy using new modality of high repetition frequency unipolar nanosecond pulses. As a tumor model, Lewis lung carcinoma (LLC1) cell line in C57BL mice (n = 42) was used. Electrochemotherapy was performed with intertumoral injection of bleomycin (50 L of 1500 IU solution) followed by nanosecond and microsecond range electrical pulse delivery via parallel plate electrodes. The 3.5 kV/cm pulses of 200 and 700 ns were delivered in a burst of 200 at frequencies of 1 kHz and 1 MHz. For comparison of treatment efficiency, a standard 1.3 kV/cm x 100 s x 8 protocol was used. It was shown that it is possible to manipulate the efficacy of unipolar sub-microsecond electrochemotherapy solely by the time delay between the pulses. Also, the results suggest that the sub-microsecond range pulses can be as effective as the protocols in European Standard Operating Procedures on Electrochemotherapy (ESOPE) using 100 s pulses.
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17
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Szlasa W, Kiełbik A, Szewczyk A, Novickij V, Tarek M, Łapińska Z, Saczko J, Kulbacka J, Rembiałkowska N. Atorvastatin Modulates the Efficacy of Electroporation and Calcium Electrochemotherapy. Int J Mol Sci 2021; 22:ijms222011245. [PMID: 34681903 PMCID: PMC8539882 DOI: 10.3390/ijms222011245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/08/2021] [Accepted: 10/15/2021] [Indexed: 12/21/2022] Open
Abstract
Electroporation is influenced by the features of the targeted cell membranes, e.g., the cholesterol content and the surface tension of the membrane. The latter is eventually affected by the organization of actin fibers. Atorvastatin is a statin known to influence both the cholesterol content and the organization of actin. This work analyzes the effects of the latter on the efficacy of electroporation of cancer cells. In addition, herein, electroporation was combined with calcium chloride (CaEP) to assess as well the effects of the statin on the efficacy of electrochemotherapy. Cholesterol-rich cell lines MDA-MB231, DU 145, and A375 underwent (1) 48 h preincubation or (2) direct treatment with 50 nM atorvastatin. We studied the impact of the statin on cholesterol and actin fiber organization and analyzed the cells’ membrane permeability. The viability of cells subjected to PEF (pulsed electric field) treatments and CaEP with 5 mM CaCl2 was examined. Finally, to assess the safety of the therapy, we analyzed the N-and E-cadherin localization using confocal laser microscopy. The results of our investigation revealed that depending on the cell line, atorvastatin preincubation decreases the total cholesterol in the steroidogenic cells and induces reorganization of actin nearby the cell membrane. Under low voltage PEFs, actin reorganization is responsible for the increase in the electroporation threshold. However, when subject to high voltage PEF, the lipid composition of the cell membrane becomes the regulatory factor. Namely, preincubation with atorvastatin reduces the cytotoxic effect of low voltage pulses and enhances the cytotoxicity and cellular changes induced by high voltage pulses. The study confirms that the surface tension regulates of membrane permeability under low voltage PEF treatment. Accordingly, to reduce the unfavorable effects of preincubation with atorvastatin, electroporation of steroidogenic cells should be performed at high voltage and combined with a calcium supply.
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Affiliation(s)
- Wojciech Szlasa
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Aleksander Kiełbik
- Medical University Hospital, 50-556 Wroclaw, Poland;
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.S.); (Z.Ł.); (J.S.); (J.K.)
| | - Anna Szewczyk
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.S.); (Z.Ł.); (J.S.); (J.K.)
- Department of Animal Developmental Biology, Institute of Experimental Biology, University of Wroclaw, 50-335 Wroclaw, Poland
| | - Vitalij Novickij
- Institute of High Magnetic Fields, Vilnius Gediminas Technical University, 03227 Vilnius, Lithuania;
| | - Mounir Tarek
- Université de Lorraine, CNRS, LPCT, F-54000 Nancy, France;
| | - Zofia Łapińska
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.S.); (Z.Ł.); (J.S.); (J.K.)
| | - Jolanta Saczko
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.S.); (Z.Ł.); (J.S.); (J.K.)
| | - Julita Kulbacka
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.S.); (Z.Ł.); (J.S.); (J.K.)
| | - Nina Rembiałkowska
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.S.); (Z.Ł.); (J.S.); (J.K.)
- Correspondence: ; Tel.: +48-717840692
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18
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Ruzgys P, Barauskaitė N, Novickij V, Novickij J, Šatkauskas S. The Evidence of the Bystander Effect after Bleomycin Electrotransfer and Irreversible Electroporation. Molecules 2021; 26:molecules26196001. [PMID: 34641546 PMCID: PMC8512684 DOI: 10.3390/molecules26196001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 12/03/2022] Open
Abstract
One of current applications of electroporation is electrochemotherapy and electroablation for local cancer treatment. Both of these electroporation modalities share some similarities with radiation therapy, one of which could be the bystander effect. In this study, we aimed to investigate the role of the bystander effect following these electroporation-based treatments. During direct CHO-K1 cell treatment, cells were electroporated using one 100 µs duration square wave electric pulse at 1400 V/cm (for bleomycin electrotransfer) or 2800 V/cm (for irreversible electroporation). To evaluate the bystander effect, the medium was taken from directly treated cells after 24 h incubation and applied on unaffected cells. Six days after the treatment, cell viability and colony sizes were evaluated using the cell colony formation assay. The results showed that the bystander effect after bleomycin electrotransfer had a strong negative impact on cell viability and cell colony size, which decreased to 2.8% and 23.1%, respectively. On the contrary, irreversible electroporation induced a strong positive bystander effect on cell viability, which increased to 149.3%. In conclusion, the results presented may serve as a platform for further analysis of the bystander effect after electroporation-based therapies and may ultimately lead to refined application of these therapies in clinics.
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Affiliation(s)
- Paulius Ruzgys
- Biophysical Research Group, Vytautas Magnus University, Vileikos st. 844404, LT-44001 Kaunas, Lithuania; (P.R.); (N.B.)
| | - Neringa Barauskaitė
- Biophysical Research Group, Vytautas Magnus University, Vileikos st. 844404, LT-44001 Kaunas, Lithuania; (P.R.); (N.B.)
| | - Vitalij Novickij
- Institute of High Magnetic Fields, Vilnius Gediminas Technical University, Naugarduko st. 4103227, LT-10224 Vilnius, Lithuania; (V.N.); (J.N.)
| | - Jurij Novickij
- Institute of High Magnetic Fields, Vilnius Gediminas Technical University, Naugarduko st. 4103227, LT-10224 Vilnius, Lithuania; (V.N.); (J.N.)
| | - Saulius Šatkauskas
- Biophysical Research Group, Vytautas Magnus University, Vileikos st. 844404, LT-44001 Kaunas, Lithuania; (P.R.); (N.B.)
- Correspondence:
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19
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Liu H, Zhao Y, Yao C, Schmelz EM, Davalos RV. Differential effects of nanosecond pulsed electric fields on cells representing progressive ovarian cancer. Bioelectrochemistry 2021; 142:107942. [PMID: 34509872 DOI: 10.1016/j.bioelechem.2021.107942] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Received: 12/09/2020] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022]
Abstract
Nanosecond pulsed electric fields (nsPEFs) may induce differential effects on tumor cells from different disease stages and could be suitable for treating tumors by preferentially targeting the late-stage/highly aggressive tumor cells. In this study, we investigated the nsPEF responses of mouse ovarian surface epithelial (MOSE) cells representing progressive ovarian cancer from benign to malignant stages and highly aggressive tumor-initiating-like cells. We established the cell-seeded 3D collagen scaffolds cultured with or without Nocodazole (eliminating the influence of cell proliferation on ablation outcome) to observe the ablation effects at 3 h and 24 h after treatment and compared the corresponding thresholds obtained by numerically calculated electric field distribution. The results showed that nsPEFs induced larger ablation areas with lower thresholds as the cell progress from benign, malignant to a highly aggressive phenotype. This differential effect was not affected by the different doubling times of the cells, as apparent by similar ablation induction after a synergistic treatment of nsPEFs and Nocodazole. The result suggests that nsPEFs could induce preferential ablation effects on highly aggressive and malignant ovarian cancer cells than their benign counterparts. This study provides an experimental basis for the research on killing malignant tumor cells via electrical treatments and may have clinical implications for treating tumors and preventing tumor recurrence after treatment.
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Affiliation(s)
- Hongmei Liu
- School of Electrical Engineering, Chongqing University, Chongqing 400033, China; Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA
| | - Yajun Zhao
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA; College of Electrical Engineering and Control Science, Nanjing Tech. University, Nanjing 211816, China
| | - Chenguo Yao
- School of Electrical Engineering, Chongqing University, Chongqing 400033, China.
| | - Eva M Schmelz
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA.
| | - Rafael V Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA.
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20
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Vižintin A, Marković S, Ščančar J, Miklavčič D. Electroporation with nanosecond pulses and bleomycin or cisplatin results in efficient cell kill and low metal release from electrodes. Bioelectrochemistry 2021; 140:107798. [PMID: 33743336 DOI: 10.1016/j.bioelechem.2021.107798] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/21/2022]
Abstract
Nanosecond electric pulses have several potential advantages in electroporation-based procedures over the conventional micro- and millisecond pulses including low level of heating, reduced electrochemical reactions and reduced muscle contractions making them alluring for use in biomedicine and food industry. The aim of this study was to evaluate if nanosecond pulses can enhance the cytotoxicity of chemotherapeutics bleomycin and cisplatin in vitro and to quantify metal release from electrodes in comparison to 100 μs pulses commonly used in electrochemotherapy. The effects of nanosecond pulse parameters (voltage, pulse duration, number of pulses) on cell membrane permeabilization, resealing and on cell survival after electroporation only and after electrochemotherapy with bleomycin and cisplatin were evaluated on Chinese hamster ovary cells. Application of permeabilizing nanosecond pulses in combination with chemotherapeutics resulted in successful cell kill. Higher extracellular concentrations of bleomycin - but not cisplatin - were needed to achieve the same decrease in cell survival with nanosecond pulses as with eight 100 μs pulses, however, the tested bleomycin concentrations were still considerably lower compared to doses used in clinical practice. Decreasing the pulse duration from microseconds to nanoseconds and concomitantly increasing the amplitude to achieve the same biological effect resulted in reduced release of aluminum ions from electroporation cuvettes.
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Affiliation(s)
- Angelika Vižintin
- University of Ljubljana, Faculty of Electrical Engineering, Tržaška cesta 25, 1000 Ljubljana, Slovenia
| | - Stefan Marković
- Jožef Stefan Institute, Department of Environmental Sciences, Jamova cesta 39, 1000 Ljubljana, Slovenia
| | - Janez Ščančar
- Jožef Stefan Institute, Department of Environmental Sciences, Jamova cesta 39, 1000 Ljubljana, Slovenia
| | - Damijan Miklavčič
- University of Ljubljana, Faculty of Electrical Engineering, Tržaška cesta 25, 1000 Ljubljana, Slovenia.
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21
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Dos Anjos DS, Sierra OR, Spugnini EP, De Nardi AB, Fonseca-Alves CE. Comparison of two different doses of bleomycin in electrochemotherapy protocols for feline cutaneous squamous cell carcinoma nonsegregated from ultraviolet light exposure. Sci Rep 2020; 10:18362. [PMID: 33110198 PMCID: PMC7591921 DOI: 10.1038/s41598-020-75472-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/15/2020] [Indexed: 12/31/2022] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is one of the most common skin tumors in cats due to chronic exposure to ultraviolet light. Local treatments such as electrochemotherapy (ECT) promote disease control or even complete remission. We hypothesize that cats could benefit from treatments using bleomycin at reduced dosages. A prospective nonrandomized single-blind study evaluated the clinical parameters, site lesion, staging, disease-free interval (DFI) and survival time by comparing the standard dose of bleomycin (15,000 UI/m2) (n = 22) with a reduced dose (10,000 UI/m2) (n = 34) in cats with cSCC that underwent ECT as the sole treatment modality. No statistically significant difference in DFI or overall survival was observed between the 2 groups. A higher DFI was found in cats with a small tumor size (less than 0.33 cm3) compared with that for cats with a large tumor size (P = 0.045). Furthermore, a reduced overall survival time for cats with a higher stage in the standard group SG (T3 and T4) (P = 0.004) was observed when compared to that for cats with a lower stage (T1 and T2). In conclusion, ECT using both doses of bleomycin may achieve the same response rate in terms of the overall response, DFI, and overall survival.
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Affiliation(s)
- Denner S Dos Anjos
- Department of Veterinary Clinic and Surgery, São Paulo State University (UNESP), Jaboticabal, Brazil.
| | - Oscar R Sierra
- Department of Veterinary Clinic and Surgery, São Paulo State University (UNESP), Jaboticabal, Brazil
| | | | - Andrigo B De Nardi
- Department of Veterinary Clinic and Surgery, São Paulo State University (UNESP), Jaboticabal, Brazil
| | - Carlos E Fonseca-Alves
- Department of Veterinary Surgery and Animal Anesthesiology, São Paulo State University - UNESP, Botucatu, SP, Brazil.
- Institute of Health Sciences, Paulista University-UNIP, Bauru, SP, Brazil.
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Novickij V, Malyško V, Želvys A, Balevičiūtė A, Zinkevičienė A, Novickij J, Girkontaitė I. Electrochemotherapy Using Doxorubicin and Nanosecond Electric Field Pulses: A Pilot in Vivo Study. Molecules 2020; 25:E4601. [PMID: 33050300 PMCID: PMC7587179 DOI: 10.3390/molecules25204601] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 12/23/2022] Open
Abstract
Pulsed electric field (PEF) is frequently used for intertumoral drug delivery resulting in a well-known anticancer treatment-electrochemotherapy. However, electrochemotherapy is associated with microsecond range of electrical pulses, while nanosecond range electrochemotherapy is almost non-existent. In this work, we analyzed the feasibility of nanosecond range pulse bursts for successful doxorubicin-based electrochemotherapy in vivo. The conventional microsecond (1.4 kV/cm × 100 µs × 8) procedure was compared to the nanosecond (3.5 kV/cm × 800 ns × 250) non-thermal PEF-based treatment. As a model, Sp2/0 tumors were developed. Additionally, basic current and voltage measurements were performed to detect the characteristic conductivity-dependent patterns and to serve as an indicator of successful tumor permeabilization both in the nano and microsecond pulse range. It was shown that nano-electrochemotherapy can be the logical evolution of the currently established European Standard Operating Procedures for Electrochemotherapy (ESOPE) protocols, offering better energy control and equivalent treatment efficacy.
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Affiliation(s)
- Vitalij Novickij
- Faculty of Electronics, Vilnius Gediminas Technical University, 03227 Vilnius, Lithuania; (V.M.); (J.N.)
| | - Veronika Malyško
- Faculty of Electronics, Vilnius Gediminas Technical University, 03227 Vilnius, Lithuania; (V.M.); (J.N.)
| | - Augustinas Želvys
- Department of Immunology, State Research Institute Centre for Innovative Medicine, 08406 Vilnius, Lithuania; (A.Ž.); (A.B.); (A.Z.); (I.G.)
| | - Austėja Balevičiūtė
- Department of Immunology, State Research Institute Centre for Innovative Medicine, 08406 Vilnius, Lithuania; (A.Ž.); (A.B.); (A.Z.); (I.G.)
| | - Auksė Zinkevičienė
- Department of Immunology, State Research Institute Centre for Innovative Medicine, 08406 Vilnius, Lithuania; (A.Ž.); (A.B.); (A.Z.); (I.G.)
| | - Jurij Novickij
- Faculty of Electronics, Vilnius Gediminas Technical University, 03227 Vilnius, Lithuania; (V.M.); (J.N.)
| | - Irutė Girkontaitė
- Department of Immunology, State Research Institute Centre for Innovative Medicine, 08406 Vilnius, Lithuania; (A.Ž.); (A.B.); (A.Z.); (I.G.)
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Bonadies A, Bertozzi E, Cristiani R, Govoni FA, Migliano E. Electrochemotherapy in Skin Malignancies of Head and Neck Cancer Patients: Clinical Efficacy and Aesthetic Benefits. Acta Derm Venereol 2019; 99:1246-1252. [PMID: 31612236 DOI: 10.2340/00015555-3341] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/16/2022] Open
Abstract
Skin malignancies of the head and neck inflict significant structural, functional, and cosmetic burdens upon those affected. We retrospectively addressed electrochemotherapy anti-tumour efficacy in head and neck skin cancer patients who were not suitable for standard treatments. Scars' physical characteristics and aesthetics were evaluated using validated scar assessment scales. Among 33 treated patients, 82% experienced a complete tumour response while 18% experienced a partial response. At a median time period of 7 months, 96% of the evaluated scars came close to resembling the normal surrounding skin showing excellent results in terms of restoration to original condition with no deformity and/or distortion and in terms of preservation of functionality, such as oral competence and eye protection. Electrochemotherapy is an effective local anticancer procedure for cutaneous tumours. In the treatment of skin malignancies of the head and neck, especially in non-surgical cases, in the elderly and in patients declining surgery, electrochemotherapy may represent a valid alternative to standard management.
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Affiliation(s)
- Antonio Bonadies
- Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute, IRCCS, IT-00144 Rome, Italy.
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Galant L, Delverdier M, Lucas MN, Raymond-Letron I, Teissie J, Tamzali Y. Calcium electroporation: The bioelectrochemical treatment of spontaneous equine skin tumors results in a local necrosis. Bioelectrochemistry 2019; 129:251-258. [PMID: 31229863 DOI: 10.1016/j.bioelechem.2019.05.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Received: 01/11/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 12/29/2022]
Abstract
Electrochemotherapy (ECT) is an anticancer bioelectrochemical therapy where electrical field pulses (electropermeabilization) increase intracellular concentration of antitumor drugs. The procedure is very effective against skin tumors. The restrictive regulations concerning anticancer drugs in veterinary medicine limit use of ECT. Electroporation with calcium (Electroporation Calcium Therapy)(ECaT) was proved to be effective in vivo on induced tumors in laboratory animals. This study evaluated the effects of ECaT in equine sarcoids (spontaneous skin tumors) on an animal cohort. Pulse parameters for ECaT were choosen for using skin contact electrodes. ECaT was applied under general anesthesia. The tumors were removed at different days after the treatment and analyzed by histology. The study assessed the volume fraction of necrosis that was >50% for 9 of 13 sarcoids. Sixteen sarcoids in 10 horses were treated with ECaT. Macroscopic changes (a crust) were observed in 14/16 tumors. The main microscopic changes were necrosis, ulceration,hemorrhages, calcifications and thrombosis. The adverse effect was an inflammatory local reaction. Surrounding tissues were not affected. This targeted effect can be explained by its control by the field distribution in the tissue and on the interstitial diffusion of the injected Ca2+.
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Affiliation(s)
- Laurine Galant
- Equine Clinic, National Veterinary School of Toulouse, France
| | - Maxence Delverdier
- Department of Histopathology, National Veterinary School of Toulouse, France
| | - Marie-Noëlle Lucas
- Department of Histopathology, National Veterinary School of Toulouse, France
| | - Isabelle Raymond-Letron
- Department of Histopathology, National Veterinary School of Toulouse, France; Platform of Experimental and Compared Histopathology, STROMALab, UMR UPS/CNRS 5223, EFS, Inserm U1031, Toulouse, France
| | - Justin Teissie
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, France.
| | - Youssef Tamzali
- Equine Clinic, National Veterinary School of Toulouse, France
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Hoejholt KL, Mužić T, Jensen SD, Dalgaard LT, Bilgin M, Nylandsted J, Heimburg T, Frandsen SK, Gehl J. Calcium electroporation and electrochemotherapy for cancer treatment: Importance of cell membrane composition investigated by lipidomics, calorimetry and in vitro efficacy. Sci Rep 2019; 9:4758. [PMID: 30894594 PMCID: PMC6427041 DOI: 10.1038/s41598-019-41188-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/20/2019] [Indexed: 12/21/2022] Open
Abstract
Calcium electroporation is a novel anti-cancer treatment investigated in clinical trials. We explored cell sensitivity to calcium electroporation and electroporation with bleomycin, using viability assays at different time and temperature points, as well as heat calorimetry, lipidomics, and flow cytometry. Three cell lines: HT29 (colon cancer), MDA-MB231 (breast cancer), and HDF-n (normal fibroblasts) were investigated for; (a) cell survival dependent on time of addition of drug relative to electroporation (1.2 kV/cm, 8 pulses, 99 µs, 1 Hz), at different temperatures (37 °C, 27 °C, 17 °C); (b) heat capacity profiles obtained by differential scanning calorimetry without added calcium; (c) lipid composition by mass spectrometry; (d) phosphatidylserine in the plasma membrane outer leaflet using flow cytometry. Temperature as well as time of drug administration affected treatment efficacy in HT29 and HDF-n cells, but not MDA-MB231 cells. Interestingly the HT29 cell line displayed a higher phase transition temperature (approximately 20 °C) versus 14 °C (HDF-n) and 15 °C (MDA-MB231). Furthermore the HT29 cell membranes had a higher ratio of ethers to esters, and a higher expression of phosphatidylserine in the outer leaflet. In conclusion, lipid composition and heat capacity of the membrane might influence permeabilisation of cells and thereby the effect of calcium electroporation and electrochemotherapy.
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Affiliation(s)
- K L Hoejholt
- Center for Experimental Drug and Gene Electrotransfer, Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - T Mužić
- Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
| | - S D Jensen
- Center for Experimental Drug and Gene Electrotransfer, Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - L T Dalgaard
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - M Bilgin
- Danish Cancer Society Research Center (DCRC), Copenhagen, Denmark
| | - J Nylandsted
- Danish Cancer Society Research Center (DCRC), Copenhagen, Denmark
| | - T Heimburg
- Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
| | - S K Frandsen
- Center for Experimental Drug and Gene Electrotransfer, Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark.
- Center for Experimental Drug and Gene Electrotransfer, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark.
| | - J Gehl
- Center for Experimental Drug and Gene Electrotransfer, Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark.
- Center for Experimental Drug and Gene Electrotransfer, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Saczko J, Pilat J, Choromanska A, Rembialkowska N, Bar J, Kaminska I, Zalewski J, Kulbacka J. The effectiveness of chemotherapy and electrochemotherapy on ovarian cell lines in vitro. Neoplasma 2019; 63:450-5. [PMID: 26925792 DOI: 10.4149/315_150930n510] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The presented study aimed to evaluate in vitro the effectiveness of improvement standard chemotherapy with bleomycin by electroporation in two various ovarian cancer cell lines. Two human ovarian cell lines OvBH-1 and SKOV-3 were used. The lines were selected because of their resistance to several therapeutic methods. As anticancer drug we use range of concentrations of bleomycin. In EP and ECT experiments different voltage values: from 0 to 1200 V/cm, 8 pulses with duration of 100μs and intervals between pulses 1s long were used. The cells viability after applied treatments was evaluated by MTT assay. The expression of heat shock proteins - HSP27 was examined by immunocytochemical ABC method.The cytotoxicity with different concentrations of bleomycin alone was not significantly decrease in both cell lines. It confirms resistance of these cells to conventional chemotherapy. The highest decrease of cell proliferation was observed after EP with bleomycin after 48h of incubation for 1000 V/cm. The intensity of expression of small heat shock proteins HSP27 slightly increased after ECT in both treated cell lines, in particular in OvBH-1. The presented study indicated that application of electroporation may effectively enhance chemotherapy with bleomycin, particularly in the case of treating ovarian cancer resistant to standard therapy.
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Yoon YE, Lee HH, Kim KH, Park SY, Moon HS, Lee SR, Hong YK, Park DS, Kim DK. Focal therapy versus robot-assisted partial nephrectomy in the management of clinical T1 renal masses: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13102. [PMID: 30407321 PMCID: PMC6250551 DOI: 10.1097/md.0000000000013102] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Robot-assisted partial nephrectomy (RPN) and focal therapy (FT) have both been successfully employed in the management of small renal masses. However, despite this being the era of minimally invasive surgery, few comparative studies exist on RPN and FT. The aim of our study is to review perioperative, renal functional and oncologic outcomes of FT and RPN in cT1 renal masses. METHODS Literature published in Medline, EMBASE, and Cochrane Library databases up to April 22, 2018, was systematically searched. We included literature comparing outcomes of FT (radiofrequency ablation, cryoablation, microwave ablation, and irreversible electroporation) and RPN. Studies that reported only on laparoscopic partial nephrectomy or open partial nephrectomy, and review articles, editorials, letters, or cost analyses were excluded. In total, data from 1166 patients were included. RESULTS From 858 total articles, 7 nonrandomized, observational studies were included. Compared with RPN, FT was associated with a significantly lower decrease of estimated glomerular filtration rate (weighted mean difference [WMD] -8.06 mL/min/1.73 m; confidence interval [CI] -15.85 to -0.26; P = .04), and lower estimated blood loss (WMD -49.61 mL; CI -60.78 to -38.45; P < .001). However, patients who underwent FT had a significantly increased risk of local recurrence (risk ratio [RR] 9.89; CI 4.24-23.04; P < .001) and distant metastasis (RR 6.42; CI 1.70-24.33; P = .006). However, operative times, lengths of stay, and complication rates were revealed to be similar between FT and RPN. CONCLUSION RPN has a substantial advantage in preventing cancer recurrence. However, in the era of minimally invasive surgery, FT has advantages in renal function preservation and less bleeding. Long-term follow-up for survival rates and comparative analysis of microwave ablation and irreversible electroporation are needed to extend FT for patients with significant morbidities and for those who need sufficient renal function preservation with minimal bleeding.
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Affiliation(s)
- Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul
| | - Hyung Ho Lee
- Department of Urology, National Health Insurance Corporation Ilsan Hospital, Gyeonggi-do
| | - Ki Hong Kim
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan
| | - Sung Yul Park
- Department of Urology, Hanyang University College of Medicine, Seoul
| | - Hong Sang Moon
- Department of Urology, Hanyang University College of Medicine, Seoul
| | - Seung Ryeol Lee
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam
| | - Young Kwon Hong
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam
| | - Dong Soo Park
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam
| | - Dae Keun Kim
- Department of Urology, CHA Seoul Station Medical Center, CHA University
- Department of Urology, School of Medicine, Graduate School, Hanyang University, Seoul, Korea
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Levin M, Landström F. [Electrochemotherapy - a simple and effective treatment of skin metastases]. Lakartidningen 2018; 115:E9YW. [PMID: 30204228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Electrochemotherapy is a simple and effective treatment of skin metastases. Electrochemotherapy is possible after previous surgery, radiotherapy and/or limb perfusion. Electrochemotherapy is most likely an under-used treatment modality in Sweden.
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Affiliation(s)
- Max Levin
- Sahlgrenska universitetssjukhuset - Jubileumskliniken Goteborg, Sweden - Jubileumskliniken Göteborg, Sweden
| | - Fredrik Landström
- Universitetssjukhuset Orebro - ÖNH-kliniken Orebro, Sweden Universitetssjukhuset Orebro - ÖNH-kliniken Orebro, Sweden
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29
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Gehl J, Sersa G, Matthiessen LW, Muir T, Soden D, Occhini A, Quaglino P, Curatolo P, Campana LG, Kunte C, Clover AJP, Bertino G, Farricha V, Odili J, Dahlstrom K, Benazzo M, Mir LM. Updated standard operating procedures for electrochemotherapy of cutaneous tumours and skin metastases. Acta Oncol 2018; 57:874-882. [PMID: 29577784 DOI: 10.1080/0284186x.2018.1454602] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 03/13/2018] [Indexed: 12/21/2022]
Abstract
Electrochemotherapy is now in routine clinical use to treat cutaneous metastases of any histology, and is listed in national and international guidelines for cutaneous metastases and primary skin cancer. Electrochemotherapy is used by dermatologists, surgeons, and oncologists, and for different degrees and manifestations of metastases to skin and primary skin tumours not amenable to surgery. This treatment utilises electric pulses to permeabilize cell membranes in tumours, thus allowing a dramatic increase of the cytotoxicity of anti-cancer agents. Response rates, often after only one treatment, are very high across all tumour types. The most frequent indications are cutaneous metastases from malignant melanoma and breast cancer. In 2006, standard operating procedures (SOPs) were written for this novel technology, greatly facilitating introduction and dissemination of the therapy. Since then considerable experience has been obtained treating a wider range of tumour histologies and increasing size of tumours which was not originally thought possible. A pan-European expert panel drawn from a range of disciplines from dermatology, general surgery, head and neck surgery, plastic surgery, and oncology met to form a consensus opinion to update the SOPs based on the experience obtained. This paper contains these updated recommendations for indications for electrochemotherapy, pre-treatment information and evaluation, treatment choices, as well as follow-up.
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Affiliation(s)
- Julie Gehl
- a Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care , Zealand University Hospital , Roskilde , Denmark
- b Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
- c Department of Oncology Herlev and Gentofte Hospital , University of Copenhagen , Herlev , Denmark
| | - Gregor Sersa
- d Department of Experimental Oncology , Institute of Oncology Ljubljana , Ljubljana , Slovenia
| | | | - Tobian Muir
- e South Tees NHS Foundation Trust , James Cook University Hospital , Middlesbrough , UK
| | - Declan Soden
- f Cork Cancer Research Centre , Western Gateway Building University College Cork , Cork , Ireland
| | - Antonio Occhini
- g Department of Otolaryngology Head and Neck Surgery , University of Pavia - IRCCS Policlinico San Matteo Foundation , Pavia , Italy
| | - Pietro Quaglino
- h Department of Medical Sciences , Dermatologic Clinic, University of Turin , Turin , Italy
| | - Pietro Curatolo
- i Department of Dermatology and Plastic Surgery , La Sapienza University , Roma , Italy
| | - Luca G Campana
- j Department of Surgery Oncology and Gastroenterology (DISCOG) , University of Padova , Padova , Italy
- k Surgical Oncology Unit , Veneto Institute of Oncology IRCCS , Padova , Italy
| | - Christian Kunte
- l Department of Dermatologic Surgery and Dermatology , Artemed Fachklinik München , Munich , Germany
- m Department of Dermatology and Allergology , Ludwig-Maximillian University , Munich , Germany
| | - A James P Clover
- f Cork Cancer Research Centre , Western Gateway Building University College Cork , Cork , Ireland
- n Department of Plastic Surgery , Cork University Hospital , Cork , Ireland
| | - Giulia Bertino
- f Cork Cancer Research Centre , Western Gateway Building University College Cork , Cork , Ireland
| | - Victor Farricha
- o Melanoma and Sarcoma Unit Department of Surgery , Portuguese Institute of Oncology, Rua Professor Lima Basto, Faculty of Medicine of Lisbon , Lisbon , Portugal
| | - Joy Odili
- p Department of Plastic Surgery , St. George's University Hospitals NHS Foundation Trust , London , UK
| | - Karin Dahlstrom
- q Department of Plastic Surgery , Herlev and Gentofte Hospital, University of Copenhagen , Copenhagen , Denmark
| | - Marco Benazzo
- g Department of Otolaryngology Head and Neck Surgery , University of Pavia - IRCCS Policlinico San Matteo Foundation , Pavia , Italy
| | - Lluis M Mir
- r Vectorology and Anticancer Therapies , UMR 8203, CNRS, Univ. Paris-Sud, Gustave Roussy, Université Paris-Saclay , Villejuif , France
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30
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Lodeizen O, de Bruin M, Eggener S, Crouzet S, Ghai S, Varkarakis I, Katz A, Dominguez-Escrig JL, Pahernik S, de Reijke T, de la Rosette J. Ablation energies for focal treatment of prostate cancer. World J Urol 2018; 37:409-418. [PMID: 29943219 PMCID: PMC6424940 DOI: 10.1007/s00345-018-2364-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/30/2018] [Indexed: 02/06/2023] Open
Abstract
Context In recent years, focal therapy has emerged as a treatment option for a selected group of men with localized prostate cancer. Cryotherapy and high-intensity focused ultrasound (HIFU) are the most investigated types of focal treatment with other options currently under evaluation. Objective The objective of the study was to give a comprehensive overview of six available focal treatment options for prostate cancer with their rationale, delivery mechanism, and outcomes. Information acquisition The SIU ICUD chapter on available Energies to Treat Prostate Cancer was used as a guide to describe the different technologies. For outcomes, a literature search was conducted using PubMed key words including focal therapy, HIFU, cryotherapy, irreversible electroporation, vascular-targeted photodynamic therapy, laser interstitial therapy, radiofrequency ablation, microwave therapy, and their synonyms in MeSH terms. Conclusion Focal therapy appears to have encouraging outcomes on quality of life and urinary and erectile function. For oncological outcomes, it is challenging to fully interpret the outcomes due to heterogeneity in patient selection and short-term follow-up. Electronic supplementary material The online version of this article (10.1007/s00345-018-2364-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olivia Lodeizen
- Olivia Lodeizen, AMC University Hospital, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Martijn de Bruin
- Olivia Lodeizen, AMC University Hospital, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Scott Eggener
- Olivia Lodeizen, AMC University Hospital, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Sébastien Crouzet
- Olivia Lodeizen, AMC University Hospital, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Sangeet Ghai
- Olivia Lodeizen, AMC University Hospital, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Ioannis Varkarakis
- Olivia Lodeizen, AMC University Hospital, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Aaron Katz
- Olivia Lodeizen, AMC University Hospital, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | | | - Sascha Pahernik
- Olivia Lodeizen, AMC University Hospital, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Theo de Reijke
- Olivia Lodeizen, AMC University Hospital, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Jean de la Rosette
- Olivia Lodeizen, AMC University Hospital, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
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Michel O, Przystupski D, Saczko J, Szewczyk A, Niedzielska N, Rossowska J, Kulbacka J. The favourable effect of catechin in electrochemotherapy in human pancreatic cancer cells. Acta Biochim Pol 2018; 65:173-184. [PMID: 29796442 DOI: 10.18388/abp.2018_2602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 01/31/2018] [Revised: 03/21/2018] [Accepted: 04/06/2018] [Indexed: 11/10/2022]
Abstract
Until recently, green tea polyphenols were considered strong antioxidants. However, the latest reports have revealed that bioflavonoids can play a multiple role in anticancer therapy, including the inhibition of cell proliferation and generation of the oxidative stress in a dose-dependent manner. The presented research was designed to examine the potential of the green tea (±)-catechin as a reinforcement of the electrochemotherapy (ECT) with cisplatin in pancreatic cancer in vitro. The study was performed on two cell lines of the pancreatic ductal adenocarcinoma (PDA) - parental EPP85-181P and multidrug-resistant EPP85-181RNOV. Prior to the ECT protocol the cells were preincubated with high or low concentration of catechin for 2 or 24 hours, respectively. We assessed the influence of preincubation on the cisplatin toxicity with and without electroporation (EP), the electrosensitivity of PDA cell lines and the uptake of the daunorubicin and propidium iodide. Additionally, we evaluated the antioxidative properties of catechin by the measurement of the ROS-related fluorescence and the immunoreactivity of the oxidative stress-related enzymes superoxide dismutase (SOD2) and glutathione S-transferase (GST). We found that co-treatment with catechin can firmly enhance the efficacy of electroporation with cisplatin in vitro. More favorable effect was obtained for 2-hour incubation, which indicates the involvement of the transcriptional-independent mechanisms of catechin action. The effect may be partially explained by the increased oxidative stress level, which was higher in multidrug-resistant cells. However, further studies on cisplatin-catechin interplay and the thorough examination of the catechin-cell membrane interaction need to be performed.
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Affiliation(s)
- Olga Michel
- Department of Medical Biochemistry, Wroclaw Medical University, Wrocław, Poland
| | - Dawid Przystupski
- Department of Medical Biochemistry, Wroclaw Medical University, Wrocław, Poland
| | - Jolanta Saczko
- Department of Medical Biochemistry, Wroclaw Medical University, Wrocław, Poland
- Department of Molecular and Cellular Biology, Wroclaw Medical University, Wrocław, Poland
| | - Anna Szewczyk
- Department of Animal Developmental Biology, Institute of Experimental Biology, University of Wroclaw, Wrocław, Poland
| | - Natalia Niedzielska
- Department of Biomedical Engineering, Wroclaw University of Technology, Wrocław, Poland
| | - Joanna Rossowska
- Institute of Immunology and Experimental Therapy Polish Academy of Sciences, Wrocław, Poland
| | - Julita Kulbacka
- Department of Medical Biochemistry, Wroclaw Medical University, Wrocław, Poland
- Department of Molecular and Cellular Biology, Wroclaw Medical University, Wrocław, Poland
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Sweeney DC, Weaver JC, Davalos RV. Characterization of Cell Membrane Permeability In Vitro Part I: Transport Behavior Induced by Single-Pulse Electric Fields. Technol Cancer Res Treat 2018; 17:1533033818792491. [PMID: 30236040 PMCID: PMC6154305 DOI: 10.1177/1533033818792491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/18/2018] [Accepted: 07/03/2018] [Indexed: 02/03/2023] Open
Abstract
Most experimental studies of electroporation focus on permeabilization of the outer cell membrane. Some experiments address delivery of ions and molecules into cells that should survive; others focus on efficient killing of the cells with minimal temperature rise. A basic method for quantifying electroporation effectiveness is measuring the membrane's diffusive permeability. More specifically, comparisons of membrane permeability between electroporation protocols often rely on relative fluorescence measurements, which are not able to be directly connected to theoretical calculations and complicate comparisons between studies. Here we present part I of a 2-part study: a research method for quantitatively determining the membrane diffusive permeability for individual cells using fluorescence microscopy. We determine diffusive permeabilities of cell membranes to propidium for electric field pulses with durations of 1 to 1000 μs and strengths of 170 to 400 kV/m and show that diffusive permeabilities can reach 1.3±0.4×10-8 m/s. This leads to a correlation between increased membrane permeability and eventual propidium uptake. We also identify a subpopulation of cells that exhibit a delayed and significant propidium uptake for relatively small single pulses. Our results provide evidence that cells, especially those that uptake propidium more slowly, can achieve large permeabilities with a single electrical pulse that may be quantitatively measured using standard fluorescence microscopy equipment and techniques.
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Affiliation(s)
- Daniel C. Sweeney
- Department of Biomedical Engineering and Mechanics, Virginia Tech,
Blacksburg, VA, USA
| | - James C. Weaver
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts
Institute of Technology, Cambridge, MA, USA
| | - Rafael V. Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech,
Blacksburg, VA, USA
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Sweeney DC, Douglas TA, Davalos RV. Characterization of Cell Membrane Permeability In Vitro Part II: Computational Model of Electroporation-Mediated Membrane Transport. Technol Cancer Res Treat 2018; 17:1533033818792490. [PMID: 30231776 PMCID: PMC6149036 DOI: 10.1177/1533033818792490] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/18/2018] [Accepted: 07/03/2018] [Indexed: 12/22/2022] Open
Abstract
Electroporation is the process by which applied electric fields generate nanoscale defects in biological membranes to more efficiently deliver drugs and other small molecules into the cells. Due to the complexity of the process, computational models of cellular electroporation are difficult to validate against quantitative molecular uptake data. In part I of this two-part report, we describe a novel method for quantitatively determining cell membrane permeability and molecular membrane transport using fluorescence microscopy. Here, in part II, we use the data from part I to develop a two-stage ordinary differential equation model of cellular electroporation. We fit our model using experimental data from cells immersed in three buffer solutions and exposed to electric field strengths of 170 to 400 kV/m and pulse durations of 1 to 1000 μs. We report that a low-conductivity 4-(2-hydroxyethyl)-1 piperazineethanesulfonic acid buffer enables molecular transport into the cell to increase more rapidly than with phosphate-buffered saline or culture medium-based buffer. For multipulse schemes, our model suggests that the interpulse delay between two opposite polarity electric field pulses does not play an appreciable role in the resultant molecular uptake for delays up to 100 μs. Our model also predicts the per-pulse permeability enhancement decreases as a function of the pulse number. This is the first report of an ordinary differential equation model of electroporation to be validated with quantitative molecular uptake data and consider both membrane permeability and charging.
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Affiliation(s)
- Daniel C. Sweeney
- Department of Biomedical Engineering and Mechanics, Virginia Tech,
Blacksburg, VA, USA
| | - Temple A. Douglas
- Department of Biomedical Engineering and Mechanics, Virginia Tech,
Blacksburg, VA, USA
| | - Rafael V. Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech,
Blacksburg, VA, USA
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Probst U, Fuhrmann I, Beyer L, Wiggermann P. Electrochemotherapy as a New Modality in Interventional Oncology: A Review. Technol Cancer Res Treat 2018; 17:1533033818785329. [PMID: 29986632 PMCID: PMC6048674 DOI: 10.1177/1533033818785329] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/01/2018] [Accepted: 05/24/2018] [Indexed: 12/18/2022] Open
Abstract
Electroporation is a well-known phenomenon that occurs at the cell membrane when cells are exposed to high-intensity electric pulses. Depending on electric pulse amplitude and number of pulses, applied electroporation can be reversible with membrane permeability recovery or irreversible. Reversible electroporation is used to introduce drugs or genetic material into the cell without affecting cell viability. Electrochemotherapy refers to a combined treatment: electroporation and drug injection to enhance its cytotoxic effect up to 1000-fold for bleomycin. Since several years, electrochemotherapy is gaining popularity as minimally invasive oncologic treatment. The adoption of electrochemotherapy procedure in interventional oncology poses several unsolved questions, since suitable tumor histology and size as well as therapeutic efficacy still needs to be deepen. Electrochemotherapy is usually applied in palliative settings for the treatment of patients with unresectable tumors to relieve pain and ameliorate quality of life. In most cases, it is used in the treatment of advanced stages of neoplasia when radical surgical treatment is not possible (eg, due to lesion location, size, and/or number). Further, electrochemotherapy allows treating tumor nodules in the proximity of important structures like vessels and nerves as the treatment does not involve tissue heating. Overall, the safety profile of electrochemotherapy is favorable. Most of the observed adverse events are local and transient, moderate local pain, erythema, edema, and muscle contractions during electroporation. The aim of this article is to review the recent published clinical experiences of electrochemotherapy use in deep-seated tumors with particular focus on liver cases. The principle of electrochemotherapy as well as the application to cutaneous metastases is briefly described. A short insight in the treatment of bone metastases, unresectable pancreas cancer, and soft tissue sarcoma will be given. Preclinical and clinical studies on treatment efficacy with electrochemotherapy of hepatic lesions and safety of the procedure adopted are discussed.
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Affiliation(s)
- Ute Probst
- Universitätsklinikum Regensburg Institut für Röntgendiagnostik, Regensburg,
Germany
| | - Irene Fuhrmann
- Universitätsklinikum Regensburg Institut für Röntgendiagnostik, Regensburg,
Germany
| | - Lukas Beyer
- Städtisches Klinikum Braunschweig, Institut für Röntgendiagnostik und
Nuklearmedizin, Braunschweig, Germany
| | - Philipp Wiggermann
- Universitätsklinikum Regensburg Institut für Röntgendiagnostik, Regensburg,
Germany
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Rezaee Z, Yadollahpour A, Rashidi S, Kunwar PS. Radiosensitizing Effect of Electrochemotherapy: A Systematic Review of Protocols and Efficiency. Curr Drug Targets 2017; 18:1893-1903. [PMID: 28641523 DOI: 10.2174/1389450118666170622091014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Received: 02/25/2017] [Revised: 05/21/2017] [Accepted: 06/11/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Electrochemotherapy (ECT) is a combination of electroporation (EP) and chemotherapy and has been reported as a potential radiosensitizing agent for radiation therapy. OBJECTIVE The main objective of this study was to systematically review of the literature to evaluate the effectiveness of ECT in sensitization of tumors to ionization radiation. In addition, the clinical considerations and mechanisms of action of radiosensitizing effect are discussed. RESULTS Nine studies were included in this review. Bleomycin and cisplatin showed radiosensitizing effects in combined protocols with EP. EP enhances the cytotoxicity of bleomycin and cisplatin by factor of 1000 and 100, respectively. The mechanism of action of these drugs is induction of single and double strand breaks in DNA molecule. Moreover, the two main mechanisms of EP are increasing drug uptake in the tumor cells and generating reactive oxygen species. A single session ECT before radiotherapy can significantly enhance the tumor response. CONCLUSION ECT is effective for different cell lines and tumors with different levels of radiosensitivity. Our findings show that ECT can be further translated into the clinic and can be matched by singledose irradiation as well as in the fractionated regime.
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Affiliation(s)
- Zohre Rezaee
- Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Yadollahpour
- Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Bioelectromagnetic Clinic, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Samaneh Rashidi
- Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Bioelectromagnetic Clinic, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Pramod S Kunwar
- Department of Pharmaceutics, Modern Institute of Pharmaceutical Sciences, Indore, India
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Zhao Y, Bhonsle S, Dong S, Lv Y, Liu H, Safaai-Jazi A, Davalos RV, Yao C. Characterization of Conductivity Changes During High-Frequency Irreversible Electroporation for Treatment Planning. IEEE Trans Biomed Eng 2017; 65:1810-1819. [PMID: 29989932 DOI: 10.1109/tbme.2017.2778101] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
For irreversible-electroporation (IRE)-based therapies, the underlying electric field distribution in the target tissue is influenced by the electroporation-induced conductivity changes and is important for predicting the treatment zone. OBJECTIVE In this study, we characterized the liver tissue conductivity changes during high-frequency irreversible electroporation (H-FIRE) treatments of widths 5 and 10 μs and proposed a method for predicting the ablation zones. METHODS To achieve this, we created a finite-element model of the tissue treated with H-FIRE and IRE pulses based on experiments conducted in an in-vivo rabbit liver study. We performed a parametric sweep on a Heaviside function that captured the tissue conductivity versus electric field behavior to yield a model current close to the experimental current during the first burst/pulse. A temperature module was added to account for the current increase in subsequent bursts/pulses. The evolution of the electric field at the end of the treatment was overlaid on the experimental ablation zones determined from hematoxylin and eosin staining to find the field thresholds of ablation. RESULTS Dynamic conductivity curves that provided a statistically significant relation between the model and experimental results were determined for H-FIRE. In addition, the field thresholds of ablation were obtained for the tested H-FIRE parameters. CONCLUSION The proposed numerical model can simulate the electroporation process during H-FIRE. SIGNIFICANCE The treatment planning method developed in this study can be translated to H-FIRE treatments of different widths and for different tissue types.
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Jung JH, Gudeloglu A, Kiziloz H, Kuntz GM, Miller A, Konety BR, Dahm P. Intravesical electromotive drug administration for non-muscle invasive bladder cancer. Cochrane Database Syst Rev 2017; 9:CD011864. [PMID: 28898400 PMCID: PMC6483767 DOI: 10.1002/14651858.cd011864.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Electromotive drug administration (EMDA) is the use of electrical current to improve the delivery of intravesical agents to reduce the risk of recurrence in people with non-muscle invasive bladder cancer (NMIBC). It is unclear how effective this is in comparison to other forms of intravesical therapy. OBJECTIVES To assess the effects of intravesical EMDA for the treatment of NMIBC. SEARCH METHODS We performed a comprehensive search using multiple databases (CENTRAL, MEDLINE, EMBASE), two clinical trial registries and a grey literature repository. We searched reference lists of relevant publications and abstract proceedings. We applied no language restrictions. The last search was February 2017. SELECTION CRITERIA We searched for randomised studies comparing EMDA of any intravesical agent used to reduce bladder cancer recurrence in conjunction with transurethral resection of bladder tumour (TURBT). DATA COLLECTION AND ANALYSIS Two review authors independently screened the literature, extracted data, assessed risk of bias and rated quality of evidence (QoE) according to GRADE on a per outcome basis. MAIN RESULTS We included three trials with 672 participants that described five distinct comparisons. The same principal investigator conducted all three trials. All studies used mitomycin C (MMC) as the chemotherapeutic agent for EMDA. 1. Postoperative MMC-EMDA induction versus postoperative Bacillus Calmette-Guérin (BCG) induction: based on one study with 72 participants with carcinoma in situ (CIS) and concurrent pT1 urothelial carcinoma, we are uncertain (very low QoE) about the effect of MMC-EMDA on time to recurrence (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.64 to 1.76; corresponding to 30 more per 1000 participants, 95% CI 180 fewer to 380 more). There was no disease progression in either treatment arm at three months' follow-up. We are uncertain (very low QoE) about serious adverse events (RR 0.75, 95% CI 0.18 to 3.11). 2. Postoperative MMC-EMDA induction versus MMC-passive diffusion (PD) induction: based on one study with 72 participants with CIS and concurrent pT1 urothelial carcinoma, postoperative MMC-EMDA may (low QoE) reduce disease recurrence (RR 0.65, 95% CI 0.44 to 0.98; corresponding to 147 fewer per 1000 participants, 95% CI 235 fewer to 8 fewer). There was no disease progression in either treatment arm at three months' follow-up. We are uncertain (very low QoE) about the effect of MMC-EMDA on serious adverse events (RR 1.50, 95% CI 0.27 to 8.45). 3. Postoperative MMC-EMDA with sequential BCG induction and maintenance versus postoperative BCG induction and maintenance: based on one study with 212 participants with pT1 urothelial carcinoma of the bladder with or without CIS, postoperative MMC-EMDA with sequential BCG may result (low QoE) in a longer time to recurrence (hazard ratio (HR) 0.51, 95% CI 0.34 to 0.77; corresponding to 181 fewer per 1000 participants, 95% CI 256 fewer to 79 fewer) and time to progression (HR 0.36, 95% CI 0.17 to 0.75; corresponding to 63 fewer per 1000 participants, 95% CI 82 fewer to 24 fewer). We are uncertain (very low QoE) about the effect of MMC-EMDA on serious adverse events (RR 1.02, 95% CI 0.21 to 4.94). 4. Single-dose, preoperative MMC-EMDA versus single-dose, postoperative MMC-PD: based on one study with 236 participants with primary pTa and pT1 urothelial carcinoma, preoperative MMC-EMDA likely (moderate QoE) results in a longer time to recurrence (HR 0.47, 95% CI 0.32 to 0.69; corresponding to 247 fewer per 1000 participants, 95% CI 341 fewer to 130 fewer) for a median follow-up of 86 months. We are uncertain (very low QoE) about the effect of MMC-EMDA on time to progression (HR 0.81, 95% CI 0.00 to 259.93; corresponding to 34 fewer per 1000 participants, 95% CI 193 fewer to 807 more) and serious adverse events (RR 0.79, 95% CI 0.30 to 2.05). 5. Single-dose, preoperative MMC-EMDA versus TURBT alone: based on one study with 233 participants with primary pTa and pT1 urothelial carcinoma, preoperative MMC-EMDA likely (moderate QoE) results in a longer time to recurrence (HR 0.40, 95% CI 0.28 to 0.57; corresponding to 304 fewer per 1000 participants, 95% CI 390 fewer to 198 fewer) for a median follow-up of 86 months. We are uncertain (very low QoE) about the effect of MMC-EMDA on time to progression (HR 0.74, 95% CI 0.00 to 247.93; corresponding to 49 fewer per 1000 participants, 95% CI 207 fewer to 793 more) or serious adverse events (HR 1.74, 95% CI 0.52 to 5.77). AUTHORS' CONCLUSIONS While the use of EMDA to administer intravesical MMC may result in a delay in time to recurrence in select patient populations, we are uncertain about its impact on serious adverse events in all settings. Common reasons for downgrading the QoE were study limitations and imprecision. A potential role for EMDA-based administration of MMC may lie in settings where more established agents (such as BCG) are not available. In the setting of low or very low QoE for most comparisons, our confidence in the effect estimates is limited and the true effect sizes may be substantially different from those reported here.
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Affiliation(s)
- Jae Hung Jung
- Yonsei University Wonju College of MedicineDepartment of Urology20 Ilsan‐roWonjuGangwonKorea, South26426
- University of MinnesotaDepartment of UrologyMinneapolis, MinnesotaUSA
- Minneapolis VA Health Care SystemUrology SectionMinneapolis, MinnesotaUSA
| | | | - Halil Kiziloz
- Hacettepe UniversityDepartment of UrologyAnkaraTurkey
| | - Gretchen M Kuntz
- University of Florida‐JacksonvilleBorland Health Sciences Library653‐1 West Eight St.2nd FL LRCJacksonvilleFloridaUSA32209
| | - Alea Miller
- Minneapolis VA Health Care SystemUrology SectionMinneapolisMinnesotaUSA
| | | | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionMinneapolisMinnesotaUSA
- University of MinnesotaDepartment of UrologyMinneapolisMinnesotaUSA
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Falk H, Lambaa S, Johannesen HH, Wooler G, Venzo A, Gehl J. Electrochemotherapy and calcium electroporation inducing a systemic immune response with local and distant remission of tumors in a patient with malignant melanoma - a case report. Acta Oncol 2017; 56:1126-1131. [PMID: 28562201 DOI: 10.1080/0284186x.2017.1290274] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Hanne Falk
- a Department of Oncology , Herlev and Gentofte Hospital, Center for Experimental Drug and Gene Electrotransfer (CEDGE), University of Copenhagen , Herlev , Denmark
| | - Susanne Lambaa
- b Department of Plastic Surgery , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Helle Hjorth Johannesen
- c Department of Radiology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Gitte Wooler
- d Department of Pathology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Alessandro Venzo
- e Department of Plastic Surgery, Rigshospitalet , University of Copenhagen , Copenhagen , Denmark
| | - Julie Gehl
- a Department of Oncology , Herlev and Gentofte Hospital, Center for Experimental Drug and Gene Electrotransfer (CEDGE), University of Copenhagen , Herlev , Denmark
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Frandsen SK, Gehl J. Effect of calcium electroporation in combination with metformin in vivo and correlation between viability and intracellular ATP level after calcium electroporation in vitro. PLoS One 2017; 12:e0181839. [PMID: 28742810 PMCID: PMC5526525 DOI: 10.1371/journal.pone.0181839] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 07/08/2017] [Indexed: 02/07/2023] Open
Abstract
Background Calcium electroporation is a new experimental anti-cancer treatment where calcium is internalized into cells by application of short, high voltage pulses. Calcium electroporation has been shown to induce tumor necrosis associated with ATP depletion while the effect on normal fibroblasts was limited when investigated in a 3D in vitro spheroid model. We aimed to investigate the effect of calcium electroporation in combination with metformin, a drug that affects intracellular ATP level. We also aimed to study the relationship between the viability and intracellular ATP levels after calcium electroporation in vitro. Methods In this study, we investigated the effect of calcium electroporation with metformin on NMRI-Foxn1nu mice in vivo on tumor size, survival, and intracellular ATP. We further investigated viability and intracellular ATP level in vitro after calcium electroporation in two human cancer cell lines: Breast (MDA-MB231) and colon (HT29), and in normal human fibroblasts (HDF-n), as well as investigating viability in human bladder cancer cells (SW780) and human small cell lung cancer cells (H69) where we have previously published intracellular ATP levels. Results Calcium electroporation significantly reduced the size and ATP level of bladder cancer tumors treated in vivo but no increased effect of metformin combined with calcium electroporation was shown on neither tumor size, survival, nor ATP level. Calcium electroporation in vitro significantly decreased viability compared with calcium alone (p<0.0001 for calcium concentrations from 0.5 mM for H69, HDF-n, and MDA-MB231; p<0.0001 for calcium concentrations from 1 mM for HT29 and SW780). Intracellular ATP levels decreased significantly after calcium electroporation (p<0.05), however no correlation between intracellular ATP level and viability after treatment was observed. Conclusion Calcium electroporation caused reduced tumor size, increased survival, and acute ATP depletion in vivo. This effect was not augmented by metformin. Calcium electroporation is a possible novel anti-cancer treatment that has been shown to cause cell death associated with acute ATP depletion in vitro and in vivo.
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Affiliation(s)
- Stine Krog Frandsen
- Center for Experimental Drug and Gene Electrotransfer, Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer, Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- * E-mail:
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Mofid B, Shankayi Z, Novin K, Dehghani S, Shankayi M, Haghighatkhah H, Firoozabadi SM. Effective Treatment of Cervical Lymph Node Metastasis of Breast Cancer by Low Voltage High-Frequency Electrochemotherapy. Acta Med Iran 2017; 55:268-271. [PMID: 28532140] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2017] [Indexed: 06/07/2023] Open
Abstract
Electrochemotherapy (ECT) is a new local treatment method for solid and superficial tumors. During this new technique, patients experience an unpleasant sensation and slight edema. Most unpleasant and painful is mainly attributed to muscle contractions provoked by high amplitude and low repetition frequency pulses. Recently, we showed that electrochemotherapy using low voltage and higher repetition frequency (LVHF ECT) is an effective tool for inhibiting tumor growth and inducing cell permeabilization. Low voltage high-frequency electrochemotherapy was developed and optimized in vitro and in vivo which and can be used in the clinic. In the present study, we report a case of cervical lymph node metastasis of breast cancer treated by the technique. In our case, LVHF ECT was successful in reducing the size and palliating the symptoms of cervical lymph node metastasis in clinical conditions, whereas other approaches were inefficient. Our electrochemotherapy technique shows good clinical results. However, more studies on this new method are necessary to prove that LVHF ECT can be considered as a standard treatment modality.
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Affiliation(s)
- Bahram Mofid
- Department of Clinical Oncology, Shohada-e-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Shankayi
- Department of Medical Physics, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Kambiz Novin
- Department of Clinical Oncology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadegh Dehghani
- Department of Medical Physics, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Shankayi
- Department of Mechanic, School of Engineering, Tarbiat Modares University, Tehran, Iran
| | - Hamidreza Haghighatkhah
- Department of Radiology, Shohada-e-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Mohammad Firoozabadi
- Department of Medical Physics, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Tarantino L, Busto G, Nasto A, Fristachi R, Cacace L, Talamo M, Accardo C, Bortone S, Gallo P, Tarantino P, Nasto RA, Di Minno MND, Ambrosino P. Percutaneous electrochemotherapy in the treatment of portal vein tumor thrombosis at hepatic hilum in patients with hepatocellular carcinoma in cirrhosis: A feasibility study. World J Gastroenterol 2017; 23:906-918. [PMID: 28223736 PMCID: PMC5296208 DOI: 10.3748/wjg.v23.i5.906] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/14/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To treated with electrochemotherapy (ECT) a prospective case series of patients with liver cirrhosis and Vp3-Vp4- portal vein tumor thrombus (PVTT) from hepatocellular carcinoma (HCC), in order to evaluate the feasibility, safety and efficacy of this new non thermal ablative technique in those patients.
METHODS Six patients (5 males and 1 female), aged 61-85 years (mean age, 70 years), four in Child-Pugh A and two in Child-Pugh B class, entered our study series. All patients were studied with three-phase computed tomography (CT), contrast enhanced ultrasound (CEUS) and ultrasound-guided percutaneous biopsy of the thrombus before ECT. All patients underwent ECT treatment (Cliniporator Vitae®, IGEA SpA, Carpi, Modena, Italy) of Vp3-Vp4 PVTT in a single session. At the end of the procedure a post-treatment biopsy of the thrombus was performed. Scheduled follow-up in all patients entailed: CEUS within 24 h after treatment; triphasic contrast-enhanced CT and CEUS at 3 mo after treatment and every six months thereafter.
RESULTS Post-treatment CEUS showed complete absence of enhancement of the treated thrombus in all cases. Post-treatment biopsy showed apoptosis and necrosis of tumor cells in all cases. The follow-up ranged from 9 to 20 mo (median, 14 mo). In 2 patients, the follow-up CT and CEUS demonstrated complete patency of the treated portal vein. Other 3 patients showed a persistent avascular non-tumoral shrinked thrombus at CEUS and CT during follow-up. No local recurrence was observed at follow-up CT and CEUS in 5/6 patients. One patient was lost to follow-up because of death from gastrointestinal hemorrage 5 wk after ECT.
CONCLUSION In patients with cirrhosis, ECT seems effective and safe for curative treatment of Vp3-Vp4 PVTT from HCC.
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Suzuki DOH, Berkenbrock JA, de Oliveira KD, Freytag JO, Rangel MMM. Novel application for electrochemotherapy: Immersion of nasal cavity in dog. Artif Organs 2016; 41:767-773. [PMID: 28028827 DOI: 10.1111/aor.12858] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Received: 06/08/2016] [Revised: 07/19/2016] [Accepted: 08/17/2016] [Indexed: 12/11/2022]
Abstract
Electrochemotherapy is a new modality of local cancer treatment that increases the delivery of chemotherapy drugs into tumor cells by applying intense electric fields. This novel electrochemotherapy application was applied as an adjuvant to surgery and eliminated intranasal tumors in dog. The treatment challenges are the surgery limitations due to anatomy and residual tumor in the bone cavity. Most of the tumoral mass on nasal cavity was surgically removed. The internal nasal cavity was immersed in liquid and bleomycin before applying electric field. The solution was necessary to increase the superficial contact between plate electrodes and residual tumor. The numerical study demonstrated electrochemotherapy efficiency in different clinical situations. The proximity between electrodes and bone (<3 mm) and bone irregularities affect the electric field distribution on tumoral tissue. The tumoral tissue around bone protuberances tends to be eliminated. Electrochemotherapy with plate electrodes inside the cavity might not be effective. Different values of electric conductivity solution were studied; the ideal value was 0.5 S/m. The numerical and experimental results confirm the successful application of electrochemotherapy on dog nasal cavity.
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Affiliation(s)
- Daniela O H Suzuki
- Institute of Biomedical Engineering, Federal University of Santa Catarina (UFSC), Florianópolis-SC
| | - José A Berkenbrock
- Institute of Biomedical Engineering, Federal University of Santa Catarina (UFSC), Florianópolis-SC
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Rotunno R, Marenco F, Ribero S, Calvieri S, Amerio P, Curatolo P, Quaglino P. Electrochemotherapy in non-melanoma head and neck skin cancers: a three-center experience and review of the literature. GIORN ITAL DERMAT V 2016; 151:610-618. [PMID: 26376042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The main purposes of this study were to evaluate the efficacy of electrochemotherapy in head and neck tumors, to assess local tumor control, its safety profile and its impact on the patients' quality of life. METHODS This is a multicenter prospective, non-randomized phase II trial. This trial was carried out at the Dermatology Clinic of the "Sapienza" University of Rome, at the Dermatology Clinic of the University of Chieti and at the Dermatology Clinic of the University of Turin. Fifty-five patients with head and neck cancer were recruited. Electrochemotherapy was carried out according to the ESOPE guidelines. Statistical analyses were performed using Stata/SE v.12.0 Statistical Software. RESULTS A significant clinical response was achieved in 50/55 patients with 91% of objective response rate (OR). Thirty-three out of 55 patients showed a complete response (CR) (60%); 17 treated patients had a partial response (PR) (31%). A significantly higher CR rate was obtained in patients not previously treated by surgery (15/19; 79%), with respect to those with a previous excision of the tumor (14/30; 47%) (P=0.025). An additional parameter influencing response is represented by anesthesia: patients treated by ECT with general anesthesia were characterized by significantly higher CR rate (68%) than those treated with local anesthesia (27%) (P=0.014). CONCLUSIONS Our experience confirmed high efficiency in local tumor control, excellent toxicity profile, tissue preservation with good cosmetic and functional results, even with repeated applications. ECT can represent a first-line treatment in the local management of head and neck cancers.
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Affiliation(s)
- Roberta Rotunno
- Dermatology and Plastic Surgery Clinic, "Sapienza" University, Rome, Italy -
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van Rijssen LB, Rombouts SJE, Walma MS, Vogel JA, Tol JA, Molenaar IQ, van Eijck CHJ, Verheij J, van de Vijver MJ, Busch ORC, Besselink MGH. Recent Advances in Pancreatic Cancer Surgery of Relevance to the Practicing Pathologist. Surg Pathol Clin 2016; 9:539-545. [PMID: 27926358 DOI: 10.1016/j.path.2016.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 06/06/2023]
Abstract
Recent advances in pancreatic surgery have the potential to improve outcomes for patients with pancreatic cancer. We address 3 new, trending topics in pancreatic surgery that are of relevance to the pathologist. First, increasing awareness of the prognostic impact of intraoperatively detected extraregional and regional lymph node metastases and the international consensus definition on lymph node sampling and reporting. Second, neoadjuvant chemotherapy, which is capable of changing 10% to 20% of initially unresectable, to resectable disease. Third, in patients who remain unresectable following neoadjuvant chemotherapy, local ablative therapies may change indications for treatment and improve outcomes.
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Affiliation(s)
- Lennart B van Rijssen
- Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Steffi J E Rombouts
- Department of Surgery, University Medical Center, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Marieke S Walma
- Department of Surgery, University Medical Center, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Jantien A Vogel
- Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Johanna A Tol
- Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Isaac Q Molenaar
- Department of Surgery, University Medical Center, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Casper H J van Eijck
- Department of Surgery, Erasmus Medical Center, Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
| | - Joanne Verheij
- Department of Pathology, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Marc J van de Vijver
- Department of Pathology, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Olivier R C Busch
- Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Marc G H Besselink
- Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands.
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Tomassini GM, Covarelli P, Tomassini MA, Corsi A, Bianchi L, Hansel K, Stingeni L. Electrochemotherapy with intravenous bleomycin for advanced non-melanoma skin cancers and for cutaneous and subcutaneous metastases from melanoma. GIORN ITAL DERMAT V 2016; 151:499-506. [PMID: 27595201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The treatment of cutaneous advanced non-melanoma skin cancers (NMSC) and multiple cutaneous and subcutaneous melanoma metastases (Mm) represents a main therapeutic challenge. Electrochemotherapy (ECT) is an anticancer procedure that facilitates the penetration of cytotoxic drugs into cancer cells by means of the application of electrical pulses. The aim of our study was to evaluate efficacy and tolerability of ECT in the treatment of advanced NMSC and Mm. METHODS Thirteen patients with a total of 88 cutaneous and subcutaneous tumour lesions were selected (69 Mm in 6 patients and 19 NMSC in 7 patients). The lesions were divided into "Target" (NMSC: 7; Mm: 9) and "Non -target" (NMSC: 12; Mm: 60) lesions according to RECIST criteria 1.1. All patients underwent ECT under mild general anaesthesia. Eight minutes following intravenous bleomycin, electrical pulses were delivered to the tumour nodules using a square wave pulse generator (CliniporatorTM, IGEA S.p.A., Carpi, Italy). RESULTS A complete response of "Target" NMSC lesions and "Target" Mm nodules was observed in 85.7% (6/7) and 33.3% (3/9), respectively. Only one NMSC underwent two courses of treatment, achieving a complete response 1 month after the second ECT session. Among Mm, 6 of 9 "Target" lesions received more than one ECT session, achieving a size reduction in 3 of 6 lesions. This improvement, however, was not classified as partial response because the size reduction was lower than 30%. In 1 patient, one Mm "Target" lesion increased in volume while other two "Target" lesions appeared stable. No statistically significant difference was observed, between the size of the lesions before treatment and after treatment, nevertheless statistical significance was achieved in the "Target" lesions comparing the response to ECT of NMSC group vs. Mm group (P<0.05). CONCLUSIONS Our study confirms the potential therapeutic role of ECT. This procedure could represent the 1st line treatment for advanced NMSC, especially in elderly patients not suitable for surgery or radiotherapy. As already described in literature, we hereby validate the effective role of ECT in the palliation of Mm.
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Affiliation(s)
- Gian M Tomassini
- Clinical Allergological and Venereological Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy -
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Heppt MV, Eigentler TK, Kähler KC, Herbst RA, Göppner D, Gambichler T, Ulrich J, Dippel E, Loquai C, Schell B, Schilling B, Schäd SG, Schultz ES, Matheis F, Tietze JK, Berking C. Immune checkpoint blockade with concurrent electrochemotherapy in advanced melanoma: a retrospective multicenter analysis. Cancer Immunol Immunother 2016; 65:951-9. [PMID: 27294607 PMCID: PMC11029138 DOI: 10.1007/s00262-016-1856-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/03/2016] [Indexed: 01/20/2023]
Abstract
Growing evidence suggests that concurrent loco-regional and systemic treatment modalities may lead to synergistic anti-tumor effects in advanced melanoma. In this retrospective multicenter study, we evaluate the use of electrochemotherapy (ECT) combined with ipilimumab or PD-1 inhibition. We investigated patients with unresectable or metastatic melanoma who received the combination of ECT and immune checkpoint blockade for distant or cutaneous metastases within 4 weeks. Clinical and laboratory data were collected and analyzed with respect to safety and efficacy. A total of 33 patients from 13 centers were identified with a median follow-up time of 9 months. Twenty-eight patients received ipilimumab, while five patients were treated with a PD-1 inhibitor (pembrolizumab n = 3, nivolumab n = 2). The local overall response rate (ORR) was 66.7 %. The systemic ORR was 19.2 and 40.0 % in the ipilimumab and PD-1 cohort, respectively. The median duration of response was not reached in either group. The median time to disease progression was 2.5 months for the entire population with 2 months for ipilimumab and 5 months for PD-1 blockade. The median overall survival was not reached in patients with ipilimumab and 15 months in the PD-1 group. Severe systemic adverse events were detected in 25.0 % in the ipilimumab group. No treatment-related deaths were observed. This is the first reported evaluation of ECT and simultaneous PD-1 inhibition and the largest published dataset on ECT with concurrent ipilimumab. The local response was lower than reported for ECT only. Ipilimumab combined with ECT was feasible, tolerable and showed a high systemic response rate.
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Affiliation(s)
- Markus V Heppt
- Department of Dermatology and Allergy, Munich University Hospital (LMU), Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Thomas K Eigentler
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Germany
| | - Katharina C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105, Kiel, Germany
| | - Rudolf A Herbst
- HELIOS Skin Cancer Center Erfurt, HELIOS Clinic Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany
| | - Daniela Göppner
- Department of Dermatology and Venereology, Otto-von-Guericke-University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Thilo Gambichler
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Jens Ulrich
- Department of Dermatology, Harzklinikum Dorothea Christiane Erxleben, Ditfurter Weg 24, 06484, Quedlinburg, Germany
| | - Edgar Dippel
- Department of Dermatology, Clinical Center Ludwigshafen, Bremserstr. 79, 67073, Ludwigshafen, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Beatrice Schell
- Department of Dermatology, SRH Wald-Klinikum Gera GmbH, Str. des Friedens 122, 07548, Gera, Germany
| | - Bastian Schilling
- Department of Dermatology, University Hospital, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Susanne G Schäd
- Department of Dermatology and Venereology, University Medical Center Rostock, Strempelstr.13, 18057, Rostock, Germany
| | - Erwin S Schultz
- Department of Dermatology, General Hospital Nuremberg, Paracelsus Medical University, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Fanny Matheis
- Department of Dermatology and Allergy, Munich University Hospital (LMU), Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Julia K Tietze
- Department of Dermatology and Allergy, Munich University Hospital (LMU), Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, Munich University Hospital (LMU), Frauenlobstr. 9-11, 80337, Munich, Germany.
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Wang X, Ip M, Leung AW, Wang P, Zhang H, Hua H, Xu C. Sonodynamic action of hypocrellin B on methicillin-resistant Staphylococcus aureus. Ultrasonics 2016; 65:137-44. [PMID: 26482395 DOI: 10.1016/j.ultras.2015.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/27/2015] [Accepted: 10/05/2015] [Indexed: 05/19/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) commonly causes refractory infections and has recently become a serious public health concern. The present study was designed to investigate sonodynamic action of hypocrellin B on MRSA. A MRSA strain (ATCC BAA-43) was used in the present study. The dark toxicity of hypocrellin B on MRSA and its uptake in MRSA first were measured. And then bacteria were incubated with hypocrellin B and exposed to ultrasound. After sonodynamic treatment, colony forming unit assay and bacterial viability assay were conducted. Membrane permeability assay, DNA fragmentation assay, and DNA synthesis assay were also performed to examine the underlying mechanism. The results showed that hypocrellin B at concentrations of up to 500 μM had no toxicity to MRSA in the dark. After incubation for 50 min, hypocrellin B could be maximally absorbed by MRSA, and exhibited significant sonodynamic activity in a dose-dependent manner. The 5-log reduction in colony forming unit (CFU) was observed after hypocrellin B (40 μM) treatment at an intensity of 1.38 W/cm(2) ultrasound for 5 min. Compared to the control, hypocrellin B alone and ultrasound sonication alone group, more dead cells were found and bacterial membrane integrity was notably damaged after sonodynamic treatment of hypocrellin B. However, no remarkable DNA damage was found in MRSA after sonodynamic treatment of hypocrellin B. All the findings demonstrated that hypocrellin B could serve as a potential antibacterial sonosensitizer to significantly cause damage to the membrane integrity of MRSA and inhibit its growth under ultrasound sonication.
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Affiliation(s)
- Xinna Wang
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Albert Wingnang Leung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Pan Wang
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hongwei Zhang
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Heyu Hua
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chuanshan Xu
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Xiang X, Tang Y, Leng Q, Zhang L, Qiu L. Targeted gene delivery to the synovial pannus in antigen-induced arthritis by ultrasound-targeted microbubble destruction in vivo. Ultrasonics 2016; 65:304-314. [PMID: 26433434 DOI: 10.1016/j.ultras.2015.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/09/2015] [Accepted: 09/16/2015] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to optimize an ultrasound-targeted microbubble destruction (UTMD) technique to improve the in vivo transfection efficiency of the gene encoding enhanced green fluorescent protein (EGFP) in the synovial pannus in an antigen-induced arthritis rabbit model. A mixture of microbubbles and plasmids was locally injected into the knee joints of an antigen-induced arthritis (AIA) rabbits. The plasmid concentrations and ultrasound conditions were varied in the experiments. We also tested local articular and intravenous injections. The rabbits were divided into five groups: (1) ultrasound+microbubbles+plasmid; (2) ultrasound+plasmid; (3) microbubble+plasmid; (4) plasmid only; (5) untreated controls. EGFP expression was observed by fluorescent microscope and immunohistochemical staining in the synovial pannus of each group. The optimal plasmid dosage and ultrasound parameter were determined based on the results of EGFP expression and the present and absent of tissue damage under light microscopy. The irradiation procedure was performed to observe the duration of the EGFP expression in the synovial pannus and other tissues and organs, as well as the damage to the normal cells. The optimal condition was determined to be a 1-MHz ultrasound pulse applied for 5 min with a power output of 2 W/cm(2) and a 20% duty cycle along with 300 μg of plasmid. Under these conditions, the synovial pannus showed significant EGFP expression without significant damage to the surrounding normal tissue. The EGFP expression induced by the local intra-articular injection was significantly more increased than that induced by the intravenous injection. The EGFP expression in the synovial pannus of the ultrasound+microbubbles+plasmid group was significantly higher than that of the other four groups (P<0.05). The expression peaked on day 5, remained detectable on day 40 and disappeared on day 60. No EGFP expression was detected in the other tissues and organs. The UTMD technique can significantly enhance the in vivo gene transfection efficiency without significant tissue damage in the synovial pannus of an AIA model. Thus, this could become a safe and effective non-viral gene transfection procedure for arthritis therapy.
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Affiliation(s)
- Xi Xiang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yuanjiao Tang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qianying Leng
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lingyan Zhang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Li Qiu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Filipovic N, Saveljic I, Jovicic N, Tanaskovic I, Zdravkovic N. Computational and experimental model of electroporation for human aorta. Acta Bioeng Biomech 2016; 18:15-20. [PMID: 28133381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE In this study the computational and experimental electroporation model with human aorta tissue is made in order to examine the reduction of smooth muscle cells. METHODS The segments in native state of the aorta are treated by electroporation method through a series of electrical impulses from 50 V/cm to 2500 V/cm. For each patient we analyzed one sample with and one sample without electroporation as a control. In the computational study, electrical field distribution is solved by the Laplace equation. The Pennes Bioheat equation without metabolism and blood perfusion heating is used to solve heat transfer problems. Different conductivity values are used in order to fit the experimental results. RESULTS Experimental histology has shown us that there are a smaller number of vascular smooth muscle cells (VSMC) nuclei at the tunica media, while the elastic fibre morphology is maintained 24 h after electroporation. In the computational model, heat generation coupled with electrical field is included. The fitting procedure is applied for conductivity values in order to make material properties of the aorta tissue. The fitting procedure gives tissue conductivity of 0.44 [S/m] for applied electrical field of 2500 V/cm. CONCLUSIONS Future studies are necessary for investigation of a new device for in-vivo ablation with electroporation of plaque stenosis. It will open up a new avenue for stenosis treatment without stent implantation.
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Affiliation(s)
- Nenad Filipovic
- Faculty of Engineering, University of Kragujevac, Kragujevac, Serbia
| | - Igor Saveljic
- Faculty of Engineering, University of Kragujevac, Kragujevac, Serbia
| | - Nemanja Jovicic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Irena Tanaskovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Nebojsa Zdravkovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Zygogianni A, Kyrgias G, Scarlatos J, Koukourakis M, Souliotis K, Kouvaris J, Kelekis N, Kouloulias V. Potential Role of Electrochemotherapy as Anticancer Treatment for Cutaneous and Subcutaneous Lesions. Asian Pac J Cancer Prev 2016; 17:3753-3757. [PMID: 27644612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate whether electrochemotherapy is a clinically and cost-effective treatment option against skin tumors. MATERIALS AND METHODS We performed an analysis of the current literature based on database searches in PubMed/MEDLINE and we included articles till July 2012. Terms used for the search were 'electrochemotherapy', 'skin cancer', 'recurrence', and 'cutaneous and subcutaneous tumors'. Only papers published in English were included. In addition, we performed an analysis of the cost effectiveness of the method. RESULTS The combination of physics and chemistry is the foundation for electrochemotherapy and its efficacy, independent of the tumor histology. Clinical data showed that ECT is well tolerated and can be used in difficult cases without other available treatment options. The analysis also showed that the treatment is feasible and cost-effective. CONCLUSIONS Electrochemotherapy is a clinically efficient, safe and cost-effective treatment and clinicians should not hesitate to use it as an alternative therapeutic modality or as palliative treatment.
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Affiliation(s)
- Anna Zygogianni
- Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, Kapodistrian University of Athens, Greece E-mail :
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