Ultrasound contrast agents nucleate inertial cavitation in vitro

Erosion of artificial endothelia in vitro by pulsed ultrasound: acoustic pressure, frequency, membrane orientation and microbubble contrast agent dependence

The erosion of cells from fibroblast monolayers simulating the vascular endothelium by 20 micros pulses of ultrasound at 500 Hz PRF was studied in relation to the peak negative acoustic pressure (P-; 0.0-2.5 MPa), ultrasound (US) frequency (1.0, 2.1 or 3.5 MHz), orientation of the monolayer (i.e., simulating the sites of ultrasound entry/exit from a blood vessel) and the presence or absence of a microbubble contrast agent (3 Vol% Albunex). The a priori hypotheses were that erosion of the monolayers would: 1. arise due to insonation treatment, 2. arise as a consequence of cavitation activity and, thus, increase with increasing P- at constant frequency, and decrease with increasing frequency at constant P-, 3. be significantly increased by the presence of a microbubble contrast agent, and 4. have a weak dependence on monolayer orientation. The data support these hypotheses. Under the most severe exposure conditions used, most of the affected cells appeared to have been lysed; however, a substantial number of viable cells were dislodged from the monolayer surface.

Effect of high-intensity focused ultrasound on whole blood with and without microbubble contrast agent

Using human whole blood samples with and without contrast agent (CA), we evaluated the effect of exposures to focused, continuous wave (CW) 1.1-MHz ultrasound for durations of 10 ms to 1 s at spatial average intensities of 560 to 2360 W/cm2. Cavitation was monitored with a passive cavitation detector and hemolysis was determined with spectroscopy. In whole blood alone, no significant cavitation, heating or hemolysis was detected at any exposure condition. Conversely, cavitation and hemolysis, but not heating, were detected in whole blood with CA. A CA concentration as low as 0.28 microL CA per mL whole blood at an intensity of 2360 W/cm2 for 1 s resulted in measurable cavitation and a 6-fold increase in hemolysis compared to shams. Cavitation and hemolysis increased proportional to the concentration of CA and duration of exposure. In samples containing 4.2 microL CA per mL whole blood exposed for 1 s, a threshold was seen at 1750 W/cm2 where cavitation and hemolysis increased 10-fold compared to exposures at lower intensities. HIFU exposure of whole blood containing CA leads to significant hemolysis in vitro and may lead to clinically significant hemolysis in vivo.

Shock wave-inertial microbubble interaction: methodology, physical characterization, and bioeffect study

A method of generating in situ shock wave-inertial microbubble interaction by a modified electrohydraulic shock wave lithotripter is proposed and tested in vitro. An annular brass ellipsoidal reflector (thickness = 28 mm) that can be mounted on the aperture rim of a Dornier XL-1 lithotripter was designed and fabricated. This ring reflector shares the same foci with the XL-1 reflector, but is 15 mm short in major axis. Thus, a small portion of the spherical shock wave, generated by a spark discharge at the first focus (F1) of the reflector, is reflected and diffracted by the ring reflector, producing a weak shock wave approximately 8.5 microseconds in front of the lithotripter pulse. Based on the configuration of the ring reflector (different combinations of six identical segments), the peak negative pressure of the preceding weak shock wave at the second focus (F2) can be adjusted from -0.96 to -1.91 MPa, at an output voltage of 25 kV. The preceding shock wave induces inertial microbubbles, most of which expand to a maximum size of 100-200 microns, with a few expanding up to 400 microns before being collapsed in situ by the ensuing lithotripter pulse. Physical characterizations utilizing polyvinylidene difluoride (PVDF) membrane hydrophone, high-speed shadowgraph imaging, and passive cavitation detection have shown strong secondary shock wave emission immediately following the propagating lithotripter shock front, and microjet formation along the wave propagation direction. Using the modified reflector, injury to mouse lymphoid cells is significantly increased at high exposure (up to 50% with shock number > 100). With optimal pulse combination, the maximum efficiency of shock wave-induced membrane permeabilization can be enhanced substantially (up to 91%), achieved at a low exposure of 50 shocks. These results suggest that shock wave-inertial microbubble interaction may be used selectively to either enhance the efficiency of shock wave-mediated macromolecule delivery at low exposure or tissue destruction at high exposure.

Sonolysis of Albunex-supplemented, 40% hematocrit human erythrocytes by pulsed 1-MHz ultrasound: pulse number, pulse duration and exposure vessel rotation dependence

The hypotheses tested were that sonolysis of erythrocytes in the presence of a gas-based ultrasound contrast agent in vitro will be related quantitatively to the duration and number of ultrasound pulses applied using a constant pulse repetition period and, at least qualitatively, to the total exposure duration (i.e., the product of pulse number x pulse duration). An objective was to determine the influence of sample rotation during insonation on the amount of hemolysis produced under these conditions. Human erythrocytes, suspended to 40% hematocrit in autologous plasma containing 3.6% (V:V) Albunex, were exposed/sham-exposed to 1-100 pulses of 1-MHz ultrasound (6.2 MPa peak positive, 3.6 MPa peak negative acoustic pressures; I(SPTP) approximately 800 W/cm2) using a 1-s pulse repetition period. Pulse durations ranged from 20-20,000 micros; samples were either stationary or rotated (200 rpm) during insonation. Hemolysis was independent of vessel rotation treatment at all tested pulse durations and pulse numbers. Levels of hemolysis statistically greater than in sham-exposed samples were obtained with > or = 50 pulses of 20 micros duration, and > or = 1 pulse of 200, 2000 or 20,000 micros duration. Hemolysis increased with increasing pulse number and pulse duration. Approximately equivalent levels of hemolysis were produced by different pulse number x pulse duration combinations, yielding the same total exposure duration.

Sonoporation of cultured cells in the rotating tube exposure system

Suspensions of Chinese hamster ovary cells were exposed to ultrasound in the presence of fluorescent dextran to determine the conditions needed for sonoporation with uptake of the large molecules. Albunex, a gas-body- based ultrasound contrast agent, was added to enhance cavitation. Ultrasound was continuous wave at frequencies of 1.0, 1.68, 2.25, 3.3, 5.3, and 7.15 MHz. Sterile 4.5-mL exposure chambers were rotated at 60 rpm to promote cavitation activity during the 1-min exposures. After exposure, cells were tested for sonoporation by counting fluorescent cells and for cell lysis by counting cells stained by trypan blue. Sonoporation was a sensitive bioeffects indicator that was detected at pressure amplitudes lower than were needed for transient cavitation or cavitation-induced cell lysis. For 10% Albunex, apparent thresholds for sonoporation, which were comparable to the levels required to perturb the gas bodies, were 0.084 MPa (spatial peak negative pressure amplitude) from 1.0-3.3 MHz and 0.27 MPa at 5.3 and 7.15 MHz. Sonoporation decreased slightly if the tube was not rotated. The effects increased for increasing Albunex concentration (with rotation). The plating efficiency of cells exposed to 0.2 MPa at 2.25 MHz and sorted by a flow cytometer was 19% (3.6% standard deviation [SD]) for fluorescent cells, compared to 67% (1% SD) for nonfluorescent exposed cells and 62% (6% SD) for sham-exposed cells. The reduced viability represents an important consideration for possible applications of sonoporation.

Frequency relationships for ultrasonic activation of free microbubbles, encapsulated microbubbles, and gas-filled micropores

The ultrasonic activation of free microbubbles, encapsulated microbubbles, and gas-filled micropores was explored using available linear theory. Encapsulated microbubbles, used in contrast agents for diagnostic ultrasound, have relatively high resonance frequencies and damping. At 2 MHz the resonance radii are 1.75 microns for free microbubbles, 4.0 microns for encapsulated microbubbles, and 1.84 microns for gas-filled micropores. Higher-pressure amplitudes are needed to elicit equivalent subharmonic, fundamental, or second-harmonic responses from the encapsulated microbubbles, and this behavior increases for higher frequencies. If an encapsulated microbubble becomes destabilized during exposure,the resulting liberated microbubble would be about twice the linear resonance size, which would be likely to produce subharmonic signals. Scattered signals used for medical imaging purposes may be indicative of bioeffects potential: The second harmonic signal is proportional to local shear stress for a microbubble on a boundary, and a strong subharmonic signal may imply destabilization and nucleation of free-microbubble cavitation activity. The potential for bioeffects from contrast agent gas bodies decreases rapidly with increasing frequency. This information should be valuable for understanding of the etiology of bioeffects related to contrast agents and for developing exposure indices and risk management strategies for their use in diagnostic ultrasound.

Sonochemicals increase the mutation frequency of V79 cells in vitro

Phosphate buffered saline (PBS) was insonated or sham-insonated (1 MHz, 35 W/cm2, continuous wave, 30 min) in rotating (200 rpm) sterile polystyrene culture tubes. After treatment, the PBS was used immediately to suspend washed Chinese hamster V79 cells in vitro. Cells were incubated in the PBS at 37 degrees C for 15 min and then transferred to complete growth medium. Some insonation regimens also involved the inclusion of Albunex (ALX; an ultrasound microbubble contrast agent) to enhance ultrasound-induced inertial cavitation. Following exposure to the pretreated PBS and 6 d of subculture in complete medium, the cells were assayed for plating efficiencies and mutation frequencies (resistance to 6-thioguanine). X-rays (3 Gy) served as a positive control. Cells exposed to insonated PBS with or without ALX or x-rays had statistically significantly elevated mean mutation frequencies (4.37+/-0.97, 4.54+/-1.00, and 24.28+/-3.83 mutant colonies/10(6) viable cells, respectively) relative to corresponding control regimens (ultrasound sham, 2.44+/-0.56; x-ray sham, 2.96+/-0.88 mutant colonies/10(6) viable cells. The data supported the hypothesis that sonochemicals resulting from inertial cavitation have mutagenic potential.

Effect of gas-containing microspheres and echo contrast agents on free radical formation by ultrasound

Stabilized microbubbles (microspheres) are widely used to enhance the contrast of ultrasound imaging. Our data provide direct evidence that the contrast agents, Levovist, PVC-AN (polyvinylidene chloride-acrylonitryl copolymer), and Albunex (compared to 5% human albumin), at concentrations comparable to those used for ultrasound imaging, enhance H2O2 production (through the superoxide-dependent pathway) in air-saturated aqueous solutions exposed to 47 kHz ultrasound above the cavitation threshold. These agents also act as scavengers of .H atoms and .OH radicals, thus lowering H2O2 formation (by recombination of .OH radicals) in argon-saturated solutions. EPR spin trapping also reveals that secondary radicals derived from the contrast agents are produced by reactions with .H and .OH which are formed by pyrolysis of water inside cavitation bubbles. In addition, the contrast agents themselves undergo pyrolysis reactions in the cavitation bubbles as demonstrated by formation of methyl radicals. Possible deleterious consequences of the formation of sonochemical intermediates may have to be assessed, particularly since some of the echo contrast agents have been shown to lower the cavitation threshold of diagnostic ultrasound. Unlike the microspheres formed from organic molecules, inorganic microspheres, Eccospheres, because of their stability and inert nature with respect to participation in free radical processes, appear to be suitable tools for enhancing the yields of aqueous sonochemical reactions.

Artificial cavitation nuclei significantly enhance acoustically induced cell transfection

The efficiency of ultrasound-mediated gene transfection was enhanced three- to fourfold, compared to previous results, through the use of green fluorescent protein reporter gene, cultured immortalized human chondrocytes and artificial cavitation nuclei in the form of Albunex. Cells were exposed to 1.0-MHz ultrasound transmitted through the bottom of six-well culture plates containing immortalized chondrocytes, media, DNA at a concentration of 40 micrograms/mL and Albunex at 50 x 10(6) bubbles/mL. Transfection efficiency increased linearly with ultrasound exposure pressure with a transfection threshold observed at a spatial average peak positive pressure (SAPP) of 0.12 MPa and reaching about 50% of the living cells when exposed to 0.41 MPa SAPP for 20 s. Adding fresh Albunex at 50 x 10(6) bubbles/mL prior to sequential 1-s, 0.32- or 0.41-MPa exposures increased transfection with each exposure, reaching 43% transfection after four exposures. Efficient in vitro and in vivo transfection now appear possible with these enhancements.

Enhancement of ultrasonically-induced hemolysis by perfluorocarbon-based compared to air-based echo-contrast agents

Hemolysis induced by ultrasonic activation of various contrast-agent gas bodies was investigated. Canine whole blood, with high concentrations of the agents held in 1 mm thick chambers, was exposed in the nearfield of a 2.4-MHz ultrasound beam in a 37 degrees C water bath. Sterile phosphate buffered saline (PBS) served as a control agent without gas bodies. Albunex (Mallinckrodt Medical, St. Louis, MO) and Levovist (Schering AG, Berlin, Germany) represented the air-based contrast agents. The experimental agents FS069 (Optison, Molecular Biosystems Inc., San Diego, CA) and modified MRX-130 (ImaRx Pharmaceutical Corp., Tucson, AZ) represented perfluorocarbon-based contrast agents. No significant ultrasonically-induced hemolysis was detected for the PBS or Levovist suspensions. After 1 s continuous exposure, ultrasonically-induced hemolysis was significant for Albunex at 0.4 MPa or higher pressure amplitudes, for FS069 at 0.2 MPa and for modified MRX-130 at 0.4 MPa. Hemolysis found after pulsed exposure with 10 micros pulses and 1 ms pulse repetition period was significant for Albunex, FS069 and modified MRX-130 above thresholds of 1.1 MPa, 0.57 MPa and 1.6 MPa, respectively. FS069 led to more hemolysis after pulsed mode exposures of 1 s duration or longer than did Albunex. Reduced concentrations of gas bodies gave increased thresholds and reduced hemolysis. These results indicate that improvements in persistence of contrast agents, which increase their clinical utility, may also enhance the potential for cavitational bioeffects.

The relationship of scattered subharmonic, 3.3-MHz fundamental and second harmonic signals to damage of monolayer cells by ultrasonically activated Albunex

Cultured Chinese hamster ovary cells attached to thin Mylar sheets were exposed to 3.3-MHz ultrasound in the presence of Albunex ultrasound contrast agent. The ultrasound beam was directed upward at the exposure chamber with the monolayer on the inside of the upper acoustic window. Cell membrane damage was detected by the firefly enzyme assay for released ATP and the subharmonic, fundamental, and second harmonic scattered signals were recorded. ATP release increased monotonically with increasing pressure amplitude above apparent thresholds of 0.28 MPa for 1-s continuous and 0.56 MPa for 100-s pulsed (10-microseconds pulses, 1-ms PRP) exposures with 5% Albunex. The subharmonic signal and, to a lesser extent, the second harmonic signal both increased with the cell membrane damage, which suggests that these signals have predictive value for bioeffects. If the monolayer was positioned on the front window of the exposure chamber, cell membrane damage was greatly reduced, which confirms the protective influence of this configuration of monolayers reported in the literature. The effect decreased both at high (50%) or low (0.5%) concentrations of Albunex. The strong nonlinear scattering of ultrasound by contrast agent gas bodies appears to provide useful indicators of gas body activity including cavitational bioeffects.

Ultrasonically induced hemolysis at high cell and gas body concentrations in a thin-disc exposure chamber

Ultrasound image contrast may be enhanced by injecting gas bodies into the blood. This in vitro study was undertaken to assess the potential for induction of hemolysis due to ultrasonic activation of the contrast agent gas bodies. Canine whole blood with Albunex (Mallinckrodt Medical, St. Louis, MO, USA) was exposed to near-field ultrasound beams in 1-mm-thick chambers held stationary (i.e., not rotated) in a 37 degrees C water bath. At 2.25 MHz, statistically significant hemolysis occurred in 0.5 hematocrit, 50% Albunex suspensions for 0.28-MPa, 1-s continuous exposure and for 0.58-MPa, 100-s exposures with 10-microsecond pulses and 1.0-ms pulse repetition period. Continuous exposure durations as short as 10 ms produced about 4.5% hemolysis, which only increased slightly to about 5.5% after 100 s. At a constant 1.6 MPa, hemolysis increased with increasing gas body concentration and with decreasing cell concentration. Hemolysis decreased with increasing frequency in a 50/50 mixture of whole blood and Albunex, with thresholds rising from 0.12 MPa continuous (1 s) and 0.47 MPa pulsed (10 microseconds:1.0 ms for 100 s) at 1.06 MHz to 0.47 MPa continuous and 1.9 MPa pulsed at 5.3 MHz.

Ultrasound contrast media and their use in obstetrics and gynecology

Contrast media have gained acceptance to enhance ultrasonography in many fields of medicine; in particular, cardiology. Several agents have been described and many more are being manufactured and tested. By increasing the number of strong sound scatterers, these agents improve images by increasing the amount of echoes. This is true both for grey-scale and color or Doppler imaging. Their use in obstetrics is very limited at the moment because of safety issues. In a laboratory setup, they have been shown to markedly enhance placental imaging. In gynecology, imaging of the uterine cavity and Fallopian tubes is greatly improved. A potential area where ultrasound contrast may find a role is gynecological oncology. Vascularity is increased in many tumors, but usually vessel diameter is small and velocity low. One can therefore expect future use of the ultrasound contrast agents in ovarian or other gynecological neoplasms.

Transfection of a reporter plasmid into cultured cells by sonoporation in vitro

Cultured Chinese hamster ovary cells were exposed to 2.25-MHz ultrasound in sterile 4.5-mL polyethylene chambers and tested for cell lysis, sonoporation and DNA transfection. Ten percent of Albunex, a gas-body-based ultrasound contrast agent, was added to ensure cavitation nucleation, and the chambers were rotated at 60 rpm to promote cavitation activity during the 1-min exposures. Uptake of large fluorescent dextran molecules by some cells was observed for spatial peak pressure amplitudes as low as 0.1 MPa, which indicates transient permeabilization and resealing, i.e., sonoporation, of these cells during exposure. Significant lysis occurred for 0.2 MPa, and increased rapidly for exposures above the apparent cavitation threshold (using the H2O2 production test) of about 0.4 MPa spatial peak pressure amplitude. In the DNA transfection tests, 20 micrograms/mL luciferase reporter plasmid was added to the suspension during exposure, and cells were assayed for proliferation ability and luciferase gene expression 2 days after exposure. Cell proliferation was greatly reduced above the cavitation threshold. Luciferase production was significant for 0.20-MPa exposure, and reached 0.33 ng per 10(6) cells at 0.8-MPa exposure. The luciferase production was great for cells exposed in medium supplemented with serum than for cells exposed in serum-free medium. Cells harvested for exposure either in the log phase or in the stationary phase of culture gave similar proliferation and transfection results. The effects essentially disappeared when the Albunex was omitted from the suspension and the tube was not rotated. Thus, sonoporation by ultrasonic cavitation in the rotating tube system yields plasmid transfection with subsequent transient gene expression.

Hemolysis of 40% hematocrit, Albunex-supplemented human erythrocytes by pulsed ultrasound: frequency, acoustic pressure and pulse length dependence

The dependence of hemolysis produced by pulsed ultrasound on ultrasound frequency, acoustic pressure and pulse length was explored. Human erythrocytes (40% hematocrit; in Albunex-supplemented autologous plasma) were exposed (60 s) to 20 or 200 microns pulses of ultrasound at frequencies of 1.02, 2.24 or 3.46 MHz and at peak negative pressures [P-] ranging from 0.0 to approximately 3.0 MPa in 0.5 MPa increments. The duty factor was 0.01. At each frequency, hemolysis increased with increasing acoustic pressure and depended weakly on pulse duration. At relatively high acoustic pressures, hemolysis depended strongly on ultrasound frequency; at lower pressures, the frequency dependence was weaker. The potential clinical significance of ultrasonic hemolysis is discussed.

Contrast-agent gas bodies enhance hemolysis induced by lithotripter shock waves and high-intensity focused ultrasound in whole blood

Fresh canine whole blood was exposed in 1.3-mL disposable pipette bulbs with or without added Albunex contrast agent to lithotripter shock waves (rate: 2 Hz; mean pressure amplitude: 14.8 MPa) or 1.28-MHz high-intensity focused ultrasound up to a mean pressure amplitude of 17.8 MPa. Significant shock-wave-induced hemolysis up to about 10% was detected after 500 or more shock waves without added agent, after 200 with 1% added agent and after 100 with 10% added contrast agent. Hemolysis was increased somewhat with added contrast agent, but this enhancement was not statistically significant. For ultrasound exposure, significant hemolysis approaching 100% was detected for 100-ms continuous exposure at 17.8 MPa without added gas bodies. Addition of 1% contrast agent enhanced the hemolysis by reducing the apparent threshold to 10 MPa. Burst mode exposure with a 100-ms total on-time (20 microseconds, 100 microseconds and 1-ms bursts) also yielded hemolysis enhancement with added contrast agent, with results similar to the 100-ms continuous exposure. The added gas bodies appear to lower cavitation thresholds by serving as cavitation nuclei in the blood.

A review of in vitro bioeffects of inertial ultrasonic cavitation from a mechanistic perspective

This selective review of the biological effects of ultrasound presents a synopsis of our current understanding of how cells insonated in vitro are affected by inertial cavitation from the standpoint of physical and chemical mechanisms. The focus of this review is on the physical and chemical mechanisms of action of inertial cavitation which appear to be effective in causing biological effects. There are several fundamental conditions which must be satisfied before cavitation-related bioeffects may arise. First, bubbles must be created and then brought into proximity to cells. Exposure methods are critical in this regard, and simple procedures such as rotation of a vessel containing the cells during exposure can drastically alter the results. Second, once association is achieved between bubbles and cells, the former must interact with the latter to produce a bioeffect. It is not certain that the inertial event is the prime mechanism by which cells are lysed; there is evidence that the turbulence associated with bubble translation may cause lysis. Additionally, there appear to be chemical and other physical mechanisms by which inertial cavitation may affect cells; these include the generation of biologically effective sonochemicals and the apparent emission of ultraviolet (UV) and soft X-rays. The evidence for inertial cavitation occurring within cells is critically reviewed.

Hemolysis of albunex-supplemented, 40% hematocrit human erythrocytes in vitro by 1-MHz pulsed ultrasound: acoustic pressure and pulse length dependence

The tested hypothesis was that ultrasound-induced hemolysis in blood supplemented with a microbubble contrast agent varies with ultrasound intensity and pulse duration. Human erythrocytes in autologous plasma containing 3.6% v:v Albunex microspheres were exposed to 1.07-MHz ultrasound pulses of 5 to 1000 mus at SPTP intensities of 0 to 1100 W/cm2. The dependence of hemolysis on the mechanical index (MI) value of the exposures was also examined. Ultrasound-induced hemolysis: (1) was evident at all pulse/intensity combinations; (2) increased generally with increasing pulse duration at constant intensity; and (3) increased with increasing MI at constant pulse duration. For pulses of 10 to 30 mus, ultrasound-induced hemolysis remained low (< or = 2%) at MI values < approximately 2 and increased sharply with further increase in MI; for 5-mus pulses, this abrupt increase in hemolysis was associated with a larger MI (approximately 3).