Depression of phagocytosis by ultrasound

Control of inflammation using non-invasive neuromodulation: past, present and promise

The nervous system has been increasingly recognized as a novel and accessible target in the regulation of inflammation. The use of implantable and invasive devices targeting neural circuits has yielded successful results in clinical settings but does have some risk or adverse effects. Recent advances in technology and understanding of mechanistic pathways have opened new avenues of non-invasive neuromodulation. Through this review we discuss the novel research and outcomes of major modalities of non-invasive neuromodulation in the context of inflammation including transcutaneous electrical, magnetic and ultrasound neuromodulation. In addition to highlighting the scientific observations and breakthroughs, we discuss the underlying mechanisms and pathways for neural regulation of inflammation.

Pulsed Ultrasound of the Spleen Prolongs Survival of Rats With Severe Intra-abdominal Sepsis

BACKGROUND

The spleen is an important contributor to the uncontrolled, excessive release of proinflammatory signals during sepsis that leads to the development of tissue injury and diffuse end-organ dysfunction. Therapeutic pulsed ultrasound (pUS) has been shown to inhibit splenic leukocyte release and reduce cytokine production in other inflammatory disease processes. We hypothesized that pUS treatment inhibits spleen-derived inflammatory responses and increases survival duration in rats with severe intra-abdominal sepsis leading to septic shock.

MATERIALS AND METHODS

Rats with intra-abdominal sepsis, induced by cecal ligation and incision, underwent abdominal washout, intra-peritoneal administration of cefazolin, and then either no further treatment (control), splenectomy, or pUS of the spleen. Animals were observed for the primary endpoint of survival duration.

RESULTS

Survival curves were significantly different for all groups (P < 0.01). Median survival increased from 9.5 h in control rats to 19.8 h in pUS rats and 35.0 h in splenectomy rats (P < 0.01). At 4 h after cecal ligation and incision, the pUS group had decreased splenic contraction and leukocyte count (P = 0.03) compared with control, indicating reduced exodus of splenic leukocytes. In addition, elevation in plasma TNF-α and MCP-1 was significantly attenuated in the pUS group (P < 0.05 versus control). Splenic β₂ adrenergic receptor levels and phosphorylated Akt were significantly more elevated in the pUS group (P < 0.01 versus control).

CONCLUSIONS

pUS significantly prolonged the survival duration of rats with severe intra-abdominal sepsis. This treatment may be an effective, noninvasive therapy that dampens detrimental immune responses during septic shock by activating β₂ adrenergic receptor-Akt phosphorylation in the cholinergic anti-inflammatory pathway.

Ultrasound prevents renal ischemia-reperfusion injury by stimulating the splenic cholinergic anti-inflammatory pathway

AKI affects both quality of life and health care costs and is an independent risk factor for mortality. At present, there are few effective treatment options for AKI. Here, we describe a nonpharmacologic, noninvasive, ultrasound-based method to prevent renal ischemia-reperfusion injury in mice, which is a model for human AKI. We exposed anesthetized mice to an ultrasound protocol 24 hours before renal ischemia. After 24 hours of reperfusion, ultrasound-treated mice exhibited preserved kidney morphology and function compared with sham-treated mice. Ultrasound exposure before renal ischemia reduced the accumulation of CD11b(+)Ly6G(high) neutrophils and CD11b(+)F4/80(high) myeloid cells in kidney tissue. Furthermore, splenectomy and adoptive transfer studies revealed that the spleen and CD4(+) T cells mediated the protective effects of ultrasound. Last, blockade or genetic deficiency of the α7 nicotinic acetylcholine receptor abrogated the protective effect of ultrasound, suggesting the involvement of the cholinergic anti-inflammatory pathway. Taken together, these results suggest that an ultrasound-based treatment could have therapeutic potential for the prevention of AKI, possibly by stimulating a splenic anti-inflammatory pathway.

Therapeutic opportunities in biological responses of ultrasound

The therapeutic benefits of several existing ultrasound-based therapies such as facilitated drug delivery, tumor ablation and thrombolysis derive largely from physical or mechanical effects. In contrast, ultrasound can also trigger various time-dependent biochemical responses in the exposed biological milieu. Several biological responses to ultrasound exposure have been previously described in the literature but only a handful of these provide therapeutic opportunities. These include the use of ultrasound for healing of soft tissues and bones, the use of ultrasound for inducing non-necrotic tumor atrophy as well as for potentiation of chemotherapeutic drugs, activation of the immune system, angiogenesis and suppression of phagocytosis. A review of these therapeutic opportunities is presented with particular emphasis on their mechanisms. Overall, this review presents the increasing importance of ultrasound's role as a biological sensitizer enabling novel therapeutic strategies.

Pre-exposure effects of 1 and 3 MHz therapeutic ultrasound on ConA activated spleenocytes

This study was performed to evaluate the pre-exposure effects of ultrasound (1 MHz or 3 MHz) on ConA activated spleenocyte proliferation and cytokine production. Cells were treated for 10 min at various intensities, rested for 1h and stimulated with the T cell activator ConA. The cells were then analyzed for the effects of non-thermal ultrasound on cell growth and the presence of IL-2, IL-4 and IFN-g. The data show that pre-exposure of spleenocytes had no significant effects on the proliferation of ConA activated spleenocytes at either 1 or 3 MHz (10 min at 0.1 or 0.5 W/cm(2)). Significant increases in IL-2 were observed in both 1 and 3 MHz pre-treated and ConA activated spleenocytes. Cells pre-treated with 1 MHz and stimulated with ConA showed a significant increase in IL-4 and IFN-g. Conversely, cells pre-treated with 3 MHz and stimulated with ConA show a significant decrease in IL-4 and IFN-g. Interleuken-4 is known to increase the growth of mast cells, inhibit macrophage activation and increases the activity of the T cell subpopulation, T(H2). Interferon-gamma is known to stimulate production of collagen in fibroblasts, enhance debridement activity of macrophage and inhibit activity of the T cell subpopulation, T(H2).

Use of splenic ultrasound: a new wave for immune thrombocytopenic purpura

AIMS

To examine whether a therapeutic dose of ultrasound waves, when directed through the thoracic wall to the spleen, would significantly affect the platelet count in patients with stable immune thrombocytopenic purpura (ITP).

METHODS

Continuous ultrasound at 1 W/cm2 spatial average-time average (SATA) intensity for up to one minute/5 cm2 treatment field was well tolerated in 13 patients with ITP and one with non-Hodgkin's lymphoma. Five healthy controls were also similarly treated. Peak platelet increments occurred four to eight hours after ultrasound treatment in the ITP group (n = 16 treatments).

RESULTS

The mean peak platelet increment was 6.25 x 10(9)/l with a 5% confidence interval of the mean (95% CI) of 3.32 to 8.93 x 10(9)/l (p = 0.0004). The mean peak platelet increment of normal controls was 6.6 (n = 5; 95% CI = -2.3 to 15.5; p = 0.21) and for sham treated patients it was 0.66 (n = 11; 95% CI = -1.5 to 2.8; p = 0.60). There was a significant inverse correlation between patient age in the ITP group and peak platelet increment (r = -0.60; p = 0.015).

CONCLUSIONS

Splenic ultrasound is a novel approach to the treatment of ITP, and may find a place in its diagnosis or management.

Evaluation of the bioeffects of prenatal ultrasound exposure in the cynomolgus macaque (Macaca fascicularis): I. Neonatal/infant observations

The frequency of use of ultrasonography for evaluating the developing embryo/fetus has continued to rise although the possible risks from exposure still remain uncertain. The cynomolgus macaque (Macaca fascicularis) is currently being used in our laboratory as a model to assess these risks. In utero exposure was performed utilizing a commercial real-time mechanical sector scanner with a 7.5 MHz scanhead (ATL, MK 600). Maximum acoustic power output for this unit is as follows: I(SPTA) = 12.0 mW/cm2, I(SPPA) = 98 W/cm2, and Im = 137 W/cm2. Animals exposed to ultrasound (N = 16) were scanned five times weekly on gestational days (GD) 21-35 +/- 2 for 10 minutes/exam (m/e), three times weekly on GD 36-60 +/- 2 for 10 m/e, and once weekly on GD 61-150 +/- 2 for 20 m/e. Controls (N = 14) were "scanned" with the unit placed on standby. Assessment of simian Apgar scores at 1, 5, and 10 minutes of life revealed higher scores for treated animals at 10 minutes (P less than or equal to 0.045); greater scores in muscle tone (P less than or equal to 0.013) and color (P less than or equal to 0.016) were observed. Evaluation of morphometrics at birth including weight, biparietal diameter, occipitofrontal diameter, head circumference, hand and foot lengths, humerus and femur lengths, arm circumference, chest circumference, tail length, skinfold thickness, and crown-rump length (CRL) indicated a significant reduction in only two parameters, birth weight (P less than or equal to 0.027) and CRL (P less than or equal to 0.033). Hematologic analysis at 2 +/- 1, 9 +/- 1, and 16 +/- 1 days of life revealed a significant difference in white blood cell counts (WBCs). Treated animals displayed lower WBCs with reductions in numbers of segmented neutrophils and monocytes at all ages observed. Hematologic differences were not significant by 5-6 months of age. No abortions, gross malformations, or stillbirths were observed in the exposed animals.

Effects of in vivo ultrasound hyperthermia on natural killer cell cytotoxicity in the hamster

The effects of in vivo ultrasound irradiation of the spleen on immunological functions were assessed with an in vitro natural killer (NK) cell cytotoxic assay. Anesthetized hamsters were exposed to 1 MHz ultrasound at intensity levels currently being used clinically for therapeutic diathermy and hyperthermia (1-5 W/cm2, for 500 sec with constant beam scanning). Hyperthermic levels in the spleen ranged from 38-43 degrees C. Significant depression of natural killer (NK) cell activity was seen 4 h after spleen irradiation as compared to sham irradiated and normal animals. A return towards normal levels was observed in experimental groups at 24 h after exposure. Sham and normal animals were not significantly different in NK activity, indicating no significant stress-related immunosuppressive effects due to handling. Differential leukocyte counts taken for each exposure condition showed significant lymphopenia at 4, 8, and 16 h after exposure, near normal levels at 24 h, and complete recovery by 48 h. The number of circulating mononuclear cells at 4 h showed a dose-related suppression as the exposure intensities were increased.

Legal liability in the use of ultrasound by office-based obstetricians

Ultrasound has proved to be a valuable diagnostic tool in the practice of obstetrics. Its rapidly increasing use by the office-based obstetrician, however, has opened a potential new area of legal vulnerability. The malpractice liability that may arise from its use is reviewed and practical ways to avoid it are considered.

Development of health risk evaluation data for diagnostic ultrasound: a historical perspective

The growth of ultrasound applications in diagnostic medicine has helped stimulate related biological effects investigations. Current data related to effects associated with diagnostic ultrasound indicate the need for additional research on cell surface structures, motility and developmental effects. Research on biological effects, especially for evaluating in vivo end points analogous to those employed by investigators using in vitro systems and simple organisms, are needed. Particular emphasis relative to potential effects on fetal and embroyonic development is indicated. Limited data also suggest the need to investigate possible effects on the immune response. There is a growing realization of the potential importance of nonthermal effects and increasing evidence that the temporal peak intensity is potentially related to the production of some effects. A number of recent comprehensive reviews have helped identify, analyze and evaluate some of the relevant data.