An optical and acoustic investigation of microbubble cavitation in small channels under therapeutic ultrasound conditions

Delivery of Cavitation Therapy With a Modified Clinical Scanner: In Vitro Evaluation

In this study, we design and implement pulses [1.67 MHz, 20-1000 cycles, 0.8-2.5 MPa, and 5-100 ms pulse repetition time (PRT)] suitable for microbubble cavitation treatments with a phased array of a clinical ultrasound scanner. A range of acoustic parameters was evaluated in a tissue-mimicking phantom with suspended Sonazoid microbubbles. Hydrophone measurements were used to optimize the transmit beamforming. A passive cavitation detection (PCD) system was designed to measure the microbubble scattered signals over a 1 s exposure. Postprocessing of the scattered signals evaluated frequency content to extract broadband energy and calculate the inertial cavitation dose (ICD). ICD was maximized at 1000 cycles (maximum pulse length), 5 ms (fastest firing rate), and 2.5 MPa peak negative pressure (PNP) (maximum pressure). Inertial cavitation was only sustained for about three pulses (out of hundreds fired) occurring within the first 100 ms of treatment. Temporal analysis of the first 1000-cycle pulse revealed that broadband energy is sustained for the entire pulse. We also demonstrate that while inertial cavitation is possible with clinically available pulse wave Doppler settings, ICD can be significantly increased using the new conditions suggested in this work. We have delivered successful image-guided cavitation treatment after modifying a clinical scanner and monitored the cavitation dose with a PCD system on a gel phantom with suspended microbubbles. We plan to apply this technique in vivo in animal tumor models next. This work demonstrates the first implementation of long, high-pressure pulses on a clinical scanner that users can optimize for cavitation treatments.

Study on the Effect of Lesion Volume and Focal Temperature Caused by HIFU Combined with Different Concentrations and Volumes of Ethanol on Porcine Liver

Background

High-intensity Focused Ultrasound (HIFU) is a rapidly developing non-invasive treatment method for tumors in recent years.

Objective

The present study aimed to investigate the lesion and temperature effects of HIFU combined with different concentrations and volumes of ethanol on porcine liver.

Material and Methods

In this experimental study, different concentrations and volumes of ethanol were injected into the focal area of porcine liver using B-mode ultrasound, and the focal temperature was monitored using a k-type needle thermocouple. The peak negative pressure and sound intensity at the focal point of porcine liver were calculated by Khokhlov-Zabolotskaya-Kuznetsov (KZK) equation. Further, the presence of cavitation effects within porcine liver was further determined by ultrasound hyperechoic. The differences in lesion volume and temperature, caused by different concentrations and volumes of ethanol on porcine liver, were measured.

Results

HIFU irradiation combined with ethanol injection caused greater lesion volume and higher focal temperature in porcine liver. At the same HIFU irradiation power, an increase in the volume of ethanol resulted in an increase in lesion volume and focal temperature. At a fixed volume of ethanol injected and HIFU irradiation power, higher ethanol concentrations resulted in higher lesion volumes and focal temperature.

Conclusion

The combination of HIFU and ethanol synergistically affects the lesion of porcine liver, manifested as the larger the ethanol concentration and volume, the larger the lesion volume and the higher the focal temperature.

Investigation of Ultrasound Mediated Extravasation of a Model Drug by Perfluorobutane Nanodroplets

OBJECTIVE

Perfluorocarbon nanodroplets (NDs) have been widely investigated as both diagnostic and therapeutic agents. There remains, however, a challenge in generating NDs that do not vaporize spontaneously but can be activated at ultrasound pressures that do not produce unwanted bioeffects. In previous work, it has been shown that phospholipid-coated perfluorobutane (PFB) NDs can potentially overcome this challenge. The aim of this study was to investigate whether these NDs can promote drug delivery.

METHODS

A combination of high-speed optical imaging and passive cavitation detection was used to study the acoustic properties of the PFB-NDs in a tissue mimicking phantom. PFB-NDs were exposed to ultrasound at frequencies from 0.5 to 1.5 MHz and peak negative pressures from 0.5 to 3.5 MPa. In addition, the penetration depth of two model drugs (Nile Red and 200 nm diameter fluorescent polymer spheres) into the phantom was measured.

RESULTS

PFB NDs were found to be stable in aqueous suspension at both 4°C and 37°C; their size remaining unchanged at 215 ± 11 nm over 24 h. Penetration of both model drugs in the phantom was found to increase with increasing ultrasound peak negative pressure and decreasing frequency and was found to be positively correlated with the energy of acoustic emissions. Extravasation depths >1 mm were observed at 0.5 MHz with pressures <1 MPa.

CONCLUSION

The results of the study thus suggest that PFB NDs can be used both as drug carriers and as nuclei for cavitation to enhance drug delivery without the need for high intensity ultrasound.

A Promising Therapeutic Strategy of Combining Acoustically Stimulated Nanobubbles and Existing Cancer Treatments

In recent years, ultrasound-stimulated microbubbles (USMBs) have gained great attention because of their wide theranostic applications. However, due to their micro-size, reaching the targeted site remains a challenge. At present, ultrasound-stimulated nanobubbles (USNBs) have attracted particular interest, and their small size allows them to extravasate easily in the blood vessels penetrating deeper into the tumor vasculature. Incorporating USNBs with existing cancer therapies such as chemotherapy, immunotherapy, and/or radiation therapy in several preclinical models has been demonstrated to have a profound effect on solid tumors. In this review, we provide an understanding of the composition and formation of nanobubbles (NBs), followed by the recent progress of the therapeutic combinatory effect of USNBs and other cancer therapies in cancer treatment.

Dynamics of crevice microbubbles that cause the twinkling artifact

The Doppler ultrasound twinkling artifact, a rapid color shift, appears on pathological mineralizations and is theorized to arise from scattering off micron-sized crevice microbubbles. However, the influence of crevice number and size as well as the bubble dynamics on twinkling is not well-understood. Cylinders with diameters of 0.8-1.2 µm and depths of 1 µm were etched into a silicon wafer and crevice bubbles were driven at 0.75, 2.5, and 5.0 MHz while monitoring with high-speed photography. Experimental results were compared to a derived crevice bubble model. On three separate wafers, cylindrical crevices (10 or 100) with diameters of 1, 10, or 100 µm and depths of 10 µm were etched and imaged with a research ultrasound system in Doppler mode at 5, 7.8, and 18.5 MHz. Within the pressure ranges studied here (∼1MPa), no bubble oscillation was observed for the 0.8-1.2 µm crevice bubbles which matched computational results. Crevices with 1 and 10 µm diameters produced more twinkling than 100 µm crevices at 5 and 7.8 MHz. In contrast, 100 µm crevices produced more twinkling than 1 or 10 µm crevices at 18.5 MHz (p < 0.001 in all cases). These results provide better insight into how crevice bubbles cause twinkling on pathological mineralizations.

In vivo high-speed microscopy of microbubbles in the chorioallantoic membrane model

Rationale: The acoustic stimulation of microbubbles within microvessels can elicit a spectrum of therapeutically relevant bioeffects from permeabilization to perfusion shutdown. These bioeffects ultimately arise from complex interactions between microbubbles and microvascular walls, though such interactions are poorly understood particularly at high pressure, due to a paucity of direct in vivo observations. The continued development of focused ultrasound methods hinges in large part on establishing links between microbubble-microvessel interactions, cavitation signals, and bioeffects. Methods: Here, a system was developed to enable simultaneous high-speed intravital imaging and cavitation monitoring of microbubbles in vivo in a chorioallantoic membrane model. Exposures were conducted using the clinical agent DefinityTM under conditions previously associated with microvascular damage (1 MHz, 0.5-3.5 MPa, 5 ms pulse length). Results: Ultrasound-activated microbubbles could be observed and were found to induce localized wall deformations that were more pronounced in smaller microvessels and increased with pressure. A central finding was that microbubbles could extravasate from microvessels (from 34% of vessels at 1 MPa to 79% at 3 MPa) during insonation (94% within 0.5 ms) and that this occurred more frequently and in progressively larger microvessels (up to 180 µm) as pressure was increased. Following microbubble extravasation, transient or sustained red blood cell leakage ensued at the extravasation site in 96% of cases for pressures ≥1 MPa. Conclusions: The results here represent the first high-speed in vivo investigation of high-pressure focused ultrasound-induced microbubble-microvessel interactions. This data provides direct evidence that the process of activated microbubble extravasation can occur in vivo and that it is linked to producing microvessel wall perforations of sufficient size to permit red blood cell leakage. The association of red blood cell leakage with microbubble extravasation provides mechanistic insight into the process of microvessel rupture, which has been widely observed in histology.

Synchronous Intravital Imaging and Cavitation Monitoring of Antivascular Focused Ultrasound in Tumor Microvasculature Using Monodisperse Low Boiling Point Nanodroplets

Focused ultrasound-stimulated microbubbles can induce blood flow shutdown and ischemic necrosis at higher pressures in an approach termed antivascular ultrasound. Combined with conventional therapies of chemotherapy, immunotherapy, and radiation therapy, this approach has demonstrated tumor growth inhibition and profound synergistic antitumor effects. However, the lower cavitation threshold of microbubbles can potentially yield off-target damage that the polydispersity of clinical agent may further exacerbate. Here we investigate the use of a monodisperse nanodroplet formulation for achieving antivascular effects in tumors. We first develop stable low boiling point monodisperse lipid nanodroplets and examine them as an alternative agent to mediate antivascular ultrasound. With synchronous intravital imaging and ultrasound monitoring of focused ultrasound-stimulated nanodroplets in tumor microvasculature, we show that nanodroplets can trigger blood flow shutdown and do so with a sharper pressure threshold and with fewer additional events than conventionally used microbubbles. We further leverage the smaller size and prolonged pharmacokinetic profile of nanodroplets to allow for potential passive accumulation in tumor tissue prior to antivascular ultrasound, which may be a means by which to promote selective tumor targeting. We find that vascular shutdown is accompanied by inertial cavitation and complex-order sub- and ultraharmonic acoustic signatures, presenting an opportunity for effective feedback control of antivascular ultrasound.

Effect of Phase-Change Nanodroplets and Ultrasound on Blood-Brain Barrier Permeability In Vitro

Phase-change nanodroplets (PCND;NDs) are emulsions with a perfluorocarbon (PFC) core that undergo acoustic vaporisation as a response to ultrasound (US). Nanodroplets change to microbubbles and cavitate while under the effect of US. This cavitation can apply forces on cell connections in biological barrier membranes, such as the blood-brain barrier (BBB), and trigger a transient and reversible increased permeability to molecules and matter. This study aims to present the preparation of lipid-based NDs and investigate their effects on the brain endothelial cell barrier in vitro. The NDs were prepared using the thin-film hydration method, followed by the PFC addition. They were characterised for size, cavitation (using a high-speed camera), and PFC encapsulation (using FTIR). The bEnd.3 (mouse brain endothelial) cells were seeded onto transwell inserts. Fluorescein with NDs and/or microbubbles were applied on the bEND3 cells and the effect of US on fluorescein permeability was measured. The Live/Dead assay was used to assess the BBB integrity after the treatments. Size and PFC content analysis indicated that the NDs were stable while stored. High-speed camera imaging confirmed that the NDs cavitate after US exposure of 0.12 MPa. The BBB cell model experiments revealed a 4-fold increase in cell membrane permeation after the combined application of US and NDs. The Live/Dead assay results indicated damage to the BBB membrane integrity, but this damage was less when compared to the one caused by microbubbles. This in vitro study shows that nanodroplets have the potential to cause BBB opening in a similar manner to microbubbles. Both cavitation agents caused damage on the endothelial cells. It appears that NDs cause less cell damage compared to microbubbles.

Versatile Ultrasound-Compatible Microfluidic Platform for In Vitro Microvasculature Flow Research and Imaging Optimization

Ultrasound localization microscopy (ULM) enables the creation of super-resolved images and velocity maps by localizing and tracking microbubble contrast agents through a vascular network over thousands of frames of ultrafast plane wave images. However, a significant challenge lies in developing ultrasound-compatible microvasculature phantoms to investigate microbubble flow and distribution in controlled environments. In this study, we introduce a new class of gelatin-based microfluidic-inspired phantoms uniquely tailored for ULM studies. These devices allow for the creation of complex and reproducible microvascular networks featuring channel diameters as small as 100 μm. Our experiments focused on microbubble behavior under ULM conditions within bifurcating and converging vessel phantoms. We evaluated the impact of bifurcation angles (25, 45, and 55°) and flow rates (0.01, 0.02, and 0.03 mL/min) on the acquisition time of branching channels. Additionally, we explored the saturation time effect of narrow channels branching off larger ones. Significantly longer acquisition times were observed for the narrow vessels, with an average increase of 72% when a 100 μm channel branched off from a 300 μm channel and an average increase of 90% for a 200 μm channel branching off from a 500 μm channel. The robustness of our fabrication method is demonstrated through the creation of two trifurcating microfluidic phantoms, including one that converges back into a single channel, a configuration that cannot be achieved through traditional methods. This new class of ULM phantoms serves as a versatile platform for noninvasively studying complex flow patterns using ultrasound imaging, unlocking new possibilities for in vitro microvasculature research and imaging optimization.

Capillary-Scale Hydrogel Microchannel Networks by Wire Templating

Microvascular networks are essential for the efficient transport of nutrients, waste products, and drugs throughout the body. Wire-templating is an accessible method for generating laboratory models of these blood vessel networks, but it has difficulty fabricating microchannels with diameters of ten microns and narrower, a requirement for modeling human capillaries. This study describes a suite of surface modification techniques to  selectively control the interactions amongst wires, hydrogels, and world-to-chip interfaces. This wire templating method enables the fabrication of perfusable hydrogel-based rounded cross-section capillary-scale networks whose diameters controllably narrow at bifurcations down to 6.1 ± 0.3 microns in diameter. Due to its low cost, accessibility, and compatibility with a wide range of common hydrogels of tunable stiffnesses such as collagen, this technique may increase the fidelity of experimental models of capillary networks for the study of human health and disease.

Radiation combined with ultrasound and microbubbles: A potential novel strategy for cancer treatment

Cancer is one of the leading causes of death worldwide. Several emerging technologies are helping to battle cancer. Cancer therapies have been effective at killing cancer cells, but a large portion of patients still die to this disease every year. As such, more aggressive treatments of primary cancers are employed and have been shown to be capable of saving a greater number of lives. Recent research advances the field of cancer therapy by employing the use of physical methods to alter tumor biology. It uses microbubbles to enhance radiation effect by damaging tumor vasculature followed by tumor cell death. The technique can specifically target tumor volumes by conforming ultrasound fields capable of microbubbles stimulation and localizing it to avoid vascular damage in surrounding tissues. Thus, this new application of ultrasound-stimulated microbubbles (USMB) can be utilized as a novel approach to cancer therapy by inducing vascular disruption resulting in tumor cell death. Using USMB alongside radiation has showed to augment the anti-vascular effect of radiation, resulting in enhanced tumor response. Recent work with nanobubbles has shown vascular permeation into intracellular space, extending the use of this new treatment method to potentially further improve the therapeutic effect of the ultrasound-based therapy. The significant enhancement of localized tumor cell kill means that radiation-based treatments can be made more potent with lower doses of radiation. This technique can manifest a greater impact on radiation oncology practice by increasing treatment effectiveness significantly while reducing normal tissue toxicity. This review article summarizes the past and recent advances in USMB enhancement of radiation treatments. The review mainly focuses on preclinical findings but also highlights some clinical findings that use USMB as a therapeutic modality in cancer therapy.