Comparative hemolytic effectiveness of 1 MHz ultrasound on human and rabbit blood in vitro

Introduction of a rabbit carotid artery model for sonothrombolysis research

The goal of this study was to develop an in vivo sonothrombolysis model for stroke research. The rabbit carotid artery has average vessel diameters similar to human M1/M2 segments and allows generation of a thrombotic occlusion using various kinds of thrombus material as well as thrombus placement under visual control. It further allows real-time monitoring of flow and clot mechanics during the sonothrombolysis procedure using high-frequency diagnostic ultrasound. In the present study, the model will be introduced and first results to show feasibility using diagnostic as well as high-intensity focused ultrasound will be presented.

Heating and Coagulation Volume Obtained with High-Intensity Focused Ultrasound Therapy: Comparison of Perflutren Protein-Type A Microspheres and MRX-133 in Rabbits

PURPOSE

To compare the efficiency of different microbubble contrast agents in the heating and coagulation of rabbit liver tissue by using high-intensity focused ultrasound therapy.

MATERIALS AND METHODS

The use of and protocols for Japan white rabbits were approved by the University of Tokyo Committee on Animal Resources. In vitro experiments were conducted in a 1-mL cylindric space of polyacrylamide gel, which contained different microbubble contrast agents (MRX-133 or perflutren protein-type A microspheres). In vivo experiments were performed in six Japan white rabbits (two for the perflutren protein-type A microsphere group, two for the MRX-133 group, and two for the control group). In each rabbit, the liver was directly subjected to high-intensity focused ultrasound after intravenous injection of different microbubble contrast agents. Natural saline was used as a control. High-intensity focused ultrasound was applied for 30 seconds by using a 2.18-MHz transducer, and the temperature increase and volume of coagulation necrosis were evaluated. Statistical analysis was performed by using an analysis of variance test, which was followed by a Student-Newman-Keuls test; a P value of <.05 was considered to indicate a statistically significant difference.

RESULTS

In the MRX-133 group, the mean temperature increase was significantly greater and faster than that in the control group (P < .01) or in the perflutren protein-type A microsphere group (P < .05). In the perflutren protein-type A microsphere group, the mean temperature increase was greater and faster than that of the control group (P < .01) for both in vitro and in vivo experiments. The mean volume of the coagulation necrosis lesion was 117.9 mm3 +/- 48.4 (+/-standard deviation) for the MRX-133 group, 45.4 mm3 +/- 24.9 for the perflutren protein-type A microsphere group, and 17.7 mm3 +/- 9.0 for the control group. In the MRX-133 group, the mean volume of coagulation necrosis was significantly greater than that of the control or the perflutren protein-type A microsphere group (P < .01), and in the perflutren protein-type A microsphere group, the volume of coagulation necrosis was greater than that of the control group (P < .05).

CONCLUSION

MRX-133 had greater efficiency than perflutren protein-type A microspheres in high-intensity focused ultrasound-induced heating and coagulation of rabbit liver tissue.

Ultrasonographic contrast media: has the time come in obstetrics and gynecology?

OBJECTIVE

The aim of this work was to review the technical aspects and clinical applications of contrast media (microbubbles and nanomolecular agents) in obstetric and gynecologic ultrasonographic imaging.

METHODS

With the use of a computerized database (MEDLINE) and several Web-based search engines (Google Scholar and Copernic), relevant articles on ultrasonographic contrast media were reviewed. References cited in these articles and not obtained via the search engines were also reviewed.

RESULTS

Ultrasonographic contrast media constitute a new and expanding technology. They are frequently used, for example, in adult cardiology. Extensive research in laboratory setups, animals, and human subjects has shown their safety and huge potential as an adjunctive tool in clinical practice. They increase signals returning from insonated tissues and are particularly effective as intravascular agents, enhancing color and Doppler signals, for instance. Preliminary results in tumor imaging are encouraging. The ultrasonographic contrast media permit pharmacokinetic perfusion studies, which may be of enormous clinical importance in the study of early cancer development. Targeted imaging and therapies are becoming a reality. Microbubbles have already brought a new dimension to diagnostic ultrasonographic imaging. Many authors have described the clinical value of these agents in liver, prostate, and breast imaging, among others. Newer types of media, the nanomolecules, are now emerging as the latest in imaging enhancers as well as therapeutic agent carriers.

CONCLUSIONS

Although showing potential in imaging of the uterus and fallopian tubes as well as some obstetric applications, the contrast media, in particular the nanomolecules, seem to be most promising in ovarian cancer.

Erythrocytes, as well as microbubble contrast agents, are important factors in improving thermal and therapeutic effects of high-intensity focused ultrasound

Erythrocytes, as well as microbubble contrast agents, are important factors in improving thermal effect of high-intensity focused ultrasound (US), or HIFU, and increasing the coagulation volume produced by HIFU irradiation. In vitro experiments used human plasma with various concentrations of human erythrocytes in combination with or without Levovist. In vivo experiments used eight Japan white rabbits with three degrees of anemia. Using a 2.17-MHz transducer, HIFU was applied for 60 s, and the temperature rise and the volume of coagulation necrosis was evaluated. There was a significant correlation between the HIFU-induced temperature rise and hematocrit, with a correlation coefficient of 0.998 (p=0.0001). Although the temperature rise was smaller at low hematocrit, it was significantly increased by adding Levovist in the suspension (p<0.01). The mean volume of coagulation necrosis was significantly greater in the rabbits with higher hematocrits (p<0.01), and that in the moderate anemia group was significantly increased by using Levovist (p<0.01).

Effect of ultrasound on nucleated erythrocytes

In this experimental study, carp erythrocytes were used as nucleated cell models to test the hypothesis that ultrasound (US) exposure can cause the change in plasma membranes and hemoglobin. To identify target cell damage, we studied hemolysis, osmotic fragility, lipid peroxidation of red blood cells and oxidation of hemoglobin in the erythrocytes. The erythrocytes were exposed to 1 MHz continuous-wave US at the intensities of 0.61 to 2.44 W/cm2 for 5 min. These results showed that US sonication at the intensities of 1.90 and 2.44 W/cm2 led to an increase in the degree of hemolysis and, at the highest used intensity (2.44 W/cm2), an increase in osmotic fragility. Ultrasound in all the used intensities induced an increase in lipid peroxidation. The results obtained showed that the level of methemoglobin has a tendency to increase after US exposure. Our results suggest that the changes in biomembranes can be due to inertial cavitation induced by US, but we cannot say which stage of the inertial event causes the damage.

Cell size relations for sonolysis

The occurrence of cell lysis following exposure to ultrasound (US) has been well documented; the specifics of the mechanistic process(es) involved have proven to be difficult to characterize. There appear to be two major mechanisms of US-induced cell lysis in vitro, acoustic cavitation and bubble transport. Both involve shear forces. Earlier research showed that the size of oil droplets was a crucial factor in their rupture by shear forces; the greater the size the greater the rupture per unit shear force. Here we find further support (Miller et al. 2000, 2001a, 2003a; Miller and Battaglia 2003; Abramwocz et al. 2003) that, under a number of experimental US conditions causing hemolysis in vitro, cell volume (i.e., size) is an apparently critical factor.

The relevance of cell size on ultrasound-induced hemolysis in mouse and human blood in vitro

This paper describes a further test of the hypothesis that cell size is an important physical parameter in ultrasound (US)-induced hemolysis, that is, the larger the cell the greater the potential for sonolysis by a cavitational mechanism. Mouse (M) and human (Hu) erythrocytes in vitro were used; their mean corpuscular volumes were 49.0 and 89.5 fL, respectively. At a US exposure in vitro in the presence of Albunex that yielded an average of 36.8% hemolysis for M blood, the Hu blood yielded an average of 54.0% hemolysis. The data supported the hypothesis. This paper also briefly discusses the difficulty of extrapolating sonolytic in vitro results to those derived in vivo.