Preclinical Study of Locoregional Therapy of Hepatocellular Carcinoma by Bioelectric Ablation with Microsecond Pulsed Electric Fields (μsPEFs)

Microsecond pulsed electric fields induce myocardial ablation by secondary mitochondrial damage and cell death mechanisms

Microsecond pulsed electric field (µsPEF) is a newer treatment modality to replace catheter ablation treatment of Atrial fibrillation (AF) due to its fewer side effects. This study aims to find out experimental parameters that effectively induce cardiomyocyte death and the precise mechanisms for microsecond pulsed electric fields (µsPEFs) ablation of cardiomyocytes. CCK8 and flow apoptosis analysis were employed to examine the effects of different µsPEFs on cardiomyocytes in vitro. The mechanisms by which the µsPEFs ablation works were explored through a combination of transcriptome study, transmission electron microscope (TEM) observation of mitochondria, pathway enrichment analysis, and interaction network analysis. In vivo experiments on mice involving HE, Masson, TUNEL and Immunofluorescence staining examinations were conducted to confirm the in vitro experimental results. When more than 30 pulses were applied, a continuous decline in post-ablation relative cell activity was observed, decreasing from 0.36 at 3 h to 0.13 (p < 0.01) at 48 h. Notably, at a voltage of 1500 V/cm and a pulse count of 50, the apoptosis rate exceeded 95%, coupled with a more stable and consistent cell ablation. Following ablation, a notable upregulation in mitochondria-related transcription levels was observed, accompanied by mitochondrial membrane disruption and an increase in Cytochrome C levels. Within a certain range, an increase in voltage and number of electric pulses corresponded to a greater quantity of cell mortality in the ablation zone. The µsPEFs induced cell injury by impairing mitochondrial function and potentially triggering the mitochondrial apoptosis pathway.

Tissue Radiologic and Pathologic Response to Biphasic Pulsed Electric Field Technology in a Porcine Model

PURPOSE

To evaluate the radiologic, pathologic, and safety characteristics of a commercially available pulsed electric field (PEF) ablation system in a porcine model.

MATERIALS AND METHODS

Monopolar biphasic PEF ablation was delivered to the liver, kidney, and longissimus dorsi muscle through a single needle via a percutaneous or open approach with the Aliya System (Galvanize Therapeutics, Redwood City, California). Six animals were ablated and evaluated in 2 cohorts (Day 3 and Day 28). Muscle, kidney, and liver were ablated in each animal. Intraprocedural cone-beam computed tomography (CT), follow-up weekly CT, blood serology, gross pathology, and histopathology were performed to characterize the radiographic evolution and tissue response.

RESULTS

There were no adverse events and no findings of electrocardiographic abnormalities, and serologic values returned to baseline by Day 28. Ablation zones were visible on unenhanced CT images during follow-up. Most identified zones became radiographically smaller over time, with some fully resolved by Day 28. The relative decrease in gross ablation zone diameter in the liver and skeletal muscle was 20% and 26%, respectively, whereas kidney sites grew in diameter by 22%. Ablation sites were focal and contained within the intended target tissue without extension to nontarget tissues or collateral structures.

CONCLUSIONS

The biphasic PEF system evaluated here resulted in a safe and predictable ablation response, with preservation of structural tissues in an animal model, offering an alternative to thermal ablative modalities, particularly near critical structures.

Current progress of pig models for liver cancer research

Preclinical trials play critical roles in assessing the safety and efficiency of novel therapeutic strategies for human diseases including live cancer. However, most therapeutic strategies that were proved to be effective in preclinical cancer models failed in human clinical trials due to the lack of appropriate disease animal models. Therefore, it is of importance and urgent to develop a precise animal model for preclinical cancer research. Liver cancer is one of the most frequently diagnosed cancers with low 5-year survival rate. Recently, porcine attracted increasing attentions as animal model in biomedical research. Porcine liver cancer model may provide a promising platform for biomedical research due to their similarities to human being in body size, anatomical characteristics, physiology and pathophysiology. In this review, we comprehensively summarized and discussed the advantages and disadvantages, rationale, current status and progress of pig models for liver cancer research.

Ginsenoside Rg3 Prolongs Survival of the Orthotopic Hepatocellular Carcinoma Model by Inducing Apoptosis and Inhibiting Angiogenesis

Aim

Microvessel density is a marker of tumor angiogenesis activity for development and metastasis. Our preliminary study showed that ginsenoside Rg3 (Rg3) induces apoptosis in hepatocellular carcinoma (HCC) in vitro. The aim of this study was to investigate the cross-link for apoptosis induction and antiangiogenesis effect of Rg3 on orthotopic HCC in vivo.

Methods

The murine HCC cells Hep1-6 were implanted in the liver of mouse. With oral feeding of Rg3 (10 mg/kg once a day for 30 days), the quantitative analysis of apoptosis was performed by using pathology and a transmission electron microscope and microvessel density was quantitatively measured by immunohistochemical staining of the CD105 antibody. The mice treated with Rg3 (n = 10) were compared with the control (n = 10) using Kaplan-Meier analysis. Animal weight and tumor weight were measured to determine the toxicity of Rg3 and antitumor effect on an orthotopic HCC tumor model.

Results

With oral feeding of Rg3 daily in the first 30 days on tumor implantation, Rg3 significantly decreased the orthotopic tumor growth and increased the survival of animals (P < 0.05). Rg3-treated mice showed a longer survival than the control (P < 0.05). Rg3 treatment induced apoptosis and inhibited angiogenesis. They contributed to the tumor shrinkage. Rg3 initialized the tumor apoptotic progress, which then weakened the tumor volume and its capability to produce the vascularized network for further growth of the tumor and remote metastasis.

Conclusion

Rg3 inhibited the activation of microtumor vessel formation in vivo besides its apoptosis induction. Rg3 may be used as an adjuvant agent in the clinical HCC treatment regimen.

Curcumin exerts cytotoxicity dependent on reactive oxygen species accumulation in non-small-cell lung cancer cells

AIM

Curcumin induces cytotoxic cell death in several human cancer cells. Here, we have investigated the effects of curcumin on non-small-cell lung cancer (NSCLC) with an aim to identify underlying mechanisms of its cytotoxic effect.

MATERIALS & METHODS

The effects of various concentrations of curcumin on the NSCLC cell lines A549 and SPC-A1 were evaluated by MTT assay, colony-forming assay and flow cytometry. Additionally, protein expression associated with different signaling pathways was assessed using western blotting.

RESULTS

Curcumin exhibited cytotoxicity against NSCLC, evident from the inhibition of cell proliferation, G2/M arrest, DNA damage, endoplasmic reticulum stress and mitochondrial apoptosis. The anticancer effect was related to reactive oxygen species (ROS) accumulation and could be reversed by ROS scavengers, catalase and N-acetyl-l-cysteine. Curcumin decreased mitochondrial transmembrane potential and induced ROS production, thereby activating the DNA damage/repair pathway and mitochondrial apoptosis.

CONCLUSION

These results indicate that curcumin could be an effective therapeutic candidate for NSCLC.

Pilot in vitro and in vivo study on a mouse model to evaluate the safety of transcutaneous low-frequency electrical nerve stimulation on cervical cancer patients

INTRODUCTION AND HYPOTHESIS

To clarify whether the pulse electrical field (PEF) caused by transcutaneous low-frequency nerve electrical stimulation (TENS) enhances the proliferation of cervical cancer cells, leading to recurrence and metastasis, and the effect of such a PEF on a cervical cancer mouse model.

METHODS

1. In vitro experiment: SiHa cervical cancer cells treated with one session of microsecond PEFs for 30 min were divided into four groups: three experimental groups and the control group. Cell proliferation and migration were determined by CCK-8 proliferation and Transwell chamber Matrigel migration assay. 2. In vivo experiment: A mouse cancer model was established by subcutaneous implantation of SiHa cells that were then were randomly divided into the TENS group and control group. The former group received one session of TENS treatment and the control group received a sham pulse. The growth trend and tumor volume of each group were compared 28 days after PEF treatment. The proliferation and apoptosis of the tumor were determined by an immunohistochemical method.

RESULTS

(1) The CCK-8 proliferation assay and cell migration ability showed no difference after PEF stimulation treatment (F = 2.478, P = 0.136 > 0.05 and F = 0.364, P = 0.779). (2) Tumor growth, size and weight showed no significant difference between the two groups. (3) Expression of VEGF, CD34, caspase-3 and Ki-67 in the tumor tissue showed no significant difference between the two groups.

CONCLUSIONS

In vitro and in vivo experiments (mice) showed that the PEF created by TENS had no effect on the proliferation and migration of SiHa cervical cancer cells and also had no effect on the tumor growth, tumor cell apoptosis and proliferation.

The local liver ablation with pulsed electric field stimulate systemic immune reaction against hepatocellular carcinoma (HCC) with time-dependent cytokine profile

AIM

How irreversible electroporation (IRE) affect immune status is still kept unknown. This preclinical study is to investigate its local and systemic immune reaction both on tumor-bearing and tumor free animals.

METHODS

Liver ablation was performed by a standard IRE instrument and proposal. Altogether 57 tumor bearing mice and 10 tumor-free porcine livers were ablated. The reaction of survival, radiology image, pathologically and immunologically were followed up. The detailed cytokines and chemokines responses were recorded dynamically post IRE ablation.

RESULTS

IRE ablation induced coagulation and necrosis in liver. It caused macrophages infiltration, in ablation zone. IRE ablation caused cellular inflammation. It, corrected the abnormal drifted Th2 in HCC back to Th1 status, promoting tumor eradication and host survival. The quantified cytokines and chemokines indicate IRE can stimulate both local immune reaction and systemic immune reaction.

CONCLUSION

Local IRE ablation changes the abnormal drifted Th2 in HCC back to Th1 status, facilitating tumor eradication and host survival.

Irreversible electroporation ablation area enhanced by synergistic high- and low-voltage pulses

Irreversible electroporation (IRE) produced by a pulsed electric field can ablate tissue. In this study, we achieved an enhancement in ablation area by using a combination of short high-voltage pulses (HVPs) to create a large electroporated area and long low-voltage pulses (LVPs) to ablate the electroporated area. The experiments were conducted in potato tuber slices. Slices were ablated with an array of four pairs of parallel steel electrodes using one of the following four electric pulse protocols: HVP, LVP, synergistic HVP+LVP (SHLVP) or LVP+HVP. Our results showed that the SHLVPs more effectively necrotized tissue than either the HVPs or LVPs, even when the SHLVP dose was the same as or lower than the HVP or LVP doses. The HVP and LVP order mattered and only HVPs+LVPs (SHLVPs) treatments increased the size of the ablation zone because the HVPs created a large electroporated area that was more susceptible to the subsequent LVPs. Real-time temperature change monitoring confirmed that the tissue was non-thermally ablated by the electric pulses. Theoretical calculations of the synergistic effects of the SHLVPs on tissue ablation were performed. Our proposed SHLVP protocol provides options for tissue ablation and may be applied to optimize the current clinical IRE protocols.

Temozolomide-perillyl alcohol conjugate induced reactive oxygen species accumulation contributes to its cytotoxicity against non-small cell lung cancer

Temozolomide-perillyl alcohol conjugate (TMZ − POH), a novel temozolomide analog, was reported to play a cytotoxic role in triple-negative breast cancer and TMZ-resistant gliomas. In a current study we had demonstrated how TMZ − POH also exhibited its cytotoxicity against non-small cell lung cancer (NSCLC), the most common type of lung cancer, as evidence from cell/tumor proliferation inhibition, G2/M arrest, DNA damage and mitochondrial apoptosis. Importantly, TMZ − POH’s cytotoxicity is closely related to reactive oxygen species (ROS) accumulation because it can be reversed by two ROS scavengers, catalase (CAT) and N-acetyl-L-cysteine (NAC). TMZ − POH induces mitochondrial transmembrane potential (MTP) decrease and ROS accumulation, in turn activates mitogen-activated protein kinase (MAPKs) signaling and mitochondrial apoptosis, and then exerts its cytotoxicity, thus proposing TMZ − POH as a potential therapeutic candidate for NSCLC.

Electric Ablation with Irreversible Electroporation (IRE) in Vital Hepatic Structures and Follow-up Investigation

Irreversible electroporation (IRE) with microsecond-pulsed electric fields (μsPEFs) can effectively ablate hepatocellular carcinomas in animal models. This preclinical study evaluates the feasibility and safety of IRE on porcine livers. Altogether, 10 pigs were included. Computed tomography (CT) was used to guide two-needle electrodes that were inserted near the hilus hepatis and gall bladder. Animals were followed-up at 2 hours and at 2, 7 and 14 days post-treatment. During and after μsPEF ablation, electrocardiographs found no cardiovascular events, and contrast CT found no portal vein thrombosis. There was necrosis in the ablation zone. Mild cystic oedema around the gall bladder was found 2 hours post-treatment. Pathological studies showed extensive cell death. There was no large vessel damage, but there was mild endothelial damage in some small vessels. Follow-up liver function tests and routine blood tests showed immediate liver function damage and recovery from the damage, which correlated to the pathological changes. These results indicate that μsPEF ablation affects liver tissue and is less effective in vessels, which enable μsPEFs to ablate central tumour lesions close to the hilus hepatis and near large vessels and bile ducts, removing some of the limitations and contraindications of conventional thermal ablation.