Rapid Impedance Spectroscopy for Monitoring Tissue Impedance, Temperature, and Treatment Outcome During Electroporation-Based Therapies

Reversible electroporation for cancer therapy

Reversible electroporation (EP) refers to the use of high-voltage electrical pulses on tissues to increase cell membrane permeability. It allows targeted delivery of high concentrations of chemotherapeutic agents including cisplatin and bleomycin, a process known as electrochemotherapy (ECT). It can also be used to deliver toxic concentrations of calcium and gene therapies that stimulate an anti-tumour immune response. ECT was validated for palliative treatment of cutaneous tumours. Evidence to date shows a mean objective response rate of ∼80% in these patients. Regression of non-treated lesions has also been demonstrated, theorized to be from an in situ vaccination effect. Advances in electrode development have also allowed treatment of deep-seated metastatic lesions and primary tumours, with safety demonstrated in vivo. Calcium EP and combination immunotherapy or immunogene electrotransfer is also feasible, but research is limited. Adverse events of ECT are minimal; however, general anaesthesia is often necessary, and improvements in modelling capabilities and electrode design are required to enable sufficient electrical coverage. International collaboration between preclinical researchers, oncologists, and interventionalists is required to identify the most effective combination therapies, to optimize procedural factors, and to expand use, indications and assessment of reversible EP. Registries with standardized data collection methods may facilitate this.

Establishing an Electrophysiological Recording Platform for Epidural Spinal Cord Stimulation in Neuropathic Pain Rats

Purpose

Spinal cord stimulation (SCS) is pivotal in treating chronic intractable pain. To elucidate the mechanism of action among conventional and current novel types of SCSs, a stable and reliable electrophysiology model in the consensus animals to mimic human SCS treatment is essential. We have recently developed a new in vivo implantable pulsed-ultrahigh-frequency (pUHF) SCS platform for conducting behavioral and electrophysiological studies in rats. However, some technical details were not fully understood. This study comprehensively analyzed methodology and technical challenges and pitfalls encountered during the development and implementation of this model.

Materials and Methods

Employing a newly developed pUHF-SCS (±3 V, 2 Hz pulses with 500-kHz biphasic radiofrequency sinewaves), we assessed analgesic effect and changes of evoked local field potentials (eLFPs) in the bilateral primary somatosensory and anterior cingulate cortices in the rats with or without spared nerve injury (SNI) using the platform. The placement of stimulating needle electrodes in the hind paw was examined and optimized for functionality.

Results

SNI enhanced the C component of eLFPs in bilateral cortexes elicited by stimulating the contralateral but not the ipsilateral lateral aspect of the hind paw. Repeated pUHF-SCS significantly reversed SNI-induced paw hypersensitivity and reduced C-component enhancement. An impedance test can determine an optimal SCS electrode function: an SCS discharge threshold of 100-400 μA for cortical activation or a motor threshold of 150-600 μA for the hind limbs. Impedance increased due to growth of fibrotic tissue but stabilized after post-implantation day 12.

Conclusion

We presented a reliable electrophysiological platform for SCS application in rat neuropathic pain model and demonstrated potent analgesic effects of pUHF-SCS. All device implantations or pUHF-SCS per se did not cause evident spinal cord damage. This safe and stable platform provides an in vivo rat model for SCS investigation of mechanisms of action and device innovation.

Advances in irreversible electroporation for prostate cancer

Irreversible electroporation is a nonthermal ablation technique that uses a high-voltage electric current to create nanosized pores in the cell membrane of a malignant tumor, thus resulting in cell death. In recent years, an increasing number of clinical studies have shown that irreversible electroporation is a safe and effective treatment for prostate cancer. We describe the progress of irreversible electroporation in prostate cancer in recent years in terms of its mechanism of action, clinical studies, advantages and disadvantages and summarize the gaps in existing studies and directions for future research.

Biological autoluminescence enables effective monitoring of yeast cell electroporation

The application of pulsed electric fields (PEFs) is becoming a promising tool for application in biotechnology, and the food industry. However, real-time monitoring of the efficiency of PEF treatment conditions is challenging, especially at the industrial scale and in continuous production conditions.  To overcome this challenge, we have developed a straightforward setup capable of real-time detection of yeast biological autoluminescence (BAL) during pulsing. Saccharomyces cerevisiae culture was exposed to 8 pulses of 100 µs width with electric field strength magnitude 2-7 kV cm-1. To assess the sensitivity of our method in detecting yeast electroporation, we conducted a comparison with established methods including impedance measurements, propidium iodide uptake, cell growth assay, and fluorescence microscopy. Our results demonstrate that yeast electroporation can be instantaneously monitored during pulsing, making it highly suitable for industrial applications. Furthermore, the simplicity of our setup facilitates its integration into continuous liquid flow systems. Additionally, we have established quantitative indicators based on a thorough statistical analysis of the data that can be implemented through a dedicated machine interface, providing efficiency indicators for analysis.

Electrochemotherapy for head and neck cancers: possibilities and limitations

Head and neck cancer continues to be among the most prevalent types of cancer globally, yet it can be managed with appropriate treatment approaches. Presently, chemotherapy and radiotherapy stand as the primary treatment modalities for various groups and regions affected by head and neck cancer. Nonetheless, these treatments are linked to adverse side effects in patients. Moreover, due to tumor resistance to multiple drugs (both intrinsic and extrinsic) and radiotherapy, along with numerous other factors, recurrences or metastases often occur. Electrochemotherapy (ECT) emerges as a clinically proven alternative that offers high efficacy, localized effect, and diminished negative factors. Electrochemotherapy involves the treatment of solid tumors by combining a non-permeable cytotoxic drug, such as bleomycin, with a locally administered pulsed electric field (PEF). It is crucial to employ this method effectively by utilizing optimal PEF protocols and drugs at concentrations that do not possess inherent cytotoxic properties. This review emphasizes an examination of diverse clinical practices of ECT concerning head and neck cancer. It specifically delves into the treatment procedure, the choice of anti-cancer drugs, pre-treatment planning, PEF protocols, and electroporation electrodes as well as the efficacy of tumor response to the treatment and encountered obstacles. We have also highlighted the significance of assessing the spatial electric field distribution in both tumor and adjacent tissues prior to treatment as it plays a pivotal role in determining treatment success. Finally, we compare the ECT methodology to conventional treatments to highlight the potential for improvement and to facilitate popularization of the technique in the area of head and neck cancers where it is not widespread yet while it is not the case with other cancer types.

Negative effects of cancellation during nanosecond range High-Frequency calcium based electrochemotherapy in vitro

Drug delivery using nanosecond pulsed electric fields is a new branch of electroporation-based treatments, which potentially can substitute European standard operating procedures for electrochemotherapy. In this work, for the first time, we characterize the effects of ultra-fast repetition frequency (1-2.5 MHz) nanosecond pulses (5-9 kV/cm, 200 and 400 ns) in the context of nano-electrochemotherapy with calcium. Additionally, we investigate the feasibility of bipolar symmetric (↑200 ns + ↓200 ns) and asymmetric (↑200 ns + ↓400 ns) nanosecond protocols for calcium delivery. The effects of bipolar cancellation and the influence of interphase delay (200 ns) are overviewed. Human lung cancer cell lines A549 and H69AR were used as a model. It was shown that unipolar pulses delivered at high frequency are effective for electrochemotherapy with a significant improvement in efficiency when the delay between separate pulses is reduced. Bipolar symmetric pulses trigger the cancellation phenomenon limiting applications for drug delivery and can be compensated by the asymmetry of the pulse (↑200 ns + ↓400 ns or ↑400 ns + ↓200 ns). The results of this study can be successfully used to derive a new generation of nsPEF protocols for successful electrochemotherapy treatments.

Spatiotemporal estimations of temperature rise during electroporation treatments using a deep neural network

The nonthermal mechanism for irreversible electroporation has been paramount for treating tumors and cardiac tissue in anatomically sensitive areas, where there is concern about damage to nearby bowels, ducts, blood vessels, or nerves. However, Joule heating still occurs as a secondary effect of applying current through a resistive tissue and must be minimized to maintain the benefits of electroporation at high voltages. Numerous thermal mitigation protocols have been proposed to minimize temperature rise, but intraoperative temperature monitoring is still needed. We show that an accurate and robust temperature prediction AI model can be developed using estimated tissue properties (bulk and dynamic conductivity), known geometric properties (probe spacing), and easily measurable treatment parameters (applied voltage, current, and pulse number). We develop the 2-layer neural network on realistic 2D finite element model simulations with conditions encompassing most electroporation applications. Calculating feature contributions, we found that temperature prediction is mostly dependent on current and pulse number and show that the model remains accurate when incorrect tissue properties are intentionally used as input parameters. Lastly, we show that the model can predict temperature rise within ex vivo perfused porcine livers, with error <0.5 °C. This model, using easily acquired parameters, is shown to predict temperature rise in over 1000 unique test conditions with <1 °C error and no observable outliers. We believe the use of simple, readily available input parameters would allow this model to be incorporated in many already available electroporation systems for real-time temperature estimations.

Real-Time Temperature Rise Estimation during Irreversible Electroporation Treatment through State-Space Modeling

To evaluate the feasibility of real-time temperature monitoring during an electroporation-based therapy procedure, a data-driven state-space model was developed. Agar phantoms mimicking low conductivity (LC) and high conductivity (HC) tissues were tested under the influences of high (HV) and low (LV) applied voltages. Real-time changes in impedance, measured by Fourier Analysis SpecTroscopy (FAST) along with the known tissue conductivity and applied voltages, were used to train the model. A theoretical finite element model was used for external validation of the model, producing model fits of 95.8, 88.4, 90.7, and 93.7% at 4 mm and 93.2, 58.9, 90.0, and 90.1% at 10 mm for the HV-HC, LV-LC, HV-LC, and LV-HC groups, respectively. The proposed model suggests that real-time temperature monitoring may be achieved with good accuracy through the use of real-time impedance monitoring.

New Architecture of Solid-State High-Voltage Pulse Generators

The application of the nanosecond pulsed electric field (nsPEF) for biomedical treatments has gained more interest in recent decades due to the development of pulsed power technologies which provides the ability to control the electric field dose applied during tests. In this context, the proposed paper describes a new architecture of solid-state high-voltage pulse generators (SS-HVPG) designed to generate fully customised sequences of quasi-rectangular pulses. The idea is based on the combination of semiconductor switches (IGBT/MOSFET) known for their flexibility and controllability with special magnetic switches to build compact and modular generators. The proposed structure is inspired by the most known pulse generator of Marx, but mixes its two variants for negative and positive polarities. Thus, the polarity of the generated pulses can be freely selected. In addition to that, the use of IGBTs/MOSFET ensures a tunable repetition rate and pulse width. The capacitors are charged via a series of magnetic switches and a flyback DC–DC converter which provides fast and efficient charging and also an adjustable amplitude of the output pulses. The design can be easily simplified giving two other modified structures, based on the same idea, for mono-polar operating (only positive or only negative pulses) with a reduced number of switches. A SPICE simulation of the generator and results of experimental tests carried out on a three stages generator are presented. The obtained results confirm the operating principle and the claimed performances of the new structure.

Electroporation Microchip with Integrated Conducting Polymer Electrode Array for Highly Sensitive Impedance Measurement

OBJECTIVE

Monitoring of impedance changes during electroporation-based treatments can be used to study the biological response and provide feedback regarding treatment progression. However, seamless integration of the sensing electrodes with the setup can be challenging and high impedance sensing electrodes limit the recording sensitivity as well as the spatial resolution. Here, we present an all-in-one microchip containing stimulation electrodes, as well as an array of low impedance, micro-scale sensing electrodes for highly sensitive electrical impedance spectroscopy.

METHODS

An in vitro platform is fabricated with integrated stimulation and sensing electrodes. To reduce the impedance, the sensing electrodes are coated with the conducting polymer PEDOT:PSS. The performance is studied during the growth of a confluent cell layer and treatment with electrical pulses.

RESULTS

Coated electrodes, compared to uncoated electrodes, show more pronounced impedance changes in a broader frequency range throughout the formation of a confluent cell layer and electrical treatment.

CONCLUSION

PEDOT:PSS coatings enhance monitoring of impedance changes with micro-scale electrodes, enabling high spatial resolution and increased sensitivity.

SIGNIFICANCE

Enhanced monitoring techniques can be utilized to study electroporation dynamics and monitor treatment progression for better understanding of underlying mechanisms and improved outcomes.

Real-time impedance feedback to enhance cutaneous gene electrotransfer in a murine skin model

Electric field mediated gene delivery methods have the ability to efficiently transfect cells in vivo with an excellent safety profile. The method has historically used a fixed number of electric pulses with identical characteristics in induce delivery. Electrical treatment does not typically compensate for subject-to-subject variation and other differences. This study was designed to investigate if delivery/expression could be increased using a novel electropulsation method that compensated for variation using real-time electrical impedance measurements. The method involved delivering plasmid DNA encoding luciferase to murine skin. Tissue impedance in a 1-3 KHz range was measured before electric pulses were applied. Impedance was also measured after each successive pulse. Pulsation was stopped when impedance values were reduced by either 80% or 95% relative to prepulse values. Standard/fixed pulsing parameters were also used for comparison. The results indicated that up to 15-fold increases in luciferase expression could be obtained when electrical treatment was ceased based upon impedance reductions. Furthermore, peak expression levels of all treatment groups pulsed using the novel pulsing method were statistically higher than those that employed standard pulsing. These results strongly suggest that applying pulses until a defined impedance-based endpoint results in higher expression.

Comparison between high-frequency irreversible electroporation and irreversible electroporation ablation of small swine liver: follow-up of DCE-MRI and pathological observations

Background:

High-frequency irreversible electroporation (H-FIRE) is a novel, next-generation nanoknife technology with the advantage of relieving irreversible electroporation (IRE)-induced muscle contractions. However, the difference between IRE and H-FIRE with distinct ablation parameters was not clearly defined. This study aimed to compare the efficacy of the two treatments in vivo.

Methods:

Ten Bama miniature swine were divided into two group: five in the 1-day group and five in the 7-day group. The efficacy of IRE and H-FIRE ablation was compared by volume transfer constant (Krans), rate constant (Kep) and extravascular extracellular volume fraction (Ve) value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), size of the ablation zone, and histologic analysis. Each animal underwent the IRE and H-FIRE. Temperatures of the electrodes were measured during ablation. DCE-MRI images were obtained 1, 4, and 7 days after ablation in the 7-day group. All animals in the two groups were euthanized 1 day or 7 days after ablation, and subsequently, IRE and H-FIRE treated liver tissues were collected for histological examination. Student's t test or Mann-Whitney U test was applied for comparing any two groups. One-way analysis of variance (ANOVA) test and Welch's ANOVA test followed by Holm-Sidak's multiple comparisons test, one-way ANOVA with repeated measures followed by Bonferroni test, or Kruskal-Wallis H test followed by Dunn's multiple comparison test was used for multiple group comparisons and post hoc analyses. Pearson correlation coefficient test was conducted to analyze the relationship between two variables.

Results:

Higher Ve was seen in IRE zone than in H-FIRE zone (0.14 ± 0.02 vs. 0.08 ± 0.05, t = 2.408, P = 0.043) on day 4, but no significant difference was seen in Ktrans or Kep between IRE and H-FIRE zones at all time points (all P > 0.05). For IRE zone, the greatest Ktrans was seen on day 7, which was significantly higher than that on day 1 (P = 0.033). The ablation zone size of H-FIRE was significantly larger than IRE 1 day (4.74 ± 0.88 cm²vs. 3.20 ± 0.77 cm², t = 3.241, P = 0.009) and 4 days (2.22 ± 0.83 cm²vs. 1.30 ± 0.50 cm², t = 2.343, P = 0.041) after treatment. Apoptotic index (0.05 ± 0.02 vs. 0.73 ± 0.06 vs. 0.68 ± 0.07, F = 241.300, P < 0.001) and heat shock protein 70 (HSP70) (0.03 ± 0.01 vs. 0.46 ± 0.09 vs. and 0.42 ± 0.07, F = 64.490, P < 0.001) were significantly different between the untreated, IRE and H-FIRE zones, but no significant difference was seen in apoptotic index or HSP70 between IRE and H-FIRE zone (both P > 0.05). Electrode temperature variations were not significantly different between the two zones (18.00 ± 3.77°C vs. 16.20 ± 7.45°C, t = 0.682, P = 0.504). The Ktrans value (r = 0.940, P = 0.017) and the Kep value (r = 0.895, P = 0.040) of the H-FIRE zone were positively correlated with the number of hepatocytes in the ablation zone.

Conclusions:

H-FIRE showed a comparable ablation effect to IRE. DCE-MRI has the potential to monitor the changes of H-FIRE ablation zone.

A framework for modeling bioimpedance measurements of nonhomogeneous tissues: a theoretical and simulation study

Objective.Bioimpedance technology is experiencing an increased use to assess health in a wide range of new consumer, research and clinical applications. However, the interaction between tissues producing bioimpedance data is often unclear.Methods.This work provides a novel theoretical framework to model bioimpedance measurements of nonhomogeneous tissues. We consider five case studies to validate the usefulness of our approach against finite element model simulations.Results.Theoretical and FEM-simulated apparent resistance and reactance data were in good agreement, with a maximum relative errors <4% and <8%, respectively.Conclusion.The biophysics-driven framework developed provides compact analytical expressions to model nonhomogeneous bioimpedance measurements including multiple tissues with arbitrary shape and electrical properties. This work provides a new perspective to interpret nonhomogeneous bioimpedance measurements usingseries,parallel, andseries-parallelcircuit-like topology equivalents.Significance.Our framework is a new tool to better understand and describe complex nonhomogeneous biological measurements as, for example, cardiac, brain and respiratory applications using (non)invasive electrodes.

High-Frequency and High-Voltage Asymmetric Bipolar Pulse Generator for Electroporation Based Technologies and Therapies

Currently, in high-frequency electroporation, much progress has been made but limited to research groups with custom-made laboratory prototype electroporators. According to the review of electroporators and economic evaluations, there is still an area of pulse parameters that needs to be investigated. The development of an asymmetric bipolar pulse generator with a maximum voltage of 4 kV and minimum duration time of a few hundred nanoseconds, would enable in vivo evaluation of biological effects of high-frequency electroporation pulses. Herein, from a series of most commonly used drivers and optical isolations in high-voltage pulse generators the one with optimal characteristics was used. In addition, the circuit topology of the developed device is described in detail. The developed device is able to generate 4 kV pulses, with theoretical 131 A maximal current and 200 ns minimal pulse duration, the maximal pulse repetition rate is 2 MHz and the burst maximal repetition rate is 1 MHz. The device was tested in vivo. The effectiveness of electrochemotherapy of high-frequency electroporation pulses is compared to “classical” electrochemotherapy pulses. In vivo electrochemotherapy with high-frequency electroporation pulses was at least as effective as with “classical” well-established electric pulses, resulting in 86% and 50% complete responses, respectively. In contrast to previous reports, however, muscle contractions were comparable between the two protocols.