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Klein N, Mercadal B, Stehling M, Ivorra A. In vitro study on the mechanisms of action of electrolytic electroporation (E2). Bioelectrochemistry 2020; 133:107482. [PMID: 32062417 DOI: 10.1016/j.bioelechem.2020.107482] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 12/18/2022]
Abstract
Electrolytic Electroporation (E2) is the combination of reversible electroporation and electrolysis. It has been proposed as a novel treatment option to ablate tissue percutaneously. The present in vitro study in cells in suspension was performed to investigate the underlying mechanisms of action of E2. Different types of experiments were performed to isolate the effects of the electrolysis and the electroporation components of the treatment. Additionally, thermal simulations were performed to determine whether significant temperature increase contributes to the effect. The results indicate that E2's cell killing efficacy is due to a combinational effect of electrolysis and reversible electroporation that takes place within the first two minutes after E2 application. The results further show that cell death after E2 treatment is significantly delayed. These observations suggest that cell death is induced in permeabilized cells due to the uptake of electrolysis species. Thermal simulations revealed a significant but innocuous temperature increase.
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Affiliation(s)
- Nina Klein
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, C/Roc Boronat 138, E-08018 Barcelona, Spain; Institut fur Bildgebende Diagnostik, Strahlenbergerstrasse 110, 63067 Offenbach, Germany; Inter Science GmbH, Reussblickstr 23, 6038 Gisikon, Lucerne, Switzerland; Catalan Industrial Doctorates Program, Spain.
| | - Borja Mercadal
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, C/Roc Boronat 138, E-08018 Barcelona, Spain
| | - Michael Stehling
- Institut fur Bildgebende Diagnostik, Strahlenbergerstrasse 110, 63067 Offenbach, Germany; Inter Science GmbH, Reussblickstr 23, 6038 Gisikon, Lucerne, Switzerland
| | - Antoni Ivorra
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, C/Roc Boronat 138, E-08018 Barcelona, Spain; Serra Húnter Fellow Programme, Universitat Pompeu Fabra, Barcelona, Spain
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Guenther E, Klein N, Mikus P, Botea F, Pautov M, Lugnani F, Macchioro M, Popescu I, Stehling MK, Rubinsky B. Toward a clinical real time tissue ablation technology: combining electroporation and electrolysis (E2). PeerJ 2020; 8:e7985. [PMID: 31998549 PMCID: PMC6977482 DOI: 10.7717/peerj.7985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/03/2019] [Indexed: 01/05/2023] Open
Abstract
Background Percutaneous image-guided tissue ablation (IGA) plays a growing role in the clinical management of solid malignancies. Electroporation is used for IGA in several modalities: irreversible electroporation (IRE), and reversible electroporation with chemotoxic drugs, called electrochemotherapy (ECT). It was shown that the combination of electrolysis and electroporation—E2—affords tissue ablation with greater efficiency, that is, lower voltages, lower energy and shorter procedure times than IRE and without the need for chemotoxic additives as in ECT. Methods A new E2 waveform was designed that delivers optimal doses of electroporation and electrolysis in a single waveform. A series of experiments were performed in the liver of pigs to evaluate E2 in the context of clinical applications. The goal was to find initial parameter boundaries in terms of electrical field, pulse duration and charge as well as tissue behavior to enable real time tissue ablation of clinically relevant volumes. Results Histological results show that a single several hundred millisecond long E2 waveform can ablate large volume of tissue at relatively low voltages while preserving the integrity of large blood vessels and lumen structures in the ablation zone without the use of chemotoxic drugs or paralyzing drugs during anesthesia. This could translate clinically into much shorter treatment times and ease of use compared to other techniques that are currently applied.
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Affiliation(s)
- Enric Guenther
- Biophysics, Inter Science GmbH, Gisikon, Lucerne, Switzerland.,Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA, USA.,Institut fur Bildgebende Diagnostik, Offenbach, Germany
| | - Nina Klein
- Biophysics, Inter Science GmbH, Gisikon, Lucerne, Switzerland.,Institut fur Bildgebende Diagnostik, Offenbach, Germany.,Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Paul Mikus
- Biophysics, Inter Science GmbH, Gisikon, Lucerne, Switzerland
| | - Florin Botea
- Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.,Center of Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihail Pautov
- Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.,Center of Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | - Irinel Popescu
- Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.,Center of Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Michael K Stehling
- Biophysics, Inter Science GmbH, Gisikon, Lucerne, Switzerland.,Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA, USA.,Institut fur Bildgebende Diagnostik, Offenbach, Germany
| | - Boris Rubinsky
- Biophysics, Inter Science GmbH, Gisikon, Lucerne, Switzerland.,Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA, USA
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Klein N, Guenther E, Botea F, Pautov M, Dima S, Tomescu D, Popescu M, Ivorra A, Stehling M, Popescu I. The combination of electroporation and electrolysis (E2) employing different electrode arrays for ablation of large tissue volumes. PLoS One 2019; 14:e0221393. [PMID: 31437212 PMCID: PMC6705851 DOI: 10.1371/journal.pone.0221393] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background The combination of electroporation with electrolysis (E2) has previously been introduced as a novel tissue ablation technique. E2 allows the utilization of a wide parameter range and may therefore be a suitable technology for development of tissue-specific application protocols. Previous studies have implied that it is possible to achieve big lesions in liver in a very short time. The goal of this study was to test a variety of electrode configurations for the E2 application to ablate large tissue volumes. Materials and methods 27 lesions were performed in healthy porcine liver of five female pigs. Four, two and bipolar electrode-arrays were used to deliver various E2 treatment protocols. Liver was harvested approx. 20h after treatment and examined with H&E and Masson’s trichrome staining, and via TUNEL staining for selective specimen. Results All animals survived the treatments without complications. With four electrodes, a lesion of up to 35x35x35mm volume can be achieved in less than 30s. The prototype bipolar electrode created lesions of 50x18x18mm volume in less than 10s. Parameters for two-electrode ablations with large exposures encompassing large veins were found to be good in terms of vessel preservation, but not optimal to reliably close the gap between the electrodes. Conclusion This study demonstrates the ability to produce large lesions in liver within seconds at lower limits of the E2 parameter space at different electrode configurations. The applicability of E2 for single electrode ablations was demonstrated with bipolar electrodes. Parameters for large 4-electrode ablation volumes were found suitable, while parameters for two electrodes still need optimization. However, since the parameter space of E2 is large, it is possible that for all electrode geometries optimal waveforms and application protocols for specific tissues will emerge with continuing research.
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Affiliation(s)
- Nina Klein
- Inter Science GmbH, Lucerne, Switzerland
- Institut fur Bildgebende Diagnostik, Offenbach, Germany
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
- * E-mail:
| | - Enric Guenther
- Inter Science GmbH, Lucerne, Switzerland
- Institut fur Bildgebende Diagnostik, Offenbach, Germany
| | - Florin Botea
- Center of General Surgery and Liver Transplantation–Fundeni Clinical Institute, Bucharest, Romania
- Center of Translational Medicine–Fundeni Clinical Institute, Bucharest, Romania
| | - Mihail Pautov
- Center of General Surgery and Liver Transplantation–Fundeni Clinical Institute, Bucharest, Romania
- Center of Translational Medicine–Fundeni Clinical Institute, Bucharest, Romania
| | - Simona Dima
- Center of General Surgery and Liver Transplantation–Fundeni Clinical Institute, Bucharest, Romania
- Center of Translational Medicine–Fundeni Clinical Institute, Bucharest, Romania
| | - Dana Tomescu
- Center of Translational Medicine–Fundeni Clinical Institute, Bucharest, Romania
- Department of Anesthesiology and Intensive Care 3, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihai Popescu
- Center of Translational Medicine–Fundeni Clinical Institute, Bucharest, Romania
- Department of Anesthesiology and Intensive Care 3, Fundeni Clinical Institute, Bucharest, Romania
| | - Antoni Ivorra
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Michael Stehling
- Inter Science GmbH, Lucerne, Switzerland
- Institut fur Bildgebende Diagnostik, Offenbach, Germany
| | - Irinel Popescu
- Center of General Surgery and Liver Transplantation–Fundeni Clinical Institute, Bucharest, Romania
- Center of Translational Medicine–Fundeni Clinical Institute, Bucharest, Romania
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