Drug-loaded nano-microcapsules delivery system mediated by ultrasound-targeted microbubble destruction: A promising therapy method

Oxygen Sensitive Drug Release Using Hemoglobin Microbubbles: A New Approach to Targeting Hypoxia in Ultrasound-Mediated Drug Delivery

Targeted drug delivery strategies using focused ultrasound (FUS) are gaining prominence in clinical application. FUS offers deep tissue penetration and precise targeting capabilities. The capabilities of FUS in targeted drug delivery are greatly enhanced by the introduction of ultrasound contrast agents (UCAs - also known as microbubbles). This study introduces a novel hypoxia-targeting drug delivery system using hemoglobin microbubbles (HbMBs) conjugated with doxorubicin-loaded liposomes (LDOX). Previously, we reported that HbMBs exhibit significant acoustic response differences between oxygenated and deoxygenated environments due to hemoglobin's conformational changes, which alters the MBs' shell elasticity as well as resonance frequency. In this study, we coated the surface of HBMBs with LDOX to create Lip-HBMB complex and subsequently investigated its drug release at different oxygen partial pressures (pO2) when exposed to an ultrasound field. Results showed significantly higher drug release at lower oxygen levels, with about 10-times higher release at 5 mmHg pO2 than 160 mmHg pO2 at 0.5 W/cm2 US intensity and 3 MHz frequency. This highlights Lip-HbMBs' potential for targeted drug delivery to hypoxic tumor regions, marking a significant advancement in focused ultrasound-mediated drug delivery. This study marks the first-ever report of ultrasound-mediated oxygen-sensitive drug uncaging, which holds promise in enhancing FUS specificity and addressing the challenges posed by metastatic cancer.

Ultrasound Responsive Smart Implantable Hydrogels for Targeted Delivery of Drugs: Reviewing Current Practices

Over the last two decades, the process of delivering therapeutic drugs to a patient with a controlled release profile has been a significant focus of drug delivery research. Scientists have given tremendous attention to ultrasound-responsive hydrogels for several decades. These smart nanosystems are more applicable than other stimuli-responsive drug delivery vehicles (ie UV-, pH- and thermal-, responsive materials) because they enable more efficient targeted treatment via relatively non-invasive means. Ultrasound (US) is capable of safely transporting energy through opaque and complex media with minimal loss of energy. It is capable of being localized to smaller regions and coupled to systems operating at various time scales. However, the properties enabling the US to propagate effectively in materials also make it very difficult to transform acoustic energy into other forms that may be used. Recent research from a variety of domains has attempted to deal with this issue, proving that ultrasonic effects can be used to control chemical and physical systems with remarkable specificity. By obviating the need for multiple intravenous injections, implantable US responsive hydrogel systems can enhance the quality of life for patients who undergo treatment with a varied dosage regimen. Ideally, the ease of self-dosing in these systems would lead to increased patient compliance with a particular therapy as well. However, excessive literature has been reported based on implanted US responsive hydrogel in various fields, but there is no comprehensive review article showing the strategies to control drug delivery profile. So, this review was aimed at discussing the current strategies for controlling and targeting drug delivery profiles using implantable hydrogel systems.

Advances in polysaccharide-based nano/microcapsules for biomedical applications: A review

Biocompatible and biodegradable polysaccharides are abundant and renewable natural materials. Polysaccharides and their derivatives are developed into various carrier materials for biomedical applications. In particular, advanced polysaccharide-based nano/microcapsules have received extensive attention in biomedical applications due to their good encapsulation ability and tunability. In recent years, polysaccharide-based nano/microcapsules have been widely used in drug carriers, gene carriers, antigen carriers, wound dressings, bioimaging and biosensors. Numerous research results have confirmed the feasibility, safety, and effectiveness of polysaccharide-based nano/microcapsules in the above-mentioned biomedical applications. This review discussed and analyzed the latest research strategies and design considerations for these applications in detail. The preparation methods, application strategies, and design considerations of polysaccharide-based nano/microcapsules are summarized and analyzed, and their challenges and future research prospects in biomedicine are further discussed. It is expected to provide researchers with inspiration and design ideas.

Big Data Analysis of Manufacturing and Preclinical Studies of Nanodrug-Targeted Delivery Systems: A Literature Review

Objective

Nanodelivery is a modern technology involving improved delivery methods and drug formulations. The current development and initial applications of nanocarriers are pointing to new directions in the current development of nanomedicine. Researchers are increasingly applying nanodelivery to the delivery of therapeutic or diagnostic agents. This article discusses the preparation and application of nanocomplexes and nanoparticles, as well as their potential future value in clinical research. Through a review and analysis, it is hoped that this will serve as a guide for the future development of various nanodelivery technologies and help researchers learn more about these technologies.

Materials and Methods

A literature search was conducted using the keywords “Nano drug delivery” or “Nanomedical materials” or “Nano”. A literature search was conducted in three major databases, PubMed, Web of Science, and Google Scholar, using the keywords such as “Nano drug delivery”, “Nanomedical materials”, or “Nanobubble drug delivery”. The initial search was screened by title and abstract. In the full-text review, the titles or abstracts were reviewed according to the selection criteria based on the inclusion criteria. The risk of bias and study quality was assessed according to the Cochrane guidelines, and possible biases such as selection bias and good selection bias were included in the review.

Results

A total of 297 studies were included in this study, of which 219 were excluded based on the screening criteria, resulting in the inclusion of 78 studies, the majority of which were original studies and clinical trials, and a small number of which provided design and route of administration analysis of nanomaterial particles and effect fluorograms and were studied in more depth. This paper summarises and reviews the views and directions of the included articles. The main directions include cyclodextrin-based or grafted cyclodextrin nanomaterials, nanobubbles, and stimuli-sensitive and temperature-sensitive nanodelivery systems.

Conclusion

The use of innovative, targeted drug delivery systems is effective in cancer drug delivery by summarising the previous studies. However, nanodelivery systems' risks and therapeutic effects need to be evaluated before clinical application. Future research in the field of targeted drug delivery nanosystems should focus on the development of nanocarriers with high in vivo delivery capacity, good synergy with therapeutic agents, and milder short-term and long-term toxicological effects and conduct comprehensive preclinical trials on nanodrug delivery systems with high potential for clinical application as soon as possible, to find nanodrug delivery systems suitable for clinical use and put them into the clinical application as soon as possible.

Ultrasound-targeted microbubble destruction (UTMD)-mediated miR-150-5p attenuates oxygen and glucose deprivation-induced cardiomyocyte injury by inhibiting TTC5 expression

BACKGROUND

Cardiomyocyte injury is a typical feature in cardiovascular diseases. Changes in cardiomyocytes strongly affect the progression of cardiovascular diseases. This work aimed to investigate the biological function and potential mechanism of action of miR-150-5p in cardiomyocytes.

METHODS AND RESULTS

A myocardial ischemia (MI) injury rat model was constructed to detect miR-150-5p and tetratricopeptide repeat domain 5 (TTC5) expression during heart ischemia injury. Primary cardiomyocytes were isolated for in vitro study. CCK-8 assays were used to detect cardiomyocyte viability. Western blots were used to detect TTC5 and P53 expression. qPCR was utilized to measure RNA expression of miR-150-5p and TTC5. The TUNEL assay was used to determine cell apoptosis. ELISA was used to determine cytokine (TNF-α, IL-1β, IL-6, and IL-8) levels in heart tissues and cell culture supernatants. A dual-luciferase reporter assay was carried out to verify the binding ability between miR-150-5p and TTC5. Oxygen-glucose deprivation (OGD) treatment significantly inhibited cell viability. Ultrasound-targeted microbubble destruction (UTMD)-mediated uptake of miR-150-5p inverted these results. Additionally, UTMD-mediated uptake of miR-150-5p retarded the effects of OGD treatment on cell apoptosis. Besides, UTMD-mediated uptake of miR-150-5p counteracted the effects of OGD treatment on the inflammatory response by regulating cytokine (TNF-α, IL-1β, IL-6, and IL-8) levels. For the mechanism of the protective effect on the heart, we predicted and confirmed that miR-150-5p bound to TTC5 and inhibited TTC5 expression.

CONCLUSIONS

UTMD-mediated uptake of miR-150-5p attenuated OGD-induced primary cardiomyocyte injury by inhibiting TTC5 expression. This discovery contributes toward further understanding the progression of primary cardiomyocyte injury.

EFFECT OF ARTERIOLAR DISTENSIBILITY ON THE LATERAL MIGRATION OF LIQUID-FILLED MICROPARTICLES FLOWING IN A HUMAN ARTERIOLE

A promising advance of bioengineering consists in the development of micro-nanoparticles as drug delivery vehicles injected intravenously or intraarterialy for targeted treatment. Proficient functioning of drug carries is conditioned by a reliable prediction of pharmacokinetics in human as well as their dynamical behavior once injected in blood stream. In this study, we aim to provide a reliable numerical prediction of dynamical behavior of microparticles in human arteriole focusing on the crucial mechanism of lateral migration. The dynamical response of the microparticle upon blood flow and arteriolar distensibility is investigated by varying main controlling parameters: viscosity ratio, confinement and capillary number. The influence of the hyperelastic arteriolar wall is highlighted through comparison with an infinitely rigid arteriolar wall. The hydrodynamic interaction in a microparticle train is examined. Fluid–structure interaction is solved by the Arbitrary Lagrangian–Eulerian method using the COMSOL Multiphysics software.

Surface PEGylated Cancer Cell Membrane-Coated Nanoparticles for Codelivery of Curcumin and Doxorubicin for the Treatment of Multidrug Resistant Esophageal Carcinoma

Objective

The emergence of multi-drug resistance (MDR) in esophageal carcinoma has severely affected the effect of chemotherapy and shortened the survival of patients. To this end, we intend to develop a biomimetic nano-targeting drug modified by cancer cell membrane, and investigate its therapeutic effect.

Methods

The degradable poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) co-loaded with doxorubicin (DOX) and curcumin (Cur) were prepared by solvent evaporation method. TE10 cell membrane and Distearoyl phosphatidylethanolamine-polyethylene glycol (DSPE-PEG) were then coated on the PLGA NPs by membrane extrusion to prepare the PEG-TE10@PLGA@DOX-Cur NPs (PMPNs). Size and zeta potential of the PMPNs were analyzed by lazer particle analyzer, and the morphology of PMPNs was observed by transmission electron microscope. The TE10 cell membrane protein on PMPNs was analyzed by gel electrophoresis. The DOX-resistant esophageal cancer cell model TE10/DOX was established through high-dose induction. The In vitro homologous targeting ability of PMPNs was evaluated by cell uptake assay, and the in vitro anti-tumor effect of PMPNs was assessed through CCK-8, clone formation and flow cytometry. A Balb/c mouse model of TE10/DOX xenograft was constructed to evaluate the anti-tumor effect in vivo and the bio-safety of PMPNs.

Results

The prepared cell membrane coated PMPNs had a regular spherical structure with an average diameter of 177 nm. PMPNs could directly target TE10 and TE10/DOX cells or TE10/DOX xenografted tumor and effectively inhibit the growth of DOX-resistant esophageal carcinoma. Besides, the PMPNs was confirmed to have high biosafety.

Conclusion

In this study, a targeted biomimetic nano-drug delivery system PMPNs was successfully prepared, which overcome the MDR of esophageal carcinoma by co-delivering DOX and sensitizer curcumin.

Numerical Investigation of the Dynamical Behavior of a Fluid-Filled Microparticle Suspended in Human Arteriole

The study of artificial microparticles (capsules and vesicles) has gained a growing interest with the emergence of bio-engineering. One of their promoting applications is their use as therapeutic vectors for drug delivery, when capsules and vesicles release their capacity in a targeted environment. The dynamic behavior of capsules and vesicles in confined or unbounded flows was widely studied in the literature and their mechanical response was truthfully described using constitutive laws with good agreement with experiences. However, in a context of biological application, to our knowledge, none of published studies investigating the mechanical response of deformable microparticle took into account the real physiological conditions: the rheological properties of blood such as carrying fluid and the mechanical properties of blood vessels. In this paper, we consider a hyperelastic microparticle suspended in human arteriole. We investigate the deformation of the microparticle resulting from its interaction with blood flow and the arteriolar wall using various capillary numbers and respecting physiological properties of blood and arterial wall. The influence of the blood viscosity model (Newtonian versus shear thinning) is investigated and a comparison with a rigid microchannel and a muscle-embedded arteriole is carried out. The fluid structure interaction (FSI) problem is solved using arbitrary Lagrangian Eulerian (ALE) method. Our simulations have revealed that the arteriolar wall distensibility deeply influences both the deformation and velocity of the microparticle: the deformation strongly increases while the velocity decreases in comparison to an infinitely rigid wall. In the context of therapeutic procedure of targeted drug-delivery, a particular attention should be addressed to these observations, in particular for their implication in the burst mechanism.

Downregulation of GSK-3β Expression via Ultrasound-Targeted Microbubble Destruction Enhances Atherosclerotic Plaque Stability in New Zealand Rabbits

Accumulating evidence suggests that atherosclerosis (AS) is the underlying cause of vascular diseases, including heart disease and stroke. Ultrasound-targeted microbubble destruction (UTMD) technology provides a tolerable, efficient and effective system for drug delivery and gene transfection, which has broad application prospects in the treatment of AS. In addition, glycogen synthase kinase (GSK)-3β has been implicated as a potentially valuable therapeutic agent for AS treatment; however, the specific molecular mechanisms remain unknown. Therefore, this study was conducted to explore the effect of downregulation of GSK-3β expression via UTMD on atherosclerotic plaque stability. We established a THP-1 macrophage-derived foam cell model in vitro and an atherosclerotic plaque model in the right common carotid artery of New Zealand rabbits. We determined levels of the relevant vulnerable plaque stability elements. The results indicate that GSK-3β was upregulated in the foam cells and in atherosclerotic rabbits. Downregulation of GSK-3β expression by UTMD suppressed vulnerable plaque factors and inflammation in vitro and in vivo, changed the cytoskeleton of the foam cells in vitro, increased Young's modulus and decreased the peak intensity of atherosclerotic plaque in vivo. Moreover, GSK-3β inhibition by UTMD did not influence the viability of the foam cells. Collectively, our results indicate that GSK-3β could be a potential target for anti-atherogenic interventions and, in particular, can improve the stability of AS plaques in combination with UTMD.

Ultrasound-Targeted Microbubble Destruction-Mediated miR-206 Overexpression Promotes Apoptosis and Inhibits Metastasis of Hepatocellular Carcinoma Cells Via Targeting PPIB

Background:

Ultrasound-targeted microbubble destruction (UTMD) has been found to be an effective method for delivering microRNAs (miRNAs, miRs). The current study is aimed at discovering the potential anti-cancer effects of UTMD-mediated miR-206 on HCC.

Methods:

In our study, the expressions of miR-206 and peptidyl-prolyl cis-trans isomerase B (PPIB) in HCC tissues and cells were detected by quantitative real-time polymerase chain reaction (qRT-PCR). PPIB expressions in HCC and adjacent normal tissues were analyzed by gene expression profiling interactive analysis (GEPIA). MiR-206 mimic and mimic control were transfected into HCC cells using UTMD. Potential binding sites between miR-206 and PPIB were predicted and confirmed by TargetScan and dual-luciferase reporter assay, respectively. Cell migration, invasion, and apoptosis were detected by wound healing assay, Transwell, and flow cytometry, respectively. The expressions of apoptosis-related proteins (Bax, Bcl-2), Epithelial-to-mesenchymal (EMT) markers (E-cadherin, N-cadherin and Snail) and PPIB were measured by Western blot.

Results:

MiR-206 expression was downregulated while PPIB expression was upregulated in HCC, and PPIB was recognized as a target gene of miR-206 in HCC tissues. UTMD-mediated miR-206 inhibited HCC cell migration and invasion while promoting apoptosis via regulating the expressions of proteins related to apoptosis, migration, and invasion by targeting PPIB.

Conclusion:

Our results suggested that the delivery of UTMD-mediated miR-206 could be a potential therapeutic method for HCC treatment, given its effects on inhibiting cell migration and invasion and promoting cell apoptosis.

Nanotechnology in Plant Science: To Make a Long Story Short

This mini-review aims at gaining knowledge on basic aspects of plant nanotechnology. While in recent years the enormous progress of nanotechnology in biomedical sciences has revolutionized therapeutic and diagnostic approaches, the comprehension of nanoparticle-plant interactions, including uptake, mobilization and accumulation, is still in its infancy. Deeper studies are needed to establish the impact of nanomaterials (NMs) on plant growth and agro-ecosystems and to develop smart nanotechnology applications in crop improvement. Herein we provide a short overview of NMs employed in plant science and concisely describe key NM-plant interactions in terms of uptake, mobilization mechanisms, and biological effects. The major current applications in plants are reviewed also discussing the potential use of polymeric soft NMs which may open new and safer opportunities for smart delivery of biomolecules and for new strategies in plant genetic engineering, with the final aim to enhance plant defense and/or stimulate plant growth and development and, ultimately, crop production. Finally, we envisage that multidisciplinary collaborative approaches will be central to fill the knowledge gap in plant nanotechnology and push toward the use of NMs in agriculture and, more in general, in plant science research.

Antitumor Effects of Intra-Arterial Delivery of Albumin-Doxorubicin Nanoparticle Conjugated Microbubbles Combined with Ultrasound-Targeted Microbubble Activation on VX2 Rabbit Liver Tumors

Image-guided intra-arterial therapies play a key role in the management of hepatic malignancies. However, limited clinical outcomes suggest the need for new multifunctional drug delivery systems to enhance local drug concentration while reducing systemic adverse reactions. Therefore, we developed the albumin-doxorubicin nanoparticle conjugated microbubble (ADMB) to enhance therapeutic efficiency by sonoporation under exposure to ultrasound. ADMB demonstrated a size distribution of 2.33 ± 1.34 µm and a doxorubicin loading efficiency of 82.7%. The echogenicity of ADMBs was sufficiently generated in the 2–9 MHz frequency range and cavitation depended on the strength of the irradiating ultrasound. In the VX2 rabbit tumor model, ADMB enhanced the therapeutic efficiency under ultrasound exposure, compared to free doxorubicin. The intra-arterial administration of ADMBs sufficiently reduced tumor growth by five times, compared to the control group. Changes in the ADC values and viable tumor fraction supported the fact that the antitumor effect of ADMBs were enhanced by evidence of necrosis ratio (over 70%) and survival tumor cell fraction (20%). Liver toxicity was comparable to that of conventional therapies. In conclusion, this study shows that tumor suppression can be sufficiently maximized by combining ultrasound exposure with intra-arterial ADMB administration.

Ultrasound‑targeted microbubble destruction‑mediated miR‑205 enhances cisplatin cytotoxicity in prostate cancer cells

MicroRNAs (miRNAs) are non-coding ~20 nucleotides long sequences that function in the initiation and development of a number of cancers. Ultrasound-targeted microbubble destruction (UTMD) is an effective method for microRNA delivery. The aim of the present study was to investigate the potential roles of UTMD-mediated miRNA (miR)-205 delivery in the development of prostate cancer (PCa). In the present study, miR-205 expression was examined by reverse transcription-quantitative polymerase chain reaction assay. miR-205 mimics were transfected into PC-3 cells using the UTMD method, and the PC-3 cells were also treated with cisplatin. Cell proliferation, apoptosis, migration and invasion abilities were detected using Cell Counting kit-8, flow cytometry, wound healing and Transwell assays, respectively. In addition, the protein expression levels of caspase-9, cleaved-caspase 9, cytochrome c (cytoc), epithelial (E)-cadherin, matrix metalloproteinase-9 (MMP-9), phosphorylated (p)-extracellular signal-regulated kinase (ERK) and ERK were measured by western blot analysis. The results of the present study demonstrated that miR-205 expression was low in human PCa cell lines compared with healthy cells and that UTMD-mediated miR-205 delivery inhibited PCa cell proliferation, migration and invasion, and promoted apoptosis modulated by cisplatin compared with UTMD-mediated miR-negative control group and miR-205-treated group. Furthermore, it was demonstrated that UTMD-mediated miR-205 transfection increased the expression of caspase-9, cleaved-caspase 9, cytochrome c and E-cadherin, and decreased the expression of MMP-9 and p-ERK. Therefore, UTMD-mediated miR-205 delivery may be a promising method for the treatment of PCa.

Drug-carrying microbubbles as a theranostic tool in convection-enhanced delivery for brain tumor therapy

Convection-enhanced delivery (CED) is a promising technique for infusing a therapeutic agent through a catheter with a pressure gradient to create bulk flow for improving drug spread into the brain. So far, gadopentetate dimeglumine (Gd-DTPA) is the most commonly applied surrogate agent for predicting drug distribution through magnetic resonance imaging (MRI). However, Gd-DTPA provides only a short observation duration, and concurrent infusion provides an indirect measure of the exact drug distribution. In this study, we propose using microbubbles as a contrast agent for MRI monitoring, and evaluate their use as a drug-carrying vehicle to directly monitor the infused drug. Results show that microbubbles can provide excellent detectability through MRI relaxometry and accurately represent drug distribution during CED infusion. Compared with the short half-life of Gd-DTPA (1-2 hours), microbubbles allow an extended observation period of up to 12 hours. Moreover, microbubbles provide a sufficiently high drug payload, and glioma mice that underwent a CED infusion of microbubbles carrying doxorubicin presented considerable tumor growth suppression and a significantly improved survival rate. This study recommends microbubbles as a new theranostic tool for CED procedures.

Effect of Low-Intensity Cavitation on the Isolated Human Thoracic Artery In Vitro

Reported here are the results of an experimental study on the response to low-intensity cavitation induced by low-frequency (4-6 W/cm², 20 kHz and 32.6 kHz) ultrasound of isolated human arterial samples taken during conventional myocardial revascularization operations. Studies have found that low-frequency ultrasound results in a significant (48%-54%) increase in isometric contraction force and does not depend on the number of exposures (10 or 20) or the time passed since the start of ultrasound (0, 10 and 20 min), but does depend on the frequency and location (internal or external) of the blood vessels for the application of ultrasound. Diltiazem (an inhibitor of slow calcium channels) and carbachol (an agonist of muscarinic receptors) used in a concentration-dependent manner did not modify the relaxation dynamics of smooth muscle affected by ultrasound. Thus, ultrasound conditioned to the augmentation of the isometric contraction force the smooth muscle of blood vessels and did not improve endothelial- and calcium channel blocker-dependent relaxation.

Ultrasound combined with targeted cationic microbubble-mediated angiogenesis gene transfection improves ischemic heart function

The present study aimed to construct targeted cationic microbubbles (TCMBs) by synthesizing cationic microbubbles conjugated to an intercellular adhesion molecule-1 (ICAM-1) antibody, and then to use the TCMBs to deliver the angiopoietin-1 (Ang-1) gene into infarcted heart tissue using ultrasound-mediated microbubble destruction. It was hypothesized that the TCMBs would accumulate in higher numbers than non-targeted cationic microbubbles (CMBs) in the infarcted heart, and would therefore increase the efficiency of targeted Ang-1 gene transfection and promote angiogenesis. The results of the study demonstrated that the ability of TCMBs to target inflammatory endothelial cells was 18.4-fold higher than that of the CMBs in vitro. The accumulation of TCMBs was greater than that of CMBs in TNF-α-stimulated human umbilical cord veins, indicated by a 212% higher acoustic intensity. In vivo, the TCMBs specifically accumulated in the myocardial infarct area in a rabbit model. Three days after ultrasound microbubble-mediated gene transfection, Ang-1 protein expression in the TCMB group was 2.7-fold higher than that of the CMB group. Angiogenesis, the thickness of the infarct region and the heart function of the TCMB group were all significantly improved compared with those in the CMB and control groups at 4 weeks following gene transfection (all P<0.01). Therefore, the results of the current study demonstrate that ultrasound-mediated TCMB destruction effectively delivered the Ang-1 gene to the infarcted myocardium, resulting in improved cardiac morphology and function in the animal model. Ultrasound-mediated TCMB destruction is a promising strategy for improving gene therapy in the future.

Use of Theranostic Strategies in Myocardial Cavitation-Enabled Therapy

The accumulation of microlesions induced by ultrasound interaction with contrast microbubbles in the myocardium potentially represents a new method of tissue reduction therapy. Anesthetized rats were treated in a heated water bath with 1.5-MHz focused ultrasound pulses triggered once every four heartbeats from the electrocardiogram during infusion of microbubble contrast agent. Treatment was guided by an 8-MHz B-mode imaging transducer, which also was used to provide estimates of left ventricular echogenicity as a possible predictor of efficacy during treatment. Strategies to reduce prospective clinical treatment durations were tested, including pulse modulation to simulate a theranostic scanning strategy and an increased agent infusion rate over shorter durations. Sources of variability, including ultrasound path variation and venous catheter placement, also were investigated. Electrocardiographic premature complexes were monitored, and Evans-blue stained cardiomyocyte scores were obtained from frozen sections. Left ventricular echogenicity reflected variations in the infused microbubble concentration, but failed to predict efficacy. Comparison of suspensions of varied microbubble size revealed that left ventricular echogenicity was dominated by larger bubbles, whereas efficacy appeared to be dependent on smaller sizes. Simulated scanning was as effective as the normal fixed-beam treatment, and high agent infusion allowed reduced treatment duration. The success of these theranostic strategies may increase the prospects for realistic clinical translation of myocardial cavitation-enabled therapy.