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      7.0-T Magnetic Resonance Imaging Characterization of Acute Blood-Brain-Barrier Disruption Achieved with Intracranial Irreversible Electroporation

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          Abstract

          The blood-brain-barrier (BBB) presents a significant obstacle to the delivery of systemically administered chemotherapeutics for the treatment of brain cancer. Irreversible electroporation (IRE) is an emerging technology that uses pulsed electric fields for the non-thermal ablation of tumors. We hypothesized that there is a minimal electric field at which BBB disruption occurs surrounding an IRE-induced zone of ablation and that this transient response can be measured using gadolinium (Gd) uptake as a surrogate marker for BBB disruption. The study was performed in a Good Laboratory Practices (GLP) compliant facility and had Institutional Animal Care and Use Committee (IACUC) approval. IRE ablations were performed in vivo in normal rat brain (n = 21) with 1-mm electrodes (0.45 mm diameter) separated by an edge-to-edge distance of 4 mm. We used an ECM830 pulse generator to deliver ninety 50-μs pulse treatments (0, 200, 400, 600, 800, and 1000 V/cm) at 1 Hz. The effects of applied electric fields and timing of Gd administration (−5, +5, +15, and +30 min) was assessed by systematically characterizing IRE-induced regions of cell death and BBB disruption with 7.0-T magnetic resonance imaging (MRI) and histopathologic evaluations. Statistical analysis on the effect of applied electric field and Gd timing was conducted via Fit of Least Squares with α = 0.05 and linear regression analysis. The focal nature of IRE treatment was confirmed with 3D MRI reconstructions with linear correlations between volume of ablation and electric field. Our results also demonstrated that IRE is an ablation technique that kills brain tissue in a focal manner depicted by MRI (n = 16) and transiently disrupts the BBB adjacent to the ablated area in a voltage-dependent manner as seen with Evan's Blue (n = 5) and Gd administration.

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          Most cited references21

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          Assumptions in the radiotherapy of glioblastoma.

          In the light of advances in computerized tomography (CT), we have retrospectively evaluated the assumptions that underlie the radiation therapy of glioblastoma: (1) No neuroradiologic technique provides an accurate delineation of tumor bulk and location, (2) glioblastoma is commonly multicentric, and (3) a major source of therapeutic failure is recurrence beyond radiotherapy fields. 1. CT scans, performed on glioblastoma patients within 2 months of postmortem examination, defined both gross and microscopic tumor extent (within a 2-cm margin) in all but 6 of 35 patients evaluated. The major source of error was subependymal spread (four patients). 2. Multicentricity occurred in only 4% of untreated and 6% of treated (radiotherapy with or without chemotherapy) patients. All multicentric lesions were identified on CT scans. 3. Serial CT scans on 42 patients revealed that glioblastoma recurred within a 2-cm margin of the primary site in 90%. Occurrences outside this margin were accurately delineated by CT in all instances. Because most patients show recurrence within or in close proximity to the original site, current radiation doses would appear to be inadequate for therapy of the primary tumor. CT scan accuracy may permit smaller-field and higher-dose irradiation therapy for glioblastoma.
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            Blood-brain barrier disruption with focused ultrasound enhances delivery of chemotherapeutic drugs for glioblastoma treatment.

            To demonstrate the feasibility of using focused ultrasound to enhance delivery of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) to glioblastomas in rats with induced tumors and determine if such an approach increases treatment efficacy. All animal experiments were approved by the animal committee and adhered to the experimental animal care guidelines. A 400-kHz focused ultrasound generator was used to transcranially disrupt the blood-brain barrier (BBB) in rat brains by delivering burst-tone ultrasound energy in the presence of microbubbles. The process was monitored in vivo by using magnetic resonance (MR) imaging. Cultured C6 glioma cells implanted in Sprague-Dawley rats were used as the tumor model. BCNU (13.5 mg/kg) was administered intravenously and its concentration in brains was quantified by using high-performance liquid chromatography. MR imaging was used to evaluate the effect of treatments longitudinally, including analysis of tumor progression and animal survival, and brain tissues were histologically examined. Methods including the two-tailed unpaired t test and the Mantel-Cox test were used for statistical analyses, with a significance level of .05. Focused ultrasound significantly enhanced the penetration of BCNU through the BBB in normal (by 340%) and tumor-implanted (by 202%) brains without causing hemorrhaging. Treatment of tumor-implanted rats with focused ultrasound alone had no beneficial effect on tumor progression or on animal survival up to 60 days. Administration of BCNU only transiently controlled tumor progression; nevertheless, relative to untreated controls, animal survival was improved by treatment with BCNU alone (increase in median survival time [IST(median)], 15.7%, P = .023). Treatment with focused ultrasound before BCNU administration controlled tumor progression (day 31: 0.05 cm(3) + or - 0.1 [standard deviation] vs 0.28 cm(3) + or - 0.1) and improved animal survival relative to untreated controls (IST(median), 85.9%, P = .0015). This study demonstrates a means of increasing localized chemotherapeutic drug delivery for brain tumor treatment and strongly supports the feasibility of this treatment in a clinical setting.
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              Tumor Ablation with Irreversible Electroporation

              We report the first successful use of irreversible electroporation for the minimally invasive treatment of aggressive cutaneous tumors implanted in mice. Irreversible electroporation is a newly developed non-thermal tissue ablation technique in which certain short duration electrical fields are used to permanently permeabilize the cell membrane, presumably through the formation of nanoscale defects in the cell membrane. Mathematical models of the electrical and thermal fields that develop during the application of the pulses were used to design an efficient treatment protocol with minimal heating of the tissue. Tumor regression was confirmed by histological studies which also revealed that it occurred as a direct result of irreversible cell membrane permeabilization. Parametric studies show that the successful outcome of the procedure is related to the applied electric field strength, the total pulse duration as well as the temporal mode of delivery of the pulses. Our best results were obtained using plate electrodes to deliver across the tumor 80 pulses of 100 µs at 0.3 Hz with an electrical field magnitude of 2500 V/cm. These conditions induced complete regression in 12 out of 13 treated tumors, (92%), in the absence of tissue heating. Irreversible electroporation is thus a new effective modality for non-thermal tumor ablation.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2012
                30 November 2012
                : 7
                : 11
                : e50482
                Affiliations
                [1 ]Bioelectromechanical Systems Lab, School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Blacksburg, Virginia, United States of America
                [2 ]Neurology and Neurosurgery, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, United States of America
                [3 ]Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, United States of America
                [4 ]Center for Biomolecular Imaging, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
                [5 ]Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
                [6 ]Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
                The Ohio State University Medical Center, United States of America
                Author notes

                Competing Interests: The authors have read the journal's policy and have the following conflicts. PAG, JHR, JLR, and RVD have patents pending on the irreversible electroporation technology. Specifically, the submitted patent applications are described: 1. MB Sano, RV Davalos, JL Robertson. Irreversible Electroporation using Tissue Vasculature to Treat Aberrant Cell Masses or Create Tissue Scaffolds. PCT/US Application 11/62067. Filing Date 11/23/11 Pending. 2. RE Neal II, PA Garcia, RV Davalos, JH Rossmeisl, Jr., JL Robertson. Treatment Planning for Electroporation-Based Therapies. US Application 12/906,923. Filing Date: 10/18/10 Pending. 3. RV Davalos, PA Garcia, JL Robertson, JH Rossmeisl, Jr., RE Neal II. Irreversible Electroporation to Treat Aberrant Cell Masses. US Application 12/491,151. Filing Date: 6/24/09 Pending. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

                Conceived and designed the experiments: PAG JHR JLR JDO AJJ TLE RVD. Performed the experiments: PAG JHR JLR JDO AJJ TLE RVD. Analyzed the data: PAG JHR. Contributed reagents/materials/analysis tools: PAG JHR JLR JDO AJJ TLE RVD. Wrote the paper: PAG JHR JLR JDO AJJ TLE RVD.

                Article
                PONE-D-12-16051
                10.1371/journal.pone.0050482
                3511570
                23226293
                cb69d478-57ea-4ea3-991f-dcc2df02fd9e
                Copyright @ 2012

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 18 May 2012
                : 25 October 2012
                Page count
                Pages: 8
                Funding
                This work was supported by the Golfers Against Cancer ( http://www.golfersagainstcancer.org/), the Center for Biomolecular Imaging in the Wake Forest School of Medicine ( http://www.wakehealth.edu/Center-for-Biomolecular-Imaging/), and NSF CAREER Award CBET-1055913 ( http://www.nsf.gov/div/index.jsp?div=cbet). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Engineering
                Bioengineering
                Biomedical Engineering
                Medical Devices
                Medicine
                Oncology
                Cancers and Neoplasms
                Neurological Tumors
                Cancer Treatment
                Radiology
                Diagnostic Radiology
                Magnetic Resonance Imaging
                Surgery
                Minimally Invasive Surgery
                Neurosurgery
                Physics
                Biophysics
                Biophysics Simulations
                Electricity
                Electric Field
                Veterinary Science

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