A Numerical Investigation of the Electric and Thermal Cell Kill Distributions in Electroporation-Based Therapies in Tissue

Electroporation-based therapies are powerful biotechnological tools for enhancing the delivery of exogeneous agents or killing tissue with pulsed electric fields (PEFs). Electrochemotherapy (ECT) and gene therapy based on gene electrotransfer (EGT) both use reversible electroporation to deliver chemotherapeutics or plasmid DNA into cells, respectively. In both ECT and EGT, the goal is to permeabilize the cell membrane while maintaining high cell viability in order to facilitate drug or gene transport into the cell cytoplasm and induce a therapeutic response. Irreversible electroporation (IRE) results in cell kill due to exposure to PEFs without drugs and is under clinical evaluation for treating otherwise unresectable tumors. These PEF therapies rely mainly on the electric field distributions and do not require changes in tissue temperature for their effectiveness. However, in immediate vicinity of the electrodes the treatment may results in cell kill due to thermal damage because of the inhomogeneous electric field distribution and high current density during the electroporation-based therapies. Therefore, the main objective of this numerical study is to evaluate the influence of pulse number and electrical conductivity in the predicted cell kill zone due to irreversible electroporation and thermal damage. Specifically, we simulated a typical IRE protocol that employs ninety 100-µs PEFs. Our results confirm that it is possible to achieve predominant cell kill due to electroporation if the PEF parameters are chosen carefully. However, if either the pulse number and/or the tissue conductivity are too high, there is also potential to achieve cell kill due to thermal damage in the immediate vicinity of the electrodes. Therefore, it is critical for physicians to be mindful of placement of electrodes with respect to critical tissue structures and treatment parameters in order to maintain the non-thermal benefits of electroporation and prevent unnecessary damage to surrounding healthy tissue, critical vascular structures, and/or adjacent organs.

[1]  Boris Rubinsky,et al.  Temperature considerations during irreversible electroporation , 2008 .

[2]  Damijan Miklavcic,et al.  Treatment planning of electroporation-based medical interventions: electrochemotherapy, gene electrotransfer and irreversible electroporation , 2012, Physics in medicine and biology.

[3]  Karin Nielsen,et al.  Irreversible electroporation for nonthermal tumor ablation in the clinical setting: a systematic review of safety and efficacy. , 2014, Journal of vascular and interventional radiology : JVIR.

[4]  Damijan Miklavcic,et al.  The effect of high frequency electric pulses on muscle contractions and antitumor efficiency in vivo for a potential use in clinical electrochemotherapy. , 2005, Bioelectrochemistry.

[5]  L. Chernomordik,et al.  Reversible electrical breakdown of lipid bilayers: formation and evolution of pores. , 1988, Biochimica et biophysica acta.

[6]  Boris Rubinsky,et al.  In vivo results of a new focal tissue ablation technique: irreversible electroporation , 2006, IEEE Transactions on Biomedical Engineering.

[7]  Boris Rubinsky,et al.  Irreversible Electroporation in Medicine , 2007, Technology in cancer research & treatment.

[8]  Rafael V. Davalos,et al.  Intracranial Nonthermal Irreversible Electroporation: In Vivo Analysis , 2010, The Journal of Membrane Biology.

[9]  Tan-Hsu Tan,et al.  Clinical Verification of A Clinical Decision Support System for Ventilator Weaning , 2013, Biomedical engineering online.

[10]  Damijan Miklavcic,et al.  Robustness of Treatment Planning for Electrochemotherapy of Deep-Seated Tumors , 2010, The Journal of Membrane Biology.

[11]  Stephen T Kee,et al.  Imaging Guided Percutaneous Irreversible Electroporation: Ultrasound and Immunohistological Correlation , 2007, Technology in cancer research & treatment.

[12]  K. Kurata,et al.  Three-dimensional analysis of irreversible electroporation: Estimation of thermal and non-thermal damage , 2014 .

[13]  D. Miklavčič,et al.  Cell membrane electroporation- Part 1: The phenomenon , 2012, IEEE Electrical Insulation Magazine.

[14]  Raphael C. Lee,et al.  Cell Injury by Electric Forces , 2005, Annals of the New York Academy of Sciences.

[15]  T. Tsong,et al.  Formation and resealing of pores of controlled sizes in human erythrocyte membrane , 1977, Nature.

[16]  O. Pakhomova,et al.  Facilitation of electroporative drug uptake and cell killing by electrosensitization , 2013, Journal of cellular and molecular medicine.

[17]  D Miklavcic,et al.  The importance of electric field distribution for effective in vivo electroporation of tissues. , 1998, Biophysical journal.

[18]  J. Weaver,et al.  Electroporation: A general phenomenon for manipulating cells and tissues , 1993, Journal of cellular biochemistry.

[19]  Steven L. Jacques,et al.  Nonlinear finite-element analysis of the role of dynamic changes in blood perfusion and optical properties in laser coagulation of tissue , 1996 .

[20]  L. Mir,et al.  [Electrochemotherapy, a new antitumor treatment: first clinical trial]. , 1991, Comptes rendus de l'Academie des sciences. Serie III, Sciences de la vie.

[21]  B. Rubinsky,et al.  Tissue Ablation with Irreversible Electroporation , 2005, Annals of Biomedical Engineering.

[22]  L. Mir,et al.  Electrochemotherapy, a new antitumor treatment. First clinical phase I‐II trial , 1993, Cancer.

[23]  Boris Rubinsky,et al.  Tumor Ablation with Irreversible Electroporation , 2007, PloS one.

[24]  Uyen D. Nguyen,et al.  Thermal modeling of lesion growth with radiofrequency ablation devices , 2004, Biomedical engineering online.

[25]  Sharon Thomsen,et al.  Thermal Damage and Rate Processes in Biologic Tissues , 2010 .

[26]  D. Dupuy,et al.  Thermal ablation of tumours: biological mechanisms and advances in therapy , 2014, Nature Reviews Cancer.

[27]  S. Kee,et al.  Irreversible electroporation (NanoKnife) in cancer treatment , 2014 .

[28]  Francis A. Duck,et al.  Physical properties of tissue : a comprehensive reference book , 1990 .

[29]  Damijan Miklavcic,et al.  Modeling of electric field distribution in tissues during electroporation , 2013, Biomedical engineering online.

[30]  Rafael V. Davalos,et al.  Towards a predictive model of electroporation-based therapies using pre-pulse electrical measurements , 2012, 2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[31]  Damijan Miklavčič,et al.  Electrochemotherapy – An easy, highly effective and safe treatment of cutaneous and subcutaneous metastases: Results of ESOPE (European Standard Operating Procedures of Electrochemotherapy) study , 2006 .

[32]  A. Ivorra Electrochemical Prevention of Needle-Tract Seeding , 2011, Annals of Biomedical Engineering.

[33]  Boris Rubinsky,et al.  Irreversible electroporation near the heart: ventricular arrhythmias can be prevented with ECG synchronization. , 2011, AJR. American journal of roentgenology.

[34]  Rafael V. Davalos,et al.  Pathology of non-thermal irreversible electroporation (N-TIRE)-induced ablation of the canine brain , 2013, Journal of veterinary science.

[35]  Helen Kavnoudias,et al.  In vivo characterization and numerical simulation of prostate properties for non‐thermal irreversible electroporation ablation , 2014, The Prostate.

[36]  Richard Heller,et al.  Phase I trial of interleukin-12 plasmid electroporation in patients with metastatic melanoma. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[37]  T. Jarm,et al.  Electrochemotherapy , 2011, Technology in cancer research & treatment.

[38]  Jacob Sosna,et al.  US findings after irreversible electroporation ablation: radiologic-pathologic correlation. , 2012, Radiology.

[39]  Raphael C. Lee,et al.  Transient and stable ionic permeabilization of isolated skeletal muscle cells after electrical shock. , 1993, The Journal of burn care & rehabilitation.

[40]  Michael C. Kolios,et al.  Comparison of thermal damage calculated using magnetic resonance thermometry, with magnetic resonance imaging post-treatment and histology, after interstitial microwave thermal therapy of rabbit brain. , 2000, Physics in medicine and biology.

[41]  Tomaz Slivnik,et al.  Sequential finite element model of tissue electropermeabilization , 2005, IEEE Transactions on Biomedical Engineering.

[42]  Vic Velanovich,et al.  Irreversible electroporation therapy in the management of locally advanced pancreatic adenocarcinoma. , 2012, Journal of the American College of Surgeons.

[43]  D Miklavcic,et al.  The effect of pulse repetition frequency on the uptake into electropermeabilized cells in vitro with possible applications in electrochemotherapy. , 2002, Bioelectrochemistry.

[44]  S. Goldberg,et al.  Irreversible electroporation ablation: is all the damage nonthermal? , 2013, Radiology.

[45]  Thomas L Ellis,et al.  Nonthermal irreversible electroporation for intracranial surgical applications. Laboratory investigation. , 2011, Journal of neurosurgery.

[46]  D Miklavcic,et al.  A validated model of in vivo electric field distribution in tissues for electrochemotherapy and for DNA electrotransfer for gene therapy. , 2000, Biochimica et biophysica acta.

[47]  Boris Rubinsky,et al.  A statistical model for multidimensional irreversible electroporation cell death in tissue , 2010, Biomedical engineering online.

[48]  D Miklavcic,et al.  Electrochemotherapy in treatment of tumours. , 2008, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[49]  Thomas L Ellis,et al.  A Parametric Study Delineating Irreversible Electroporation from Thermal Damage Based on a Minimally Invasive Intracranial Procedure , 2011, Biomedical engineering online.

[50]  Damijan Miklavčič,et al.  Electroporation-based technologies for medicine: principles, applications, and challenges. , 2014, Annual review of biomedical engineering.

[51]  D. Miklavcic,et al.  Cell membrane electroporation-Part 3: the equipment , 2014, IEEE Electrical Insulation Magazine.

[52]  Damijan Miklavcic,et al.  Intraoperative electrochemotherapy of colorectal liver metastases , 2014, Journal of surgical oncology.

[53]  D Miklavcic,et al.  Antitumor effectiveness of electrochemotherapy: a systematic review and meta-analysis. , 2013, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[54]  Jon F Edd,et al.  Mathematical Modeling of Irreversible Electroporation for Treatment Planning , 2007, Technology in cancer research & treatment.

[55]  J. Weaver,et al.  Theory of electroporation: A review , 1996 .

[56]  I. Lackovic,et al.  Three-dimensional finite-element analysis of joule heating in electrochemotherapy and in vivo gene electrotransfer , 2009, IEEE Transactions on Dielectrics and Electrical Insulation.

[57]  Rafael V. Davalos,et al.  Experimental Characterization and Numerical Modeling of Tissue Electrical Conductivity during Pulsed Electric Fields for Irreversible Electroporation Treatment Planning , 2012, IEEE Transactions on Biomedical Engineering.

[58]  Majid Maybody,et al.  Renal tissue ablation with irreversible electroporation: preliminary results in a porcine model. , 2011, Urology.

[59]  Stuart K. Roberts,et al.  Irreversible Electroporation for Unresectable Hepatocellular Carcinoma: Initial Experience and Review of Safety and Outcomes , 2013, Technology in cancer research & treatment.

[60]  John C. Bischof,et al.  Irreversible Electroporation: An In Vivo Study with Dorsal Skin Fold Chamber , 2012, Annals of Biomedical Engineering.

[61]  Christopher L Brace,et al.  Principles of and advances in percutaneous ablation. , 2011, Radiology.

[62]  Rafael V. Davalos,et al.  Successful treatment of a large soft tissue sarcoma with irreversible electroporation. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[63]  M. Prausnitz,et al.  Quantitative study of electroporation-mediated molecular uptake and cell viability. , 2001, Biophysical journal.

[64]  T. L. Ellis,et al.  Non-Thermal Irreversible Electroporation (N-TIRE) and Adjuvant Fractionated Radiotherapeutic Multimodal Therapy for Intracranial Malignant Glioma in a Canine Patient , 2011, Technology in cancer research & treatment.

[65]  M. Yarmush,et al.  Irreversible electroporation: evolution of a laboratory technique in interventional oncology. , 2014, Diagnostic and interventional radiology.

[66]  Boris Rubinsky,et al.  Theoretical analysis of the thermal effects during in vivo tissue electroporation. , 2003, Bioelectrochemistry.

[67]  Damijan Miklavcic,et al.  Equivalent Pulse Parameters for Electroporation , 2011, IEEE Transactions on Biomedical Engineering.

[68]  Helen Kavnoudias,et al.  Investigation of the safety of irreversible electroporation in humans. , 2011, Journal of vascular and interventional radiology : JVIR.

[69]  Boris Rubinsky,et al.  Irreversible Electroporation: Implications for Prostate Ablation , 2007, Technology in cancer research & treatment.

[70]  Samuel K. Park,et al.  Irreversible electroporation: evaluation of nonthermal and thermal ablative capabilities in the porcine kidney. , 2013, Urology.

[71]  D Miklavcic,et al.  Vascular disrupting action of electroporation and electrochemotherapy with bleomycin in murine sarcoma , 2008, British Journal of Cancer.

[72]  John A. Pearce,et al.  Relationship between Arrhenius models of thermal damage and the CEM 43 thermal dose , 2009, BiOS.

[73]  Hadi Shafiee,et al.  A preliminary study to delineate irreversible electroporation from thermal damage using the arrhenius equation. , 2009, Journal of biomechanical engineering.

[74]  Stephen B. Solomon,et al.  Percutaneous Irreversible Electroporation Lung Ablation: Preliminary Results in a Porcine Model , 2011, CardioVascular and Interventional Radiology.

[75]  R. Lee,et al.  Biophysical injury mechanisms in electrical shock trauma. , 2000, Annual review of biomedical engineering.

[76]  C. Suárez,et al.  The Role of Ph Fronts in Tissue Electroporation Based Treatments , 2013, PloS one.

[77]  Damijan Miklavcic,et al.  Towards treatment planning and treatment of deep-seated solid tumors by electrochemotherapy , 2010, Biomedical engineering online.

[78]  Damijan Miklavcic,et al.  Antivascular effects of electrochemotherapy: implications in treatment of bleeding metastases , 2010, Expert review of anticancer therapy.

[79]  G. Narayanan,et al.  Percutaneous irreversible electroporation for downstaging and control of unresectable pancreatic adenocarcinoma. , 2012, Journal of vascular and interventional radiology : JVIR.

[80]  C. Arena,et al.  An experimental and numerical investigation of phase change electrodes for therapeutic irreversible electroporation. , 2013, Journal of biomechanical engineering.

[81]  Robert C. G. Martin,et al.  Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures , 2013, Journal of surgical oncology.

[82]  Francis A. Duck,et al.  Mechanical Properties of Tissue , 1990 .

[83]  Boris Rubinsky,et al.  Irreversible Electroporation: A New Ablation Modality — Clinical Implications , 2007, Technology in cancer research & treatment.

[84]  S. Goldberg,et al.  Characterization of irreversible electroporation ablation in in vivo porcine liver. , 2012, AJR. American journal of roentgenology.

[85]  U. Pliquett,et al.  Joule heating during solid tissue electroporation , 2003, Medical and Biological Engineering and Computing.