High-precision, non-invasive anti-microvascular approach via concurrent ultrasound and laser irradiation

Antivascular therapy represents a proven strategy to treat angiogenesis. By applying synchronized ultrasound bursts and nanosecond laser irradiation, we developed a novel, selective, non-invasive, localized antivascular method, termed photo-mediated ultrasound therapy (PUT). PUT takes advantage of the high native optical contrast among biological tissues and can treat microvessels without causing collateral damage to the surrounding tissue. In a chicken yolk sac membrane model, under the same ultrasound parameters (1 MHz at 0.45 MPa and 10 Hz with 10% duty cycle), PUT with 4 mJ/cm2 and 6 mJ/cm2 laser fluence induced 51% (p = 0.001) and 37% (p = 0.018) vessel diameter reductions respectively. With 8 mJ/cm2 laser fluence, PUT would yield vessel disruption (90%, p < 0.01). Selectivity of PUT was demonstrated by utilizing laser wavelengths at 578 nm or 650 nm, where PUT selectively shrank veins or occluded arteries. In a rabbit ear model, PUT induced a 68.5% reduction in blood perfusion after 7 days (p < 0.001) without damaging the surrounding cells. In vitro experiments in human blood suggested that cavitation may play a role in PUT. In conclusion, PUT holds significant promise as a novel non-invasive antivascular method with the capability to precisely target blood vessels.

[1]  C. Glittenberg,et al.  Non-responders to treatment with antagonists of vascular endothelial growth factor in age-related macular degeneration , 2013, British Journal of Ophthalmology.

[2]  G. Paltauf,et al.  Photoacoustic cavitation in spherical and cylindrical absorbers , 1999 .

[3]  C. Regillo,et al.  Bevacizumab for neovascular age-related macular degeneration using a treat-and-extend regimen: clinical and economic impact. , 2012, American journal of ophthalmology.

[4]  H. Komatsu [Antibody therapy in cancer]. , 2010, Nihon rinsho. Japanese journal of clinical medicine.

[5]  P. Carmeliet,et al.  Molecular mechanisms and clinical applications of angiogenesis , 2011, Nature.

[6]  Napoleone Ferrara,et al.  Antiangiogenic Therapy for Cancer: An Update , 2007, Cancer journal.

[7]  H. Hoffman,et al.  Photospallation: a new theory and mechanism for mid-infrared corneal ablations. , 2000, Journal of refractive surgery.

[8]  Xinmai Yang,et al.  Laser-enhanced cavitation during high intensity focused ultrasound: An in vivo study. , 2013, Applied physics letters.

[9]  Aflibercept , 2019, Reactions Weekly.

[10]  C. Cheung,et al.  THREE-YEAR RESULTS OF POLYPOIDAL CHOROIDAL VASCULOPATHY TREATED WITH PHOTODYNAMIC THERAPY: Retrospective Study and Systematic Review , 2015, Retina.

[11]  J. McCaughan,et al.  Photodynamic Therapy , 1999, Drugs & aging.

[12]  T. Dougherty Photodynamic therapy. , 1993, Photochemistry and photobiology.

[13]  Ronald A. Roy,et al.  Applications of Acoustics and Cavitation to Noninvasive Therapy and Drug Delivery , 2008 .

[14]  Michael D. Ober,et al.  Choroidal infarction following photodynamic therapy with verteporfin. , 2005, Archives of ophthalmology.

[15]  Baocun Sun,et al.  Anti-VEGF– and anti-VEGF receptor–induced vascular alteration in mouse healthy tissues , 2013, Proceedings of the National Academy of Sciences.

[16]  Sarah E. Seton-Rogers Tumour microenvironment: Means of resistance , 2013, Nature Reviews Cancer.

[17]  A. Koch,et al.  Angiogenesis and vasculogenesis in rheumatoid arthritis , 2010, Current opinion in rheumatology.

[18]  P. Kolari Penetration of unfocused laser light into the skin , 2004, Archives of Dermatological Research.

[19]  L. Sedighipour,et al.  Comparison of the effects of low energy laser and ultrasound in treatment of shoulder myofascial pain syndrome: a randomized single-blinded clinical trial. , 2011, European journal of physical and rehabilitation medicine.

[20]  R. Gabriel,et al.  Ação do laser terapêutico e do ultrassom na regeneração nervosa periférica , 2012 .

[21]  A. Reynolds,et al.  Anti-angiogenic therapy for cancer: current progress, unresolved questions and future directions , 2014, Angiogenesis.

[22]  Preclinical photoacoustic models: application for ultrasensitive single cell malaria diagnosis in large vein and artery. , 2016, Biomedical optics express.

[23]  Jeffrey W. Clark,et al.  Lessons from phase III clinical trials on anti-VEGF therapy for cancer , 2006, Nature Clinical Practice Oncology.

[24]  A. Vogel,et al.  Mechanisms of pulsed laser ablation of biological tissues. , 2003, Chemical reviews.

[25]  J. Geschwind,et al.  Intra-Arterial Therapies for Hepatocellular Carcinoma: Where Do We Stand? , 2010, Annals of Surgical Oncology.

[26]  Nico de Jong,et al.  Droplets, Bubbles and Ultrasound Interactions. , 2016, Advances in experimental medicine and biology.

[27]  M. Corbett,et al.  A systematic review of photodynamic therapy in the treatment of pre-cancerous skin conditions, Barrett's oesophagus and cancers of the biliary tract, brain, head and neck, lung, oesophagus and skin. , 2010, Health technology assessment.

[28]  J. Haga,et al.  Molecular basis of the effects of shear stress on vascular endothelial cells. , 2005, Journal of biomechanics.

[29]  Alice Z Chuang,et al.  Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity. , 2011, The New England journal of medicine.

[30]  J. Caminal,et al.  Retinal hemangioblastoma regression after single session of photodynamic therapy. , 2014, JAMA ophthalmology.

[31]  S. Ferrari,et al.  Author contributions , 2021 .

[32]  H. Hoffman,et al.  Minimizing Thermal Damage in Corneal Ablation with Short Pulse Mid-infrared Lasers. , 1999, Journal of biomedical optics.

[33]  Fred P. Seeber,et al.  OP-TEC national center for optics and photonics education and ANSI Z136.5 American National Standard for the safe use of lasers in educational institutions – How they will work together to improve laser safety in educational institutions , 2009 .

[34]  Hongqin Wei,et al.  Hemostatic Effects of Microbubble-Enhanced Low-Intensity Ultrasound in a Liver Avulsion Injury Model , 2014, PloS one.

[35]  S. Quaggin Turning a blind eye to anti-VEGF toxicities. , 2012, The Journal of clinical investigation.

[36]  S. Mitchell,et al.  Pulmonary arteriovenous malformations: techniques and long-term outcome of embolotherapy. , 1988, Radiology.

[37]  C. Sehgal,et al.  The disruption of murine tumor neovasculature by low-intensity ultrasound-comparison between 1- and 3-MHz sonication frequencies. , 2008, Academic radiology.

[38]  M. Venermo,et al.  Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound‐guided foam sclerotherapy for the treatment of great saphenous varicose veins , 2016, The British journal of surgery.

[39]  Bernard Choi,et al.  Vascular effects of photodynamic and pulsed dye laser therapy protocols , 2008, Lasers in surgery and medicine.

[40]  R. Avery,et al.  Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. , 2006, Ophthalmology.

[41]  D M Eckmann,et al.  Bubble motion in a blood vessel: shear stress induced endothelial cell injury. , 2009, Journal of biomechanical engineering.

[42]  L. Ellis,et al.  VEGF-targeted therapy: mechanisms of anti-tumour activity , 2008, Nature Reviews Cancer.

[43]  B. Ballermann,et al.  Shear stress and the endothelium. , 1998, Kidney international. Supplement.

[44]  Michael D Feldman,et al.  The antivascular action of physiotherapy ultrasound on murine tumors. , 2005, Ultrasound in medicine & biology.

[45]  Mazen A. Juratli,et al.  Real-Time Label-Free Embolus Detection Using In Vivo Photoacoustic Flow Cytometry , 2016, PloS one.

[46]  W. Hall,et al.  Selective Photothermolysis : Precise Microsurgery by Selective Absorption of Pulsed Radiation , 2005 .

[47]  R. White,et al.  Pulmonary arteriovenous malformations: diagnosis and transcatheter embolotherapy. , 1996, Journal of vascular and interventional radiology : JVIR.

[48]  Rakesh K. Jain,et al.  Principles and mechanisms of vessel normalization for cancer and other angiogenic diseases , 2011, Nature Reviews Drug Discovery.

[49]  Katherine W Ferrara,et al.  Insonation of Targeted Microbubbles Produces Regions of Reduced Blood Flow Within Tumor Vasculature , 2012, Investigative radiology.

[50]  Jonathan T Butcher,et al.  An ex-ovo chicken embryo culture system suitable for imaging and microsurgery applications. , 2010, Journal of visualized experiments : JoVE.

[51]  Lawrence A Crum,et al.  Vascular effects induced by combined 1-MHz ultrasound and microbubble contrast agent treatments in vivo. , 2005, Ultrasound in medicine & biology.

[52]  M. Tanter,et al.  Statistics of acoustically induced bubble-nucleation events in in vitro blood: a feasibility study. , 2013, Ultrasound in medicine & biology.

[53]  M. Dellian,et al.  Anti-vascular tumor therapy: recent advances, pitfalls and clinical perspectives. , 2004, Drug resistance updates : reviews and commentaries in antimicrobial and anticancer chemotherapy.

[54]  Ronald A. Roy,et al.  Role of acoustic cavitation in the delivery and monitoring of cancer treatment by high-intensity focused ultrasound (HIFU) , 2007, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[55]  J. Haller Current anti-vascular endothelial growth factor dosing regimens: benefits and burden. , 2013, Ophthalmology.

[56]  O. Leavy Therapeutic antibodies: past, present and future , 2010, Nature Reviews Immunology.

[57]  Benjamin J Kim,et al.  Sporadic visual acuity loss in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). , 2014, American journal of ophthalmology.

[58]  Dmitri O. Lapotko,et al.  Laser-induced micro-bubbles in cells , 2005 .

[59]  A. Giaccia,et al.  Hypoxia, inflammation, and the tumor microenvironment in metastatic disease , 2010, Cancer and Metastasis Reviews.

[60]  Jennifer K. Sun,et al.  Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. , 2015, The New England journal of medicine.

[61]  R. Baumann,et al.  Oxygen pressure in intra- and extraembryonic blood vessels of early chick embryo. , 1988, Respiration physiology.

[62]  Zheng Huang,et al.  Side‐by‐side comparison of photodynamic therapy and pulsed‐dye laser treatment of port‐wine stain birthmarks , 2013, The British journal of dermatology.

[63]  H. Jennissen,et al.  Chick ex ovo culture and ex ovo CAM assay: how it really works. , 2009, Journal of visualized experiments : JoVE.

[64]  Stanley B. Brown,et al.  Photodynamic Therapy: Two photons are better than one , 2008 .

[65]  A. Rosa,et al.  The Interaction between Childhood Bullying and the FKBP5 Gene on Psychotic-Like Experiences and Stress Reactivity in Real Life , 2016, PloS one.

[66]  Ralph M Bunte,et al.  The antivascular action of physiotherapy ultrasound on a murine tumor: role of a microbubble contrast agent. , 2007, Ultrasound in medicine & biology.

[67]  N. Breusing,et al.  Combination of PDT and inhibitor treatment affects melanoma cells and spares keratinocytes. , 2011, Free radical biology & medicine.

[68]  H. Dvorak,et al.  Concordant release of glycolysis proteins into the plasma preceding a diagnosis of ER+ breast cancer. , 2012, Cancer research.

[69]  ntonio,et al.  ACTION OF THERAPEUTIC LASER AND ULTRASOUND IN PERIPHERAL NERVE REGENERATION , 2012 .