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Researchers Mark Prausnitz and Robyn Schlicher use
a confocal microscope to study cells whose membranes have been
opened by the application of ultrasound.
Georgia Tech Photo: Gary Meek

Transmission electron micrograph showing a prostate
cancer cell immediately after exposure to ultrasound. Image has
been color enhanced to show to the spot where the cell membrane
has been removed.
Image courtesy of Robyn Schlicher, Robert Apkarian
and Mark Baran

Scanning electron micrograph showing a prostate
cancer cell immediately after exposure to ultrasound. Image has
been color enhanced to show to the spot where the cell membrane
has been removed.
Image courtesy of Robyn Schlicher, Robert Apkarian
and Mark Baran

Brightfield (above) and confocal/fluorescence (below)
microscopy of prostate cancer cells before (left), immediately
after (center) and long after (right) exposure to ultrasound.
Holes in cell membranes are highlighted with an arrow.
Image courtesy of Robyn Schlicher
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Using five different microscopy techniques,
the researchers showed that the violent collapse of bubbles – an
effect caused by the ultrasound – creates enough force to open holes
in the membranes of cells suspended in a liquid medium. The holes,
which are closed by the cells in a matter of minutes, allow entry of
therapeutic molecules as large as 50 nanometers in diameter – larger
than most proteins and similar in size to the DNA used for gene
therapy.
“The holes are made by mechanical interaction with the collapsing
bubbles,” said Mark Prausnitz, an associate professor in the School of
Chemical and Biomolecular Engineering at the Georgia Institute of
Technology. “The bubbles oscillate in the ultrasound field and
collapse, causing a shock wave to be released. Fluid movement
associated with the resulting shock wave opens holes in the cell
membranes, which allow molecules from the outside to enter. The cells
then respond to the creation of the holes by mobilizing intracellular
vesicles to patch the holes within minutes.”
Done by scientists at Georgia Tech and Emory University in Atlanta,
the research was reported in the journal Ultrasound in Medicine and
Biology (Vol. 32, No. 6). The work was supported by the National
Institutes of Health (NIH) and the National Science Foundation (NSF).
Ultrasound is the same type of energy already widely used for
diagnostic imaging. Drug delivery employs higher power levels and
different frequencies, and bubbles may be introduced to enhance the
effect.
Ultrasound drug delivery could be particularly attractive for gene
therapy, which has successfully used viruses to insert genetic
material into cells – but with side effects. It could also be used for
more targeted delivery of chemotherapy agents.
“One of the great benefits of ultrasound is that it is noninvasive,”
Prausnitz said. “You could give a chemotherapeutic drug locally or
throughout the body, then focus the ultrasound only on areas where
tumors exist. That would increase the cell permeability and drug
uptake only in the targeted cells and avoid affecting healthy cells
elsewhere.”
Researchers have only recently found that the application of
ultrasound can help move drugs into cells by increasing the
permeability of cell membranes. It had been hypothesized, but not
definitively shown, that the ultrasound increased the permeability by
opening holes in cell membranes.
Prausnitz and collaborators Robyn Schlicher, Harish Radhakrisha,
Timothy Tolentino, Vladimir Zarnitsyn of Georgia Tech and Robert
Apkarian (now deceased) of Emory University set out to study the
phenomenon in detail using a line of prostate cancer cells. They used
scanning and transmission electron microscopy of fixed cells and two
types of optical microscopy of living cells to assess ultrasound
effects and cell responses.
Beyond demonstrating that ultrasound punched holes in cell membranes,
the researchers also studied the mechanism by which cells repair the
holes. After the ultrasound exposure, they introduced into the cell
medium a chemical not normally taken up by the cells. By varying when
the chemical was introduced, they were able to determine that most of
the cells had repaired their membranes within minutes.
Though the researchers used prostate cancer cells in the study
reported in the journal, they have also studied other types of cells
and believe ultrasound offers a general way to briefly create openings
in many classes of cells.
Researchers face a number of challenges, including FDA approval,
before ultrasound can be used to deliver drugs in humans. For example,
the effects of the ultrasound were not consistent across the entire
volume of cells, with only about a third affected. Researchers will
also have to address safety concerns and optimize the creation of
collapsing bubbles – a phenomenon known as cavitation – within bodily
tissues.
“Before we can use ultrasound for therapy in the body, we will have to
learn how to control the exposure,” Prausnitz noted. “If we can
properly design the impact that ultrasound makes on a cell, we can
generate an impact that the cell can deal with. We want just enough
impact to allow transport into the cell, but not so much of an impact
that the cell would be stressed beyond its ability to repair the
injury.”
Researchers don’t yet know if the membrane holes cause long-term harm
to the affected cells. General assays show that cells survive after
resealing the membrane holes, but detailed studies of cell behavior
are still needed. Evidence from other researchers suggests that cell
membranes are frequently damaged and repaired inside the body –
without long-term ill effects. That suggests cells may similarly
tolerate ultrasound’s effects.
“One of the real challenges is going to be translating the successes
that have occurred in the laboratory and in small animals into
clinical success in people,” said Prausnitz. “Now that we better
understand the mechanism of ultrasound’s effects, we can more
effectively take advantage of it for medical therapy.”
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