Invasive brain interventions often result in complications and long recovery times. In addition, the delivery of therapeutic agents via the blood supply is often impossible because the Blood-Brain Barrier (BBB) protects the brain tissue from foreign molecules. Laboratory experiments and first clinical trials have shown that focused ultrasound (FUS) beams can be used for noninvasive interventions. However, the utilization of FUS in the brain has been seriously limited by the difficulty of delivering ultrasound through the skull bone. The hypothesis of this grant has been that trans-cranial therapeutic FUS exposures can be delivered noninvasively through an intact skull. This hypothesis has now been validated in multiple clinical studies that demonstrate that brain tissue can be noninvasively coagulated in the central part of the brain. During the current grant period, we furthered our initial research and developed methods to enhance FUS interaction with tissue using microbubbles, thus making whole brain sonications feasible. We have further studied the impact of ultrasound exposures on brain tissue and demonstrated chemotherapy delivery across the BBB. We have shown significant increases in animal survival with multiple treatments. We have shown similar gains by using targeted natural killer cells. We have also developed the methods for clinical BBB modulation for chemotherapy treatments using a current clinical device. Our study plan is to exploit our novel findings during this grant period and provide the methods for novel treatments. Our goals are: First, to utilize our method of super-resolution localization of individual microbubbles to explore the feasibility of micro-surgery and precision drug delivery. Second, to construct and test new array concepts that eliminate the need for a large waterbath and provide patient specific array geometry for repeated treatments. The impact of this research could be huge if even one of these new ideas could be translated to the clinic. For example, the methods proposed here could make tumor and epilepsy surgery available for a larger number of patients and the BBB modulation could increase the effectiveness of chemotherapy and potentially even provide treatments for patients with Alzheimer`s Disease.

Public Health Relevance

The overall objective of this research is to develop a non-invasive focused ultrasound method for high spatial resolution brain surgery and drug delivery. Therefore it addresses several major issues related to brain treatments. First, the method is completely non-invasive so the risk of infection and effects caused by normal brain penetration are removed. Second, the method can deliver large therapeutic molecules into an image targeted location in the brain. This will open the possibility to use many medications that currently do not penetrate in the brain. This method could improve the treatment of brain tumors, epilepsy and Alzheimer's disease patients just to mention few.

National Institute of Health (NIH)
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
Research Project (R01)
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Neuroscience and Ophthalmic Imaging Technologies Study Section (NOIT)
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King, Randy Lee
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Sunnybrook Research Institute
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M4 3M5
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McMahon, Dallan; Hynynen, Kullervo (2018) Reply to Kovacs et al.: Concerning acute inflammatory response following focused ultrasound and microbubbles in the brain. Theranostics 8:2249-2250
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