Targeted Neuronal Injury for the Non-Invasive Disconnection of Brain Circuitry
Summary
The goal of the protocol is to provide a method for producing non-invasive neuronal lesions in the brain. The method utilizes Magnetic Resonance-guided Focused Ultrasound (MRgFUS) to open the Blood Brain Barrier in a transient and focal manner, in order to deliver a circulating neurotoxin to the brain parenchyma.
Abstract
Surgical intervention can be quite effective for treating certain types of medically intractable neurological diseases. This approach is particularly useful for disorders in which identifiable neuronal circuitry plays a key role, such as epilepsy and movement disorders. Currently available surgical modalities, while effective, generally involve an invasive surgical procedure, which can result in surgical injury to non-target tissues. Consequently, it would be of value to expand the range of surgical approaches to include a technique that is both non-invasive and neurotoxic.
Here, a method is presented for producing focal, neuronal lesions in the brain in a non-invasive manner. This approach utilizes low-intensity focused ultrasound together with intravenous microbubbles to transiently and focally open the Blood Brain Barrier (BBB). The period of transient BBB opening is then exploited to focally deliver a systemically administered neurotoxin to a targeted brain area. The neurotoxin quinolinic acid (QA) is normally BBB-impermeable, and is well-tolerated when administered intraperitoneally or intravenously. However, when QA gains direct access to brain tissue, it is toxic to the neurons. This method has been used in rats and mice to target specific brain regions. Immediately after MRgFUS, successful opening of the BBB is confirmed using contrast enhanced T1-weighted imaging. After the procedure, T2 imaging shows injury restricted to the targeted area of the brain and the loss of neurons in the targeted area can be confirmed post-mortem utilizing histological techniques. Notably, animals injected with saline rather than QA do demonstrate opening of the BBB, but dot not exhibit injury or neuronal loss. This method, termed Precise Intracerebral Non-invasive Guided surgery (PING) could provide a non-invasive approach for treating neurological disorders associated with disturbances in neural circuitry.
Introduction
The purpose of this method is to provide a means for producing non-invasive neuronal lesions in a targeted region of the brain. The rationale for developing such an approach is to disconnect neuronal circuitry contributing to neurological disorders. For instance, surgery can be quite effective in treating certain medically intractable neurological disorders, such as drug resistant epilepsy (DRE)1. However, each of the available surgical modalities possess limitations in terms of producing undesirable collateral damage to the brain. Traditional resective surgery can be highly invasive with the risk of bleeding, infection, blood clots, stroke, seizures, swelling of the brain, and nerve damage2. Alternatives to resective surgery that are minimally invasive or non-invasive include laser interstitial thermal therapy and radiosurgery, which have also proved to be effective in suppressing seizures in DRE. More recently, thermal lesions produced by high-intensity focused ultrasound (HIFU) have shown promise in reducing seizures. HIFU is non-invasive; however, its treatment window is currently limited to more central areas of the brain because of the risk of thermal injury to non-target tissue located in the vicinity of the skull. Despite such limitations, the benefits of surgery often outweigh the potential risks. For instance, although surgery for DRE can produce collateral brain damage, its beneficial effects in suppressing seizures and improving quality of life typically prevail over the surgical risks.
The method described herein, Precise Intracerebral Non-invasive Guided surgery (PING), was developed for the purpose of disconnecting neural circuitry, while limiting collateral brain damage. The method utilizes low intensity focused ultrasound combined with intravenous injection of microbubbles to open the BBB, in order to deliver a neurotoxin. This approach does not produce thermal lesions to the brain3,4,5,6,7, and the period of BBB opening can be exploited to deliver BBB-impermeable compounds to the brain parenchyma. The opening of the BBB is transient, and can be produced in a targeted manner using magnetic resonance imaging guidance. In our studies, the period of BBB opening has been utilized to deliver a circulating neurotoxin to a targeted area of the brain parenchyma in rats and mice8,9. Quinolinic acid is a neurotoxin that is well tolerated when administered intravenously10, intraarterially10, or intraperitoneally8,9,11. The lack of QA toxicity is due to its poor BBB permeability, which has been reported to be negligible10. In contrast, direct injection of QA into the brain parenchyma produces neuronal lesions that spare neighboring axons12,13. Thus, when circulating QA gains access to the brain parenchyma in the targeted area of BBB opening, neuronal death is produced8,9. The present method thus produces focal neuronal loss in a precisely targeted and non-invasive manner.
Protocol
Representative Results
Discussion
The PING method is designed to produce non-invasive, targeted neuronal lesions. The method derives from a strong and growing foundation of research in the field of focused ultrasound3,4,5,6,7. The ability to provide focal access to specific areas of the brain parenchyma via transient opening of the BBB has created an avenue for delivering a wide variety of age…
Disclosures
The authors have nothing to disclose.
Acknowledgements
The authors recognize Rene Jack Roy for his excellent technical support in the area of MRI. This work was supported by the National Institutes of Health (R01 NS102194 to KSL and R01 CA217953-01 to MW), the Chester Fund (KSL), and the Focused Ultrasound Foundation (KSL and JW).
Materials
| 7T-ClinScan MRI System | Bruker Biospin, Ettinglen, Germany | MR Image Acquisition | |
| Acoustic Gel | Litho CLEAR | 11-601 | High Viscosity Accoustic Transmission Gel |
| DPX Mounting Medium | Electron Microscopy Sciences | 13512 | Resin Based Cover Glass Mountant |
| Fluoro-Jade B | EDM Millipore | AG310 | High Affinity Stain For Degenerating Neurons |
| Fluovac anesthetic adsorber | Harvard Apparatus | 34-0388 | Organic Anaesthesia Scavenger |
| FUS System | Image Guided Therapy, Pessac, France | LabFUS | MR Compatible Small Animal Focused Ultrasound System |
| Gadodiamide | GE Healthcare AS, Oslo, Norway | Omniscan | MR Contrast Agent |
| Heparin | SAGENT | NDC2502140010 | Anti-Coagulant |
| Hypodermic needle 30G x 1/2 | Becton-Dickinson | 26027 | Tail Vein Catheterization |
| Insulin syringe 28G1/2 (1ml) | EXEL | 26027 | Administration of Injectables to Tail Vein Catheter |
| Isofluorane atomizer | SurgiVet | VCT302 | Anaesthesia Administration |
| Isoflurane | Henry Schein | NDC1169567762 | Anaesthesia |
| KMnO4 | Sigma | 223468 | Reagent Used in Fluoro-Jade B Staining |
| Microbubbles | Produced internally: A. Klibanov | 305106 | Blood Brain Barrier Disrupting Agent |
| Microbubbles (commercial source) | Lantheus Medical Imaging, North Billerica, MA | Definity microbubbles | Blood Brain Barrier Disrupting Agent |
| Monitoring & Gating System | Small Animal Instruments | Model 1030 | Respiration Monitoring |
| Multisizer 3 Coulter counter | Beckman-Coulter, Hialeah, FL | Multisizer 3 | Used to Determine Average Size of Microbubbles |
| Optixcare EYE LUBE | CLC MEDICA, Ontario, Canada | 11611 | Corneal Protectant-Eye Lube |
| PE10 tubing | Becton-Dickinson | 427401 | Tail Vein Catheter Component |
| Quinolinic Acid | Santa Cruz Biotechnology, Dallas, TX | CAS 89-00-9 | Neurotoxin |
| Sprague-Dawley Rats | Taconic Biosciences | SD-M | Rat Model |
| Syringe Pump | Carnegie Medicin | CMA 100 | Controlled Delivery of Quinolinic Acid |
| Thermoguide Software | Image Guided Therapy, Pessac, France | Thermoguide | Drives Lab FUS System |
| Tish Rats | In-house colony | Rat Model | |
| Veet depilatory cream | Reckitt Benckiser | Removal of Scalp Hair |
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