Noninvasive, localized, and transient brain drug delivery using focused ultrasound and microbubbles.

摘要

In the United States, Alzheimer's disease (AD), Parkinson's disease (PD), and brain cancer caused 72,432, 19,566 and 12,886 deaths in 2006, respectively. Whereas the number of deaths due to major disorders such as heart disease, stroke, and prostate cancer have decreased since 2006, deaths attributed to AD, PD, and brain cancer have not. Treatment options for patients with CNS disorders remain limited despite significant advances in knowledge of CNS disease pathways and development of neurologically potent agents. One of the major obstacles is that the cerebral microvasculature is lined by a specialized and highly regulated blood-brain barrier (BBB) that prevents large agents from entering the brain extracellular space. The purpose of this dissertation is to design a noninvasive, localized, and transient BBB opening system using focused ultrasound (FUS) and determine ultrasound and microbubble conditions that can effectively and safely deliver large pharmacologically-relevant-sized agents to the brain.;To meet this end, an in vivo mouse brain drug delivery system using a stereotactic-based targeting method was developed. FUS was applied noninvasively through the intact skin and skull, which allowed for long-term and high-throughput studies. With this system, more than 150 mice were exposed to one of 31 distinct acoustic and microbubble conditions. The feasibility of delivering a large MRI contrast agent was first demonstrated in vivo in both wild-type and transgenic Alzheimer's disease model (APP/PS1) mice. A wide range of acoustic and microbubble conditions were then evaluated for their ability to deliver agents to a target region. Interestingly, the possible design space of parameters was found to be vast and different conditions resulted in distinct spatial distributions and doses delivered. In particular, BBB opening was shown to be dependent on the microbubble diameter, acoustic pressure, pulse repetition frequency (PRF), and pulse length (PL). Each set of conditions determined both the size of agents that can traverse the BBB, and also the level of safety of the technique. In one set of conditions (peak-rarefactional pressure: 0.61 MPa, PRF: 10 Hz, PL: 20 ms), large 70-kDa dextran was delivered to a target region, but were associated with detectable damaged sites as indicated by dark neurons, microvacuolations, and erythrocyte extravasations. Another set of conditions (peak-rarefactional pressure: 0.46 MPa, PRF: 5 Hz, PL: 0.2 ms) delivered 3-kDa dextran homogeneously and diffusely to a target region in the brain without any detectable dark neurons, microvacuolations, or erythrocyte extravasations. Each distinct set of conditions may thus be used for different clinical application, i.e., treatment of brain cancer and AD. In conclusion, an effective method to noninvasively, locally, and transiently deliver large therapeutic agents through the BBB was developed.