From the January 2015 issue of HealthCare Business News magazine
Given the morbidity associated with more invasive approaches, there is particular interest in using focused ultrasound to treat the brain. The body of evidence demonstrating safe and effective focused ultrasound ablation of brain targets has grown to more than 300 patients. This non-invasive treatment option - the ExAblate magnetic resonance imaging-guided focused ultrasound (MRgFUS) system (InSightec, Haifa, Israel) - has been approved in Europe for the treatment of essential tremor, tremors associated with Parkinson's disease and neuropathic pain. Results of a pilot U.S. study on focused ultrasound for treatment of essential tremor were recently published in the New England Journal of Medicine, and a pivotal study - to obtain approval by the U.S. Food and Drug Administration (FDA) - recently completed enrollment of patients at eight sites worldwide. Clinical trials are also underway for the treatment of Parkinson's tremor, Parkinson's dyskinesia, brain tumors, and obsessive compulsive disorder. Studies are being organized for the treatment of depression, epilepsy and Alzheimer's disease.
Figure 2: This is a list of bioeffects that
focused ultrasound can produce in tissue.
These various effects enable the treatment
of a wide range of clinical indications.
Although thermal ablation is currently the most widely used biomechanism of focused ultrasound, there are many other biological effects that can be produced at the focus. FUS can act via thermal and mechanical mechanisms within the tissue, leading to a variety of bioeffects (see figure 2) that enable treatment of many medical conditions. Of particular significance is the ability of focused ultrasound to: (1) temporarily make the blood-brain barrier more permeable; (2) induce neuromodulation; (3) promote an immune response; and (4) enable localized drug delivery. It is important to note that research demonstrating these non-ablative effects of focused ultrasound is still early stage and consists primarily of preclinical and anecdotal clinical evidence; these represent potential high-impact areas of benefit.
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Figure 3: Focused ultrasound can loosen
the dense network of endothelial cells
joined by tight junctions that line the
blood vessels in the brain, enhancing
the release of drugs from the bloodstream
into the brain tissue.
Opening the blood-brain barrier
Building on the promising ablation experience, attention has begun to shift toward other ways to use focused ultrasound to treat the brain, such as its effect on the blood-brain barrier (BBB).The BBB is a dense and protective physiological barrier that separates the interior of blood vessels and the surrounding brain tissue. The BBB keeps toxins that may travel through the bloodstream out of the brain. However, this network of endothelial cells connected by tight junctions that line the vessels also significantly limits delivery of beneficial drugs and genes to their intended targets within the brain (see Figure 3).
