Toward a clinical real time tissue ablation technology: combining electroporation and electrolysis (E2)

Abstract

Background Percutaneous image-guided tissue ablation (IGA) plays a growing role in the clinical management of solid malignancies. Electroporation is used for IGA in several modalities: irreversible electroporation (IRE), and reversible electroporation with chemotoxic drugs, called electrochemotherapy (ECT). It was shown that the combination of electrolysis and electroporation—E2—affords tissue ablation with greater efficiency, that is, lower voltages, lower energy and shorter procedure times than IRE and without the need for chemotoxic additives as in ECT. Methods A new E2 waveform was designed that delivers optimal doses of electroporation and electrolysis in a single waveform. A series of experiments were performed in the liver of pigs to evaluate E2 in the context of clinical applications. The goal was to find initial parameter boundaries in terms of electrical field, pulse duration and charge as well as tissue behavior to enable real time tissue ablation of clinically relevant volumes. Results Histological results show that a single several hundred millisecond long E2 waveform can ablate large volume of tissue at relatively low voltages while preserving the integrity of large blood vessels and lumen structures in the ablation zone without the use of chemotoxic drugs or paralyzing drugs during anesthesia. This could translate clinically into much shorter treatment times and ease of use compared to other techniques that are currently applied.

Advances in the Electrochemical Treatment of Cancers and Tumors: Exploring the Current Trends, Advancements, and Mechanisms of Electrolytic Tumor Ablation

“…They were able to generate a greater extent of damage for a smaller applied charge per electrode area and called for further research on the model. In 2020, Guenther et al [22] further explored these findings and attempted to create a singular E2 waveform for the effective application of the E2 technique. Irreversible electroporation (IRE) uses electrodes to deliver short bursts of 10 1 Hz pulses over the course of 90-10 total bursts.…”

“…Adapted with permission from Ref. [22]in accordance with a Creative Commons Attribution 4.0 license; Copyright (2020) The Authors.…”

Distribución espacial de la permeabilización y frentes de pH en un modelo 2D inducido por la electroporación electrolítica: Simulaciones

“…En la actualidad una nueva técnica de electroporación electrolítica (E2) está brindando excelentes resultados en el tratamiento de tumores (Guenther et al, 2020;Klein et al, 2019;Kim et al, 2020). Dicha técnica consiste en la combinación de la ablación electrolítica (EA), también conocida como terapia electroquímica (EChT), y la electroporación.…”

“…Dicha técnica consiste en la combinación de la ablación electrolítica (EA), también conocida como terapia electroquímica (EChT), y la electroporación. La E2 consiste en la aplicación de un pulso similar a un decaimiento exponencial, que tiene una etapa inicial de alta tensión destinada a electroporar las membranas celulares, y una etapa posterior de baja tensión y larga duración destinada a suministrar suficiente corriente para inducir la electrólisis en la interfaz entre los electrodos (Guenther et al, 2020;Klein et al, 2019). Esta combinación permite mejorar la eficacia de la ablación electrolítica en función del tiempo de exposición, y a la vez, mitigar las contracciones musculares provocadas por la electroporación, empleando unos pocos pulsos de campo eléctrico.…”

Incorporation of Reversible Electroporation Into Electrolysis Accelerates Apoptosis for Rat Liver Tissue

“…15 Electrolysis plays a key role in their combination and requires optimization of initial voltage and total applied electrical charge based on electrode configurations to maximize their synergistic performance. [9][10][11][12][13] Several previous studies have performed synergistic ablation histologically, focusing on electrical parameters and electrode geometric configurations, [14][15][16][17] yet it remains challenging to achieve. In this study, we performed an immunohistochemical evaluation of apoptosis to quantify the effects of variations in electrical energy used in electrolysis and the synergistic coupling of electrolysis with electroporation using microscale electrodes.…”