Name: magnetic resonance-guided high intensity focused ultrasound generated hyperthermia: a feasible treatment method in a murine rhabdomyosarcoma model
Uploaded: 2023-01-13T14:10:00
Description: Watch this Scientific Journal Video about Magnetic Resonance-Guided High Intensity Focused Ultrasound Generated Hyperthermia: A Feasible Treatment Method in a Murine Rhabdomyosarcoma Model at JoVE.com

We would like to acknowledge our sources of funding for this project and the personnel involved including: C17 Research Grant, Canada Graduate Scholarship, Ontario Student Opportunity Trust Fund, and James J. Hammond Fund.

Research was performed in compliance with the animal care committees with approved animal use protocols under a supervising veterinarian at The Centre for Phenogenomics (TCP) and University Health Network (UHN) Animal Resource Centre (ARC) animal research facilities. All procedures, excluding the MRgHIFU, involving the animals were done in a biological safety cabinet (BSC) to minimize animal exposure to external air or susceptible infection.
1. Mouse breeding
<p class="jove_...

<ol>
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L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment-related+cardiotoxicity+in+survivors+of+childhood+cancer.">Treatment-related cardiotoxicity in survivors of childhood cancer.</a> Nature Reviews Clinical Oncology. 10 (12), 697-710 (2013).</li><li>Winter, S., Fasola, S., Brisse, H., Mosseri, V., Orbach, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relapse+after+localized+rhabdomyosarcoma:+Evaluation+of+the+efficacy+of+second-line+chemotherapy.">Relapse after localized rhabdomyosarcoma: Evaluation of the efficacy of second-line chemotherapy.</a> Pediatric Blood &amp; Cancer. 62 (11), 1935-1941 (2015).</li><li>Wood, B. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Phase+I+study+of+heat-deployed+liposomal+doxorubicin+during+radiofrequency+ablation+for+hepatic+malignancies.">Phase I study of heat-deployed liposomal doxorubicin during radiofrequency ablation for hepatic malignancies.</a> Journal of Vascular and Interventional Radiology. 23 (2), 248-255 (2012).</li><li>Bulbake, U., Doppalapudi, S., Kommineni, N., Khan, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Liposomal+formulations+in+clinical+use:+an+updated+review.">Liposomal formulations in clinical use: an updated review.</a> Pharmaceutics. 9 (2), 12 (2017).</li><li>Zagar, T. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Two+phase+I+dose-escalation/pharmacokinetics+studies+of+low+temperature+liposomal+doxorubicin+(LTLD)+and+mild+local+hyperthermia+in+heavily+pretreated+patients+with+local+regionally+recurrent+breast+cancer.">Two phase I dose-escalation/pharmacokinetics studies of low temperature liposomal doxorubicin (LTLD) and mild local hyperthermia in heavily pretreated patients with local regionally recurrent breast cancer.</a> International Journal of Hyperthermia. 30 (5), 285-294 (2014).</li><li>. A phase I study of lyso-thermosensitive liposomal doxorubicin and MR-HIFU for pediatric refractory solid tumors Available from: <a target="_blank" href="https://clinicaltrials.gov/ct2/show/NCT02536183">https://clinicaltrials.gov/ct2/show/NCT02536183</a> (2019)</li><li>PanDox: targeted doxorubicin in pancreatic tumours (PanDox). University of Oxford Available from: <a target="_blank" href="https://clinicaltrials.gov/ct2/show/NCT04852367">https://clinicaltrials.gov/ct2/show/NCT04852367</a> (2021)</li><li>. Image-guided targeted doxorubicin delivery with hyperthermia to optimize loco-regional control in breast cancer (i-GO) Available from: <a target="_blank" href="https://clinicaltrials.gov/ct2/show/NCT03749850">https://clinicaltrials.gov/ct2/show/NCT03749850</a> (2018)</li><li>De Vita, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lysyl+oxidase+engineered+lipid+nanovesicles+for+the+treatment+of+triple+negative+breast+cancer.">Lysyl oxidase engineered lipid nanovesicles for the treatment of triple negative breast cancer.</a> Scientific Reports. 11 (1), 5107 (2021).</li><li>Sapareto, S. A., Dewey, W. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thermal+dose+determination+in+cancer+therapy.">Thermal dose determination in cancer therapy.</a> International Journal of Radiation Oncology, Biology, Physics. 10 (6), 787-800 (1984).</li><li>Kok, H. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Heating+technology+for+malignant+tumors:+a+review.">Heating technology for malignant tumors: a review.</a> International Journal of Hyperthermia. 37 (1), 711-741 (2020).</li><li>Kokuryo, D., Kumamoto, E., Kuroda, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recent+technological+advancements+in+thermometry.">Recent technological advancements in thermometry.</a> Advanced Drug Delivery Reviews. 163, 19-39 (2020).</li><li>Bongiovanni, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=3-T+magnetic+resonance-guided+high-intensity+focused+ultrasound+(3+T-MR-HIFU)+for+the+treatment+of+pain+from+bone+metastases+of+solid+tumors.">3-T magnetic resonance-guided high-intensity focused ultrasound (3 T-MR-HIFU) for the treatment of pain from bone metastases of solid tumors.</a> Support Care Cancer. 30 (7), 5737-5745 (2022).</li><li>Seifert, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regional+hyperthermia+combined+with+chemotherapy+in+paediatric,+adolescent+and+young+adult+patients:+current+and+future+perspectives.">Regional hyperthermia combined with chemotherapy in paediatric, adolescent and young adult patients: current and future perspectives.</a> Radiation Oncology. 11, 65 (2016).</li><li>Dewhirst, M. W., Lee, C. -. T., Ashcraft, K. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+future+of+biology+in+driving+the+field+of+hyperthermia.">The future of biology in driving the field of hyperthermia.</a> International Journal of Hyperthermia. 32 (1), 4-13 (2016).</li><li>Dewhirst, M. W., Vujaskovic, Z., Jones, E., Thrall, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Re-setting+the+biologic+rationale+for+thermal+therapy.">Re-setting the biologic rationale for thermal therapy.</a> International Journal of Hyperthermia. 21 (8), 779-790 (2005).</li><li>Repasky, E. A., Evans, S. S., Dewhirst, M. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Temperature+matters!+And+why+it+should+matter+to+tumor+immunologists.">Temperature matters! And why it should matter to tumor immunologists.</a> Cancer Immunology Research. 1 (4), 210-216 (2013).</li><li>Hijnen, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thermal+combination+therapies+for+local+drug+delivery+by+magnetic+resonance-guided+high-intensity+focused+ultrasound.">Thermal combination therapies for local drug delivery by magnetic resonance-guided high-intensity focused ultrasound.</a> Proceedings of the National Academy of Sciences. 114 (24), E4802-E4811 (2017).</li><li>Shultz, L. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+cancer+growth+and+therapy+in+immunodeficient+mouse+models.">Human cancer growth and therapy in immunodeficient mouse models.</a> Cold Spring Harbor Protocols. 2014 (7), 694-708 (2014).</li><li>De Vita, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deciphering+the+genomic+landscape+and+pharmacological+profile+of+uncommon+entities+of+adult+rhabdomyosarcomas.">Deciphering the genomic landscape and pharmacological profile of uncommon entities of adult rhabdomyosarcomas.</a> International Journal of Molecular Sciences. 22 (21), 11564 (2021).</li><li>McKinnon, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+screening+of+FGFR4-driven+tumorigenesis+identifies+PI3K/mTOR+inhibition+as+a+therapeutic+strategy+in+rhabdomyosarcoma.">Functional screening of FGFR4-driven tumorigenesis identifies PI3K/mTOR inhibition as a therapeutic strategy in rhabdomyosarcoma.</a> Oncogene. 37 (20), 2630-2644 (2018).</li><li>Zaporzan, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=MatMRI+and+MatHIFU:+software+toolboxes+for+real-time+monitoring+and+control+of+MR-guided+HIFU.">MatMRI and MatHIFU: software toolboxes for real-time monitoring and control of MR-guided HIFU.</a> Journal of Therapeutic Ultrasound. 1, (2013).</li><li>Dunne, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Heat-activated+drug+delivery+increases+tumor+accumulation+of+synergistic+chemotherapies.">Heat-activated drug delivery increases tumor accumulation of synergistic chemotherapies.</a> Journal of Controlled Release. 308, 197-208 (2019).</li><li>Zhao, Y. X., Hu, X. Y., Zhong, X., Shen, H., Yuan, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High-intensity+focused+ultrasound+treatment+as+an+alternative+regimen+for+myxofibrosarcoma.">High-intensity focused ultrasound treatment as an alternative regimen for myxofibrosarcoma.</a> Dermatologic Therapy. 34 (2), 14816 (2021).</li><li>Vanni, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Myxofibrosarcoma+landscape:+diagnostic+pitfalls,+clinical+management+and+future+perspectives.">Myxofibrosarcoma landscape: diagnostic pitfalls, clinical management and future perspectives.</a> Therapeutic Advances in Medical Oncology. 14, 17588359221093973 (2022).</li></ol>

The protocol developed herein was used to target hind limb tumors using MRgHIFU for mild HT treatment and release encapsulated drugs from liposomes in vivo. Several critical steps were encountered in this protocol during the pilot study, and optimizing these critical steps accounted for the improved treatment success over the pilot study. First is the complete removal of the hair on the area to be sonicated. Any gas trapping within the fur prevents the ultrasound beam from passing and blocks ultrasound passage i...

An erratum was issued for:&#160;<a href="https://www.jove.com/t/64544">Magnetic Resonance-Guided High Intensity Focused Ultrasound Generated Hyperthermia: A Feasible Treatment Method in a Murine Rhabdomyosarcoma Model </a>. The Authors section was updated from:
Claire Wunker1,2 
Karolina Piorkowska3 
Ben Keunen3 
Yael Babichev2 
Suzanne M. Wong3,4 
Maximilian Regenold5 
Michael Dunne5 
Julia Nomikos1,2 
Maryam Siddiqui6 
Samuel Pichardo6 
Warren Foltz7 
Adam C. Waspe3,8 
Justin T. Gerstle3,9 
Rebecca A. Gladdy1,2,10 
1 Institute of Medical Science, University of Toronto 
2 2Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital 
3 The Wilfred and Joyce Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children 
4 Institute of Biomedical Engineering, University of Toronto 
5 Leslie Dan Faculty of Pharmacy, University of Toronto 
6 Departments of Radiology and Clinical Neurosciences, University of Calgary 
7 Department of Radiation Oncology, University of Toronto 
8 Department of Medical Imaging, University of Toronto 
9 Department of Pediatric Surgery, University of Toronto 
10 Department of Surgery, University of Toronto
to:
Claire Wunker1,2 
Karolina Piorkowska3 
Ben Keunen3 
Yael Babichev2 
Suzanne M. Wong3,4 
Maximilian Regenold5 
Michael Dunne5 
Julia Nomikos1,2 
Maryam Siddiqui6 
Samuel Pichardo6 
Warren Foltz7 
Adam C. Waspe3,8 
Justin T. Gerstle3,9 
James M. Drake1,3,4,10 
Rebecca A. Gladdy1,2,10 
1 Institute of Medical Science, University of Toronto 
2 Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital 
3 The Wilfred and Joyce Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children 
4 Institute of Biomedical Engineering, University of Toronto 
5 Leslie Dan Faculty of Pharmacy, University of Toronto 
6 Departments of Radiology and Clinical Neurosciences, University of Calgary 
7 Department of Radiation Oncology, University of Toronto 
8 Department of Medical Imaging, University of Toronto 
9 Department of Pediatric Surgery, University of Toronto 
10 Department of Surgery, University of Toronto

An erratum was issued for:&#160;<a href="https://www.jove.com/t/64544">Magnetic Resonance-Guided High Intensity Focused Ultrasound Generated Hyperthermia: A Feasible Treatment Method in a Murine Rhabdomyosarcoma Model
</a>. The Authors section was updated.

Erratum: Magnetic Resonance-Guided High Intensity Focused Ultrasound Generated Hyperthermia: A Feasible Treatment Method in a Murine Rhabdomyosarcoma Model

Rhabdomyosarcoma (RMS) is a skeletal muscle tumor that most commonly occurs in children and young adults1. Localized disease is often treated with multimodal treatment, including chemotherapy, ionizing radiation, and surgery. The use of multi-drug chemotherapy regimens is more prevalent in pediatric patients, with improved outcomes compared to their adult counterparts2; however, despite ongoing research efforts, the 5-year survival rate remains at around 30% in the most aggressive form of the disease3,4. The chemotherapy standard of care is a multidrug regimen that includes vincristine, cyclophosphamide, and actinomycin D. In cases of relapsed or recurrent disease, alternate chemotherapies are used, including standard (free) doxorubicin (FD) and ifosfamide1. While all these chemotherapies have systemic toxicities, the cardiotoxicity of doxorubicin imposes a life-long dose limitation5-7. To increase the amount of the drug delivered to the tumor and to minimize systemic toxicity, alternative formulations have been developed, including liposomal encapsulation. These can be non-thermosensitive doxorubicin, which has been approved for the treatment of breast cancer and hepatocellular carcinoma, or thermosensitive doxorubicin, for which clinical trials are ongoing8,9,10,11,12,13. Alternative methods for delivering liposomal encapsulated drugs such as multi-vesicular liposomes and ligand-targeted liposomes have been evaluated and show promise for the treatment of tumors9. In this study, the addition of heat has multifactorial impacts, including drug release14. The combination of hyperthermia (HT) generated with magnetic resonance-guided high intensity focused ultrasound (MRgHIFU) and thermosensitive liposomal doxorubicin (TLD) is a novel multimodal therapeutic approach for using this toxic yet effective drug to treat RMS, while minimizing dose-limiting toxicity and potentially increasing the immune response to the tumor.
Doxorubicin releases rapidly from TLD at temperatures &#62;39 &#176;C, well above the average human body temperature of 37 &#176;C but not high enough to cause tissue damage or ablation; this starts to occur at 43 &#176;C, but occurs more rapidly as temperatures approach 60 &#176;C15. Various methods have been used to generate HT in vivo, including lasers, microwaves, radiofrequency ablation, and focused ultrasound, many of which are invasive heating methods16. MRgHIFU is a noninvasive, nonionizing heating method that facilitates precise temperature settings within the target tissue in situ. Magnetic resonance (MR) imaging crucially provides real-time imaging, where computer software can be used, to calculate a thermometry measurement of the tissue throughout treatment; subsequently, this data can be used to control the ultrasound therapy in real time to reach and maintain a desired temperature set point17. MRgHIFU has been tested in various tissue types and can be used for a wide range of temperature treatments, from mild HT to ablation, as well as clinically to successfully treat painful bone metastases18. Additionally, HT has been shown to cause tumor cytotoxicity, modulate protein expression, and alter the immune response in the tumor microenvironment19,20,21,22. One study combined mild HT with TLD, followed by ablation with MRgHIFU, in a synergetic R1 rat model23, resulting in necrosis in the tumor core and drug delivery to the periphery. Traditionally, radiotherapy has been used as an adjunct therapy to damage tumor cells and decrease local disease recurrence. However, its use is limited by lifetime dosing and off-target damage1. Thus, HT is unique in that it can cause some of the same effects without the same toxicities or limitations.
Preclinical animal models for RMS include syngeneic immunocompetent models and patient derived xenografts (PDX) in immunocompromised hosts. While the immunocompromised models allow for growth of the human tumors, they lack the appropriate tumor microenvironment and are limited in their ability to study immune response24. FGFR4-activating mutation is a promising marker for poor prognosis and a potential therapeutic target in adult and pediatric RMS1,25. In the syngeneic RMS models developed in the Gladdy lab, the tumors are able to grow in an immunocompetent host, which develops innate and adaptive immune responses to the tumor26. As HT influences the immune response, observation of the change in the murine immune response is a valuable advantage of this tumor model. To test both the tumor response to TLD in comparison to FD, as well as the change in the immune response of the tumor to both chemotherapy and HT, a protocol was developed and employed to treat syngeneic murine RMS tumors in vivo using MRgHIFU and TLD, which is the focus of this study.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>1.5mL Eppendorf tubes</td>
			<td>Eppendorf</td>
			<td>22363204</td>
			<td></td>
		</tr>
		<tr>
			<td>1kb plus DNA Ladder</td>
			<td>Froggabio</td>
			<td>DM015-R500</td>
			<td></td>
		</tr>
		<tr>
			<td>2x HS-Red Taq (PCR mix)</td>
			<td>Wisent</td>
			<td>801-200-MM</td>
			<td></td>
		</tr>
		<tr>
			<td>7 Tesla MRI BioSpec</td>
			<td>Bruker</td>
			<td>T184931</td>
			<td>70/30 BioSpec, Bruker, Ettlingen, Germany</td>
		</tr>
		<tr>
			<td>C1000 Thermal cycler</td>
			<td>Biorad</td>
			<td>1851148</td>
			<td></td>
		</tr>
		<tr>
			<td>Clippers</td>
			<td>Whal Peanut</td>
			<td>8655</td>
			<td></td>
		</tr>
		<tr>
			<td>Compressed ultrasound gel</td>
			<td>Aquaflex</td>
			<td>HF54-004</td>
			<td></td>
		</tr>
		<tr>
			<td>Convection heating device</td>
			<td>3M Bair Hugger</td>
			<td>70200791401</td>
			<td></td>
		</tr>
		<tr>
			<td>Depiliatory cream</td>
			<td>Nair</td>
			<td>61700222611</td>
			<td>Shopper&#39;s Drug Mart</td>
		</tr>
		<tr>
			<td>DMEM</td>
			<td>Wisent</td>
			<td>219-065-LK</td>
			<td></td>
		</tr>
		<tr>
			<td>DNeasy extraction kit</td>
			<td>Qiagen&#160;</td>
			<td>69504</td>
			<td></td>
		</tr>
		<tr>
			<td>DPBS</td>
			<td>Wisent</td>
			<td>311-420-CL</td>
			<td></td>
		</tr>
		<tr>
			<td>Drug injection system</td>
			<td>Harvard Apparatus</td>
			<td>PY2 70-2131</td>
			<td>PHD 22/2200 MRI compatible Syringe Pump</td>
		</tr>
		<tr>
			<td>Eye lubricant</td>
			<td>Optixcare</td>
			<td>50-218-8442</td>
			<td></td>
		</tr>
		<tr>
			<td>F10 Media</td>
			<td>Wisent</td>
			<td>318-050-CL</td>
			<td></td>
		</tr>
		<tr>
			<td>FBS</td>
			<td>Wisent</td>
			<td>081-105</td>
			<td></td>
		</tr>
		<tr>
			<td>Froggarose</td>
			<td>FroggaBio</td>
			<td>A87</td>
			<td></td>
		</tr>
		<tr>
			<td>Gel Molecular Imager</td>
			<td>BioRad</td>
			<td>GelDocXR</td>
			<td></td>
		</tr>
		<tr>
			<td>Glutamax</td>
			<td>Wisent</td>
			<td>609-065-EL</td>
			<td></td>
		</tr>
		<tr>
			<td>Heat Lamp</td>
			<td>Morganville Scientific</td>
			<td>HL0100&#160;</td>
			<td>Similar to this product</td>
		</tr>
		<tr>
			<td>Intravascular Polyethylene tubing (0.015&#34; ID x 0.043&#34; OD, 20G)</td>
			<td>SAI infusion</td>
			<td>PE-20-100</td>
			<td></td>
		</tr>
		<tr>
			<td>Isoflurane</td>
			<td>Sigma</td>
			<td>792632</td>
			<td></td>
		</tr>
		<tr>
			<td>M25FV24C Cell line</td>
			<td>Gladdy Lab</td>
			<td>N/A</td>
			<td></td>
		</tr>
		<tr>
			<td>Microliter Syringe</td>
			<td>Hamilton</td>
			<td>01-01-7648</td>
			<td></td>
		</tr>
		<tr>
			<td>Molecular Imager Gel Doc XR</td>
			<td>Biorad</td>
			<td>170-8170</td>
			<td></td>
		</tr>
		<tr>
			<td>Mouse holder</td>
			<td>The 3D printing material used was ABS-M30i, and it was printed on FDM Fortus 380mc machine&#160;</td>
			<td>N/A</td>
			<td>Dimensions: length = 43 mm, outer radius = 15 mm, inner width (where the mouse would sit) = 20.7 mm.&#160;</td>
		</tr>
		<tr>
			<td>MyRun Machine</td>
			<td>Cosmo Bio Co Ltd</td>
			<td>CBJ-IMR-001-EX</td>
			<td></td>
		</tr>
		<tr>
			<td>Nanodrop 8000 Spectrophotometer</td>
			<td>Thermo Scientific</td>
			<td>ND-8000-GL</td>
			<td></td>
		</tr>
		<tr>
			<td>p53 primers</td>
			<td>Eurofins</td>
			<td>N/A</td>
			<td>Custom Primers</td>
		</tr>
		<tr>
			<td>PCR tubes</td>
			<td>Diamed</td>
			<td>SSI3131-06</td>
			<td></td>
		</tr>
		<tr>
			<td>Penicillin/Streptomycin</td>
			<td>Wisent</td>
			<td>450-200-EL</td>
			<td></td>
		</tr>
		<tr>
			<td>Proteus software&#160;</td>
			<td>Pichardo lab</td>
			<td>N/A</td>
			<td></td>
		</tr>
		<tr>
			<td>Respiratory monitoring system</td>
			<td>SAII</td>
			<td>Model 1030</td>
			<td>MR-compatible monitoring and gating system for small animals</td>
		</tr>
		<tr>
			<td>Small Bore HIFU device, LabFUS</td>
			<td>Image Guided Therapy</td>
			<td>N/A</td>
			<td>LabFUS, Image Guided Therapy, Pessac, France Number of elements 8 
			frequency 2.5 MHz 
			diameter&#160; 25 mm 
			radius of curvature 20 mm 
			Focal spot size 0.6 mm x 0.6 mm x 2.0 mm 
			 
			Motor: axes 2 
			 
			Generator: 
			Number of channels 8 
			Maximum electrical power/channel Wel 4 
			Maximum electrical power Wel 32 
			Bandwidth 0.5 - 5 MHz 
			Control per channel: Freq., Phase and. amplitude 
			Measurements per channel: Vrms, Irms, cos(theta) 
			Duty Cycle at 100% power % 100% for 1 min. 
			 
			Transducer: 
			Number of elements 8 
			frequency&#160; 2.5 MHz 
			diameter 25 mm 
			radius of curvature 20 mm 
			Focal spot size&#160; 0.6 mm x 0.6 mm x 2.0 mm</td>
		</tr>
		<tr>
			<td>SYBR Safe</td>
			<td>ThermoFisher Scientific</td>
			<td>S33102</td>
			<td></td>
		</tr>
		<tr>
			<td>TAE</td>
			<td>Wisent</td>
			<td>811-540-FL</td>
			<td></td>
		</tr>
		<tr>
			<td>Tail vein catheter (27G 0.5&#34; )</td>
			<td>Terumo Medical Corp</td>
			<td>15253</td>
			<td></td>
		</tr>
		<tr>
			<td>Thermal probes</td>
			<td>Rugged Monitoring</td>
			<td>L201-08</td>
			<td></td>
		</tr>
		<tr>
			<td>Trypan blue</td>
			<td>ThermoFisher Scientific</td>
			<td>15250061</td>
			<td></td>
		</tr>
		<tr>
			<td>Trypsin</td>
			<td>Wisent</td>
			<td>325-052-EL</td>
			<td></td>
		</tr>
		<tr>
			<td>Ultrasound Gel</td>
			<td>Aquasonic</td>
			<td>PLI 01-08</td>
			<td></td>
		</tr>
	</tbody>
</table>

magnetic resonance-guided high intensity focused ultrasound generated hyperthermia: a feasible treatment method in a murine rhabdomyosarcoma model

Magnetic resonance-guided high intensity focused ultrasound (MRgHIFU) is an established method for producing localized hyperthermia. Given the real-time imaging and acoustic energy modulation, this modality enables precise temperature control within a defined area. Many thermal applications are being explored with this noninvasive, nonionizing technology, such as hyperthermia generation, to release drugs from thermosensitive liposomal carriers. These drugs can include chemotherapies such as doxorubicin, for which targeted release is desired due to the dose-limiting systemic side effects, namely cardiotoxicity. Doxorubicin is a mainstay for treating a variety of malignant tumors and is commonly used in relapsed or recurrent rhabdomyosarcoma (RMS). RMS is the most common solid soft tissue extracranial tumor in children and young adults. Despite aggressive, multimodal therapy, RMS survival rates have remained the same for the past 30 years. To explore a solution for addressing this unmet need, an experimental protocol was developed to evaluate the release of thermosensitive liposomal doxorubicin (TLD) in an immunocompetent, syngeneic RMS mouse model using MRgHIFU as the source of hyperthermia for drug release.

Using the MRgHIFU-generated hyperthermia protocol, the tumors in the hind limb were able to be consistently heated to the desired set temperature for the duration of the treatment (Figure 4 shows a representative treatment, 10 or 20 min, n = 65). To consider a treatment to be successful, the ROI had to be maintained above 39 &#176;C for the entirety of the treatment, with &#60;6 &#176;C variation throughout the treatment and without heating of off-target tissue. Additionally, the core temper...

Watch this Scientific Journal Video about Magnetic Resonance-Guided High Intensity Focused Ultrasound Generated Hyperthermia: A Feasible Treatment Method in a Murine Rhabdomyosarcoma Model at JoVE.com

Magnetic Resonance-Guided High Intensity Focused Ultrasound Generated Hyperthermia: A Feasible Treatment Method in a Murine Rhabdomyosarcoma Model

Presented here is a protocol to use controlled hyperthermia, generated by magnetic resonance-guided high intensity focused ultrasound, to trigger drug release from temperature-sensitive liposomes in a rhabdomyosarcoma mouse model.

Magnetic resonance-guided high intensity focused ultrasound (MRgHIFU) is an established method for producing localized hyperthermia. Given the real-time ...

This protocol allows for novel preclinical testing of tumor targeted hyperthermia in combination with thermo sensitive drugs, which can be applied to improve survival and reduce systemic toxicity in sarcoma patients. The main advantage of this technique is that the chemotherapy release is confined to the heated region maximizing drug release within the tumor while minimizing the systemic release of the drug in healthy tissue. Our methods can be translated clinically to treat sarcomas.Also, our work is learning how localized hypothermia can incite the immune system to help the body target cancer alongside standard chemotherapy. Demonstrating the procedure will be Dr.Warren Foltz, the lead MRI physicist at the Star Innovation Center, Dr.Adam Waspe, the lead HIFU physicist at the Hospital for Sick Children, and Suzanne Wong, a master's graduate in applied science from the Drake Lab at the hospital for Sick Children in Toronto. To begin shave the hind leg of the restrained mouse using clippers and wipe it with 70%ethanol.Aspirate approximately 10, 000 cells in 10 microliters of cell suspension solution using a microliter syringe. Extend the right hind leg of the mouse and inject the cell suspension in a steady motion into the thigh musculature using a microliter syringe with a 26 gauge needle. The needle should be inserted parallel to the femur toward the knee, taking care not to hit the sciatic nerve.Remove the needle and return the mouse to a second cage. Evaluate the animals daily and monitor their hind limbs for tumor growth through palpation. Image the anesthetized mouse using the MRI scanner.On the T2 weighted image take note of in plaine dimensions and the number of axial slices that the tumor appears within. Note the location of the tumor in reference to the femur and lateral surface of the thigh where the ultrasound wave would enter. To prepare the small bore HIFU system, turn the generator on, put the membrane on the transducer and fill the transducer with enough deionized water until the membrane is expanded below the transducer.But not so firm that it would compress the mouse. Degas the water in the transducer circuit for 30 minutes to remove dissolved oxygen from the medium. After anesthetizing the mouse and transferring it to a nose cone, apply a corneal lubricant to the eyes to prevent damage due to the lack of blink reflex under anesthesia.Shave the right hind limb of the mouse. Apply depilatory cream to the shaved area including the entire right hind limb. Position the mouse under a heat lamp while in the biosafety cabinet to help with thermal regulation.And remove the hair and depilatory cream one minute after application. Move the mouse to an MRI compatible nose cone on the MRI sled and place the mouse with the non-tumor bearing side down and the tumor superior inside a 3D printed mouse holder on the sled. Place a heat lamp near the mouse to keep it warm.If needed, cut to compressed ultrasound gel pad segment to put under the mouse lining the bottom of the holder with a thickness to level the tumor to the top of the holder. Tuck the uninvolved leg away from the tumor leg, either under the mouse or extended with the tumor leg flexed. Ensure the feet are not in the near field or far field of the tumor and ultrasound beam path.To insert the esophageal temperature probe thread the esophageal probe through the nose cone and scruff the neck of the mouse. Tilt the mouse's nose up to create a line from its mouth straight to its stomach by extending the head. Slide the thermal probe above the tongue about 0.5 centimeters into the mouse's esophagus and replace the nose cone around the mouse's nose.Secure the esophageal probe and nose cone at the top of the sled. Next, insert the rectal temperature probe and secure it with tape. Insert another gel pad if needed and apply eye lubricant or ultrasound gel around the right hind limb to fill any gaps.Insert a 27 gauge butterfly needle tail vein catheter into a lateral tail vein attached to a micro tubing with 40 microliters of dead space and tape securely. Place the respiratory monitor with the connecting cable toward the head of the mouse so it does not interfere with the placement of the ultrasound transducer, secure with tape. Use two people to carry the prepared mouse, mouse sled, anesthesia line, respiratory line, tail vein catheter, and thermal probe cords into the MRI scanner and place them into the MRI sled holder.Everybody has been screened and nothing is brought into the MR suite, which is ferromagnetic or could be damaged within the strong magnetic field of the system. After the HIFU software operator moves the meniscus of the transducer directly over the tumor for an initial alignment, apply eye lubricant, or degassed ultrasound gel, to the hairless skin above the tumor and couple the HIFU transducer to the tumor area. Connect the drug delivery line from the automatic pump to the tail vein catheter and calculate the amount of dead space in the tail vein line and the connecting line.Slide the mouse HIFU sled on MRI rails into the center of the MRI and place the air convection warming device on the warmest setting. Point the tube blowing air toward the mouse in the center of the MRI bore and secure it with tape. The warming device will later be turned to its lowest setting to prevent overheating of the mouse during sonication.Acquire the survey MR images of both axial and sagittal to determine the tumor location for sonication targeting, including depth. Adjust the transducer position accordingly using the HIFU software by inserting the desired movement distance as measured on the image, and then clicking the arrow direction to move. Also, note the location of the drift tube.Repeat as necessary. Determine the location of the focal spot of the transducer in the cornal plane by performing a brief 50 millivolts continuous test shot sonication for five seconds during the test shot thermometry acquisition. Align the MR survey images with the cornal view of the focal spot within the HIFU software.Review the images for tumor location relative to the bony structure and the rectum, and revise the transducer positioning as deemed necessary. Repeat the test shot sonication during nine repetition thermal imaging to confirm whether there is even and accurate heating in the tumor volume with minimal off-target heating. Adjust the slice location, transducer location and depth of steering and confirm heating performance with repeat test shots as deemed necessary.Using the HIFU treatment monitoring software, define the region of interest, or ROI, for thermometry monitoring within the final heating profile by measuring the distance to move and then altering the grid coordinates in the program. Set an ROI within the fluid signal from the drift tube for drift correction of the thermometry output. If this fluid signal is not well defined within the axial planning image at the level of the tumor then the direct output from the fiber optic temperature probe within the drift tube is used for drift correction.Enter the baseline temperature based on the rectal probe temperature for thermometry measurements. Open the 20 minute hyperthermia treatment specifications in the software and start sonication once the reference MR Images are collected and the thermometry begins. Perform a 20 minute treatment during thermal imaging using the built-in proportional integrative derivative, or PID, controller software.Inject the selected drug 1.5 minutes after the temperature in the ROI warms to the desired temperature. If the rectal temperature is increasing rapidly during the treatment and exceeds 40 degrees Celsius, halt sonication and allow the rectal temperature to drop before restarting. After treatment completion, remove the mouse from the MRI bore, ensuring hemostasis at the tail vein catheter insertion site and transfer it to the biosafety cabinet.Wash off the ultrasound gel and lubricant from the hind leg using water. Transfer the mouse to its cage and monitor its recovery. Point the heat lamp at one end of the cage to assist with thermal regulation during recovery.Using this hyperthermia protocol, the tumors in the hind limb were able to be consistently heated to the desired set temperature for the duration of the treatment. The temperature monitored during the representative treatment is shown in this figure. Average top 10th percentile and top 90th percentile temperatures of all voxels in the ROI are presented here.Average temperatures during treatment within the ROI for each mouse were tested during the optimization phase with the standard deviation. The overall average temperature is also shown. The success rates of hyperthermia treatment were also improved over time.Treatment success was dependent on the inclusion criteria. That is the systemic temperature, the tumor temperature and variation with the ROI and no distal heating. Here, the blue line represents the percentage of mice for which the treatment was successful and the orange bars represent the number of mice treated.Each treatment refers to a separate date on which the experiments were conducted. To determine the optimal hypothermia treatment time for further studies, two durations of treatment were tested, 10 minutes and 20 minutes. High performance liquid chromatography and mass spectrometry, or HPLC MS, was used to assess the amount of doxorubicin in the tumors and quantify the difference in doxorubicin accumulation between tested durations.The results demonstrate the significance between the amount of doxorubicin in the tumor in the 20 minute thermosensitive liposomal doxorubicin plus hyperthermia group compared to the normal thermia control. No differences were seen in the tumor in the free doxorubicin groups. When preparing and positioning the mass it is imperative that the HIFU beam is unobstructed.Air bubbles in the gel or bone in the beam path must be avoided. We collect tissue and blood to analyze the pharmacokinetics and toxicity levels in various organs as well as examine the immediate and delayed response of the immune system to treatment.

Research

JoVE Journal

Cancer Research

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