Ultrasound Isn’t Just for Pregnancy. How It’s Helping Treat the Brain.
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Hey, future of everything listeners, a quick a note before we get into today's episode, which is about new lesson base ive alternatives to some brain surgeries. There are some graphic descriptions of these procedures. So heads up, if that makes you scream sh now onto the show. Hi, danny. Hey, so dane.

have you ever had an ultrasound on your brain?

No, I did have one on my knee after I told my A C L years ago. And have you won?

No, I had several when I was pregnant, but that had nothing to do with my brain.

And that's a classic one, right? You know, the food imaging with the the wish wish.

Exactly, that's the diagnostic use of ultrasound. Doctors also use ultrasound to treat some conditions, though the ultrasound waves Carry energy, and when it's used in a specific controlled way, I can modify or even destroy tisa.

Yeah, that's called the blame. Doctors can use alter sound to break up kidney stones or to treat symptoms of conditions like parkinsons and a central trauma. But most people probably associate ultra sound with imaging. And the wish, wish.

the rush sound, is actually what I teach, what I teach out to sound, because the reason why we can hear the heartbeat of the blood gushing in our arteries is because that's called the doppler effect elisa knife.

Gu is the director of colombia universities ultrasound and elasticity imaging labor talk.

That's the early time that we enter without the sound, the acoustic audible range in humans. And we can hear the wash wash .

knife do is working on new technology that could expand how ultra sound is used even further beyond imaging and ablation to actually getting drugs directly into the brain.

This has been A A very, very old problem. Unfortunately, you have a lot of good drugs, but you know, there is a the sparry background barrier in our brains that filters basically one hundred percent of large molecule drugs and nine, nine percent of small molecule drugs.

Gona fog. And researchers like her are experimenting with using ultrasound to open that blood brain barrier. So those drugs can go where there needed, no surgery required.

And once you're able to open that barrier and get drugs in, you can also get things out like diagnostic information about serious diseases like brain cancer. Again, no surgery required.

From the wall street journal, this is the future of everything. I'm danny Lewis .

and I am sara garden burg.

Today we're talking about how briefly breaking through the blood brain barrier with ultrasound could lead to new treatments for serious .

diseases and could even help doctors diagnose their patients without brain surgery. Stay with us.

In order to get into why researchers are looking at alter sound as a tool to treat the brain, we have to talk about the blood brain barrier basically because it's a barrier that can be good. IT helps prevent things like viruses and bacteria from getting in the brain, but IT also blocks drugs like cancer medications and new therapies and gene therapies.

IT basically looks like a junction or a offence essentially between cells, that line of blood vessel.

That's Michael cabinet. He's got a lot of titles, professor and executive vice chairman of neurological surgery as well as vice chair for research at wild cornell medicine. Basically, he's the brain guy.

If you have a Young children who use magnitudes, for example, they kind of snap together, right?

If you don't know what magnetites are, their squares and triangles lined with magnets on the edges, when they get close to one another, they stick together.

That's what these cells do, and they encircle the tube. But there can be gaps between those cells.

If you're trying to treat the lungs or liver, for example, there is no barrier to getting medication to them directly through the bloodstream. But the brain, the black brain, berrier, is in the way all .

of these things are very large, very complex and will not get into the brain. So the only way you can get them in is either directly inject them surgically, or if you could open the blind brain barrier, then you could just inject them into the bloodstream, and they will get .

through that first method. Capital mentioned direct injection IT involves a drill.

We make a small hole about the size of quarter, and then you put a little a very fine tubes that's about the size of maybe two human hairs, and then you attach that to an infusion that will inject this very small amount of fluent, and usually maybe a one drop.

This approach, which sets up a catheter, has some disadvantages. First of all, it's surgery on your brain. And with that, bleeding is always a possibility. Another disadvantage control.

Another issue with direct injection is not just a safety issue. It's that we can't always control exactly where the fluid is gonna. So if you put a tube in a catheter and the solution comes out, if you're trying to target a very small area of the brain, that works pretty well because the fluid will come out and pretty much cover the area you want.

Essentially, the drip, drip, drip of the catheter directs the drug to the area of the brain exactly below the catheter. And that's IT.

But if you're trying to cover a larger area of the brain or an area that doesn't have a uniform shape, then it's not so easy to get the solution to spread exactly the way you want.

You could put more catheters to cover a larger area as capital was explaining IT to us, though, I started to picture pinhead from the hell razor series.

We have sites to show you the procedure .

is not something out of a supernatural horror movie. Capital emphasize this sort of treatment is relatively low risk. Even so, surgery, specifically brain surgery, can be extremely nerve racking. So what if you could avoid that and open the blood brain barrier briefly, reliably, precisely, and no invasively.

We actually have gas bubbles that you gain ject into A V list through the vain in people. The bubbles is a secret sauce.

That's a lisa, a fog of columbia university. Again, SHE and other researchers like her are using ultra sounds imaging technology, combined with these things called micro bubbles to open the blood brain barrier. And when we say micro, we mean micro.

very small microsites. So one thousand and a millimeter, and they flow in our veins and arteries, and when the other some hits them, they said, resonating .

Normally with imaging. The ultra sound waves bounce back off the tissue or blood. In some cases, doctors already use microbes bles to make these images a lot clear, because when the bubbles resonate, they reflect back more of the ultrasound.

It's called contrast, enhances imaging. So now, all of a sudden, where you have a dark image because you can't see the outside reflection, then hands the reflection from the attract. And so the and almost Sparkling, you can see a Sparkling heart.

But connive g says the resonating microbes bles can also make the blood brain barrier more premium.

extra pressure that's built from the actual bubble that we have there, absorbing the other sound wave, this bubble is set to solve, and the time junctions around the bubble are said to relax.

Think of IT this way. The micro bubbles are injected into your bloodstream as they travel through your system. A doctor points in ulsan emitter at a part of the brain they want to treat.

When the bubbles reach that area, the ultrasound makes them vibrate. And the added pressure from these dancing bubbles makes the blood brain barrier loosen up, basically creating a door wet. So instead of drilling a hole and inserting a catheter drip, doctors can inject the drug into the bloodstream through the armor and I V drip. The drug can even be administered orally and then open the blood brain barrier in the precise part of the brain affected by the disease.

So we're going to increase the dose, the local dose, not the systemic those, and then get more into the brain where you need IT. So lower systemic dose, but hire in the brain that actually considered success.

Plus you can get those drugs to more parts of the brain in one go, rather than the road, which involves multiple catheters. Ka fog says you can open the door, and the drugs will flow more evenly across the targeted region. And when the ultra sound is turned off, the blood brain barrier will close up again, and the kidneys clear the microbes bles carnifex says this could help treat a wide range of diseases like alzheimer's.

Pediatric leoma, which are a type of brain tumor, and children IT could be used for parkinsons, A, L S, maybe even addiction and depression. But capital says controlling the flow of these drugs may be trickier than anticipated. He compares direct injection to disrupting the blood brain barrier through ultrasound.

Once you injected in the brain, very little is going out into the bloodstream. Whether if you inject something to the bloodstream, what if IT does do something different? If he gets into your liver, your long, then IT does in the brain, only a fraction of what you put into the bloodstream is actually going to go into the brain. The majority going to stay in the bloodstream .

and go all over the body. Cabot also says, if the door is open to drugs, then other things could get in to.

which includes blood cells. So there is the possibility of some small amount of bleeding. And then, of course, if someone has an infection or something, the blood dream could get into the brain if you open the blood brain barrier.

Nevertheless, cabot does share many of knifed was hopes for this method of treatment.

These are all things we have to work on. I'm not saying this will happen, but our job is to think of all the things that could happen and then make sure that they don't.

But if you can get things into the brain, you can also get things out. Could this same technology be used to diagnose diseases without a tissue biopsy? Danny has more on that side of alter sound after the break.

Diagnosing an issue in the brain like a tumour, for example, can be a lot of work, while some brain diseases can be diagnosed with blood tests or by sapling spinal fluid through a lumbar punctures procedure, also known as a spinal tap IT can be really hard to get a detailed diagnosis without having to do a biopsy, which in the brain takes a lot more work than, say, sapling, a mall on your skin.

In the reasons we typically do brain by options is when we've got diagnostic uncertainty.

Doctor eric loth art is a neurosurgeon and runs the neurotechnology division at washington university school of medicine. Insane Lewis.

we get to everyone, we get a cats scan, we create a three d model of the brain. And we plan on software, a trajectory of where to put in needs, so we can withdraw some tissue.

And then finally, after all that planning, there's the actual brain surgery to .

make an incision, the skull troll hole in the skull, and get a probe into the brain. And we have kind of special soccer where we cut that piece of tissue and hold IT in that chAmber so that we can withdraw the probe and we can take that decision consent to the pologies.

It's a lot of work. IT takes a lot of time. And doctor luthor says, like with any surgery, there are some chance of things going wrong.

There's always a restabit. There's always a risk for infection. And with every brain or dream, there's a risk for something catastrophic, coma, death, paralysis. We never take these procedures likely .

that a lot to get a tissue sample. But doctor luthor says, even after all that, you still might not get a conclusive diagnosis.

We only use that when we absolutely really have to. We can't biopsy people Willy nilly. And that's actually a fundamental barrier to really understanding the human brain.

Here's where he says ultrasound could come into because, as we mentioned earlier, disrupting the blood brain barrier is like opening a door. If medication can get in, that means some things could get out like DNA fragments into other biomarkers. Those are molecules that can be a sign of a condition or disease, among other things.

If we can touch the brain without touching the brain, that is a fundamental .

frame shift forward. dr. Or lutha and his team called this process a sno biopic, a biopsy with sound.

What we hope is in the future, a sono obser can be performed as if you are doing a tron scan. To look at the hard .

hung chain is associate professor of biomedical engineering at washington university. Insane Lewis SHE works with doctor lutha. Here's how the sono biopsy would work.

Say a doctor has spotted something concerning on the patients MRI. And he wants to see if they have a brain tumor. That patient could come into the office, have an injection of micro bubbles, gip, the same microbot bles we heard about earlier. An ultra sound beam is directed at the suspected tumor. Once the microbes les reached the area of the brain, the ultra sound gets them isolating and the blood brain barrier starts to open.

So the opening size can be controlled in a way that the barberry barrier can be open, but the opening size is so small that we only get this small molecules to be leak through.

Because if a disrupted blood brain barrier can let drugs into the brain, chen say's DNA from a tumour, for example, can naturally flow out into the bloodstream. The doctor would then take a blood sample from the patient and send IT off to a lab to test for the specific biomarkers. Let's say, doctors suspected patient has a tumor caused by a specific mutation. They can test your blood and they might find some traces of IT, but chen says that's not very accurate on its own.

Even when you see the ball markers in the blood, you don't know where to come from. You have to combine with other like imaging to guess, oh, a highly likely come from tumor plus because .

so little gets through the blood brain barrier or naturally, doctor loose arts says the blood tests have to be really sensitive, but a sono biopsy would allow more of these biomarkers to exit the brain, making them easier to spot.

That is trying to get more, more centive to detect those biomarkers, but let's enrich those biomarkers at the source.

And instead of having to get a brain biopsy at a specialized facility, dr. Lothar's says sono biopsies are simple enough. They could eventually be brought out of the hospital and into the offices of primary care doctors.

That's the explicit al. We feel a hundred percent confidence that this can be done in a doctors office and that what was originally in the Operating room using a biopsy under anesthetic really comes of no more, just getting your blood drawn.

dr. r. Luzarches team has just started with a clinical study testing this out on a handful of patients. So that goal is a bit far in the future. But others agree that doing a biopsy by disrupting the blood brain barrier has promised my father.

who was a cardy surgeon. I I remember red that I was a kid saying how much he hates needle by upsets of anything because he just doesn't believe that it's a good enough saying .

doctor Michael cabin, the wild cornell neurologist and neurosurgeon we heard from earlier.

Obviously, that helps a lot, but there is a risk of what we call sampling error where you're just taking a portion of a cheaper might have different consistencies. And there may be parts that we think are dead costumers outgrow their blood supply and the middle can often die. And we wanted get the live part right.

And if a doctor misses that active malignant part of the tumor, they might not get an accurate diagnosis. Doing multiple biopsies means having to make multiple incisions in the skull that increases the risk of something going wrong.

If you can open up the blood brain barrier in the area of the tumor a bit, you could have have a more of a sample, so you can have greater sensitivity to detect the tumor signals and be able to for what type of tumor this may be, and even see if there are particular changes in the tumor DNA that would make IT more amenable to specific types .

of chemotherapy. But sono biopsies are a new technique, and just because it's not surgical doesn't mean it's risk free.

The number one risk is hamerton .

hung change from washington university in sante Lewis.

Because what the microbes is doing is is going to pop inside the blood vesle. And then if we apply the ultra energy not under this control fashion, then we can cause vector damage.

Darker cabinet also says there is a slight risk that tumor cells could leave the brain and enter the bloodstream, though he thinks that's unlikely. Doctor lutha and professor chens say, if done correctly, their method only disrupts the blood brain barrier enough to allow some genetic material to slip through not entire cells. However, the real maker break for whether sono will become part of the clinical standard of care is if they're reliable, even though doctor lutha is optimistic that sano biopsies will one day be simple enough for everyday doctors to use capital. T thinks that's a ways off.

I think you will become more common. I think you will remain for a while at high and centers that are treating a lot of patients with brain tumors, for example, because I think that's the everywhere it's going to be applied first, both for diagnosis and for delivery of therapies. But it's unlike that's going to be in your general practice is office anytime soon.

But even given these chAllenges, doctor capital says ultrasound does have potential for new uses beyond imaging and debate tion. IT just might take some time to work out what those new uses are.

We are definitely at the stage of showing that it's possible. We are not nearly at the stage of showing exactly how useful IT is in every situation, and that's what we're going to have to do and that's what's being done right now.

The future of everything is a production of the wall street journal. Steph anie ilga fruits is the editorial director of the future of everything. This episode was produced by danny Lewis .

and charred garden burke. Our fact checker is a partners. Nathan Michael, level and just coffin are our sound designers, and road music .

cater milsom is our supervising producer. I should all muslims is our development producer. Scott sloy and Chris are the deputy editors, and philanthus atterson is the head of news audio for the world street.

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