Patent Application
20090299417
The present invention relates to medical instruments, systems and methods for delivering electrotherapy to tissue.
Nanosecond-pulsed electric fields (nsPEF) applied to tissue have been shown to impart low energy in the tissue leading to very little heat production. The ability of nsPEF to penetrate into the cell to permeabilize intracellular organelles is known. (See Schoenbach et al., 2001, Bioelectromagnetics 22, 440-448; Buescher and Schoenbach, 2003, IEEE Transactions on Dielectrics and Electrical Insulation 10, 788-794; White J A, et al., 2004, J Biol Chem. 2004 May 28; 279(22):22964-72. Epub 2004 Mar. 16.).
The electric fields of nsPEFs differ from those commonly used for classical electroporation in at least three (3) ways. First, the durations range from 1 microsecond to 200 picoseconds with rise times from 50 nanoseconds to 50 picoseconds. Second, nsPEFs can have a 20-fold larger amplitude, such as about 1 kV/cm to megavolts/cm or more. These differences in pulse parameters are believed to allow nanosecond-width pulses to penetrate into cells and electroporate organelle membranes in addition to the plasma membrane. Two separate factors are believed to produce the intracellular penetration. First, the rise time of the nsPEFs is faster than the charging time of the plasma membrane, resulting in penetration of the electric field into the cell interior. This internal field generates a current that charges the outer plasma membrane. Most cells exhibit a charging time constant of about 100 nanoseconds. This is for cells in a suspension, and would be longer for tissues. After this charging time, the resulting charge redistribution will screen out the electric field from the cell interior unless the field strength within the plasma membrane has become large enough to generate pores that provide the second mechanism for intracellular penetration.
Second, if the potential difference across the membrane exceeds about 1.6 volts, the formation of nanopores occurs within nanoseconds or less. This allows conduction current to enter the cell during the time that the pores are open. For the large field strengths used for nsPEFs, all of the molecules and organelles inside the cell will be exposed to the imposed electric field for up to hundreds of nanoseconds during each pulse due to the timing of the charging current and the open time of the field-induced pores. By applying multiple pulses, the total time of field exposure can be increased in proportion to the number of pulses applied.
The present invention discloses instruments, systems and methods for delivering electrotherapy to tissue. In particular, the instruments, systems and methods of the present invention are capable of delivering electrotherapy to tissue without imparting substantial electrical or thermal damage to the surface of the tissue, e.g., the skin.
In one embodiment, the invention can be a medical instrument for delivering electrotherapy to tissues at a controllable, localized depth without the electrical field used for the electrotherapy causing damage to the surface skin. The medical instrument can include an outer support member having a ground plate at a distal end of the outer support member and a protrusive element having a tip that extends beyond the ground plate. The protrusive element can include a conducting material. A portion of the protrusive element proximate the ground plate can be an electrical insulator and a portion of the protrusive element proximate the distal end of the protrusive element can include a first electrode. The protrusive element can be designed to penetrate into tissue below the tissue surface while a tissue contacting surface of the ground plate rests against the tissue surface. The protrusive element can extend from within a perimeter of the ground plate.
In some embodiments, at least a portion of the tissue-contacting surface of the ground plate is not itself, and is not coated with, an electrically insulating material and at least a portion of the first electrode is not itself, and is not coated with, an electrically insulating material. The entire tissue contacting surface of the ground plate can be free of any electrically insulating coating. The protrusive element, the ground plate, or both can be removable.
The tissue contacting surface of the ground plate can be symmetric along at least one axis passing through and perpendicular to a longitudinal axis of the protrusive element. The ground plate can have a tissue contacting surface that is symmetric along at least two axes passing through and perpendicular to a longitudinal axis of the protrusive element. In some embodiments, the ground plate can have a tissue contacting surface that is symmetric along two orthogonal axes passing through and perpendicular to a longitudinal axis of the protrusive element.
The protrusive element can include a needle that can be made of an electrically conductive material. The needle can be coated with an electrical insulator. The portion of the protrusive element proximate the ground plate that acts as an electrical insulator can be at least about 0.15 cm in length, at least about 0.2 cm in length, at least about 0.3 cm in length or at least about 0.5 cm in length.
The first electrode can be 4 cm or less in length. A tissue contacting surface of the ground plate can be a ring and the protrusive element can extend from the center of the ring.
The medical instrument can also include one or more additional protrusive elements having sharp tips that extend beyond the ground plate, wherein a portion of each additional protrusive element proximate the ground plate can act as an electrical insulator and a portion of each additional protrusive element proximate the distal end of each additional protrusive element can include additional first electrodes. Each additional protrusive element can be designed to penetrate into tissue below a tissue surface while the ground plate rests against the tissue surface. In embodiments where the medical instrument includes one or more additional protrusive elements, the first electrode and at least one additional first electrode can be wired such that the first electrode and at least one additional first electrode can be independently energized at the same or different voltages. The medical instrument can include at least two protrusive elements that can extend from within a perimeter of the ground plate.
In another embodiment, the invention can be a system for delivering electrotherapy to tissue. The system can include the medical instrument for delivering electrotherapy to tissue, described above, and a power supply electrically coupled to the ground plate and the first electrode. The power supply can generate electrical signals to the medical instrument for delivering electrotherapy to tissue.
The power supply can include a pulse generator. The pulse generator can include a nanosecond pulsed electric field (nsPEF) generator.
In another embodiment, the invention can be a method of delivering electrotherapy to subsurface tissue of a mammalian subject. The method includes inserting the protrusive element of the above-described medical instrument for delivering electrotherapy to subsurface tissue into subsurface tissue where the ground plate can be contacting a tissue surface. The method can include applying one or more nanosecond pulses creating a voltage difference between the ground plate and the first electrode of 1 to 100 kV. The method can also include measuring the skin thickness of the mammalian subject and selecting a medical instrument where the portion of the protrusive element that acts as an insulator is at least as long as the measured skin thickness.
The pulses can be applied to selectively target fiber septae. The pulses selectively targeting fiber septae can be applied to reduce dimpling of the tissue surface.
The nanosecond pulse can be 100 picoseconds to 1 microsecond in duration. The peak power produced between the ground plate and the first electrode can be greater than or equal to about 1 MW. The peak electrical field produced by the pulse can be at least 10 kV/cm. The temperature increase of the surface tissue proximate the first electrode caused by the nanosecond pulsed electric field can be about 1 degree Celsius or less.
These and other embodiments are described in more detail below.
The invention is described with more particularity below. The scope of this invention may be better understood by referring to the following description taken in conjunction with the accompanying drawings, in which:
a)-(e) are bottom views of several exemplary geometries of the ground plate and the protrusive elements that can be used in the exemplary medical instruments disclosed herein.
a)-(c) are bottom views of several exemplary geometries of the ground plate and the protrusive elements where the ground plate includes a plurality of ground plate segments.
a) and (b) are cross-sectional views of skin and adipose tissue illustrating normal and abnormal fat layers, respectively.
a) is a graph of the potential distribution in the vicinity of the needle during the capacitive phase; and (b) is a graph of the electrical field distribution in the vicinity of the needle during the capacitive phase.
a) is a graph of the conductive phase equal-potential distribution for Example 1; and (b) is a graph of the conductive phase electrical field distribution along the scanning line for Example 1.
a) is a graph of the conductive phase potential distribution in the vicinity of the needle for Example 1; and (b) is a graph of the conductive phase electrical field distribution in the vicinity of the needle for Example 1.
a) is a graph of the conductive phase equal-potential distribution for Example 2; and (b) is a graph of the conductive phase electrical field distribution along the scanning line for Example 2.
a) is a graph of the conductive phase potential distribution in the vicinity of the needle for Example 2; and (b) is a graph of the conductive phase electrical field distribution in the vicinity of the needle for Example 2.
a) is a graph of the conductive phase equal-potential distribution for Example 3; and (b) is a graph of the conductive phase electrical field distribution along the scanning line for Example 3.
a) is a graph of the conductive phase potential distribution in the vicinity of the needle for Example 3; and (b) is a graph of the conductive phase electrical field distribution in the vicinity of the needle for Example 3.
The inventive medical instruments, systems and methods are designed to deliver a nanosecond pulsed electric field (nsPEF) to a controlled volume of target tissue without causing thermal or electrical damage to the surface of the tissue.
As shown in
The protrusive element 16 can include an electrically conducting material partially or fully coated with an electrical insulator. The protrusive element 16 can include a needle 28 comprising an electrically conductive material partially or fully coated with an electrical insulator 20. The electrical insulator 20 can be an electrical insulating jacket formed from one or more electrically insulating sheaths or coatings. Exemplary electrical insulators 20 include Parylene, polyimide, fluoropolymers, including polytetrafluoroethylene, such as that sold under the TEFLON mark, and other medically useful coatings. The sheath can be applied using shrink wrapping techniques, conventional techniques for applying liquid coatings, or other known coating techniques, such as vapor deposition. The thickness of the electrical insulator 20 can be about 0.127 mm or less, about 0.0762 mm or less or about 0.0254 mm or less.
The electrical insulator 20 can form the majority of the protrusive element and the first electrode 22 can attach to the end of the insulator 20. As shown in
One of the benefits of the inventive medical instrument 10 and system 34 is that the medical instrument 10 can deliver targeted treatment to a volume of subsurface tissue 26, e.g. subcutaneous tissue, with a nsPEF without causing thermal or electrical damage to the tissue surface 24 or other surrounding tissue. In part, this is possible because, when compared to conventional electroporation, the inventive instrument 10 and system 34 utilize pulses that are generally more than 100 times shorter at a power level that is generally more than 10,000 times larger.
In some embodiments no electrically insulating coating is applied to the ground plate 14. In some embodiments, at least a portion of the ground plate 14 is not coated with an electrically insulating coating. In other embodiments, at least a portion of the first electrode 22 is not coated with electrically insulating material 20. In still other embodiments, at least a portion of the ground plate is not coated with an electrically insulating coating and at least a portion of the first electrode 22 is not coated with electrically insulating material 20.
The electrically insulating material 20 extending along the protrusive element 16 from a point proximate the ground plate 14 can have a length 36 of at least about 0.2 cm, at least about 0.3 cm, at least about 0.4 cm, at least about 0.5 cm, or at least about 0.6 cm. The length 36 of the electrically insulating material 20 can range from 0.1 cm to 2 cm, from 0.15 cm to 1 cm, from 0.15 cm to 0.7 cm, from 0.2 cm to 0.6 cm, or any combination thereof, e.g., 0.1 cm to 0.6 cm.
The electrical field created by the nanosecond pulses is strongest in the tissue immediately surrounding the first electrode 22. Because the first electrode 22 is at an end of the protrusive element 16 beyond the electrically insulating material 20, the first electrode 22 can be at least the length of the electrically insulating material 20 below the tissue surface 24. The amplitude of the electrical field decays rapidly as the distance from the first electrode 22 increases. Thus, the spacing provided by the electrically insulating material 20 can allow the first electrode 22 to deliver nsPEF treatments to a volume of subsurface tissue 26 without causing thermal or electrical damage to the tissue surface layer 24, e.g., the epidermis.
The first electrode 22 can have a cylindrical, needle shape. In such instances, the first electrode may have a diameter 38 of about 1 mm or less, about 0.75 mm or less, about 0.5 mm or less, or about 0.3 mm or less. All other variables being constant, the electric field in the subsurface tissue 26 proximate the first electrode 22 will increase as the diameter 38 of the first electrode 22 decreases.
The protrusive element 16 can be solid or hollow, such as a needle 28. Where the protrusive element 16 is hollow, the hollow cavity within the protrusive element 16 can be connected to a reservoir, as in a hypodermic needle, and used to inject active and inert ingredients to supplement the nsPEF treatments.
The length 40 of the first electrode 22, or exposed length 40 of the first electrode 22 where the protrusive element 16 is a conductive needle 28 coated with an electrically insulating material 20, can be at least about 0.001 cm, at least about 0.01 cm, at least about 0.1 cm, at least about 0.2 cm, at least about 0.3 cm, at least about 0.4 cm or at least about 0.5 cm. The exposed length 40 of the first electrode 22 can be about 4 cm or less, 2 cm or less, 1 cm or less, about 0.5 cm or less, about 0.4 cm or less, about 0.3 cm or less, about 0.2 cm or less, about 0.1 cm or less, about 0.05 cm or less, about 0.01 cm or less, or about 0.001 cm or less. The range of the exposed length 40 of the first electrode 22 can be any combination of the above maximums and minimums, e.g., range from about 0.001 cm to about 0.1 cm.
As shown in
As seen in
The power supply 42 can include a pulse generator capable of producing pulse durations of about 10 microseconds or less, or ranging in duration from about 5 microsecond to about 200 picoseconds, or from about 1 microsecond to about 1 nanosecond, or from about 10 nanoseconds to about 400 nanoseconds, or a range of any combination of pulse durations disclosed herein, e.g., about 1 microsecond to 150 nanoseconds. The nanosecond pulses applied in the associated method can have any of the above-identified ranges.
The electrodes 14, 22 can comprise an electrical conductor that is resistant to corrosion, e.g., stainless steel. The tissue contacting surface 30 of the ground plate 14 and the first electrode 22 can be electropolished or otherwise planarized. Electropolishing removes corners and sharp edges to minimize undesirable corona discharge when large voltages associated with generating nsPEF are applied to the electrodes 14, 22. Polishing in general is used to provide a smoother surface for charges to reside upon and to eliminate sharp edges that focus and enhance the electric field in that region. This results in a reduction of corona discharges.
As shown in
As shown in
The ground plate 14 can have any number of possible shapes, including circle, ellipse, oval, triangle, and polygons, such as squares, pentagons, hexagons, heptagons, etc. The shape of the ground plate 14 can be such that the nanopulses create a generally symmetric electrical field around the first electrode 22. As shown in
As shown in
As shown in
The protrusive element 16, the ground plate 14, or both 14, 16 can be replaceable. The protrusive element 16 and the ground plate 14 can be part of a single replaceable element or can be separate elements. The replaceable units can be removably attached to the medical instrument 10 using any attachment method compatible with medical usage. As an example, the luer lock and luer slip systems used for hypodermic needles can be used for attaching the protrusive element 16 and the ground plate 14 can be attached using a twist-on, snap-on, or other attachment system. Because the protrusive element 16 and the ground plate 14 may be replaced, a single medical instrument base can provide flexibility in terms of protrusive element geometry and ground plate geometry.
In some embodiments, the protrusive element 16, the ground plate 14, or both can be disposable. Because the protrusive element 16 comes into contact with bodily fluids during use, the ability to simply dispose of used protrusive elements 16 simplifies maintenance of a sterile environment that reduces the risk of infection or contamination.
The invention also includes a method of delivering electrotherapy to tissue. The method includes inserting the protrusive element 16 of the above-described medical instrument 10 for delivering electrotherapy through a tissue surface, e.g., the epidermis, into subsurface tissue 26 where the ground plate 14 can be contacting a tissue surface 24. The method can include applying a nanosecond pulse to create a voltage difference between the ground plate 14 and the first electrode 22 of about 1 to about 100 kV, or about 1 to about 70 kV, or about 1.5 to about 40 kV, or about 3 to about 30 kV or about 5 to about 30 kV, or about 10 to about 30 kV or about 15 to about 25 kV, or any combination thereof, e.g., about 1.5 to about 30 kV. The medical instrument 10 for delivering electrotherapy can be used to treat various conditions and target tissues including, but not limited to, tumors, such as carcinomas, lipomas, melanomas; cellulite; sweat glands; hair follicles; stem cells; fatty deposits; connective tissue and other conditions of the skin and subcutaneous tissues.
In such embodiments, the protrusive element 16 of the medical instrument 10 can be dimensioned such that first electrode is adjacent to the target tissue. For example, the protrusive element 16 can penetrate the skin and into the subcutaneous tissue 26 for treatment of a tumor. In another example, the protrusive element 16 can penetrate into the dermal layer for treatments targets at sweat glands or hair follicles.
Trials have demonstrated that nsPEF treatments can cause thermal injury to subcutaneous tissue, such as fiber septae 56. The pulsed electric field treatments can selectively damage fiber septae 56 in adipose tissue 26 being treated. It is believed that the selective treatment due to the orientation of the pulsed electrical field and the high conductivity of fiber septae relative to surrounding adipose tissue.
Treatment of fiber septae 56, or other connective tissues, using pulsed electric fields can reduce or eliminate dimpling of the skin caused by adipocyte lobules 58 held in tension by septal tethers 56 oriented perpendicular to the tissue surface 24. As shown in
The method can include administering a plurality of nanosecond pulsed electric fields. The method can include administering at least 50 nsPEF pulses. The method can include administering a plurality of nanopulses designed to deliver a threshold total energy sufficient to treat a targeted tissue volume. The number of pulses can be modified during treatment based on real time current measurements, whereby the system calculates the total energy delivered and shuts off after reaching a preprogrammed threshold level of energy.
The nanosecond pulse can be 1 to 600 nanoseconds in duration, 10 to 400 nanoseconds in duration, 20 to 200 nanoseconds in duration, or 50 to 150 nanoseconds in duration. The peak power produced between the ground plate and the first electrode can be at least about 5 MW, at least about 7 MW or at least about 10 MW. The peak electrical field produced by the pulse can be at least about 1 kV/cm, at least about 5 kV/cm, at least about 10 kV/cm, or at least about 12 kV/cm. The temperature increase of the tissue proximate the first electrode caused by the nanosecond pulsed electric field can be about 1 degree Celsius or less, about 0.5 degree Celsius or less, about 0.25 degree Celsius or less, or about 0.01 degree Celsius or less. The temperature increase of the tissue surface proximate the first electrode caused by the nanosecond pulsed electric field can be about 1 degree Celsius or less, about 0.5 degree Celsius or less, about 0.25 degree Celsius or less, or about 0.01 degree Celsius or less.
Nanosecond-pulsed electric fields (nsPEFs) are extremely short in duration, high in electric field and power and low in energy. In contrast to electroporation, nsPEFs unexpectedly have effects on intracellular structures (such as the endoplasmic reticulum, nucleus, mitochondria, Golgi apparatus etc.) and functions as well as cell viability. For example, effects on cell viability can be lethal or non-lethal depending on the cell type and the nsPEF conditions. In addition, nsPEFs can have effects on the plasma membrane. However, the effects are specifically different than those observed in electroporation. Unexpectedly, nanosecond-pulsed electric fields can cause the formation of “nanopores” that are on the order of nanometers. Unlike electroporation, these nanopores allow the passage of ions, such as sodium, potassium, calcium, but not larger molecules such as drugs of DNA.
For example, in one example propidium iodide (PI) was used as a marker for “cell permeability.” Propidium iodide has a molecular weight of 668 daltons and is about one (1) nanometer in diameter. As part of the study nsPEF conditions were manipulated to control whether PI could penetrate into cells treated by nsPEF.
In addition, nsPEFs introduced using a single needle electrode 10 described above have been shown to effect extracellular structures in adipose tissue, including collagen structures. Collagen is a protein secreted from a cell into the extracellular space. This is believed to be the first observation of pulsed electric field effects on structures that are not part of the cell. Thus, it would be possible for a single needle electrode 10 to deliver nsPEFs that effect other extracellular proteins and structures of the extracellular matrix.
The electrical fields produced by the devices disclosed herein have been modeled. Although not necessary for practicing the invention, the following discussion of the modeling results is included to provide insight into the instrument, system and method disclosed herein. These models are provided for illustrative purposes and should not be considered to limit the scope of inventive compositions and methods.
The dielectric relaxation time (tRC) can be defined as:
where, ∈0 is the electric permittivity of free space (8.85×10−12 F/m), ∈r is the relative permittivity, and σ is the conductivity. To model the electrical field in tissue, it was assumed that all the tissue properties were linear, which means that susceptibility is not a function of the E-field strength. Modeling was conducted at a frequency of 100 MHz and the dielectric properties of the relevant tissues were chosen as follows:
The corresponding dielectric relaxation time (tRC) at 100 MHz was calculated by using Eq. (1). The resulting dielectric relaxation time was 2 nanoseconds for adipose tissue and 0.5 nanoseconds for skin. Both of the times are much less than a pulse application time of 100 ns. Using these values, the predominant electrical field during the modeled nsPEF would be the conductive phase electrical field.
However, the dielectric properties of tissue are frequency dependent. For example, at 1 MHz, adipose tissue has a relative permittivity of 30 and a conductivity of 0.02 S/m. Using these values, the dielectric relaxation time (tRC) is 13 nanoseconds. For lower frequency examples, the dielectric relaxation time is even longer.
The electrical field distribution modeling utilized MAGIC, a 3-D software which is based on Particle in Cell (PIC) leapfrog algorithm, and AMAZE-Precision. In order to simplify the modeling, the potential distribution for both the capacitive phase and the resistive phase were calculate separately.
The single needle device used for the modeling can be represented by the medical instrument 10 is shown in
In nsPEF, the dielectric relaxation time is generally much less than the pulse application time. This is supported by the experimental observations that the pulse rises rapidly. Therefore modeling of the conductive phase was of interest. However, a review of the field distribution in the capacitive phase was of interest because the capacitive phase could cause the skin to suffer increased electrical stress. One result for the capacitive phase is shown in
Due to capacitive coupling, the voltage not only appears in the needle insulator but also the surrounding tissues as shown in
The conductive phase was modeled using the conductivity values rather than the permittivity values of the tissue. As discussed previously, with pulses on the order of 100 nanosecond, the conductive phase is the dominant phase where the dielectric relaxation time is much less than the pulse application time. The modeling evaluated the influence of the needle insertion depth, shrink tubing length, and the thickness of the skin layer on the electrical field distribution for the parameters shown in the table below.
In Example 1, the 0.4 cm of the protrusive element 16 closest to the tissue surface 24 is coated with an electrically insulating material 20. Thus, when the protrusive element is inserted into the skin, the first electrode 22 begins 0.3 cm below the lowest extent of the skin and extends another 0.3 cm.
In Example 2, the 0.7 cm of the protrusive element 16 closest to the tissue surface 24 is coated with an electrically insulating material 20. Thus, when the protrusive element is inserted into the skin, the first electrode 22 begins 0.6 cm below the lowest extent of the skin and extends another 0.3 cm.
In Example 3, the 0.7 cm of the protrusive element 16 closest to the tissue surface 24 is coated with an electrically insulating material 20. Thus, when the protrusive element is inserted into the skin, the first electrode 22 begins 0.4 cm below the lowest extent of the skin and extends another 0.3 cm.
The modeling results indicate that the electrical field can be localized in the vicinity of the first electrode. The electrical field decreases over a distance of 0.5 cm to about 1/10 of the value at the surface of the first electrode, as shown in
The electrical field amplitude appears to be independent from the insulation tubing length. This can be seen by comparing
Using the same type of analysis,
The single needle ground plate device has a highly non-uniform electric field as demonstrated in the modeling. Most of the high field distribution is concentrated in the vicinity of the exposed needle. For a constant voltage but different insertion length, shrink tubing length and skin thickness, the electrical field decays in a very similar way over distance: it decreases over a distance of 0.5 cm to about 1/10 of the value at the needle surface, as shown in
In the capacitive phase, the skin tissue is exposed to a slight electrical field. However, the generated pulses have a very fast risetime (<10 ns) which means the capacitive phase is much shorter compared to the conductive phase. This appears to allow the use of high voltage pulse that do not damage the skin. In the conductive phase, which is the dominant phase in the treatment, the insulator, i.e. adipose tissue, can hold the entire voltage and effectively protect the skin making the electrical field in the skin becomes negligible.
The foregoing is provided for purposes of illustrating, explaining, and describing embodiments of this invention. Modifications and adaptations to these embodiments will be apparent to those skilled in the art and may be made without departing from the scope or spirit of this invention.
This application claims priority to U.S. Provisional Patent Application No. 61/042,948 filed Apr. 7, 2008, the entirety of which is hereby incorporated by reference.
| Number | Date | Country | |
|---|---|---|---|
| 61042948 | Apr 2008 | US |
