- Medical Student, King Edward Medical College, Lahore, Pakistan,
- Department of Neurosurgery, University of Washington, Seattle, Washington, United States.
Zaid Aljuboori, Department of Neurosurgery, University of Washington, Seattle, Washington, United States.
DOI:10.25259/SNI_296_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Azeem S1, Rashid M1, Aljuboori Z2. Use of nanosecond pulsed electric fields in brain tumors. Surg Neurol Int 01-Jul-2022;13:286
How to cite this URL: Azeem S1, Rashid M1, Aljuboori Z2. Use of nanosecond pulsed electric fields in brain tumors. Surg Neurol Int 01-Jul-2022;13:286. Available from: https://surgicalneurologyint.com/surgicalint-articles/11685/
Nanosecond pulsed electric fields (nsPEFs) are a recently discovered technology where intense electric pulses are used to treat tumors. They penetrate intracellular organelles without causing much damage to the plasma membrane. The major mechanism of action is through inducing mitochondrial-dependent apoptosis. This treatment method has been used in malignancies such as melanoma but not widely in the treatment of CNS tumors. The use of this promising technology in the treatment of CNS tumors may offer new hope for patients afflicted with these conditions.
The use of nsPEFs in medicine has been a subject of considerable interest since the early 2000s, especially in the field of oncology. nsPEFs are very intense electric pulses in the nanosecond (ns) domain (ranging from 3 to 600 ns). Furthermore, other forms of electric pulses include those in the millisecond (ms), microsecond (µs), and picosecond (ps) domain.
There are two unique properties of nsPEFs that distinguish them from pulses in the other domains: their effects in penetration to intracellular organelles and the large electric field amplitude. Unlike conventional electroporation methods, they target intracellular organelles without causing much damage to the plasma membrane, only forming ≈1 nm pores there. It has been found that the basic mechanism of apoptosis through nsPEFs is mitochondrial-dependent caspase activation, confirmed by the presence of cytochrome c after the application of nsPEFs to cultured cells.[
It is also found that nsPEFs have a profound effect on causing an antitumor response in experimental mice.[
nsPEFs have previously been used in superficial malignancies as well as tumors including but not limited to melanoma, hepatocellular carcinoma, pancreatic cancer, basal cell carcinoma, cutaneous papilloma, squamous cell carcinoma, kidney cancer, and prostate cancer.[
Microsecond pulsed electric fields have been able to induce irreversible membrane permeabilization and apoptosis, and reactive oxygen species (ROS) production, resulting in tumor volume reduction in medulloblastoma cancer stem cells.[
Although the clinical use of nsPEFs in CNS tumors has been limited, they are promising in cancer treatment as they show several advantages over conventional surgical resection, electrochemotherapy, and invasive techniques. Being minimally invasive, drug-free, and nonthermogenetic, nsPEFs can certainly be an asset in the treatment of brain tumors. Furthermore, it is shown that nsPEFs can cause apoptosis without the entry of calcium (Ca2+) and are effective in intracellular penetration so, therefore, have wide applications in causing regression of tumor cell lines. Since nsPEFs cause disruption of vascularization of these tumor cells, it can cause regression of growth by necrosis as well.[
According to a report by Bardet et al.,[
Cancer remains a major cause of mortality all around the globe despite consistent efforts of the scientific community to find the best possible solution. Although CNS tumors may not be eliminated by nsPEFs in absolute terms, any ray of hope is worth considering and trying for.
1. Bardet SM, Carr L, Soueid M, Arnaud-Cormos D, Leveque P, O’Connor RP. Multiphoton imaging reveals that nanosecond pulsed electric fields collapse tumor and normal vascular perfusion in human glioblastoma xenografts. Sci Rep. 2016. 6: 34443
2. Beebe SJ, White J, Blackmore PF, Deng Y, Somers K, Schoenbach KH. Diverse effects of nanosecond pulsed electric fields on cells and tissues. DNA Cell Biol. 2003. 22: 785-96
3. Breton M, Mir LM. Microsecond and nanosecond electric pulses in cancer treatments. Bioelectromagnetics. 2012. 33: 106-23
4. Consales C, Merla C, Benassi B, Garcia-Sanchez T, Muscat A, André FM. Biological effects of ultrashort electric pulses in a neuroblastoma cell line: The energy density role. Int J Radiat Biol. 2022. 98: 109-21
5. Davies IW, Merla C, Casciati A, Tanori M, Zambotti A, Mancuso M. Push-pull configuration of high-power MOSFETs for generation of nanosecond pulses for electropermeabilization of cells. Int J Microw Wirel Technol. 2019. 11: 645-57
6. Tanori M, Casciati A, Zambotti A, Pinto R, Gianlorenzi I, Pannicelli A. Microsecond pulsed electric fields: An effective way to selectively target and radiosensitize medulloblastoma cancer stem cells. Int J Radiat Oncol. 2021. 109: 1495-507
7. Yin S, Chen X, Hu C, Zhang X, Hu Z, Yu J. Nanosecond pulsed electric field (nsPEF) treatment for hepatocellular carcinoma: A novel locoregional ablation decreasing lung metastasis. Cancer Lett. 2014. 346: 285-91
8. Zhao J, Chen S, Zhu L, Zhang L, Liu J, Xu D. Antitumor effect and immune response of nanosecond pulsed electric fields in pancreatic cancer. Front Oncol. 2020. 10: 621092