Abstract:
A method of treating a condition associate with accumulation of an agent in cells in a patient includes exposing the cells to ultrasound, to selectively kill or induce apoptosis in the cells. The cells include the accumulated agent.

Description:
BACKGROUND 
       [0001]    Accumulation of agents, such as proteins, lipids, bacteria, viruses, parasites or particles, leads to, or is associated with, pathological conditions. For example, nucleolin, a protein normally expressed in the nucleus or the cytoplasm has been shown to be expressed at the cell surface in neoplastic cells and endothelial cells of angiogenic vessels in vivo. Mi Y, et al. Apoptosis in leukemia cells is accompanied by alterations in the levels and localization of nucleolin.  J Biol Chem  278:8572-9 (2003); Sven C, et al. Nucleolin Expressed at the Cell Surface is a Marker of Endothelial Cells in Angiogenic Blood Vessels,  Journal of Cell Biology,  Vol. 164, No. 4, 871-878 (2003). Another example is P-glycoprotein (P-gp), a plasma membrane protein, which is over expressed in tumor cells that present a multidrug resistance (MDR) phenotype, which causes efflux of several structurally unrelated therapeutic drugs used for cancer treatment. Loo T W, et al. Identification of Residues in the Drug Translocation Pathway of the Human Multidrug Resistance P-glycoprotein by Arginine Mutagenesis,  Journal of Biological Chemistry,  Vol. 284, No. 36, 24074-24087 (2009). Deposition and subsequent accumulation of intracellular protein aggregates has been observed in several neurodegenerative disorders, such as α-synuclein in Parkinson&#39;s disease, β-amyloid and tau in Alzheimer&#39;s disease, and huntingtin in Huntington&#39;s diseases, and prion protein (PrP) in transmissible prion encephalopathies. Brandin P, et al. Prion-Like Transmission of Protein Aggregates in Neurodegenerative Diseases,  Nat Rev Mol Cell Biol.  Vol. 11, No. 4, 301-307 (2010). Poly A binding protein (PABP) accumulates in the cytoplasm of beta herpesviruses (HCMV)-infected cells. Perez C, et al. Translational control of cytoplasmic poly A binding protein (PABP) abundance in HCMV-infected cells,  J Virol.  October 27 (2010) Epub. 
         [0002]    Intracellular lipids accumulation is commonly observed in advanced atherosclerotic plaques. Monocyte infiltration in the intima layer of the vascular wall is followed by differentiation into macrophages, which in turn take up modified lipoproteins and become macrophage foam cells as a result of such intracellular lipids accumulation. Persson J, et al. Interleukin-1 beta and tumour necrosis factor-alpha impede neutral lipid turnover in macrophage-derived foam cells,  BMC Immunology,  9(7) (2008). Obesity is associate with the accumulation of lipids in fat cells. 
         [0003]    Some bacteria may accumulate inside cells, for example  Mycobacterium tubercolosis  and  Pseudomonas aeruginosa. M. tubercolosis  causes the formation of hard nodules or tubercles in the lungs, parasitizes macrophages by blocking the phagosome-lysosome fusion, a process called phagosome maturation arrest, and by replicating inside the phagosome. Vergne I, et al. Cell Biology of  Mycobacterium tubercolosis  Phagosome,  Ann Rev Cell Dev Biol.,  Vol. 20, 367-94 (2004). Similarly,  P. aeruginosa  colonizes the lungs of patients with cystic fibrosis and produces biofilms, alginates, and specific lipid A modifications, which allow the bacteria to escape immune response and cause severe chronic inflammation. Moskowitz S M, et al. The Role of  Pseudomonas  Lipopolysaccharide in Cystic Fibrosis Airway Infection,  Subcell Biochem.,  Vol. 53, 241-53 (2010). Production of biofilms by  Haemophilus influenzae, Streptococcus pneumoniae,  and other bacteria, has been linked to chronic otitis media in pediatric patients. Hall-Stoodley L, et al. Direct Detection of Bacterial Biofilms on the Middle-Ear Mucosa of Children With Chronic Otitis Media,  JAMA , Vol. 256, No. 2, 202-11 (2006). 
         [0004]    Some protozoan parasites present intracellular accumulation, for example  Plasmodium, Leishmania, Trypanosoma  and  Toxoplasma. Plasmodium,  the agent causing malaria, replicates and accumulates inside erythrocytes, provoking cell rupture and dissemination of the agent, while the main sites of sequestration of the infected erythrocytes containing the trophozoites, schizonts and gametocytes of the parasite have been shown to be the lung, spleen, and adipose tissue, but also the brain, skin, bone marrow, and skeletal and cardiac muscle. Franke-Fayard B, et al. Sequestration and Tissue Accumulation of Human Malaria Parasites: Can We Learn Anything from Rodent Models of Malaria?,  PLoS Pathogens , Vol. 6, No. 9, e1001032 (2010). Similarly,  Leishmania mexicana  and  Trypanosome cruzi  reside and proliferate inside macrophages. Zhang S et al. Delineation of Diverse Macrophage Activation Programs in Response to Intracellular Parasites and Cytokines,  PLoS Negl Trop Dis,  Vol. 4, No. 3: e648 (2010). 
         [0005]    Viruses replicate in the host cell, and the accumulation of the viral particles may result in changes to the plasma membrane. Examples include HIV, hepatitis C and rhinovirus. Ma Y, et al. NS3 helicase domains involved in infectious intracellular hepatitis C virus particle assembly, J Virol. 82 (15) 7624-39 (2008); Korant B D, Butterworth B E, Inhibition by zinc of rhinovirus protein cleavage: interaction of zinc with capsid polypeptides,  J Virol.  18(1):298-306 (1976). 
         [0006]    Ultrasound is a technique that may be used to destroy or induce apoptosis of cells. U.S. Pat. No. 6,821,274 (2004). The technique has been used to selectively remove or kill cells based on differences is the membrane stiffness, such as that caused by cross-linking from AGE-modification. The ultrasound is targeted to harmonic frequencies of the cross-linked cell membranes or components. International Publication No. WO2009/143411 (2009). 
       SUMMARY 
       [0007]    In a first aspect, the present invention is a method of treating a condition associate with accumulation of an agent in cells in a patient comprising exposing the cells to ultrasound, to selectively kill or induce apoptosis in the cells. The cells include the accumulated agent. 
         [0008]    In a second aspect, the present invention is a method of removing cells from a sample, comprising exposing the sample to ultrasound, to selectively kill or induce apoptosis in the cells. The cells comprise an accumulated agent. 
     
    
     DETAILED DESCRIPTION 
       [0009]    The present invention makes use of the discovery that the differential resonant frequency of a cell caused by the accumulation of at least one agent that causes, or is associated with, a pathological or undesired condition, such as proteins, lipids, bacteria, viruses, parasites or particles, may be used to distinguish and eliminate cells in which the accumulated agent leads to a difference in the resonant frequency of the cell, by applying ultrasound treatment. The cells associated with the accumulated agent have a resonant frequency which is distinct from cells of the same type. By selecting the frequency of the ultrasound applied to the tissue to feed energy into the resonant frequency, the cells with the accumulated agent will be destroyed or induced to undergo apoptosis. In an aspect of the invention, the cells are not AGE-modified cells. In another aspect of the invention, the cells are not tumor cells. In yet another aspect of the invention, the cells are not cancerous. 
         [0010]    The ultrasound technique for removing cell-associated accumulation from a patient is selected for its ability to selectively kill or induce apoptosis in cells having accumulation of the agent associated with the pathological condition, while avoiding removal or destruction of cells that do not present the accumulation. For example, cells expressing high levels of nucleolin on the plasma membrane of the cell may be selected due changes in the stiffness and deformability of the cell. As used herein, “selectively kill or induce apoptosis” means that more of the cells which are the target of the killing or inducing apoptosis are so affected, as compared to other cell subject to the same exposure. 
         [0011]    Ultrasound devices can be used according to practices well known to those skilled in the art to destroy cells by vibrational techniques, for example U.S. Pat. No. 5,601,526 (1997) and International Publication No. WO2009/143411 (2009). Ultrasound parameters, such as frequency, power and pulsation, can be screened for effectiveness in selectively destroying the targeted cells. Differential destruction or inducement of apoptosis may be by selection of the stiffer cells, or by selection of the cells by their resonant frequencies. Ultrasound as described above can be applied to a subject with monitoring to determine that inflammatory responses such as fever or swelling do not exceed limits well known to be safe. This process can be repeated at intervals to maintain a level of therapeutic benefit. Evaluation of improvement or maintenance of a desired result can be used to direct the frequency of reapplication of ultrasound according to the present invention. The application and reapplication can be determined with the goal of gradual improvement to avoid overwhelming natural mechanisms, such as removal of cells and cellular debris by scavenging cells. 
         [0012]    A variety of techniques are available to determine whether ultrasound may be used to selectively remove or kill the cells having the accumulated agent, that leads to, or is associated with, a pathological or undesired condition. The stiffness of individual cells may be determined, by techniques such as those described in U.S. Pat. No. 6,067,859 (2000). Elastic properties of tissue may be measured, by techniques such as those described in U.S. Pat. No. 7,751,057 (2010). Furthermore, application of a variety of ultrasound parameters to cells or a tissue sample, followed by examination of the cells or the tissue sample for destruction or subsequent apoptosis, may also be used to determine whether ultrasound may selectively remove or kill the cells. 
       EXAMPLES 
     Example 1 (Prophetic) Ultrasound Removal of Cell-Associated Accumulation of Nucleolin in Leukemia Cells 
       [0013]    Blood of a patient containing leukemia cells expressing nucleolin on the cell surface is treated with ultrasound. After first diagnosing the patient, a blood sample is taken for further analysis. Leukemia cells are isolated from the blood sample, and examined using an optical stretcher (U.S. Pat. No. 6,067,859), to determine the relative stiffness of the cells and/or the resonant vibrational frequencies of the cell. This information is then used to select driving frequencies, intensity and length of time of treatment of the ultrasound, to selectively destroy or induce apoptosis, in the leukemia cells in vivo or ex vivo. 
       Example 2 (Prophetic) Ultrasound Removal of Cell-Associated Accumulation of P-Glycoprotein in Colon Cancer Cells 
       [0014]    Colon tissue from a patient containing colon cancer cells that present a multidrug resistance (MDR) phenotype are examined and determined to be overexpressing P-glycoprotein on the cell surface. The cells are then examined using an optical stretcher (U.S. Pat. No. 6,067,859), to determine the relative stiffness of the cells and/or the resonant vibrational frequencies of the cell. This information is then used to select driving frequencies, intensity and length of time of treatment of the ultrasound. For example, an ultrasound generating probe may be included at the tip of a colonoscopy device. The ultrasound generating probe could generate pulses of ultrasound at the appropriate frequency, to selectively destroy colon cancer cells that present a multidrug resistance (MDR) phenotype, after the probe has been placed proximate to the tumor. The success of the treatment is monitored by subsequent colonoscopy. 
       Example 3 (Prophetic) Ultrasound Removal of Cell-Associated Accumulation of  Plasmodium    
       [0015]    Blood of a patient, containing erythrocytes infected with  Plasmodium , is treated with ultrasound. After first diagnosing the patient, a blood sample is taken for further analysis. Erythrocytes infected with  Plasmodium  are isolated from the blood sample, and examined using an optical stretcher (U.S. Pat, No. 6,067,859), to determine the relative stiffness of the erythrocytes and/or the resonant vibrational frequencies of the erythrocytes. In addition, the  Plasmodium  parasite could also be examined using the optical stretcher, to determine ultrasound parameters capable of direct destruction of the parasite. This information is then used to select driving frequencies, intensity and length of time of treatment of the ultrasound, to selectively destroy infected erythrocytes and/or the  Plasmodium  parasites, in the patient&#39;s blood either in vivo or ex vivo. 
       Example 4 (Prophetic) Removal of Macrophages and Tubercles Infected with  Mycobacterium tubercolosis    
       [0016]    A biopsy of an area in the lung of a patient containing tubercles and macrophages infected with  M. tubercolosis  is taken. The biopsy is treated with ultrasound applied at a range of frequencies and intensities, to determine conditions necessary to selectively destroy or induce apoptosis in the infected marcophages, the tubercles and/or the  M. tubercolosis  bacterial cells. The lungs of the patient are then treated with ultrasound. Time of exposure may range from three to sixty minutes daily for up to 20 days. At the end of the treatment, the patients are tested to determine the reduction in the size and/or number of tubercles present in the lungs of the patient. 
       Example 5 (Prophetic) Removal of Alginates caused by  Pseudomonas aeruginosa  Infection in the Lungs of Patients with Cystic Fibrosis 
       [0017]    An alginate sample from the Lungs of the Patient is treated with ultrasound applied at a range of frequencies and intensities, to determine conditions necessary to selectively destroy or break down the alginate. The lungs of the patient are then treated with ultrasound. Time of exposure may range from three to sixty minutes daily for up to 20 days. At the end of the treatment, the patient is tested to determine the reduction of alginates in the lungs. 
       REFERENCES 
       [0018]    1. Mi Y, et al. Apoptosis in leukemia cells is accompanied by alterations in the levels and localization of nucleolin.  J Biol Chem  278:8572-9 (2003). 
         [0019]    2. Sven C, et al, Nucleolin Expressed at the Cell Surface is a Marker of Endothelial Cells in Angiogenic Blood Vessels,  Journal of Cell Biology,  Vol. 164, No. 4, 871-878 (2003). 
         [0020]    3. Loo T W, et al. Identification of Residues in the Drug Translocation Pathway of the Human Multidrug Resistance P-glycoprotein by Arginine Mutagenesis,  Journal of Biological Chemistry,  Vol. 284, No. 36, 24074-24087 (2009). 
         [0021]    4. Brandin P, et al. Prion-Like Transmission of Protein Aggregates in Neurodegenerative Diseases,  Nat Rev Mol Cell Biol.  Vol. 11, No. 4, 301-307 (2010). 
         [0022]    5. Perez C, et al. Translational control of cytoplasmic poly A binding protein (PABP) abundance in HCMV-infected cells,  J Virol.  October 27 (2010) Epub. 
         [0023]    6. Persson J, et al. Interleukin-1beta and tumour necrosis factor-alpha impede neutral lipid turnover in macrophage-derived foam cells,  BMC Immunology,  9(7) (2008). 
         [0024]    7. Vergne I, et al. Cell Biology of  Mycobacterium tubercolosis  Phagosome,  Ann Rev Cell Dev Biol.,  Vol. 20, 367-94 (2004). 
         [0025]    8. Moskowitz S M, et al. The Role of  Pseudomonas  Lipopolysaccharide in Cystic Fibrosis Airway Infection,  Subcell Biochem.,  Vol. 53, 241-53 (2010). 
         [0026]    9. Hall-Stoodley L, et al., Direct Detection of Bacterial Biofilms on the Middle-Ear Mucosa of Children With Chronic Otitis Media,  JAMA,  Vol. 256, No. 2, 202-11 (2006). 
         [0027]    10. Franke-Fayard B, et al., Sequestration and Tissue Accumulation of Human Malaria Parasites: Can We Learn Anything from Rodent Models of Malaria?,  PLoS Pathogens,  Vol. 6, No. 9, e1001032 (2010). 
         [0028]    11. Zhang S, et al. Delineation of Diverse Macrophage Activation Programs in Response to Intracellular Parasites and Cytokines,  PLoS Negl Trop Dis,  Vol. 4, No. 3: e648 (2010). 
         [0029]    12. Ma Y, et al. NS3 helicase domains involved in infectious intracellular hepatitis C virus particle assembly, J Virol. 82 (15) 7624-39 (2008). 
         [0030]    13. Korant B D, Butterworth B E, Inhibition by zinc of rhinovirus protein cleavage: interaction of zinc with capsid polypeptides,  J Virol.  18(1):298-306 (1976). 
         [0031]    14. U.S. Pat. No. 6,821,274 (2004). 
         [0032]    15. International Publication No. WO2009/143411 (2009). 
         [0033]    16. U.S. Pat. No. 5,601,526 (1997). 
         [0034]    17. U.S. Pat. No. 6,067,859 (2000). 
         [0035]    18. U.S. Pat. No. 7,751,057 (2010).