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In vivo gene transfer into muscle via electro-sonoporation.

Among the nonviral techniques for gene transfer in vivo, electroporation is simple, potent, inexpensive, and safe. To upregulate the expression levels of the transferred gene, we investigated the applicability of in vivo electro-sonoporation, which consists of a combination of electric pulse and ultrasound, for gene transfer using plasmid DNA encoding luciferase and mouse interleukin-12 (mIL-12). The quadriceps muscles of mice were injected with plasmid DNA, then sonoporated for 5 min, and electroporated by a pair of electrode plates at the middle of the duration of sonoporation. Three days later, mice that had undergone electro-sonoporation demonstrated twofold higher luciferase activity and low tissue damage in quadriceps muscle compared to mice having undergone electroporation alone. Serum mIL-12 levels in mice that had undergone electro-sonoporation (peaking at 25.5 ng/ml) were twofold higher after gene transfer than were those in mice having undergone electroporation alone (peaking at 14.3 ng/ml), and maintained high serum level of 13.9 ng/ml at 28 days after gene transfer. The efficacy of gene transfer via electro-sonoporation was superior when the plasmid DNA solution was 0.85% NaCl compared to albumin microbubble echo-contrast material. These results demonstrated that gene transfer into muscle via electro-sonoporation could provide a new potent nonviral technique for gene transfer in vivo.

Animals↗

Bedside confirmation of a persistent left superior vena cava based on aberrantly positioned central venous catheter on chest radiograph.

This is a report of incidental diagnosis of a persistent left superior vena cava (PLSVC) based on an abnormal positioning of central venous catheter seen on chest radiograph and an abnormal pressure waveform. Non-invasive bedside tests included venography with simultaneous chest radiograph and a transthoracic echocardiography with an agitated saline microbubble contrast. These tests led to the diagnosis of PLSVC. Although PLSVC is the most common venous thoracic anomaly that produces a diagnostic dilemma, not many anaesthetists and intensivists are familiar with its appearance, diagnosis and implications. The clinical significance of PLSVC and diagnostic options are discussed.

Aged↗

Evaluation of the performance of hysterosalpingo contrast sonography in 500 consecutive, unselected, infertile women.

The performance of hysterosalpingo contrast sonography (Hy Co Sy) as a first-line, outpatient investigation of tubal patency was examined in 500 consecutive, infertile women, at one centre. Hy Co Sy was completed in 463 (92.6%) cases, using a galactose microbubble contrast agent (Echovist-200) and transvaginal sonography. Initial plain scanning identified adnexal pathology in 198 women (39.6%). Examination with Echovist was attempted for 905 tubes and only 67 (7.4%) were not assessable; after the first 100 women this decreased to 35 tubes (4.8%). A sonographic appearance compatible with blocked tubes was found on 118 (14.1%) occasions but it was also possible to identify variations in the appearance/filling/spilling patterns of individual tubes which increased the number assessed as abnormal to 193 (23.0%). Comparison with laparoscopy and dye chromopertubation findings from the past three years was possible for 185 (37%) women, representing 282 tubes, which gave Hy Co Sy an overall concordance rate of 85.8%, sensitivity of 90.4%, specificity of 70.3%, positive predictive value of 91.2% and negative predictive value of 68.2%. Some 51.0% of women described only mild discomfort and there were no significant postprocedure complications. Hy Co Sy appears to be an acceptable first-line screen and may select out women in whom more invasive investigations are likely to reveal pathology.

Adult↗

The value of contrast cross-sectional echocardiography in the diagnosis of tricuspid regurgitation.

Reflux of contrast into the inferior vena cava and hepatic veins during held expiration was studied in 70 subjects using subxiphoid 2D echocardiography. Venous reflux of contrast occurred in 7/19 normal subjects (group 1), 13/17 patients with definite or probable tricuspid regurgitation (group 2), 10/13 patients with congestive cardiac failure (group 3) and 10/21 patients with miscellaneous cardiac conditions unlikely to be associated with tricuspid regurgitation (group 4). There were 30 patients with no appearance of microbubbles in the inferior vena cava and hepatic veins on suspended expiration: 10 of these had reflux of contrast when breathing was restarted. Of the 17 patients with atrial fibrillation, 14 showed reflux, but there were 3 patients with no reflux. We conclude that the appearance of contrast in the IVC and hepatic veins may be found in many subjects in whom tricuspid regurgitation is unlikely on clinical grounds, even when recordings are taken in held expiration. Atrial fibrillation alone does not necessarily cause venous reflux of contrast. Demonstration of simple venous reflux of contrast by 2D echocardiography is too non-specific for routine use in the detection of tricuspid regurgitation.

Adolescent↗

Assessment of myocardial perfusion during CABG surgery with two-dimensional transesophageal contrast echocardiography.

No reliable, quantifiable index of tissue perfusion is currently available to assess the efforts of coronary artery bypass graft (CABG) surgery. We used two-dimensional transesophageal contrast echocardiography with sonicated Renografin-76 microbubbles to determine the distribution of myocardial blood flow during coronary artery bypass graft surgery in 15 patients. Sonicated Renografin-76 contrast agent was injected into the aortic root of all patients after institution of cardiopulmonary bypass and application of the aortic occlusive clamp. Eight patients had contrast agent injected directly into the free proximal end of the vein-CABG anastomosis. All patients again received aortic root injections during reperfusion after anastomosis of the proximal aortovein and distal coronary artery. Echocardiographic images of the left ventricle short axis at the level of the papillary muscles were obtained in real time and analyzed retrospectively from videotape. Injection of contrast provided information about the magnitude and geometric distribution of coronary artery-vein bypass run-off and enabled identification of poorly perfused myocardial regions. When predicted myocardial perfusion patterns, based on preoperative evaluation of epicardial vessel distribution derived from coronary angiography, were compared to actual perfusion patterns assessed with intraoperative echocardiography, contrast regional myocardial perfusion patterns were predicted 84% of the time (71-97%, 95% confidence limit). Regional myocardial perfusion deficits detected after coronary bypass grafting were associated with regional wall motion abnormalities detected after separation from cardiopulmonary bypass. Our technique makes possible on-line visualization of changes in regional blood flow in the heart before, during, and after CABG.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Mechanisms of incomplete cardioplegia distribution during coronary artery surgery. An intraoperative transesophageal contrast echocardiography study.

BACKGROUND: Cardioplegia is used to protect the myocardium from ischemic injury during open-heart surgery. However, the delivery of cardioplegic solutions may be impaired by anatomic and/or functional conditions, such as the development of transient aortic regurgitation during antegrade administration of cardioplegia or shunting through a foramen ovale during retrograde administration. In this study, the authors used a new method of cardioplegia administration, based on intraoperative contrast echocardiography, to detect on-line causes of inadequate cardioplegia delivery. METHODS: Forty patients with coronary artery disease and a competent aortic valve, who were treated consecutively, were enrolled in this study. Patients were monitored intraoperatively by transesophageal contrast echocardiography during cardioplegia delivery. Antegrade cardioplegia was administered into the aortic root following aortic occlusion in all patients. Twenty-two patients also received retrograde cardioplegia, administered through the right atrium. The echo-contrast agent consisted of a stable suspension of 5% human albumin microbubbles with a concentration of 4 x 10(8) microbubbles/ml and a diameter of 4 +/- 1 mu. RESULTS: Antegrade cardioplegia was not associated with aortic regurgitation in 23 of 40 (58%) patients. Seven patients (17%) had only mild aortic regurgitation, four patients (10%) had moderate regurgitation, and six (15%) had severe aortic regurgitation. The percent of myocardial opacification was 76.0 +/- 10.5 in the 23 patients who did not have aortic regurgitation, 76.0 +/- 17.0 in the 7 patients who had mild regurgitation, 52.5 +/- 18.1 in the 4 patients who had moderate regurgitation, and 48.5 +/- 18.3 in 6 patients who had severe aortic regurgitation (Kruskal-Wallis stat, 12.9; P < 0.005). Retrograde cardioplegia was not associated with right-to-left shunt in 11 of 22 patients (50%). In seven patients (32%), there was only a mild passage of contrast material to the left atrium. In the remaining four patients (18%), there was a moderate (one patient) to severe (three patients) right-to-left shunt at the level of the fossa ovalis. CONCLUSIONS: This study shows that incomplete myocardial distribution of cardioplegia, secondary to transient aortic valve incompetence or shunting through the foramen ovale, is not uncommon in patients undergoing coronary surgery.

Cardioplegic Solutions↗

Accelerated arteriolar gas embolism reabsorption by an exogenous surfactant.

BACKGROUND: Cerebrovascular gas embolism can cause profound neurologic dysfunction, and there are few treatments. The authors tested the hypothesis that an exogenous surfactant can be delivered into the bloodstream to alter the air-blood interfacial mechanics of an intravascular gas embolism and produce bubble conformations, which favor more rapid bubble absorption. METHODS: Microbubbles of air were injected into the rat cremaster microcirculation after intravascular administration of either saline (control, n = 5) or Dow Corning Antifoam 1510US (surfactant, n = 5). Embolism dimensions and dynamics were directly observed after entrapment using intravital microscopy. RESULTS: To achieve embolization, the surfactant group required twice as many injections as did controls (3.2 +/- 1.3 vs. 1.6 +/- 0.9; P < 0.05). There was no difference in the initial lodging configuration between groups. After bubble entrapment, there was significantly more local vasoconstriction in the surfactant group (24.2% average decrease in diameter) than in controls (3.4%; P < 0.05). This was accompanied by a 92.7% bubble elongation in the surfactant group versus 8.2% in controls (P < 0.05). Embolism shape change was coupled with surfactant-enhanced breakup into multiple smaller bubbles, which reabsorbed nearly 30% more rapidly than did parent bubbles in the control group (P < 0.05). CONCLUSIONS: Intravascular exogenous surfactant did not affect initial bubble conformation but dramatically increased bubble breakup and rate of reabsorption. This was evidenced by both the large shape change after entrapment and enhancement of bubble breakup in the surfactant group. These dynamic surfactant-induced changes increase the total embolism surface area and markedly accelerate bubble reabsorption.

Absorption↗

Surfactants attenuate gas embolism-induced thrombin production.

BACKGROUND: There are no pharmacologic strategies to prevent embolism bubble-induced blood clot formation. The authors conducted experiments to measure thrombin production in sheared whole blood in the presence and absence of bubbles and three surface-active compounds. METHODS: Blood samples were obtained from six volunteers seven times. The thrombin-specific substrate Boc-VPR-MCA was added to citrated blood diluted with HEPES-buffered saline. Experimental groups were as follows: sparging (air microbubble embolization) with surfactant present; sparging alone; surfactant alone; and neither surfactant nor sparging. The surfactants were Dow Corning Antifoam 1510US, Perftoran, and Pluronic F-127. Blood was sheared by a cone-plate viscometer at 100 and 500 s-1 for 5, 10, and 20 min at 37 degrees C, pipetted into excess stop buffer, and evaluated fluorimetrically. Mean values of fluorescence intensity +/- SDs for each group were compared using ANOVA. Differences were considered significant at P < 0.05 using the Bonferroni correction. RESULTS: For fixed shear rate, thrombin production increased 2.3- to 5.7-fold (P < 0.05) as shear duration lengthened. For fixed shear duration, thrombin production increased 1.9- to 3.9-fold (P < 0.05) with increasing shear rate. For fixed shear rate and duration, sparging increased thrombin production 2.1- to 3.7-fold (P < 0.05). Surfactant addition without sparging did not change thrombin production (P > 0.05). Surfactants attenuated thrombin production in sparged samples 31.8-70.9% (P < 0.05). CONCLUSIONS: Thrombin production is shear rate and duration-dependent. Sparging increases thrombin production. Surfactants added before sparging attenuate thrombin production. Surfactants may have a clinical application to attenuate gas embolism-induced clotting.

Blood Platelets↗

Surfactant reduction in embolism bubble adhesion and endothelial damage.

BACKGROUND: Surfactants may reduce the adhesion force holding bubbles to the vessel wall in gas embolism. The authors measured bubble adhesion force using excised microvessels. They assessed endothelial damage by measuring vessel reactivity and with microscopy. METHODS: Microbubbles injected into arterioles resided for 5, 10, or 30 min, with intact or damaged endothelium. Perfusion was with rat serum alone (control) or with 1% Perftoran (OJSC SPC Perftoran, Moscow, Russia) or 1% Pluronic F-127 (Molecular Probes, Eugene, OR) added. Pressure across the bubble, bubble length, and bubble diameter were measured, and adhesion force per unit surface area, K = deltaPD/4 l, was calculated. Vessel reactivity was assessed using topical application of phenylephrine and acetylcholine. RESULTS: With the endothelium intact, K was higher in controls than with Perftoran at 10 and 30 min or Pluronic F-127 at 10 min (P < 0.05). With surfactant added after air perfusion to damage the endothelium, K was lower (P < 0.05) at all times for both Perftoran and Pluronic F-127. With surfactant in the perfusate before air perfusion, K was lower at 10 and 30 min for Perftoran and at 10 min for Pluronic F-127 than for controls (P < 0.05). Phenylephrine-induced vasoconstriction was identical among groups. Acetylcholine-induced vasodilatation was the same among groups with an intact endothelium but was found to be lower in controls after air perfusion that followed surfactant exposure than in either surfactant group (P < 0.05). CONCLUSIONS: Surfactants reduced bubble adhesion force and preserved basic endothelial structure and vasodilatory function despite attempts to damage the endothelium. Surfactants seem to protect the endothelium from mechanically induced injury in addition to decreasing bubble adhesion forces.

Adhesiveness↗

Surfactants reduce platelet-bubble and platelet-platelet binding induced by in vitro air embolism.

BACKGROUND: The effect of gas bubbles on platelet behavior is poorly characterized. The authors assessed platelet-bubble and platelet-platelet binding in platelet-rich plasma in the presence and absence of bubbles and three surface-active compounds. METHODS: Platelet-rich plasma was prepared from blood drawn from 16 volunteers. Experimental groups were surfactant alone, sparging (microbubble embolization) alone, sparging with surfactant, and neither sparging nor surfactant. The surfactants were Pluronic F-127 (Molecular Probes, Eugene, OR), Perftoran (OJSC SPC Perftoran, Moscow, Russia), and Dow Corning Antifoam 1510US (Dow Corning, Midland, MI). Videomicroscopy images of specimens drawn through rectangular glass microcapillaries on an inverted microscope and Coulter counter measurements were used to assess platelet-bubble and platelet-platelet binding, respectively, in calcium-free and recalcified samples. Histamine-induced and adenosine diphosphate-induced platelet-platelet binding were measured in unsparged samples. Differences between groups were considered significant for P < 0.05 using analysis of variance and the Bonferroni correction. RESULTS: Sixty to 100 platelets adhered to bubbles in sparged, surfactant-free samples. With sparging and surfactant, few platelets adhered to bubbles. Numbers of platelet singlets and multimers not adherent to bubbles were different (P < 0.05) compared both with unsparged samples and sparged samples without surfactant. No significant platelet-platelet binding occurred in uncalcified, sparged samples, although 20-30 platelets adhered to bubbles. Without sparging, histamine and adenosine diphosphate provoked platelet-platelet binding with and without surfactants present. CONCLUSIONS: Sparging causes platelets to bind to air bubbles and each other. Surfactants added before sparging attenuate platelet-bubble and platelet-platelet binding. Surfactants may have a clinical role in attenuating gas embolism-induced platelet-bubble and platelet-platelet binding.

Adenosine Diphosphate↗

Detection of false lumen perfusion at the beginning of cardiopulmonary bypass in patients undergoing repair of aortic dissection.

OBJECTIVE: In patients undergoing surgical repair of aortic dissection, false lumen perfusion during cardiopulmonary bypass may produce central nervous system damage, myocardial ischemia, aortic rupture, and death. We describe a method to detect false lumen perfusion at the beginning of retrograde aortic perfusion that may prevent these complications. DESIGN: Sonicated albumin microbubbles (8 mL) were injected through a side branch of the extracorporeal circulation line to detect true lumen and/or false lumen perfusion of the thoracic aorta at the beginning of cardiopulmonary bypass. Transesophageal echocardiography was used to image aortic perfusion. SETTING: The study was performed in a cardiac surgery theater. PATIENTS: A total of 27 consecutive patients undergoing operation for Type I aortic dissection were studied. INTERVENTIONS: All patients underwent surgical repair of aortic dissection and retrograde aortic perfusion through one femoral artery. MEASUREMENTS AND MAIN RESULTS: Patients were divided into three groups: Group I, those having adequate true lumen perfusion: brisk appearance and washout of contrast in the true lumen with no, poor, or delayed opacification of the false lumen; Group II, those having mixed true lumen and false lumen perfusion: simultaneous opacification of both lumens; Group III, those having inappropriate false lumen perfusion: same criteria as for adequate true lumen perfusion applied to the false lumen. The true lumen was perfused in 13 patients, both lumens in 11 patients, and false lumen alone in three patients. In these three patients, cannulation was repeated through the contralateral femoral artery with restoration of true lumen perfusion; the first patient died of diffuse cerebral ischemic damage and renal failure, another one experienced temporary postoperative monoparesis, and the last had no neurologic sequelae. CONCLUSIONS: Contrast echocardiography allows immediate detection of retrograde aortic perfusion during cardiopulmonary bypass and may help prevent neurologic complications and death in patients with Type I dissection.

Adult↗

Polymeric microballoons as ultrasound contrast agents. Physical and ultrasonic properties compared with sonicated albumin.

Air-filled polymeric microballoons were prepared with number-mean diameters of approximately 3 microns, volume-mean diameters of approximately 5 microns, and narrow particle-size distributions (standard deviation [SD] = 1.2 microns in number and SD = 2.0 microns in volume). More than 99% of the particles were below 8 microns. These particles were found to be highly echogenic for ultrasound, showing backscatter coefficients at 7.5 MHz, similar to the ones obtained with sonicated albumin microspheres. However, at 2.25 MHz, microballoons were less echogenic than albumin microspheres. These results are consistent with ultrasound attenuation measurements, which showed a maximum at 8 to 9 MHz for the microballoons compared with a reported value of 3.5 to 4.5 MHz for albumin microbubbles. Polymeric microballoons were found to be stable in plasma or under applied pressure as evidenced by unchanged particle concentration and echogenicity. Albumin microspheres were particularly unstable to applied pressure (150 mm Hg) and showed a rapid decrease in both particle counts and echogenicity.

Air↗

Detection of experimental rat liver tumors by contrast-assisted ultrasonography.

RATIONALE AND OBJECTIVES: The authors characterized the effect of intravenous lipid-coated microbubbles (LCMs) on the echogenicity of malignant liver tumors. METHODS: Novikoff hepatoma cells were inoculated into the livers of 16 anesthetized Sprague-Dawley rats. Sonograms were obtained weekly after tail-vein injection with either 0.2 mL/kg LCMs or saline control. RESULTS: A statistically significant difference in the signal-to-noise ratio (SNR) was observed between the group that received LCMs (10 rats) and the group that received saline (6 rats) (P < .01). The effect persisted for 30 minutes after contrast injection. Selective leakage and accumulation of LCMs into the tumor tissue itself was confirmed histologically using lipid-specific counterstains. CONCLUSIONS: Intravenous injection of the LCM contrast agent produces a rapid increase in the echogenicity of the experimental Novikoff tumor in the rat liver.

Animals↗

An investigation of the relationship between ultrasound echo enhancement and Doppler frequency shift using a pulsatile arterial flow phantom.

RATIONALE AND OBJECTIVES: Based on the echo-enhancing effect of microbubbles, various agents have been developed to improve the diagnostic confidence in patients with inadequate Doppler signals. In the clinical trials of the echo enhancer Levovist, there were a few isolated cases in which the maximum flow velocities of the enhanced Doppler spectra appeared to higher than the velocities in the nonenhanced baseline spectra. This raised the concern that echo enhancement could give a false indication of maximum flow velocity. This study investigated whether a systematic association between echo enhancement and velocity shift exists. METHODS: A pulsatile flow phantom that simulated the elasticity of blood vessels and the acoustic attenuation of extravascular tissue was used to compare enhanced with unenhanced Doppler spectra under accurately reproducible flow conditions. The experiments were carried out with varied sound attenuation and evaluated with dedicated spectral analysis software that included a special averaging tool. RESULTS: Levovist enhanced the Doppler signal by 16 to 31 dB, and the enhanced and unenhanced power spectra presented identical distribution of spectral power density under all flow conditions. CONCLUSIONS: The measurements gave no evidence that echo enhancement with Levovist falsifies the Doppler measurement of flow velocity.

Blood Flow Velocity↗

Evaluation of metastases and reactive lymph nodes in Doppler sonography using an ultrasound contrast enhancer.

RATIONALE AND OBJECTIVES: The authors conducted a prospective study in D-galactose signal-enhanced Doppler sonography of lymph nodes to investigate new aspects in differentiating malignant from reactive lymph nodes of patients with suspected malignancy of the neck. METHODS: Twenty-one patients with suspected squamous epithelial cell carcinoma metastases of the neck were examined by Doppler sonography before and after administration of an ultrasound signal-enhancing agent, consisting of D-galactose microbubbles. Qualitative sonomorphology, peak flow rates, and pulsatility and resistive indices were assessed. RESULTS: Compared with conventional Doppler, enhanced Doppler sonography gave detailed additional information about vascularization of metastases or reactive lymph nodes. Signal-enhanced Doppler of metastases showed a relatively characteristic pattern of vascularity, therefore facilitating differential diagnoses and allowing better discrimination from surrounding tissue, demonstrated by the infiltration of neighboring vessels in the neck. Concerning reactive lymph nodes, vascularization could be stated and measured in many cases only after signal enhancement. Evaluating peak velocities and pulsatility and resistive indices could not differentiate significantly malignant from reactive lymph nodes. CONCLUSIONS: Administration of a D-galactose-based signal-enhancer helps to differentiate malignant from reactive lymph nodes of the neck. It is superior to conventional Doppler by improving evaluation of the vascularity and could be of use for staging procedures.

Aged↗

Human pharmacokinetics and safety evaluation of SonoVue, a new contrast agent for ultrasound imaging.

RATIONALE AND OBJECTIVES: To assess in humans the pharmacokinetics of SonoVue, a new echo contrast agent based on stabilized sulfur hexafluoride (SF6) microbubbles and to provide additional safety and tolerability information on the compound. METHODS: The blood kinetics and pulmonary elimination of SF6 after intravenous bolus injection of two dosage levels (0.03 and 0.3 mL/kg) of SonoVue were evaluated in 12 healthy subjects (7 men, 5 women). In addition, safety and tolerability were evaluated by monitoring vital signs, adverse effects, discomfort, and physical examination and laboratory parameters associated with the SonoVue injection. RESULTS: The blood kinetics of SF6 was not dose dependent. SF6 was rapidly removed from the blood by the pulmonary route, with 40% to 50% of the injected dose eliminated within the first minute after administration and 80% to 90% eliminated by 11 minutes after administration; the elimination was similar in men and women and independent of dose. Both dosages were well tolerated. No adverse effects were observed immediately or during the 24-hour follow-up period. CONCLUSIONS: SonoVue was shown to be rapidly removed from the blood. The route of SF6 elimination was by means of the lungs in the expired air. SonoVue appeared to be safe and well tolerated in healthy subjects.

Adult↗

Influence of bubble size distribution on the echogenicity of ultrasound contrast agents: a study of SonoVue.

RATIONALE AND OBJECTIVES: To study the relative contributions of different bubble size classes to SonoVue's echogenicity in fundamental acoustic imaging modes. SonoVue is a contrast agent, previously known as BR1, with a bubble size distribution extending from approximately 0.7 to 10 microm. METHODS: A model for the acoustic response of SonoVue was determined and validated for a set of experimental data. This model was used to simulate the acoustic response of a standard batch of SonoVue as the sum of responses of non-overlapping bubble size classes. RESULTS: The simulation was first validated for a standard SonoVue bubble size distribution. When this distribution was considered as five size classes with equal numbers of bubbles, it was found that bubbles smaller than 2 microm accounted for 60% of the total number but contained only 5% of the total gas volume. The simulation results indicated marked differences in the acoustic contributions from these classes, with 80% of the acoustic efficacy provided by bubbles 3 to 9 microm in diameter. The study also compared bubble distributions in number, surface, and volume, with the distribution computed in terms of acoustic efficacy. CONCLUSIONS: This study shows why bubble volume is a much better indicator of SonoVue's efficacy than is bubble count. A low threshold in diameter was found for SonoVue microbubbles at approximately 2 microm, under which size bubbles do not contribute appreciably to the echogenicity at medical ultrasound frequencies.

Computer Simulation↗

Clinical safety of SonoVue, a new contrast agent for ultrasound imaging, in healthy volunteers and in patients with chronic obstructive pulmonary disease.

RATIONALE AND OBJECTIVES: To evaluate the safety profile of SonoVue, a new echo-contrast agent based on stabilized sulfur hexafluoride (SF6) microbubbles, in healthy volunteers and in patients with chronic obstructive pulmonary disease (COPD). METHODS: Safety and tolerability of SonoVue were evaluated in 66 healthy volunteers during two placebo-controlled phase I studies (a single intravenous ascending-dose study in 36 volunteers given SonoVue doses of 0.003 to 0.12 mL/kg and a multiple-dose study in 30 subjects given cumulative doses of 0.15 to 0.6 mL/kg) and in 12 patients with COPD of various degrees of clinical severity, who were given SonoVue at a dosage of 4 mL (corresponding to 0.057 mL/kg in a 70-kg patient). Adverse events were monitored up to 48 to 72 hours after administration. All volunteers underwent extensive safety assessments (monitoring of vital signs, electrocardiogram, blood oxygen saturation, laboratory assessments, and Mini-Mental test) up to 24 to 72 hours after administration. In addition, patients with COPD underwent specific lung function tests, such as forced expiratory volume, forced vital capacity, and forced midexpiratory flow. RESULTS: No serious adverse events occurred throughout the study. All nonserious adverse events were minor, mild, and rapidly self-resolving. No difference in the incidence of adverse events was observed among the various dosages of SonoVue and between SonoVue and placebo. There were no clinically significant changes in any of the safety assessments. No statistically significant differences between SonoVue and placebo were observed in mean forced expiratory volume, forced vital capacity, or forced midexpiratory flow levels. No substantial changes from baseline in blood oxygen saturation were observed for either study agent at any postinjection time point. CONCLUSIONS: SonoVue showed a good safety profile both in healthy subjects and in patients with COPD.

Adult↗