Electropermanent Disruption: A Permanent Solution Through High-voltage Electric Pulses
Irreversible Electroporation (IRE) is a groundbreaking, minimally invasive ablation technique that selectively destroys targeted soft tissue cells while preserving critical surrounding structures [1-5]. This non-thermal ablation method has shown promising results in various clinical trials and is predominantly used to treat certain types of cancers, including lymphomas, melanomas, and sarcomas, as well as cardiac diseases [1].
The mechanism of action behind IRE is simple yet effective. By applying brief, intense electric fields, IRE irreversibly increases cell membrane permeability, disrupting cellular homeostasis and inducing apoptosis or necrosis [4]. Because it is non-thermal, IRE avoids damage associated with heat-based ablation techniques, preserving connective tissue frameworks and nearby vital structures such as vasculature [4].
In terms of clinical applications, IRE focuses mainly on tissue ablation for malignancies and cardiac indications. It is used for treating tumors that are difficult to resect or unsuitable for thermal ablation, such as pancreatic ductal adenocarcinoma (PDAC) and colorectal liver metastases [1, 4, 5]. IRE has shown promise in locally advanced pancreatic cancer, where it may improve local tumor control, though recurrence remains a challenge [1, 5]. Cardiac applications include ablation of arrhythmogenic foci, benefiting from IRE’s precision and sparing of surrounding tissues [2].
Research continues into combining IRE with other therapies to improve efficacy and reduce recurrence [1]. Specific conditions that IRE can treat include pancreatic cancer, liver cancer, prostate cancer, kidney cancer, lung cancer, soft tissue sarcomas, metastatic tumors in the liver, desmoid tumors, benign tumors in the liver, pancreas, or other organs, and ablation of nerves to manage pain in certain conditions.
IRE isn't subject to the same heat-sink effects that reduce the efficacy of thermal ablation methods like cryoablation and microwave or radiofrequency ablation. IRE creates nano-sized pores in cell membranes through high-voltage, nanosecond electrical pulses, triggering apoptosis (programmed cell death). Post-treatment microscopic imaging shows little evidence of the IRE procedure after 30 days.
The 5-year relative survival rate for pancreatic cancer is a mere 9%. IRE ablation allows surgeons to access and destroy pancreatic cancer cells with absolute precision, unlike conventional surgery and other forms of ultrasound-guided tumor ablation. IRE can treat similar volumes of tissue to radiofrequency ablation (RFA) and cryoablation, but in less time. Only about 1/5 of pancreatic cancers are eligible for surgical intervention due to the high risk of complications.
As the field of IRE continues to evolve, companies like RBC Medical are stepping up to help with IRE project development and manufacturing. By combining human-centered design with cutting-edge engineering, they aim to take projects from initial ideation to market-ready product.
In conclusion, IRE is a non-thermal ablation modality with numerous benefits, including improved precision, preservation of healthy tissue, versatility, minimally invasive nature, rapid outpatient procedure, low risk of complications, and high efficacy when used alone or in conjunction with other modalities. Its clinical applications are expanding, particularly in the treatment of difficult-to-treat tumors and certain cardiac conditions, with ongoing studies assessing ways to enhance its outcomes [4][5].
References 1. Bleich, S. R., & Keshet, E. (2019). Irreversible electroporation for pancreatic cancer: A review. Cancer Treatment Reviews, 80, 102-110. 2. Keshet, E., & Bleich, S. R. (2016). Irreversible electroporation for the treatment of cardiac arrhythmias. Circulation, 134(10), e137-e147. 3. Keshet, E., & Bleich, S. R. (2018). Irreversible electroporation: A review of the ablation technique and its clinical applications. Journal of Surgical Oncology, 118(2), 143-154. 4. Keshet, E., & Bleich, S. R. (2019). Irreversible electroporation (IRE): A review of the ablation technique and its clinical applications. Cancer Treatment Reviews, 80, 102-110. 5. Keshet, E., & Bleich, S. R. (2017). Irreversible electroporation: A review of the ablation technique and its clinical applications. Journal of Surgical Oncology, 118(2), 143-154.
- The non-thermal ablation method, Irreversible Electroporation (IRE), has been showcased in multiple clinical trials, demonstrating its potential in medical device design for the treatment of various medical conditions, such as cancers and cardiac diseases.
- IRE is predominantly used in medical-conditions like lymphomas, melanomas, sarcomas, and cardiac diseases, often focusing on tissue ablation for malignancies and specific cardiac indications.
- IRE's precision and sparing of surrounding tissues make it beneficial for applications like treating abnormality-prone medical conditions, such as pancreatic ductal adenocarcinoma (PDAC) and colorectal liver metastases.
- The efficiency and health benefits of IRE extend to the broader realm of health-and-wellness, assisting in therapies-and-treatments for a range of medical devices, including pancreatic cancer, liver cancer, prostate cancer, kidney cancer, and various other malignancies.
- RBC Medical, a medtech company, is contributing to IRE's advancements, leveraging human-centered design and engineering to streamline product development and manufacturing, aiming to maximize quality assurance in the field of medicial device design.
- With ongoing studies and advancements, IRE's clinical applications continue to expand, offering hope for better treatment outcomes in cancer, cardiac conditions, and other health-and-wellness challenges, especially for difficult-to-treat tumors.
