Technology has radically transformed healthcare. Medical device engineers, researchers, and surgeons are pioneering new treatment modalities grounded in cutting-edge tech. Every year, these new methods provide innovative ways to tackle complex medical issues with increased safety and better results.
Irreversible electroporation (IRE) is one of those methods .
Irreversible Electroporation is a non-thermal ablation modality that is being used to treat soft tissue diseases, most notably in cardiology and oncology. Electroporation is an established, effective procedure for manipulating cells and recent breakthroughs have made irreversible electroporation an exciting non-thermal ablation modality. Simply put, it has empowered doctors to overcome many limitations associated with conventional surgical procedures. In this article, we explore what IRE is and how it works, as well as its clinical applications, benefits, and contraindications.
How Does Irreversible Electroporation Ablation Work?
Like other ablation modalities, IRE offers the potential to be an outpatient treatment for creating soft tissue lesions to treat cancerous tumors and cardiac diseases such as atrial fibrilation. Ablation procedures are long established medical treatments for killing targeted tissues; however the mechanism of cell death that IRE uses makes it unique among other conventional thermal ablation options.
To perform the procedure, needle electrodes are inserted, often minimally invasively, and navigated towards the targeted tissue. Real-time CT or ultrasound guidance enables doctors to place the needles adjacent to the target.
Once the needles are in place, a series of high-voltage , nanosecond electrical pulses are delivered to the electrodes. This generates electrical fields that create nano-sized pores in the cell membranes adjacent to the electrode. Unlike traditional electroporation, irreversible electroporation uses relatively higher voltages and longer electrical pulses to ensure the pores in the cell membrane do not heal.
The pores created increase cell permeability, which triggers the natural process of programmed cell death known as apoptosis . Ultimately, the immune system responds to apoptosis and removes the cellular debris from the affected area in the aftermath of the IRE procedure .
The IRE process is called irreversible because the damage caused by the high-voltage renders the target tissue incapable of repairing itself due to the pores in the cell membrane not closing. The result is permanent cell death.
How Does Irreversible Electroporation Compare to Other Ablation Methods?
In contrast to other ablation methods, IRE ensures the conservation of the extracellular matrix. This is due to the fact that IRE uses non-thermal energy to destroy target tissue, a unique mechanism that also preserves vital structures within the ablated zone . This is critical for cardiac ablation where heating of the esophagus is a major concern or for tumor ablation where vasculature is often present near the tumor. IRE offers a potentially much safer treatment option with the same efficiency.
For comparison, IRE treats similar volumes of tissue to radiofrequency ablation (RFA) and cryoablation, but in less time. For example, an abnormal cell structure with a volume of 4cm X 3cm can be successfully destroyed in under four minutes with IRE.
Depending on the disease state, IRE can be used on its own or as part of a broader treatment plan that may include conventional surgery. It can even be used as a precursor to other treatment modalities like chemotherapy to help increase a patient’s chances of remission.
What Is Irreversible Electroporation Used for?
IRE has demonstrated promising results in clinical trial after clinical trial . Today, IRE procedures are predominantly used to treat certain types of cancers, including lymphomas, melanomas, and sarcomas as well as cardiac diseases. Let’s look at some specific conditions that IRE can treat.
- 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
- Ablation of nerves to manage pain in certain conditions.
Though more long-term data is needed to fully assess the efficacy of IRE , there is strong evidence to suggest that this technology is an invaluable tool for many conditions. To understand exactly how promising IRE really is, let’s turn our attention to one of its major clinical applications to date.
Real-Life Example of Irreversible Electroporation – Pancreatic Cancer
Perhaps most promising is IRE’s ability to treat pancreatic cancer. This deadly disease is known to spread rapidly and evade early detection. In fact, by the time the cancer is diagnosed, it has usually metastasized.
According to the American Cancer Society , nearly 65,000 Americans will be diagnosed with pancreatic cancer this year, while over 55,000 will die from the disease . What’s most troubling is that <1/5 of those cancers are eligible for surgical intervention due to the high risk of complications. It’s no wonder that the 5-year relative survival rate for pancreatic cancer is a mere 9%.
IRE is a beacon of hope for these people. Consider the fact that pancreatic cancers are often deemed inoperable if they involve arteries like the celiac trunk, common hepatic artery, or superior mesenteric artery (SMA)—all major blood vessels in the vicinity of the pancreas.
IRE ablation allows surgeons to access these sensitively placed tumor cells with absolute precision, in a way that conventional surgery and other forms of ultrasound-guided tumor ablation cannot. Put simply, IRE destroys cancer cells without harming healthy cells and vital structures.
In fact, post-treatment microscopic imaging shows that little evidence remains of the IRE procedure after 30 days. Meanwhile, adjacent tissue, like blood vessels , nerves, bile ducts , gallbladder, and bowels, continue to function normally.
IRE also isn’t subject to the same heat-sink effects that reduce the efficacy of thermal ablation methods like cryoablation (extreme cold) and microwave or radiofrequency ablation (extreme heat).
The 7 Benefits of Irreversible Electroporation Ablation
The beneficial effects of IRE have been well-documented in clinical trials. Below is a brief summary of the characteristics that make this technology such an attractive option among healthcare providers.
- Improves precision
- Preserves healthy tissue
- Versatile treatment option
- Minimally invasive
- Rapid outpatient procedure
- Low risk of complications
- High efficacy when used alone or in conjunction with other modalities.
Turn Your Irreversible Electroporation Project Into a Reality, With RBC Medical
As we’ve seen, IRE is a minimally invasive, emerging treatment modality that boasts a variety of clinical applications—especially against tumor cells in highly sensitive regions like the pancreas. There’s no doubt that IRE will witness rapid adoption in the coming years among medical practitioners.
Need a hand with your irreversible electroporation (IRE) project? RBC Medical can help . For over 25 years, we’ve developed and manufactured medical devices on behalf of medical device companies just like yours. By combining human-centered design with cutting-edge engineering, we can take you from initial ideation to market-ready product.
What are you waiting for? Contact us today to discover how RBC Medical can bring your IRE project to life .