ECE2019 Poster Presentations Adrenal and Neuroendocrine Tumours 2 (60 abstracts)
Microwave ablation of the adrenal gland for treatment of functioning adrenocortical tumours: porcine in vivo study
Padraig Donlon 1 , Hojjatollah Fallahi 2 , Warren Beard Beard 2 , Atif Shazad 1 , Lindsay Heflin 2 , Whitney Cox 2 , Brooke Bloomberg 2 , James Lillich 2 , Chanran Ganta 2 , Gerard O’Sullivan 3 , Giuseppi Ruvio 1 , Paula O’Shea 3 , Martin O’Halloran 1 , Punit Prakash 2 & Michael Dennedy 1
1National University of Ireland Galway, Galway, Ireland; 2Kansas State University, Manhattan, NY, USA; 3Galway University Hospitals, Galway, Ireland.
Objective: To evaluate MTA as a precision ablation methodology for adrenocortical tissue, simultaneously evaluating effects on adjacent non-targeted tissue.
Methodology: A directional MTA applicator was used in vivo on adrenals of 8 male pigs: (i) sham (n=2); (ii) 45 watts for 60 seconds (n=3); (iii) 70 watts for 60 seconds (n=3). Blood was drawn intraprocedurally and at 48h for measurement of metanephrines, cortisol, ACTH and aldosterone (LCMS). Animal sacrifice/tissue harvest occurred at 48 h. Ablation-zone volume was assessed by basic histology (H&E). Tissue function was assessed by expression of CYP17 and CYP11B1 (IHC). Tissue damage was assessed by expression of damage associated molecular patterns (DAMPs) HSP70 and HMGB1 (IHC).
Results: A specific ablation zone (0.67±0.37 cm3) was achieved, morphologicaly demonstrating coagulative necrosis, absence of DAMPS, and absence of steroidogenic enzyme expression. Non-targeted adrenocortical tissue was preserved functionally and structurally as confirmed by the expression of DAMPs and steroidogenic enzymes within the cells, and delineated by an immune cell infiltrate. Medullary damage occured in all ablated adrenals, consistent with cellular necrosis in the tissue, raised intra-procedural metanephrines, and transient intra-procedural hypertension.
Conclusion: For the first time, MTA is shown as a safe, effective method to precisely ablate adrenal cortex of volumes equivalent to FAT, while preserving adjacent non-targeted cortex. Intraprocedural alpha blockade is necessary to pre-treat possible intra-procedural medullary catecholamine surge. This presents exciting short-term translational potential for the therapy of FAT
Acknowledgement This project has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No 75308). Thanks to Dr Celso Gomez Sanchez for kindly gifting the steroidogenic antibodies for this study.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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