Of sight and sound
Dr. Kullervo Hynynen, director of Physical Sciences at Sunnybrook Research Institute (SRI), is the recipient of the 2016 Visionary Award from the Focused Ultrasound Foundation. The award recognizes a person who has helped shape the future of focused ultrasound and whose dedication has advanced the field.
In 1996 he did what was considered impossible: open the blood-brain barrier safely and reversibly, using focused ultrasound under MRI guidance. Over the next two decades Hynynen further developed the technology, low-intensity focused ultrasound, to disrupt the barrier, which blocks about 97% of small and large molecules from entering the brain. In 2015 Hynynen was lead physicist of a team at SRI that was the world’s first to deliver chemotherapy noninvasively across the blood-brain barrier of a patient with brain cancer.
He and Dr. Isabelle Aubert, a neurobiologist at SRI, have used the technique to deliver antibodies directly into the brains of mice with Alzheimer’s disease. The therapy substantially shrank amyloid plaques, a telltale sign of the disorder. They also showed, in another first, that focused ultrasound alone could destroy amyloid build-up and restore cognitive function in impaired mice. This work is moving steadily toward clinical trials.
On another front, Hynynen’s work in high-intensity focused ultrasound (HIFU) is already being used clinically. Here, sound waves are concentrated to an area to generate enough heat to destroy targeted cells. Discoveries he made with colleagues in research and industry led to the formation of a company, InSightec, which commercialized the technology. The system, which pairs HIFU with MRI to guide and monitor delivery, is approved for use in the U.S. for uterine fibroids, growths that can cause excessive menstrual bleeding and pain. The usual surgical treatment is hysterectomy, which, in addition to rendering a woman infertile, carries risks of complications and involves a long recovery. The treatment has revolutionized care for women with this condition, transforming a major surgery into a noninvasive procedure that spares fertility and allows women to resume their lifestyles within a day.
Even more recently, in August 2016, the U.S. Food and Drug Administration and Health Canada approved InSightec’s brain device for treatment of essential tremor, the most common movement disorder, which afflicts about half a million Canadians. They did so on the back of a seminal clinical trial showing that focused ultrasound safely and effectively reduces tremor in people for whom nothing else had worked.
Hynynen has formed two startup companies to commercialize some of his research for the benefit of patients. One, FUS Instruments, is developing image-guided focused ultrasound systems for preclinical research. Its technologies are compatible with large- and small-bore MRI and CT systems, and diagnostic ultrasound. The goal is to enable more labs to conduct research into focused ultrasound to speed translation of this work into the clinic. The other company, Harmonic Medical Inc., is developing novel focused ultrasound systems for noninvasive surgery and precise delivery of energy to ablate tissues deep in the body. The aim is to produce low-cost systems that increase access to the technology.
In accepting the award, Hynynen reflected on his career and the promise of therapeutic ultrasound to change patient care radically. “In the early days, when I would present at scientific meetings about the potential of focused ultrasound; it was quite discouraging when only a few people made up the audience. That certainly has changed with the recent clinical success, but I think that we are just scratching the surface of the potential of this technology. I have no doubt that focused ultrasound will become a major surgical tool and disrupt the way brain diseases are treated.”
