Blood–brain barrier opening with ultrasound device in patients with glioblastoma | Hacker News Reader

Blood–brain barrier opening with ultrasound device in patients with glioblastoma

thelancet.com

62 pointsbookofjoe31 comments

Blood-brain barrier is one of the problems few antiviral drugs work against rabies virus once it reaches CNS. Maybe we are one step closer to a protocol that finally works reliably.

I wonder if this will have implications for other brain conditions, like Parkinson's, depression, or narcolepsy where some protein or hormone is missing from the brain and can't be delivered across the BBB.

CRISPR for example is too big for the blood-brain barrier

Nice proof of concept of opening the BBB but I see they didn't mention anything about the chemo improving survival for these patients yet... I guess that will only be the next phase of the trial?

That may be a different and much harder problem. Glioblastoma is an aggressive brain cancer and that diagnosis is basically a death sentence, with a median survival time of something like 15 months. Since these are patients with recurrent glioblastoma, generally this means they've already had brain surgery, radiation, and chemo. At that point, as a recent paper puts it, "treatment options are limited and management of recurrent glioblastoma remains challenging". Which I believe is oncologist for "they're fucked". So my guess is that this is the beginning of a long road of searching for agents and regimens that will be deadly enough to kill the tumor without harming the very similar brain tissue that it's nestled in.

Median survival is just that: half the people have less, half the people have more.

Since you are not an oncologist, could you please cite the recent paper in question? That would be helpful for understanding the context in which the statement was made that led to your (insensitive) interpretation.

Protip: you can find quotes by putting them into Google, which is what I just did: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794906/

Yes, half the people have less, half more. But even the "more" half is very bad news. 5-year survival is ~4%. My dad made it something like 16 months, although his quality of life was quite poor for most of that; the tumor had already caused some neurological complications, and the surgery kicked off frequent seizures that were debilitating. From what I've read, poor quality of life is typical of aggressive gliomas, even when in nominal remission. And then there's the half who have less; my mom got about 4 months, most of which was taken up with radiation and chemo.

Please let me know in the future if I can bring up any of my prose to your sensitivity standards. That's a big concern of mine when writing on the internet.

I am very sorry for your loss. This is clearly a sensitive and emotional subject for many, thus my comment. I did not mean to offend you, but can see that I have, and apologize for that. I should have known better.

Thanks for sharing the link, very helpful to understand the context for your statements regarding poor prognosis, specifically 5-year survival and the various new promising approaches being attempted.

>>> I did not mean to offend you, but can see that I have, and apologize for that. I should have known better.

Reading his first comment, there is no way you would have known about his loss.

Right. I think the "they're fucked" threw me off, because "they" sounds impersonal, as though talking about others without having had the personal experience. However, that very phrase should have alerted me to the fact that anyone who knows as much about the topic and uses strong language is very likely emotionally involved, and therefore it is wiser to tread lightly. This is what I should have known better, and will improve upon for next time.

Sure, but so what?

In most of the world's conversations, if somebody talks about a thing, people tend to think, "Oh, maybe they know about the thing." Here on HN, though, and wherever reply guys roam free, you see a lot of the opposite. "I'll just assume I know way more about this than the person I'm going to run my mouth at."

I don't think it should be my job to preemptively trot out my credentials every time I whip up a paragraph on something. Especially when, as here, those credentials are not only some of the most painful episodes in my life, but are also guaranteed conversational bombs. Instead, maybe we could have a norm of assuming that people aren't total idiots.

His comment was frank, but it wasn’t insensitive. It’s important to be able to distinguish between those two things.

Just for the record, the only objectionable part of your comment (IMO) was the "(insentive)" part, because it assumed the worst

So sorry to hear both your parents had glioblastoma. We are struggling with this in our family now. Given how rare GBM is, did anyone try to identify possible causal factors in your parents’ case?

Some halfhearted effort was made. But they really only lived in the same place 5 or 6 years, and there was no obvious cause. Since they both had left temporal lobe tumors, the area involved in language, and since they were both good with words, I joke that we all just overused that part of our brain, so that's what'll be coming for me too.

My best guess is that I just got unlucky here, but the causes are not well understood, so who knows.

I feel for you. My dad was on the less side of that, having died just shy of three months from onset of symptoms. The tumor was located in a region called the thalamus, they said in all likelihood they would never be able to resection it without causing more problems than just leaving it be and sticking to chemo.. not that it mattered in the end, the chemo compromised his immune system and he perished to fungal pneumonia.

Yeah, it's just a bucket of terrible choices, isn't it? People can do without a leg or a lung, but the brain is so delicate and subtle that there are no good options. Personally, if this ends up being my fate, I'm doing it the way Brittany Maynard did. Throw a good party while I'm still of sound mind and exit on my own terms. [1]

My sympathies to you and your family. It's such a hard thing. And having it go that fast can just be overwhelming.

[1] https://en.wikipedia.org/wiki/Brittany_Maynard

I can't even begin to describe how upsetting it is that anybody would deny us the right to a dignified end citing their own beliefs and ignoring our own.

I am sorry for your loss. Thank you for sharing all this here. It has really put the article into perspective.

Is it possible that headphones could possibly open or weaken that barrier? Of course it would be a much weaker effect as the sound frequency is different.

No. Or at least as far as we know.

Ultrasound is still a mechanical force that can be focussed in a specific area to open a part of the Blood Brain Barrier.

Wifi and bluetooth are electromagnetic, and interact less with the brain. Their transmission power is also extremely low. So they don’t do much.

Super powerful MRI scanners (3T or more) can heat up the body a little bit with electromagnetic waves, but still no focal damage or anything.

Trauma however, or certain diseases can open the barrier.

I think they were asking about acoustic vibrations generated from wearing headphones, rather than EM radiation?

That was my reading too.

Pretty cool! Would love to have been able to read the methods to figure out how their imaging can resolve if the blood brain barrier is ‘open’

The blood brain barrier is not a membrane, like the meninges (dura, pia, arach, etc) It is the way that molecules are "filtered" by the endothelium before going out of the bloodstream. I would Guess you can use contrast that would normally not cross the barrier to judge its permeability

Thank you for this concise explanation. I feel like every time the term BBB comes up nobody really knows how it works and I've never taken the time to research

Very cool! Is this the same physical principle as the old 'Jet Injectors' [0]. But using the ultrasound transducer as the mechanical force?

[0] https://en.wikipedia.org/wiki/Jet_injector

GBM as it stands is a death sentence, I hope this is a start to the road to ending that.

My father in law died of glioblastoma about 6 months after he was diagnosed. Any advances on this is welcome.

My tax accountant had Glioblastoma. Text me the news, 6 months later he was dead. Horrible horrible disease.

Can't wait to have the brain eaten by MRSA :)

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