Francesco Prada, MD, has returned to the Istituto Neurologico Carlo Besta in Milan, Italy after two years of working with the Foundation in Charlottesville. Prada is a neurosurgeon who joined the Foundation in July 2017 as our first clinical Merkin scholar and agreed to stay for a year beyond his fellowship as the Foundation’s Brain Program Director. During these two years he also served as Assistant Professor at the University of Virginia (UVA).
As he transitions back to his home institution in Milan, Dr. Prada spoke with us about the status of his projects and what he hopes to accomplish in the near future.
In our last update, we shared a number of projects that you were working on. Where do you stand on those?
Sonodynamic Therapy
We finalized our preclinical safety study on sonodynamic therapy to address glioblastoma. Our goal was to use compounds that are typically used for intraoperative visualization of the tumor for surgical guidance (5-ala/fluorescein) to induce cell death in a small animal glioma model. We had quite good results, and we have submitted a paper for publication. We also completed a safety study in a large animal model and we are analyzing the results. It is my hope that if this technique is proven safe in preclinical models, it can be translated into the clinical setting. I will drive most of my efforts towards starting such a clinical study here in Milan, and. I hope the Foundation will have an interest in funding this work.
Microbubble Mapping
I collaborated with neurosurgeons and scientists at UVA on a project to create a map of microbubble distribution in the human brain. Eventually this map will assist in planning microbubble-based clinical treatments. We have created the necessary software and are in the process of collecting data. I actually began collecting data for this project before I came to the Foundation, and I plan to continue this project in Milan.
On the Horizon
Two other studies will begin soon. One involves analyzing the interaction between focused ultrasound and microbubbles in a preclinical model. I will work in conjunction with fellow Merkin Scholar Frederic Padilla, PhD, and other colleagues from UVA’s Department of Neurosurgery and Biomedical Engineering on the study.
The second project beginning soon will explore the use of Kranion® software as a simulation tool. I plan to compare the treatment area predicted by Kranion® to the actual treatment area outlined by standard practices.
Are there additional projects that you have planned?
While in Virginia, we conducted in vivo and preclinical studies characterizing the acoustic properties of a patented prosthesis that replaces the skull, which could allow us to use ultrasound guidance rather than MR. We are hoping to begin a preclinical study opening the blood-brain barrier (BBB) and other therapeutic ultrasound modalities under ultrasound guidance in a preclinical model. We expect this technique will offer improved imaging and less interference with the focused ultrasound. Our ultimate goal is to be able to clinically treat the brain using ultrasound guidance.
Tell us about your Institute.
The hospital associated with the Carlo Besto Neurological Institute recently purchased the Insightec Exablate Neuro device, and we are currently using focused ultrasound to treat patients with movement disorders. We have approximately ten people working on focused ultrasound clinically, and we treat about one patient per week.
Soon, we will install the lower frequency Insightec device, and we hope to use it for sonodynamic therapy and opening the BBB.
What is also really exciting to me is that we are building what – to my knowledge – is the first preclinical laboratory for focused ultrasound in Italy. I hope to champion this project by combining the great scientific background on neuroscience my Institute has to offer with the connections, collaborations, and friendships I had the opportunity to create while working for the Foundation.
What are you excited about in the field now?
The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) is tasked with educating clinicians and researchers about safe ultrasound practices. Recently, they included microbubble imaging in the brain in their guidelines for the first time. I am excited about how this recognition will bolster the focused ultrasound work in this space.
Also really exciting is the fact that focused ultrasound is still a new technique when we think about applications for the nervous system, and many possibilities are still open. Furthermore, it is of uppermost importance to communicate properly with patients, without creating false hope. I am really looking forward to creating a program for the greater public talking about the option to treat disease with sound.
What is your advice for people applying for the next Merkin Scholar position?
I would say be prepared to stay longer. It was an honor to be asked to lead the Foundation’s Brain Program. There is a lot of interesting work that the Foundation is supporting, and I was able to form collaborations there that will continue long after I have left.