Biomolecular Ultrasound and Sonogenetics
David Maresca
1,*
,
Anupama Lakshmanan
2,*
,
Mohamad Abedi
2
,
Avinoam Bar-Zion
1
,
Arash
Farhadi
2
,
George J. Lu
1
,
Jerzy O. Szablowski
1
,
Di Wu
3
,
Sangjin Yoo
1
, and
Mikhail G.
Shapiro
1
1
Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena,
California 91125, USA
2
Division of Biology and Biological Engineering, California Institute of Technology, Pasadena,
California 91125, USA
3
Division of Engineering and Applied Sciences, California Institute of Technology, Pasadena,
California 91125, USA
Abstract
Visualizing and modulating molecular and cellular processes occurring deep within living
organisms is fundamental to our study of basic biology and disease. Currently, the most
sophisticated tools available to dynamically monitor and control cellular events rely on light-
responsive proteins, which are difficult to use outside of optically transparent model systems,
cultured cells, or surgically accessed regions owing to strong scattering of light by biological
tissue. In contrast, ultrasound is a widely used medical imaging and therapeutic modality that
enables the observation and perturbation of internal anatomy and physiology but has historically
had limited ability to monitor and control specific cellular processes. Recent advances are
beginning to address this limitation through the development of biomolecular tools that allow
ultrasound to connect directly to cellular functions such as gene expression. Driven by the
discovery and engineering of new contrast agents, reporter genes, and bioswitches, the nascent
field of biomolecular ultrasound carries a wave of exciting opportunities.
Keywords
biomolecular; ultrasound; sonogenetics; gas vesicles; imaging; reporter gene
1. INTRODUCTION
Studying biological function within the context of living organisms and the development of
biomolecular and cellular therapy requires methods to image and control the function of
specific molecules and cells in vivo. However, most popular methods for achieving
spatiotemporally precise interactions with biological substances, such as fluorescent imaging
*
These authors contributed equally
DISCLOSURE STATEMENT
The authors are not aware of any affiliations, memberships, funding, or financial holdings that might be perceived as affecting the
objectivity of this review.
HHS Public Access
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Published in final edited form as:
Annu Rev Chem Biomol Eng
. 2018 June 07; 9: 229–252. doi:10.1146/annurev-
chembioeng-060817-084034.
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and optogenetics, have limited utility in deep tissues owing to the strong scattering of visible
light. Unlike photons, which are scattered within approximately one millimeter of tissue,
ultrasound waves easily penetrate several centimeters deep while retaining spatial and
temporal coherence. This capability has made ultrasound one of the world’s leading
modalities for medical imaging of anatomy, physiology, and noninvasive therapy. However,
historically ultrasound has played a relatively small role in molecular and cell biology owing
to a lack of effective methods to couple sound waves to specific processes such as gene
expression and cellular signaling.
Recent advances are changing this picture by enabling ultrasound to image and control the
function of specific biomolecules and cells and drive biomolecular transport across cellular
and tissue barriers. These emerging capabilities for biomolecular ultrasound are the focus of
this review. We start with a brief primer on ultrasound physics and technology. We then
describe the development of genetically encodable acoustic biomolecules, which could serve
as the ultrasound equivalents of fluorescent proteins for noninvasive molecular and cellular
imaging. Next, we discuss proteins and genetic circuits allowing focused ultrasound (FUS)
to remotely control gene expression and other aspects of cellular signaling through
sonogenetic strategies analogous to optogenetics and chemogenetics. Finally, we discuss the
role of ultrasound in enhancing the transport of biomolecules across cell membranes and
tissue boundaries. We aim to convey both the exhilarating recent developments underlying
the emergence of biomolecular ultrasound and the exciting opportunities this nascent field
holds for creative biomolecular and ultrasound engineers.
2. BRIEF BACKGROUND ON BIOMEDICAL ULTRASOUND
2.1. Wave Behavior and Tissue Interactions
Ultrasound is defined by sound wave frequencies above those audible to humans (
>
20,000
Hz). Generated by transducers coupled to a transmission medium such as biological tissue,
ultrasound waves travel through the medium and interact with its components to form
images or provide momentum and energy for perturbation. In biological tissues, as in
liquids, compression waves are dominant and are used for most modes of imaging and
control. In tissue, sound waves travel at ~1,540 m/s and are reflected and scattered wherever
they experience a change in acoustic impedance, which is a function of the local density and
compressibility (
1
) (Figure 1
a
). The relative homogeneity of the speed of sound in soft
tissues results in sound waves remaining coherent as they traverse the tissue, enabling simple
image reconstruction without major aberrations (
2
). By comparison, visible light is strongly
scattered in tissues, making it challenging for it to retain a ballistic path at depths greater
than a few hundred microns (Figure 1
b
).
Ultrasound reflection at tissue interfaces is highly directional and reveals anatomical
contours. Soft tissues have similar acoustic impedance values, resulting in relatively low
contrast between them; air and bones have much lower and higher acoustic impedances,
respectively, resulting in strong reflections (
2
). When the ultrasound wave encounters a
target smaller than approximately one-tenth of the wavelength, it is scattered
omnidirectionally (
3
). Biological tissues include a wide range of such scatterers in the form
of fibers, cells, and organelles. The echo from a single scatterer is usually very weak. When
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several very close scatterers are imaged, the result is a dominant spatially coherent
interference pattern called speckle (
2
). The amplitude of the ultrasound wave decreases
exponentially as a function of depth. Part of the energy of the ultrasonic wave is absorbed in
the tissue and dissipated as heat. Attenuation refers to both absorption and any reduction in
wave amplitude owing to reflection or scattering. Each tissue is characterized by a different
attenuation coefficient value, which increases nonlinearly with frequency (
2
). As they pass
through a medium, ultrasound waves also deposit momentum into that medium, resulting in
mechanical forces known as acoustic radiation forces (ARF). Appreciable at higher
ultrasound intensities and pulse durations, these forces, as well as localized heating, can be
used to perturb and manipulate tissues and other materials.
2.2. Ultrasound Imaging
Ultrasound imaging is the most prescribed diagnostic modality in clinical practice (
4
).
Typical equipment involves an ultrasound scanner and an ultrasound probe made of a linear
array of transducer elements (i.e., 128 to 256 ultrasound transmitting/receiving elements)
(
5
). Numerous ultrasound imaging modes have been translated to clinical practice; several of
these modes are relevant to biomolecular ultrasound.
2.2.1. B-mode imaging—
Ultrasound scanners are primarily used to produce real-time 2D
images of underlying tissue (Figure 1
d
). These grayscale images are referred to as B-mode
images (where B stands for brightness) and are acquired through transmission into a tissue
of short ultrasound pulses and recording of backscattered echoes. The location of a
scattering or reflecting source is reconstructed from the arrival time of its signal at each
array element in a process known as beamforming. The position of a point in the
reconstructed B-mode image depends on the time of flight of the echo and the position of
the transmitting probe element. The in-depth or axial resolution of B-mode images depends
on the wavelength (
λ
=
c
tissue
/f
US
, where
c
is the speed of sound in tissue and
f
is the
ultrasound wave frequency) and the number of cycles of vibration of the transmitted pulse.
The axial resolution typically ranges from 500 μm (medical imaging) down to 50 μm
(ultrasound biomicroscopy) (
6
). Because both attenuation and resolution increase with
frequency, there is an inherent tradeoff between resolution and imaging depth (Figure 1
c
).
The lateral resolution of B-mode images depends on the transmitted ultrasound beam width
and is typically a few hundred microns. The transverse resolution or image thickness is
usually on the order of a millimeter. B-mode imaging is used to image every organ of the
body with the exception of bones or air-filled organs such as the lungs.
2.2.2. Doppler imaging—
Ultrasound Doppler imaging detects the motion of red blood
cells (RBCs) and, therefore, blood flow (
7
). RBCs scatter weak ultrasound echoes, which
can be captured with modern ultrasound probes. At a given depth in tissue, the temporal
shifts observed in consecutive RBC echoes allow detection of the displacement of RBCs and
derivation of a Doppler signal proportional to RBC velocity. One can generate vascular
images displaying either the velocity (color Doppler) or the energy of RBC echoes (power
Doppler) (
8
).
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2.2.3. Contrast imaging—
Contrast-enhanced ultrasound relies on the administration of
contrast agents to label specific aspects of anatomy or physiology. The conventional contrast
agents used for this purpose are microbubbles: synthetic, micron-sized bubbles of gas
stabilized by a lipid or protein shell (
9
–
12
). When injected into the blood stream,
microbubbles produce strong scattering as they resonate at ultrasound imaging frequencies
(1–20 MHz). Dedicated ultrasound contrast modes have been developed to benefit from that
resonant behavior, such as amplitude modulation (
13
) or phase inversion (
14
), allowing the
detection of microbubbles in vivo with higher specificity. Microbubbles can also be used to
enhance Doppler imaging.
2.2.4. Ultrafast imaging—
Conventional B-mode imaging uses a series of focused
transmissions along an ultrasound array to form an image, such that the acquisition of a 10-
cm-deep image with a 128-element probe takes at least 128
*
10 cm
*
2/1,540 m/s ~ 17 ms,
resulting in a frame rate of 59 Hz. A major recent advance, known as ultrafast ultrasound,
uses single–plane wave transmissions, rather than focused line transmissions, to form
images, resulting in a two-orders-of-magnitude acceleration in frame rate (
15
). The
equivalent temporal resolution for a 10-cm image is 10 cm
*
2/1,540 m/s ~ 130 μs, or 7,700
frames per second. This advance was made possible by improvements in computer hardware
allowing flexible software beamforming. This technology was initially developed for shear
wave elastography and later applied to Doppler imaging.
2.2.5. Functional ultrasound imaging—
Ultrafast Doppler imaging has raised the
sensitivity of conventional Doppler imaging by a factor of 30, leading to high-resolution,
high–signal-to-noise ratio maps of the brain vasculature in rodents (
16
). The sequential
acquisition of vascular maps of the brain with ultrafast Doppler has enabled the detection of
neural activity through neurovascular coupling (
17
). Research efforts are ongoing to turn
functional ultrasound imaging of the brain into a full-fledged neuroscience modality that
complements functional magnetic resonance imaging (MRI) with improved spatiotemporal
resolution, portability, and cost.
2.2.6. Ultrasound localization microscopy—
Superresolution ultrasound imaging, also
based on ultrafast ultrasound, was recently introduced using microbubbles as blinking
sources. It was used to generate sub–10 μm–resolution images of the brain or tumors at the
organ scale (Figure 1
d
) (
18
,
19
).
To obtain 3D information, linear array transducers are typically translated in the transverse
direction, acquiring multiple 2D planes. In the future, all the imaging modes described above
could be translated into 3D with the use of dedicated ultrasound probes made of 2D arrays
of transducers.
2.3. Focused Ultrasound Actuation
Thanks to the low attenuation of soft tissues, energy can be deposited at a specific location
deep within the body using FUS (Figure 1
e
). Ultrasound can be applied based on known
anatomical targeting or used under real-time guidance from magnetic resonance imaging
(
20
), allowing accurate localization of the target site and monitoring effects on the tissue.
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Ultrasound can be focused using either a curved single-element transducer or electronically
focused multielement phased arrays, which in addition to steering the beam can correct for
wave-front aberrations caused by acoustically mismatched tissues, such as the human skull
(
21
).
There are three basic modes of ultrasound energy delivery (Figure 2): heat generation,
exertion of ARF, and acoustic cavitation (
22
). Heating occurs owing to viscous dissipation
as molecules move back and forth at the ultrasound focus, increasing with greater acoustic
frequency and intensity. Reaching substantial temperature elevations typically requires pulse
durations on the order of seconds. ARF in traveling ultrasound waves arises from the loss of
momentum as sound waves become attenuated or reflected; by conservation, this momentum
is transferred to particles in the medium. This effect scales with attenuation and usually
requires pulses on the order of milliseconds for target tissues to reach their maximal elastic
response to ARF. In addition to traveling waves, ARF can also arise in standing ultrasound
waves owing to the presence of pressure nodes and antinodes, attracting or repelling
particles based on their material properties (
23
). Finally, cavitation arises through the
interaction of ultrasound with bubbles, which may arise spontaneously in the medium or
become nucleated at material interfaces or are introduced as external cavitation agents (
24
).
Cavitation can be stable, with gas bubbles periodically oscillating around their initial radius
at the frequency of the acoustic wave, or inertial, in which rapid growth of the bubble
followed by violent collapse releases large forces and fluid jets into surrounding media.
Stable cavitation occurs preferentially at the resonance frequency of each bubble, with
inertial cavitation becoming more likely with increases in the ratio between the peak
negative pressure and the square root of the frequency—a ratio termed the mechanical index,
with units of MPa MHz −½ (
1
).
Each of these modes has been exploited for therapeutic purposes, such as thermal tissue
ablation (
25
–
28
), local drug delivery (
29
–
31
), and thrombolysis (
32
), and has the potential to
interact with biomolecules. Not covered in this review, unfocused ultrasound in the 20–100-
kHz range is also widely used in laboratory and industrial processes to disrupt material
structures, accelerate chemical processes, and clean surfaces. Most of these effects are
thought to be mediated by cavitation (
33
).
2.4. Comparison of Ultrasound with Other Modalities for Imaging and Control
In comparison with other modalities for imaging and control of biological function,
ultrasound provides exceptionally high temporal resolution with scalable, frequency-
dependent spatial resolution and penetration depth. In addition, it offers a relatively wide
variety of physical interactions for potential biomolecular coupling. Many of these unique
advantages stem from fortuitous physical parameters. The density and compressibility of
tissue lead to ultrasound wavelengths in the mid-micron range, whereas the relative
homogeneity of tissue on this size scale leads to low scattering, enabling sound waves to
penetrate deeply and be treated as coherent on their way in and out of the body. These
characteristics also make it intrinsically straightforward to do things with ultrasound that
may be harder with other modalities, such as pulse and wave-front shaping and
superresolved signal reconstruction. In addition, the ability of ultrasound to deposit focused
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momentum and energy in media allows it to interact with appropriate molecules, cells, and
tissues through thermal and mechanical mechanisms.
However, ultrasound does have some limitations compared with other methods. For instance,
its ability to penetrate bony enclosures and air-filled compartments is limited compared with
magnetic resonance and radioactive techniques. Furthermore, although the spatial precision
of ultrasound can be scaled with frequency, achieving a (nonsuper-)spatial resolution
approaching optical imaging (~1 μm) would require using a frequency (1.5 GHz) (
34
) that is
readily attenuated within less than 1 mm of tissue, obviating a key advantage of ultrasound
compared with optical methods. Most importantly for the purpose of this review, ultrasound
currently has far fewer biomolecular tools to connect it to cellular and molecular function.
However, as addressed in the following sections, new tools are starting to emerge to address
this gap.
3. BIOMOLECULAR CONTRAST AGENTS AND REPORTER GENES FOR
ULTRASOUND
3.1. Gas Vesicles
For several decades, micron-sized synthetic bubbles have been used as ultrasound contrast
agents, leading to important preclinical and clinical applications (
9
–
11
). Although these
bubbles can be functionalized to recognize and bind to specific targets in the bloodstream,
their size and limited in vivo stability make it challenging to use them for molecular imaging
of extravascular targets and monitoring of dynamic cellular processes. In 2014, a unique
class of gas-filled proteins called gas vesicles were introduced as the first biomolecular
contrast agents for ultrasound, paving the way for more direct visualization of cellular and
molecular function using sound waves (
35
).
3.1.1. Basic biology and history of gas vesicles as ultrasound reporters—
Gas
vesicles (GVs) were initially identified in 1965 as components of gas vacuoles found in
cyanobacteria (
36
), themselves first observed in 1895 as intracellular bodies whose native
function is to regulate cellular buoyancy for optimal access to light and nutrients (
37
). GVs
of different shapes and sizes have been identified in a variety of bacteria and archaea and
have been studied by pioneering biology groups to determine their basic genetic, structural,
physical, and biochemical properties (
38
,
39
). GVs are cylindrical or spindle-shaped protein
nanostructures, with lengths ranging from 100 nm to 2 μm and widths of 45–200 nm (Figure
3
a,b
). GVs comprise a 2-nm-thick amphiphilic shell that allows gas from the surrounding
media to freely permeate in and out of their hollow interior, while excluding the aqueous
phase. This amphiphilicity is accomplished by the primary structural constituent of GVs, a
~7.5-kDa protein called GvpA, which is predicted to fold into a beta sheet structure with
hydrophobic and hydrophilic faces (
40
) (Figure 3
c
). In addition to GvpA, a cluster of 7–13
other genes is needed to enable GV production (Figure 3
d
), encoding minor structural
proteins and assembly factors such as chaperones and nucleators (
38
,
39
).
GVs are a remarkable product of evolution. First, whereas nanoscale bubbles are highly
unstable owing to their high Laplace pressure, GVs are fundamentally physically stable and
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in equilibrium with their surroundings; gas dissolved in surrounding media equilibrates with
the contents of GVs on a microsecond timescale (
41
). Second, despite having a ratio of
~75:1 between their diameter and shell thickness, GVs can withstand pressures of up to 1.3
MPa before collapsing (
38
). Third, the entire GV structure, with a molecular weight in the
range of ~50–350 MDa, is self-assembled mostly from a single 7.5-kDa protein repeated in
its shell in a highly ordered arrangement.
The first demonstration of GVs as acoustic biomolecules, published in 2014, showed that
GVs from
Anabaena flos-aquae
(Ana) and
Halobacterium salinarum NRC-1
(Halo) could
produce ultrasound contrast in their purified form, inside cells, and after injection in vivo
(Figure 3
e
), opening the door to their development as biomolecular reporters for ultrasound
and as targeted nanoscale agents for molecular imaging (
35
). The GVs were detectable at
concentrations below 12 pM (corresponding to ~3.5 μg/ml or 0.005% volume fraction) (
35
,
42
). This initial study provided a glimpse of the potential of GVs to serve as background-
subtracted imaging agents based on their ability to collapse at specific acoustic pressures, the
ability to distinguish multiple GV types for multiplexing, and their production of nonlinear
acoustic signals. Since then, considerable progress has been made in understanding and
engineering the acoustic properties of GVs, enhancing the ability of ultrasound to detect
them, and developing them as acoustic reporter genes (
42
–
46
).
3.1.2. Understanding and engineering the acoustic and targeting properties of
gas vesicles—
From the perspective of biomolecular engineering, the genetic encodability
of GVs raises the possibility of tuning the properties of these acoustic contrast agents at the
level of their DNA sequence and constituent proteins. The outer shell of GVs is composed
almost entirely of GV proteins A and C (GvpA and GvpC). GvpA is a ~7.5-kDa amphiphilic
protein that composes the primary GV shell material, whereas GvpC forms the outer
scaffold that influences shape and structural integrity (Figure 3
d
) (
38
,
39
).
In 2016, a versatile molecular engineering platform based on GvpC was established to
modify the mechanical, acoustic, surface, and targeting properties of purified Ana GVs (
43
).
This platform was based on removing the wild-type GvpC bound to Ana GV shells and
replacing it with genetically engineered versions of this protein. This is done conveniently
by treating Ana GVs with 6-M urea to remove its native GvpC and incubating the stripped
GVs with new GvpC proteins expressed recombinantly in
Escherichia coli
(Figure 3
f
).
Unbound molecules are removed by repeated separation of GVs via centrifugally assisted
flotation. This modular approach allows the testing and use of many different GvpC variants
on the same stripped GV backbone (Figure 3
g
).
Based on GvpC’s large influence on GV shell mechanics (
38
), engineering this protein
enables modulation of the way GVs respond to and scatter ultrasound (
43
). For example, it
allows tuning of the pressure at which GVs collapse and thereby lose their ultrasound
contrast, enabling multiplexed imaging through serial collapse (Figure 3
h
). The direct
relationship established between hydrostatic and acoustic GV collapse pressures provides a
convenient method to evaluate GV modifications to generate tuned variants (
43
). In addition
to mechanical tuning, GvpC can be used as a genetic handle for GV functionalization to
achieve cell-specific molecular targeting, tuning of GV uptake by macrophages, and
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multimodal imaging with ultrasound and fluorescence (Figure 3
g
). GvpC functionalization
is achieved by direct fusion of the relevant peptides, or via a bio-orthogonal covalent
attachment using the SpyTag-SpyCatcher protein assembly system. Genetic fusion to GvpC
has also been used to develop GVs as antigen display particles (
47
).
Although initial engineering efforts have primarily focused on substituting one component
of GVs purified from native hosts with genetically engineered versions, an alternative
strategy would be to engineer GVs entirely at the level of their DNA sequence and express
these modified gene clusters in native or heterologous hosts. Natural GVs come in a variety
of shapes, sizes, and collapse pressures depending on their microbial origin (
38
,
39
). A
rational genetic engineering approach combining elements from different native GV gene
clusters, or making functionally conservative mutations in certain GV genes, could be used
to engineer hybrid or mutant GVs that display unique mechanical and acoustic phenotypes.
Such mutations have been shown in basic studies to produce a variety of GV shape
phenotypes (
48
–
50
). This aspect is further explored in the context of developing acoustic
reporter genes, as elaborated in a later section.
3.1.3. Gas vesicle mechanics and pulse sequences for imaging them—
Among
the most useful properties of GVs for ultrasound imaging is their nonlinear mechanical
response to ultrasound. This response was originally observed as backscattering at
harmonics of the excitation frequency and was understood in subsequent studies as the
product of nonlinear buckling deformations of the GV shell (
44
,
45
) (Figure 3
i
). In these
studies, finite element modeling of two types of single GVs predicted the existence of a
pressure-dependent buckling behavior of the GV shell at the applied acoustic frequency,
with these step changes in GV volume resulting in harmonic scattering (Figure 3
j
). This
buckling takes place only above a threshold pressure specific to each GV type, which can be
tuned through genetic engineering (
45
). Remarkably, these buckling deformations are fully
reversible when they take place at megahertz frequencies, allowing GVs to respond to
thousands of ultrasound cycles every second. This reversibility is aided by the inability of
GV-contained gas to exit the shell on a sub-microsecond timescale, so that it becomes
compressed after buckling and resists the total collapse of GVs (
44
). Pressures that produce
buckling under ultrasound tend to collapse GVs irreversibly when applied hydrostatically, as
this quasistatic compression allows gas molecules to exit the GV during pressurization, with
the shell carrying the full compressive load by itself.
The specific nondestructive detection of GVs in vivo against anatomical background is key
to ensuring the success of GVs as ultrasound reporters. Toward this end, an imaging
approach was recently developed to take advantage of GVs’ nonlinear buckling behavior.
This technique uses an amplitude modulation (AM) sequence that detects differential
backscattering generated by two consecutive transmissions of different amplitudes, with the
stronger and weaker pulses above and below the buckling threshold, respectively (
45
). AM
produced greater GV contrast specificity and was used to distinguish engineered GVs from
linear scatterers in vitro (Figure 3
k
) and in vivo.
Mechanical modeling of GVs also yielded an estimate of the scattering cross section of
single GVs (
44
). For Halo GVs, this cross section was similar to that of a RBC at 20 MHz,
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despite the GV being 4,500 times smaller (volumes of 20 aL for a GV and 90 pL for a
RBC).
3.1.4. Development of acoustic reporter genes—
The discovery of GVs as acoustic
biomolecules raises the potential of their development as acoustic reporter genes (ARGs),
which could do for ultrasound what green fluorescent protein (GFP) and its derivatives have
done for optical imaging. Development of ARGs requires functional heterologous
expression of GV operons, which was initially pursued in commensal and therapeutic
microbes as a means to image their location and function inside mammalian hosts—an
important capability for basic microbiome research and biomedical synthetic biology. In the
first study to introduce ARGs,
E. coli
and
Salmonella typhimurium
cells were genetically
engineered to produce ultrasound image contrast (
46
) (Figure 4
a
). This development
required engineering a hybrid GV gene cluster with components from two organisms. This
was necessitated by the observations that the transfer of GV gene clusters from organisms
producing known echogenic GVs (Ana and Halo) did not result in GV production in
E. coli.
At the same time, the expression of a known
E. coli
–compatible GV gene cluster from
Bacillus megaterium
(
51
) produced small GVs conferring little to no ultrasound contrast to
their host cells. The solution was to combine the structural proteins GvpA and GvpC from
Ana with the assembly factors from
B. megaterium
. This resulted in cells with strong
ultrasound contrast corresponding to their expression of this hybrid operon, which was
named ARG1 (Figure 4
a
).
On average, cells transformed to express ARG1 produced 100 GVs per cell, accounting for
approximately 10% of their intracellular volume (Figure 4
b
). Placed downstream from a
chemically inducible promoter, these cells produced ultrasound contrast corresponding to
the expected transfer function of the inducer (Figure 4
c,d
). By using appropriate promoters,
ARGs were adapted to a range of microbes, such as probiotic bacterial strain
E. coli
Nissle
1917 (EcN) and the medically relevant attenuated
S. typhimurium
strain ELH1301. The
spatial distribution of EcN-expressing ARGs could be imaged with ultrasound in the mouse
colon (Figure 4
e
); their spatial arrangement was more clearly delineated compared with the
diffuse optical signals generated by EcN cells expressing a bioluminescent reporter.
An important aspect of reporter genes is the ability to multiplex different colors of the
reporter (e.g., blue and green fluorescent protein) to visualize multiple cell types or
molecular signals. Following the strategy used with purified GVs, genetic modification of
GvpC in the ARG1 cluster resulted in intracellular GVs with different acoustic collapse
pressures, allowing duplex imaging (
46
). Future genetic engineering of ARGs will also
benefit from high-throughput screening to develop variants with new acoustic or
biochemical properties. Toward this end, bacterial colonies containing ARG plasmids can be
imaged with ultrasound directly on agar plates, allowing rapid detection of different ARG
phenotypes.
Beyond the development of ARGs for microbial imaging, there is a strong impetus to
develop ARGs for mammalian cells, as this would allow the imaging of mammalian gene
expression and tracking of the location and function of cellular therapeutics. Toward this
end, a major effort is under way to transfer the genetic machinery encoding GVs from
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prokaryotes to eukaryotes. This effort represents a significant synthetic biology challenge
owing to the large number of genes involved in the operon, the importance of their
stoichiometry, and the requirement that the proteins they encode find each other and self-
assemble inside the cell.
3.2. Alternative Biomolecular Reporters for Ultrasound
In addition to GVs, other possibilities could be explored as potential sources of biomolecular
and genetically encodable ultrasound contrast. One possible reporter gene mechanism
involves local accumulation of synthetic microbubble contrast agents in tissues expressing a
biorthogonal binding group. Turnbull and colleagues (
52
) pioneered this approach by
transfecting cells with an engineered transmembrane protein displaying an extracellular
peptide substrate for biotinylation, together with an endoplasmic reticulum–targeted biotin
ligase enzyme. This resulted in the display of biotin on the surface of cells. Transgenic mice
expressing this construct under the control of a vascular promoter displayed biotin on their
vascular endothelium, leading to accumulation of intravenous avidin-functionalized
microbubbles, which were visualized with ultrasound.
Another possibility involves local generation of bubbles with gas-producing enzymes.
Mattrey and collaborators (
53
,
54
) showed that 200–500-nm silica nanoparticles loaded with
catalase, which produces water and molecular oxygen from H
2
O
2
, can generate ultrasound-
visible bubbles in peroxide-rich media and tissues. Although free bubbles generated via this
mechanism are physically unstable, they had apparent lifetimes of several minutes in tissue,
allowing imaging. This constitutes an example of an active molecular sensor (of peroxide)
for ultrasound and raises the possibility that a gas-producing enzyme such as catalase could
serve as a reporter gene. However, this possibility entails questions about the availability of
reactants, the kinetics of gas formation and dissolution, and the potential impact of the
enzymatic activity and free bubble formation on the cell. Finally, although they are outside
the scope of this review, emerging synthetic technologies, such as perfluorocarbon
nanodroplets that become converted to microscale bubbles after exposure to ultrasound (
55
),
could be used as synthetic labels for cells or as extravasating targeted contrast agents.
4. SONOGENETIC ACTUATION OF CELLULAR SIGNALING
FUS has a long history of use as a therapeutic modality, with current applications primarily
focused on localized ablation of deep tissue targets (
25
–
28
). However, ultrasound’s ability to
be focused and deliver energy to a site of interest with millimeter precision could also be
used to provide an input signal for biomolecular and cellular signaling. For example,
ultrasound’s ability to controllably elevate temperature by several degrees Celsius under
image guidance could provide a safe, rapid, reversible signal for biomolecular actuation. In
addition, its ability to apply mechanical forces to tissues and scattering objects could be
harnessed to control mechanical signaling. Coupled to appropriate genetically encoded
molecular constructs, this would provide sonogenetic control of cellular function, analogous
to optogenetic and chemogenetic techniques, which use optical and chemical inputs.
Specific examples would be the excitability of specific neurons, the proliferation of
microbes in the gut, or the release of cell-expressing therapeutic payloads.
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4.1. Thermally Mediated Ultrasonic Control
A wide array of thermal bioswitches have the potential to translate elevations in temperature
into biochemical reactions that control cellular signaling and/or the expression of specific
genes. These switches include heat shock promoters (
56
), temperature-sensitive ion channels
(
57
), riboswitches (
58
), and heat-responsive transcription repressors (
59
,
60
).
Pioneering studies on temperature-mediated responses to ultrasound have focused on the
mammalian heat shock promoter HSP70, whose induction upon FUS has been linked to
several genetic outputs, including the expression of reporter genes (
61
), suicide genes (
62
),
and cytokines (
63
). HSP70 is a good starting point for thermal control because it is tightly
repressed in the off state and rapidly inducible after only a few minutes of stimulation at
43°C, with the potential to reach several thousand-fold induction (
64
,
65
). However, HSP70
can also respond to other stress stimuli, such as hypoxia, glucose starvation, and viral
infection (
66
), which renders controlling gene expression solely via changes in temperature
more challenging. Moreover, thermal induction of HSPs is transient and varies among cell
types; therefore, it is ineffective in some cell types, such as neurons (
67
,
68
). Finally, in
bacteria, heat shock promoters have a fairly modest dynamic range and also respond
pleiotropically (
69
,
70
).
Recently, a new class of tunable, orthogonal temperature-dependent transcriptional
repressors was engineered to enable the next generation of sonogenetic thermal bioswitches
(
71
) (Figure 5
a
). These switches use engineered versions of the orthogonal bacterial
transcriptional repressors TlpA and TcI, which have sharp transition temperatures (3–4°C)
and more than 300-fold induction. These switches were engineered using directed evolution
to have tunable set-points within the biomedically relevant temperature range of 32–46°C.
They have been integrated into thermal logic circuits to perform complex functions, such as
multiplexing and bandpass activation, and provide precise control over the spatiotemporal
profile and dose of gene expression. Spatially precise activation of these circuits with FUS
was demonstrated in bacterial culture phantoms and inside mammalian hosts with a brief
thermal pulse (
71
). Unlike other bioswitches, these proteins respond solely to temperature
elevations, with a sharp transition that can be tuned for specific applications. Combining
these molecular devices with synthetic biology circuits may advance the use of FUS beyond
simple transient switches to more complex functions, such as sustained, multiplexed, and
on-off switching.
Nontranscriptional responses to ultrasound based on temperature may also be possible. For
example, magnetic and optical hyperthermia have been used in conjunction with
temperature-sensitive ion channels (
72
–
76
). Unfortunately, most temperature-sensitive
channels also respond to other inputs and depend on cellular states such as membrane
potential and pH. RNA thermometers could provide thermal responses at the translational
level, but these switches typically suffer from a broad thermal transition, with relatively
small fold changes and leaky expression at baseline (
58
).
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4.2. Mechanical Actuation of Receptors
As a complement to thermal approaches, ARFs applied to cells could be used to actuate
mechanical signaling. For example, ultrasound amplified by microbubbles can be used to
control mechanosensitive signaling elements, such as ion channels. This concept was first
demonstrated in vitro, where ultrasound triggered the opening of the
E. coli
–derived
mechanosensitive ion channel MscL heterologously expressed in mammalian cells (
77
)
(Figure 5
b
). Subsequently, the endogenous mechanosensitive channel Trp4 was stimulated in
the worm
Caenorhabditis elegans
, in a study that also introduced the term sonogenetics (
78
).
More recently, the Piezo1 mechanosensitive ion channel was expressed in HEK293T and
immune cells and perturbed using a microbubble-mediated acoustic mechanism for remote-
controlled gene activation (
79
). Whereas the kinetics typically associated with thermal
actuation are on the order of seconds, mechanical actuation can operate on millisecond
timescales, potentially enabling control of cell signaling with higher temporal precision.
However, techniques that require microbubbles are limited in their mammalian applications
owing to the difficulty of delivering bubbles out of the blood stream. Several recent studies
have reported effects on mechanosensitive ion channels in vitro in the absence of
microbubbles (
80
,
81
); however, the potential involvement of fluid streaming in these
phenomena may make them less likely to be applicable in vivo.
4.3. Ultrasonic Neuromodulation
Another emerging use of ultrasound in biophysical systems is the excitation or inhibition of
neural activity. Compared with established neuromodulation techniques, such as transcranial
magnetic stimulation, transcranial electrical stimulation, deep brain stimulation, infrared
stimulation, and optogenetics, ultrasonic neuromodulation (UNM) offers unique advantages
as a noninvasive technique that can be focused deeply and precisely inside the brain. The
concept and modern use of UNM were advanced by Fry and colleagues (
82
) in the 1950s
and Tyler and colleagues (
83
,
84
) in 2008, respectively, followed by studies in multiple labs
demonstrating the effects of ultrasound on movement behavior and neural signaling. UNM is
typically performed with relatively low frequencies (0.25~0.7 MHz) to facilitate
transmission through the skull and low intensities (
<
100 W cm
–2
averaged over the pulse
train) to minimize the possibility of side effects, such as cavitation and heating (
85
,
86
).
Parameters leading to motor and sensory responses have been examined in species ranging
from mice (
87
–
90
) to humans (
91
,
92
).
A major issue facing the UNM field is lack of knowledge about the biomolecular, cellular,
and neural circuit mechanisms underpinning this technique. For example, there is
contradictory evidence about whether the motor responses elicited by UNM are the result of
direct modulation of the motor cortex or a by-product of sensory activation. Recently, two
independent groups have demonstrated that UNM can produce off-target sensory responses
in mice (
93
) and guinea pigs (
94
) owing to indirect effects on the auditory system. Although
the frequencies used in UNM are inaudible, they may produce mechanical vibrations or
shear waves in the brain and skull that can be transmitted to the ears. Deafening of the
animals confirmed that this effect is likely responsible for some of the motor behaviors
attributed in the literature to direct UNM stimulation. These findings are consistent with
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historical reports of somatosensory and auditory percepts owing to ultrasound in humans
(
95
,
96
).
At the same time, several studies with in vitro preparations have reported the ability of UNM
to directly stimulate or inhibit neurons. In an early study, Tyler et al. (
83
) found that
ultrasound is capable of opening voltage-gated ion channels to evoke action potentials in
brain slices, and it was hypothesized that the mechanical effect of ultrasound might change
the viscoelastic properties of the cell membrane and kinetics of membrane-bound proteins
(
80
,
97
,
98
). In a theoretical study, Shoham and colleagues (
99
) suggested that UNM is
mediated by the nucleation and cavitation of bubbles inside the lipid bilayer. However, this
mechanism has not been confirmed experimentally, and detailed biophysical studies are
needed to fully elucidate how ultrasound affects neuronal excitability. Once a mechanistic
understanding is obtained, the UNM strategy could be optimally tuned for direct, spatially
selective control of human brain function, and neurons could be genetically modified to
strengthen their response to ultrasound for sonogenetic applications.
5. ULTRASOUND-ASSISTED BIOMOLECULAR TRANSPORT
A final mechanism by which ultrasound can interact with biomolecules is by enhancing their
transport through cellular and tissue barriers. This mechanism typically relies on the
cavitational behavior of microbubbles to translate applied ultrasound fields into local strain
on a scale much smaller than the ultrasound wavelength.
5.1. Cellular Sonoporation
Sonoporation is the process of creating pores in cell membranes using ultrasound to
facilitate the transport of molecules into or out of the cell (Figure 6
a
). Both stable and
inertial cavitation have been used for this purpose. Stably vibrating bubbles can potentially
create pores by pushing or pulling on the membranes of adjacent cells (
100
). In addition,
stable cavitation creates acoustic microstreaming that can assist in propelling drugs into cells
(
100
). Meanwhile, inertial cavitation results in the implosion of the microbubble and the
formation of jets, leading to membrane disruption (
101
). By focusing the ultrasound beam at
the desired location, these mechanisms can improve the delivery of molecules such as drugs
(
102
) and genes (
103
) into target cells.
5.2. Vascular Barrier Opening
Delivering biomolecules and other substances to the central nervous system poses a
particular challenge owing to the blood-brain barrier (BBB), an endothelial tissue with
specialized tight junctions, which limits the physical transport of molecules from the blood
into the brain. Additionally, vascular cells in the BBB are less permeable owing to their
reduced number of fenestrations, less-efficient pinocytosis, and expression of efflux pumps.
While the BBB protects the brain from unwanted metabolites and pathogens, its
consequence for neuroscience and neuropsychiatric medicine is that only small, lipophilic
molecules are typically capable of entering the brain from the bloodstream, limiting the tools
available for research and therapy. Work over the past two decades has demonstrated that
FUS applied transcranially after an intravenous administration of microbubbles results in
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