As an alternative to viral-mediated therapies, non-viral-mediated gene therapies provide a unique opportunity to advance the field through the use of acoustic microspheres. These serve as a non-invasive, monitoring systems coupled with the opportunity to provide a localized delivery method, without the associated risks of ionizing radiation or potential chromosomal insertion (mutagenesis). The ongoing work of the investigators from the University of Bergen have broken new ground with their report of the use of acoustic microspheres to both monitor and better deliver chemotherapy to patients suffering from pancreatic cancer (Kotopoulis et al. 2013). The dual approach to therapy has been realized and presents a propitious beginning. Due to the advent and improvement of this technology, the list of potential applications of drug UTMD (ultrasound-targeted microbubble destruction) – from small molecules to plasmid DNA – is seemingly limitless. To this end, CV microbubble drug delivery may encompass the three forms of intervention, including pre-event management; HDL regulation via gene therapy, and intra-event relief; vascular reperfusion by sonothrombolyis, and post-event maintenance; prevention of restenosis through siRNA silencing.

The CEUS migration from diagnostic to therapeutic applications has opened new horizons for the volumetric analyses of microvascular perfusion monitoring and therapeutic delivery of localized agents. The ongoing developments in this technology provide a platform for designer therapies useful in complex diseases. In addition, the concurrent advancement of acoustic hardware, software and “wetware” will accelerate this progress. Collaborations between academia, industry and pharma should begin to focus their efforts to further define the underlying mechanisms, as well as determine the most relevant technology applications. This coupling of investigations and optimization for acoustic sonoporation will provide an opportunity to advance the field of medicine (Castle et al. 2013). This will require forward–looking study design, which has the highest potential for translational success, as research advances from discovery through to early clinical trials. In doing so, the concept of using microspheres to safely and effectively administer therapy is rapidly becoming a reality.