2021 Focused Ultrasound Foundation - Midyear Report

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2021 Focused Ultrasound Foundation - Midyear Report
Focused Ultrasound Foundation

2021
Midyear Report
2021 Focused Ultrasound Foundation - Midyear Report
2021 Focused Ultrasound Foundation - Midyear Report
Growth and Progress
Despite Confusing Times
We were hoping by this time Covid’s grip on the way
we live and work would have relented. Unfortunately, this
has not occurred and there remains often confusing rules
and regulations impacting where and how we work, travel,
and learn.

But the good news is that the Foundation staff and focused
ultrasound community at large have adjusted to operating
in this state of uncertainty. The field continues to grow—to
thrive, actually—with increasing momentum, as documented
here and in our recent 2021 State of the Field report.

This year has already seen first-in-human clinical trials,
important brain and body studies, workshops, strategic
partnerships, reimbursement wins, developments in
Asia—and even a record number of interns and fellows at
the Foundation.

This widespread progress is a testimony to the commitment
of all the stakeholders in the focused ultrasound community
to improve the lives of millions of people around the world
with a wide variety of serious medical disorders.

We thank you for your continued interest, support, and effort.
Be well.

Neal F. Kassell, MD

             Focused Ultrasound Foundation | 2021 Midyear Report   1
2021 Focused Ultrasound Foundation - Midyear Report
creating knowledge research milestones
           Global research institutions have pioneered focused ultrasound
           in the areas of veterinary cancer, MR imaging, transcranial histotripsy, and liver tumors.

                                    preclinical                            Improving MRI for
                                                                           Focused ultrasound

                                       studies
                                                                           A collaborative team of researchers at
                                                                           the University of Virginia and Virginia
                                                                           Polytechnic Institute and State
                                                                           University developed a transcranial
                                                                           focused ultrasound treatment bath that
                                                                           is invisible during MRI scans. Because

Clinical trial                                                             degassed water degrades the quality of
                                                                           the MR-guided images, this important
Veterinary cancer                                                          and innovative advance could be used
                                                                           to replace degassed water as an acoustic
Researchers at Oklahoma State
                                                                           coupling bath. The newly designed
University studied whether two types
                                                                           coupling bath material contains specially
of focused ultrasound—mechanical and
                                                                           designed iron oxide nanoparticles. n
thermal ablation—would be effective
in treating various types of low-grade
tumors in dogs. The group treated
a total of 11 dogs with six different
types of tumors and then compared
the therapeutic and immunological
effectiveness of the treatments.
Several of the dogs had
complete tumor remission. n

2       Focused Ultrasound Foundation | 2021 Midyear Report
2021 Focused Ultrasound Foundation - Midyear Report
creating knowledge research milestones

                                         Cholangiocarcinoma
                                         Liver tumors
What is                                  Preclinical researchers at Virginia           Transcranial
                                         Polytechnic Institute and State
Histotripsy?                             University completed a study to
                                                                                       Histotripsy
                                         determine the optimal histotripsy
Histotripsy is a mode of focused                                                       Researchers at the University of
                                         parameters to ablate cholangiocarcinoma,
ultrasound involving very short, high-                                                 Michigan completed in-vivo brain
                                         a rare liver cancer with a low 5-year
intensity ultrasound pulses (powerful                                                  histotripsy experiments in a preclinical
                                         survival rate of 10%. The study was
pressure waves) to mechanically                                                        model to demonstrate the safety
                                         conducted in collaboration with Hospital
break up tissue to destroy it.                                                         of the technique. This project, which
                                         Universitari Mutua de Terrassa in             is currently in review for academic
Histotripsy is a fundamentally           Barcelona, Spain, that provided               publication, helped move the
different mechanism of action than       human liver tissue specimens for use          technology closer to clinical work with
thermal ablation and could allow for     in histotripsy experiments. n                 histotripsy for brain tumor treatment. n
much faster treatment times, as it
enables single-session treatment of
much larger targets than possible

histotripsy
with thermal ablation. n

                                                                                                  time

                   pressure

                                                                          Focused Ultrasound Foundation | 2021 Midyear Report     3
2021 Focused Ultrasound Foundation - Midyear Report
creating knowledge research milestones
           The brain is considered the vanguard target for focused
           ultrasound. Important human studies are assessing treatment for glioblastoma and
           liquid biopsy to improve brain tumor marker detection.

                           clinical trials                                                   Enhanced blood testing
                                                                                             Brain tumors
                                                                                             Researchers from Sunnybrook and the
                                                                                             University of Toronto completed the
                                                                                             first clinical study to test the ability
                                                                                             of focused ultrasound to enhance brain

Glioblastoma                                    Glioblastoma                                 tumor biomarker detection from
                                                                                             a routine blood sample. Nine patients
BBB opening +                                   Sonodynamic                                  with GBM underwent the technique—
chemotherapy                                    therapy                                      called liquid biopsy—before and after
                                                                                             focused ultrasound treatment that
A new clinical trial is underway at             The first three high-grade glioma
                                                                                             disrupted the blood-brain barrier to
Northwestern University in Chicago,             patients have been enrolled in a new
                                                                                             enhance chemotherapy delivery. The
Illinois, for patients with recurrent           sonodynamic therapy and focused
                                                                                             results suggest that liquid biopsy could
glioblastoma (GBM).                             ultrasound clinical trial at the Ivy Brain
                                                                                             reduce the need for invasive brain tumor
                                                Tumor Center at Barrow Neurological
Phase I of the trial is determining the                                                      biopsies and allow for better monitoring
                                                Institute in Phoenix, Arizona. This trial
safe dose of the chemotherapy drug                                                           of GBM treatment responses.
                                                is investigating the use of focused
Abraxane®; phase II will evaluate the
                                                ultrasound to treat patients with            The world-first results were published in
effectiveness of combining the drug
                                                recurrent GBM and other high-grade           the Journal of Neuro-Oncology. n
with opening the blood-brain barrier
                                                gliomas. Researchers are exploring
using CarThera’s SonoCloud device after
                                                sonodynamic therapy—or using focused
surgical removal of the recurrent GBM. n
                                                ultrasound to activate a drug to
                                                cause cell death only in the tumor—
                                                in these patients. n

                                                                                             “        To detect cancer biomarkers
                                                                                             through a blood test could provide
                                                                                             a diagnosis for patients and either
                                                                                             avoid an operation or allow the
                                                                                             surgery to be planned in advance.”
                                                                                             — James Perry, MD
                                                                                               Sunnybrook

4       Focused Ultrasound Foundation | 2021 Midyear Report
2021 Focused Ultrasound Foundation - Midyear Report
creating knowledge research milestones

                                            patient spotlight
Barbara’s story
Glioblastoma
Barbara Frisbie wholeheartedly “loves       poor track record of conventional GBM          “Rick and I have been involved with
life.” And she has much to love about her   treatments and decided to pursue a             the Focused Ultrasound Foundation for
life in Kilmarnock, Virginia, with her      different course: noninvasive focused          many years,” says Barbara. “We believe
husband of 58 years, Rick, their two sons   ultrasound. She recently became the            in the technology and the promise that
and four grandchildren, and many friends.   first patient treated in a GBM focused         it holds for humanity. I feel fortunate to
                                            ultrasound clinical trial at the University    be able to take part in a clinical trial.”
On March 5, 2021, Barbara suddenly
                                            of Virginia (UVA). The trial—led by
suffered a seizure and was flown to                                                        “The use of focused ultrasound to open
                                            Jason Sheehan, MD, PhD, Professor of
VCU Medical Center in Richmond,                                                            the blood-brain barrier should permit
                                            Neurological Surgery at UVA and the
Virginia, where she was diagnosed                                                          appreciably more chemotherapy to be
                                            Foundation’s Senior Advisor for Brain
with a glioblastoma (GBM). GBMs are                                                        delivered to brain tumors and, hopefully,
                                            Tumor Research—aims to open the
an aggressive type of malignant brain                                                      lead to therapeutic benefits,” adds Dr.
                                            blood-brain barrier to allow higher
tumor with a generally poor prognosis.                                                     Sheehan. “This approach could be a
                                            concentrations of chemotherapy to enter
                                                                                           game changer.” n
After completing the initial surgery        the brain to destroy any residual tumor
and radiation, Barbara considered the       tissue and hinder regrowth.

                                                                                               Read Barbara’s full story on the
                                                                                               Foundation’s website.

                                                                              Focused Ultrasound Foundation | 2021 Midyear Report       5
2021 Focused Ultrasound Foundation - Midyear Report
creating knowledge research milestones
           Additional major brain research beginning in 2021 is focusing on
           debilitating pain, Parkinson’s disease, and pediatric DIPG.

                          clinical trials                                                       Pediatric DIPG
                                                                                                A team at Columbia University has
                                                                                                launched their first-in-human clinical
                                                                                                trial using focused ultrasound to treat
                                                                                                diffuse intrinsic pontine gliomas (DIPGs),
                                                                                                a malignant brain tumor that typically
                                                                                                affects young children. The phase I
Trigeminal neuralgia Parkinson’s disease                                                        trial is assessing the use of focused

A team at the University of Maryland            A novel pivotal trial validating the use        ultrasound to disrupt the blood-brain

has launched a clinical trial investigating     of focused ultrasound to treat the              barrier to allow increased amounts of

the use of focused ultrasound to address        cardinal features of Parkinson’s disease        chemotherapy to more effectively reach

trigeminal neuralgia, a chronic and             (PD) was published in the New England           the brain tumor. n

disabling pain condition. Researchers are       Journal of Medicine.
using focused ultrasound to ablate
                                                Professor José Obeso and his team at
a small nucleus in the thalamus located
                                                HM CINAC in Madrid, Spain, collaborated
deep within the brain—called the
                                                with W. Jeffrey Elias, MD, at the School
central lateral nucleus—which is known
                                                of Medicine at the University of
to play a role in pain perception and
                                                Virginia. Both groups used focused
transmission. n
                                                ultrasound to successfully ablate a
                                                portion of the brain called the subthalamic
                                                nucleus, a proven neurosurgical target
                                                for treating features of PD. n

october meeting                                               The Foundation is sponsoring
                                                              a virtual workshop on focused
                                                              ultrasound for DIPG in October.

6       Focused Ultrasound Foundation | 2021 Midyear Report
2021 Focused Ultrasound Foundation - Midyear Report
creating knowledge research milestones
           A first-in-human heart valve disease trial and positive results using
           focused ultrasound to relieve significant hand movement issues are highlights of clinical trials
           around the globe.

Focal hand dystonia
                                                                                        Inaugural
A team of researchers in Japan led by                                                   Andrew J. Lockhart
Takaomi Taira, MD, PhD, investigated
whether focused ultrasound
                                                                                        Postdoctoral Fellow
thalamotomy could be used to treat                                                      Caitlin Tydings, MD, was awarded
focal hand dystonia (FHD), which                                                        the inaugural Andrew J. Lockhart
causes excessive and involuntary muscle
contractions in the fingers, hand,
                                          Aortic stenosis                               Postdoctoral Fellowship in Focused
                                                                                        Ultrasound and Immuno-Oncology.
and forearm. Researchers concluded        A team of clinicians and researchers          At Children’s National Hospital,
that focused ultrasound thalamotomy       from France and The Netherlands               Dr. Tydings is developing focused
significantly improved FHD. n             shared results from a clinical trial using    ultrasound as an immune modulator
                                          focused ultrasound to treat calcific          in pediatric cancers. The one-year
                                          aortic stenosis, the most common              fellowship—established through the
                                          disease for heart valves. The study           generosity of the Lockhart family
                                          uses Cardiawave’s Valvosoft , an
                                                                       ®
                                                                                        in honor of their son, Andrew J.
                                          investigational device being developed        Lockhart—is designed for early-career
                                          to mechanically soften hardened               researchers as a way for the Foundation
                                          valves, improve valve function, and           to cultivate the next generation
                                          reduce symptoms.                              of investigators who could advance
                                                                                        the development and clinical
                                          The first-in-human results were published
                                                                                        adoption of focused ultrasound in
                                          in Circulation. n
                                                                                        immuno-oncology. n

                                                                           Focused Ultrasound Foundation | 2021 Midyear Report   7
2021 Focused Ultrasound Foundation - Midyear Report
convening the community
              Providing critical space for conversations continues to be a major
              focus of the Foundation’s work and resources.

GBM Workshop                                       23-28 October 2022
                                                         please join us
In May, the Foundation partnered with
the Society for Neuro-oncology and
the AANS/CNS Tumor Section to host
a virtual workshop discussing focused
ultrasound for GBM. More than 260
attendees from nearly 60 institutions
                                                   8th Symposium
worldwide convened to share                        on Focused Ultrasound
knowledge, identify gaps in evidence,
                                                   This meeting is being planned as          clinicians, and other stakeholders
and create a roadmap for the technical
                                                   a hybrid virtual and in-person event in   virtually—more than 1,800 participants
developments, laboratory studies, and
                                                   Bethesda, Maryland.                       from 58 countries—to showcase the
clinical trials necessary for focused
ultrasound to progress in the treatment                                                      tremendous progress in the field of
                                                   The final proceedings from the 7th
of GBM. n                                                                                    focused ultrasound. n
                                                   International Symposium on Focused
                                                   Ultrasound are now available. The
                                                   2020 fall symposium united scientists,
         A video archive of the presentations is
                      available on our website.

                                                   +250
    A white paper summarizing the workshop’s
           proceedings is also available online.

                                                   Scientific presentations

                                                   19
                                                   Expert panels

8         Focused Ultrasound Foundation | 2021 Midyear Report
fostering collaboration
           Facilitating patient access and commercialization of the
           technology through strategic professional and trade partnerships remains a priority for
           the Foundation.

new partnerships

 125
                                          Advocacy

Connecting with
Professional organizations
                                          As part of the Foundation’s advocacy
                                          efforts, we partnered with the Medical
                                          Device Manufacturers Association
                                          (MDMA), a national trade association
                                                                                     “         We believe it’s important

                                                                                      to have all the various trade

                                                                                      associations—including MDMA,

                                          based in Washington, DC, that provides      MITA, and AdvaMed—engaged
The Foundation has partnered with         educational and advocacy assistance to      with focused ultrasound companies
the American Brain Coalition (ABC),       innovative and entrepreneurial medical
                                                                                      and the Foundation so they can
joining a group of more than 125 of       technology companies. Through
the United States’ leading professional                                               better understand the issues
                                          this partnership, the Foundation and
neurological, psychological, and          10 focused ultrasound companies have        we face and effectively advocate on
psychiatric organizations. The ABC is     become members of MDMA. n                   our behalf.”
a nonprofit umbrella organization
that serves as a powerful voice for                                                   — Jessica Foley, PhD
                                                                                        Chief Scientific Officer
people with brain disorders by uniting
                                                                                        Head of Advocacy and Government
various organizations to try to reduce                                                  Relations
the burden of these conditions to                                                       Focused Ultrasound Foundation
individuals, families, and society.

Through this relationship, the
Foundation hopes to bolster its current
advocacy efforts to demonstrate
focused ultrasound’s potential to treat
brain disorders. n

                                                                        Focused Ultrasound Foundation | 2021 Midyear Report   9
cultivating the next generation
           A record number of students and graduates collaborated with
           the Foundation’s medical, scientific, and communications teams.

Wide range of
Internship projects
As part of the 10th year of our robust          Baruch College                                     Ultrasound Microbubble Tumor Analysis
                                                Telemedicine and Telesurgery White Paper           Caleb Hallinan
summer internship program, the
                                                Isabella Berkeley                                  Optimization and Application of
Foundation accepted a record 15
                                                                                                   a FUSF low-cost Hydrophone Scanning System
students and recent graduates. Their            Cornell University                                 Colin Haws
                                                Profiling Asia-Based Companies and Conducting
projects ranged from                            Research on Strategics in Relation to Regulatory   Neuronavigation with VR and Kranion
                                                Approved FUSF Indications                          Adam Kippenhan
a technical nature—such as analyzing
                                                Dylan Shen                                         Optimizing Internet-Based Electronic Outreach
ultrasound wave behavior in a
                                                                                                   Regarding Focused Ultrasound: Facilitating
real-world application; constructing            North Carolina Central University                  Broader Understanding, Reach, and Engagement
                                                Advocacy to Expand Equitable Access to Focused     Darrah Sheehan
computer-based models for treatment             Ultrasound Treatment in Women’s Health
                                                Samia Taliaferro                                   Neuronavigation with Kranion
planning; and simulating focused
                                                                                                   Kathleen Nguyen
ultrasound procedures to improve                Penn State University and
                                                                                                   University of Virginia
patient care—to research, advocacy,             Harvard University
                                                                                                   School of Medicine
                                                Review paper on Theranostics in the Vasculature:
and communications. n                                                                              Sonodynamic Therapy Landscape Analysis
                                                Bioeffects of Ultrasound and Microbubbles
                                                                                                   Leslie Hansen
                                                to Induce Vascular Shut Down
                                                Cancer Immunotherapy Landscape Analysis            Western Albemarle High School
               Summer Interns                   Jackie Brenner
                                                                                                   Optimizing Internet-Based Electronic Outreach

15
                                                Piedmont Virginia                                  Regarding Focused Ultrasound: Facilitating
                                                Community College                                  Broader Understanding, Reach, and Engagement
                                                                                                   Kimball Sheehan
               students                         HIFU Knee Phantom
                                                Jack Snell                                         Xavier University and
                                                                                                   Harvard University

 9
                                                University of Exeter, UK
                                                Focused Ultrasound for Gene Therapy Review         FUSF Hydrophone Tank Lens Application
                                                Juliette Strubel                                   Expanding Simulation Research at FUSF Using
               academic institutions
                                                                                                   CIVA Software
                                                University of Virginia                             Dawn Bordenave
                                                Sonodynamic Therapy Landscape Analysis
     The Foundation’s summer technical          Isha Bhatia

internships are generously funded
by the Claude Moore Charitable
Foundation.

10      Focused Ultrasound Foundation | 2021 Midyear Report
cultivating the next generation

                                         Webinar showcasing
                                         Women in science
A banner year for                        Jackie Brenner—a Foundation intern
                                         who reaches hundreds of thousands
Global Scholars                          of young adults using social media
The Foundation’s Global Scholars         channels like TikTok and Discord to
Program has had a record year in 2021,   teach the basics of science, technology,
supporting:                              engineering, and math—used her
                                         Discord platform, STEMPotential,

24
                                         to host a two-day webinar series
                                         showcasing successful women in STEM.
               students from

20             institutions across

 7             countries
                                         +600                     people from

                                         around the world tuned in to the
                                                                                        Jackie began interning at the

                                                                                        Foundation in 2019, when she
               Canada
               Cyprus                    weekend series, which included                 examined the effects of anesthesia
               Italy                     webinars and panel discussions with
                                                                                        with focused ultrasound in
               Russia                    graduate students, medical students,
               South Korea                                                              glioblastoma. She has transitioned
                                         and medical doctors. n
               United Kingdom
                                                                                        that experience into her current
               United States
                                                                                        internship, where she is researching

                                                                                        the bioeffects of microbubbles
Students in this program paired up
with an established researcher in the                                                   with ultrasound to induce vascular
field of focused ultrasound to conduct                                                  shutdown, sonodynamic therapy,
laboratory or clinical research for                                                     and other immunotherapy
a three-month summer internship. n
                                                                                        projects under the guidance

                                                                                        of Frédéric Padilla, PhD, the

                                                                                        Foundation’s Director of Applied

                                                                                        Physics Research.

                                                                         Focused Ultrasound Foundation | 2021 Midyear Report   11
overcoming barriers
           Regulatory approvals and reimbursement “wins” for new
           clinical applications of focused ultrasound continue around the world.

                                               Essential tremor

                                                                                                          +75
                                               In May, Aetna became the first national
                                               insurance payor in the US to cover
                                               focused ultrasound for medication-

 Reimbursement                                 refractory essential tremor (ET). The
                                                                                          More than 75 treatment centers around
                                               treatment earned FDA approval in
 Highlights                                                                               the world now offer focused ultrasound for ET.
                                               2016 and already has nationwide US

                                                                                          4,000
                                               Medicare coverage.

                                               In 2020, manufacturers reported
                                               a record 1,540 ET patient treatments
                                               across the globe. Reimbursement is a key
                                                                                          Nearly 4,000 patients worldwide have
                                               component in the adoption of focused
 April | In the UK, national                                                              been treated to date.
                                               ultrasound as a standard of care. n
 government insurance coverage went
 into effect for focused ultrasound
 treatment of essential tremor.

 January | A new Category I CPT®
 code went into effect for focused
 ultrasound ablation of malignant
 prostate tissue with EDAP-TMS’ Focal
 One® device, valid for both Medicare
 and private payer reimbursement in
 the US.

 July | The American Medical
 Association issued a new Category III
 CPT® code for histotripsy of the liver.

                                                                                                   Essential tremor
                                                                                                   Medicare and Aetna now provide
                                                                                                   reimbursement in all 50 states
                                                                                                   and Washington, DC.

12     Focused Ultrasound Foundation | 2021 Midyear Report
overcoming barriers

                                          patient spotlight
Tom’s story
Essential tremor
Tom Donegan comes from a “proud           clinical trial assessing bilateral (both sides)
Irish Catholic family” of 11 children—    focused ultrasound treatment.
eight of whom have essential tremor
                                          Today, Tom says, “I feel like I have my
(ET). While he first started noticing
                                          life back. It’s tremendous. Neither of
symptoms in his late 20s, Tom was not
                                          my hands shake anymore. And I don’t
officially diagnosed with ET until
                                          have to take any medication—at all.
age 55, when he could no longer even
                                          I’m hopeful that all my brothers
write his name.
                                          and sisters can benefit from this too.”           “It’s been a game-changer and a life-
In September 2019, Tom underwent                                                            saver. It’s the answer.”
                                          Tom’s brother Phil was successfully
focused ultrasound treatment on his
                                          treated with focused ultrasound on just           Focused ultrasound for essential
left (dominant) side at the University
                                          his dominant side in March 2020 at                tremor is now covered by Medicare in
of Maryland Medical Center. A year
                                          the West Virginia University Rockefeller          all 50 US states. n
later, he was thrilled to have a second
                                          Neuroscience Institute. He received
procedure to address the tremor in his
                                          a second treatment in spring of 2021 on
non-dominant hand as part of a new ET
                                          his nondominant side at the University
                                          of Maryland. and he too Phil says,

                                                                                               Watch Tom and Phil’s story on the
                                                                                               Foundation’s website.

                                                                             Focused Ultrasound Foundation | 2021 Midyear Report    13
overcoming barriers
          Geographic expansion of focused ultrasound is making the
          treatment available to an ever increasing number of patients around the globe.

19
Reimbursement
Expanded                                                                                        Regulatory
                                                                                                Highlights
The Centers for Medicare and Medicaid          Medicare patients in Kentucky, Ohio,
Services announced in March expanded           and 10 states in the Northeast now have
coverage for patients undergoing               access to focused ultrasound therapy
focused ultrasound treatment for               for TDPD; a total of 19 states have
tremor-dominant Parkinson’s disease            announced coverage for the treatment
(TDPD). The decision means that                under Medicare. n
                                                                                                February | Insightec received
                                                                                                approval in China for treatment of
                                                                                                essential tremor and Parkinson’s
                                                                                                disease, tremor.

                                                                                                May | Profound Medical received
                                                                                                the CE Mark in 33 European countries
                                                                                                for treatment of desmoid tumors.

                                                                                                May | Insightec received approval
                                                                                                in Singapore for treatment of
                                                                                                essential tremor and Parkinson’s
                                                                                                disease, tremor.

                                                       Parkinson’s disease reimbursement
                                                               is now available in 19 states.

14     Focused Ultrasound Foundation | 2021 Midyear Report
aggregating & sharing knowledge
           Webinars and publications communicate the latest news
           on focused ultrasound for a broad range of audiences, from clinicians and industry to
           patients and donors.

                                           2021 State of the Field
                                           Report available
                                           The 2021 State of the Field Report
Webinars                                   documents the progress that is only

Educate thousands                          possible through the hard work,
                                           time, and resources of everyone in
Virtual meetings and webinars continued    our community.
to serve as an optimal vehicle for
                                           New this year: an in-depth analysis of
sharing information in the first half of
                                           all research areas; the cumulative
2021. The Foundation’s webinar series
                                           number of mechanisms of action by
covered a wide variety of topics from
                                           indication and stage of research;
neuroethics to advancing women in
                                           and a detailed look at industry trends,
the field. n
                                           regulatory approvals, and investments
                                           in the field. n
l “Picture a Scientist” Panel Discussion
  with Women in Focused Ultrasound                                                                          The 2021 State of the Field Report
                                                                                                            available on the Foundation’s website.
l Focused Ultrasound for Pediatrics
                                              Highlights
l Neuroethics for
  Novel Neurotechnologies

l Focused Ultrasound for
  Cancer Immunotherapy
                                                           Distinct indications   152                                             34
                                                                                                  Indications with regulatory approvals

l Noninvasive HIFU Treatment
  of Varicose Veins:                                              New indications  11          Insured for bone metastases in US120m
  European Experience and
  US Market Perspective
                                                                                    6
                                                      New indications in clinical trials        Eligible patients in the US   302.4m
                                                 Commercial treatment sites       799                                             54
                                                                                                          Clinical device manufacturers

                                                       Clinical research sites    235              FUS industry investment     $326m

                                                                                    6
                                                              Veterinary program sites                                             6
                                                                                                               New FUS industry companies

52,200+        Combined webinar views
                                                             Centers of Excellence 10                                             15
                                                                                                  Companies with regulatory approvals

                                                                                  Focused Ultrasound Foundation | 2021 Midyear Report          15
raising awareness
              Foundation Chairman reaches thousands
              and shares the promise of focused ultrasound treatment across
              multiple virtual platforms.

1
Podcast

In a interview on Health Professional
Radio in June, Foundation chairman
Neal F. Kassell, MD, talked with host
                                                   2
                                                   Blog

                                                   In a popular post published in the
                                                   Foundation’s newsletter in May,
                                                   “Driving Focused Ultrasound into the
                                                                                              3
                                                                                              Virtual presentation

                                                                                              Dr. Kassell also shared current news about
                                                                                              the Foundation and the potential of
                                                                                              focused ultrasound at a Member-Led
Neal Howard about the massive                      Mainstream,” Dr. Kassell shared the five   Forum at the Economic Club of
potential of focused ultrasound and the            elements needed to transform the           Washington, DC (ECW), in April. According
current state of research and treatment            Foundation’s vision into a reality and     to ECW, these “topic-driven, member-
for the technology around the globe.               establish focused ultrasound as a          only, and off-the-record” virtual forums
                                                   mainstream standard of care accessible     are designed to discuss “important issues
Listen on SoundCloud or YouTube
                                                   and utilized globally:                     of the day.” As a result of connections
to hear about the promise of focused
                                                                                              made during the presentation, the
ultrasound therapy for a wide range                   1          evidence
                                                                                              Foundation was also proud to participate
of conditions. n
                                                      2          awareness                    in the ECW’s summer internship program,
                                                                                              which—in partnership with Urban
                                                      3     $    capital                      Alliance—allows scholars to gain real
                                                                                              life work experience, professional
                                                      4		        partners
                                                                                              development, and financial support to
                                                      5		        businesses                   offset college expenses. n

                                                   Focus Feature
                                                   Parkinson’s disease
                                                   The Foundation’s latest Focus Feature,     of Parkinson’s (PD). Focused ultrasound
                                                   “Focused Ultrasound and Parkinson’s        is currently approved in the US and
                                                   Disease,” was released in April            Europe for treatment of tremor-
     Read the full report on                       during Parkinson’s Awareness Month,        dominated PD. This special report—and
     the Foundation’s website                      documenting the important progress         much more about focused ultrasound
                                                   that has been made in the field of         for PD—can be found on our website. n
                                                   focused ultrasound for the treatment

16         Focused Ultrasound Foundation | 2021 Midyear Report
raising awareness

                                               patient spotlight
Rich’s story
Parkinson’s disease
Rich Nagy was on a motorcycle                  with focused ultrasound in October 2020.
camping trip in 2017 when he first             “After only the third sonication, I already
began experiencing the symptoms of             had no involuntary motion in my hand
Parkinson’s disease (PD). Over time            at all! I was just astonished that my
his symptoms worsened, and he was              tremor had stopped.”
eventually diagnosed with PD by
                                               He also noticed that the tension and
a neurologist in his hometown of
                                               nervousness often associated with
Gilbertsville, Pennsylvania.
                                               PD was immediately gone: “It was the            balance—which he assumes is due to
Rich poured himself into researching the       first time in several years that I actually     disease progression, Rich says, “For me,
pros and cons of the various treatment         felt normal.”                                   focused ultrasound was a wonderful
options. He eventually connected with                                                          decision. I have absolutely no regrets,
                                               Nearly a year since his treatment,
Dr. Jeff Elias at the University of Virginia                                                   and I encourage anyone who might be
                                               Rich does not need any medications
in Charlottesville and was treated there                                                       considering the treatment to pursue it
                                               to help with movement issues. And
                                                                                               whole-heartedly.” n
                                               despite noting the return of some mild
                                               symptoms over time—such as issues with

                                                                                                  Read Rich‘s full story on the
                                                                                                  Foundation’s website.

                                                                                 Focused Ultrasound Foundation | 2021 Midyear Report      17
building momentum in Asia
           Medical therapy revolutionization in Asia is occurring due to the rapidly
           growing field of focused ultrasound, made possible through the ambition, time, and resources
           of the global focused ultrasound community.

                                                Asia by the
                                                Numbers
                                                Asia leads the world in                     Regulatory approvals and
                                                commercial treatment sites                  reimbursement in the region

Focused Ultrasound
Hong Kong Foundation
The Foundation created a Hong Kong
subsidiary, Focused Ultrasound Hong
                                                              318
                                                of the 799 total sites are located there.
                                                                                                                 29
                                                                                            indications have been approved for
                                                                                            treatment with focused ultrasound.

                                                               66                                                 9
Kong Foundation (FUSHK), through
which funds are already being received
from Hong Kong and Asia-based
philanthropists to be distributed to
research institutions in Asia. FUSHK will
officially launch in 2022. n                    new FUS commercial treatment sites          Countries in Asia provide reimbursement
                                                have been identified in 2020.               for a total of 7 indications:

                                                                                              Benign prostatic hyperplasia
                                                                                              Bone metastases
                                                                                              Essential tremor
                                                                                              Neuropathic pain
                                                                                              Parkinson’s disease, tremor dominant
                                                                                              Prostate cancer
                                                                                              Uterine fibroids
                                                                                              Major depressive disorder
                                                                                              Alzheimer’s disease

18      Focused Ultrasound Foundation | 2021 Midyear Report
building momentum in Asia
The region leads global regulatory approvals with 28 of
32 occurring in Asia last year, most of which were in Hong Kong and Thailand.

                        28
                         New
                         Approvals

                                      China | NMPA                                       Kazakhstan | NCEM

                                      Benign prostatic hyperplasia                       Essential tremor
                                      Prostate cancer                                    Neuropathic pain
                                                                                         Parkinson‘s disease, tremor

                                      Japan | MHLW                                       Taiwan | FDA
                                      Parkinson‘s disease, dyskinesia
                                                                                         Prostate cancer
                                      Parkinson‘s disease, tremor

                                      Hong Kong | MDD                                    Thailand | FDA

                                      Arthritis, facetogenic                             Arthritis, facetogenic
                                      Bone cancer                                        Bone cancer
                                      Bone metastases                                    Bone metastases
                                      Bone tumors, benign                                Bone tumors, benign
                                      Essential tremor                                   Essential tremor
                                      Multiple myeloma                                   Multiple myeloma
                                      Neuropathic pain                                   Neuropathic pain
                                      Parkinson’s disease, tremor                        Parkinson’s disease, tremor
                                      Uterine adenomyosis                                Prostate cancer
                                      Uterine fibroids                                   Uterine adenomyosis

                                                         Focused Ultrasound Foundation | 2021 Midyear Report           19
building momentum in Asia
            Clinicians, advisors, and manufacturers in Asia have become critical
            partners to the Foundation.

                                                 Companies
                                                 Spotlight
Our ambassadors
in Asia
The Focused Ultrasound Foundation                Neurosona is a Korean focused                  NaviFUS has designed and
has valuable assets on the ground in             ultrasound company that aims to                manufactured neuronavigation and
Asia connecting with manufacturers,              develop the technology for brain               ultrasound-guided focused ultrasound
industry partners, researchers, and              treatments, including neuromodulation.         systems for the treatment of brain
scientists in order to further expand the        Their low-intensity focused ultrasound         diseases and disorders in Taiwan since
global reach of focused ultrasound.              platform has already been used for             2015. Their three current devices are
                                                 several pilot clinical trials, including the   being used in clinical trials for brain
                                                 treatment of major depressive disorder         tumors, epilepsy, and soon, Alzheimer’s
                                                 and Alzheimer’s disease. n                     disease. Biomechanisms in development
                                                                                                include blood-brain barrier opening
Dong-Guk Paeng, PhD, serves as an                                                               and neuromodulation. n
ambassador of the Foundation in Asia,
cultivating relationships with laboratory
and clinical research sites, commercial          Shanghai A&S Science
treatment sites, and manufacturers               Technology Development
throughout the region. n                         has manufactured and marketed                  IMage Guided Therapy—
                                                 diagnostic and therapeutic ultrasound          also known as IMGT Co., LTD—is a
                                                 devices in China and internationally for       Korean company that is developing
                                                 more than 20 years. Its tumor ablation         a nanotechnology-based gene and
                                                 device, HIFUNIT9000, is used to treat          drug delivery system. The system uses
Jessica Che-yi Chao is Chief Advisor             uterine fibroids and various cancers. n        ultrasound-guided focused ultrasound
of Asia who builds and strengthens                                                              to provide enhanced immunotherapy
connections with Asia-based                                                                     solutions. Their portable focused
philanthropists, investors, manufacturers,                                                      ultrasound device is designed to target
and partners. She is also a member                                                              desired treatment areas that contain
of the Foundation’s Council. n                                                                  malignant tumors, such as breast
                                                                                                cancer, sarcoma, and thyroid cancer. n

 20      Focused Ultrasound Foundation | 2021 Midyear Report
building momentum in Asia

                                     FUS + drug delivery
                                     Pancreatic cancer

“
                                     Clinicians at Seoul National University
       I first heard of focused      Hospital in Korea are using low
ultrasound when I attended           power (mechanical) effects of focused
                                     ultrasound to treat pancreatic
a speech by Neal Kassell, MD,
                                     cancer lesions to try to enhance
at an event in Hong Kong.
                                     the effectiveness of the anti-cancer
I was immediately struck by this     FOLFIRINOX regimen. The hope is
innovative alternative to the        that the treatment will help disrupt
trauma of more conventional          the dense tumor stroma to allow
                                     better penetration and effectiveness
treatments. I am happy to support
                                     of the drugs. n
the Focused Ultrasound Hong

Kong Foundation’s efforts in

the hopes that this treatment

becomes widely accepted

treatment in Asia.”
— Alasdair Morrison
   Focused Ultrasound Hong Kong
   Foundation donor

                                                                      Focused Ultrasound Foundation | 2021 Midyear Report   21
mobilizing resources
           Advancing focused ultrasound worldwide and increasing
           awareness in the clinic is aided by the addition of new Senior Advisors.

                                                Foundation announces
                                                new Senior Advisors

                                                                                           “
                                                Alan H. Matsumoto, MD, MA, joined
                                                the Foundation as a Senior Advisor for              Clinical trials and research
                                                Medical Imaging and Image-Guided           support by the Foundation and
                                                Therapeutics. He provides input on
                                                                                           others should accelerate the
                                                research projects and represent the
                                                                                           application of revolutionary
                                                Foundation at scientific and medical
                                                                                           focused ultrasound-based
                                                meetings. An expert in his specialty,
                                                Dr. Matsumoto has been on faculty          therapeutic options for brain tumor

                                                at the University of Virginia (UVA)        patients. I am delighted to help
                                                since 1991, where he is currently          in the neuro-oncology efforts of
                                                Chair and Theodore E. Keats Professor      the Foundation team.”
                                                of Radiology in the Department of          — Jason Sheehan
                                                Radiology and Medical Imaging.
                                                He is also Medical Director of UVA’s
                                                Focused Ultrasound Center, which was       Jason Sheehan, MD, PhD, joined the
                                                named the Foundation’s first Focused       Foundation as a Senior Advisor for
                                                Ultrasound Center of Excellence in 2009.   Brain Tumor Research. In this role he
                                                                                           is helping to define the Foundation’s

                                                “
                                                                                           overall strategy for brain tumor research,
                                                         I look forward to this            as well as engaging in Foundation-
                                                                                           initiated laboratory and clinical research,
                                                opportunity to help advance the
                                                                                           interfacing with medical societies, and
                                                science and clinical application
                                                                                           assisting in organizing collaborative
                                                of this cutting-edge technology
                                                                                           workshops. He is the Harrison
                                                which is being used to deliver             Distinguished Chair of Neurosurgery
                                                novel and life-changing therapies          and Professor of Neurological Surgery,
                                                to patients.”                              Radiation Oncology, Biomedical
                                                — Alan Matsumoto                           Engineering, and Neuroscience at UVA. n

Above, top to bottom
Alan H. Matsumoto, Jason Sheehan

22      Focused Ultrasound Foundation | 2021 Midyear Report
mobilizing resources

Four new members
Join Council
The Foundation’s Council—a group of
passionate, enthusiastic advocates who
connect the Foundation to the greater
community—added four new members
this year.

“        Focused ultrasound shows
great promise for improving
patients’ lives, and I am particularly
committed to technologies
that may transform treatment
for multiple cancers.”

                                         “                                          “
— Bob Hugin
  Former Chairman and CEO
  Celgene Corporation                           Focused ultrasound                           I’m dazzled by the potential

“
                                         shows tremendous promise                   of focused ultrasound to treat
                                         to be a revolutionary therapeutic          a massive number of human
        I first learned about focused
                                         technology for human and                   conditions, but I am even more
ultrasound several years ago,
                                         veterinary medicine. I am delighted        amazed at the speed of execution
and I continue to be amazed by its
                                         to be a part of this remarkable            in making these dreams reality.”
wide variety of mechanisms and
                                         community that is committed to             — Mary Lou Jepsen, PhD
potential applications.”                                                              CEO, Founder, and Chair of the Board
                                         improving millions of lives.”
                                                                                      Openwater
— Carolyn Yeh
                                         — Mark Onetto
  Vice President
                                           Retired Senior Vice President
  Yale Club Hong Kong
                                           Amazon.com, Inc.

Above middle, top to bottom
Bob Hugin, Mark Onetto

Above right, top to bottom
Mary Lou Jepsen, Carolyn Yeh

                                                                       Focused Ultrasound Foundation | 2021 Midyear Report   23
Board                                     Council
Neal F. Kassell, MD                       Co-chairs
Chairman, Focused Ultrasound Foundation
                                          Jane P. Batten
Former Co-chair of Neurosurgery,
   University of Virginia                 Charles H. Seilheimer, Jr.
Scott Beardsley, PhD                                     .....
Dean, University of Virginia Darden
  School of Business                      John B. Adams, Jr.
Eugene V. Fife                            Dorothy N. Batten
Founding Principal, Vawter Capital, LLC
                                          Ellen Block
Former Chairman,
   Goldman Sachs International            Amanda Brown
John R. Grisham                           Deborah Caldwell
Author
                                          Jessica Che-yi Chao
William A. Hawkins III
                                          Nancy J. &
Senior Advisor, EW Healthcare Partners
Retired Chairman & CEO, Medtronic           Thomas N. Chewning

Daniel P. Jordan, PhD                     Marguerite & Norwood Davis
President Emeritus,                       Peter Gabriel
   Thomas Jefferson Foundation
                                          David Goode
Syaru Shirley Lin, PhD
Adjunct Professor,                        Rick Hamilton
   Chinese University of Hong Kong        Alice Handy
Director, Goldman Sachs Asia Bank
                                          Diane Heller
Michael R. Lincoln
Global Business Department Chair,         Robert J. Hugin
   Cooley LLP                             Kat Imhoff
Michael Milken                            Mary Lou Jepsen, PhD
Chairman, Milken Institute
                                          Dean L. Kamen
Edward D. Miller, MD
Former CEO, Johns Hopkins Medicine        Ann Kingston

Frederic H. Moll, MD                      Harry Lester
Chief Development Officer, Johnson &      Jonna Mendez
   Johnson Medical Devices Companies
Co-founder, Auris Health, Inc.            Jane Metcalfe

Charles “Wick” Moorman IV                 Paula F. Newcomb
Former Chairman & CEO, Norfolk Southern   Marc Onetto
Former CEO, Amtrak
                                          Mary Lou Seilheimer
Steve H. Rusckowski
Chairman, President, and CEO,             Alice H. Siegel
   Quest Diagnostics Inc.                 Allan C. Stam, PhD
Former CEO, Philips Healthcare
                                          Fredi & Howard Stevenson
Gary Shapiro
President & CEO, Consumer Technology      Bernice Szeto
   Association (CTA)®                     Andrew C. von Eschenbach, MD
Carl P. Zeithaml, PhD                     Claude Wasserstein
Dean and F. S. Cornell Professor of
  Free Enterprise, McIntire School        Carolyn Yeh
  of Commerce, University of Virginia

24         Focused Ultrasound Foundation | 2021 Midyear Report
Focused Ultrasound Foundation | 2021 Midyear Report   25
1230 Cedars Court, Suite 206
Charlottesville, VA 22903
434.220.4993 main line

fusfoundation.org

26      Focused Ultrasound Foundation | 2021 Midyear Report
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