Enhanced Protoscolicidal Activity of Pulsed Electric Fields Combined With Albendazole: An in Vitro Study

Introduction: Cystic echinococcosis (CE), caused by the metacestode stage of Echinococcus granulosus, remains a significant zoonotic disease with serious health and economic burden worldwide, especially in endemic regions. Despite the availability of surgical and pharmacological treatments, complications such as cyst content leakage and recurrence are prevalent, necessitating novel and more effective therapeutic approaches. Accordingly, this study aimed to evaluate the synergistic protoscolicidal effects of pulsed electric fields (PEF) and albendazole (ALB). Methods: Protoscoleces were aseptically extracted from hydatid cysts in sheep livers and exposed to PEF at intensities of ۷۰, ۱۵۰, and ۱۳۰۰ V/cm for ۱۵–۶۰ minutes. Experimental groups included (۱) PEF alone, (۲) PEF combined with ALB, and (۳) ALB alone. Moreover, viability of protoscoleces was assessed using the standard eosin exclusion assay. Results: PEF alone increased mortality in a time-dependent and intensity-dependent manner, reaching ۱۰۰% at ۶۰ minutes. In addition, PEF+ALB (۱۰۰ μg/mL) and ALB alone (۱۰۰ μg/mL) achieved ۱۰۰% mortality at ۳۰–۴۵ and ۶۰ minutes, respectively. Nonetheless, PEF+ALB significantly outperformed PEF alone at early time points: ۷۰ V/cm/۱۵ minutes (۷۲.۰۳% vs. ۸۷.۶%, P<۰.۰۱), ۱۳۰۰ V/cm/۱۵ minutes (۸۶.۷۹% vs. ۹۵%, P<۰.۰۵), and ۱۳۰۰ V/cm/۳۰ minutes (۹۴.۳% vs. ۱۰۰%, P<۰.۰۱). Conclusion: While these findings provide preliminary in vitro proof-of-concept for a synergistic effect, clinical application remains premature. Thus, further investigations must prioritize experiments with clinically relevant ALB concentrations, ex vivo studies on intact cysts, and in vivo validation. The clinical applicability of PEF in CE management requires extensive further research.