A Facile Ion-Doping Strategy To Regulate Tumor Microenvironments for Enhanced Multimodal Tumor Theranostics

Tumor Microenvironment-Responsive Fe(III)-Porphyrin Nanotheranostics for Tumor Imaging and Targeted Chemodynamic-Photodynamic Therapy

The development of effective and safe tumor nanotheranostics remains a research imperative. Herein, tumor microenvironment (TME)-responsive Fe(III)-porphyrin (TCPP) coordination nanoparticles (FT@HA NPs) were prepared using a simple one-pot method followed by modification with hyaluronic acid (HA). FT@HA NPs specifically accumulated in CD44 receptor-overexpressed tumor tissues through the targeting property of HA and upon endocytosis by tumor cells. After cell internalization, intracellular acidic microenvironments and high levels of glutathione (GSH) triggered the rapid decomposition of FT@HA NPs to release free TCPP molecules and Fe(III) ions. The released Fe(III) ions could trigger GSH depletion and Fenton reaction, activating chemodynamic therapy (CDT). Meanwhile, the fluorescence and photodynamic effects of the TCPP could be also activated, achieving controlled reactive oxygen species (ROS) generation and avoiding side effects on normal tissues. Moreover, the rapid consumption of GSH further enhanced the efficacy of CDT and photodynamic therapy (PDT). The in vivo experiments further demonstrated that the antitumor effect of these nanotheranostics was significantly enhanced and that their toxicity and side effects against normal tissues were effectively suppressed. The FT@HA NPs can be applied for activated tumor combination therapy under the guidance of dual-mode imaging including fluorescence imaging and magnetic resonance imaging, providing an effective strategy for the design and preparation of TME-responsive multifunctional nanotheranostics for precise tumor imaging and combination therapy.

Porous yolk-shell Fe/Fe3O4 nanoparticles with controlled exposure of highly active Fe(0) for cancer therapy

The iron-based Fenton-type reaction has drawn tremendous attention in cancer therapy. Compared with oxidized iron, Fe(0) possesses high catalytic activity but unstable for biomedical application. Here, we report a new strategy to stabilize Fe(0) via a porous yolk shell nanostructure of Fe/Fe₃O₄ (PYSNPs) in normal physiological condition, and to control the release of Fe(0) in tumor microenvironment for enhanced cancer therapy. These PYSNPs display superior tumor inhibition with the IC₅₀ down to 20 μg/mL (over 1 mg/mL for iron oxide nanoparticles as control) for HepG2 cell. A single intravenous injection of as low as 1 mg/kg dosage is effective to suppress tumor growth in vivo. Moreover, the disintegration of PYSNPs in the acidic tumor microenvironment could cause significant change in MRI signal for contrast-enhanced diagnosis. Of note, the resulting Fe₃O₄ fragments are renal clearable with minimized side effect. In all, this work represented a nanoplatform to stabilize and selectively deliver Fe(0) for highly effective cancer therapy.

Updates on the applications of iron-based nanoplatforms in tumor theranostics

With the development of biomedicine and materials science, the emerging research of iron-based nanoplatforms (INPs) have provided a bright future for tumor theranostics. Thanks to its excellent biocompatibility and diverse application potential, some INPs have successfully transformed from the laboratory to the clinic and market, making it one of the most successful nanoplatforms. Further investigations associated with its enormous biomedical potential is continuing, and new features of them are being demonstrated. The discovery of ferroptosis therapy opens up new avenue for the applications of INPs in tumor therapy, which is attracting tremendous attention from worldwide. It is well established that some of the INPs are capable of triggering the tumor cell ferroptosis efficiently, accelerating the tumor cell death process. Combined with anti-tumor drugs or other tumor therapy approaches, the INPs-induced ferroptosis are expected to break the bottleneck in the treatment of drug-resistant malignant tumors. In addition, other applications of INPs in tumor theranostics field are still active. Featured with the catalase-like ability, INPs were also well documented to reverse the tumor hypoxia as nanozymes, assisting and enhancing the oxygen-consuming tumor therapy approaches. And the unique magnetic property of INPs endow it with great potential in tumor diagnosis, hyperthermal therapy and target drug delivery. It is of great significance to summarize these new advances. Herein, the latest reports of the applications of INPs in tumor theranostics are classified to expound the trend of its research and development. The featured functions of it will be discussed in detail to provide a new insight. The key issues needing to be addressed and the development prospective will be put forward. We hope that this review will be helpful to understand the ample potential of INPs in tumor theranostics field.

Intelligent Fe-Mn Layered Double Hydroxides Nanosheets Anchored with Upconversion Nanoparticles for Oxygen-Elevated Synergetic Therapy and Bioimaging

Multimodal synergistic therapy based on photodynamic therapy (PDT), photothermal therapy (PTT), and chemodynamic therapy (CDT) has attracted increasing attention in cancer therapy. However, the scant therapeutic efficiency is always a barrier for further application. Herein, a smart tumor microenvironment (TME) responsive nanocatalysts are developed by adopting Fe-Mn layered double hydroxides (FeMn-LDH) as an effective photothermal nanocarrier to load mesoporous silica and chlorin e6 (Ce6)-covalently coated upconversion nanoparticles (UCSP) for multimodal imaging for directed therapy. Under acidic TME, FeMn-LDH degrades into Fe³⁺ and Mn²⁺ ions to initiate a Fenton-like reaction inducing CDT and enhancing magnetic resonance imaging. Additionally, Fe³⁺ can decompose H₂ O₂ to oxygen (O₂ ), enhancing PDT guided by UCSP. As a representative noninvasive imaging probe, the upconversion luminescence will recover after decomposition of FeMn-LDH, and provide high-resolution upconversion luminescent imaging guidance for pinpointed PDT. Moreover, the photothermal properties of FeMn-LDH can further enhance CDT effects. The synergistic therapy and multifunctional imaging can realize the integration of diagnosis and treatment.

Temperature Feedback-Controlled Photothermal/Photodynamic/Chemodynamic Combination Cancer Therapy Based on NaGdF4 :Er,Yb@NaGdF4 :Nd@Cu-BIF Nanoassemblies

The intelligent design of multifunctional nanoplatforms is critical for cancer therapy. Herein, NaGdF₄ :Er,Yb@NaGdF₄ :Nd@Cu(II) boron-imidazolate frameworks (denoted as CSNPs@Cu-BIF) nanoassemblies are designed and fabricated. Upon a single 808 nm laser irradiation, the nanoassemblies not only show the outstanding photothermal conversion capacity (η = 41.7%) but also generate cytotoxic reactive oxygen species through an in situ Fenton-like reaction and fluorescence resonance energy transfer. Importantly, the nanoassemblies simultaneously introduce remarkable antitumor efficacy via photothermal/photodynamic/chemodynamic combination therapy both in vitro and in vivo. To improve the therapeutic effect of solid tumor ablation, it is highly desirable to monitor the treatment process in real-time. Multiclinical imaging modalities of ultrasonography are employed to systematically investigate the ablation mechanism of solid tumors in vivo. Furthermore, the significant difference between the eigen temperature of CSNPs@Cu-BIF nanoassemblies obtained by the temperature-sensitive emission bands signal changes and the apparent temperature recorded by the thermal imaging camera is 14.55 K at equilibrium. This current work therefore supplies an alternative strategy in temperature feedback-controlled accurate cancer therapy.

Nanoplatform-based cascade engineering for cancer therapy

Various therapeutic techniques have been studied for treating cancer precisely and effectively, such as targeted drug delivery, phototherapy, tumor-specific catalytic therapy, and synergistic therapy, which, however, evoke numerous challenges due to the inherent limitations of these therapeutic modalities and intricate biological circumstances as well. With the remarkable advances of nanotechnology, nanoplatform-based cascade engineering, as an efficient and booming strategy, has been tactfully introduced to optimize these cancer therapies. Based on the designed nanoplatforms, pre-supposed cascade processes could be triggered under specific conditions to generate/deliver more therapeutic species or produce stronger tumoricidal effects inside tumors, aiming to achieve cancer therapy with increased anti-tumor efficacy and diminished side effects. In this review, the recent advances in nanoplatform-based cascade engineering for cancer therapy are summarized and discussed, with an emphasis on the design of smart nanoplatforms with unique structures, compositions and properties, and the implementation of specific cascade processes by means of endogenous tumor microenvironment (TME) resources and/or exogenous energy inputs. This fascinating strategy presents unprecedented potential in the enhancement of cancer therapies, and offers better controllability, specificity and effectiveness of therapeutic functions compared to the corresponding single components/functions. In the end, challenges and prospects of such a burgeoning strategy in the field of cancer therapy will be discussed, hopefully to facilitate its further development to meet the personalized treatment demands.

Regulation of redox balance using a biocompatible nanoplatform enhances phototherapy efficacy and suppresses tumor metastasis

Many cancer treatments including photodynamic therapy (PDT) utilize reactive oxygen species (ROS) to kill tumor cells. However, elevated antioxidant defense systems in cancer cells result in resistance to the therapy involving ROS. Here we describe a highly effective phototherapy through regulation of redox homeostasis with a biocompatible and versatile nanotherapeutic to inhibit tumor growth and metastasis. We systematically explore and exploit methylene blue adsorbed polydopamine nanoparticles as a targeted and precise nanocarrier, oxidative stress amplifier, photodynamic/photothermal agent, and multimodal probe for fluorescence, photothermal and photoacoustic imaging to enhance anti-tumor efficacy. Remarkably, following the glutathione-stimulated photosensitizer release to generate exogenous ROS, polydopamine eliminates the endogenous ROS scavenging system through depleting the primary antioxidant, thus amplifying the phototherapy and effectively suppressing tumor growth in vitro and in vivo. Furthermore, this approach enables a robust inhibition against breast cancer metastasis, as oxidative stress is a vital impediment to distant metastasis in tumor cells. Innovative, safe and effective nanotherapeutics via regulation of redox balance may provide a clinically relevant approach for cancer treatment.

A redox-triggered C-centered free radicals nanogenerator for self-enhanced magnetic resonance imaging and chemodynamic therapy

Current chemodynamic therapy (CDT) has been restricted by the requirement of strongly acidic conditions, insufficient endogenous H₂O₂ and upregulated cellular antioxidant defense. To overcome these obstacles, the carrier-free Fe(III)-ART nanoparticle is developed via coordination driven self-assembly of Fe³⁺ and hydrolyzed ART and evaluated as a redox-triggered C-centered free radicals nanogenerator for self-enhanced magnetic resonance imaging and chemodynamic therapy. The carrier-free Fe(III)-ART NPs can be triggered by intracellular GSH to release ART and Fe³⁺, which is further reduced to Fe²⁺ that catalyzed the endoperoxide of ART to generate C-centered free radicals. Notably, unlike current CDT, such a free radical generation process is without reliance on pH or endogenous H₂O₂. Meanwhile, the concurrent GSH depletion can diminish the antioxidation of tumors and enhance CDT. The C-centered free radicals-mediated apoptosis and GSH depletion-induced ferrotosis act in synergy, leading to potent tumor growth inhibition and superior anticancer efficacy in vitro and in vivo. Moreover, Fe(III)-ART NPs exhibit redox-triggered T₂ relaxivity and contribute to activatable MRI-guided CDT. The development of biodegradable Fe(III)-ART NPs with superior anticancer efficacy, favorable pharmacokinetics and good biocompatibility provides a promising strategy to break through the bottlenecks of traditional CDT and greatly promotes the development of next-generation cancer theranostics.

Tumor-Triggered Disassembly of a Multiple-Agent-Therapy Probe for Efficient Cellular Internalization

Integration of multiple agent therapy (MAT) into one probe is promising for improving therapeutic efficiency for cancer treatment. However, MAT probe, if entering the cell as a whole, may not be optimal for each therapeutic agent (with different physicochemical properties), to achieve their best performance, hindering strategy optimization. A peptide-conjugated-AIEgen (FC-PyTPA) is presented: upon loading with siRNA, it self-assembles into FC_siRNA -PyTPA. When approaching the region near tumor cells, FC_siRNA -PyTPA responds to extracellular MMP-2 and is cleaved into FC_siRNA and PyTPA. The former enters cells mainly by macropinocytosis and the latter is internalized into cells mainly through caveolae-mediated endocytosis. This two-part strategy greatly improves the internalization efficiency of each individual therapeutic agent. Inside the cell, self-assembly of nanofiber precursor F, gene interference of C_siRNA , and ROS production of PyTPA are activated to inhibit tumor growth.

GSH depletion liposome adjuvant for augmenting the photothermal immunotherapy of breast cancer

The high redox level of tumor microenvironment inhibits the oxidation treatment and the immune response. Here, we innovatively develop maleimide liposome (ML) adjuvants to promote immunogenic cell death (ICD) induction and dendritic cells (DCs) maturation by glutathione (GSH) depletion for augmenting the photothermal immunotherapy of breast cancer. The ML effectively depletes the intracellular GSH and up-regulates reactive oxygen species (ROS) in both tumor cells and DCs. In tumor cells, the ROS boosted the ABTS·⁺ production to activate photothermal-induced ICD. In DCs, it relieved the immunosuppression, promoting DC maturation (57%) and antigen presenting. As a result of the ML assistant, the therapeutic systems improved the infiltration of CD8⁺ T cells to 53% in tumor tissues, eliciting strong abscopal effect and antimetastasis effect. The MLs were believed to be a superior candidate of adjuvants for enhancing immune response and cancer therapeutic efficacy.

Endogenous Labile Iron Pool-Mediated Free Radical Generation for Cancer Chemodynamic Therapy

Current chemodynamic therapy (CDT) primarily relies on the delivery of transition metal ions with Fenton activity to trigger hydroxyl radical production from hydrogen peroxide. However, administration of an excess amount of exogenous Fenton-type heavy metals may cause potential adverse effects to human health, including acute and chronic damages. Here, we present a new CDT strategy that uses intracellular labile iron pool (LIP) as the endogenous source of Fenton-reactive metals for eliciting free radical generation, and the discovery of hydroperoxides (R'OOH) as an optimal LIP-mediated chemodynamic agent against cancer. By simulating the metabolic fates of peroxo compounds within cells, R'OOH was found to have excellent free radical-producing ability in the presence of labile iron(II) and to suffer only moderate elimination by glutathione/glutathione peroxidase, which contributes to its superior chemodynamic efficacy. The LIP-initiated nontoxic-to-toxic transition of R'OOH, together with increased LIP levels in tumor cells, enabled efficient and specific CDT of cancer. Moreover, pH/labile iron(II) cascade-responsive nanomedicines comprising encapsulated methyl linoleate hydroperoxide and LIP-increasing agent in pH-sensitive polymer particles were fabricated to realize enhanced CDT. This work not only paves the way to using endogenous Fenton-type metals for cancer therapy but also offers a paradigm for the exploration of high-performance chemodynamic agents activated by intracellular LIP.

All-in-One Theranostic Nanomedicine with Ultrabright Second Near-Infrared Emission for Tumor-Modulated Bioimaging and Chemodynamic/Photodynamic Therapy

Reactive oxygen species (ROS)-based therapeutic modalities including chemodynamic therapy (CDT) and photodynamic therapy (PDT) hold great promise for conquering malignant tumors. However, these two methods tend to be restricted by the overexpressed glutathione (GSH) and hypoxia in the tumor microenvironment (TME). Here, we develop biodegradable copper/manganese silicate nanosphere (CMSN)-coated lanthanide-doped nanoparticles (LDNPs) for trimodal imaging-guided CDT/PDT synergistic therapy. The tridoped Yb³⁺/Er³⁺/Tm³⁺ in the ultrasmall core and the optimal Yb³⁺/Ce³⁺ doping in the shell enable the ultrabright dual-mode upconversion (UC) and downconversion (DC) emissions of LDNPs under near-infrared (NIR) laser excitation. The luminescence in the second near-infrared (NIR-II, 1000-1700 nm) window offers deep-tissue penetration, high spatial resolution, and reduced autofluorescence when used for optical imaging. Significantly, the CMSNs are capable of relieving the hypoxic TME through decomposing H₂O₂ to produce O₂, which can react with the sample to generate ¹O₂ upon excitation of UC photons (PDT). The GSH-triggered degradation of CMSNs results in the release of Fenton-like Mn²⁺ and Cu⁺ ions for ^•OH generation (CDT); simultaneously, the released Mn²⁺ ions couple with NIR-II luminescence imaging, computed tomography (CT) imaging, and magnetic resonance (MR) imaging of LDNPs, performing a TME-amplified trimodal effect. In such a nanomedicine, the TME modulation, bimetallic silicate photosensitizer, Fenton-like nanocatalyst, and NIR-II/MR/CT contrast agent were achieved "one for all", thereby realizing highly efficient tumor theranostics.

Biodegradable iron-coordinated hollow polydopamine nanospheres for dihydroartemisinin delivery and selectively enhanced therapy in tumor cells

As the semisynthetic derivative and active metabolite of the effective anti-malarial drug artemisinin, dihydroartemisinin (DHA) has been investigated as an emerging therapeutic agent for tumor treatment based on the cytotoxicity of free-radicals originating from interactions with ferrous ions. Meanwhile, simultaneously delivering DHA and iron ions to tumors for selectively killing cancer cells is still a great challenge in DHA tumor therapy. Herein, we develop a facile yet efficient strategy based on iron-coordinated hollow polydopamine nanospheres to load DHA (DHA@HPDA-Fe). The as-prepared nanoagent is biodegradable and exhibits controllable release of DHA and Fe ions in tumor microenvironments, resulting in ferrous ion-enhanced production of cytotoxic reactive oxygen species (ROS) by DHA and thus effectively killing the tumor cells. In vivo therapy experiments indicated that the anti-tumor efficacy of DHA@HPDA-Fe was about 3.05 times greater than that of free DHA, and the tumor inhibition ratio was 88.7% compared with the control group, accompanied by negligible side effects, indicating that the proposed nanomedicine platform is promising for anti-tumor applications.

A Graphdiyne Oxide-Based Iron Sponge with Photothermally Enhanced Tumor-Specific Fenton Chemistry

Fenton reaction-mediated oncotherapy is an emerging strategy which uses iron ions to catalytically convert endogenous hydrogen peroxide into hydroxyl radicals, the most reactive oxygen species found in biology, for efficient cancer therapy. However, Fenton reaction efficiency in tumor tissue is typically limited due to restrictive conditions. One strategy to overcome this obstacle is to increase the temperature specifically at the tumor site. Herein, a tumor-targeting iron sponge (TTIS) nanocomposite based on graphdiyne oxide, which has a high affinity for iron is described. TTIS can accumulate in tumor tissue by decoration with a tumor-targeting polymer to enable tumor photoacoustic and magnetic resonance imaging. With its excellent photothermal conversion efficiency (37.5%), TTIS is an efficient photothermal therapy (PTT) agent. Moreover, the heat produced in the process of PTT can accelerate the release of iron ions from TTIS and simultaneously enhance the efficiency of the Fenton reaction, thus achieving a combined PTT and Fenton reaction-mediated cancer therapy. This work introduces a graphdiyne oxide-based iron sponge that exerts an enhanced antitumor effect through PTT and Fenton chemistry.

A Cu9S5 nanoparticle-based CpG delivery system for synergistic photothermal-, photodynamic- and immunotherapy

Despite its great potential in cancer therapy, phototherapy, including photothermal therapy (PTT) and photodynamic therapy (PDT), often cause metastasis of tumors. Immunotherapy has revolutionized the cancer treatment owing to the capability of activating immune system to eliminate tumors. However, the integration of phototherapy and immunotherapy in a single nanoagent for cancer therapy is still a challenging task. Here, we fabricated (Cu₉S₅@mSiO₂-PpIX@MnO₂@CpG (CSPM@CpG)) as a synergistic therapeutic model for phototherapy enhanced immunotherapy. The intracellular uptake of cytosine-phosphate-guanine (CpG) promoted the infiltration of cytotoxic T lymphocytes (CTLs) in tumor tissue, further stimulating the production of interferon gamma (IFN-γ) and remarkably elevating the immune response level. Excellent anti-tumor effects have been achieved by synergistic PTT/PDT/immunotherapy. The metastasis of tumors was effectively inhibited by the immune response of CpG. Thus, our proposed work provides a strategy to combine phototherapy with immunotherapy to enhance the therapeutic efficiency and further inhibit metastasis of tumors.

CpG oligonucleotides can stimulate an anticancer immune response. Zhou et al. now develop nanoparticles that can deliver CpG, which promotes cancer cell death after photothermal and photodynamic therapy in vitro and in vivo, concomitant with an immunological response.

In Situ Formation of Nanotheranostics to Overcome the Blood-Brain Barrier and Enhance Treatment of Orthotopic Glioma

Glioblastoma is one of the most lethal cancers and needs effective therapeutics. The development of coordination-driven metal-organic nanoassemblies, which can cross the blood-brain barrier (BBB) and blood-brain tumor barrier (BBTB) and have multiple desired functions, may provide a promising solution to this issue. Here, we report an in situ assembled nanoplatform based on RGD peptide-modified bisulfite-zinc^II-dipicolylamine-Arg-Gly-Asp (Bis(DPA-Zn)-RGD) and ultrasmall Au-ICG nanoparticles. Attributed to its positive charges and neovascular targeting properties, Bis(DPA-Zn)-RGD can be selectively delivered to the tumor site, and then assembled in situ into large nanoclusters with subsequently administered Au-ICG nanoparticles. Au nanoparticles with ultrasmall size (∼7 nm) can successfully cross the BBB. The obtained nanoclusters exhibit strong near-infrared-red (NIR) absorption and an enhanced tumor retention effect, enabling precise orthotopic fluorescence/photoacoustic imaging. With the aid of image guidance, the photothermal effect of the nanoclusters is observed to suppress tumor progression with the inhibition efficiency reaching up to 93.9%. Meanwhile, no photothermal damage can be found for normal brain tissues. These results, herein, suggest a feasible nanotheranostic agent with the ability to overcome the BBB and BBTB for imaging and therapy of orthotopic brain tumors.

Au2Pt-PEG-Ce6 nanoformulation with dual nanozyme activities for synergistic chemodynamic therapy / phototherapy

Although synergistic therapy for tumors has displayed significant promise for effective treatment of cancer, developing a simple and effective strategy to build a multi-functional nanoplatform is still a huge challenge. By virtue of the characteristics of tumor microenvironment, such as hypoxia, slight acidity and H₂O₂ overexpression, Au₂Pt-PEG-Ce6 nanoformulation is constructed for collaborative chemodynamic/phototherapy of tumors. Specifically, the Au₂Pt nanozymes with multiple functions are synthesized in one step at room temperature. The photosensitizer chlorin e6 (Ce6) is covalently linked to Au₂Pt nanozymes for photodynamic therapy (PDT). Interestingly, the Au₂Pt nanozymes possess catalase- and peroxidase-like activities simultaneously, which not only can generate O₂ for relaxation of tumor hypoxia and enhancement of PDT efficiency but also can produce ∙OH for chemodynamic therapy (CDT). In addition, the high photothermal conversion efficiency (η = 31.5%) of Au₂Pt-PEG-Ce6 nanoformulation provides the possibility for photoacoustic (PA) and photothermal (PT) imaging guided photothermal therapy (PTT). Moreover, the presence of high-Z elements (Au and Pt) in Au₂Pt-PEG-Ce6 nanoformulation endows it with the ability to act as an X-ray computed tomography (CT) imaging contrast agent. All in all, the Au₂Pt-PEG-Ce6 exhibits great potential in multimodal imaging-guided synergistic PTT/PDT/CDT with remarkably tumor specificity and enhanced therapy.

A mitochondria-targeting magnetothermogenic nanozyme for magnet-induced synergistic cancer therapy

Magnetic hyperthermia therapy (MHT) and chemodynamic therapy (CDT) are non-invasive in situ treatments without depth limitations and with minimum adverse effects on surrounding healthy tissue. We herein report a mitochondria-targeting magnetothermogenic nanozyme (Ir@MnFe2O4 NPs) for highly efficient cancer therapy. An iridium(III) complex (Ir) acts as a mitochondria-targeting agent on the surface of MnFe2O4 NPs. On exposure to an alternating magnetic field (AMF), the Ir@MnFe2O4 NPs induce a localized increase in temperature causing mitochondrial damage (MHT effect). Meanwhile glutathione (GSH) reduces Fe(III) to Fe(II) on the NPs surface, which in turn catalyzes the conversion of H2O2 to cytotoxic •OH (CDT effect). The depletion of GSH (a •OH scavenger) increases CDT efficacy, while the localized increase in temperature increases the rate of conversion of both Fe(III) to Fe(II) and H2O2 to •OH further enhancing the CDT effect. In addition, the disruption of cellular redox homeostasis due to CDT, leads to greater sensitivity of the cell towards MHT. This nanoplatform integrates these excellent therapeutic properties, with two-photon microscopy (TPM) (demonstrated in vitro) and magnetic resonance imaging (MRI) (demonstrated in vivo) to enable the precise and effective treatment of cancer.

Nanomaterials for the regulation of the tumor microenvironment and theranostics

Cancer has become one of the primary threats to human beings, and traditional therapies (including surgery, chemotherapy and radiotherapy) show limited therapeutic efficacy due to the complexity of tumor biology. Furthermore, determining how to utilize the differences between the tumor microenvironment (TME) and healthy tissues and exploring new nanoplatforms that can realize early diagnosis and effective and non-toxic therapy are challenges in cancer theranostics. Numerous researchers have designed multifunctional nanomaterials and investigated their personalized therapy and regulation abilities toward TME, including oxygen generation, glutathione consumption and the production of reactive oxygen species and multi-model imaging effects. This review will introduce the latest progress in the design of multi-functional nanomedicines for the regulation of TME and their theranostics, and it will provide a critical angle for the future development of nanomedicine.

Specific "Unlocking" of a Nanozyme-Based Butterfly Effect To Break the Evolutionary Fitness of Chaotic Tumors

Chaos and the natural evolution of tumor systems can lead to the failure of tumor therapies. Herein, we demonstrate that iridium oxide nanoparticles (IrO_x ) possess acid-activated oxidase and peroxidase-like functions and wide pH-dependent catalase-like properties. The integration of glucose oxidase (GOD) unlocked the oxidase and peroxidase activities of IrO_x by the production of gluconic acid from glucose by GOD catalysis in cancer cells, and the produced H₂ O₂ was converted into O₂ to compensate its consumption in GOD catalysis owing to the catalase-like function of the nanozyme, thus resulting in the continual consumption of glucose and the self-supply of substrates to generate superoxide anion and hydroxyl radical. Moreover, IrO_x can constantly consume glutathione (GSH) by self-cyclic valence alternation of Ir^IV and Ir^III . These cascade reactions lead to a "butterfly effect" of initial starvation therapy and the subsequent pressure of multiple reactive oxygen species (ROS) to completely break the self-adaption of cancer cells.

Synthesis of gadolinium/iron-bimetal-phenolic coordination polymer nanoparticles for theranostic applications

Integration of diagnostic and therapeutic components into a single coordination polymer nanoparticle is desirable for theranostic applications, but still challenging. Herein, we report the synthesis of bimetal-phenolic coordination polymer nanoparticles using gadolinium nitrate and ferrous sulphate as a metal source, and plant polyphenols (i.e., tannic acid) as an organic ligand via a metal-catechol coordination assembly process. Such coordination polymers show a tunable molar ratio of Gd/Fe and high dispersibility and stability in aqueous solution. The coordination polymers reveal composition-dependent performance for longitudinal relaxivity and photothermal conversion. The longitudinal relaxivity is positively related to the molar ratio of Gd/Fe, while the photothermal performance is negatively related to the molar ratio of Gd/Fe in the coordination polymers. The coordination polymers with an optimized molar ratio of Gd/Fe exhibit an ultra-small hydrodynamic diameter (∼23 nm), a high r₁ value (9.3 mM^-1 s^-1) with low r₂/r₁ (1.26) and high photothermal conversion efficiency (η = 37%). They can be used as a contrast agent for T₁-weighted magnetic resonance imaging of EMT-6 tumor bearing mice, which can effectively enhance the signals of tumors. They can also effectively suppress tumor growth via photothermal therapy. This work brings new insights for the synthesis of multifunctional coordination polymer nanoparticles and extending their potential applications in theranostics.

Quantum dot-pulsed dendritic cell vaccines plus macrophage polarization for amplified cancer immunotherapy

Dendritic cell (DC) vaccines hold great potential in cancer immunotherapy, but the suboptimal design of DC vaccines and the immunosuppressive tumor microenvironment largely impair their anti-tumor efficacy. Here, quantum dot (QD) pulsed-DC vaccines integrating with tumor-associated macrophage polarization are developed for amplified anti-tumor immunity. Semiconductor QDs are engineered with diverse functions to act as fluorescence nanoprobes, immunomodulatory adjuvants, and nanocarriers to load tumor antigens and Toll-like receptor 9 agonists. The QD-pulsed DC vaccines enable spatiotemporal tracking of lymphatic drainage and efficacy evaluation of DC immunotherapy, and trigger potent immunoactivation. Specifically, designer DC vaccine plus macrophage polarization elicits potent immune response to stimulate innate and adaptive antitumor immunity and ameliorate the immunosuppressive tumor microenvironment. As a new combination therapy, this strategy greatly boosts antigen-specific T-cell immunity and thus strongly inhibits local tumor growth and tumor metastasis in vivo. This study may provide an applicable treatment for cancer immunotherapy.

Biomineralization-inspired nanozyme for single-wavelength laser activated photothermal-photodynamic synergistic treatment against hypoxic tumors

Hypoxia, one of the features of most solid tumors, can severely impede the efficiency of oxygen-dependent treatments such as chemotherapy, radiotherapy and type-II photodynamic therapy. Herein, a catalase-like nanozyme RuO₂@BSA (RB) was first prepared through a biomineralization strategy, and a high efficiency near-infrared photosensitizer (IR-808-Br₂) was further loaded into the protein shell to generate the safe and versatile RuO₂@BSA@IR-808-Br₂ (RBIR) for the imaging-guided enhanced phototherapy against hypoxic tumors. RB not only acts like a catalase, but also serves as a photothermal agent that speeds up the oxygen supply under near-infrared irradiation (808 nm). The loaded NIR photosensitizer could immediately convert molecular oxygen (O₂) to cytotoxic singlet oxygen (¹O₂) upon the same laser irradiation. Results indicated that RBIR achieved enhanced therapeutic outcomes with negligible side effects. Features such as a simple synthetic route and imaging-guided and single-wavelength-excited phototherapy make the nanozyme a promising agent for clinical applications.

Advanced nanotechnology for hypoxia-associated antitumor therapy

Hypoxia is a hallmark of the tumor microenvironment, which promotes the proliferation, metastasis and invasion of tumors and stimulates the resistance of cancer treatments, leading to the serious consequence of tumor recurrence. Many nanotechnology-based studies have been conducted to improve the efficacy of cancer treatments using a hypoxia strategy. This is usually achieved by (i) activating bioreductive prodrugs in the tumor hypoxic/exacerbated hypoxic microenvironment, or (ii) delivering therapeutic agents to hypoxic tumor tissue using targeting molecules. Normally, a good therapeutic effect can be expected upon modulating the hypoxic microenvironment for tumor treatments. To achieve this, various nanotechnology strategies based on overcoming hypoxia have been exploited to alleviate tumor hypoxia and enhance the therapeutic efficacy of tumor therapy, including (i) reducing oxygen consumption by inhibiting cell respiration, (ii) normalizing tumor vessels to promote blood flow in the tumor, (iii) carrying exogenous oxygen into the tumor, and (iv) generating oxygen in situ. The strategy of in situ oxygen production is refined, and the scope of this strategy is further expanded. Finally, the inspiration of using advanced nanotechnology in hypoxia-associated antitumor therapy guides the study of tumor hypoxia for clinical use.

Layered double hydroxide nanosheets: towards ultrasensitive tumor microenvironment responsive synergistic therapy

The tumor microenvironment (TME), which is characterised by high H₂O₂ and glutathione (GSH) levels, low pH value and hypoxia, imposes crucial influences on tumor therapeutic outcomes. Rational design and preparation of nanomaterial systems that are responsive to the intrinsic properties of the TME open a promising avenue towards tumor-specific treatment. Herein, CoMn-layered double hydroxide (CoMn-LDH) nanosheets were synthesized via a bottom-up method followed by surface modification with a photosensitizer, chlorin e6 (Ce6), which exhibited TME-responsive imaging as well as photodynamic and chemodynamic synergistic therapy (PDT/CDT). Due to their ultralow bond energy and large adsorption energy, CoMn-LDH nanosheets show fast self-degradability in a GSH (10 mM) microenvironment, giving an excellent CDT activity in mildly acidic conditions (pH = 6.5), superior GSH removal ability (99.82%) and O₂ production (35.37 μg L^-1 s^-1). Moreover, Ce6/CoMn-LDH nanosheets display satisfactory photoacoustic (PA) imaging and GSH-enhanced magnetic resonance imaging (MRI) with a 45.1-fold T₁-enhancement. In addition, both in vitro and in vivo therapeutic tests based on Ce6/CoMn-LDH demonstrate a satisfactory anticancer activity with complete cancer cell apoptosis and dramatic tumor elimination. This work provides a new perspective for the design of multifunctional 2D nanosheets towards a fully promoted TME-responsive synergistic therapy, which holds great promise for future clinical diagnosis and treatment.

GSH-triggered release of sulfur dioxide gas to regulate redox balance for enhanced photodynamic therapy

Herein, a promising strategy is explored to regulate redox balance in tumor cells by simultaneously consuming GSH and releasing SO₂ gas for enhanced photodynamic therapy.

A tumor-microenvironment fully responsive nano-platform for MRI-guided photodynamic and photothermal synergistic therapy

Multifunctional intelligent theranostics agents are promising for next-generation oncotherapy.

A glutathione-depleted prodrug platform of MnO2-coated hollow polydopamine nanospheres for effective cancer diagnosis and therapy

A biocompatible and efficient nanoplatform for tumor diagnosis and treatment was fabricated based on manganese oxide-coated hollow polydopamine loaded with dihydroartemisinin.

A multimodal imaging-guided nanoreactor for cooperative combination of tumor starvation and multiple mechanism-enhanced mild temperature phototherapy

A unique nanoreactor Fe-PDAP/GOx/ICG is engineered to realize starvation therapy and enhanced phototherapy via multilevel mechanisms for simultaneous glucose consumption, oxygen supply, glutathione (GSH) depletion, and heat-resistance relief.

Nanoparticle facilitated delivery of peroxides for effective cancer treatments

Peroxide nanoparticles increase the intratumoral H₂O₂ concentration for the catalytic production of ˙OH and O₂, which further enhance O₂/ROS-dependent anticancer therapies.

Recent Progress of Nanoscale Metal-Organic Frameworks in Cancer Theranostics and the Challenges of Their Clinical Application

The growing incidence of cancer raises an urgent need to develop effective diagnostic and therapeutic strategies. With the rapid development of nanomedicine, nanoscale metal-organic frameworks (NMOFs) presented promising potential in various biomedical applications in the last 2 decades, especially in cancer theranostics. Due to the unique features of NMOFs, including structural diversities, enormous porosity, multifunctionality and biocompatibility, they have been widely used to deliver imaging contrast agents and therapeutic drugs. Moreover, multiple types of contrast agents, anti-cancer drugs and targeting ligands could be co-delivered through one single NMOF to enable combination therapy. Co-delivering system using NMOFs helped to avoid multidrug resistance, to reduce adverse effects, to achieve imaging-guided precise therapy and to enhance anti-cancer efficacy. This review summarized the recent research advances on the application of NMOFs in biomedical imaging and cancer treatments in the last few years. The current challenges that impeding their translation to clinical practices and the perspectives for their future applications were also highlighted and discussed.

A "Missile-Detonation" Strategy to Precisely Supply and Efficiently Amplify Cerenkov Radiation Energy for Cancer Theranostics

Cerenkov radiation (CR) from radionuclides can act as a built-in light source for cancer theranostics, opening a new horizon in biomedical applications. However, considerably low tumor-targeting efficiency of existing radionuclides and radionuclide-based nanomedicines limits the efficacy of CR-induced theranostics (CRIT). It remains a challenge to precisely and efficiently supply CR energy to the tumor site. Here, a "missile-detonation" strategy is reported, in which a high dose of p-SCN-Bn-deferoxamine-porphyrin-PEG nanocomplex (Df-PPN) is first adminstered as a CR energy receiver/missile to passively target to tumor, and then a low dose of the 89 Zr-labeled Df-PPN is administrated as a CR energy donor/detonator, which can be visualized and quantified by Cerenkov energy transfer imaging, positron-emission tomography, and fluorescence imaging. Based on homologous properties, the colocalization of Df-PPN and 89 Zr-Df-PPN in the tumor site is maximized and efficient CR energy transfer is enabled, which maximizes the tumor-targeted CRIT efficacy in an optimal spatiotemporal setting while also reducing adverse off-target effects from CRIT. This precise and efficient CRIT strategy causes significant tumor vascular damage and inhibited tumor growth.

Therapeutic applications of multifunctional nanozymes

Nanozymes, which are functional nanomaterials with enzyme-like characteristics, have emerged as a highly-stable and low-cost alternative to natural enzymes. Apart from overcoming the limitations of natural enzymes (e.g., high cost, low stability or complex production), nanozymes are also equipped with the unique intrinsic properties of nanomaterials such as magnetism, luminescence or near infrared absorbance. Therefore, the development of nanozymes exhibiting additional functions to their catalytic activity has opened up new opportunities and applications within the biomedical field. To highlight the progress in the field, this review summarizes the novel applications of multifunctional nanozymes in various biomedical-related fields ranging from cancer diagnosis, cancer and antibacterial therapy to regenerative medicine. Future challenges and perspectives that may advance nanozyme research are also discussed at the end of the review.

Engineering pH-Responsive BODIPY Nanoparticles for Tumor Selective Multimodal Imaging and Phototherapy

It is a challenge to develop multifunctional theranostic agents in one molecule, which simultaneously possesses tumor imaging ability with a high signal-to-noise ratio and excellent therapeutic activity. In this work, we synthesized and screened a series of BODIPY (BDP) with various absorption and fluorescence. The interplay of the molecular structure, pH-sensitive absorption and emission, and photodynamic and photothermal activities was well studied in detail. Photoinduced electron transfer, intramolecular charge transfer, and heavy atom effect were leveraged to engineer BDP with tumor imaging and therapeutic functions. The BDP nanoparticle formulations possessed multifunctional biological features, including selective treatment of cancer cells, near-infrared fluorescence, photoacoustic and computed tomography imaging, and photodynamic and photothermal therapy, as validated by cellular and animal experiments. These results not only give a new horizon to multifunctional BDP for biological applications but also show a new way to design the organic dye for tumor imaging and phototherapy.

Triggering Sequential Catalytic Fenton Reaction on 2D MXenes for Hyperthermia-Augmented Synergistic Nanocatalytic Cancer Therapy

The unique characteristics of a tumor microenvironment (TME) enable the development of new tumor-therapeutic modalities with high efficiency, biosafety, and tumor specificity. In this work, we report on the construction of photothermal-enhanced and nanocatalyst-enabled sequential catalytic reaction for TME-specific cancer therapy. This conceptual advance is achieved by engineering the surface of two-dimensional Ti₃C₂ MXene with two separate catalysts, including natural glucose oxidase (GOD) as glucose catalysts and superparamagnetic iron oxide nanoparticles (IONPs) as Fenton-reaction nanocatalysts. A sequential catalytic reaction is triggered by using GOD for catalyzing the tumor-overtaken glucose to generate large amounts of hydrogen peroxide molecules. Subsequently IONPs can catalyze the transformation of pregenerated hydrogen peroxide into large amounts of highly toxic hydroxyl radicals to kill the cancer cells subsequently in TME-enabled acidity condition. The two-dimensional (2D) Ti₃C₂ MXene matrix efficiently converts the near-infrared light into thermal energy to synergistically enhance the catalytic efficiency of this sequential catalytic reaction and therefore achieve the high synergistic cancer-therapeutic outcome, accompanied with the high biocompatibility of the constructed composite nanocatalysts. Both in vitro cancer-cell evaluation and in vivo tumor xenograft on nude mice with complete tumor eradication demonstrate the high synergistic efficiency of photothermal-enhanced sequential nanocatalytic cancer therapy. Therefore, this work substantially broadens the biomedical applications of 2D MXenes to nanocatalytic cancer therapy by enhancing the Fenton reaction-based nanocatalytic therapy via converting the near-infrared light into thermal energy and subsequently elevating the local Fenton-reaction temperature.

Low density lipoprotein receptor (LDLR)-targeted lipid nanoparticles for the delivery of sorafenib and Dihydroartemisinin in liver cancers

AIMS

Liver cancer is one of the leading causes of cancer mortality worldwide. Inspired by the biological structure and function of low-density lipoprotein (LDL), in this study, an ApopB-100 based targeted lipid nanoparticles was synthesized to improve the therapeutic efficacy in liver cancer treatment.

MAIN METHODS

The biological composition of ApopB is similar to LDL which can effectively increase the targeting efficiency of nanoparticles in LDL receptor (LDLR)-overexpressed liver tumors.

KEYFINDINGS

We have demonstrated that the co-administration of sorafenib (SRF) and Dihydroartemisinin (DHA) could exhibit synergistic anticancer effect in HepG2 liver cancer cells. DHA produced excessive cellular reactive oxygen species (ROS) and induced greater apoptosis of cancer cells. LDL-based SRF/DHA-loaded lipid nanoparticles (LD-SDN) showed remarkable decrease in the cell viability compared to that of either of single drug treated cancer cells. Combination of SRF+DHA resulted in predominant SubG1 proportion of cells. LD-SDN exhibited the highest SubG1 (%) of cells compared to that of any of the individual drugs. Most importantly, robust antitumor response and delayed tumor growth was observed for LD-SDN treated xenograft tumor model. Ki67 proliferation index of LD-SDN (22.1 ± 5.6%) is significantly lesser compared to that of either control (86.2 ± 6.9%) or SRF (75.4 ± 4.89%) or DHA (69.4 ± 6.9%).

SIGNIFICANCES

These data provide strong evidence that LDL-mimetic lipid nanoformulations could be utilized as a biocompatible and tumor targeted platform for the delivery of multiple anticancer drugs in cancer treatment.

O2-Generating Metal-Organic Framework-Based Hydrophobic Photosensitizer Delivery System for Enhanced Photodynamic Therapy

Photodynamic therapy (PDT) has been introduced as a photochemical process for treatment by causing cancer cell death and necrosis, with higher accuracy and few side effects. However, the hydrophobicity of most photosensitizers and hypoxia at the tumor sites are two crucial problems to be solved to achieve a successful PDT. Herein, we designed and constructed a novel metal-organic framework-based drug delivery system (BSA-MnO₂/Ce6@ZIF-8) with tumor microenvironment controllability. In our system, the hydrophobic photosensitizer chlorin e6 (Ce6) was one-pot incorporated into the matrix of zeolitic imidazolate framework 8 (ZIF-8) to form the Ce6@ZIF-8 compound, which can efficiently keep the Ce6 molecules isolated and avoid them self-aggregate, and the loading rate of Ce6 was high up to 28.3 wt %. The bovine serum albumin (BSA)-MnO₂ nanoparticles (NPs) with catalase-like activity were loaded onto the surface of ZIF-8, having the capacity for self-sufficiency of O₂ under the circumstance of H₂O₂ in acid solution, relieving hypoxia in cancer cells and thereby improving the PDT efficiency greatly when irradiated by low power density (230 mW/cm²) 650 nm light. Moreover, the MnO₂ NPs react with H₂O₂ in acid solution to produce Mn²⁺, granting the system the qualification of a contrast agent for magnetic resonance imaging. Therefore, our nanoplatform would further contribute to the treatment of hypoxic tumors in clinical practice.

Near-infrared light and tumor microenvironment dual responsive size-switchable nanocapsules for multimodal tumor theranostics

Smart drug delivery systems (SDDSs) for cancer treatment are of considerable interest in the field of theranostics. However, developing SDDSs with early diagnostic capability, enhanced drug delivery and efficient biodegradability still remains a scientific challenge. Herein, we report near-infrared light and tumor microenvironment (TME), dual responsive as well as size-switchable nanocapsules. These nanocapsules are made of a PLGA-polymer matrix coated with Fe/FeO core-shell nanocrystals and co-loaded with chemotherapy drug and photothermal agent. Smartly engineered nanocapsules can not only shrink and decompose into small-sized nanodrugs upon drug release but also can regulate the TME to overproduce reactive oxygen species for enhanced synergistic therapy in tumors. In vivo experiments demonstrate that these nanocapsules can target to tumor sites through fluorescence/magnetic resonance imaging and offer remarkable therapeutic results. Our synthetic strategy provides a platform for next generation smart nanocapsules with enhanced permeability and retention effect, multimodal anticancer theranostics, and biodegradability.

Fabrication of H2O2-driven nanoreactors for innovative cancer treatments

The increased production of hydrogen peroxide (H₂O₂) is a typical feature of cancerous cells. This feature is closely associated with elevated oxidative stress inside solid tumour microenvironments, which thus impairs either the growth of cancer cells or their sensitivity to many cancer therapeutics. To date, numerous innovative strategies that target tumour H₂O₂ have been designed for effective cancer treatment. More recently, with the rapid advancement of nanomedicine, several nanoreactors, which are highly efficient in converting endogenous H₂O₂ to more toxic reactive oxygen species, promoting in situ H₂O₂, or decomposing endogenous H₂O₂ to molecular oxygen for tumour hypoxia attenuation, have been designed and attempted for effective cancer treatment. This review focuses on the latest progress of such innovative H₂O₂-driven nanoreactor-mediated cancer treatments. Afterwards, future perspectives on the development of tumour H₂O₂-driven nanoreactor-mediated cancer treatments and their potential clinical translations will be discussed.

Intelligent nanoflowers: a full tumor microenvironment-responsive multimodal cancer theranostic nanoplatform

Although the collaborative therapy of chemotherapy (CT) and photodynamic therapy (PDT) is much more efficient for tumor treatment than monotherapies, premature leakage of drugs from nanocarriers and hypoxia in the tumor microenvironment (TME) result in systemic toxicity and suboptimal therapy efficiency. To overcome these limitations, we developed an intelligent nanoflower composite (termed FHCPC@MnO2) by coating functionalized polyphosphazene on superparamagnetic Fe3O4 nanoclusters and then growing MnO2 nanosheets as an outer shell. The FHCPC@MnO2 nanoflowers with multistage H2O2/pH/GSH-responsive properties could fully exploit TME characteristics, including supernormal glutathione (GSH) levels, low pH and high H2O2, to realize the specific release of drugs in tumors and maximum synergetic therapeutic effects. The MnO2 nanosheets can elevate O2 concentration by catalytic decomposition of H2O2 and can be simultaneously reduced to Mn2+ by overexpressed GSH in the acidic TME. Meanwhile, the inner polyphosphazene containing (bis-(4-hydroxyphenyl)-disulfide) is GSH- and pH-sensitively biodegradable to release the anticancer drug curcumin (CUR) and photosensitizer chlorin e6 (Ce6) in the TME. Therefore, the "triple-responsive" and synergetic strategy simultaneously endows the nanoflowers with specific drug release, relieving hypoxia and the antioxidant capability of the tumor and achieving significant optimization of CT and PDT. In addition, the resulting Mn2+ ions and Fe3O4 core enable in vivo T1/T2 magnetic resonance imaging (MRI), while the released Ce6 can simultaneously provide a fluorescence imaging (FL) function. Unsurprisingly, the intelligent nanoflowers exhibited remarkable multimodal theranostic performance both in vitro and in vivo, suggesting their great potential for precision medicine.