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Umar H, Wahab HA, Attiq A, Amjad MW, Bukhari SNA, Ahmad W. Platinum-based targeted chemotherapies and reversal of cisplatin resistance in non-small cell lung cancer (NSCLC). Mutat Res 2024; 828:111856. [PMID: 38520879 DOI: 10.1016/j.mrfmmm.2024.111856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/04/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
Lung cancer is the one of the most prevalent cancer in the world. It kills more people from cancer than any other cause and is especially common in underdeveloped nations. With 1.2 million instances, it is also the most prevalent cancer in men worldwide, making about 16.7% of the total cancer burden. Surgery is the main form of curative treatment for early-stage lung cancer. However, the majority of patients had incurable advanced non-small cell lung cancer (NSCLC) recurrence after curative purpose surgery, which is indicative of the aggressiveness of the illness and the dismal outlook. The gold standard of treatment for NSCLC patients includes drug targeting of specific mutated genes drive in development of lung cancer. Furthermore, patients with advanced NSCLC and those with early-stage illness needing adjuvant therapy should use cisplatin as it is the more active platinum drug. So, this review encompasses the non-small cell lung cancer microenvironment, treatment approaches, and use of cisplatin as a first-line regimen for NSCLC, its mechanism of action, cisplatin resistance in NSCLC and also the prevention strategies to revert the drug resistance.
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Affiliation(s)
- Hassaan Umar
- School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, Pulau Pinang 11800, Malaysia
| | - Habibah A Wahab
- School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, Pulau Pinang 11800, Malaysia.
| | - Ali Attiq
- School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, Pulau Pinang 11800, Malaysia
| | - Muhammad Wahab Amjad
- Center for Ultrasound Molecular Imaging and Therapeutics, Pittsburgh Heart, Lung, Blood and, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Syed Nasir Abbas Bukhari
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Aljouf 72341, Saudi Arabia
| | - Waqas Ahmad
- School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, Pulau Pinang 11800, Malaysia.
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2
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Mukaya EH, Mbianda XY. Macromolecular Prodrugs Containing Organoiron-Based Compounds in Cancer Research: A Review. Mini Rev Med Chem 2019; 20:726-738. [PMID: 31702511 DOI: 10.2174/1389557519666191107142926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/10/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022]
Abstract
Among the methods used for the treatment of cancer, chemotherapy is widely used, and it is by far one of the most unpleasant procedures given to a patient because of its severe side effects; while being necessary. One of the major problems in cancer chemotherapy is the limited selectivity of most of the drugs in current clinical use. Following administration, the active agent is distributed over the entire body and reaches not only the target cells or tissues but also interacts with healthy cells. In an attempt to overcome the side effects of anticancer drugs, the modification of the anticancer bioactive compounds has been a topic of active research for years. Numerous delivery systems such as drugcontaining liposomes, microencapsulation, nanoparticles, and water-soluble polymers have been used for the delivery of bioactive compounds to the site of action. Water-soluble polymeric conjugates and co-conjugates have remained the most outstanding delivery technique. This review will discuss the development of polymeric conjugates and co-conjugates of ferrocene in cancer research.
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Affiliation(s)
- Elie Hembe Mukaya
- Department of Applied Chemistry, University of Johannesburg, Doornfontein Campus P.O. Box 17011, Johannesburg, South Africa
| | - Xavier Yangkou Mbianda
- Department of Applied Chemistry, University of Johannesburg, Doornfontein Campus P.O. Box 17011, Johannesburg, South Africa
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3
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Polyamidoamine-Drug Conjugates Containing Metal-Based Anticancer Compounds. J Inorg Organomet Polym Mater 2019. [DOI: 10.1007/s10904-019-01325-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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4
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Xiao H, Yan L, Dempsey EM, Song W, Qi R, Li W, Huang Y, Jing X, Zhou D, Ding J, Chen X. Recent progress in polymer-based platinum drug delivery systems. Prog Polym Sci 2018. [DOI: 10.1016/j.progpolymsci.2018.07.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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5
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Mukaya HE, Van Zyl RL, Jansen van Vuuren NC, Chen CT, Mbianda XY. Synthesis, characterization, biological evaluation, and drug release study of polyamidoamine-containing neridronate. INT J POLYM MATER PO 2018. [DOI: 10.1080/00914037.2018.1466135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hembe E. Mukaya
- Department of Applied Chemistry; Faculty of Science, University of Johannesburg, Johannesburg, Republic of South Africa
| | - Robyn L. Van Zyl
- Pharmacology Division, Department of Pharmacy and Pharmacology; WITS Research Institute for Malaria (WRIM), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Republic of South Africa
| | - Natasha C. Jansen van Vuuren
- Pharmacology Division, Department of Pharmacy and Pharmacology; WITS Research Institute for Malaria (WRIM), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Republic of South Africa
| | - Chien-Teng Chen
- Pharmacology Division, Department of Pharmacy and Pharmacology; WITS Research Institute for Malaria (WRIM), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Republic of South Africa
| | - Xavier Y. Mbianda
- Department of Applied Chemistry; Faculty of Science, University of Johannesburg, Johannesburg, Republic of South Africa
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Mukaya EH, Van Zyl R, Van Vuuren NJ, Yangkou Mbianda X. Polymeric prodrugs containing neridronate and ferrocene: Synthesis, characterization, and antimalarial activity. INT J POLYM MATER PO 2017. [DOI: 10.1080/00914037.2017.1342248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Elie Hembe Mukaya
- Department of Applied Chemistry, University of Johannesburg, Doornfontein Campus, Johannesburg, Republic of South Africa
| | - Robyn Van Zyl
- Pharmacology Division, Department of Pharmacy and Pharmacology; WITS Institute for Malaria (WRIM), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Natasha Jansen Van Vuuren
- Pharmacology Division, Department of Pharmacy and Pharmacology; WITS Institute for Malaria (WRIM), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Xavier Yangkou Mbianda
- Department of Applied Chemistry, University of Johannesburg, Doornfontein Campus, Johannesburg, Republic of South Africa
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Ulbrich K, Holá K, Šubr V, Bakandritsos A, Tuček J, Zbořil R. Targeted Drug Delivery with Polymers and Magnetic Nanoparticles: Covalent and Noncovalent Approaches, Release Control, and Clinical Studies. Chem Rev 2016; 116:5338-431. [DOI: 10.1021/acs.chemrev.5b00589] [Citation(s) in RCA: 1120] [Impact Index Per Article: 140.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Karel Ulbrich
- Institute
of Macromolecular Chemistry, The Czech Academy of Sciences, v.v.i., Heyrovsky Square 2, 162 06 Prague 6, Czech Republic
| | - Kateřina Holá
- Regional
Centre of Advanced Technologies and Materials, Department of Physical
Chemistry, Faculty of Science, Palacky University, 17 Listopadu 1192/12, 771 46 Olomouc, Czech Republic
| | - Vladimir Šubr
- Institute
of Macromolecular Chemistry, The Czech Academy of Sciences, v.v.i., Heyrovsky Square 2, 162 06 Prague 6, Czech Republic
| | - Aristides Bakandritsos
- Regional
Centre of Advanced Technologies and Materials, Department of Physical
Chemistry, Faculty of Science, Palacky University, 17 Listopadu 1192/12, 771 46 Olomouc, Czech Republic
| | - Jiří Tuček
- Regional
Centre of Advanced Technologies and Materials, Department of Physical
Chemistry, Faculty of Science, Palacky University, 17 Listopadu 1192/12, 771 46 Olomouc, Czech Republic
| | - Radek Zbořil
- Regional
Centre of Advanced Technologies and Materials, Department of Physical
Chemistry, Faculty of Science, Palacky University, 17 Listopadu 1192/12, 771 46 Olomouc, Czech Republic
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Callari M, Thomas DS, Stenzel MH. The dual-role of Pt(iv) complexes as active drug and crosslinker for micelles based on β-cyclodextrin grafted polymer. J Mater Chem B 2016; 4:2114-2123. [DOI: 10.1039/c5tb02429c] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Amphiphilic block copolymer based on poly(ethylene glycol) methyl ether methacrylate (POEGMEMA) and a block with pendant cyclodextrin units were self-assembled into micelles in the presence of the hydrophobic bile acid-based Pt(IV) drug, which also acted as crosslinker.
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Affiliation(s)
- Manuela Callari
- Centre for Advanced Macromolecular Design
- School of Chemistry
- University of New South Wales
- Sydney
- Australia
| | - Donald S. Thomas
- Mark Wainwright Analytical Centre
- University of New South Wales
- Sydney
- Australia
| | - Martina H. Stenzel
- Centre for Advanced Macromolecular Design
- School of Chemistry
- University of New South Wales
- Sydney
- Australia
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9
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In Memory of Dr. Eberhard W. Neuse (1925–2014). J Inorg Organomet Polym Mater 2015. [DOI: 10.1007/s10904-015-0191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kim J, Pramanick S, Lee D, Park H, Kim WJ. Polymeric biomaterials for the delivery of platinum-based anticancer drugs. Biomater Sci 2015. [PMID: 26221935 DOI: 10.1039/c5bm00039d] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Since cisplatin, cis-diamminedichloroplatinum(ii), received FDA approval for use in cancer treatment in 1978, platinum-based drugs have been one of the most widely used drugs for the treatment of tumors in testicles, ovaries, head and neck. However, there are concerns associated with the use of platinum-based anticancer drugs, owing to severe side effects and drug resistance. In order to overcome these limitations, various drug-delivery systems have been developed based on diverse organic and inorganic materials. In particular, the versatility of polymeric materials facilitates the tuning of drug-delivery systems to meet their primary goals. This review focuses on the progress made over the last five years in the application of polymeric nanoparticles for the delivery of platinum-based anticancer drugs. The present article not only describes the fundamental principles underlying the implementation of polymeric nanomaterials in platinum-based drug delivery, but also summarizes concepts and strategies employed in the development of drug-delivery systems.
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Affiliation(s)
- Jihoon Kim
- Center for Self-assembly and Complexity, Institute for Basic Science and Department of Chemistry, Pohang University of Science and Technology (POSTECH), 77 Cheongam-ro, Nam-gu, Pohang 790-784, Republic of Korea
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Mukaya HE, Mbianda XY. Macromolecular Co-conjugate of Ferrocene and Bisphosphonate: Synthesis, Characterization and Kinetic Drug Release Study. J Inorg Organomet Polym Mater 2015. [DOI: 10.1007/s10904-015-0205-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Synthesis and Preliminary Bio-evaluation of Polyaspartamide Co-conjugates of p-Amino-salicylic Acid Chelated Platinum(II) and Ferrocene Complexes. J Inorg Organomet Polym Mater 2015. [DOI: 10.1007/s10904-015-0174-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Callari M, Aldrich-Wright JR, de Souza PL, Stenzel MH. Polymers with platinum drugs and other macromolecular metal complexes for cancer treatment. Prog Polym Sci 2014. [DOI: 10.1016/j.progpolymsci.2014.05.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Oberoi HS, Nukolova NV, Kabanov AV, Bronich TK. Nanocarriers for delivery of platinum anticancer drugs. Adv Drug Deliv Rev 2013; 65:1667-85. [PMID: 24113520 PMCID: PMC4197009 DOI: 10.1016/j.addr.2013.09.014] [Citation(s) in RCA: 298] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 09/19/2013] [Accepted: 09/25/2013] [Indexed: 12/18/2022]
Abstract
Platinum based anticancer drugs have revolutionized cancer chemotherapy, and continue to be in widespread clinical use especially for management of tumors of the ovary, testes, and the head and neck. However, several dose limiting toxicities associated with platinum drug use, partial anti-tumor response in most patients, development of drug resistance, tumor relapse, and many other challenges have severely limited the patient quality of life. These limitations have motivated an extensive research effort towards development of new strategies for improving platinum therapy. Nanocarrier-based delivery of platinum compounds is one such area of intense research effort beginning to provide encouraging preclinical and clinical results and may allow the development of the next generation of platinum chemotherapy. This review highlights current understanding on the pharmacology and limitations of platinum compounds in clinical use, and provides a comprehensive analysis of various platinum-polymer complexes, micelles, dendrimers, liposomes and other nanoparticles currently under investigation for delivery of platinum drugs.
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Affiliation(s)
- Hardeep S. Oberoi
- Department of Pharmaceutical Sciences and Center for Drug Delivery and Nanomedicine, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Natalia V. Nukolova
- Department of Chemistry, M.V. Lomonosov Moscow State University, Leninskie Gory, Moscow 119992, Russia
- Russian State Medical University, Department of Medical Nanobiotechnology, Ostrovityanova 1, Moscow 117997, Russia
| | - Alexander V. Kabanov
- Department of Chemistry, M.V. Lomonosov Moscow State University, Leninskie Gory, Moscow 119992, Russia
- Center for Nanotechnology in Drug Delivery and Division of Molecular Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC 27599, USA
| | - Tatiana K. Bronich
- Department of Pharmaceutical Sciences and Center for Drug Delivery and Nanomedicine, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Huang C, Neoh KG, Xu L, Kang ET, Chiong E. Polymeric nanoparticles with encapsulated superparamagnetic iron oxide and conjugated cisplatin for potential bladder cancer therapy. Biomacromolecules 2012; 13:2513-20. [PMID: 22793172 DOI: 10.1021/bm300739w] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Amphiphilic poly(ε-caprolactone)-b-poly(propargyl methacrylate-click-mercaptosuccinic acid-co-poly(ethylene glycol) methyl ether methacrylate) (PCL-b-P(PMA-click-MSA-co-PEGMA)) were synthesized by a combination of ring-opening polymerization, reversible addition-fragmentation chain transfer (RAFT) polymerization, and thiol-yne "click" reaction. The hydrophobic PCL core can be used to load superparamagnetic iron oxide nanoparticles (SPIONs), while the pendant dicarboxylic groups in the hydrophilic shell are used to coordinate cisplatin. These SPIONs-loaded, cisplatin-conjugated polymeric nanoparticles (Pt-Fe-PNs) are superparamagnetic at room temperature and are mucoadhesive. Release of cisplatin from Pt-Fe-PNs in artificial urine at 37 °C was characterized by an initial burst release with a release of ∼30% of the cisplatin in the first 4 h followed by a slow sustained release over 4 days. The cisplatin release can be further enhanced by increasing the temperature. These Pt-Fe-PNs can effectively induce cytotoxicity against UMUC3 bladder cancer cells with IC(50) of 32.3 μM. These results indicate that Pt-Fe-PNs is potentially a promising cisplatin delivery vehicle which can be combined with SPIONs-induced hyperthermia for bladder cancer therapy.
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Affiliation(s)
- Chao Huang
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Kent Ridge, Singapore
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Huynh VT, Quek JY, de Souza PL, Stenzel MH. Block Copolymer Micelles with Pendant Bifunctional Chelator for Platinum Drugs: Effect of Spacer Length on the Viability of Tumor Cells. Biomacromolecules 2012; 13:1010-23. [DOI: 10.1021/bm2017299] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Vien T. Huynh
- Centre for Advanced Macromolecular
Design (CAMD), The University of New South Wales, Sydney NSW 2052, Australia
- Liverpool Hospital Clinical
School, and Molecular Medicine Research Group, University of Western Sydney, Sydney NSW 2170, Australia
| | - Jing Yang Quek
- Centre for Advanced Macromolecular
Design (CAMD), The University of New South Wales, Sydney NSW 2052, Australia
| | - Paul L. de Souza
- Liverpool Hospital Clinical
School, and Molecular Medicine Research Group, University of Western Sydney, Sydney NSW 2170, Australia
| | - Martina H. Stenzel
- Centre for Advanced Macromolecular
Design (CAMD), The University of New South Wales, Sydney NSW 2052, Australia
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Macromolecular Co-Conjugates of Methotrexate and Ferrocene in the Chemotherapy of Cancer. J Inorg Organomet Polym Mater 2011. [DOI: 10.1007/s10904-011-9595-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huynh VT, de Souza P, Stenzel MH. Polymeric Micelles with Pendant Dicarboxylato Chelating Ligands Prepared via a Michael Addition for cis-Platinum Drug Delivery. Macromolecules 2011. [DOI: 10.1021/ma2016503] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Vien T. Huynh
- Centre of Advanced Macromolecular Design (CAMD), The University of New South Wales, Sydney NSW 2052, Australia
| | - Paul de Souza
- St.George Hospital Clinical School, The University of New South Wales, Sydney NSW 2052, Australia
- Molecular Medicine Research Group, University of Western Sydney School of Medicine, Campbelltown, NSW, Australia
| | - Martina H. Stenzel
- Centre of Advanced Macromolecular Design (CAMD), The University of New South Wales, Sydney NSW 2052, Australia
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Huynh VT, Chen G, Souza PD, Stenzel MH. Thiol–yne and Thiol–ene “Click” Chemistry as a Tool for a Variety of Platinum Drug Delivery Carriers, from Statistical Copolymers to Crosslinked Micelles. Biomacromolecules 2011; 12:1738-51. [DOI: 10.1021/bm200135e] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Vien T. Huynh
- Centre of Advanced Macromolecular Design (CAMD), The University of New South Wales, Sydney NSW 2052, Australia
| | - Gaojian Chen
- Centre for Soft Condensed Matter Physics and Interdisciplinary Research, Soochow University, Suzhou 215006, China
| | - Paul de Souza
- St. George Hospital Clinical School, The University of New South Wales, Sydney NSW 2052, Australia
| | - Martina H. Stenzel
- Centre of Advanced Macromolecular Design (CAMD), The University of New South Wales, Sydney NSW 2052, Australia
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Polymeric Conjugates of Selected Aminoquinoline Derivatives as Potential Drug Adjuvants in Cancer Chemotherapy. J Inorg Organomet Polym Mater 2011. [DOI: 10.1007/s10904-011-9461-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Water-Soluble Macromolecular Platinum Conjugates Derived from 1,2-Dihydroxyl-Functionalized Carrier Polymers. J Inorg Organomet Polym Mater 2010. [DOI: 10.1007/s10904-010-9326-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Casolaro M, Cini R, Del Bello B, Ferrali M, Maellaro E. Cisplatin/Hydrogel Complex In Cancer Therapy. Biomacromolecules 2009; 10:944-9. [DOI: 10.1021/bm8014939] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mario Casolaro
- Dipartimento di Scienze e Tecnologie Chimiche e dei Biosistemi, and Dipartimento di Fisiopatologia, Medicina Sperimentale e Sanità Pubblica, Università degli Studi di Siena, Via Aldo Moro 2, I-53100 Siena, Italy
| | - Renzo Cini
- Dipartimento di Scienze e Tecnologie Chimiche e dei Biosistemi, and Dipartimento di Fisiopatologia, Medicina Sperimentale e Sanità Pubblica, Università degli Studi di Siena, Via Aldo Moro 2, I-53100 Siena, Italy
| | - Barbara Del Bello
- Dipartimento di Scienze e Tecnologie Chimiche e dei Biosistemi, and Dipartimento di Fisiopatologia, Medicina Sperimentale e Sanità Pubblica, Università degli Studi di Siena, Via Aldo Moro 2, I-53100 Siena, Italy
| | - Marco Ferrali
- Dipartimento di Scienze e Tecnologie Chimiche e dei Biosistemi, and Dipartimento di Fisiopatologia, Medicina Sperimentale e Sanità Pubblica, Università degli Studi di Siena, Via Aldo Moro 2, I-53100 Siena, Italy
| | - Emilia Maellaro
- Dipartimento di Scienze e Tecnologie Chimiche e dei Biosistemi, and Dipartimento di Fisiopatologia, Medicina Sperimentale e Sanità Pubblica, Università degli Studi di Siena, Via Aldo Moro 2, I-53100 Siena, Italy
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