1
|
Aranha MDC, Alencar LMR, Souto EB, Kamei DT, Lopes AM. Dual Chemotherapeutic Loading in Oxalate Transferrin-Conjugated Polymersomes Incorporated into Chitosan Hydrogels for Site-Specific Targeting of Melanoma Cells. Pharmaceuticals (Basel) 2024; 17:1177. [PMID: 39338339 PMCID: PMC11434979 DOI: 10.3390/ph17091177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/24/2024] [Accepted: 09/03/2024] [Indexed: 09/30/2024] Open
Abstract
In this work, we developed a smart drug delivery system composed of poly (ethylene glycol)-block-poly (ε-caprolactone) (PEG-PCL)-based polymersomes (Ps) loaded with doxorubicin (DOX) and vemurafenib (VEM). To enhance targeted delivery to malignant melanoma cells, these drug-loaded nanovesicles were conjugated to the oxalate transferrin variant (oxalate Tf) and incorporated into three-dimensional chitosan hydrogels. This innovative approach represents the first application of oxalate Tf for the precision delivery of drug-loaded polymersomes within a semi-solid dosage form based on chitosan hydrogels. These resulting semi-solids exhibited a sustained release profile for both encapsulated drugs. To evaluate their potency, we compared the cytotoxicity of native Tf-Ps with oxalate Tf-Ps. Notably, the oxalate Tf-Ps demonstrated a 3-fold decrease in cell viability against melanoma cells compared to normal cells and were 1.6-fold more potent than native Tf-Ps, indicating the greater potency of this nanoformulation. These findings suggest that dual-drug delivery using an oxalate-Tf-targeting ligand significantly enhances the drug delivery efficiency of Tf-conjugated nanovesicles and offers a promising strategy to overcome the challenge of multidrug resistance in melanoma therapy.
Collapse
Affiliation(s)
- Mariana de C. Aranha
- Department of Biotechnology, Lorena School of Engineering, University of São Paulo (EEL/USP), Lorena 12602-810, Brazil;
| | - Luciana M. R. Alencar
- Laboratory of Biophysics and Nanosystems, Physics Department, Federal University of Maranhão, São Luís 65080-805, Brazil
| | - Eliana B. Souto
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Belfield, Dublin 4, D04 V1W8 Dublin, Ireland;
| | - Daniel T. Kamei
- Department of Bioengineering, University of California, Los Angeles, 420 Westwood Plaza, 5121 Engineering V, Los Angeles, CA 90095, USA
| | - André M. Lopes
- Department of Biotechnology, Lorena School of Engineering, University of São Paulo (EEL/USP), Lorena 12602-810, Brazil;
| |
Collapse
|
2
|
D'Angelo NA, Noronha MA, Câmara MCC, Kurnik IS, Feng C, Araujo VHS, Santos JHPM, Feitosa V, Molino JVD, Rangel-Yagui CO, Chorilli M, Ho EA, Lopes AM. Doxorubicin nanoformulations on therapy against cancer: An overview from the last 10 years. BIOMATERIALS ADVANCES 2022; 133:112623. [PMID: 35525766 DOI: 10.1016/j.msec.2021.112623] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
Doxorubicin (DOX) is a natural antibiotic with antineoplastic activity. It has been used for over 40 years and remains one of the most used drugs in chemotherapy for a variety of cancers. However, cardiotoxicity limits its use for long periods. To overcome this limitation, encapsulation in smart drug delivery systems (DDS) brings advantages in comparison with free drug administration (i.e., conventional anticancer drug therapy). In this review, we present the most relevant nanostructures used for DOX encapsulation over the last 10 years, such as liposomes, micelles and polymeric vesicles (i.e., polymersomes), micro/nanoemulsions, different types of polymeric nanoparticles and hydrogel nanoparticles, as well as novel approaches for DOX encapsulation. The studies highlighted here show these nanoformulations achieved higher solubility, improved tumor cytotoxicity, prolonged DOX release, as well as reduced side effects, among other interesting advantages.
Collapse
Affiliation(s)
- Natália A D'Angelo
- Faculty of Pharmaceutical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Mariana A Noronha
- Faculty of Pharmaceutical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Mayra C C Câmara
- Faculty of Pharmaceutical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Isabelle S Kurnik
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Chuying Feng
- Laboratory for Drug Delivery and Biomaterials, School of Pharmacy, University of Waterloo, 10 Victoria St S, Kitchener, Ontario N2G1C5, Canada
| | - Victor H S Araujo
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - João H P M Santos
- Department of Biochemical and Pharmaceutical Technology, University of São Paulo (USP), São Paulo, Brazil; Micromanufacturing Laboratory, Center for Bionanomanufacturing, Institute for Technological Research (IPT), São Paulo, Brazil
| | - Valker Feitosa
- Micromanufacturing Laboratory, Center for Bionanomanufacturing, Institute for Technological Research (IPT), São Paulo, Brazil
| | | | - Carlota O Rangel-Yagui
- Department of Biochemical and Pharmaceutical Technology, University of São Paulo (USP), São Paulo, Brazil
| | - Marlus Chorilli
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Emmanuel A Ho
- Laboratory for Drug Delivery and Biomaterials, School of Pharmacy, University of Waterloo, 10 Victoria St S, Kitchener, Ontario N2G1C5, Canada
| | - André M Lopes
- Faculty of Pharmaceutical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.
| |
Collapse
|
3
|
Iron, Copper, and Zinc Homeostasis: Physiology, Physiopathology, and Nanomediated Applications. NANOMATERIALS 2021; 11:nano11112958. [PMID: 34835722 PMCID: PMC8620808 DOI: 10.3390/nano11112958] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 12/14/2022]
Abstract
Understanding of how the human organism functions has preoccupied researchers in medicine for a very long time. While most of the mechanisms are well understood and detailed thoroughly, medicine has yet much to discover. Iron (Fe), Copper (Cu), and Zinc (Zn) are elements on which organisms, ranging from simple bacteria all the way to complex ones such as mammals, rely on these divalent ions. Compounded by the continuously evolving biotechnologies, these ions are still relevant today. This review article aims at recapping the mechanisms involved in Fe, Cu, and Zn homeostasis. By applying the knowledge and expanding on future research areas, this article aims to shine new light of existing illness. Thanks to the expanding field of nanotechnology, genetic disorders such as hemochromatosis and thalassemia can be managed today. Nanoparticles (NPs) improve delivery of ions and confer targeting capabilities, with the potential for use in treatment and diagnosis. Iron deficiency, cancer, and sepsis are persisting major issues. While targeted delivery using Fe NPs can be used as food fortifiers, chemotherapeutic agents against cancer cells and microbes have been developed using both Fe and Cu NPs. A fast and accurate means of diagnosis is a major impacting factor on outcome of patients, especially when critically ill. Good quality imaging and bed side diagnostic tools are possible using NPs, which may positively impact outcome.
Collapse
|
4
|
Satija S, Sharma P, Kaur H, Dhanjal DS, Chopra RS, Khurana N, Vyas M, Sharma N, Tambuwala MM, Bakshi HA, Charbe NB, Zacconi FC, Chellappan DK, Dua K, Mehta M. Perfluorocarbons therapeutics in modern cancer nanotechnology for hypoxia-induced anti-tumor therapy. Curr Pharm Des 2021; 27:4376-4387. [PMID: 34459378 DOI: 10.2174/1381612827666210830100907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022]
Abstract
With an estimated failure rate of about 90%, immunotherapies that are intended for the treatment of solid tumors have caused an anomalous rise in the mortality rate over the past decades. It is apparent that resistance towards such therapies primarily occurs due to elevated levels of HIF-1 (Hypoxia-induced factor) in tumor cells, which are caused by disrupted microcirculation and diffusion mechanisms. With the advent of nanotechnology, several innovative advances were brought to the fore; and, one such promising direction is the use of perfluorocarbon nanoparticles in the management of solid tumors. Perfluorocarbon nanoparticles enhance the response of hypoxia-based agents (HBAs) within the tumor cells and have been found to augment the entry of HBAs into the tumor micro-environment. The heightened penetration of HBAs causes chronic hypoxia, thus aiding in the process of cell quiescence. In addition, this technology has also been applied in photodynamic therapy, where oxygen self-enriched photosensitizers loaded perfluorocarbon nanoparticles are employed. The resulting processes initiate a cascade, depleting tumour oxygen and turning it into a reactive oxygen species eventually to destroy the tumour cell. This review elaborates on the multiple applications of nanotechnology based perfluorocarbon formulations that are being currently employed in the treatment of tumour hypoxia.
Collapse
Affiliation(s)
- Saurabh Satija
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara-144411, Punjab. India
| | - Prabal Sharma
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara-144411, Punjab. India
| | - Harpreet Kaur
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara-144411, Punjab. India
| | - Daljeet Singh Dhanjal
- School of Bioengineering and BioSciences, Lovely Professional University, Phagwara-144411, Punjab. India
| | - Reena Singh Chopra
- School of Bioengineering and BioSciences, Lovely Professional University, Phagwara-144411, Punjab. India
| | - Navneet Khurana
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara-144411, Punjab. India
| | - Manish Vyas
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara-144411, Punjab. India
| | - Neha Sharma
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara-144411, Punjab. India
| | - Murtaza M Tambuwala
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, County Londonderry, BT52 1SA, Northern Ireland. United Kingdom
| | - Hamid A Bakshi
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, County Londonderry, BT52 1SA, Northern Ireland. United Kingdom
| | - Nitin B Charbe
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, 1010 West Avenue B, MSC 131, Kingsville, Texas, 78363. United States
| | - Flavia C Zacconi
- Departamento de Química Orgánica, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Av. Vicuña McKenna 4860, 7820436 Macul, Santiago. Chile
| | - Dinesh Kumar Chellappan
- Department of Life Sciences, School of Pharmacy, International Medical University, Bukit Jalil 57000, Kuala Lumpur. Malaysia
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo NSW 2007. Australia
| | - Meenu Mehta
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara-144411, Punjab. India
| |
Collapse
|
5
|
Santana-Armas ML, Tros de Ilarduya C. Strategies for cancer gene-delivery improvement by non-viral vectors. Int J Pharm 2021; 596:120291. [DOI: 10.1016/j.ijpharm.2021.120291] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 12/21/2022]
|
6
|
Aires Fernandes M, O. Eloy J, Tavares Luiz M, Ramos Junior SL, Borges JC, Rodríguez de la Fuente L, Ortega-de San Luis C, Maldonado Marchetti J, Santos-Martinez MJ, Chorilli M. Transferrin-functionalized liposomes for docetaxel delivery to prostate cancer cells. Colloids Surf A Physicochem Eng Asp 2021. [DOI: 10.1016/j.colsurfa.2020.125806] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
7
|
Guo M, Qu D, Qin Y, Chen Y, Liu Y, Huang M, Chen Y. Transferrin-Functionalized Microemulsions Coloaded with Coix Seed Oil and Tripterine Deeply Penetrate To Improve Cervical Cancer Therapy. Mol Pharm 2019; 16:4826-4835. [PMID: 31663764 DOI: 10.1021/acs.molpharmaceut.9b00717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Mengfei Guo
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
- Jiangsu Provincial Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Ding Qu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
- Jiangsu Provincial Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Yue Qin
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
- Jiangsu Provincial Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Yunyan Chen
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
- Jiangsu Provincial Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Yuping Liu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
- Jiangsu Provincial Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Mengmeng Huang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
- Jiangsu Provincial Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Yan Chen
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
- Jiangsu Provincial Academy of Traditional Chinese Medicine, Nanjing 210028, China
| |
Collapse
|
8
|
Transferrin Receptor Targeted Cellular Delivery of Doxorubicin Via a Reduction-Responsive Peptide-Drug Conjugate. Pharm Res 2019; 36:168. [DOI: 10.1007/s11095-019-2688-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/15/2019] [Indexed: 12/11/2022]
|
9
|
Nurunnabi M, Khatun Z, Badruddoza AZM, McCarthy JR, Lee YK, Huh KM. Biomaterials and Bioengineering Approaches for Mitochondria and Nuclear Targeting Drug Delivery. ACS Biomater Sci Eng 2019. [DOI: 10.1021/acsbiomaterials.8b01615] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Md Nurunnabi
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02129 United States
| | - Zehedina Khatun
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts 02111 United States
| | - Abu Zayed Md Badruddoza
- Department of Chemical and Life Science Engineering, Virginia Commonwealth University, Richmond, Virginia 23219 United States
| | - Jason R. McCarthy
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02129 United States
| | - Yong-kyu Lee
- Department of Chemical and Biological Engineering, Korea National University of Transportation, Chungju 380-706, Republic of Korea
| | - Kang Moo Huh
- Department of Polymer Science and Engineering, Chungnam National University, Daejeon 305-764, Republic of Korea
| |
Collapse
|
10
|
Moghimipour E, Rezaei M, Kouchak M, Ramezani Z, Amini M, Ahmadi Angali K, Saremy S, Abedin Dorkoosh F, Handali S. A mechanistic study of the effect of transferrin conjugation on cytotoxicity of targeted liposomes. J Microencapsul 2018; 35:548-558. [PMID: 30445885 DOI: 10.1080/02652048.2018.1547325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study was performed to prepare 5-fluorouracil (5FU) containing targeted liposomes for the safety and efficacy enhancement. Liposomes were prepared using thin layer method and transferrin (Tf) was employed as the targeting ligand. Morphology of 5FU-loaded liposomes was assessed by transmission electron microscopy (TEM). The in vitro cytotoxicity was investigated via MTT assay on HT-29, CT26 and fibroblast cells. Mitochondrial membrane and cell death evaluations were also investigated. Resulted showed that the encapsulation efficiency (EE%) and particle size of the liposomes were 40.12% and 130 nm, respectively. TEM image implied that liposomes were spherical in shape. In cancer cells, targeted liposomes triggered the mitochondrial apoptotic pathway by lower production of reactive oxygen species (ROS) (63.58 vs 84.95 fluorescence intensity), reduced mitochondrial membrane potential and releasing of cytochrome c (68.66 vs 51.13 ng/mL). The results of this study indicated that Tf-targeted 5FU liposomes can be employed as promising nanocarrier for the delivery of drugs to cancer cells.
Collapse
Affiliation(s)
- Eskandar Moghimipour
- a Nanotechnology Research Center , Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran.,b Cellular and Molecular Research Center , Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran
| | - Mohsen Rezaei
- c Department of Toxicology, Faculty of Medical Sciences , Tarbiat Modares University , Tehran , Iran
| | - Maryam Kouchak
- a Nanotechnology Research Center , Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran
| | - Zahra Ramezani
- a Nanotechnology Research Center , Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran
| | - Mohsen Amini
- d Department of Medicinal Chemistry, Faculty of Pharmacy , Tehran University of Medical Sciences , Tehran , Iran
| | - Kambiz Ahmadi Angali
- e Department of Biostatistics, School of Public Health , Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran
| | - Sadegh Saremy
- b Cellular and Molecular Research Center , Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran
| | - Farid Abedin Dorkoosh
- f Department of Pharmaceutics, Faculty of Pharmacy , Tehran University of Medical Sciences , Tehran , Iran.,g Medical Biomaterial Research Centre (MBRC), Tehran University of Medical Sciences , Tehran , Iran
| | - Somayeh Handali
- a Nanotechnology Research Center , Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran
| |
Collapse
|
11
|
Qi J, Ye X, Li L, Bai H, Xu C. Improving the specific antitumor efficacy of ONC by fusion with N-terminal domain of transferrin. Biosci Biotechnol Biochem 2018; 82:1153-1158. [PMID: 29629632 DOI: 10.1080/09168451.2018.1456318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Onconase (ONC) as a novel anti-tumor drug has a significant killing effect on a variety of tumor cells. Drug delivery system mediated by transferrin (TF) and TF receptor (TfR), which can significantly increase the amount of drug uptake in the tumor cells, enhance the initiative target efficiency of drugs and reduce its toxic side effects. It has been widely used in drug delivery and clinical trials. In this study, the rONC-TFn was expressed in Escherichia coli by linking ONC with the N-terminal domain of TF (TFn). ELISA and competitive binding analysis demonstrated that rONC-TFn can bind to TfR. The rONC-TFn protein showed much higher cytotoxicity to the cultured HepG2 and Hela cells than rONC. These results suggested that the N-terminal domain protein of TF promoted the tumor targeting of ONC, and thus the rONC-TFn fusion protein may be further developed as a potential targeted anti-tumor drug.
Collapse
Affiliation(s)
- Jianying Qi
- a College of Life Science , Henan Normal University , Xinxiang , China.,b Key Laboratory for Cell Differentiation Regulation , Henan Normal University , Xinxiang , China
| | - Xianlong Ye
- a College of Life Science , Henan Normal University , Xinxiang , China
| | - Lingling Li
- a College of Life Science , Henan Normal University , Xinxiang , China.,b Key Laboratory for Cell Differentiation Regulation , Henan Normal University , Xinxiang , China
| | - Haijing Bai
- a College of Life Science , Henan Normal University , Xinxiang , China.,b Key Laboratory for Cell Differentiation Regulation , Henan Normal University , Xinxiang , China
| | - Cunshuan Xu
- a College of Life Science , Henan Normal University , Xinxiang , China.,b Key Laboratory for Cell Differentiation Regulation , Henan Normal University , Xinxiang , China
| |
Collapse
|
12
|
Nanoparticles and targeted drug delivery in cancer therapy. Immunol Lett 2017; 190:64-83. [PMID: 28760499 DOI: 10.1016/j.imlet.2017.07.015] [Citation(s) in RCA: 262] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/04/2017] [Accepted: 07/26/2017] [Indexed: 12/11/2022]
Abstract
Surgery, chemotherapy, radiotherapy, and hormone therapy are the main common anti-tumor therapeutic approaches. However, the non-specific targeting of cancer cells has made these approaches non-effective in the significant number of patients. Non-specific targeting of malignant cells also makes indispensable the application of the higher doses of drugs to reach the tumor region. Therefore, there are two main barriers in the way to reach the tumor area with maximum efficacy. The first, inhibition of drug delivery to healthy non-cancer cells and the second, the direct conduction of drugs into tumor site. Nanoparticles (NPs) are the new identified tools by which we can deliver drugs into tumor cells with minimum drug leakage into normal cells. Conjugation of NPs with ligands of cancer specific tumor biomarkers is a potent therapeutic approach to treat cancer diseases with the high efficacy. It has been shown that conjugation of nanocarriers with molecules such as antibodies and their variable fragments, peptides, nucleic aptamers, vitamins, and carbohydrates can lead to effective targeted drug delivery to cancer cells and thereby cancer attenuation. In this review, we will discuss on the efficacy of the different targeting approaches used for targeted drug delivery to malignant cells by NPs.
Collapse
|
13
|
Lopes AM, Chen KY, Kamei DT. A transferrin variant as the targeting ligand for polymeric nanoparticles incorporated in 3-D PLGA porous scaffolds. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 73:373-380. [PMID: 28183621 DOI: 10.1016/j.msec.2016.12.091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/10/2016] [Accepted: 12/19/2016] [Indexed: 01/11/2023]
Abstract
We have developed doxorubicin (DOX)-loaded poly(lactide-co-glycolide) (PLGA) nanoparticles (DP) conjugated with polyethylene glycol (PEG) and transferrin (Tf) to form Tf-PEG-DPs (TPDPs), and incorporated these TPDPs into three-dimensional (3-D) PLGA porous scaffolds to form a controlled delivery system. To our knowledge, this represents the first use of a Tf variant (oxalate Tf) to improve the targeted delivery of drug-encapsulated nanoparticles (NPs) in PLGA scaffolds to PC3 prostate cancer cells. The PLGA scaffolds with TPDPs incorporated have been shown to release drugs for sustained delivery and provided a continuous release of DOX. The MTS assay was also performed to determine the potency of native and oxalate TPDPs, and a 3.0-fold decrease in IC50 values were observed between the native and oxalate TPDPs. The lower IC50 value for the oxalate version signifies greater potency compared to the native version, since a lower concentration of drug was required to achieve the same therapeutic effect. These results suggest that this technology has potential to become a new implantable polymeric device to improve the controlled and targeted drug delivery of Tf-conjugated NPs for cancer therapy.
Collapse
Affiliation(s)
- André M Lopes
- Department of Bioengineering, University of California, Los Angeles, 420 Westwood Plaza, 5121 Engineering V, Los Angeles, CA 90095, USA
| | - Kevin Y Chen
- Department of Bioengineering, University of California, Los Angeles, 420 Westwood Plaza, 5121 Engineering V, Los Angeles, CA 90095, USA
| | - Daniel T Kamei
- Department of Bioengineering, University of California, Los Angeles, 420 Westwood Plaza, 5121 Engineering V, Los Angeles, CA 90095, USA.
| |
Collapse
|
14
|
Das A, Nag S, Mason AB, Barroso MM. Endosome-mitochondria interactions are modulated by iron release from transferrin. J Cell Biol 2016; 214:831-45. [PMID: 27646275 PMCID: PMC5037410 DOI: 10.1083/jcb.201602069] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 08/11/2016] [Indexed: 12/21/2022] Open
Abstract
Using superresolution and quantitative fluorescence microscopy, Das et al. have revealed that iron-transferrin–containing endosomes directly interact with mitochondria, facilitating iron transfer in epithelial cells. Their findings further enrich the repertoire of organelle–organelle direct interactions to accomplish a functional significance. Transient “kiss and run” interactions between endosomes containing iron-bound transferrin (Tf) and mitochondria have been shown to facilitate direct iron transfer in erythroid cells. In this study, we used superresolution three-dimensional (3D) direct stochastic optical reconstruction microscopy to show that Tf-containing endosomes directly interact with mitochondria in epithelial cells. We used live-cell time-lapse fluorescence microscopy, followed by 3D rendering, object tracking, and a distance transformation algorithm, to track Tf-endosomes and characterize the dynamics of their interactions with mitochondria. Quenching of iron sensor RDA-labeled mitochondria confirmed functional iron transfer by an interacting Tf-endosome. The motility of Tf-endosomes is significantly reduced upon interaction with mitochondria. To further assess the functional role of iron in the ability of Tf-endosomes to interact with mitochondria, we blocked endosomal iron release by using a Tf K206E/K534A mutant. Blocking intraendosomal iron release led to significantly increased motility of Tf-endosomes and increased duration of endosome–mitochondria interactions. Thus, intraendosomal iron regulates the kinetics of the interactions between Tf-containing endosomes and mitochondria in epithelial cells.
Collapse
Affiliation(s)
- Anupam Das
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY 12208
| | - Sagarika Nag
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY 12208
| | - Anne B Mason
- Department of Biochemistry, University of Vermont College of Medicine, Burlington, VT 05405
| | - Margarida M Barroso
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY 12208
| |
Collapse
|
15
|
Cooper BM, Putnam D. Polymers for siRNA Delivery: A Critical Assessment of Current Technology Prospects for Clinical Application. ACS Biomater Sci Eng 2016; 2:1837-1850. [PMID: 33440520 DOI: 10.1021/acsbiomaterials.6b00363] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The number of polymer-based vectors for siRNA delivery in clinical trials lags behind other delivery strategies; however, the molecular architectures and chemical compositions available to polymers make them attractive candidates for further exploration. Polymer vectors are extensively investigated in academic laboratories worldwide with fundamental progress having recently been made in the areas of high-throughput screening, synthetic methods, cellular internalization, endosomal escape and computational prediction and analysis. This review assesses recent advances within the field and highlights relevant developments from within the complementary fields of nanotechnology and protein chemistry with the intent to propose future work that addresses key gaps within the current body of knowledge, potentially advancing the development of the next generation of polymeric vectors.
Collapse
Affiliation(s)
- Bailey M Cooper
- Meinig School of Biomedical Engineering and ‡Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, New York 14853, United States
| | - David Putnam
- Meinig School of Biomedical Engineering and Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, New York 14853, United States
| |
Collapse
|
16
|
Guo J, O'Driscoll CM, Holmes JD, Rahme K. Bioconjugated gold nanoparticles enhance cellular uptake: A proof of concept study for siRNA delivery in prostate cancer cells. Int J Pharm 2016; 509:16-27. [PMID: 27188645 DOI: 10.1016/j.ijpharm.2016.05.027] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 12/19/2022]
Abstract
The chemistry of gold nanoparticles (AuNPs) facilitates surface modifications and thus these bioengineered NPs have been investigated as a means of delivering a variety of therapeutic cargos to treat cancer. In this study we have developed AuNPs conjugated with targeting ligands to enhance cell-specific uptake in prostate cancer cells, with a purpose of providing efficient non-viral gene delivery systems in the treatment of prostate cancer. As a consequence, two novel AuNPs were synthesised namely AuNPs-PEG-Tf (negatively charged AuNPs with the transferrin targeting ligands) and AuNPs-PEI-FA (positively charged AuNPs with the folate-receptor targeting ligands). Both bioconjugated AuNPs demonstrated low cytotoxicity in prostate cancer cells. The attachment of the targeting ligand Tf to AuNPs successfully achieved receptor-mediated cellular uptake in PC-3 cells, a prostate cancer cell line highly expressing Tf receptors. The AuNPs-PEI-FA effectively complexed small interfering RNA (siRNA) through electrostatic interaction. At the cellular level the AuNPs-PEI-FA specifically delivered siRNA into LNCaP cells, a prostate cancer cell line overexpressing prostate specific membrane antigen (PSMA, exhibits a hydrolase enzymic activity with a folate substrate). Following endolysosomal escape the AuNPs-PEI-FA.siRNA formulation produced enhanced endogenous gene silencing compared to the non-targeted formulation. Our results suggest both formulations have potential as non-viral gene delivery vectors in the treatment of prostate cancer.
Collapse
Affiliation(s)
- Jianfeng Guo
- Pharmacodelivery Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | | | - Justin D Holmes
- Materials Chemistry and Analysis Group, Department of Chemistry and The Tyndall National Institute, University College Cork, Cork, Ireland; Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland
| | - Kamil Rahme
- Materials Chemistry and Analysis Group, Department of Chemistry and The Tyndall National Institute, University College Cork, Cork, Ireland; Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland; Department of Sciences, Faculty of Natural and Applied Science, Notre Dame University (Louaize), Zouk Mosbeh, Lebanon.
| |
Collapse
|
17
|
Ezzati Nazhad Dolatabadi J, Omidi Y. Solid lipid-based nanocarriers as efficient targeted drug and gene delivery systems. Trends Analyt Chem 2016. [DOI: 10.1016/j.trac.2015.12.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
18
|
Shan L, Shan X, Zhang T, Zhai K, Gao G, Chen X, Gu Y. Transferrin-conjugated paclitaxel prodrugs for targeted cancer therapy. RSC Adv 2016. [DOI: 10.1039/c6ra15141h] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Paclitaxel (PTX) is one of the most effective chemotherapeutic drugs ever developed and is effective against a wide spectrum of tumors.
Collapse
Affiliation(s)
- Lingling Shan
- Institute of Pharmaceutical Biotechnology
- School of Biology and Food Engineering
- School of Continuing Education
- Suzhou University
- Suzhou 234000
| | - Xin Shan
- Institute of Pharmaceutical Biotechnology
- School of Biology and Food Engineering
- School of Continuing Education
- Suzhou University
- Suzhou 234000
| | - Tinging Zhang
- Institute of Pharmaceutical Biotechnology
- School of Biology and Food Engineering
- School of Continuing Education
- Suzhou University
- Suzhou 234000
| | - Kefeng Zhai
- Institute of Pharmaceutical Biotechnology
- School of Biology and Food Engineering
- School of Continuing Education
- Suzhou University
- Suzhou 234000
| | - Guizhen Gao
- Institute of Pharmaceutical Biotechnology
- School of Biology and Food Engineering
- School of Continuing Education
- Suzhou University
- Suzhou 234000
| | - XiaoYuan Chen
- Laboratory of Molecular Imaging and Nanomedicine
- National Institute of Biomedical Imaging and Bioengineering
- National Institutes of Health
- Bethesda 20892
- USA
| | - Yueqing Gu
- Department of Biomedical Engineering
- State Key Laboratory of Natural Medicines
- School of Life Science and Technology
- China Pharmaceutical University
- Nanjing 210009
| |
Collapse
|
19
|
Xu YY, Gao P, Sun Y, Duan YR. Development of targeted therapies in treatment of glioblastoma. Cancer Biol Med 2015; 12:223-37. [PMID: 26487967 PMCID: PMC4607828 DOI: 10.7497/j.issn.2095-3941.2015.0020] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/22/2015] [Indexed: 12/12/2022] Open
Abstract
Glioblastoma (GBM) is a type of tumor that is highly lethal despite maximal therapy. Standard therapeutic approaches provide modest improvement in progression-free and overall survival, necessitating the investigation of novel therapies. Oncologic therapy has recently experienced a rapid evolution toward "targeted therapy", with drugs directed against specific targets which play essential roles in the proliferation, survival, and invasiveness of GBM cells, including numerous molecules involved in signal transduction pathways. Inhibitors of these molecules have already entered or are undergoing clinical trials. However, significant challenges in their development remain because several preclinical and clinical studies present conflicting results. In this article, we will provide an up-to-date review of the current targeted therapies in GBM.
Collapse
Affiliation(s)
- Yuan-Yuan Xu
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200032, China
| | - Pei Gao
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200032, China
| | - Ying Sun
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200032, China
| | - You-Rong Duan
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200032, China
| |
Collapse
|
20
|
Zhang W, Peng F, Zhou T, Huang Y, Zhang L, Ye P, Lu M, Yang G, Gai Y, Yang T, Ma X, Xiang G. Targeted delivery of chemically modified anti-miR-221 to hepatocellular carcinoma with negatively charged liposomes. Int J Nanomedicine 2015; 10:4825-36. [PMID: 26251599 PMCID: PMC4524461 DOI: 10.2147/ijn.s79598] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death. Gene therapy was established as a new strategy for treating HCC. To explore the potential delivery system to support the gene therapy of HCC, negatively charged liposomal delivery system was used to deliver miR-221 antisense oligonucleotide (anti-miR-221) to the transferrin (Tf) receptor over expressed HepG2 cells. The liposome exhibited a mean particle size of 122.5 nm, zeta potential of −15.74 mV, anti-miR-221 encapsulation efficiency of 70%, and excellent colloidal stability at 4°C. Anti-miR-221-encapsulated Tf-targeted liposome demonstrated a 15-fold higher delivery efficiency compared to nontargeted liposome in HepG2 cells in vitro. Anti-miR-221 Tf-targeted liposome effectively delivered anti-miR-221 to HepG2 cells, upregulated miR-221 target genes PTEN, P27kip1, and TIMP3, and exhibited greater silencing efficiency over nontargeted anti-miR-221 liposome. After intravenous injection into HepG2 tumor-bearing xenografted mice with Cy3-labeled anti-miR-221 Tf-targeted liposome, Cy3-anti-miR-221 was successfully delivered to the tumor site and increased the expressions of PTEN, P27kip1, and TIMP3. Our results demonstrate that the Tf-targeted negatively charged liposome could be a potential therapeutic modality in the gene therapy of human HCC.
Collapse
Affiliation(s)
- Wendian Zhang
- school of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Fangqi Peng
- school of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Taotao Zhou
- school of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yifei Huang
- Department of Pharmacy, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Peng Ye
- Department of Pharmacy, Wuhan University, Renmin Hospital, Wuhan, People's Republic of China
| | - Miao Lu
- school of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Guang Yang
- School of Medicine, Jianghan University, Wuhan, People's Republic of China
| | - Yongkang Gai
- school of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Tan Yang
- school of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xiang Ma
- school of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Guangya Xiang
- school of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| |
Collapse
|
21
|
Voth B, Nagasawa DT, Pelargos PE, Chung LK, Ung N, Gopen Q, Tenn S, Kamei DT, Yang I. Transferrin receptors and glioblastoma multiforme: Current findings and potential for treatment. J Clin Neurosci 2015; 22:1071-6. [DOI: 10.1016/j.jocn.2015.02.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 02/08/2015] [Indexed: 01/21/2023]
|
22
|
Shao Z, Shao J, Tan B, Guan S, Liu Z, Zhao Z, He F, Zhao J. Targeted lung cancer therapy: preparation and optimization of transferrin-decorated nanostructured lipid carriers as novel nanomedicine for co-delivery of anticancer drugs and DNA. Int J Nanomedicine 2015; 10:1223-33. [PMID: 25709444 PMCID: PMC4334334 DOI: 10.2147/ijn.s77837] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Nanostructured lipid carriers (NLC) represent an improved generation of lipid nanoparticles. They have specific nanostructures to accommodate drugs/genes, and thus achieve higher loading capacity. The aim of this study was to develop transferrin (Tf)-decorated NLC as multifunctional nanomedicine for co-delivery of paclitaxel (PTX) and enhanced green fluorescence protein plasmid. Methods Firstly, Tf-conjugated ligands were synthesized. Secondly, PTX- and DNA-loaded NLC (PTX-DNA-NLC) was prepared. Finally, Tf-containing ligands were used for the surface decoration of NLC. Their average size, zeta potential, drug, and gene loading were evaluated. Human non-small cell lung carcinoma cell line (NCl-H460 cells) was used for the testing of in vitro transfection efficiency, and in vivo transfection efficiency of NLC was evaluated on mice bearing NCl-H460 cells. Results Tf-decorated PTX and DNA co-encapsulated NLC (Tf-PTX-DNA-NLC) were nano-sized particles with positive zeta potential. Tf-PTX-DNA-NLC displayed low cytotoxicity, high gene transfection efficiency, and enhanced antitumor activity in vitro and in vivo. Conclusion The results demonstrated that Tf-PTX-DNA-NLC can achieve impressive antitumor activity and gene transfection efficiency. Tf decoration also enhanced the active targeting ability of the carriers to NCl-H460 cells. The novel drug and gene delivery system offers a promising strategy for the treatment of lung cancer.
Collapse
Affiliation(s)
- Zhenyu Shao
- Department of Radiotherapy, Cancer Centre, Qilu Hospital, Shandong University, Ji'nan, Shandong, People's Republic of China
| | - Jingyu Shao
- Affiliated Hospital of Northwest Institute of Mechanical and Electrical Engineering, Xianyang, Shaanxi, People's Republic of China
| | - Bingxu Tan
- Department of Radiotherapy, Cancer Centre, Qilu Hospital, Shandong University, Ji'nan, Shandong, People's Republic of China
| | - Shanghui Guan
- Department of Radiotherapy, Cancer Centre, Qilu Hospital, Shandong University, Ji'nan, Shandong, People's Republic of China
| | - Zhulong Liu
- Department of Radiotherapy, Cancer Centre, Qilu Hospital, Shandong University, Ji'nan, Shandong, People's Republic of China
| | - Zengjun Zhao
- Department of Radiotherapy, Cancer Centre, Qilu Hospital, Shandong University, Ji'nan, Shandong, People's Republic of China
| | - Fangfang He
- Department of Radiotherapy, Cancer Centre, Qilu Hospital, Shandong University, Ji'nan, Shandong, People's Republic of China
| | - Jian Zhao
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Ji'nan, Shandong, People's Republic of China
| |
Collapse
|
23
|
Han Y, Zhang Y, Li D, Chen Y, Sun J, Kong F. Transferrin-modified nanostructured lipid carriers as multifunctional nanomedicine for codelivery of DNA and doxorubicin. Int J Nanomedicine 2014; 9:4107-16. [PMID: 25187713 PMCID: PMC4149457 DOI: 10.2147/ijn.s67770] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Nanostructured lipid carriers (NLC), composed of solid and liquid lipids, and surfactants are potentially good colloidal drug carriers. The aim of this study was to develop surface-modified NLC as multifunctional nanomedicine for codelivery of enhanced green fluorescence protein plasmid (pEGFP) and doxorubicin (DOX). METHODS TWO DIFFERENT NANOCARRIERS: pEGFP- and DOX-loaded NLC, and solid lipid nanoparticles (SLN) were prepared. Transferrin-containing ligands were used for the surface coating of the vectors. Their average size, zeta potential, and drug encapsulation capacity were evaluated. In vitro transfection efficiency of the modified vectors was evaluated in human alveolar adenocarcinoma cell line (A549 cells), and in vivo transfection efficiency of the modified vectors was evaluated in a mouse bearing A549 cells model. RESULTS Transferrin-modified DOX and pEGFP coencapsulated NLC (T-NLC) has a particle size of 198 nm and a +19 mV surface charge. The in vitro cell viabilities of the T-NLC formulations were over 80% compared with the control. T-NLC displayed remarkably greater gene transfection efficiency and enhanced antitumor activity than DOX- and pEGFP-coencapsulated SLN in vivo. CONCLUSION The results demonstrate that T-NLC noticeably enhanced antitumor activity through the combination of gene therapy with chemotherapy. Also coating of active transferrin improved the lung cancer cell-targeting of the carriers. In summary, the novel gene and drug delivery system offers a promising strategy for the treatment of lung cancer.
Collapse
Affiliation(s)
- Yiqun Han
- Department of Respiratory Medicine, General Hospital of Ji'nan Command, PLA, Ji'nan, People's Republic of China
| | - Ying Zhang
- Center of Interventional Therapy, Ji'nan Infectious Disease Hospital, PLA, Ji'nan, People's Republic of China
| | - Danni Li
- Department of Internal Neurology, Ji'nan Central Hospital Affiliated to Shandong University, PLA, Ji'nan, People's Republic of China
| | - Yuanyuan Chen
- Department of Respiratory Medicine, General Hospital of Ji'nan Command, PLA, Ji'nan, People's Republic of China
| | - Jiping Sun
- Department of Respiratory Medicine, General Hospital of Ji'nan Command, PLA, Ji'nan, People's Republic of China
| | - Fansheng Kong
- Department of Hematology, General Hospital of Ji'nan Command, PLA, Ji'nan, People's Republic of China
| |
Collapse
|