Ultrasound-mediated nano drug delivery for treating cancer: Fundamental physics to future directions

The application of biocompatible nanocarriers in medicine has provided several benefits over conventional treatment methods. However, achieving high treatment efficacy and deep penetration of nanocarriers in tumor tissue is still challenging. To address this, stimuli-responsive nano-sized drug delivery systems (DDSs) are an active area of investigation in delivering anticancer drugs. While ultrasound is mainly used for diagnostic purposes, it can also be applied to affect cellular function and the delivery/release of anticancer drugs. Therapeutic ultrasound (TUS) has shown potential as both a stand-alone anticancer treatment and a method to induce targeted drug release from nanocarrier systems. TUS approaches have been used to overcome various physiological obstacles, including endothelial barriers, the tumor microenvironment (TME), and immunological hurdles. Combining nanomedicine and ultrasound as a smart DDS can increase in situ drug delivery and improve access to impermeable tissues. Furthermore, smart DDSs can perform targeted drug release in response to distinctive TMEs, external triggers, or dual/multi-stimulus. This results in enhanced treatment efficacy and reduced damage to surrounding healthy tissue or organs at risk. Integrating DDSs and ultrasound is still in its early stages. More research and clinical trials are required to fully understand ultrasound's underlying physical mechanisms and interactions with various types of nanocarriers and different types of cells and tissues. In the present review, ultrasound-mediated nano-sized DDS, specifically focused on cancer treatment, is presented and discussed. Ultrasound interaction with nanoparticles (NPs), drug release mechanisms, and various types of ultrasound-sensitive NPs are examined. Additionally, in vitro, in vivo, and clinical applications of TUS are reviewed in light of the critical challenges that need to be considered to advance TUS toward an efficient, secure, straightforward, and accessible cancer treatment. This study also presents effective TUS parameters and safety considerations for this treatment modality and gives recommendations about system design and operation. Finally, future perspectives are considered, and different TUS approaches are examined and discussed in detail. This review investigates drug release and delivery through ultrasound-mediated nano-sized cancer treatment, both pre-clinically and clinically.

Physically stimulus-responsive nanoparticles for therapy and diagnosis

Nanoparticles offer numerous advantages in various fields of science, particularly in medicine. Over recent years, the use of nanoparticles in disease diagnosis and treatments has increased dramatically by the development of stimuli-responsive nano-systems, which can respond to internal or external stimuli. In the last 10 years, many preclinical studies were performed on physically triggered nano-systems to develop and optimize stable, precise, and selective therapeutic or diagnostic agents. In this regard, the systems must meet the requirements of efficacy, toxicity, pharmacokinetics, and safety before clinical investigation. Several undesired aspects need to be addressed to successfully translate these physical stimuli-responsive nano-systems, as biomaterials, into clinical practice. These have to be commonly taken into account when developing physically triggered systems; thus, also applicable for nano-systems based on nanomaterials. This review focuses on physically triggered nano-systems (PTNSs), with diagnostic or therapeutic and theranostic applications. Several types of physically triggered nano-systems based on polymeric micelles and hydrogels, mesoporous silica, and magnets are reviewed and discussed in various aspects.

Photo- and Acid-Degradable Polyacylhydrazone-Doxorubicin Conjugates

Light-mediated polymer degradation has attracted considerable attention in various applications, including photo-patterning, tissue engineering and photo-triggered drug delivery. In this study, we report the synthesis and characterization of a new, linear, main-chain photo- and acid-degradable copolymer based on acylhydrazone linkages. The polymer was synthesized via a step-growth copolymerization of adipic acid dihydrazide with a bifunctional poly(ethylene glycol) bearing benzaldehyde end-groups, under mild acidic conditions, to afford a hydrophilic PEG-alt-adipic acid (PEG-alt-AA) alternating copolymer. The synthesized polymer was characterized by size exclusion chromatography, proton nuclear magnetic resonance and attenuated total reflection-Fourier transform infrared spectroscopies. The main-chain photo- and acid-induced degradation of the copolymer in dimethylsulfoxide and water, respectively, was verified by UV-vis spectroscopy at light intensities as low as 0.1 mW cm⁻² at λ = 254 nm. Next, a model anticancer drug, doxorubicin (DOX), was chemically linked to the polymer chain end(s) via acylhydrazone bond(s), resulting in amphiphilic PEG-alt-adipic acid-DOX (PEG-alt-AA-DOX) polymer–drug conjugates. The conjugates were self-assembled in water to form spherical nanoparticles, as evidenced by scanning and transmission electron microscopies. The irradiation of the self-assembled PEG-alt-AA-DOX conjugates with UV light and the decrease of the solution pH resulted in the disruption of the assemblies due to the photolysis and acidolysis of the acylhydrazone bonds, and the release of the therapeutic cargo.

Ultrasound-Responsive Nanocarriers in Cancer Treatment: A Review

The safe and effective delivery of anticancer agents to diseased tissues is one of the significant challenges in cancer therapy. Conventional anticancer agents are generally cytotoxins with poor pharmacokinetics and bioavailability. Nanocarriers are nanosized particles designed for the selectivity of anticancer drugs and gene transport to tumors. They are small enough to extravasate into solid tumors, where they slowly release their therapeutic load by passive leakage or biodegradation. Using smart nanocarriers, the rate of release of the entrapped therapeutic(s) can be increased, and greater exposure of the tumor cells to the therapeutics can be achieved when the nanocarriers are exposed to certain internally (enzymes, pH, and temperature) or externally (light, magnetic field, and ultrasound) applied stimuli that trigger the release of their load in a safe and controlled manner, spatially and temporally. This review gives a comprehensive overview of recent research findings on the different types of stimuli-responsive nanocarriers and their application in cancer treatment with a particular focus on ultrasound.

Three-Step Synthesis of a Redox-Responsive Blend of PEG-block-PLA and PLA and Application to the Nanoencapsulation of Retinol

Smart polymeric nanocarriers have been developed to deliver therapeutic agents directly to the intended site of action, with superior efficacy. Herein, a mixture of poly(lactide) (PLA) and redox-responsive poly(ethylene glycol)-block-poly(lactide) (PEG-block-PLA) containing a disulfide bond was synthesized in three steps. The nanoprecipitation method was used to prepare an aqueous suspension of polymeric nanocarriers with a hydrodynamic diameter close to 100 nm. Retinol, an anti-aging agent very common in cosmetics, was loaded into these smart nanocarriers as a model to measure their capacity to encapsulate and to protect a lipophilic active molecule. Retinol was encapsulated with a high efficiency with final loading close to 10% w/w. The stimuli-responsive behavior of these nanocarriers was demonstrated in vitro, in the presence of l-Glutathione, susceptible to break of disulfide bond. The toxicity was low on human keratinocytes in vitro and was mainly related to the active molecule. Those results show that it is not necessary to use 100% of smart copolymer in a nanosystem to obtain a triggered release of their content.

Ultrasound-Responsive Carriers for Therapeutic Applications

Ultrasound (US)-responsive carriers have emerged as promising theranostic candidates because of their ability to enhance US-contrast, promote image-guided drug delivery, cause on-demand pulsatile release of drugs in response to ultrasound stimuli, as well as to enhance the permeability of physiological barriers such as the stratum corneum, the vascular endothelium, and the blood-brain barrier (BBB). US-responsive carriers include microbubbles MBs, liposomes, droplets, hydrogels, and nanobubble-nanoparticle complexes and have been explored for cavitation-mediated US-responsive drug delivery. Recently, a transient increase in the permeability of the BBB by microbubble (MB)-assisted low-frequency US has shown promise in enhancing the delivery of therapeutic agents in the case of neurological disorders. Further, the periodic mechanical stimulus generated by US-responsive MBs have also been explored in tissue engineering and has directly influenced the differentiation of mesenchymal stem cells into cartilage. This Review discusses the various types of US-responsive carriers and explores their emerging roles in therapeutics ranging from drug delivery to tissue engineering.

Disulfide-Based Self-Immolative Linkers and Functional Bioconjugates for Biological Applications

It is of vital importance to reversibly mask and selectively activate bioactive agents for advanced therapeutic and diagnostic purposes, aiming to efficiently suppress background interferences and attenuate systemic toxicity. This strategy has been involved in diverse applications spanning from chemical/biological sensors and diagnostics to drug delivery nanocarriers. Among these, redox-responsive disulfide linkages have been extensively utilized by taking advantage of extracellular and intracellular glutathione (GSH) gradients. However, direct conjugation of cleavable triggers to bioactive agents through disulfide bonds suffers from bulky steric hindrance and limited choice of trigger-drug combinations. Fortunately, the emergence of disulfide self-immolative linkers (DSILs) provides a general and robust strategy to not only mask various bioactive agents through the formation of dynamic disulfide linkages but also make it possible to be selectively activated upon disulfide cleavage in the reductive cytoplasmic milieu. In this review, recent developments in DSILs are focused with special attention on emerging chemical design strategies and functional applications in the biomedical field.

Ultrasound Reversible Response Nanocarrier Based on Sodium Alginate Modified Mesoporous Silica Nanoparticles

Mesoporous silica nanoparticles (MSN) covered by polymer coatings, cross-linked by weak coordination bonds were expected to present a reversible responsiveness under on-off ultrasound stimuli. Herein, we prepared a sodium alginate (SA) modified MSN with carboxyl-calcium (COO--Ca2+) coordination bonds in the modified layer, which could block the mesopores of MSN and effectively prevent the cargo from pre-releasing before stimulation. The coordination bonds would be destroyed under the stimulation of low intensity ultrasound (20 kHz) or high intensity focused ultrasound (HIFU, 1.1 MHz), leading to a rapid and significant cargo release, and then they could be reformed when ultrasound was turned off, resulting in an instant cargo release stopping. The reversible cleavage and reformation of this coordination bonds under on-off ultrasound stimulus were confirmed by the gel-sol transition behaviors of the SA-CaCl2 gels. An excellent real-time control of rhodamine B (RhB) release performance was obtained under the ultrasound stimuli. Obviously, the cargo release ratio could reach to nearly 40% when HIFU (80 W) was turned on for 5 min, and remained basically constant when ultrasound was turned off, which would finally reach to nearly 100% within 30 min under this on-off pulsatile status. These hybrid MSN based nanoparticles with excellent reversible ultrasound on-off responsiveness were of great interest in on-demand drug delivery applications in the future.

HIFU induced particles redistribution in polymer matrix via synchrotron radiation X-ray microtomography

High-intensity Focused Ultrasound (HIFU) was used to stimulate the embedded copper sulfate (CuSO₄) particles to release from the crosslinked poly (methyl methacrylate-co-butyl acrylate) copolymer solid matrix. In order to better understand the ultrasound release mechanism for drug/polymer delivery systems, the synchrotron radiation X-ray computed microtomography (SR-CT) was used to non-destructively investigate the structure of drug/polymer delivery systems after different HIFU treatment time. For the first time, we clearly demonstrate that ultrasonic waves can overcome the constraints of the polymer chain and drive the filler to move from the strong region to the weak region in the solid polymer matrix, thus resulting in a change in distribution of the filler in solid polymers. This result also demonstrates that SR-CT is a powerful technique which can be used to quantitatively study the 3D structure of fillers/polymers composite as it can take a broader and overall view than the conventional localized two-dimensional analysis method such as SEM, TEM.

pH and Ultrasound Dual-Responsive Polydopamine-Coated Mesoporous Silica Nanoparticles for Controlled Drug Delivery

A pH- and ultrasound dual-responsive drug release pattern was successfully achieved using mesoporous silica nanoparticles (MSNs) coated with polydopamine (PDA). In this paper, the PDA shell on the MSN surface was obtained through oxidative self-polymerization under the alkaline condition. The morphology and structure of this composite nanoparticle were fully characterized by a series of analyses, such as infrared (IR), transmission electron microscopy, and thermogravimetric analysis. Doxorubicin hydrochloride (DOX)-loaded composite nanoparticles were used to study the performances of responsive drug storage/release behavior, and this kind of hybrid material displayed an apparent pH response in DOX releasing under the acidic condition. Beyond that, upon high-intensity focused ultrasound exposure, loaded DOX in composite nanoparticles was successfully triggered to release from pores because of the ultrasonic cavitation effect, and the DOX-releasing pattern could be optimized into a unique pulsatile fashion by switching the on/off status. From the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, it was observed that our blank nanoparticles showed no toxicity to HeLa cells, but DOX-loaded nanoparticles could inhibit the growth of tumor cells. Furthermore, these composite nanoparticles displayed an effective near-IR photothermal conversion capability with a relatively high conversion efficiency (∼37%). These as-desired drug delivery carriers might have a great potential for future cancer treatment that combine the chemotherapy and photothermal therapy.

A core/shell stabilized polysaccharide-based nanoparticle with intracellular environment-sensitive drug delivery for breast cancer therapy

In this work, we developed a novel core/shell chitosan (Cs)/hyaluronan (HA)-based hybrid nanoparticle, i.e. SNX@Cs-SNX/cHA, with good stability in the bloodstream and intracellular environment-sensitive drug delivery for breast cancer therapy.

Preparation of multilocation reduction-sensitive core crosslinked folate-PEG-coated micelles for rapid release of doxorubicin and tariquidar to overcome drug resistance

Herein, we prepared folate-targeting core crosslinked polymeric micelles (CCL/FA) containing multiple disulfide bonds located at the interface and core of the micelles to co-deliver doxorubicin (DOX) and the P-glycoprotein (P-gp) inhibitor tariquidar (TQR) for reversing drug resistance. The stability and redox-responsive behavior of the CCL/FA micelles was evaluated through the changes in morphology, molecular weight and hydrodynamic size. On the one hand, the micelles possessed good stability, which led to the suppression of drug release from the CCL micelles in the physiological environment. On the other hand, under reductive conditions, the CCL micelles collapsed rapidly and accelerated drug release markedly. In vitro cytotoxicity measurements, combined with confocal laser scanning microscopy (CLSM) and flow cytometry, confirmed that the dual-drug-loaded micelles exhibited obviously higher cytotoxicity to MCF-7/ADR-resistant cells than free DOX · HCl, single-drug loaded CCL micelles and nontargeted CCL micelles. The results imply that co-delivering DOX and TQR by CCL/FA micelles may be a promising way of overcoming multidrug resistance in tumor treatments.

Temperature, ultrasound and redox triple-responsive poly(N-isopropylacrylamide) block copolymer: synthesis, characterization and controlled release

Triple stimuli-responsive polymers PNiPAAm-S-S-PXCL containing a disulfide (–S–S–) bond as a junction point between hydrophilic and hydrophobic chains were synthesized and characterized.

Bioinspired ultrasound-responsive fluorescent metal–ligand cross-linked polymer assemblies

We proposed a general strategy to construct bioinspired ultrasound-responsive fluorescent metal–ligand cross-linked polymer assemblies.

Ultrasound responsive block copolymer micelle of poly(ethylene glycol)-poly(propylene glycol) obtained through click reaction

The well-defined amphiphilic poly(ethylene glycol)-block-poly(propylene glycol) copolymer containing 1, 2, 3-triazole moiety and multiple ester bonds (PEG-click-PPG) was prepared by click reaction strategy. The PEG-click-PPG copolymer can self-assemble into spherical micelles in aqueous solution. It is found that high intensity focused ultrasound (HIFU) can open the copolymer PEG-click-PPG micelles and trigger the release of the payload in the micelle. The multiple ester bonds introduced in the junction point of the copolymer chain through click reactions were cleaved under HIFU, and leads to the disruption of the copolymer micelle and fast release of loaded cargo. The click reaction provides a convenient way to construct ultrasound responsive copolymer micelles with weak bonds.

Disulfide-bridged cleavable PEGylation in polymeric nanomedicine for controlled therapeutic delivery

PEGylation in polymeric nanomedicine has gained substantial predominance in biomedical applications due to its resistance to protein absorption, which is critically important for a therapeutic delivery system in blood circulation. The shielding layer of PEGylation, however, creates significant steric hindrance that negatively impacts cellular uptake and intracellular distribution at the target site. This unexpected effect compromises the biological efficacy of the encapsulated payload. To address this issue, one of the key strategies is to tether the disulfide bond to PEG for constructing a disulfide-bridged cleavable PEGylation. The reversible disulfide bond can be cleaved to enable selective PEG detachment. This article provides an overview on the strategy, method and progress of PEGylation nanosystem with the cleavable disulfide bond.

Reduction-sensitive polymeric nanocarriers in cancer therapy: a comprehensive review

Redox potential is regarded as a significant signal to distinguish between the extra-cellular and intra-cellular environments, as well as between tumor and normal tissues. Taking advantage of this physiological differentiation, various reduction-sensitive polymeric nanocarriers (RSPNs) have been designed and explored to demonstrate excellent stability during blood circulation but rapidly degrade and effectively trigger drug release in tumor cells. Therefore, this smart RSPN delivery system has attracted much attention in recent years, as it represents one of the most promising drug delivery strategies in cancer therapy. In this review, we will provide a comprehensive overview of RSPNs with various reducible linkages and functional groups up to date, including their design and synthetic strategies, preparation methods, drug release behavior, and their in vitro and in vivo efficacy in cancer therapy. In addition, dual- and triple-sensitive nanocarriers based on reducible disulfide bond-containing linkages will also be discussed.

A drug-perfluorocarbon nanoemulsion with an ultrathin silica coating for the synergistic effect of chemotherapy and ablation by high-intensity focused ultrasound

The synergistic effect of chemotherapy and ablation using high-intensity focused ultrasound (HIFU) is realized with a newly developed drug-delivery system. The system comprises an ultrathin silica shell surrounding a poly(lactic-co-glycolic acid) nanoemulsion core containing the drug (CPT) and a perfluorocarbon (PFOB). This nanosystem presents many advantages in drug delivery, such as excellent structural stability, high drug-loading capacity, and rapid HIFU-mediated drug release.

Polypeptide-based "smart" micelles for dual-drug delivery: a combination study of experiments and simulations

A dual-drug-loaded micelle is designed and constructed from a mixture of poly(propylene oxide)-b-poly(γ-benzyl-l-glutamate)-b-poly(ethylene glycol) (PPO-b-PBLG-b-PEG) triblock terpolymers and two model drugs, doxorubicin (DOX) and naproxen (Nap). In the micelles, the DOX is chemically linked to the PBLG backbones through an acid-cleavable hydrazone bond, whereas the Nap is physically encapsulated in the cores. The drug loading and releasing behaviors of the dual-drug-loaded micelles as well as single drug-loaded micelles (DOX-conjugated or Nap-loaded micelles) are studied. The structures of micelles are characterized by means of microscopies and dynamic light scattering, and further examined by dissipative particle dynamics (DPD) simulations. It is revealed that the micelles possess a core-shell-corona structure in which the PPO/Nap, PBLG/DOX, and PEG aggregate to form the core, shell, and corona, respectively. In vitro studies reveal that the release of DOX and Nap is pH- and thermosensitive. Such drug releasing behaviors are also examined by DPD simulations, and more information regarding the mechanism is obtained. In addition, the bio-related properties such as cellular uptake of the micelles and biocompatibility of the deliveries are evaluated. The results show that the dual-drug-loaded micelles are biocompatible at normal physiological conditions and retain the anti-cancer efficiency.