A HMCuS@MnO2 nanocomplex responsive to multiple tumor environmental clues for photoacoustic/fluorescence/magnetic resonance trimodal imaging-guided and enhanced photothermal/photodynamic therapy

Tailored Drug Delivery Platforms: Stimulus-Responsive Core-Shell Structured Nanocarriers

Core-shell structured nanocarriers have come into the scientific spotlight in recent years due to their intriguing properties and wide applications in materials chemistry, biology, and biomedicine. Tailored core-shell structures to achieve desired performance have emerged as a research frontier in the development of smart drug delivery system. However, systematic reviews on the design and loading/release mechanisms of stimulus-responsive core-shell structured nanocarriers are uncommon. This review starts with the categories of core-shell structured nanocarriers with different means of drug payload, and then highlights the controlled release mechanism realized through stimulus-response processes triggered under different environments. Finally, some multifaceted perspectives on the design of core-shell structured materials as drug carriers are addressed. This work aims to provide new enlightenments and prospects in the drug delivery field for further developing advanced and smart nanocarriers.

Polydopamine nanomotors loaded indocyanine green and ferric ion for photothermal and photodynamic synergistic therapy of tumor

The limited penetration depth of nanodrugs in the tumor and the severe hypoxia inside the tumor significantly reduce the efficacy of photothermal-photodynamic synergistic therapy (PTT-PDT). Here, we synthesized a methoxypolyethylene glycol amine (mPEG-NH₂)-modified walnut-shaped polydopamine nanomotor (PDA-PEG) driven by near-infrared light (NIR). At the same time, it also loaded the photosensitizer indocyanine green (ICG) via electrostatic/hydrophobicinteractions and chelated with ferric ion (Fe³⁺). Under the irradiation of NIR, the asymmetry of PDA-PEG morphology led to the asymmetry of local photothermal effects and the formation of thermal gradient, which can make the nanomotor move autonomously. This ability of autonomous movement was proved to be used to improve the permeability of the nanomotor in three-dimensional (3D) tumor sphere. Fe³⁺ can catalyze endogenous hydrogen peroxide to produce oxygen, so as to overcome the hypoxia of tumor microenvironment and thereby generate more singlet oxygen to kill tumor cells. Animal experiments in vivo confirmed that the nanomotors had a good PTT-PDT synergistic treatment effect. The introduction of nanomotor technology has brought new ideas for cancer optical therapy.

Photodynamic Opening of the Blood-Brain Barrier and the Meningeal Lymphatic System: The New Niche in Immunotherapy for Brain Tumors

Photodynamic therapy (PDT) is a promising add-on therapy to the current standard of care for patients with glioblastoma (GBM). The traditional explanation of the anti-cancer PDT effects involves the PDT-induced generation of a singlet oxygen in the GBM cells, which causes tumor cell death and microvasculature collapse. Recently, new vascular mechanisms of PDT associated with opening of the blood-brain barrier (OBBB) and the activation of functions of the meningeal lymphatic vessels have been discovered. In this review, we highlight the emerging trends and future promises of immunotherapy for brain tumors and discuss PDT-OBBB as a new niche and an important informative platform for the development of innovative pharmacological strategies for the modulation of brain tumor immunity and the improvement of immunotherapy for GBM.

A Smart Nanoreactor Based on an O2-Economized Dual Energy Inhibition Strategy Armed with Dual Multi-stimuli-Responsive "Doorkeepers" for Enhanced CDT/PTT of Rheumatoid Arthritis

Activated fibroblast-like synovial (FLS) cells are regarded as an important target for rheumatoid arthritis (RA) treatment via starvation therapy mediated by glucose oxidase (GOx). However, the hypoxic RA-FLS environment greatly reduces the oxidation process of glucose and leads to a poor therapeutic effect of the GOx-based starvation therapy. In this work, we designed a hollow mesoporous copper sulfide nanoparticles (CuS NPs)-based smart GOx/atovaquone (ATO) codelivery system (named as V-HAGC) targeting RA-FLS cells to realize a O₂-economized dual energy inhibition strategy to solve the limitation of GOx-based starvation therapy. V-HAGC armed with dual multi-stimuli-responsive "doorkeepers" can guard drugs intelligently. Once under the stimulation of photothermal and acidic conditions at the targeted area, the dual intelligent responsive "doors" would orderly open to realize the controllable release of drugs. Besides, the efficacy of V-HAGC would be much improved by the additional chemodynamic therapy (CDT) and photothermal therapy (PTT) stimulated by CuS NPs. Meanwhile, the upregulated H₂O₂ and acid levels by starvation therapy would promote the Fenton-like reaction of CuS NPs under O₂-economized dual energy inhibition, which could enhance the PTT and CDT efficacy as well. In vitro and in vivo evaluations revealed V-HAGC with much improved efficacy of this combination therapy for RA. In general, the smart V-HAGC based on the O₂-economized dual energy inhibition strategy combined with enhanced CDT and PTT has the potential to be an alternative methodology in the treatment of RA.

Platinum-based nanocomposites loaded with MTH1 inhibitor amplify oxidative damage for cancer therapy

Photodynamic therapy (PDT) is a promising therapeutic strategy for tumor ablation by generating highly toxic reactive oxygen species (ROS) to damage DNA and other biomacromolecules. However, the local hypoxic microenvironment of the tumor and the presence of ROS-defensing system, such as the mobilization of mutt homolog 1 (MTH1) to sanitize ROS-oxidized nucleotide pool, severely limit the efficiency of PDT. Therefore, a novel tumor ablation strategy was developed that not only focused on the enhancement of ROS generation but also weakened the ROS-defensing system by inhibiting MTH1 enzyme activity. In our work, a simple one-step reduction approach was applied to enable platinum nanoparticles (Pt NPs) with catalase activity to grow in situ in the nanochannels of mesoporous silica nanoparticles (MSNs). After physical encapsulation of photosensitizer chlorin e6 (Ce6) and MTH1 inhibitor TH588, the drug loading nanoplatform was modified with an arginine-glycine-aspartic acid (RGD) functionalized liposome shell, resulting in the fabrication of amplified oxidative damage nanoplatform MSN-Pt@Ce6/TH588 @Liposome-RGD (MPCT@Li-R). The prepared MPCT@Li-R NPs could continuously catalyze the decomposition of hydrogen peroxide (H₂O₂) into oxygen (O₂) in tumor, thus promoting the generation of singlet oxygen during PDT process for improved oxidative damage of bases. Simultaneously, acid responsive released TH588 hindered MTH1-mediated scavenging of oxidative bases, further aggravating DNA oxidative damage. Consequently, this cascade therapy strategy exhibited excellent tumor suppression efficiency both in vitro and in vivo.

A dual gate-controlled intelligent nanoreactor enables collaborative precise treatment for cancer nanotherapy

Recently, disulfiram (DSF), approved by the FDA as an anti-alcoholic drug, has been proved as an effective antitumor drug after chelating with Cu²⁺. To overcome the shortage of intracellular Cu²⁺, we have constructed a dual gate-controlled intelligent nanoreactor (HA-DSF@HCuS@FePtMn, HDHF) via the ingenious combination of hollow copper sulfide (HCuS) nanoparticles, DSF and FePtMn nanocrystals. HDHF has a NIR-actuated gate and enzyme-actuated gate that could be opened in the hyaluronidase-abundant tumor microenvironment with NIR laser irradiation to trigger drug (DSF/FePtMn) release and synergistic therapy. Moreover, the FePtMn nanocrystals could continuously release Fe²⁺, which could catalyze H₂O₂ into highly cytotoxic hydroxyl radicals (˙OH), triggering chemodynamic therapy (CDT). When exposed to NIR laser, HCuS could collapse and release Cu²⁺, which could immediately chelate with DSF, forming the effective anticancer drug (Cu(DTC)₂) and enabling DSF-based chemotherapy. More importantly, the efficient photothermal therapy (PTT) effect of HCuS could accelerate the FePtMn-based CDT and the release of Cu²⁺/DSF, improving tumor treatment efficiency. Thus, this study represents a distinctive paradigm of a dual gate-controlled intelligent nanoreactor enabled PTT-augmented DSF-based chemotherapy and FePtMn-based CDT for cancer nanotherapy.

Dual-Mode Tumor Imaging Using Probes That Are Responsive to Hypoxia-Induced Pathological Conditions

Hypoxia in solid tumors is associated with poor prognosis, increased aggressiveness, and strong resistance to therapeutics, making accurate monitoring of hypoxia important. Several imaging modalities have been used to study hypoxia, but each modality has inherent limitations. The use of a second modality can compensate for the limitations and validate the results of any single imaging modality. In this review, we describe dual-mode imaging systems for the detection of hypoxia that have been reported since the start of the 21st century. First, we provide a brief overview of the hallmarks of hypoxia used for imaging and the imaging modalities used to detect hypoxia, including optical imaging, ultrasound imaging, photoacoustic imaging, single-photon emission tomography, X-ray computed tomography, positron emission tomography, Cerenkov radiation energy transfer imaging, magnetic resonance imaging, electron paramagnetic resonance imaging, magnetic particle imaging, and surface-enhanced Raman spectroscopy, and mass spectrometric imaging. These overviews are followed by examples of hypoxia-relevant imaging using a mixture of probes for complementary single-mode imaging techniques. Then, we describe dual-mode molecular switches that are responsive in multiple imaging modalities to at least one hypoxia-induced pathological change. Finally, we offer future perspectives toward dual-mode imaging of hypoxia and hypoxia-induced pathophysiological changes in tumor microenvironments.

Application of "smart" multifunctional nanoprobes in tumor diagnosis and treatment

Cancer is one of the major diseases that pose a threat to human health and life, especially because it is difficult to diagnose and cure, and recurs easily. In recent years, the development of nanotechnology has provided researchers with new tools for cancer treatment. In particular, nanoprobes that facilitate integrated diagnosis and treatment, high-resolution imaging, and accurate tumor targeting provide new avenues for the early detection and treatment of cancer. This review focuses on the preparations and applications of two kinds of "smart" multifunctional nanoprobes: "Off-On" nanoprobes and "Charge-Reversal" nanoprobes. This review also briefly discusses their mechanisms of action, as they could provide new ideas for the further development of this field.

Mitochondria-targeted accumulation of oxygen-irrelevant free radicals for enhanced synergistic low-temperature photothermal and thermodynamic therapy

BACKGROUND

Although lower temperature (< 45 °C) photothermal therapy (LPTT) have attracted enormous attention in cancer therapy, the therapeutic effect is still unsatisfying when applying LPTT alone. Therefore, combining with other therapies is urgently needed to improve the therapeutic effect of LPTT. Recently reported oxygen-irrelevant free radicals based thermodynamic therapy (TDT) exhibit promising potential for hypoxic tumor treatment. However, overexpression of glutathione (GSH) in cancer cells would potently scavenge the free radicals before their arrival to the specific site and dramatically diminish the therapeutic efficacy.

METHODS AND RESULTS

In this work, a core-shell nanoplatform with an appropriate size composed of arginine-glycine-aspartate (RGD) functioned polydopamine (PDA) as a shell and a triphenylphosphonium (TPP) modified hollow mesoporous manganese dioxide (H-mMnO2) as a core was designed and fabricated for the first time. This nanostructure endows a size-controllable hollow cavity mMnO2 and thickness-tunable PDA layers, which effectively prevented the pre-matured release of encapsulated azo initiator 2,2'-azobis[2-(2-imidazolin-2-yl) propane] dihydrochloride (AIBI) and revealed pH/NIR dual-responsive release performance. With the mitochondria-targeting ability of TPP, the smart nanocomposites (AIBI@H-mMnO2-TPP@PDA-RGD, AHTPR) could efficiently induce mitochondrial associated apoptosis in cancer cells at relatively low temperatures (< 45 °C) via selectively releasing oxygen-irrelevant free radicals in mitochondria and facilitating the depletion of intracellular GSH, exhibiting the advantages of mitochondria-targeted LPTT/TDT. More importantly, remarkable inhibition of tumor growth was observed in a subcutaneous xenograft model of osteosarcoma (OS) with negligible side effects.

CONCLUSIONS

The synergistic therapy efficacy was confirmed by effectively inducing cancer cell death in vitro and completely eradicating the tumors in vivo. Additionally, the excellent biosafety and biocompatibility of the nanoplatforms were confirmed both in vitro and in vivo. Taken together, the current study provides a novel paradigm toward oxygen-independent free-radical-based cancer therapy, especially for the treatment of hypoxic solid tumors.

Hyaluronan-fullerene/AIEgen nanogel as CD44-targeted delivery of tirapazamine for synergistic photodynamic-hypoxia activated therapy

The therapeutic effect of oxygen-concentration-dependent photodynamic therapy (PDT) can be diminished in the hypoxic environment of solid tumours, the effective solution to this problem is utilising hypoxic-activated bioreduction therapy (BRT). In this research, a biocompatible HA-C60/TPENH₂nanogel which can specifically bind to CD44 receptor was developed for highly efficient PDT-BRT synergistic therapy. The nanogel was degradable in acidic microenvironments of tumours and facilitated the release of biological reduction prodrug tirapazamine (TPZ). Importantly, HA-C60/TPENH₂nanogel produced reactive oxygen species and consumed oxygen content in the cell to activate TPZ, leading to higher cytotoxicity than the free TPZ did. The intracellular observation of nanogel indicated that the HA-C60/TPENH₂nanogel was self-fluorescence for cell imaging. This study applied PDT-BRT to design smart HA-based nanogel with targeted delivery, pH response, and AIEgen feature for efficient cancer therapy.

Construction of a nanotheranostic system Zr-MOF@PPa/AF@PEG for improved photodynamic therapy effects based on the PDT‑oxygen consumption and hypoxia sensitive chemotherapeutic drug

Photodynamic therapy (PDT) has gained much attention in tumor therapy because of its special advantages. PDT heavily depends on the oxygen, yet the tumor microenvironment (TME) is a hypoxic and acid milieu, which weakens the PDT effect. Based on the consideration that the TME deteriorated by the PDT oxygen consumption could activate the hypoxic-sensitive small-molecule drug, we designed and prepared an integrated nanocomposite including zirconium ion metal organic framework (carrier), pyropheophorbide-a (PPa, photosensitizer), and 6-amino flavone (AF, hypoxic-sensitive drug), aiming to exert a cascaded PDT-chemotherapy (CT) antitumor effect and to solve the hypoxic challenge. The prepared nanocomposite showed great stability under the physiological (pH 7.4) condition and could continuously release PPa and AF under slightly acidic pH condition (pH 6.4), suggesting a tumor microenvironment responsive feature. Systematical in vitro and in vivo researches under various conditions (light, dark, hypoxic and normoxic) have showed that the obtained Zr-MOF@PPa/AF@PEG nanoparticles (NPs) had good biocompatibility and could achieve efficient antitumor effects based on PDT- chemotherapy (CT) cascade process. Finally, bright red fluorescence was observed in the tumor cells after internalization implying an application potential in tumor imaging.

MnO2 nanosheets anchored with polypyrrole nanoparticles as a multifunctional platform for combined photothermal/photodynamic therapy of tumors

Herein, PPy@MnO₂ nanocomposites were first harvested by anchoring MnO₂ nanosheets on polypyrrole (PPy) nanoparticles via an in situ redox reaction, then polyethylene glycol (PEG) modifier and methylene blue (MB) photosensitizer were linked through electrostatic interactions to obtain PPy@MnO₂-PEG-MB nanoarchitectures. PPy nanoparticles ensure photothermal therapy (PTT) ability and MnO₂ nanosheets ameliorate tumor hypoxia for enhanced photodynamic therapy (PDT). Therefore, a multifunctional nanotherapeutic system was constructed for the combined PTT/PDT of tumors. For extracellular photothermal properties, the optimal temperature elevation was 52.6 °C with 54.4% photothermal conversion efficiency. The extracellular PDT ability was measured by detecting ¹O₂ generation; more ¹O₂ was produced under acidic conditions in the presence of H₂O₂ (a simulated tumor microenvironment). The effective cellular uptake of the nanotherapeutic system in HeLa cells was observed by confocal laser scanning microscopy (CLSM). CLSM also indicated that more ¹O₂ was generated by the nanotherapeutic system as compared to free MB in HeLa cells, confirming the amelioration of tumor hypoxia by MnO₂ nanosheets. MTT assays demonstrated that the nanotherapeutic system possessed superior biocompatibility without laser irradiation, and the lowest cell viabilities for single PTT and PDT groups were 13.78%, 38.82% respectively, while there was only 1.29% cell viability in the combined PTT and PDT group. These results suggest that the strategy of assembling PPy with MnO₂ for a multifunctional PTT and enhanced PDT nanoplatform was realized, and opens up an unimpeded approach for integrating photothermal reduction materials with MnO₂ for use in synergistic PTT and PDT.

Overcoming chemotherapy resistance using pH-sensitive hollow MnO2 nanoshells that target the hypoxic tumor microenvironment of metastasized oral squamous cell carcinoma

BACKGROUND

Smart nanoscale drug delivery systems that target acidic tumor microenvironments (TME) could offer controlled release of drugs and modulate the hypoxic TME to enhance cancer therapy. The majority of previously reported MnO₂ nanostructures are nanoparticles, nanosheets, or nanocomposites incorporated with other types of nanoparticles, which may not offer the most effective method for drug loading or for the controlled release of therapeutic payloads. Previous studies have designed MnO₂ nanoshells that achieve tumor-specific and enhanced combination therapy for localized advanced cancer. However, the therapeutic effect of MnO₂ nanoshells on metastatic cancer is still uncertain.

RESULT

Here, intelligent "theranostic" platforms were synthesized based on hollow mesoporous MnO₂ (H-MnO₂) nanoshells that were loaded with chemotherapy agents docetaxel and cisplatin (TP) to form H-MnO₂-PEG/TP nanoshells, which were designed to alleviate tumor hypoxia, attenuate angiogenesis, trigger the dissolution of Mn²⁺, and synergize the efficacy of first-class anticancer chemotherapy. The obtained H-MnO₂-PEG/TP nanoshells decomposed in the acidic TME, releasing the loaded drugs (TP) and simultaneously attenuated tumor hypoxia and hypoxia-inducible factor-1α (HIF-1α) expression by inducing endogenous tumor hydrogen peroxide (H₂O₂) decomposition. In vitro experiments showed that compared with the control group, the proliferation, colony formation and migration ability of CAL27 and SCC7 cells were significantly reduced in H-MnO₂-PEG/TP group, while cell apoptosis was enhanced, and the expression of hypoxia-inducible factor-1α(HIF-1α) was down-regulated. In vivo experiments showed that tumor to normal organ uptake ratio (T/N ratio) of mice in H-MnO₂-PEG/TP group was significantly higher than that in TP group alone (without the nanoparticle), and tumor growth was partially delayed. In the H-MnO₂-PEG/TP treatment group, HE staining showed that most of the tumor cells were severely damaged, and TUNEL assay showed cell apoptosis was up-regulated. He staining of renal and liver sections showed no obvious fibrosis, necrosis or hypertrophy, indicating good biosafety. Fluorescence staining showed that HIF-1α expression was decreased, suggesting that the accumulation of MnO₂ in the tumor caused the decomposition of H₂O₂ into O₂ and alleviated the hypoxia of the tumor.

CONCLUSION

In conclusion, a remarkable in vivo and in vitro synergistic therapeutic effect is achieved through the combination of TP chemotherapy, which simultaneously triggered a series of antiangiogenic and oxidative antitumor reactions.

MnO2 nanoflowers as a multifunctional nano-platform for enhanced photothermal/photodynamic therapy and MR imaging

Photodynamic therapy (PDT) has been regarded as a promising strategy for tumor therapy. However, heterogeneous tumor microenvironments severely limit the efficacy of photodynamic therapy. In this work, a multifunctional theranostic platform (MnO2-SiO2-APTES&Ce6 (MSA&C)) was fabricated based on MnO2 nanoflowers, which afforded MRI-guided synergistic therapy incorporating PDT and second near-infrared window (NIR-II) photothermal therapy (PTT). Herein, MnO2 nanoflowers are first proposed as a NIR-II photothermal agent. In the MSA&C system, MnO2 nanoflowers were employed for effective photosensitizer loading, relieving tumor hypoxia, and NIR-II PTT and tumor-specific imaging. The large amount of photosensitizer, reduced tumor hypoxia, and hyperthermia all contributed to the improvement of PDT. The quantity of reactive oxygen species (ROS) generated during PDT in turn down-regulated the expression of heat shock proteins (HSP 70), thereby improving photothermal performance. Positively charged (3-aminopropyl)triethoxysilane (APTES) was used to promote cellular uptake, further improving treatment efficiency. In this system, the MSA&C nanoflowers can not only alleviate tumor hypoxia, but they also obviously induce cell apoptosis under laser irradiation through a ROS- and hyperthermia-mediated mechanism, thereby leading to remarkable tumor growth inhibition. Furthermore, the Mn2+ ions generated during treatment can be explored for MR imaging, and this could be used to finally realize MRI-guided enhanced PDT/PTT.

Recent research progress in the construction of active free radical nanoreactors and their applications in photodynamic therapy

Photodynamic therapy is the most important treatment strategy in free radical therapy. However, tumor microenvironment hypoxia is a key obstacle in PDT. In order to overcome this obstacle, the strategy of in situ production of O₂/radicals by catalytic reaction in solid tumors was proposed. In recent years, it has been found that there are many oxygen-independent carbon-based free radicals that can generate toxic active free radicals under laser irradiation and lead to tumor cell death. Based on the rational design of multifunctional nano-medicine, the active free radical nano-generator has opened up a new way for the highly developed nanotechnology and tumor cooperative therapy to improve the therapeutic effect. In this paper, the research status of active free radical nano-generators, especially reactive oxygen species, including the construction mechanism of active free radical nanomaterials, is reviewed and the application of free radical nano-generators in tumor therapy is emphasized.

Antimonene Nanosheets-Based Z-Scheme Heterostructure with Enhanced Reactive Oxygen Species Generation and Photothermal Conversion Efficiency for Photonic Therapy of Cancer

A Z-scheme heterojunction with high separation efficiency of photogenerated electrons and holes and enhanced reduction/oxidation potentials, which can enhance reactive oxygen species generation and photothermal conversion efficiency, exhibits tremendous potential in photonic theranostics. Herein, antimonene nanosheets (Sb NSs) are functionalized with photosensitizer 5,10,15,20-Tetrakis(4-hydroxy-phenyl)-21H,12H-porphine (THPP) and a poly(ethylene glycol) (PEG) modifier. The Sb-THPP-PEG NSs thus fabricated are found to form a Z-scheme heterojunction structure between Sb and THPP, based on their valence band and bandgap level analysis. The Z-scheme heterojunction structure enables the Sb-THPP-PEG NSs multiple promising features for cancer therapy. Firstly, due to improved electron-hole pairs separation efficiency and redox potential, new reactive oxygen species •O₂ ^- is generated, besides the production of ¹ O₂ by THPP. Secondly, the assembly of THPP enhances the NIR-light-to-heat conversion of Sb NS, a photothermal conversion efficiency as high as 44.6% is obtained by this Sb-THPP-PEG NSs photonic nanomedicine. Moreover, the photothermal, fluorescent, and photoacoustic imaging properties of Sb-THPP-PEG NSs allow multimodal imaging-guided tumor treatment.

Advances in Hollow Inorganic Nanomedicines for Photothermal-Based Therapies

Nanotechnology has prompted the development of hollow inorganic nanomedicine. These medicines are now widely investigated as photothermal-based therapies for various diseases due to their high loading capacity, tuneable wavelength, relatively small size and low density. We begin this review with a brief introduction, followed by a summary of the development of imaging-guided photothermal therapy (PTT) for cancer treatment during the last three years (from 2017 to 2020). We then introduce the antibacterial effects of these medicines on some bacterial infections, in which the pathogenic bacteria can be killed by mild photothermal effects, ions and antibiotic release. Other diseases can also be treated using hollow inorganic photothermal agents. Specifically, we discuss the use of PTT for treating Alzheimer's disease, obesity and endometriosis. Finally, we share our perspectives on the current challenges and future prospects of using hollow inorganic materials in clinical PTT for various diseases.

Pt@polydopamine nanoparticles as nanozymes for enhanced photodynamic and photothermal therapy

Polydopamine nanoparticles were used to stabilize a nano-Pt catalyst to relieve tumor hypoxia for enhanced photodynamic therapy and photothermal therapy.

Carbon nanocage-based nanozyme as an endogenous H2O2-activated oxygenerator for real-time bimodal imaging and enhanced phototherapy of esophageal cancer

Intelligent phototherapy by theranostic nanosystems that can be activated by a tumor microenvironment has high sensitivity and specificity. However, hypoxia and low drug accumulation in tumors greatly limit its clinical application. Herein, we have designed a cage-like carbon-manganese nanozyme, which effectively relieves tumor hypoxia and delivers numerous photosensitizers (PSs) to the tumor site, for real-time imaging and enhanced phototherapy of esophageal cancer. Specifically, bovine serum albumin (BSA) was used as a template and reducing agent for preparing a BSA-MnO2 nanozyme; then a BSA-MnO2/IR820@OCNC (BMIOC) nanosystem was successfully synthesized by crosslinking BSA-MnO2 on the surface of IR820-loaded carboxylated carbon nanocages (OCNCs). Abundant PSs were successfully delivered to tumor sites via hollow OCNCs, and the final loading rate of IR820 reached 42.8%. The intratumor BMIOC nanosystem can be initiated by a tumor microenvironment to switch on its magnetic resonance (MR) imaging signal, and photothermal therapy (PTT) and photodynamic therapy (PDT) functions. Notably, the BSA-MnO2 nanozyme, with intrinsic catalase (CAT)-like activity, catalyzed endogenous H2O2 for oxygen generation to overcome tumor hypoxia and enhance PDT, thereby leading to more efficient therapeutic effects in combination with OCNC-elevated PTT. In addition, the H2O2-activated and acid-enhanced properties enable our nanosystem to be specific to tumors, protecting normal tissues from damage. By integrating a high drug loading capacity, a hypoxia regulation function, an enlarged phototherapy effect, and bimodal imaging into a nanozyme-mediated nanoreactor, this work realizes a "one for all" system and represents promising clinical translation for efficient esophageal cancer theranostics.