Novel reduction-sensitive micellar nanoparticles assembled from Rituximab-doxorubicin conjugates as smart and intuitive drug delivery systems for the treatment of non-Hodgkin's lymphoma

Combining nanotechnology with monoclonal antibody drugs for rheumatoid arthritis treatments

Rheumatoid arthritis (RA) is a systemic immune disease characterized by synovial inflammation. Patients with RA commonly experience significant damage to their hand and foot joints, which can lead to joint deformities and even disability. Traditional treatments have several clinical drawbacks, including unclear pharmacological mechanisms and serious side effects. However, the emergence of antibody drugs offers a promising approach to overcome these limitations by specifically targeting interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and other cytokines that are closely related to the onset of RA. This approach reduces the incidence of adverse effects and contributes to significant therapeutic outcomes. Furthermore, combining these antibody drugs with drug delivery nanosystems (DDSs) can improve their tissue accumulation and bioavailability.Herein, we provide a summary of the pathogenesis of RA, the available antibody drugs and DDSs that improve the efficacy of these drugs. However, several challenges need to be addressed in their clinical applications, including patient compliance, stability, immunogenicity, immunosupression, target and synergistic effects. We propose strategies to overcome these limitations. In summary, we are optimistic about the prospects of treating RA with antibody drugs, given their specific targeting mechanisms and the potential benefits of combining them with DDSs.

Nanomedicines in B cell-targeting therapies

B cells play multiple roles in immune responses related to autoimmune diseases as well as different types of cancers. As such, strategies focused on B cell targeting attracted wide interest and developed intensively. There are several common mechanisms various B cell targeting therapies have relied on, including direct B cell depletion, modulation of B cell antigen receptor (BCR) signaling, targeting B cell survival factors, targeting the B cell and T cell costimulation, and immune checkpoint blockade. Nanocarriers, used as drug delivery vehicles, possess numerous advantages to low molecular weight drugs, reducing drug toxicity, enhancing blood circulation time, as well as augmenting targeting efficacy and improving therapeutic effect. Herein, we review the commonly used targets involved in B cell targeting approaches and the utilization of various nanocarriers as B cell-targeted delivery vehicles. STATEMENT OF SIGNIFICANCE: As B cells are engaged significantly in the development of many kinds of diseases, utilization of nanomedicines in B cell depletion therapies have been rapidly developed. Although numerous studies focused on B cell targeting have already been done, there are still various potential receptors awaiting further investigation. This review summarizes the most relevant studies that utilized nanotechnologies associated with different B cell depletion approaches, providing a useful tool for selection of receptors, agents and/or nanocarriers matching specific diseases. Along with uncovering new targets in the function map of B cells, there will be a growing number of candidates that can benefit from nanoscale drug delivery.

Nanomedicine - a promising therapy for hematological malignancies

Hematological tumors are a group of diseases defined as the clonal proliferation of blood-forming cells. In recent years, incidences of hematological malignancies have increased. Traditional methods of diagnosing hematological tumors are primarily based on observing morphological features under light microscopy, and molecular diagnostics and immunological indicators are powerful auxiliary diagnostic methods. However, traditional methods cannot efficiently identify tumor markers and limit the efficiency and accuracy of diagnosis. Although treatment methods have been improved continuously, chemotherapy remains a primary technique for the treatment of hematological tumors. Traditional chemotherapy exhibits poor drug selectivity and lacks good biocompatibility and pharmacokinetic properties. The therapeutic effect is not ideal and the risk of toxic side effects is high. The nanosize and surface charge properties of nanodrugs are effective in improving drug delivery efficiency. The high load and rich surface modification methods of nanomaterials provide various possibilities for improving the biocompatibility and pharmacokinetics of drugs, as well as the targeting of drugs. In addition, a nanomedicine loading platform can load multiple drugs simultaneously and design the optimal proportion of combined drug schemes, which can improve the efficacy of drugs and reduce the occurrence of drug resistance. With their unique physical and chemical properties and biological characteristics, the application of nanoparticles in the diagnosis and treatment of hematological tumors has received considerable attention. In this review, we summarize recent advances in the application of various types of nanostructures for the diagnosis and treatment of hematological malignancies, investigate the advantages of nanomedicine compared with the traditional diagnosis and treatment of hematological tumors, and discuss their biological security and application prospects.

How the discovery of rituximab impacted the treatment of B-cell non-Hodgkin's lymphomas

Non-Hodgkin's lymphoma (NHL) is the sixth-most common cancer in the UK, accounting for around 13,700 new cases every year. Until the late 1990s, treatment relied on intensive chemotherapy, such as CHOP (cyclophosphamide-doxorubicin HCl-vincristine [Oncovin]-prednisone). The use of standard CHOP therapy and its variations had resulted in poor five-year survival rates (as low as 26%), particularly in patients with aggressive NHL. Rituximab (Rituxan) was the first chimeric (mouse/human) monoclonal antibody approved for the treatment of NHL. It was approved by the US Food and Drug Administration in 1997 for indolent forms of NHL. It subsequently received EU approval in June 1998, and was licensed under the trade name Mabthera (Roche, Basel, Switzerland). It then went on to be approved for the first-line treatment of aggressive forms of NHL, such as diffuse large B-cell lymphoma (to be used in combination with CHOP or other anthracycline-based chemotherapy) in 2006. It is directed against the CD20 protein, an antigen found on the surface of B-cell lymphomas. With minimal toxicity, activity as a single-agent (for indolent forms of NHL) and safety when combined with chemotherapy (for aggressive forms), it represents great progress in this field. Here, we analyze how this antibody therapeutic was developed from basic molecular and cellular considerations through to preclinical and clinical evaluations and how it came to be a first-line treatment for NHL, and we discuss the impacts the advent of rituximab had on treatment outcomes for patients with DLBCL compared with the pre-rituximab era.

Smart pH responsive drug delivery system based on poly(HEMA-co-DMAEMA) nanohydrogel

The advent of smart nanohydrogel has revealed new opportunities for scientists to develop the most efficient anti-cancer vehicles with safe and biocompatible profile. In this experiment, using reversible addition-fragmentation chain transfer polymerization method as a novel, safe and smart pH responsive formulation of poly (hydroxyethyl methacrylate-co-N,N-dimethylaminoethyl methacrylate) and poly (ethylene glycol)-diacrylate as cross-linker were synthesized. The synthesized structure was confirmed by Fourier-transform infrared spectroscopy and proton nuclear magnetic resonance methods. The pH responsive behavior of the synthesized particles was checked by size measurement in two different pH values (5.5 and 7.4) by dynamic light scattering and transmission electron microscopy. The prepared structure had nanometer sizes of 180 in medium with pH of 7.4, when it encountered acidic medium (e.g. pH 5.5), the particles swelled to about 400 nm. The efficiency of the prepared pH responsive nanohydrogels was tested as a drug delivery system. An anti-cancer drug, doxorubicin successfully interacted with this material. The release profiles of nanoparticles carrying drug molecules were checked in two different simulated pH of healthy organs (7.4) and tumor site (5.5). Despite lower release in pH of 7.4 (∼20%), an increased drug release of 80% was obtained in pH of 5.5. The in vitro toxicity assay, apoptosis evaluation and uptake experiments were performed on breast cancer cell line (MCF-7), which showed a time dependency cellular entrance, an enhanced cytotoxicity and apoptosis induction by the doxorubicin loaded nanoparticles. Hemolysis assays confirmed the safety and hemocompatibility of the developed nanohydrogel. The suitable size (<200 nm), pH responsive behavior, anti-proliferative activity and apoptosis induction in cancer cells and hemocompatibility were the noticeable features of the developed doxorubicin adsorbed nanoparticle, which introduced this formulation as an ideal vehicle in anti-cancer drug delivery.

Cancer nanomedicine: mechanisms, obstacles and strategies

Targeting nanoparticles to cancers for improved therapeutic efficacy and decreased side effects remains a popular concept in the past decades. Although the enhanced permeability and retention effect serves as a key rationale for all the currently commercialized nanoformulations, it does not enable uniform delivery of nanoparticles to all tumorous regions in all patients with sufficient quantities. Also, the increase in overall survival is often modest. Many factors may influence the delivering process of nanoparticles, which must be taken into consideration for the promise of nanomedicine in patients to be realized. Herein, we review the mechanisms and influencing factors during the delivery of cancer therapeutics and summarize current strategies that have been developed for the fabrication of smart drug delivery systems.

Past, Present, and Future of Rituximab-The World's First Oncology Monoclonal Antibody Therapy

Rituximab is a chimeric mouse/human monoclonal antibody (mAb) therapy with binding specificity to CD20. It was the first therapeutic antibody approved for oncology patients and was the top-selling oncology drug for nearly a decade with sales reaching $8.58 billion in 2016. Since its initial approval in 1997, it has improved outcomes in all B-cell malignancies, including diffuse large B-cell lymphoma, follicular lymphoma, and chronic lymphocytic leukemia. Despite widespread use, most mechanistic data have been gathered from in vitro studies while the roles of the various response mechanisms in humans are still largely undetermined. Polymorphisms in Fc gamma receptor and complement protein genes have been implicated as potential predictors of differential response to rituximab, but have not yet shown sufficient influence to impact clinical decisions. Unlike most targeted therapies developed today, no known biomarkers to indicate target engagement/tumor response have been identified, aside from reduced tumor burden. The lack of companion biomarkers beyond CD20 itself has made it difficult to predict which patients will respond to any given anti-CD20 antibody. In the past decade, two new anti-CD20 antibodies have been approved: ofatumumab, which binds a distinct epitope of CD20, and obinutuzumab, a mAb derived from rituximab with modifications to the Fc portion and to its glycosylation. Both are fully humanized and have biological activity that is distinct from that of rituximab. In addition to these new anti-CD20 antibodies, another imminent change in targeted lymphoma treatment is the multitude of biosimilars that are becoming available as rituximab's patent expires. While the widespread use of rituximab itself will likely continue, its biosimilars will increase global access to the therapy. This review discusses current research into mechanisms and potential biomarkers of rituximab response, as well as its biosimilars and the newer CD20 binding mAb therapies. Increased ability to assess the effectiveness of rituximab in an individual patient, along with the availability of alternative anti-CD20 antibodies will likely lead to dramatic changes in how we use CD20 antibodies going forward.

Nano-delivery system targeting to cancer stem cell cluster of differentiation biomarkers

Cancer stem cells (CSCs) are one of the most important origins of cancer progression and metastasis. CSCs have unique self-renewal properties and diverse cell membrane receptors that induced the resistance to the conventional chemotherapeutic agents. Therefore, the therapeutic removal of CSCs could result in the cancer cure with lack of recurrence and metastasis. In this regard, targeting CSCs in accordance to their specific biomarkers is a talented attitude in cancer therapy. Various CSCs surface biomarkers have been described, which some of them exhibited similarities on different cancer cell types, while the others are cancer specific and have just been reported on one or a few types of cancers. In this review, the importance of CSCs in cancer development and therapeutic response has been stated. Different CSCs cluster of differentiation (CD) biomarkers and their specific function and applications in the treatment of cancers have been discussed, Special attention has been made on targeted nano-delivery systems. In this regard, several examples have been illustrated concerning specific natural and artificial ligands against CSCs CD biomarkers that could be decorated on various nanoparticulated drug delivery systems to enhance therapeutic index of chemotherapeutic agents or anticancer gene therapy. The outlook of CSCs biomarkers discovery and therapeutic/diagnostic applications was discussed.