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Zhu H, Yang Y, Duan Y, Zheng X, Lin Z, Zhou J. Nrf2/FSP1/CoQ10 axis-mediated ferroptosis is involved in sodium aescinate-induced nephrotoxicity. Arch Biochem Biophys 2024; 759:110100. [PMID: 39033970 DOI: 10.1016/j.abb.2024.110100] [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: 06/07/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
Sodium aescinate (SA), an active compound found in horse chestnut seeds, is widely used in clinical practice. Recently, the incidence of SA-induced adverse events, particularly renal impairment, has increased. Our previous work demonstrated that SA causes severe nephrotoxicity via nephrocyte ferroptosis; however, the underlying mechanism remains to be fully elucidated. In the current study, we investigated additional molecular pathways involved in SA-induced nephrotoxicity. Our results showed that SA inhibited cell viability, disrupted cellular membrane integrity, and enhanced reactive oxygen species (ROS), ferrous iron (Fe2+), and malondialdehyde (MDA) levels, as well as lipid peroxidation in rat proximal renal tubular epithelial cell line (NRK-52E) cells. SA also depleted coenzyme Q10 (CoQ10, ubiquinone) and nicotinamide adenine dinucleotide (NADH) and reduced ferroptosis suppressor protein 1 (FSP1) and polyprenyltransferase (coenzyme Q2, COQ2) activity, triggering lipid peroxidation and ROS accumulation in mouse kidneys and NRK-52E cells. The overexpression of COQ2, FSP1, or CoQ10 (ubiquinone) supplementation effectively attenuated SA-induced ferroptosis, whereas iFSP1 or 4-formylbenzoic acid (4-CBA) pretreatment exacerbated SA-induced nephrotoxicity. Additionally, SA decreased nuclear factor-erythroid-2-related factor 2 (Nrf2) levels and inhibited Nrf2 binding to the -1170/-1180 bp ARE site in FSP1 promoter, resulting in FSP1 suppression. Overexpression of Nrf2 or its agonist dimethyl fumarate (DMF) promoted FSP1 expression, thereby improving cellular antioxidant capacity and alleviating SA-induced ferroptosis. These results suggest that SA-triggers renal injury through oxidative stress and ferroptosis, driven by the suppression of the Nrf2/FSP1/CoQ10 axis.
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Affiliation(s)
- Haiyan Zhu
- School of Medicine, Yichun University,576 XueFu Road, Yuanzhou District, Yichun 336000, P.R. China
| | - Yijing Yang
- School of Medicine, Yichun University,576 XueFu Road, Yuanzhou District, Yichun 336000, P.R. China
| | - Yenan Duan
- School of Medicine, Yichun University,576 XueFu Road, Yuanzhou District, Yichun 336000, P.R. China
| | - Xin Zheng
- School of Medicine, Yichun University,576 XueFu Road, Yuanzhou District, Yichun 336000, P.R. China
| | - Zixiong Lin
- School of Medicine, Yichun University,576 XueFu Road, Yuanzhou District, Yichun 336000, P.R. China
| | - Jie Zhou
- School of Medicine, Yichun University,576 XueFu Road, Yuanzhou District, Yichun 336000, P.R. China.
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2
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Wang J, Wu Z, Zhu M, Zhao Y, Xie J. ROS induced pyroptosis in inflammatory disease and cancer. Front Immunol 2024; 15:1378990. [PMID: 39011036 PMCID: PMC11246884 DOI: 10.3389/fimmu.2024.1378990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/18/2024] [Indexed: 07/17/2024] Open
Abstract
Pyroptosis, a form of caspase-1-dependent cell death, also known as inflammation-dependent death, plays a crucial role in diseases such as stroke, heart disease, or tumors. Since its elucidation, pyroptosis has attracted widespread attention from various sectors. Reactive oxygen species (ROS) can regulate numerous cellular signaling pathways. Through further research on ROS and pyroptosis, the level of ROS has been revealed to be pivotal for the occurrence of pyroptosis, establishing a close relationship between the two. This review primarily focuses on the molecular mechanisms of ROS and pyroptosis in tumors and inflammatory diseases, exploring key proteins that may serve as drug targets linking ROS and pyroptosis and emerging fields targeting pyroptosis. Additionally, the potential future development of compounds and proteins that influence ROS-regulated cell pyroptosis is anticipated, aiming to provide insights for the development of anti-tumor and anti-inflammatory drugs.
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Affiliation(s)
- Jingsong Wang
- Department of Pharmacy, Guangyuan Central Hospital, Guangyuan, Sichuan, China
| | - Ziyong Wu
- Department of Pharmacy, Ezhou Central Hospital, Ezhou, Hubei, China
| | - Min Zhu
- Department of Pharmacy, Xuchang Central Hospital, Xuchang, Henan, China
| | - Yang Zhao
- Department of Pharmacy, Guangyuan Central Hospital, Guangyuan, Sichuan, China
| | - Jingwen Xie
- Department of Pharmacy, Guangyuan Central Hospital, Guangyuan, Sichuan, China
- Department of Health, Chongqing Industry & Trade Polytechnic, Chongqing, China
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3
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Dou Y, Wang Y, Tian S, Song Q, Deng Y, Zhang Z, Chen P, Sun Y. Metal-organic framework (MOF)-based materials for pyroptosis-mediated cancer therapy. Chem Commun (Camb) 2024; 60:6476-6487. [PMID: 38853690 DOI: 10.1039/d4cc02084g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Pyroptosis is regarded as a promising strategy to modulate tumor immune microenvironments for anticancer therapy. Although pyroptosis inducers have been extensively explored in the biomedical field, their drug resistance, off-targeting capacity, and adverse effects do not fulfill the growing demands of therapy. Nowadays, metal-organic frameworks (MOFs) with unique structures and facile synthesis/functionalization characteristics have shown great potential in anticancer therapy. The flexible choices of metal ions and ligands endow MOFs with inherent anti-cancer efficiency, whereas the porous structures in MOFs make them ideal vehicles for delivering various chemodrug-based pyroptosis inducers. In this review, we provide the latest advances in MOF-based materials to evoke pyroptosis and give a brief but comprehensive review of the different types of MOFs for pyroptosis-mediated cancer therapy. Finally, we also discuss the current challenges of MOF-based pyroptosis inducers and their future prospects in this field.
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Affiliation(s)
- You Dou
- College of Pharmacy, Hubei University of Science & Technology, Xianning 437100, China.
- State Key Laboratory of Green Pesticide, College of Chemistry, Central China Normal University, Wuhan 430079, China.
| | - Yuting Wang
- Key Laboratory of Fermentation Engineering (Ministry of Education), School of Life and Health Sciences, Hubei University of Technology, Wuhan 430068, China.
| | - Shu Tian
- State Key Laboratory of Green Pesticide, College of Chemistry, Central China Normal University, Wuhan 430079, China.
| | - Qiao Song
- State Key Laboratory of Green Pesticide, College of Chemistry, Central China Normal University, Wuhan 430079, China.
| | - Yun Deng
- Key Laboratory of Optoelectronic Chemical Materials and Devices of Ministry of Education, Jianghan University, Wuhan 430056, China
| | - Zhipeng Zhang
- College of Pharmacy, Hubei University of Science & Technology, Xianning 437100, China.
| | - PeiYao Chen
- Key Laboratory of Fermentation Engineering (Ministry of Education), School of Life and Health Sciences, Hubei University of Technology, Wuhan 430068, China.
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Guangxi Medical University, Nanning 530021, China
| | - Yao Sun
- State Key Laboratory of Green Pesticide, College of Chemistry, Central China Normal University, Wuhan 430079, China.
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Mao Z, Hu Y, Zhao Y, Zhang X, Guo L, Wang X, Zhang J, Miao M. The Mutual Regulatory Role of Ferroptosis and Immunotherapy in Anti-tumor Therapy. Apoptosis 2024:10.1007/s10495-024-01988-9. [PMID: 38853203 DOI: 10.1007/s10495-024-01988-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 06/11/2024]
Abstract
Ferroptosis is a form of cell death that is triggered by the presence of ferrous ions and is characterized by lipid peroxidation induced by these ions. The mechanism exhibits distinct morphological characteristics compared to apoptosis, autophagy, and necrosis. A notable aspect of ferroptosis is its ability to inhibit uncontrolled tumor replication and immortalization, especially in malignant, drug-resistant, and metastatic tumors. Additionally, immunotherapy, a novel therapeutic approach for tumors, has been found to have a reciprocal regulatory relationship with ferroptosis in the context of anti-tumor therapy. A comprehensive analysis of ferroptosis and immunotherapy in tumor therapy is presented in this paper, highlighting the potential for mutual adjuvant effects. Specifically, we discuss the mechanisms underlying ferroptosis and immunotherapy, emphasizing their ability to improve the tumor immune microenvironment and enhance immunotherapeutic effects. Furthermore, we investigate how immunotherapeutic factors may increase the sensitivity of tumor cells to ferroptosis. We aim to provide a prospective view of the promising value of combined ferroptosis and immunotherapy in anticancer therapy by elucidating the mutual regulatory network between each.
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Affiliation(s)
- Zhiguo Mao
- Department of Pharmacology, Zhengdong New District, Henan University of Chinese Medicine, No. 156 Jinshui East Road, Zhengzhou, 450046, Henan, China
- Collaborative Innovation Center of Research and Development, Whole Industry Chain of Yu-Yao in Henan Province, Henan, China
| | - Yilong Hu
- Department of Pharmacology, Zhengdong New District, Henan University of Chinese Medicine, No. 156 Jinshui East Road, Zhengzhou, 450046, Henan, China
- Collaborative Innovation Center of Research and Development, Whole Industry Chain of Yu-Yao in Henan Province, Henan, China
| | - Yinan Zhao
- Department of Pharmacology, Zhengdong New District, Henan University of Chinese Medicine, No. 156 Jinshui East Road, Zhengzhou, 450046, Henan, China
- Collaborative Innovation Center of Research and Development, Whole Industry Chain of Yu-Yao in Henan Province, Henan, China
| | - Xiaolei Zhang
- Department of Pharmacology, Zhengdong New District, Henan University of Chinese Medicine, No. 156 Jinshui East Road, Zhengzhou, 450046, Henan, China
- Collaborative Innovation Center of Research and Development, Whole Industry Chain of Yu-Yao in Henan Province, Henan, China
| | - Lin Guo
- Department of Pharmacology, Zhengdong New District, Henan University of Chinese Medicine, No. 156 Jinshui East Road, Zhengzhou, 450046, Henan, China
- Collaborative Innovation Center of Research and Development, Whole Industry Chain of Yu-Yao in Henan Province, Henan, China
| | - Xiaoran Wang
- Department of Pharmacology, Zhengdong New District, Henan University of Chinese Medicine, No. 156 Jinshui East Road, Zhengzhou, 450046, Henan, China
- Collaborative Innovation Center of Research and Development, Whole Industry Chain of Yu-Yao in Henan Province, Henan, China
| | - Jinying Zhang
- Department of Pharmacology, Zhengdong New District, Henan University of Chinese Medicine, No. 156 Jinshui East Road, Zhengzhou, 450046, Henan, China
- Collaborative Innovation Center of Research and Development, Whole Industry Chain of Yu-Yao in Henan Province, Henan, China
| | - Mingsan Miao
- Department of Pharmacology, Zhengdong New District, Henan University of Chinese Medicine, No. 156 Jinshui East Road, Zhengzhou, 450046, Henan, China.
- Collaborative Innovation Center of Research and Development, Whole Industry Chain of Yu-Yao in Henan Province, Henan, China.
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Liang Q, Wang Y, Li Y, Wang J, Liu C, Li Y. Ferroptosis: emerging roles in lung cancer and potential implications in biological compounds. Front Pharmacol 2024; 15:1374182. [PMID: 38783959 PMCID: PMC11111967 DOI: 10.3389/fphar.2024.1374182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Lung cancer has high metastasis and drug resistance. The prognosis of lung cancer patients is poor and the patients' survival chances are easily neglected. Ferroptosis is a programmed cell death proposed in 2012, which differs from apoptosis, necrosis and autophagy. Ferroptosis is a novel type of regulated cell death which is driven by iron-dependent lipid peroxidation and subsequent plasma membrane ruptures. It has broad prospects in the field of tumor disease treatment. At present, multiple studies have shown that biological compounds can induce ferroptosis in lung cancer cells, which exhibits significant anti-cancer effects, and they have the advantages in high safety, minimal side effects, and less possibility to drug resistance. In this review, we summarize the biological compounds used for the treatment of lung cancer by focusing on ferroptosis and its mechanism. In addition, we systematically review the current research status of combining nanotechnology with biological compounds for tumor treatment, shed new light for targeting ferroptosis pathways and applying biological compounds-based therapies.
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Affiliation(s)
- Qiuran Liang
- The Second Clinical Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yuehui Wang
- The Second Clinical Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yili Li
- The Second Clinical Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jinyan Wang
- The Second Clinical Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Chuanbo Liu
- Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yicong Li
- Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
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Ai S, Li Y, Zheng H, Zhang M, Tao J, Liu W, Peng L, Wang Z, Wang Y. Collision of herbal medicine and nanotechnology: a bibliometric analysis of herbal nanoparticles from 2004 to 2023. J Nanobiotechnology 2024; 22:140. [PMID: 38556857 PMCID: PMC10983666 DOI: 10.1186/s12951-024-02426-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/18/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Herbal nanoparticles are made from natural herbs/medicinal plants, their extracts, or a combination with other nanoparticle carriers. Compared to traditional herbs, herbal nanoparticles lead to improved bioavailability, enhanced stability, and reduced toxicity. Previous research indicates that herbal medicine nanomaterials are rapidly advancing and making significant progress; however, bibliometric analysis and knowledge mapping for herbal nanoparticles are currently lacking. We performed a bibliometric analysis by retrieving publications related to herbal nanoparticles from the Web of Science Core Collection (WoSCC) database spanning from 2004 to 2023. Data processing was performed using the R package Bibliometrix, VOSviewers, and CiteSpace. RESULTS In total, 1876 articles related to herbal nanoparticles were identified, originating from various countries, with China being the primary contributing country. The number of publications in this field increases annually. Beijing University of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, and Saveetha University in India are prominent research institutions in this domain. The Journal "International Journal of Nanomedicine" has the highest number of publications. The number of authors of these publications reached 8234, with Yan Zhao, Yue Zhang, and Huihua Qu being the most prolific authors and Yan Zhao being the most frequently cited author. "Traditional Chinese medicine," "drug delivery," and "green synthesis" are the main research focal points. Themes such as "green synthesis," "curcumin," "wound healing," "drug delivery," and "carbon dots" may represent emerging research areas. CONCLUSIONS Our study findings assist in identifying the latest research frontiers and hot topics, providing valuable references for scholars investigating the role of nanotechnology in herbal medicine.
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Affiliation(s)
- Sinan Ai
- China-Japan Friendship Hospital, Beijing, China
- Beijing Key Laboratory for Immune-Mediated Inflammatory Diseases, Institute of Medical Science, China-Japan Friendship Hospital, Beijing, China
| | - Yake Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Huijuan Zheng
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Meiling Zhang
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiayin Tao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Weijing Liu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Liang Peng
- China-Japan Friendship Hospital, Beijing, China.
- Beijing Key Laboratory for Immune-Mediated Inflammatory Diseases, Institute of Medical Science, China-Japan Friendship Hospital, Beijing, China.
| | - Zhen Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
| | - Yaoxian Wang
- Henan University of Chinese Medicine, Zhengzhou, Henan, China.
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7
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Sun S, He Y, Xu J, Leng S, Liu Y, Wan H, Yan L, Xu Y. Enhancing cell pyroptosis with biomimetic nanoparticles for melanoma chemo-immunotherapy. J Control Release 2024; 367:470-485. [PMID: 38290565 DOI: 10.1016/j.jconrel.2024.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
Despite the fact that immunotherapy has significantly improved the prognosis of melanoma patients, the non-response rate of monoimmunotherapy is considerably high due to insufficient tumor immunogenicity. Therefore, it is necessary to develop alternative methods of combination therapy with enhanced antitumor efficiency and less systemic toxicity. In this study, we reported a cancer cell membrane-coated zeolitic imidazole framework-8 (ZIF-8) encapsulating pyroptosis-inducer oxaliplatin (OXA) and immunomodulator imiquimod (R837) for chemoimmunotherapy. With the assistance of DNA methyltransferase inhibitor decitabine (DCT), upregulated Gasdermin E (GSDME) was cleaved by OXA-activated caspase-3, further inducing tumor cell pyroptosis, then localized antitumor immunity was enhanced by immune adjuvant R837, followed by triggering systemic antitumor immune responses. These results provided a proof-of-concept for the use of cell membrane-coated biomimetic nanoparticles as a promising drug carrier of combination therapy and a potential insight for pyroptosis-based melanoma chemo-immunotherapy.
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Affiliation(s)
- Shiquan Sun
- Department of Dermatovenereology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, PR China; Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou 215006, PR China
| | - Yong He
- R&D Department of 3D printing, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, PR China
| | - Jiaqi Xu
- Department of Dermatovenereology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, PR China
| | - Shaolong Leng
- Department of Dermatovenereology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, PR China
| | - Yu Liu
- Department of Dermatovenereology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, PR China
| | - Huanhuan Wan
- Department of Dermatovenereology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, PR China
| | - Leping Yan
- Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, PR China.
| | - Yunsheng Xu
- Department of Dermatovenereology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, PR China.
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Lei L, Dai W, Man J, Hu H, Jin Q, Zhang B, Tang Z. Lonidamine liposomes to enhance photodynamic and photothermal therapy of hepatocellular carcinoma by inhibiting glycolysis. J Nanobiotechnology 2023; 21:482. [PMID: 38102658 PMCID: PMC10724989 DOI: 10.1186/s12951-023-02260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
Phototherapy, including photodynamic therapy (PDT) and photothermal therapy (PTT), has great promise in the treatment of cancer. However, there are many obstacles that can restrict the therapeutic efficacy of phototherapy. The hypoxic tumor microenvironment can restrict the production of reactive oxygen species (ROS) in PDT. As for PTT, the thermotolerance of cancer cells may lead to ineffective PTT. In this study, IR780 and glycolysis inhibitor lonidamine (LND)-encapsulated liposomes are prepared for photodynamic and photothermal therapy of hepatocellular carcinoma. IR780 can be used as a photosensitizer and photothermal agent for simultaneous PDT and PTT after being irradiated with 808 nm laser. LND can reduce the oxygen consumption of cancer cells by inhibiting glycolysis, which will relieve tumor hypoxia and produce more ROS for PDT. On the other hand, energy supply can be blocked by LND-induced glycolysis inhibition, which will inhibit the production of heat shock proteins (HSPs), reduce the thermotolerance of tumor cells, and finally enhance the therapeutic efficacy of PTT. The enhanced PTT is studied by measuring intracellular HSPs, ATP level, and mitochondrial membrane potential. The antitumor effect of IR780 and LND co-loaded liposomes is extensively investigated by in vitro and in vivo experiments. This research provides an innovative strategy to simultaneously enhance the therapeutic efficacy of PDT and PTT by inhibiting glycolysis, which is promising for future creative approaches to cancer phototherapy.
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Affiliation(s)
- Lei Lei
- Department of Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, 322000, China
| | - Wenbin Dai
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Jiaping Man
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Haitao Hu
- Department of Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, 322000, China
| | - Qiao Jin
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China.
| | - Bo Zhang
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
| | - Zhe Tang
- Department of Surgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, 322000, China.
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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