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Chen X, Chen C, Tu Z, Guo Z, Lu T, Li J, Wen Y, Chen D, Lei W, Wen W, Li H. Intranasal PAMAM-G3 scavenges cell-free DNA attenuating the allergic airway inflammation. Cell Death Discov 2024; 10:213. [PMID: 38698016 PMCID: PMC11065999 DOI: 10.1038/s41420-024-01980-x] [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: 10/15/2023] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
Allergic airway inflammation (AAI), including allergic rhinitis (AR) and allergic asthma, is driven by epithelial barrier dysfunction and type 2 inflammation. However, the underlying mechanism remains uncertain and available treatments are constrained. Consequently, we aim to explore the role of cell-free DNA (cfDNA) in AAI and assess the potential alleviating effects of cationic polymers (CPs) through cfDNA elimination. Levels of cfDNA were evaluated in AR patients, allergen-stimulated human bronchial epithelium (BEAS-2B cells) and primary human nasal epithelium from both AR and healthy control (HC), and AAI murine model. Polyamidoamine dendrimers-generation 3 (PAMAM-G3), a classic type of cationic polymers, were applied to investigate whether the clearance of cfDNA could ameliorate airway epithelial dysfunction and inhibit AAI. The levels of cfDNA in the plasma and nasal secretion from AR were higher than those from HC (P < 0.05). Additionally, cfDNA levels in the exhaled breath condensate (EBC) were positively correlated with Interleukin (IL)-5 levels in EBC (R = 0.4191, P = 0.0001). Plasma cfDNA levels negatively correlated with the duration of allergen immunotherapy treatment (R = -0.4297, P = 0.006). Allergen stimulated cfDNA secretion in vitro (P < 0.001) and in vivo (P < 0.0001), which could be effectively scavenged with PAMAM-G3. The application of PAMAM-G3 inhibited epithelial barrier dysfunction in vitro and attenuated the development of AAI in vivo. This study elucidates that cfDNA, a promising biomarker for monitoring disease severity, aggravates AAI and the application of intranasal PAMAM-G3 could potentially be a novel therapeutic intervention for AAI. Allergen stimulates the secretion of cell-free DNA (cfDNA) in both human and mouse airway. Intranasal polyamidoamine dendrimers-generation 3 (PAMAM-G3) scavenges cfDNA and alleviates allergic airway inflammation.
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Affiliation(s)
- Xiumin Chen
- Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Hospital, Sun Yat-sen University, Guangzhou, China
| | - Changhui Chen
- Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhaoxu Tu
- Department of Otorhinolaryngology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zeling Guo
- Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tong Lu
- Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian Li
- Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Otorhinolaryngology, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-sen University, Nanning, China
| | - Yihui Wen
- Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dehua Chen
- Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenbin Lei
- Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
- Otorhinolaryngology Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Weiping Wen
- Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
- Otorhinolaryngology Hospital, Sun Yat-sen University, Guangzhou, China.
- Department of Otorhinolaryngology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Hang Li
- Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
- Otorhinolaryngology Hospital, Sun Yat-sen University, Guangzhou, China.
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Wei C, Li P, Liu L, Zhang H, Zhao T, Chen Y. Degradable Poly(amino acid) Vesicles Modulate DNA-Induced Inflammation after Traumatic Brain Injury. Biomacromolecules 2023; 24:909-920. [PMID: 36629517 DOI: 10.1021/acs.biomac.2c01334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Following brain trauma, secondary injury from molecular and cellular changes causes progressive cerebral tissue damage. Acute/chronic neuroinflammation following traumatic brain injury (TBI) is a key player in the development of secondary injury. Rapidly elevated cell-free DNAs (cfDNAs) due to cell death could lead to production of inflammatory cytokines that aggravate TBI. Herein, we designed poly(amino acid)-based cationic nanoparticles (cNPs) and applied them intravenously in a TBI mice model with the purpose of scavenging cfDNA in the brain and suppressing the acute inflammation. In turn, these cNPs could effectively eliminate endogenous cfDNA, inhibit excessive activation of inflammation, and promote neural functional recovery.
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Affiliation(s)
- Cong Wei
- School of Materials Science and Engineering, Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-sen University, Guangzhou 510275, China
| | - Peipei Li
- School of Materials Science and Engineering, Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-sen University, Guangzhou 510275, China
| | - Lixin Liu
- School of Materials Science and Engineering, Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-sen University, Guangzhou 510275, China.,State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou 510006, Guangdong, China.,Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Hong Zhang
- Department of Biomedical Engineering, Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Jinan University, Guangzhou 510632, China
| | - Tianyu Zhao
- School of Materials Science and Engineering, Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-sen University, Guangzhou 510275, China
| | - Yongming Chen
- School of Materials Science and Engineering, Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-sen University, Guangzhou 510275, China.,State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou 510006, Guangdong, China.,Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
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Olson LB, Hunter NI, Rempel RE, Yu H, Spencer DM, Sullenger CZ, Greene WS, Varanko AK, Eghtesadi SA, Chilkoti A, Pisetsky DS, Everitt JI, Sullenger BA. Mixed-surface polyamidoamine polymer variants retain nucleic acid-scavenger ability with reduced toxicity. iScience 2022; 25:105542. [PMID: 36444294 PMCID: PMC9700028 DOI: 10.1016/j.isci.2022.105542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/02/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Nucleic acid-binding polymers can have anti-inflammatory properties and beneficial effects in animal models of infection, trauma, cancer, and autoimmunity. PAMAM G3, a polyamidoamine dendrimer, is fully cationic bearing 32 protonable surface amines. However, while PAMAM G3 treatment leads to improved outcomes for mice infected with influenza, at risk of cancer metastasis, or genetically prone to lupus, its administration can lead to serosal inflammation and elevation of biomarkers of liver and kidney damage. Variants with reduced density of cationic charge through the interspersal of hydroxyl groups were evaluated as potentially better-tolerated alternatives. Notably, the variant PAMAM G3 50:50, similar in size as PAMAM G3 but with half the charge, was not toxic in cell culture, less associated with weight loss or serosal inflammation after parenteral administration, and remained effective in reducing glomerulonephritis in lupus-prone mice. Identification of such modified scavengers should facilitate their development as safe and effective anti-inflammatory agents.
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Affiliation(s)
- Lyra B. Olson
- Department of Surgery, Duke University, Durham, NC 27710, USA
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC 27710, USA
| | - Nicole I. Hunter
- Department of Surgery, Duke University, Durham, NC 27710, USA
- Department of Chemistry, Duke University, Durham, NC 27710, USA
| | | | - Haixiang Yu
- Department of Surgery, Duke University, Durham, NC 27710, USA
| | - Diane M. Spencer
- Department of Medicine and Immunology, Division of Rheumatology, Duke University Medical Center, Durham, NC 27710, USA
| | - Cynthia Z. Sullenger
- Department of Surgery, Duke University, Durham, NC 27710, USA
- Department of Biology, Duke University, Durham, NC 27710, USA
| | | | | | - Seyed A. Eghtesadi
- Department of Biomedical Engineering, Duke University, Durham, NC 27710, USA
| | - Ashutosh Chilkoti
- Department of Biomedical Engineering, Duke University, Durham, NC 27710, USA
| | - David S. Pisetsky
- Department of Medicine and Immunology, Division of Rheumatology, Duke University Medical Center, Durham, NC 27710, USA
- Medical Research Service, Veterans Administration Medical Center, Durham, NC 27705, USA
| | | | - Bruce A. Sullenger
- Department of Surgery, Duke University, Durham, NC 27710, USA
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC 27710, USA
- Department of Biomedical Engineering, Duke University, Durham, NC 27710, USA
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Nanoparticulate cell-free DNA scavenger for treating inflammatory bone loss in periodontitis. Nat Commun 2022; 13:5925. [PMID: 36207325 PMCID: PMC9546917 DOI: 10.1038/s41467-022-33492-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 09/20/2022] [Indexed: 11/12/2022] Open
Abstract
Periodontitis is a common type of inflammatory bone loss and a risk factor for systemic diseases. The pathogenesis of periodontitis involves inflammatory dysregulation, which represents a target for new therapeutic strategies to treat periodontitis. After establishing the correlation of cell-free DNA (cfDNA) level with periodontitis in patient samples, we test the hypothesis that the cfDNA-scavenging approach will benefit periodontitis treatment. We create a nanoparticulate cfDNA scavenger specific for periodontitis by coating selenium-doped hydroxyapatite nanoparticles (SeHANs) with cationic polyamidoamine dendrimers (PAMAM-G3), namely G3@SeHANs, and compare the activities of G3@SeHANs with those of soluble PAMAM-G3 polymer. Both G3@SeHANs and PAMAM-G3 inhibit periodontitis-related proinflammation in vitro by scavenging cfDNA and alleviate inflammatory bone loss in a mouse model of ligature-induced periodontitis. G3@SeHANs also regulate the mononuclear phagocyte system in a periodontitis environment, promoting the M2 over the M1 macrophage phenotype. G3@SeHANs show greater therapeutic effects than PAMAM-G3 in reducing proinflammation and alveolar bone loss in vivo. Our findings demonstrate the importance of cfDNA in periodontitis and the potential for using hydroxyapatite-based nanoparticulate cfDNA scavengers to ameliorate periodontitis. Periodontitis is a common type of inflammatory bone loss, and cell-free DNA (cfDNA) can be a major source that enhances the periodontal tissue destruction. Here, the authors show that a cfDNA-scavenging approach is able to ameliorate periodontitis by using nanoparticulate cfDNA scavenger.
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Zhong H, Liang H, Yan Y, Chen L, Zhao T, Liu L, Chen Y. Nucleic Acid-Scavenging Hydrogels Accelerate Diabetic Wound Healing. Biomacromolecules 2022; 23:3396-3406. [PMID: 35786877 DOI: 10.1021/acs.biomac.2c00526] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chronic inflammation is a typical feature and a major impediment in refractory diabetic foot ulcer (DFU). High levels of extracellular cell-free nucleic acid (cfDNA) have recently been known to play a critical role in the cause of inflammation. Herein, we fabricated polyacrylamide-based cationic hydrogels and topically applied them to the ulcer of a diabetic rat model. The cfDNA level in the wound area was significantly reduced after hydrogel adsorption, and the level of inflammation was eliminated. In turn, the wound closure was significantly promoted without introducing systemic toxicity. Cationic hydrogels represent an effective material to combat uncontrolled inflammation in DFU.
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Affiliation(s)
- Hai Zhong
- School of Materials Science and Engineering, Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-sen University, Guangzhou 510006, China
| | - Huiyi Liang
- School of Materials Science and Engineering, Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-sen University, Guangzhou 510006, China
| | - Yanzi Yan
- School of Materials Science and Engineering, Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-sen University, Guangzhou 510006, China
| | - Lei Chen
- Department of Burns, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Tianyu Zhao
- School of Materials Science and Engineering, Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-sen University, Guangzhou 510006, China
| | - Lixin Liu
- School of Materials Science and Engineering, Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-sen University, Guangzhou 510006, China
| | - Yongming Chen
- School of Materials Science and Engineering, Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-sen University, Guangzhou 510006, China
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Olson LB, Hunter NI, Rempel RE, Sullenger BA. Targeting DAMPs with nucleic acid scavengers to treat lupus. Transl Res 2022; 245:30-40. [PMID: 35245691 PMCID: PMC9167234 DOI: 10.1016/j.trsl.2022.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/16/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic and often progressive autoimmune disorder marked clinically by a variable constellation of symptoms including fatigue, rash, joint pains, and kidney damage. The lungs, heart, gastrointestinal system, and brain can also be impacted, and individuals with lupus are at higher risk for atherosclerosis, thrombosis, thyroid disease, and other disorders associated with chronic inflammation . Autoimmune diseases are marked by erroneous immune responses in which the target of the immune response is a "self"-antigen, or autoantigen, driven by the development of antigen-specific B or T cells that have overcome the normal systems of self-tolerance built into the development of B and T cells. SLE is specifically characterized by the production of autoantibodies against nucleic acids and their binding proteins, including anti-double stranded DNA, anti-Smith (an RNA binding protein), and many others . These antibodies bind their nuclear-derived antigens to form immune complexes that cause injury and scarring through direct deposition in tissues and activation of innate immune cells . In over 50% of SLE patients, immune complex aggregation in the kidneys drives intrarenal inflammation and injury and leads to lupus nephritis, a progressive destruction of the glomeruli that is one of the most common causes of lupus-related death . To counter this pathology increasing attention has turned to developing approaches to reduce the development and continued generation of such autoantibodies. In particular, the molecular and cellular events that lead to long term, continuous activation of such autoimmune responses have become the focus of new therapeutic strategies to limit renal and other pathologies in lupus patients. The focus of this review is to consider how the innate immune system is involved in the development and progression of lupus nephritis and how a novel approach to inhibit innate immune activation by neutralizing the activators of this response, called Damage Associated Molecular Patterns, may represent a promising approach to treat this and other autoimmune disorders.
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Affiliation(s)
- Lyra B Olson
- Department of Surgery, Duke University, Durham, North Carolina; Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina
| | - Nicole I Hunter
- Department of Surgery, Duke University, Durham, North Carolina; Department of Chemistry, Duke University, Durham, North Carolina
| | - Rachel E Rempel
- Department of Surgery, Duke University, Durham, North Carolina
| | - Bruce A Sullenger
- Department of Surgery, Duke University, Durham, North Carolina; Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina; Department of Biomedical Engineering, Duke University, Durham, North Carolina.
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Kelly L, Olson LB, Rempel RE, Everitt JI, Levine D, Nair SK, Davis ME, Sullenger BA. β-Cyclodextrin-containing polymer treatment of cutaneous lupus and influenza improves outcomes. Mol Ther 2022; 30:845-854. [PMID: 34628051 PMCID: PMC8821959 DOI: 10.1016/j.ymthe.2021.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/27/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023] Open
Abstract
Nucleic acid (NA)-containing damage- and pathogen-associated molecular patterns (DAMPs and PAMPs, respectively) are implicated in numerous pathological conditions from infectious diseases to autoimmune disorders. Nucleic acid-binding polymers, including polyamidoamine (PAMAM) dendrimers, have demonstrated anti-inflammatory properties when administered to neutralize DAMPs/PAMPs. The PAMAM G3 variant has been shown to have beneficial effects in a cutaneous lupus erythematosus (CLE) murine model and improve survival of mice challenged with influenza. Unfortunately, the narrow therapeutic window of cationic PAMAM dendrimers makes their clinical development challenging. An alternative nucleic acid-binding polymer that has been evaluated in humans is a linear β-cyclodextrin-containing polymer (CDP). CDP's characteristics prompted us to evaluate its anti-inflammatory potential in CLE autoimmune and influenza infectious disease mouse models. We report that CDP effectively inhibits NA-containing DAMP-mediated activation of Toll-like receptors (TLRs) in cell culture, improves healing in lupus mice, and does not immunocompromise treated animals upon influenza infection but improves survival even when administered 3 days after infection. Finally, as anticipated, we observe limited toxicity in animals treated with CDP compared with PAMAM G3. Thus, CDP is a new anti-inflammatory agent that may be readily translated to the clinic to combat diseases associated with pathological NA-containing DAMPs/PAMPs.
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Affiliation(s)
- Linsley Kelly
- Department of Surgery, Duke University, Durham, NC 27710, USA
| | - Lyra B Olson
- Department of Surgery, Department of Pharmacology and Cancer Biology, Duke Medical Scientist Training Program, Duke University, Durham, NC 27710, USA
| | - Rachel E Rempel
- Department of Surgery, Duke University, Durham, NC 27710, USA
| | | | - Dana Levine
- Chemical Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Smita K Nair
- Department of Surgery, Department of Neurosurgery, Department of Pathology, Duke University, Durham, NC 27710, USA
| | - Mark E Davis
- Chemical Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Bruce A Sullenger
- Department of Surgery, Department of Pharmacology and Cancer Biology, Department of Neurosurgery, Department of Biomedical Engineering, Duke University, Durham, NC 27710, USA.
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Xie B, Du K, Huang F, Lin Z, Wu L. Cationic Nanomaterials for Autoimmune Diseases Therapy. Front Pharmacol 2022; 12:762362. [PMID: 35126109 PMCID: PMC8813968 DOI: 10.3389/fphar.2021.762362] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/30/2021] [Indexed: 01/14/2023] Open
Abstract
Cationic nanomaterials are defined as nanoscale structures smaller than 100 nm bearing positive charges. They have been investigated to apply to many aspects including clinical diagnosis, gene delivery, drug delivery, and tissue engineering for years. Recently, a novel concept has been made to use cationic nanomaterials as cell-free nucleic acid scavengers and inhibits the inflammatory responses in autoimmune diseases. Here, we highlighted different types of cationic materials which have the potential for autoimmune disease treatment and reviewed the strategy for autoimmune diseases therapy based on cationic nanoparticles. This review will also demonstrate the challenges and possible solutions that are encountered during the development of cationic materials-based therapeutics for autoimmune diseases.
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Affiliation(s)
- Baozhao Xie
- Division of Rheumatology, Department of Internal Medicine, the 7th Affiliated Hospital, Guang Xi Medical University, Wuzhou, China
| | - Keqian Du
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Fujian Huang
- Center for Chemical Biology and Drug Discovery, Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Zhiming Lin
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Zhiming Lin, ; Linping Wu,
| | - Linping Wu
- Center for Chemical Biology and Drug Discovery, Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
- *Correspondence: Zhiming Lin, ; Linping Wu,
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Tsuji N, Agbor-Enoh S. Cell-free DNA beyond a biomarker for rejection: Biological trigger of tissue injury and potential therapeutics. J Heart Lung Transplant 2021; 40:405-413. [PMID: 33926787 DOI: 10.1016/j.healun.2021.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
Cell-free DNA, measured as donor-derived cell-free DNA is developed as a non-specific biomarker for allograft injury and transplant rejection. However, cell-free DNA characteristics are more specific, its fragment length, nucleotide content, and composition, as well as the tissue source of origin, are intrinsically linked to the underlying disease pathogenesis, showing distinct features in acute cellular rejection and antibody-mediated rejection for example. Further, cell-free DNA and cell-free mitochondrial DNA can directly trigger tissue injury as damage-associated molecular patterns through three major intracellular receptors, toll-like receptor 9 , cyclic guanosine monophosphate-adenosine monophosphate synthase, and inflammasomes (i.e., absent in melanoma 2: AIM2). Therefore, in addition to its role as a non-specific marker for allograft injury, cell-free DNA analysis may be used to phenotype transplant rejection, and to non-invasively point the underlying molecular mechanisms with allograft injury. Novel treatment approaches targeting these cell-free DNA pathways may be useful to treat transplant rejection and prevent end-organ dysfunction. In this review, we discuss the link between cell-free DNA characteristics and disease, the role of cell-free DNA as a damage-associated molecular pattern, and novel therapeutics targeting these cell-free DNA molecular pathways and their potential utility to treat transplant rejection.
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Affiliation(s)
- Naoko Tsuji
- Renal Diagnostics and Therapeutics Unit, National Institutes of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland
| | - Sean Agbor-Enoh
- Lasker Clinical Research Tenure Track Investigator and Laboratory Chief, Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute, Bethesda, Maryland; Lung Transplantation Program, Johns Hopkins School of Medicine, Baltimore, M.
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Circulating Free DNA and Its Emerging Role in Autoimmune Diseases. J Pers Med 2021; 11:jpm11020151. [PMID: 33672659 PMCID: PMC7924199 DOI: 10.3390/jpm11020151] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/06/2021] [Accepted: 02/17/2021] [Indexed: 12/12/2022] Open
Abstract
Liquid biopsies can be used to analyse tissue-derived information, including cell-free DNA (cfDNA), circulating rare cells, and circulating extracellular vesicles in the blood or other bodily fluids, representing a new way to guide therapeutic decisions in cancer. Among the new challenges of liquid biopsy, we found clinical application in nontumour pathologies, including autoimmune diseases. Since the discovery of the presence of high levels of cfDNA in patients with systemic lupus erythaematosus (SLE) in the 1960s, cfDNA research in autoimmune diseases has mainly focused on the overall quantification of cfDNA and its association with disease activity. However, with technological advancements and the increasing understanding of the role of DNA sensing receptors in inflammation and autoimmunity, interest in cfDNA and autoimmune diseases has not expanded until recently. In this review, we provide an overview of the basic biology of cfDNA in the context of autoimmune diseases as a biomarker of disease activity, progression, and prediction of the treatment response. We discuss and integrate available information about these important aspects.
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Dawulieti J, Sun M, Zhao Y, Shao D, Yan H, Lao YH, Hu H, Cui L, Lv X, Liu F, Chi CW, Zhang Y, Li M, Zhang M, Tian H, Chen X, Leong KW, Chen L. Treatment of severe sepsis with nanoparticulate cell-free DNA scavengers. SCIENCE ADVANCES 2020; 6:eaay7148. [PMID: 32523983 PMCID: PMC7259927 DOI: 10.1126/sciadv.aay7148] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 03/25/2020] [Indexed: 05/20/2023]
Abstract
Severe sepsis represents a common, expensive, and deadly health care issue with limited therapeutic options. Gaining insights into the inflammatory dysregulation that causes sepsis would help develop new therapeutic strategies against severe sepsis. In this study, we identified the crucial role of cell-free DNA (cfDNA) in the regulation of the Toll-like receptor 9-mediated proinflammatory pathway in severe sepsis progression. Hypothesizing that removing cfDNA would be beneficial for sepsis treatment, we used polyethylenimine (PEI) and synthesized PEI-functionalized, biodegradable mesoporous silica nanoparticles with different charge densities as cfDNA scavengers. These nucleic acid-binding nanoparticles (NABNs) showed superior performance compared with their nucleic acid-binding polymer counterparts on inhibition of cfDNA-induced inflammation and subsequent multiple organ injury caused by severe sepsis. Furthermore, NABNs exhibited enhanced accumulation and retention in the inflamed cecum, along with a more desirable in vivo safety profile. Together, our results revealed a key contribution of cfDNA in severe sepsis and shed a light on the development of NABN-based therapeutics for sepsis therapy, which currently remains intractable.
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Affiliation(s)
- Jianati Dawulieti
- Department of Pharmacology, Nanomedicine Engineering Laboratory of Jilin Province, College of Basic Medical Sciences and School of Nursing, Jilin University, Changchun 130021, China
| | - Madi Sun
- Department of Pharmacology, Nanomedicine Engineering Laboratory of Jilin Province, College of Basic Medical Sciences and School of Nursing, Jilin University, Changchun 130021, China
- Institutes of Life Sciences, National Engineering Research Center for Tissue Restoration and Reconstruction, School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou International Campus, Guangzhou, Guangdong 510006, China
| | - Yawei Zhao
- Department of Pharmacology, Nanomedicine Engineering Laboratory of Jilin Province, College of Basic Medical Sciences and School of Nursing, Jilin University, Changchun 130021, China
| | - Dan Shao
- Institutes of Life Sciences, National Engineering Research Center for Tissue Restoration and Reconstruction, School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou International Campus, Guangzhou, Guangdong 510006, China
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Huize Yan
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Yeh-Hsing Lao
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Hanze Hu
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Lianzhi Cui
- Clinical Laboratory, Jilin Cancer Hospital, Changchun 130012, China
| | - Xiaoyan Lv
- Clinical Laboratory, The Second Hospital of Jilin University, Changchun 130021, China
| | - Feng Liu
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, China
| | - Chun-Wei Chi
- Department of Biomedical Engineering CUNY–City College of New York, New York, NY 10031, USA
| | - Yue Zhang
- Department of Pharmacology, Nanomedicine Engineering Laboratory of Jilin Province, College of Basic Medical Sciences and School of Nursing, Jilin University, Changchun 130021, China
| | - Mingqiang Li
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
- Guangdong Provincial Key Laboratory of Liver Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China
| | - Ming Zhang
- Department of Pharmacology, Nanomedicine Engineering Laboratory of Jilin Province, College of Basic Medical Sciences and School of Nursing, Jilin University, Changchun 130021, China
| | - Huayu Tian
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, China
| | - Xuesi Chen
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, China
| | - Kam W. Leong
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
- Department of Systems Biology, Columbia University Medical Center, New York, NY 10032, USA
| | - Li Chen
- Department of Pharmacology, Nanomedicine Engineering Laboratory of Jilin Province, College of Basic Medical Sciences and School of Nursing, Jilin University, Changchun 130021, China
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12
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Cationic nanoparticle as an inhibitor of cell-free DNA-induced inflammation. Nat Commun 2018; 9:4291. [PMID: 30327464 PMCID: PMC6191420 DOI: 10.1038/s41467-018-06603-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 08/23/2018] [Indexed: 12/11/2022] Open
Abstract
Cell-free DNA (cfDNA) released from damaged or dead cells can activate DNA sensors that exacerbate the pathogenesis of rheumatoid arthritis (RA). Here we show that ~40 nm cationic nanoparticles (cNP) can scavenge cfDNA derived from RA patients and inhibit the activation of primary synovial fluid monocytes and fibroblast-like synoviocytes. Using clinical scoring, micro-CT images, MRI, and histology, we show that intravenous injection of cNP into a CpG-induced mouse model or collagen-induced arthritis rat model can relieve RA symptoms including ankle and tissue swelling, and bone and cartilage damage. This culminates in the manifestation of partial mobility recovery of the treated rats in a rotational cage test. Mechanistic studies on intracellular trafficking and biodistribution of cNP, as well as measurement of cytokine expression in the joints and cfDNA levels in systemic circulation and inflamed joints also correlate with therapeutic outcomes. This work suggests a new direction of nanomedicine in treating inflammatory diseases. Cell-free DNA (cfDNA) released from damaged or dead cells can activate DNA sensors that exacerbate the pathogenesis of rheumatoid arthritis (RA). Here the authors use ~40 nm cationic nanoparticles to scavenge cfDNA, and demonstrate the potential for nanomedicine to relieve debilitating RA symptoms.
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13
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Chen HH, Yuan H, Cho H, Feng Y, Ngoy S, Kumar ATN, Liao R, Chao W, Josephson L, Sosnovik DE. Theranostic Nucleic Acid Binding Nanoprobe Exerts Anti-inflammatory and Cytoprotective Effects in Ischemic Injury. Am J Cancer Res 2017; 7:814-825. [PMID: 28382156 PMCID: PMC5381246 DOI: 10.7150/thno.17366] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 11/25/2016] [Indexed: 01/24/2023] Open
Abstract
Extracellular nucleic acids are proinflammatory molecules that have been implicated in a diverse range of diseases. We report here the development of a multivalent nucleic acid scavenging nanoprobe, where the fluorochrome thiazole orange (TO) is conjugated to a polymeric 40 kDa dextran carrier. Dextran-TO (Dex-TO) has nanomolar affinity for mammalian and bacterial nucleic acids and attenuates the production of inflammatory cytokines from activated macrophages exposed to DNA and RNA. Mice with myocardial ischemia reperfusion that were treated with Dex-TO showed a decrease in myocardial macrophage infiltration at 24 hours (p<0.05) and a decrease in infarct size (18% ± 9%, p<0.01) on day 7. Dex-TO allows sites of injury to be identified with fluorescence imaging, while simultaneously exerting an anti-inflammatory and cytoprotective effect. Dex-TO could be of significant diagnostic and therapeutic (theranostic) utility in a broad range of conditions including ischemia, trauma, burns, sepsis and autoimmune disease.
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Mechanisms of Chromatin Remodeling and Repurposing During Extracellular Translocation. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2017; 106:113-137. [DOI: 10.1016/bs.apcsb.2016.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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15
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Jackman JG, Juwarker H, Poveromo LP, Levinson H, Leong KW, Sullenger BA. Polycationic Nanofibers for Nucleic Acid Scavenging. Biomacromolecules 2016; 17:3706-3713. [PMID: 27741396 DOI: 10.1021/acs.biomac.6b01236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Dying cells release nucleic acids (NA) and NA-containing complexes that activate inflammatory pathways of immune cells. Sustained activation of these pathways contributes to chronic inflammation frequently encountered in autoimmune and inflammatory diseases. In this study, grafting of cationic polymers onto a nanofibrous mesh enabled local scavenging of negatively charged pro-inflammatory molecules in the extracellular space. Nucleic acid scavenging nanofibers (NASFs) formed from poly(styrene-alt-maleic anhydride) conjugated with 1.8 kDa bPEI resulted in nanofibers of diameters 486 ± 9 nm. NASFs inhibited the NF-κB response stimulated by the negatively charged agonists, CpG and poly(I:C), in Ramos-blue cells but not Pam3CSK4, a nonanionic agonist. Moreover, NASFs significantly impeded NF-κB activation in cells stimulated with damage-associated molecular pattern molecules (DAMPs) released from doxorubicin killed cancer cells. In vivo application of NASFs to open wounds demonstrated nucleic acid scavenging in wounds of diabetic mice infected with Pseudomonas aeruginosa, suggesting the in vivo efficacy of NASFs. This simple technique of generating NASF results in effective localized anti-inflammation in vitro and local nucleic acid scavenging in vivo.
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Affiliation(s)
| | | | | | | | - Kam W Leong
- Department of Biomedical Engineering, Columbia University , New York, New York, United States
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16
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Stearns NA, Zhou S, Petri M, Binder SR, Pisetsky DS. The Use of Poly-L-Lysine as a Capture Agent to Enhance the Detection of Antinuclear Antibodies by ELISA. PLoS One 2016; 11:e0161818. [PMID: 27611194 PMCID: PMC5017613 DOI: 10.1371/journal.pone.0161818] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 08/13/2016] [Indexed: 01/23/2023] Open
Abstract
Antibodies to nuclear antigens (antinuclear antibodies or ANAs) are the serological hallmark of systemic lupus erythematosus (SLE). These antibodies bind diverse nuclear antigens that include DNA, histones and non-histone proteins as well as complexes of proteins with DNA and RNA. Because of the frequency of ANA expression in SLE, testing is an important component of clinical evaluation as well as determination of eligibility for clinical trials or utilization of certain therapies. Immunofluorescence assays have been commonly used for this purpose although this approach can be limited by issues of throughput, variability and difficulty in determining positivity. ELISA and multiplex assays are also useful approaches although these assays may give an incomplete picture of antibodies present. To develop a sensitive and quantitative ANA assay, we have explored an ELISA platform in which plates are pre-coated with a positively charged nucleic acid binding polymer (NABP) to increase adherence of antigens containing DNA or RNA. As a source of antigens, we have used supernatants of Jurkat cells undergoing apoptosis in vitro. As results presented show, a poly-L-lysine (PLL) pre-coat significantly enhances detection of antibodies to DNA as well as antigens such as histones, SSA, SSB and RNP. Comparison of the ELISA assay with the PLL pre-coat with a multiplex assay using the BioPlex® 2200 system indicated good agreement in results for a panel of lupus sera. Together, these studies indicate that a pre-coat with a positively charged polymer can increase the sensitivity of an ANA ELISA using as antigens molecules released from dead and dying cells. This assay platform may facilitate ANA testing by providing an ensemble of antigens more similar in composition and structure with antigens present in vivo, with a NABP promoting adherence via charge-charge interactions.
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Affiliation(s)
- Nancy A. Stearns
- Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Shuxia Zhou
- Bio-Rad Laboratories Clinical Diagnostic Group, 400 Alfred Nobel Drive, Hercules, California, United States of America
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, Maryland, United States of America
| | - Steven R. Binder
- Bio-Rad Laboratories Clinical Diagnostic Group, 400 Alfred Nobel Drive, Hercules, California, United States of America
| | - David S. Pisetsky
- Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Medical Research Service, VA Medical Center, Durham, North Carolina, United States of America
- * E-mail:
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17
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Scavenging nucleic acid debris to combat autoimmunity and infectious disease. Proc Natl Acad Sci U S A 2016; 113:9728-33. [PMID: 27528673 DOI: 10.1073/pnas.1607011113] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Nucleic acid-containing debris released from dead and dying cells can be recognized as damage-associated molecular patterns (DAMPs) or pattern-associated molecular patterns (PAMPs) by the innate immune system. Inappropriate activation of the innate immune response can engender pathological inflammation and autoimmune disease. To combat such diseases, major efforts have been made to therapeutically target the pattern recognition receptors (PRRs) such as the Toll-like receptors (TLRs) that recognize such DAMPs and PAMPs, or the downstream effector molecules they engender, to limit inflammation. Unfortunately, such strategies can limit the ability of the immune system to combat infection. Previously, we demonstrated that nucleic acid-binding polymers can act as molecular scavengers and limit the ability of artificial nucleic acid ligands to activate PRRs. Herein, we demonstrate that nucleic acid scavengers (NASs) can limit pathological inflammation and nucleic acid-associated autoimmunity in lupus-prone mice. Moreover, we observe that such NASs do not limit an animal's ability to combat viral infection, but rather their administration improves survival when animals are challenged with lethal doses of influenza. These results indicate that molecules that scavenge extracellular nucleic acid debris represent potentially safer agents to control pathological inflammation associated with a wide range of autoimmune and infectious diseases.
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Stearns NA, Pisetsky DS. The role of monogamous bivalency and Fc interactions in the binding of anti-DNA antibodies to DNA antigen. Clin Immunol 2016; 166-167:38-47. [PMID: 27083935 DOI: 10.1016/j.clim.2016.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 11/18/2022]
Abstract
Antibodies to DNA (anti-DNA) are the serological hallmark of systemic lupus erythematosus. These antibodies can bind DNA avidly by monogamous bivalency, a mechanism which requires the interaction of both Fab combining regions with antigenic determinants on the same polynucleotide. To explore further this mechanism, we tested Fab and F(ab')2 fragments prepared from IgG from patient plasmas in an ELISA with native DNA antigen, detecting antibody with a peroxidase conjugated anti-Fab reagent. These studies showed that Fab fragments, which can only bind monovalently, had negligible activity. Although bivalent F(ab')2 fragments would be predicted to bind DNA, these fragments also showed poor anti-DNA activity. Control studies showed that the fragments retained antibody activity to tetanus toxoid and an EBV antigen preparation. Together, these findings suggest that anti-DNA avidity depends on monogamous bivalency, with the antibody Fc portion also influencing DNA binding, in a mechanism which can be termed Fc-dependent monogamous bivalency.
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Affiliation(s)
- Nancy A Stearns
- Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Medical Research Service, VA Medical Center, Durham, NC, USA
| | - David S Pisetsky
- Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Medical Research Service, VA Medical Center, Durham, NC, USA.
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Li J, Yu F, Chen Y, Oupický D. Polymeric drugs: Advances in the development of pharmacologically active polymers. J Control Release 2015; 219:369-382. [PMID: 26410809 DOI: 10.1016/j.jconrel.2015.09.043] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 02/06/2023]
Abstract
Synthetic polymers play a critical role in pharmaceutical discovery and development. Current research and applications of pharmaceutical polymers are mainly focused on their functions as excipients and inert carriers of other pharmacologically active agents. This review article surveys recent advances in alternative pharmaceutical use of polymers as pharmacologically active agents known as polymeric drugs. Emphasis is placed on the benefits of polymeric drugs that are associated with their macromolecular character and their ability to explore biologically relevant multivalency processes. We discuss the main therapeutic uses of polymeric drugs as sequestrants, antimicrobials, antivirals, and anticancer and anti-inflammatory agents.
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Affiliation(s)
- Jing Li
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Fei Yu
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yi Chen
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - David Oupický
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, USA; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA; Department of Chemistry, University of Nebraska Lincoln, Lincoln, NE, USA; Department of Pharmaceutical Sciences, China Pharmaceutical University, Nanjing, China.
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20
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Wang X, Stearns NA, Li X, Pisetsky DS. The effect of polyamines on the binding of anti-DNA antibodies from patients with SLE and normal human subjects. Clin Immunol 2014; 153:94-103. [PMID: 24732074 DOI: 10.1016/j.clim.2014.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/02/2014] [Accepted: 04/04/2014] [Indexed: 11/18/2022]
Abstract
Antibodies to DNA (anti-DNA) are the serological hallmark of systemic lupus erythematosus (SLE). To elucidate specificity further, the effect of polyamines on the binding of anti-DNA antibodies from patients with lupus was tested by ELISA to calf thymus (CT) DNA; we also assessed the binding of plasmas of patients and normal human subjects (NHS) to Micrococcus luteus (MC) DNA. As these studies showed, spermine can dose-dependently inhibit SLE anti-DNA binding to CT DNA and can promote dissociation of preformed immune complexes. With MC DNA as antigen, spermine failed to inhibit the NHS anti-DNA binding. Studies using plasmas adsorbed to a CT DNA cellulose affinity indicated that SLE plasmas are mixtures of anti-DNA that differ in inhibition by spermine and binding to conserved and non-conserved determinants. Together, these studies demonstrate that spermine can influence the binding of anti-DNA autoantibodies and may contribute to the antigenicity of DNA.
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Affiliation(s)
- Xiao Wang
- Department of Rheumatology, Qilu Hospital, Shandong University, Jinan, China; Medical Research Service, Durham Veterans Administration Medical Center, Durham, NC, USA
| | - Nancy A Stearns
- Medical Research Service, Durham Veterans Administration Medical Center, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA
| | - Xingfu Li
- Department of Rheumatology, Qilu Hospital, Shandong University, Jinan, China
| | - David S Pisetsky
- Medical Research Service, Durham Veterans Administration Medical Center, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA.
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21
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Does anti-DNA positivity increase the incidence of secondary antiphospholipid syndrome in lupus patients? THE EGYPTIAN RHEUMATOLOGIST 2013. [DOI: 10.1016/j.ejr.2013.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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