Nanosensitizers for sonodynamic therapy for glioblastoma multiforme: current progress and future perspectives

Glioblastoma multiforme(GBM) is the most common primary malignant brain tumor, and it is associated with poor prognosis. Its characteristics of being highly invasive and undergoing heterogeneous genetic mutation, as well as the presence of the blood–brain barrier(BBB), have reduced the efficacy of GBM treatment. The emergence of a novel therapeutic method, namely, sonodynamic therapy(SDT), provides a promising strategy for eradicating tumors via activated sonosensitizers coupled with low-intensity ultrasound. SDT can provide tumor killing effects for deep-seated tumors, such as brain tumors. However, conventional sonosensitizers cannot effectively reach the tumor region and kill additional tumor cells, especially brain tumor cells. Efforts should be made to develop a method to help therapeutic agents pass through the BBB and accumulate in brain tumors. With the development of novel multifunctional nanosensitizers and newly emerging combination strategies, the killing ability and selectivity of SDT have greatly improved and are accompanied with fewer side effects. In this review, we systematically summarize the findings of previous studies on SDT for GBM, with a focus on recent developments and promising directions for future research.

Combined therapy with bevacizumab and photodynamic therapy for myopic choroidal neovascularization: A oneyear follow-up controlled study

AIMTo evaluate the efficacy and safety of a combined treatment for myopic choroidal neovascularization (CNV) using photodynamic therapy (PDT) and intravitreal bevacizumab and to compare it with intravitreal bevacizumab monotherapy.

Ranibizumab alone or in combination with photodynamic therapy vs photodynamic therapy for polypoidal choroidal vasculopathy: a systematic review and Meta-analysis

AIMTo compare the efficacy of intravitreal ranibizumab (IVR) alone or in combination with photodynamic therapy (PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy (PCV).METHODSA systematic search of a wide range of databases (including PubMed, EMBASE, Cochrane Library and Web of Science) was searched to identify relevant studies. Both randomized controlled trials (RCTs) and non-RCT studies were included. Methodological quality of included literatures was evaluated according to the Newcastle-Ottawa Scale. RevMan 5.2.7 software was used to do the Meta-analysis.RESULTSThree RCTs and 6 retrospective studies were included. The results showed that PDT monotherapy had a significantly higher proportion in patients who achieved complete regression of polyps than IVR monotherapy at months 3, 6, and 12 (All P≤0.01), respectively. However, IVR had a tendency to be more effective in improving vision on the basis of RCTs. The proportion of patients who gained complete regression of polyps revealed that there was no significant difference between the combination treatment and PDT monotherapy. The mean change of best-corrected visual acuity (BCVA) from baseline showed that the combination treatment had significant superiority in improving vision vs PDT monotherapy at months 3, 6 and 24 (All P<0.05), respectively. In the mean time, this comparison result was also significant at month 12 (P<0.01) after removal of a heterogeneous study.CONCLUSIONIVR has non-inferiority compare with PDT either in stabilizing or in improving vision, although it can hardly promote the regression of polyps. The combination treatment of PDT and IVR can exert a synergistic effect on regressing polyps and on maintaining or improving visual acuity. Thus, it can be the first-line therapy for PCV.

Indocyanine Green-Conjugated Magnetic Prussian Blue Nanoparticles for Synchronous Photothermal/Photodynamic Tumor Therapy

Indocyanine green(ICG) is capable of inducing a photothermal effect and the production of cytotoxic reactive oxygen species for cancer therapy. However, the major challenge in applying ICG molecules for antitumor therapy is associated with their instability in aqueous conditions and rapid clearance from blood circulation,which causes insufficient bioavailability at the tumor site.Herein, we conjugated ICG molecules with Prussian blue nanoparticles enclosing a Fe_3O_4 nanocore, which was facilitated by cationic polyethyleneimine via electrostatic adsorption. The nanocarrier-loaded ICG formed stable aggregates that enhanced cellular uptake and prevented fluorescence quenching. Moreover, the strong superparamagnetism of the Fe_3O_4 core in the obtained nanocomposites further improved cellular internalization of the drugs guided by a localized magnetic field. The therapeutic efficacy of this nanoplatform was evaluated using tumor models established in nude mice, which demonstrated remarkable tumor ablation in vivo due to strong photothermal/photodynamic effects. This study provides promising evidence that this multifunctional nanoagent might function as an efficient mediator for combining photothermal and photodynamic cancer therapy.

Breast cancer as photodynamic therapy target: Enhanced therapeutic efficiency by overview of tumor complexity

Photodynamic therapy is a minimally invasive and clinically approved procedure for eliminating selected malignant cells with specific light activation of a photosensitizer agent. Whereas interstitial and intra-operative approaches have been investigated for the ablation of a broad range of superficial or bulky solid tumors such as breast cancer, the majority of approved photodynamic therapy protocols are for the treatment of superficial lesions of skin and luminal organs. This review article will discuss recent progress in research focused mainly on assessing the efficacies of various photosensitizers used in photodynamic therapy, as well as the combinatory strategies of various therapeutic modalities for improving treatments of parenchymal and/or stromal tissues of breast cancer solid tumors. Cytotoxic agents are used in cancer treatments for their effect on rapidly proliferating cancer cells. However, such therapeutics often lack specificity, which can lead to toxicity and undesirable side effects. Many approaches are designed to targettumors. Selective therapies can be established by focusing on distinctive intracellular(receptors, apoptotic pathways, multidrug resistance system, nitric oxidemediated stress) and environmental(glucose, pH) differences between tumor and healthy tissue. A rational design of effective combination regimens for breast cancer treatment involves a better understanding of the mechanisms and molecular interactions of cytotoxic agents that underlie drug resistance and sensitivity.

Nanotechnology assisted photo-and sonodynamic therapy for overcoming drug resistance

Drug resistance is considered the most important reason for the clinical failure of cancer chemotherapy.Circumventing drug resistance and improving the efficacy of anticancer agents remains a major challenge.Over the past several decades,photodynamic therapy(PDT)and sonodynamic therapy(SDT)have attracted substantial attention for their efficacy in cancer treatment,and have been combined with chemotherapy to overcome drug resistance.However,simultaneously delivering sensitizers and chemotherapy drugs to same tumor cell remains challenging,thus greatly limiting this combinational therapy.The rapid development of nanotechnology provides a new approach to solve this problem.Nano-based drug delivery systems can not only improve the targeted delivery of agents but also co-deliver multiple drug components in single nanoparticles to achieve optimal synergistic effects.In this review,we briefly summarize the mechanisms of drug resistance,discuss the advantages and disadvantages of PDT and SDT in reversing drug resistance,and describe state-of-the-art research using nano-mediated PDT and SDT to solve these refractory problems.This review also highlights the clinical translational potential for this combinational therapy.

Photosensitizer Nanoparticles Boost Photodynamic Therapy for Pancreatic Cancer Treatment

Patients with pancreatic cancer(PCa)have a poor prognosis apart from the few suitable for surgery.Photodynamic therapy(PDT)is a minimally invasive treatment modality whose efficacy and safety in treating unresectable localized PCa have been corroborated in clinic.Yet,it suffers from certain limitations during clinical exploitation,including insufficient photosensitizers(PSs)delivery,tumor-oxygenation dependency,and treatment escape of aggressive tumors.To overcome these obstacles,an increasing number of researchers are currently on a quest to develop photosensitizer nanoparticles(NPs)by the use of a variety of nanocarrier systems to improve cellular uptake and biodistribution of photosensitizers.Encapsulation of PSs with NPs endows them significantly higher accumulation within PCa tumors due to the increased solubility and stability in blood circulation.A number of approaches have been explored to produce NPs co-delivering multi-agents affording PDT-based synergistic therapies for improved response rates and durability of response after treatment.This review provides an overview of available data regarding the design,methodology,and oncological outcome of the innovative NPs-based PDT of PCa.

Advances in photosensitizer-related design for photodynamic therapy

Photodynamic therapy(PDT)is highly effective in treating tumors located near body surface,offering strong tumor suppression and low damage to normal tissue nearby.PDT is also effective for treating a number of other conditions.PDT not only provide a precise and selective method for the treatment of various diseases by itself,it can also be used in combination with other traditional therapies.Because PDT uses light as the unique targeting mechanism,it has simpler and more direct targeting capability than traditional therapies.The core material of a PDT system is the photosensitizer which converts light energy to therapeutic factors/substances.Different photosensitizers have their distinct characteristics,leading to different advantages and disadvantages.These could be enhanced or compensated by using proper PDT system.Therefore,the selected type of photosensitizer would heavily influence the overall design of a PDT system.In this article,we evaluated major types of inorganic and organic PDT photosensitizers,and discussed future research directions in the field.

Design consideration of phthalocyanines as sensitizers for enhanced sono-photodynamic combinatorial therapy of cancer

Cancer remains one of the diseases with the highest incidence and mortality globally.Conventional treatment modalities have demonstrated threatening drawbacks including invasiveness,noncontrollability,and development of resistance for some,including chemotherapy,radiation,and surgery.Sono-photodynamic combinatorial therapy(SPDT)has been developed as an alternative treatment modality which offers a non-invasive and controllable therapeutic approach.SPDT combines the mechanism of action of sonodynamic therapy(SDT),which uses ultrasound,and photodynamic therapy(PDT),which uses light,to activate a sensitizer and initiate cancer eradication.The use of phthalocyanines(Pcs)as sensitizers for SPDT is gaining interest owing to their ability to induce intracellular oxidative stress and initiate toxicity under SDT and PDT.This review discusses some of the structural prerequisites of Pcs which may influence their overall SPDT activities in cancer therapy.

光动力治疗瘢痕疙瘩的研究进展

瘢痕疙瘩是继发于皮肤外伤或自发形成和过度生长的病理性瘢痕组织,具有增生能力强、复发率高等特点,严重影响患者的身心健康。目前的治疗方法有手术切除、皮损内注射、放射疗法,但效果常不能令人满意。光动力疗法(photodynamic therapy,PDT)是药械联合的非侵入性治疗方式,目前被广泛应用于皮肤肿瘤及多种皮肤疾病的治疗。近年来相继有临床报道PDT可有效治疗瘢痕疙瘩。本文对PDT在瘢痕疙瘩治疗中的研究进展进行综述。

金纳米颗粒负载光敏剂在改善恶性肿瘤光动力治疗中的研究进展

金纳米颗粒(AuNPs)是纳米医学中常用的纳米材料之一。AuNPs作为载体可以将药物精确地输送至靶细胞或靶组织,提高疾病的诊断和治疗效率。光动力疗法(PDT)在治疗肿瘤上拥有巨大潜力,是被批准用于临床治疗的新方法。有证据表明,光敏剂(PS)通过共价键或者非共价键的相互作用包被在AuNPs上,不仅能提高肿瘤细胞对PS的有效摄取,增强PDT的效率,还可以克服单纯PDT的局限性。该文综述了AuNPs的类型、特点及其应用,着重介绍了AuNPs与PDT相结合的抗癌活性。

Modulation of reactive oxygen species to enhance sonodynamic therapy

Reactive oxygen species(ROS),involving in many biological reactions,play an important role in disease treatment.Among the various ROS-based therapeutic modalities,sonodynamic therapy(SDT)stands out with its unique advantages.In turn,the SDT efficacy is mainly dependent on the ROS levels in the disease microenvironment.Therefore,in recent years,researchers have extensively investigated SDT with high ROS generation capacity.In this review,we focus on effective strategies to improve the therapeutic ef-ficiency of SDT by modulating ROS,overview the basic mechanisms of ROS generation by sonosensitizers,highlight the rational design of sonosensitizers,and summarize strategies to improve the SDT efficacy by modulating disease microenvironment.In addition,multiple ROS synergistic treatment modalities and the prospect of SDT are discussed.We believe that the understanding and exploration of SDT enhancement strategies will facilitate the clinical translation of SDT.

光动力疗法治疗神经胶质瘤的研究进展

神经胶质瘤因其恶性程度及复发率较高,已逐渐成为影响人类健康的主要因素。目前针对神经胶质瘤的手术、化、放疗等治疗手段都存在局限性。近年来,光动力疗法(PDT)在治疗恶性肿瘤方面受到极大关注并已取得显著进步。本文介绍了PDT单独疗法、PDT联合其他疗法应用于神经胶质瘤的治疗现状,提出将PDT开发成为神经胶质瘤患者的一种新的安全有效的辅助治疗方式。

Platelet membrane-coated C-TiO_(2) hollow nanospheres for combined sonodynamic and alkyl-radical cancer therapy

The therapeutic efficiency of sonodynamic therapy(SDT)mainly depends on the presence of oxygen(O_(2))to generate harmful reactive oxygen species(ROS);thus,the hypoxic tumor microenvironment significantly limits the efficacy of SDT.Therefore,the development of oxygen-independent free radical generators and associated combination therapy tactics can be a promising field to facilitate the anticancer capability of SDT.In this study,a biomimetic drug delivery system(C-TiO_(2)/AIPH@PM)composed of an alkyl-radical generator(2,2′-azobis[2-(2-imidazolin-2-yl)propane]dihydrochloride,AIPH)-loaded C-TiO_(2) hollow nanoshells(HNSs)as the inner cores,and a platelet membrane(PM)as the outer shells is successfully prepared for synergistic SDT and oxygen-independent alkyl-radical therapy.The PM encapsulation can significantly prolong the blood circulation time of CTiO_(2)/AIPH@PM compared with C-TiO_(2)/AIPH while enabling C-TiO_(2)/AIPH@PM to achieve tumor targeting.C-TiO_(2)/AIPH@PM can efficiently produce ROS and alkyl radicals,which can achieve a more thorough tumor eradication regardless of the normoxic or hypoxic conditions.Furthermore,the generation of these radicals improves the efficiency of SDT.In addition,nitrogen(N_(2))produced due to the decomposition of AIPH enhances the acoustic cavitation effect and lowers the cavitation threshold,thereby enhancing the penetration of CTiO_(2)/AIPH@PM at the tumor sites.Both in vitro and in vivo experiments demonstrate that CTiO_(2)/AIPH@PM possesses good biosafety,ultrasound imaging performance,and excellent anticancer efficacy.This study provides a new strategy to achieve oxygen-independent free radical production and enhance therapeutic efficacy by combining SDT and free radical therapy.

Beyond Antibiotics:Photo/Sonodynamic Approaches for Bacterial Theranostics

Rapid evolution and propagation of multidrug resistance among bacterial pathogens are outpacing the development of new antibiotics,but antimicrobial photodynamic therapy(aPDT)provides an excellent alternative.This treatment depends on the interaction between light and photoactivated sensitizer to generate reactive oxygen species(ROS),which are highly cytotoxic to induce apoptosis in virtually all microorganisms without resistance concern.When replacing light with low-frequency ultrasonic wave to activate sensitizer,a novel ultrasounddriven treatment emerges as antimicrobial sonodynamic therapy(aSDT).Recent advances in aPDT and aSDT reveal golden opportunities for the management of multidrug resistant bacterial infections,especially in the theranostic application where imaging diagnosis can be accomplished facilely with the inherent optical characteristics of sensitizers,and the generated ROS by aPDT/SDT cause broad-spectrum oxidative damage for sterilization.In this review,we systemically outline the mechanisms,targets,and current progress of aPDT/SDT for bacterial theranostic application.Furthermore,potential limitations and future perspectives are also highlighted.

Antitumor immune responses induced by photodynamic and sonodynamic therapy:a narrative review

The immune system has the function of immune surveillance to resist the occurrence and development of tumors,and is essential for inhibition of tumor metastasis.Nevertheless,tumor cells can still suppress immune responses through multiple mechanisms to escape recognition and elimination.Photodynamic and sonodynamic therapy involve systemic or local use of sensitizers followed by light or ultrasound treatment of the affected area,leading to tumor cell death by various mechanisms.The capability of the immune system is essentially affected by photodynamic and sonodynamic therapy.To understand the tumor therapeutic mechanisms of photodynamic and sonodynamic therapy and to explore the use of these modalities for improvement of the antitumor immune effect,extensive preclinical and clinical studies have been carried out.Besides direct killing of tumors,photodynamic and sonodynamic therapy also cause inflammatory reactions,achieve antitumor immune responses,and potentially prevent tumor recurrence,thereby treating both primary and metastatic tumors.In this review,we summarize the antitumor immune responses induced by photodynamic and sonodynamic therapy,describe the processes of the antitumor immune responses in detail,and discuss the clinical applications of the resulting antitumor immunity.

光动力疗法与PD-1/PD-L1抑制剂联合抗肿瘤治疗的研究进展

光动力疗法已经成为多种肿瘤辅助治疗的重要选择之一。近年来,针对免疫检查点的单克隆抗体已显示出对一系列癌症的临床治疗前景。将光动力疗法与免疫检查点抑制剂相结合的治疗方案有助于扩大治疗效果并最大限度地减少不良反应,已经在动物及人体研究中显示出初步的联合抗肿瘤效果。该文综述光动力疗法联合免疫检查点抑制剂在乳腺癌、结直肠癌、肾细胞癌、恶性黑素瘤等恶性肿瘤中的抗肿瘤及免疫学效应,为优化抗肿瘤联合治疗方案提供理论基础。

HAL光动力治疗联合吡柔比星对膀胱癌细胞的杀伤作用及其机制的体外实验研究

目的探讨六氨基乙酰丙酸(HAL)光动力治疗(PDT)联合吡柔比星(THP)在体外对膀胱癌细胞的协同杀伤作用及可能的机制。方法将膀胱癌细胞株RT4和T24细胞分为空白对照组、PDT组、THP组、PDT+THP组,各组经过相应的处理后,采用CCK-8法检测对细胞增殖的影响,Western blot检测P-gp蛋白的表达,Hoechst/PI双染法检测对细胞凋亡的影响,RT-q PCR检测Bcl-2和Bax基因的表达。结果与单独PDT处理和单独THP处理相比,PDT+THP处理能够显著抑制RT4和T24细胞的增殖能力(均P<0.01),降低癌细胞P-gp蛋白的表达,并增加细胞凋亡能力、下调Bcl-2基因表达(均P<0.01)、上调Bax基因表达(均P<0.01)。结论HAL介导的PDT联合THP对膀胱癌细胞具有协同杀伤作用,其机制可能与联合治疗降低了癌细胞的耐药性、促进癌细胞凋亡有关。

药物联用抑制白念珠菌生长的研究进展

白念珠菌是念珠菌属最常见的种类之一,是临床上重要的侵袭性念珠菌感染来源。由于传统抗真菌药物的广泛使用,临床已经分离出很多耐药白念珠菌,导致部分传统药物在临床治疗效果明显下降。同时,一些化合物自身的毒性限制了其临床应用。在这种背景下,联合疗法由于发挥了各种药物或手段的协同作用,有可能改进单独用药的不足,具有抑制白念珠菌生长的巨大潜力。

Two-dimensional metal-organic-framework as a unique theranostic nano-platform for nuclear imaging and chemo-photodynamic cancer therapy

Nanoscale metal organic frameworks (NMOFs) with porous structure and inherent biodegradability are attractive nanomedicine platforms.In addition to conventional particulate NMOFs,two-dimensional (2D) NMOFs are emerging as a unique type of NMOFs which however have been relatively less explored for nanomedicine applications.Herein,2D NMOFs composed of Zn2+ and tetrakis(4-carboxyphenyl) porphyrin (TCPP) are fabricated and functionalized with polyethylene glycol (PEG).Compared to their particulate counterpart,such 2D NMOFs show greatly increased drug loading capacity and enhanced light-triggered singlet oxygen production,promising for chemotherapy and photodynamic therapy (PDT),respectively.Utilizing the porphyrin structure of TCPP,our 2D NMOFs could be labeled with a diagnostic radioisotope,99mTc,for single photon emission computer tomography (SPECT) imaging,which reveals efficient tumor homing of those 2D NMOFs upon intravenous injection.While offering a remarkable synergistic in vivo antitumor effect for the combined chemo-PDT,such 2D NMOFs show efficient biodegradation and rapid renal clearance.Our work presents the great promise of 2D NMOFs for nanomedicine applications.