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392 N. Nomikou et al.
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minimal (Zhang et al. 2017). Drug molecules can also be attached to polymer chains via enzyme-cleavable linkers to create amphiphilic polymer-drug conjugates that can self-assemble into micelles. Specic enzymes have the capacity to break the conju­gation, destabilizing the micelles, and liberating the drug. For example, Wang et al. (
2020) conjugated doxorubicin to Angelica sinensis polysaccharide via an MMP-2
sensitive peptide to form amphiphilic conjugates that self-assemble into micelles. The presence of the enzyme increased drug release by 90%, compared to the enzyme-free environment.
(c) Enzyme-sensitive gateke epers.
Mesoporous silica nanoparticles (MSNs) are becoming an extremely popular alternative to organic enzyme-sensitive nanoparticles. In these systems, therapeutic agents can be loaded into the porous structures and can be trapped by capping the pores. These caps, also called gatekeepers, can be engineered to release or degrade in the presence of specic enzymes. For instance, Eskandari et al. ( MMP-2-responsive MSNs capped with gold nanoparticles (AuNPs) for the entrap­ment of doxorubicin. The AuNP gatekeeperswere attached to the surface of the MSNs via an MMP-2-sensitive peptide, which was conjugated onto the MSNs through an amidation reaction with carboxyl groups that were pre-functionalized onto the MSN surface. In the presence of MMP-2, 90% of the entrapped doxorub icin was released in 8 h, while release was minimal in the absence of the enzyme. Iron oxide nanoparticles have also been used as gatekeepingmoieties to trap therapeu­tic agents within MSN pores. When the gatekeeping/capping is stabilized via macromolecular linkers containing trypt ophan residues, it becomes breakable by indoleamine 2,3-dioxygenase 1, an enzyme that is present in the tum our microenvi­ronment and can metabolize tryptophan to N-formylkynurenine, causing drug release selectively in the tumour mass (Qiao et al. 2019).
2019) described
(d) Enzyme-triggered size change.
Nanoparticle-based drug delivery in solid tumours signicantly relies on the enhanced permeability and retention (EPR) effect. The EPR effect is intensely oper­ational when nanoparticles of sizes 100 – 200 nm are injected. These nanoparticles are too large to be cleared by the kidneys or escape from normal vasculature to healthy tissues, but they can permeate the dysfunctional tumour vasculature and be retained in the tumour mass. However, upon extravasation, nanoparticles of this size range show poor diffusion due to the dense nature of tumour tissues and they lack the penetrative ability of smaller nanoparticles. Nanoparticulate drug carriers have been designed to undergo enzyme-triggered size reduction in the tumour microenviron­ment, aiming to improve diffusion of the therapeutic system throughout the tumour mass and potentially improve cellular uptake (Hadi et al.
2020) described the assembly of nanoclusters using folate functionalized
et al. ( albumins and carboxylesterase-sensitive tetrachloroperylene monoamide which, under the action of tumour-expressed carboxylesterase, can break down from 100 nm nanoclusters into 10 nm nanoparticles, with improved diffusion capability.
2021). For example, Cai
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Alternatively, in terms of enzyme-induced size-shifting, it may be desirable to have nanoparticles that aggregate to form larger structures. For mucosal drug delivery, nanoparticles that can penetrate through the mucus layer, can also back­diffuse into outer mucus regions, reducing their accumulation. In order to prevent back-diffusion, a solid–lipid nanocarrier (120 nm), formed with a phosphate ester surfactant and octadecylamine, was developed, to penetrate through the mucus and form aggregates in the presence of alkaline phosphatase, which is a cell membrane­bound enzyme (Le-Vinh et al. 2021). Microaggregates of 5–8 mm were formed due to particle electrostatic interactions induced by the enzymatic phosphate removal, after approx. 30 min of exposure to the enzyme. This innovative system may be used for mucosal drug delivery to alkaline phosphatase-ex pressing tissues, such as the colon, cervix, vagina, lung, and mucus-secreting tumours.
(e) Enzyme-driven charge shift.
Finally, enzymes can be used to degrade away negatively charged coatings that protect nanocarriers in blood circulation, to expose the positive charge underneath the coating and enhance cellular uptake or promote lysosomal/endosomal escape. He et al. ( containing hyaluronic acid shell. These nanoparticles undergo an enzyme-dependent charge shift in the presence of overexpressed hyaluronidase. This is an enzyme that is abundant both in the extracellular tumour microenvironment and in the cytoplasm of tumour cells. In the corresponding study, it was found that in the extracellular hyaluronidase-rich environment, the coating of the nanoparticles was partially degraded, and the charge shifts from -12 mV to neutral. This shift, along with the active targeting ability of hyaluronic acid, promotes nanoparticle cellular uptake. Once internalized, the intracellular action of hyaluronidase further degrades the coating, increasing the charge to +39 mV, while releasing more doxorubicin. Moreover, this drastic increase in surface positive charge accelerates the lyso­somal/endosomal escape of doxorubicin into the cytoplasm (Fig.
2021) fabricated polymeric nanoparticles coated with a doxorubicin-
15.1).
15.2.2 pH-Responsive Nanoparticles
A common hallmark in pathology is an abnormal level of acidity in the extracellular environment of the affected tissue(s). Cancer, inammatory disease, ischemia, as well as stroke are a few examples of where this phenomenon is known to occur. The pH of the tumour microenvironment, for instance, is around pH 6.4–pH 6.8, while blood and healthy tissue, however, present neutral environments (pH 7.0–pH 7.4). There are also disparities in pH within individual cells themselves. For example, the pH of the cytosol is between pH 7.0 and pH 7.4, while the pH of lysosomal/ endosomal compartments varies from pH 4.0 to pH 6.0 (Mi 2020).
These wide pH differentials can be exploited in nanomedicine to achieve targeted therapeutic activity, at either the tissue or cellular level. pH-responsive nanomedicines commonly utilize (a) acid-labile linkers, (b) pH-dependent charge
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Fig. 15.1 Enzyme-triggered charge shift can promote both cellular uptake and lysosomal escape of doxorubicin (DOX) (He et al.
2021)
shifts, and (c) pH-stimulated hydrophilic to hydrophobic trans itions. Another inter­esting strategy is the employment of (d) pH (low) insertion peptide (pHLIP) tech­nology (Reshetnyak et al.
2020).
(a) Acid-labile linkers.
Acid-labile bonds or linkages can be used to directly conjugate drugs onto nanocarriers, or they can be integrated into the structure of a nanocarrier itself. In the former, acidic environments can promote the break of pH-sensitive bonds, resulting in the release of drug molecules. In the latter, acidic conditions can trigger the disassembly or degradation of the nanocarrier to release the encapsulated ther­apeutic agent(s). To date, multiple pH-labile bonds have been reported. These include 2,3-dimethylmaleic anhydride linkages, imine, benzoic-imine, ketal, ortho ester, acetal, cyclic acetal, citraconic amide, b-thiopropionate oxime, and hydrazone bonds (Zhuo et al.
2020; Mi
2020
).
Hydrazone bonds can readily undergo hydrolysis under acidic conditions, a reaction thought to be initiated by the protonation of the imine nitrogen (Kölmel and Kool
2017). The most common means of forming hydrazone bonds involves a
condensation reaction between hydrazine and an aldehyde or ketone group (Sonawane et al. 2017). For example, Gatti et al. (2018) exploited the ketone group on doxorubicin to form a hydrazone conjugated prodrug with poly(lactic acid). The polymeric micelles formed from the prodrug and a block copolymer surfactant were found to release over two-fold more free doxorubicin in acidic conditions, when compared to the release at physiological pH, over a 2-day period.
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However, direct drug conjugation using hydrazone bonds is quite limiting since there are not many drugs that contain aldehyde or ketone functional groups (Sonawane et al. 2017). To overcome this limitation, hydrazone bonds can solely be used to build pH-sensitive polymeric nanoparticles for carrying therapeutic agents, hence, avoiding any drug conjugation. Yang et al. ( with paclitaxel-loaded polymeric micelles by incorporating a hydrazone bond between the hydrophilic and hydrophobic portions of an amphiphilic polymer capable of self-assembling into micelles. In acidic pH, the hydrazone linkage breaks, destabilizing the micelles and releasing the encapsulated paclitaxel.
(b) pH-dependent charge shifts
Nanoparticles can be engineered to carry a neutral or negative charge in pH 7.0– pH 7.4 environments, and a positive charge in acidic environments. This would allow nanoparticles to remain stable in circulation, while promoting cellular uptake in acidic conditions or stimulating lysosomal/endosomal escape. Nanoparticles can be equipped with a pH-triggered charge reversal ability in a few different ways. One way is the breakage of pH-sensitive bonds such as the b-carboxylic amide bond, which can be incorporated via the addition of various anhydrides, such as cis-4­cyclohexene-1,2-dicarboxinic anhydride, carboxy dimethylmaleic anhydride, cis­aconitic anhydride, 2,3-dimethylmaleic anhydride, and citraconic anhydride (Zhang et al. 2022;Mi 2020). Hu et al. (2020) was inspired by this technique and used a pH-sensitive polymer containing 2,3-dimethylmaleic anhydride (DA), which was used to form a nanocarrier of two prodrugs, a-cyclodextrin (a-CD)-nitric oxide and a-CD-chlorine e6. In physiological pH, the b-carboxylic amide bond of the polymer is stable, the DA group remains in place and the nanoparticles have a negative charge due to the exposed carboxyl groups. Upon entering the acidic pH environment of bacterial biolms, the amide bond is hydrolysed leading to the exposure of protonated amino groups and a positive charge. This charge switch allows deeper penetration of the nanocarriers into biolms and better interaction with the negatively charged bacterial surface.
Protonation is another way of increasing positive charge. It is possible for anionic polymers containing carboxyl or sulfonyl groups to be deprotonated at physiological pH and protonated when exposed to increased acidity (Zhang et al. 2022). For example, Lin et al. (2018) functionalized nanoparticles with histamine, which contains imidazole groups that can become protonated in acidic pH (pKa = 6.95), leading to a neutral to positive surface charge transition.
2019) attempted this
(c) pH-dependent hydrophobicit y.
The environmental pH can have an impact on a polymers hydrophobicity. For instance, at low pH, protonation can cause a polymer to switch from a hydrophobic to a hydrophilic polymer. Such behaviour can be used to disrupt nanosystems and cause them to release their payload under specic pH conditions, as shown by Wang et al. (2019a, b). For example, when drug-containing nanoparticles were prepared using two amphiphilic polymers, and the pH-responsive polymer poly(ethylene glycol)-block-poly diisopropylaminoethyl methacrylate-block-poly dopamine,
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Fig. 15.2 (a) Steps for the formation of a pH-responsive nanoparticle decorated with pHLIPs (Palanikumar et al. tured peptide. But as acidity increases, the peptide begins to spontaneously fold into an alpha helical shape and inserts itself into the lipid bilayer
2020), (b) In healthy tissue with neutral pH, the pHLIP resembles an unstruc-
protonation of the latter at acidic pH (pKa = 6.8) caused a shift from hydrophobic to hydrophilic, thereby destabilizing the nanoparticles and resulting in drug release (Albuquerque et al. 2021).
Hydrophobicity-based conformational changes in certain peptides can be induced by pH changes. This phenomenon is exploited in the pH (Low) Insertion Peptide (pHLIP) technology which enables specic peptides to be inserted into cell mem­branes in response to an acidic pH. pHLIPs predominantly contain protonatable, negatively charged residues, and hydrophobic residues. When residues are proton­ated at low pH, the prior negative charge is countered and the hydrophobicity of the overall peptide increases, enabling peptide insertion. Commonly used residues are asparagine and glutamate and their pKas would not allow for protonation or deprotonation to occur at physiological pH. The rate of protonation and deprotonation is inuenced by the dielectric environment, leading to a rise in carboxyl group pKas near the cell membrane. As peptides dissolve further into the membrane, the dielectric environment shifts to favour intrahelical hydrogen bonds. Thus, the peptide undergoes a conformational change from an unstructured peptide outside the cell membrane into an alpha helical structure spanning across the cell membrane (Fig.
15.2). pHLIPs have been used recently by Palanikumar et al. (2020)
to enhance the cellular internalization of nanoparticles in tumours. The group utilized polylactic-co-glycolic acid (PLGA) as a backbone for pH-responsive hybrid
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nanoparticles loaded with doxorubicin-triphenylphosphine. The PLGA centre is enveloped in a cross-linked bovine serum albumin coating that is decorated with pHLIPs. The pHLIPs contain glutamate residues (with a measured pKa of 6.5) that are protonated to increase the hydrophobicity of the peptide causing its transition into a transmembrane a-helix structure, which can be translocated across the lipid bilayer. This membrane insertion allowed the nanoparticles t more direct passage. Alternatively, nanoparticles could internalize via clathrin-mediated endocytosis. Here, the mode of action is thought to involve pHLIPs activation within the acidic endosomal pH and this then drives endosomal escape (Nguyen et al.
it was found that a small proportion of the
o enter the cytosol via a
2019; Reshetnyak et al. 2020).
15.2.3 Glucose-Responsive Nanoparticles
Currently, diabetes is managed by regular insulin injections taken dail y, which is associated with pain and complications (e.g. infection). On that basis, self-regulating insulin delivery systems to deli ver precise doses of insulin in response to changes in blood glucose levels are of signicant value. To this end, many glucose-responsive insulin delivery nanosystems have been developed for the treatment of diabetes. Overall, these strategies can be broken down into two main categories: a) the use of glucose oxidase (GOx) enzyme, and b) the use of phenyl boronic acid (PBA)­containing polymers (Zhao et al. 2017).
(a) Targeting glucose using GOx.
GOx is the oxidoreductase enzyme that catalyses the conversion of b-D-glucose into D-glucono-d-lactone, giving off hydrogen peroxide as a by-product. D-glucono­d-lactone then undergoes non-enzymatic hydrolysis into D-gluconic acid (Kornecki et al. 2020). GOx can be immobilized onto an insulin-loaded nanocarrier that degrades in acidic pH, and in the presence of glucose, D-gluconic acid is produced, dropping the pH, and relea sing insulin from the nanocarrier. This was well demon­strated by Jamwal et al. ( acryloyl crosslinked dextran dialdehyde nanoparticles. These nanoparticles were able to show a modest increase in insulin release in response to glucose (Das et al.
2020). A similar result is achieved when GOx is co-loaded along with insulin and
catalase into pH-responsive acetalated dextran nanoparticles (Volpatti et al. 2020).
(b) Targeting glucose using PBA-containing materials.
Nanoparticles based on PBA-containing polymers are often preferred to protein­based systems like GOx due to their improved stability in the body, long-term storage stability, and better glucose-sensitivity (Das et al. derivatives have high afnity for cis-diol-containing compounds and can bind these through reversible 5- or 6-membered cyclic boronic ester formation. Thus, PBA-based nanoparticles can be designed to interact with the cis-diols found in glucose molecules. PBA moieties are Lewis acids, and in aqueous solution, they
2019), who immobilized GOx via Schiff base linkage onto
2020). PBA and its
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exist in equilibrium between two forms: a relatively hydrophobic (i.e. neutral) trigonal-planar form and a relatively hydrophilic negatively charged tetrahedral boronate form. Cyclic boronic esters with cis-diols tend to occur with the hydrophilic form because it pushes the ionization equilibrium towards the hydrophilic PBA making it the more stable and favourable route. Then, upon binding with cis-diols, the PBA-containing polymer is made more hydrophilic. Th licity subseq
uently causes PBA-based nanoparticles to swell and eventually disas-
is change in hydrophi-
semble in response to glucose, releasing their payload. It is, however, important to mention that PBA has a reported pKa of approximately 8–9, and only at a pH above the pKa will the equilibrium shift to the hydrophilic form. Hence, at physi ological pH = 7.4, the dominant form will actually be the hydrophobic counterpart. This
o t
explains why early research was limited t
sivene
respon
ss in alkaline conditions. It was only until researchers were able to
he demonstration of glucose-
nd ways of lowering the pKa of PBA-based polymers that practical designs began appearing in the scientic literature. Essentially, the pKa of PBA can be lowered by the addition of electron-withdrawing groups, such as the a ddition of an amino group adjacent to the PBA moiety or a halo, nitro, or carbonyl group into the phenyl ring of PBA (Zhao et al.
2017; Das et al. 2020; Gaballa
and Theato
2019). For example,
FITC-insulin loaded polymeric micelles were developed using the PBA-containing block copolymer, poly[(N-acryloylmorpholine-block-(N-acryloylmorpholine-co­PBA)], and a cis-diol containing polymer. By the addition of 2 mg/mL glucose, boronate ester bonds with glucose began to form causing the hydrophobic core to swell, consequently increasing the size of the micelles from 80 nm to 190 nm and releasing insulin. When glucose concentration was in
contai
diol micelle collapse (Gaballa and Theato
ning polymer was sufciently replaced by glucose to cause complete
2019).
creased t
o 5 mg/mL, the cis-
15.2.4 Redox-Responsive Nanoparticles
The use of redox-responsive drug delivery systems is a promising approach for the targeted treatment of cancer. The reducing environment of tumours is regulated by the reduction–oxidation states of NADPH/NADP GSH refers specically to the reduced form of glutathione, while GSSG is the oxidized form that consists of two glutathione molecules linked via a disulde bond. The concentration range of intracellular GSH is between 0.5 and 10 mM, where it is mainly found in the mitochondria and cytosol, while the extracellular concentration range is 2–20 μM (Guo et al. achieved through the structural design of the nanoparticle carrier (Wang et al.
2019a, b; Lu et al. 2021), the GSH-dependent activation of a prodrug to an active
drug (Luo et al. 2022, Li et al. 2020) or both (Ling et al. 2019). The functional components of the nanoparticle carrier that interacts with GSH are the chemical bonds that are cleaved when GSH levels reach a certain threshold, allowing for a targeted release of their cargo (Gisbert-Garzaran and Vallet-Regi
+
and glutathione (GSH/GSSG).
2018). Targeting based on GSH can be
2021). Amongst
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the different types of redox-responsive bonds used, the disulde (S–S) bonds are the most extensivel y studied (Guo et al. 2018) and can be incorporated in both polymer­based (Wang et al. 2019a, b) and metallic (Lu et al. 2021 nanoparticles. or can be used to modify the main polymer molecule by addition of side-chains that are intended to mediate drug conjugation. The disulde bonds can also be used to directly conjugate therapeutic agents on to the surface of nanoparticles (particularly for metallic nanoparticles). Polymers with disulde within the backbone (connecting individual repeating units of monomer
have
but disulde bonds linking their side-chains to drugs on the other hand are relatively easier to manufacture and more stable (Gisbert-Garzaran and Vallet-Regi
Specially designed polymer-drug conjugates, where the drug is linked to the polymer via disulde bonds, or polymerization of small molecule drugs with redox-responsive bonds can lead to the formation of nanoparticulate structures, and the latter may have the capacity to accommodate additional therapeutic agents (Luo et al. consisting of doxorubicin linked to poly[N-(2-hydroxypropyl) methacrylamide] via disulde bonds, that formed micelles through self-assembly due to its amphiphilic properties, allowing the encapsulation of a photosensitizer. These nanoparticles degraded in the presence of GSH intratumourally, subsequently releasing doxoru­bicin and the photosensitizer. In another study by Li et al. ( agent 10-hydroxycamptothecin was polymerized with disulde bonds among indi­vidual molecules to produce a polymer-prodrug or poly-prodrug, that was used as the inner core of nanoparticles with an amphiphilic lipid-PEG shell, allowing for a prolonged circulation in blood.
The application of platinum (Pt)-based anticancer drugs has faced many chal­lenges due to their poor blood circulation, non-specic targeting, and the irreversible deactivation (via reduction) induced by thiol-containing species (e.g. GSH) that are abundant in the cytoplasm (Ling et al. enhanced activity owing to molecular targeting (Johnstone et al. 2016 the aforementioned GSH-induced reduction renders them ineffective. This issue may be addressed by substituting the Pt(II) species for Pt(IV) prodrugs, while incorpo­rating these agents into nanoparticles improves blood circulation time and tumour accumulation levels. As proof of this concept, a study has reported the formulation of Pt(IV) prodrug-containing lipid-PEG nanoparticles via self-assembly. Upon intra­cellular disintegration of the nanoparticles and in the presence of GSH, the released Pt(IV) prodrug is converted to the active Pt(II) metabolite, successfully inhibiting the progression of cisplatin-resistant tumours (Fig. the efcacy of GSH-sensitive nanoparticles, in terms of improving anticancer activity and tumour targeting, would depend on the type of cancer, since GSH levels can greatly vary among different cancers.
The disulde bonds can be inserted in the backbone of the polymer
s v
ia such bonds) are highly sensitive to GSH
poor stability, as well as being complex to synthesize. Polymers with
2022; Li et al. 2020). Luo et al. (2022) reported a polymeric prodrug
2019). Pt(II)-based substances allow for
15.3) (Ling et al.
) drug-carrying
2021).
2020), the anti-cancer
); however,
2019). Importantly,
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Fig. 15.3 Pt(IV) prodrug-carrying lipid-PEG NPs for targeted treatment of cancer cells. Pt (IV) prodrugs are prepared by oxidation of cisplatin [Pt(II)-based drug], followed by the addition of super hydrophobic ligands to the intermediate. These are then self-assembled into nanoparticles with lipid-PEG allowing efcient circulation in blood. At the tumour site, nanoparticle structure is degraded into irregular-shaped debris in the presence of GSH and subsequently releases the Pt (IV) prodrug. Pt(IV) undergoes GSH-induced reduction to its active form Pt(II) and triggers apoptosis, as well as lowering the intracellular GSH levels
15.2.5 Reactive Oxygen Species (ROS)-Responsive
Nanoparticles
ROS play an important role in many biological mechanisms and intracellular signalling. ROS levels can be elevated in certain pathological microenvironments, such as inammatory diseases, neurodegenerative diseases, and cancer. ROS-responsive nanoparticles offer a more-specic targeting system for cancer treatment compared to GSH-dependent redox responsive systems due to tumour hypoxia, which results in much higher ROS levels in tumour cells (as high as 100 × 10
-6
M), compared to healthy tissues (~20 × 10 The elevated levels of ROS can be exploited by using ROS-responsive nanoparticles that have oxidation-labile linkages/bonds embedded within the nanoparticle struc­ture or on its surface. Examples of such linkages are boronic acids/esters, alkylene sulphide, aminoacrylate, peroxalate ester, polyproline thioether, and thioketal (Rinaldi et al. 2022; Liang and Liu 2016). Based on these moieties, ROS-i nduced
-9
M) (Xu et al. 2017a, b).
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drug release from nanocarriers is possible through nanocarrier destabilization/deg­radation and/or through carrier-drug linker cleavage.
A category of ROS-responsive nanocarriers utilize thioether-containing poly­mers, such as poly(ethylyene sulde), which undergo phase transition from hydro­phobic to hydrophilic states under oxidative environments. The ROS-induced phase transition of the nanoparticle building block leads to nanoparticle disintegratio n with subsequent payload release (Napoli et al.
2004). A similar effect was achieved when
poly (propylene sulde) or an amphiphilic diblock copolymer of propylene sulde and N,N-dimethylacrylamide were used to form the nanoparticulate carriers (Gupta
2012; Poole et al. 2015).
et al.
Polymers containing selenium or tellurium have also been exploited for ROS-induced drug delivery. ROS oxidation of monoselenium and monotellurium compounds can lead to phase transition from hydrophobic to hydrophilic com­pounds, similarly to sulfur-containing polymers, and can be used for the production of ROS-responsive drug nanocarriers (Ren et al.
2012; Wang et al. 2015). For
instance, doxorubicin-carrying self-assembled micelles, constructed using a hydro­phobic monoselenide-containing block polymer and PEG, have been designed for controlled drug release upon exposure to 0.1% H
(Ma et al. 2010). The solu-
2O2
bility switchstrategy described above has also been applied using boronic ester­containing polymers in drug nanocarriers. In a non-solubility switchapproach, when aryl boronic ester is incorporated in polymers that form nanoparticles, the latter can be degraded in response to ROS and release the payload (de Gracia et al.
2012).
Boronic acids/esters have previously been shown to be highly responsive to
, which plays an important role in the pathogenesis of chronic inammation.
H
2O2
Hence, while the majority of studies involving ROS-responsive nanoparticles are on cancer therapeutics, these systems offer exciting prospects for the diagnosis and treatment of inammatory vascular diseases, such as atherosclerosis. A recent study by Tang et al. (
2021) developed a ROS-responsive biomimetic nanoparticle formu-
lation for the treatment of atherosclerosis. The co-polymer was synthesized by conjugation of ROS-sensitive boronic ester onto dextran, which was used to encap­sulate rapamycin.
Thioketal linkers are also known to be readily cleaved by ROS and are employed in various drug delivery systems with potential applications in inammatory disease or cancer treatments. For instance, complexation of a cationic poly(amino thioketal) and DNA has been used in gene delivery (Shim and Xia 2013). Alternatively, the thioketal group can be used as a linker between the nanocarrier and the drug, to enable ROS-induced drug release (Yuan et al. 2014).
Alternatively, ROS may be exploited to activate prodrugs, and similarly to GSH-sensitive prodrugs, different types of ROS-sensitive prodrugs have been reported. A representative example is the prodrugs formed by polymerizing individ­ual monomers of a drug using ROS-responsive linkages to produce a poly-prodrug that can then be coated with an appropriate polymer-based coating to enhance blood circulation. In a proof of concept study, the anticancer agent mitoxantrone (MTO) was polymerized using ROS-cleaved linkages, and the resulting polydrug formed nanoparticles through self-assembly with lipid-PEG (Fig. 15.4) (Xu et al. 2017a, b).