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7 PEGylated Nanocarrier asaPromising Tool forSite-Specic Delivery ofTherapeutics
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S. Acharya et al.
PEGylated Nanocarriers forGene Therapy
LopamudraMishra, LakshmiKumari, YashSharma, KanakChahar, SatyamKhare, PreetiPatel, DilpreetSingh, andBalakDasKurmi
Abstract
The developed disease and mutations in treatment need emerging strategies to
tackle physiological and biopharmaceutical challenges. Many drugs/therapies
are available for symptomatic relief; however, they are sometimes only partially
effective and have a number of dangerous adverse effects. New therapeutic
approaches must therefore be developed to overcome complications and target
permanent cures for specic diseases. Permanent and targeted clinical care has
been signicantly impacted by the production of nanotechnology-based prod-
ucts. The use of nanotechnology has aided in the creation of extremely disease-
selective gene therapy systems, which will be able to deliver the gene in the body
to correct the abnormality and recover the genetic function. Carriers like lipo-
somes, dendrimers, and polymer nanomaterials have recently gained attention as
possible drug delivery systems for various complex physiological diseases,
decreasing toxicity and increasing biocompatibility. PEGylated nanocarriers are
8
L. Mishra · L. Kumari · S. Khare Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab, India
Y. Sharma · K. Chahar Department of Pharmaceutical Quality Assurance, ISF College of Pharmacy, Moga, Punjab, India
P. Patel Department of Pharmaceutical Chemistry, ISF College of Pharmacy, Moga, Punjab, India
D. Singh University Institute of Pharma Sciences, Chandigarh University, Gharuan, Mohali, India
B. D. Kurmi ( Department of Pharmaceutical Quality Assurance, ISF College of Pharmacy, Moga, Punjab, India
Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab, India
*)
239
240
L. Mishra et al.
signicantly the most cutting-edge techniques for non-invasive gene delivery
technologies. When compared to non-PEGylated complexes, PEGylated nano-
carriers showed superior biodistribution, enhanced safety proles, and effective
gene transfer in vector-based nanoformulations. Additionally, compared to poly-
meric systems PEGylation improves the gene expression and stability in a sys-
tem that has been progressively studied in pre-clinical settings. In the present
chapter, we compiled the utilization of PEGylated nanocarriers along with differ-
ent formulation approaches for gene therapy in an extensive set of disease condi-
tions and barriers.
Keywords
Gene therapy · CNS · CVS · Vectors · PEGylation · Liposomes

8.1 Introduction

8.1.1 Background onGene Therapy
Gene therapies entail the effective intracellular delivery of certain genomic materi­als (transgene) inside specic cells to produce a pharmacological effect by replac­ing or repairing an existing abnormality or giving the cells a new genetic function (Nayerossadat etal. 2012; Stone 2010). To turn off a particular gene or restore a specic gene function, various gene delivery-based systems may be used in gene therapy. Gene therapy’s ultimate objective is to replace the malfunctioning or miss­ing gene with a single dose of the appropriate base material (Katare and Aeri 2010).
In 1989, tumor-inltrating lymphocytes underwent the rst human gene transfer, and the rst human gene therapy was performed on the adenosine deaminase (ADA) gene in 1990 to treat SCID (severe combined immunodeciency defect) patients (Aiuti etal. 2017). Due to its immense therapeutic potential to cure a variety of genetic illnesses by introducing novel genes (DNA and RNA) into target cells together with transgene expression, gene therapy has expanded quickly (Cao etal.
2019). Moreover, the direct invivo delivery of certain naked therapeutic genes is
unfeasible and rife with difculties, such as the susceptibility to prone gene degra­dation with nucleases in plasma having non-specicity towards the targeted cells, and the inability of entering negatively charged genes into negatively charged cel­lular membranes (Razi Sooyani etal. 2013). In fact, just six gene therapies have been approved in the west despite around 2600 gene therapeutics were nished or been tested in clinical studies (Ginn etal. 2018). The European Medicines Agency (EMA) have granted conditional marketing authorization to Glybera®, an AAV­based treatment for familial lipoprotein lipase impairment, in 2012.
The US Food and Drug Administration (FDA) licensed IMLYGIC®, a herpes simplex virus type 1 that have been genetically altered, in 2015 for the local treat­ment of melanoma patients’ unresectable lesions. The European Medicines Agency (EMA) approved Strimvelis® in 2016 as a treatment for severe combined
8 PEGylated Nanocarriers forGene Therapy
241
immunodeciency brought on by adenosine deaminase deciency (ADA-SCID). The FDA authorized three gene therapies in 2017. Both KYMRIAH® and YESCARTA® are genetically altered autologous CAR T cell immunotherapies that are directed against CD19; they are both approved for the treatment of non-Hodgkin lymphoma, and KYMRIAH® is also approved by regulatory authorities to treat acute lymphoblastic leukemia. AAV-based gene therapy called LUXTURNA® is intended to treat biallelic RPE65 mutation-related retinal degeneration (Anguela and High 2019). There are mainly two basic subcategories of gene therapy: somatic and germline. Germline gene therapy has a lot of potential; however, it cannot cur­rently be used because of ethical constraints. Somatic cells are the only cells in humans that have been altered by gene therapy thus far (Goncalves and Paiva 2017). Genetic material can generally be transferred by a vector that can be dened as the vehicle which is helpful to deliver particularly the desired gene. The ideal vector could provide an accurate or precise dosage of genetic material to every target cell, enabling the production of the gene product without hazardous side effects (Wang etal. 2019).
An ideal vector must be non-immunogenic, safe, and able to transport a gene to a certain cell type. It should also be able to accommodate foreign genes of a suitable size and achieve the amount and duration of trans-genic expression necessary to rectify the deciency (Davis and Cooper 2007). Transduction is usually the transfer of a gene using a viral vector, whereas transfection describes the transfer of a gene using a non-viral vector. Although, there are several viral as well as nonviral vectors for gene delivery as depicted in Fig.8.1, the prime utilization in a therapy depend on genetic material being transported on the cell membrane and ultimately inside the cell nucleus (Ramamoorth and Narvekar 2015).
Fig. 8.1 Various types of vectors used for gene therapy along with its advantages and limitations
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8.2 Challenges forGene Delivery andPEGylation
asaSolution
Efcient as well as safe delivery of genes into the target cells remains a signicant challenge. There are several challenges associated with gene delivery, including poor stability, low transfection efciency, rapid clearance by the immune system, and off-target effects. To overcome these challenges, various gene delivery vectors developed rationally, which includes viral and non-viral vectors (Wang etal. 2013). Retrovirus (RV), adenovirus (AD), adeno-associated virus (AAV), and lentivirus (LV) are examples of viral vectors that often demonstrate a wide variety of species and tissue tropism and require for straightforward preparation and administration techniques. They also exhibit persistent gene expression and excellent transduction efciency (Boulaiz etal. 2005). However, they possess a number of disadvantages includes high cost, limited target cell selectivity, high toxicity, immunogenicity, and mutagenicity, as well as the inability to transfer large-sized genes.
Circumventing the immune response to a particular vector is wide known prin­ciple challenge which induces an immune response, especially, adenovirus and AAV, particularly express the immunogenic epitopes inside the organism (Razi Sooyani etal. 2013). Despite appearing to be less effective than viral approaches, nonviral delivery mechanisms like nanocarriers have inherent benets including exibility and safety. For the creation of nanocarriers along with minimal toxicity, high cell selectivity, and high stability, nanoparticle complexes modied by func­tional molecules such as peptides, proteins, integrins, lectins, and antibodies has been developed (Wang etal. 2022). There are several kinds of nanoparticles (NPs) that can be used as nanocarriers, including micelles, dendrimers, inorganic or metal NPs, quantum dots (QDs), liposomes, and polymeric NPs. These nanocarriers must circulate inside the blood stream for as long as feasible in order to reach target tis­sues at appropriate concentrations (Edis etal. 2021).
An example of one of these methods is coating the therapeutic’s surface with the help of inert polymer that prevents interactions with bloodstream constituents and gives it “stealth” qualities. Since, it often has a long history of being safe for humans and is regarded as generally recommended as safe (GRAS) by the FDA, polyethyl­ene glycol (PEG) is the “stealth” polymer that is most frequently utilized in the drug delivery industry (Padin-Gonzalez etal. 2022).
PEGylation, the attachment of polyethylene glycol (PEG) onto the surface of gene delivery vectors, have been shown to upregulate the efciency as well as safety of gene delivery in order to improve its pharmacokinetic and pharmacodynamic properties (Lu and Zhang 2018). PEGylation can increase the stability of gene delivery vectors inside the bloodstream, reduce clearance by the immune system, and enhance their ability to penetrate target cells (Suk etal. 2016). Also, it has been proven to increase the circulation time of gene therapy vectors in the bloodstream, reduce clearance by the immune system, and improve target cell uptake. Moreover, PEGylation can reduce the toxicity and immunogenicity of gene delivery vectors (Suk etal. 2016; Chen etal. 2016).
8 PEGylated Nanocarriers forGene Therapy
243
In the 1970s, Davis and colleagues developed the term “PEGylation,” which they dened as the attachment of polyethylene glycol (PEG) with drug molecules (Hamidi etal. 2006). Preparing conjugates of protein/peptide drugs with PEGs with varying degrees of polymerization was the major goal of this procedure. Later, the goal is to change the pharmacokinetic prole as well in the invivo course of the bound drug in the body of host following systemic administration (Veronese and Pasut 2005; Roberts etal. 2020).Talking about chemistry of PEGs, PEGs are amphi­philic polymers made of ethylene oxide repeating units that are comparatively chemically inert. PEG molecules come in a wide range of molecular weights and are accessible commercially. PEGs arenamed depending on the amount of ethylene oxide units present in the polymer chain. PEGs may be arranged in a variety of ways and are primarily divided into two classes: linear polymers and branched polymers. Additionally, PEGs can be categorized into two groups: PEGs with free hydroxyl (–OH) groups at both ends and PEGs with one or two methoxylated end group(s) (i.e., –OH replaced by –OCH3) (Hamidi etal. 2006).
Nanocarriers are often utilized to carry genes and medicinal molecules, with or without coupling of ligands. Because of their unique targeting mechanism and regu­lated drug release prole, these carriers are highly selectable and efcient (Edis etal. 2021). The reticuloendothelial system (RES) removes nanocarriers from the circulation, which is their main disadvantage. RES absorption, stability, immunoge­nicity, drug leakage, hydrophobicity and hemolytic toxicity, are the key reasons why nanocarriers’ employment is constrained in the biomedical area, despite the fact that they have demonstrated a wide variety of uses (Su and Kang 2020). PEGylation of nanocarriers is the only method available to bypass the restrictions. PEGylation is the process of coating or conjugating polyethylene glycol (PEG) with nanocarrier systems.
To increase biocompatibility and get around the opsonins of nanocarriers, PEGylation have been an absolute boon in the nanomedicine eld (Verhoef and Anchordoquy 2013). PEGylation, however, may protect the targeting ligand and hinder the targeting of a particular cell, but un-PEGylated nanocarriers show fast clearance from the blood circulation. Because of this, there are less opportunities for targeted nanocarriers to engage with or be recognized by the appropriate recep­tor site, which will ultimately result in a less successful therapeutic outcome (Li and Huang 2010). Additionally, PEGylation causes nanocarriers to expand in size and molecular weight, which might change their biological capabilities. The charge, size, biocompatibility, contact with macrophages, and circulation duration of nano­carriers can all be affected by the molecular weight as well as density of PEG chains. When compared to PEG or targeting ligand conjugation alone, PEGylated targeted nanocarriers (PEG + targeting ligand) have demonstrated improved targeting out­comes at clinical level (van Vlerken etal. 2007). PEGylation is applicable to reduce the immunogenicity and prolong the circulation of various viral gene vectorssuch as adenovirus and associated virus (Wonganan and Croyle 2010)..
The development of an ideal PEGylated nanocarrier for systemic usefulness in the early 1980s and 1990s was prompted by the reproducibility of protein PEGylation which was used for generating efcient circulating, and subsequently more
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effective intravenous therapies for drug and gene delivery (Klibanov etal. 1990). The mononuclear phagocyte system (MPS) cells quickly remove NPs from sys­temic circulation after they are recognized as foreign objects, preventing accumula­tion in target cells and tissues (Ahmed etal. 2005). However, PEG coatings on NPs protect the surface from aggregation, phagocytosis, and opsonization, prolonging circulation time, much like what was seen with PEGylated proteins.
Doxil®, the rst PEGylated nanoparticle (NP) product to receive FDA approval, was introduced in 1995. With a drug half-life of around 72h along with circulation half-life of 36h, Doxil “Stealth®” liposomes improves doxorubicin bioavailability about 90-fold in 1week after injection compared to free drug (Gabizon etal. 2003; Laginha etal. 2005). Since then, PEGylation has established itself as a staple in NP formulation. PEG chains presented on NPs produce a hydrated cloud with a sizable excluded volume which can sterically prevent NPs from interacting with nearby NPs or blood components because of their hydrophilic nature. Additionally, the exibility of PEG’s conformational range makes it thermodynamically unfavorable for outside substances to penetrate the PEG corona (Lu and Zhang 2018). Ultimately, gene delivery is still a major problem in the eld of gene therapy. PEGylation, on the other hand, has become a potential method for enhancing the effectiveness and security of gene delivery vectors. The area of gene therapy has the potential to undergo a revolution with the introduction of PEGylated gene delivery vectors, opening the door for the creation of safer and more effective gene treatments.
8.3 Types ofPEGylated Nanocarriers
Number of nanocarriers, including liposomes, dendrimers, polymeric nanoparticles, polymeric micelles, metal-organic frameworks have achieved clinical authorization for the efcient delivery of a wide range of therapies, making them promising instruments for the targeted drug delivery for the treatment of cancer and many other disorders. They have the benets of being biocompatible, comparatively harmless, and naturally able to shield the encapsulated payload from enzymatic degradation. Other unfavorable circumstances and advantages and disadvantages are given in Table8.1 (Taher etal. 2023). Additionally, by changing the pharmaco­kinetic prole of the medications, they found to improve the therapeutic efcacy of the encapsulated pharmaceuticals and reduce their toxicity. Due to their combined benets, nanoscale drug carriers have been approved for use in several clinical set­tings with a range of small molecule therapies, most recently siRNA.However, wor­ries about potential carrier toxicity occasionally prevent the broad use of nanocarrier-based treatments in medicine (Gajbhiye etal. 2020).
In rare instances in animal trials, it has been observed that nanocarriers with specic physical and chemical properties stimulate host-immune system, leading to several side effects and/or a lack of benecial effects of the medicine that is encap­sulated. For instance, the size of the generated nanocarriers’ particles or surface electrostatic charges are crucial in dening such immune responses. Immune cells in these trials effectively identify the nanoparticles as alien substances, leading to
8 PEGylated Nanocarriers forGene Therapy
Table 8.1 Advantages and disadvantages of PEGylated nanocarriers
Nanocarriers Liposomes Liposomes offered numerous
Micelle Polymeric micelles possess
Nanogels Nanogels have shown
Inorganic nanoparticles
Advantages Disadvantages
Production cost of liposomes advantages in delivering genes into the cells Liposomes can be complexed either with negatively or positively charged molecules Liposome offers a huge degree of protection to DNA from degradative processes Liposomes are enabled to carry large pieces of DNA, as big as a chromosome Liposomes must be targeted into specic cells or tissues
several unique features that favor their applicability for drug delivery in cancer. The main advantage of polymeric micelles is their capability to solubilize several solubility compromised drugs within the core, thus improving their bioavailability
excellent biocompatibility with a high loading capacity for different guest molecules as they possess hydrophilic properties and due to their unique physical properties, nanogels showed distinct advantages over other types of nanomaterials for various biomedical utilities
Inorganic nanoparticles possess several properties such as non-toxic, hydrophilic, biocompatible, and shows high stability when compared to organic materials. These drug delivery systems are designed for improving drug efcacy and reduced down the adverse effects have been evolved by the development of various novel inorganic nanoparticles
is high
Leakage and fusion of
encapsulated complexed drug
may be possible
Sometimes phospholipids
present on liposomes
undergoes oxidation and
hydrolysis-like reactions
Shorter half-life
Polymeric micelles mainly
show two weaknesses: one of
which is low payload of drugs
and the other is less stability
in aqueous medium. Hence,
this part pledged with drug
loading capacity of polymeric
micelles
One of the major challenges
during the formation of
nanogels with the help of such
polymers is to limit the
particle size, that requires
ne-tuning of the polymer
concentrations or various
environmental parameters
includes temperature, pH, and
ionic strength
There are several issues shown
by inorganic nanoparticles
including long-term stability,
low drug loading efciency,
and also brings batch-to-batch
variations. Moreover,
non-biodegradability as well
as long-term toxicity are the
limitations of inorganic
nanocarriers
245
References Suk etal.
(2016)
Shiraishi and Yokoyama (2019)
Vijayan etal. (2017)
Karakoti etal. (2011)
(continued)
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Table 8.1
Nanocarriers Polymeric
nanoparticles
(continued)
Advantages Disadvantages
Polymeric nanoparticles offered huge advantages over conventional systems which may include biocompatibility, biodegradability, easy to fabricate, non-immunogenic, non-toxic, and site-specic targeting to organs or tissues
The limitations of these
polymeric nanoparticles
include toxic degradation,
toxic monomers aggregation,
residual material associated
with them, as well as toxic
degradation process
References Suk etal.
(2016)
the multilayered immune responses (Geiger etal. 2018). Additionally, it has been noted that the nanoparticles interact with circulating protein levels, including com­plement proteins, which is the prime part of humoral immune response, causing the mononuclear phagocyte system (MPS) to quickly eliminate them from body. The innate immune system’s mononuclear phagocyte system (MPS), which is made up of dendritic cells (DCs), monocytes, and macrophages, is essential for the phagocy­tosis of pathogens during all stages of the immune response. When considered col­lectively, these immune system interactions having the potential to affect the invivo fate of administered nanocarriers and may reduce their therapeutic efcacy.

8.3.1 PEGylated Liposome

The most effective nanocarriers that have achieved commercial success are lipo­somes. The Greek terms “lipos” and “soma,” which translate to “fat” and “body,” majorly, are the source of the word “liposome.” A liposome is a globular lipid bilayer that ranges in size from 50 to 1000nm. Cholesterol and phospholipids are used to make it. After that, polyethylene glycol (PEG)-based liposomes were cre­ated to improve their clinical acceptability (Mohamed etal. 2019).
PEGylation can be done in two different ways: by combining PEG-lipids with liposomal dispersion before liposome formation (post-insertion approach) or by adding PEG-lipids to the composition of lipids prior to liposome formation. The effectiveness of liposomal PEGylation is inuenced by both the dimension and saturation density of the PEG.Although very long PEG chains result in a dramatic drop-in transfection activity, very small PEG molecules cannot stop protein absorp­tion and speed up blood circulation. Typically, medium-length PEG molecules are utilized to modify liposomes. The covering density increases with the molecular PEG-lipid/lipid composition ratio (Jain and Nahar 2010). Figure8.2 illustrates the de-PEGylation system, where PEG is getting cleaved from the liposomes after the liposomes reached the target site in order to improve endosomal escape of carrier.
Liposome PEGylation prolongs circulation duration by limiting liposome­macrophage interaction and MPS uptake. Additionally, PEG-liposomes are known to assemble in tumor foci. The steric barrier among PEG-liposomes and macro­phages and attachment to blood proteins determine how PEG-liposomes interact