Single Component Organic Photosensitizer with NIR-I Emission Realizing Type-I Photodynamic and GSH-Depletion Caused Ferroptosis Synergistic Theranostics

Dual-target regulation of glutathione and heat shock proteins via molecular-carrier-pathway triple-engineering for potentiated phototherapy

Photodynamic therapy (PDT) and photothermal therapy (PTT) face efficacy limitations due to overexpressed glutathione (GSH) and activated heat shock proteins (HSPs). Here, we synthesized a multifunctional agent N3-4F (N3) through molecular engineering. Leveraging strong acceptor-donor (A-D) interactions and reduced singlet-triplet energy gap (ΔES-T), N3 demonstrated exceptional type I/II reactive oxygen species (ROS) generation. An extended π-conjugated backbone with long alkyl chains enhanced light absorption and conferred a remarkable photothermal conversion efficiency (PCE) of 44.9%. To overcome tumor microenvironmental limitations, we engineered a disulfide bond-integrated nanocarrier and co-delivered HSP inhibitor KNK437 (437), selectively depleting intracellular GSH while disrupting thermoresistance. In vivo studies revealed that N3@437 under 808 nm laser irradiation achieved 94.9% tumor growth inhibition and markedly suppressed lung metastasis. By employing a triple-pronged strategy of molecular engineering, nanocarrier design, and pathway blockage, this work pioneered a paradigm that concurrently depletes GSH and inhibits HSPs. This breakthrough enables enhanced PDT/PTT performance, offering a transformative solution for combating tumor adaptive resistance.

Recent Advances in Strategies to Enhance Photodynamic and Photothermal Therapy Performance of Single-Component Organic Phototherapeutic Agents

Photodynamic therapy (PDT) and photothermal therapy (PTT) have emerged as promising treatment options, showcasing immense potential in addressing both oncologic and nononcologic diseases. Single-component organic phototherapeutic agents (SCOPAs) offer advantages compared to inorganic or multicomponent nanomedicine, including better biosafety, lower toxicity, simpler synthesis, and enhanced reproducibility. Nonetheless, how to further improve the therapeutic effectiveness of SCOPAs remains a challenging research area. This review delves deeply into strategies to improve the performance of PDT or PTT by optimizing the structural design of SCOPAs. These strategies encompass augmenting reactive oxygen species (ROS) generation, mitigating oxygen dependence, elevating light absorption capacity, broadening the absorption region, and enhancing the photothermal conversion efficiency (PCE). Additionally, this review also underscores the ideal strategies for developing SCOPAs with balanced PDT and PTT. Furthermore, the potential synergies are highlighted between PDT and PTT with other treatment modalities such as ferroptosis, gas therapy, chemotherapy, and immunotherapy. By providing a comprehensive analysis of these strategies, this review aspires to serve as a valuable resource for clinicians and researchers, facilitating the wider application and advancement of SCOPAs-mediated PDT and PTT.

Ferroptosis: A novel cell death modality as a synergistic therapeutic strategy with photodynamic therapy

Although there has been significant progress in current comprehensive anticancer treatments centered on surgery, postoperative recurrence and tumor metastasis still significantly affect both prognosis and quality of life of the patient. Hence, the development of precisely targeted tumor therapies and exploration of immunotherapy represent additional strategies for tumor treatment. Photodynamic therapy (PDT) is a relatively safe treatment modality that not only induces multiple modes of tumor cell death but also mediates the secondary immunological responses against tumor resistance and metastasis. Ferroptosis, an iron-dependent type of programmed cell death characterized by accumulation of reactive oxygen species and lipid peroxidation products to lethal levels, has emerged as an attractive target trigger for tumor therapies. Recent research has revealed a close association between PDT and ferroptosis, suggesting that combining ferroptosis inducers with PDT could strengthen their synergistic anti-tumor efficiency. Here in this review, we discuss the rationale for combining PDT with ferroptosis inducers and highlight the progress of single-molecule photosensitizers to induce ferroptosis, as well as the applications of photosensitizers combined with other therapeutic drugs for collaborative therapy. Furthermore, given the current research dilemma, we propose potential therapeutic strategies to advance the combined usage of PDT and ferroptosis inducers, providing the basis and guidelines for prospective clinical translation and research directionality with regard to PDT.

Pyrrolopyrrole Cyanine J-Aggregates with Amplified Superoxide Radical Generation, GSH Depletion, and Photothermal Action for Hypoxic Cancer Phototherapy

The elevated glutathione (GSH) level and hypoxia in tumor cells are two key obstacles to realizing the high performance of phototherapy. Herein, the electron-donating rotors are introduced to wings of electron-withdrawing pyrrolopyrrole cyanine (PPCy) to form donor-acceptor-donor structure J-aggregates for amplified superoxide radical generation, GSH depletion, and photothermal action for hypoxic cancer phototherapy to tackle this challenge. Three PPCy photosensitizers (PPCy-H, PPCy-Br, and PPCy-TPE) produce hydroxyl radicals (•OH) and superoxide radicals (O2•-) in hypoxia tumors exclusively as well as excellent photothermal performances under light irradiation. More importantly, GSH as an "electron reservoir" could effectively participate in photoredox processes, continuously consuming GSH and simultaneously generating more superoxide radicals. Notably, the structure-function relationship results reveal that PPCy-TPE nanoparticles (NPs) possess a high molar extinction coefficient (8.5 × 104 M-1 cm-1 at 778 nm) with the broadest absorption band in the near-infrared region, the most significant type I total ROS enhancement, and the highest photothermal conversion efficiency (41.3%). Furthermore, PPCy-TPE NPs have been successfully applied for in vitro and in vivo hypoxic cancer phototherapy under an 808 nm laser with outstanding specificity and biological safety. This work provides a promising single phototherapy agent against hypoxic tumors with efficient type I PDT/PTT synergistic therapy.

Photoimmunotherapy for cancer treatment based on organic small molecules: Recent strategies and future directions

Photodynamic therapy (PDT) is considered as a promising anticancer approach, owning to its high efficiency and spatiotemporal selectivity. Ample evidence indicated that PDT can trigger immunogenic cell death by releasing antigens that activate immune cells to promote anti-tumor immunity. Nevertheless, the inherent nature of tumors and their complex heterogeneity often limits the efficiency of PDT, which can be overcome with a novel strategy of photo-immunotherapy (PIT) strategy. By exploring the principles of PDT induction and ICD enhancement, combined with other therapies such as chemotherapy or immune checkpoint blockade, the tailored solutions can be designed to address specific challenges of drug resistance, hypoxic conditions, and tumor immunosuppressive microenvironments (TIMEs), which enables targeted enhancement of systemic immunity to address most distant and recurrent cancers. The present article summarizes the specific strategies of PIT and discusses recent existing limitations. More importantly, we anticipate that the perspectives presented herein will help address the clinical translation challenges associated with PIT.

Redox-manipulating nanocarriers for anticancer drug delivery: a systematic review

Spatiotemporally controlled cargo release is a key advantage of nanocarriers in anti-tumor therapy. Various external or internal stimuli-responsive nanomedicines have been reported for their ability to increase drug levels at the diseased site and enhance therapeutic efficacy through a triggered release mechanism. Redox-manipulating nanocarriers, by exploiting the redox imbalances in tumor tissues, can achieve precise drug release, enhancing therapeutic efficacy while minimizing damage to healthy cells. As a typical redox-sensitive bond, the disulfide bond is considered a promising tool for designing tumor-specific, stimulus-responsive drug delivery systems (DDS). The intracellular redox imbalance caused by tumor microenvironment (TME) regulation has emerged as an appealing therapeutic target for cancer treatment. Sustained glutathione (GSH) depletion in the TME by redox-manipulating nanocarriers can exacerbate oxidative stress through the exchange of disulfide-thiol bonds, thereby enhancing the efficacy of ROS-based cancer therapy. Intriguingly, GSH depletion is simultaneously associated with glutathione peroxidase 4 (GPX4) inhibition and dihydrolipoamide S-acetyltransferase (DLAT) oligomerization, triggering mechanisms such as ferroptosis and cuproptosis, which increase the sensitivity of tumor cells. Hence, in this review, we present a comprehensive summary of the advances in disulfide based redox-manipulating nanocarriers for anticancer drug delivery and provide an overview of some representative achievements for combinational therapy and theragnostic. The high concentration of GSH in the TME enables the engineering of redox-responsive nanocarriers for GSH-triggered on-demand drug delivery, which relies on the thiol-disulfide exchange reaction between GSH and disulfide-containing vehicles. Conversely, redox-manipulating nanocarriers can deplete GSH, thereby enhancing the efficacy of ROS-based treatment nanoplatforms. In brief, we summarize the up-to-date developments of the redox-manipulating nanocarriers for cancer therapy based on DDS and provide viewpoints for the establishment of more stringent anti-tumor nanoplatform.

A review on ferroptosis and photodynamic therapy synergism: Enhancing anticancer treatment

Ferroptosis is an iron-dependent programmed cell death modality, which has showed great potential in anticancer treatment. Photodynamic therapy (PDT) is widely used in clinic as an anticancer therapy. PDT combined with ferroptosis-promoting therapy has been found to be a promising strategy to improve anti-cancer therapy efficacy. Fenton reaction in ferroptosis can provide oxygen for PDT, and PDT can produce reactive oxygen species for Fenton reaction to enhance ferroptosis. In this review, we briefly present the importance of ferroptosis in anticancer treatment, mechanism of ferroptosis, researches on PDT induced ferroptosis, and the mechanism of the synergistic effect of PDT and ferroptosis on cancer killing.

An Activatable Prodrug Nanosystem for Ultrasound-Driven Multimodal Tumor Therapy and Metastasis Inhibition

Ultrasound, featuring deep tissue penetration and noninvasiveness, offers a new opportunity to activate functional materials in a tumor-selective manner. However, very few direct ultrasound-responsive redox systems are applicable under therapeutic ultrasound (1 MHz). Herein, the investigations on nanoprodrug of DHE@PEG-SS-DSPE are reported, which exhibit glutathione-activated release of dihydroethidium (DHE) in tumor cells. DHE is stable with good biosafety and is transformed into cytotoxic ethidium to induce DNA damage under medical ultrasound irradiation, accompanied by the generation of reactive oxygen species. Further, DHE@PEG-SS-DSPE could effectively induce ferroptosis through glutathione depletion, lipid peroxide accumulation, and downregulation of glutathione peroxidase 4. In vivo studies confirmed that DHE@PEG-SS-DSPE nanoparticles effectively inhibit both the growth of solid tumors and the expression of metastasis-related proteins in mice, thus effectively inhibiting lung metastasis. This DHE-based prodrug nanosystem could lay a foundation for the design of ultrasound-driven therapeutic agents.