Antitumor therapy for breast cancer: Focus on tumor-associated macrophages and nanosized drug delivery systems

Engineering exosome membrane disguised thermal responsive system for targeted drug delivery and controlled release across the blood-brain barrier

The blood-brain barrier (BBB) presents a significant challenge for the delivery of chemotherapy drugs to brain tumors, leading to ineffective drug concentrations at the tumor site and contributing to chemotherapy resistance. The hypoxic tumor microenvironment further complicates this process, ultimately resulting in poor patient prognosis. In this study, we developed a thermoresponsive nanocarrier system that incorporates (Ru)(Pt) bimetallic nanoparticles onto defective TiOx nanoparticles with abundant oxygen vacancies, generating composite Ru/Pt-TiOx nanoparticles with photothermal and photocatalytic properties. The Ru and Pt in the nanoparticles enhance the metal-carrier interactions, with Ru increasing both light absorption and photothermal conversion efficiency and Pt catalyzing the conversion of endogenous H2O2 in tumors to produce oxygen. The oxygen produced within the tumor microenvironment reduces HIF-1α, MDR1 and P-gp expression, thereby inhibiting efflux and allowing doxorubicin to accumulate inside the cells. DOX was incorporated into a phase change material and combined with multiple Ru/Pt-TiOx nanoparticles to form composite RPTiOx-DOX particles that can control the release of DOX under near-infrared irradiation. In an effort to overcome the blocking effect of the BBB, we wrapped the RPTiOx-DOX nanoparticles with Angiopep-2-functionalized macrophage exosome membranes. Furthermore, the changes in the internal environment promote macrophage phenotypic transformation (M2→M1) to some extent and further inhibit tumor growth via immunoregulation. In this work, a novel drug delivery system capable of traversing the BBB and exerting synergistic antitumor effects through photostimulated therapeutic agents is described, providing innovative insights for the development of stimulus-responsive composite nanoparticle drug formulations.

Carrier-Free Nanocombo-Sensitized Photoimmunotherapy via Activation of α2-Adrenergic Receptors

Photodynamic therapy (PDT)-based photoimmunotherapy has attracted increasing attention in the field of cancer immunotherapy. Nonetheless, monotherapy alone proves insufficient in eliciting robust and enduring tumor immunogenicity within the "cold" microenvironment of triple-negative breast cancer. Therefore, it is imperative to integrate phototherapy and immunostimulation strategies to achieve synergistic effects. Here, we developed a carrier-free nanocombo comprising a photosensitizer (chlorin e6, Ce6) and an α2-adrenergic receptor (α2-AR) agonist (guanfacine, GFC) to enhance photoimmunotherapy through α2-AR activation. Ce6 and GFC possessed the ability to self-assemble into spherical nanoparticles, with the resulting Ce6-GFC (CeG) exhibiting exceptional drug loading efficiency (approaching 100%) and long-lasting colloidal stability, along with effective in vivo tumor-targeting capabilities. Following near-infrared laser irradiation, CeG-mediated phototherapy instigated a rapid generation of reactive oxygen species, leading to membrane disruption and the release of tumor-associated antigens, thereby facilitating dendritic cell maturation. Furthermore, α2-AR agonists served to repolarize M2 tumor-associated macrophages toward the M1 phenotype via adenylyl cyclase-mediated activation of α2-AR, thereby promoting the recruitment and activation of cytotoxic T lymphocytes. As a result, the carrier-free nanocombo significantly enhanced the efficacy of photoimmunotherapy in combatting poorly immunogenic breast tumors in female mice. Our findings showcase a "killing two birds with one stone" approach that boosts tumor immunogenicity, mitigates tumor immunosuppression, and advances the field of photoimmunotherapy.

Targeting c-Met in breast cancer: From mechanisms of chemoresistance to novel therapeutic strategies

Breast cancer presents a significant challenge due to its heterogeneity and propensity for developing chemoresistance, particularly in the triple-negative subtype. c-Mesenchymal epithelial transition factor (c-Met), a receptor tyrosine kinase, presents a promising target for breast cancer therapy due to its involvement in disease progression and poor prognosis. However, the heterogeneous expression of c-Met within breast cancer subtypes and individual tumors complicates targeted therapy. Also, cancer cells can develop resistance to c-Met inhibitors through various mechanisms, including bypass signaling pathways and genetic mutations. The off-target effects of c-Met inhibitors further limit their clinical utility, necessitating the development of more selective agents. To overcome these challenges, personalized treatment approaches and combination therapies are being explored to improve treatment efficacy while minimizing adverse effects. Novel c-Met inhibitors with improved selectivity and reduced off-target toxicity show promise in preclinical studies. Additionally, targeted delivery systems aim to enhance drug localization and reduce systemic toxicity. Future directions involve refining inhibitor design and integrating c-Met inhibition into personalized treatment regimens guided by molecular profiling. This review explores the mechanisms by which c-Met contributes to chemoresistance in breast cancer and current challenges in targeting c-Met for breast cancer therapy. It discusses strategies to optimize treatment outcomes, ultimately improving patient prognosis and reducing mortality rates associated with this devastating disease.

Unleashing nanotechnology to redefine tumor-associated macrophage dynamics and non-coding RNA crosstalk in breast cancer

Breast cancer is a significant global health issue. Tumor-associated macrophages (TAMs) are crucial in influencing the tumor microenvironment and the progression of the disease. TAMs exhibit remarkable plasticity in adopting distinct phenotypes ranging from pro-inflammatory and anti-tumorigenic (M1-like) to immunosuppressive and tumor-promoting (M2-like). This review elucidates the multifaceted roles of TAMs in driving breast tumor growth, angiogenesis, invasion, and metastatic dissemination. Significantly, it highlights the intricate crosstalk between TAMs and non-coding RNAs (ncRNAs), including microRNAs, long noncoding RNAs, and circular RNAs, as a crucial regulatory mechanism modulating TAM polarization and functional dynamics that present potential therapeutic targets. Nanotechnology-based strategies are explored as a promising approach to reprogramming TAMs toward an anti-tumor phenotype. Various nanoparticle delivery systems have shown potential for modulating TAM polarization and inhibiting tumor-promoting effects. Notably, nanoparticles can deliver ncRNA therapeutics to TAMs, offering unique opportunities to modulate their polarization and activity.

Targeting tumor-associated macrophages with nanocarrier-based treatment for breast cancer: A step toward developing innovative anti-cancer therapeutics

Tumor-associated macrophages (TAMs) promote tumor advancement in many ways, such as inducing angiogenesis and the formation of new blood vessels that provide tumors with nourishment and oxygen. TAMs also facilitate tumor invasion and metastasis by secreting enzymes that degrade the extracellular matrix and generating pro-inflammatory cytokines that enhance the migration of tumor cells. TAMs also have a role in inhibiting the immune response against malignancies. To accomplish this, they release immunosuppressive cytokines such as IL-10, and TAMs can hinder the function of T cells and natural killer cells, which play crucial roles in the immune system's ability to combat cancer. The role of TAMs in breast cancer advancement is a complex and dynamic field of research. Therefore, TAMs are a highly favorable focus for innovative breast cancer treatments. This review presents an extensive overview of the correlation between TAMs and breast cancer development as well as its role in the tumor microenvironment (TME) shedding light on their impact on tumor advancement and immune evasion mechanisms. Notably, our study provides an innovative approach to employing nanomedicine approaches for targeted TAM therapy in breast cancer, providing an in-depth overview of recent advances in this emerging field.

Examining the influence of tumor-infiltrating macrophages on breast cancer outcomes and identifying relevant genes for diagnostic purposes

OBJECTIVE

The purpose of this research was to investigate how different types of immune cells impact the outlook of individuals with breast cancer, as well as identify the essential genes associated with immune cell subtype enrichment.

METHODS

The Cancer Genome Atlas (TCGA) database and Gene Expression Omnibus (GEO) database were used to obtain global transcriptome sequencing data sets of breast tissue. The study utilized the CIBERSORT algorithm to determine the presence of 22 different types of immune cells in both breast cancer tissue and normal breast tissue.Immune cell infiltration content was utilized to conduct univariate COX analysis in order to identify risk factors linked to breast cancer prognosis.

RESULTS

Univariate COX analysis indicates that Macrophages M1 and B cells naive are beneficial factors for the outlook of individuals with breast cancer (P < 0.05), while Macrophages M2 and Monocytes are detrimental factors for the prognosis of breast cancer patients (P < 0.05). The high infiltration group of macrophage M2 had a poorer prognosis compared to the low infiltration group (P < 0.001); Conversely, the high infiltration group of macrophage M1 had a better prognosis than the low infiltration group (P = 0.002).

CONCLUSION

The study provided an overview of immune cell infiltration in breast cancer tissues, identifying macrophage M1 and macrophage M2 as potential factors in breast cancer development and progression. Additionally, genes associated with macrophage phenotype were analyzed, offering insights into macrophage polarization mechanisms.

Ultrasound -Induced Thermal Effect Enhances the Efficacy of Chemotherapy and Immunotherapy in Tumor Treatment

Background

The inadequate perfusion, frequently resulting from abnormal vascular configuration, gives rise to tumor hypoxia. The presence of this condition hinders the effective delivery of therapeutic drugs and the infiltration of immune cells into the tumor, thereby compromising the efficacy of treatments against tumors. The objective of this study is to exploit the thermal effect of ultrasound (US) in order to induce localized temperature elevation within the tumor, thereby facilitating vasodilation, augmenting drug delivery, and enhancing immune cell infiltration.

Methods

The selection of US parameters was based on intratumor temperature elevation and their impact on cell viability. Vasodilation and hypoxia improvement were investigated using enzyme-linked immunosorbent assay (ELISA) and immunofluorescence examination. The distribution and accumulation of commercial pegylated liposomal doxorubicin (PLD) and PD-L1 antibody (anti-PD-L1) in the tumor were analyzed through frozen section analysis, ELISA, and in vivo fluorescence imaging. The evaluation of tumor immune microenvironment was conducted using flow cytometry (FCM). The efficacy of US-enhanced chemotherapy in combination with immunotherapy was investigated by monitoring tumor growth and survival rate after various treatments.

Results

The US irradiation condition of 0.8 W/cm2 for 10 min effectively elevated the tumor temperature to approximately 40 °C without causing any cellular or tissue damage, and sufficiently induced vasodilation, thereby enhancing the distribution and delivery of PLD and anti-PD-L1 in US-treated tumors. Moreover, it effectively mitigated tumor hypoxia while significantly increasing M1-phenotype tumor-associated macrophages (TAMs) and CD8+ T cells, as well as decreasing M2-phenotype TAMs. By incorporating US irradiation, the therapeutic efficacy of PLD and anti-PD-L1 was substantially boosted, leading to effective suppression of tumor growth and prolonged survival in mice.

Conclusion

The application of US (0.8 W/cm2 for 10 min) can effectively induce vasodilation and enhance the delivery of PLD and anti-PD-L1 into tumors, thereby reshaping the immunosuppressive tumor microenvironment and optimizing therapeutic outcomes.

Nanoparticles in tumor microenvironment remodeling and cancer immunotherapy

Cancer immunotherapy and vaccine development have significantly improved the fight against cancers. Despite these advancements, challenges remain, particularly in the clinical delivery of immunomodulatory compounds. The tumor microenvironment (TME), comprising macrophages, fibroblasts, and immune cells, plays a crucial role in immune response modulation. Nanoparticles, engineered to reshape the TME, have shown promising results in enhancing immunotherapy by facilitating targeted delivery and immune modulation. These nanoparticles can suppress fibroblast activation, promote M1 macrophage polarization, aid dendritic cell maturation, and encourage T cell infiltration. Biomimetic nanoparticles further enhance immunotherapy by increasing the internalization of immunomodulatory agents in immune cells such as dendritic cells. Moreover, exosomes, whether naturally secreted by cells in the body or bioengineered, have been explored to regulate the TME and immune-related cells to affect cancer immunotherapy. Stimuli-responsive nanocarriers, activated by pH, redox, and light conditions, exhibit the potential to accelerate immunotherapy. The co-application of nanoparticles with immune checkpoint inhibitors is an emerging strategy to boost anti-tumor immunity. With their ability to induce long-term immunity, nanoarchitectures are promising structures in vaccine development. This review underscores the critical role of nanoparticles in overcoming current challenges and driving the advancement of cancer immunotherapy and TME modification.

Repolarizing Tumor-Associated Macrophages and inducing immunogenic cell Death: A targeted liposomal strategy to boost cancer immunotherapy

Cancer immunotherapy has shown promise in treating various malignancies. However, the presence of an immunosuppressive tumor microenvironment (TME) triggered by M2 tumor-associated macrophages (TAMs) and the limited tumor cell antigenicity have hindered its broader application. To address these challenges, we developed DOX/R837@ManL, a liposome loaded with imiquimod (R837) and doxorubicin (DOX), modified with mannose-polyethylene glycol (Man-PEG). DOX/R837@ManL employed a mannose receptor (MRC1)-mediated targeting strategy, allowing it to accumulate selectively at M2 Tumor associated macrophages (TAMs) and tumor sites. R837, an immune adjuvant, promoted the conversion of immunosuppressive M2 TAMs into immunostimulatory M1 TAMs, and reshaped the immunosuppressive TME. Simultaneously, DOX release induced immunogenic cell death (ICD) in tumor cells and enhanced tumor cell antigenicity by promoting dendritic cells (DCs) maturation. Through targeted delivery, the synergistic action of R837 and DOX activated innate immunity and coordinated adaptive immunity, enhancing immunotherapy efficacy. In vivo experiments have demonstrated that DOX/R837@ManL effectively eliminated primary tumors and lung metastases, while also preventing tumor recurrence post-surgery. These findings highlighted the potential of DOX/R837@ManL as a promising strategy for cancer immunotherapy.

Targeting and repolarizing M2-like tumor-associated macrophage-mediated MR imaging and tumor immunotherapy by biomimetic nanoparticles

Anti-tumor M1-like and pro-tumor M2-like tumor-associated macrophages (TAMs) coexist in tumor microenvironments (TME). The adverse effects of these M1/M2 subsets on tumors directly affect the current strategies to improve anti-tumor immune response. Therefore, it has attracted great attention to change the tumor immunosuppressive microenvironment by reprogramming TAMs. In this paper, we constructed biomimetic nanoparticles (HMMDN-Met@PM) targeting M2-like TAMs for macrophage re-polarization. In detail, the core of the biomimetic nanoparticles is metformin-loaded hollow mesoporous manganese dioxide nanoparticles (HMMDN-Met). Benefited from the hollow and porous structure of HMMDN, metformin, the regulator of M1/M2 adopted in this work, can be easily and widely loaded into HMMDN. Moreover, macrophage membranes were utilized for HMMDN-Met coating (HMMDN-Met@MM) to prevent the premature drug leakage and provide specific molecular recognition/TME targeting. In addition, M2 macrophage targeting peptide (M2pep) was modified on the surface of macrophage membrane to specifically deliver the drug to M2-like TAMs to promote the polarization of M2 to M1 macrophages. Through in vitro and in vivo studies, we found that the expression of surface markers and inflammatory factors CD206, Arg-1 and IL-10 of type M2 macrophages decreased, while the surface markers of type M1 macrophages and the expression of inflammatory factors CD80, TNF-α and iNOS increased, indicating the successful re-polarization of M2 macrophages and finally realizing the inhibition of tumor growth. At the same time, under the acidic and GSH conditions of tumor, HMMDN was decomposed into Mn2+, which is a contrast agent for magnetic resonance imaging, thus realizing the tracking of tumor. This work practices biomimetic nanosystem in targeted imaging and immunotherapy, paving the way for strategy designing for tumor inhibition.

Unveiling the Immune Microenvironment's Role in Breast Cancer: A Glimpse into Promising Frontiers

Breast cancer (BC), one of the most widespread and devastating diseases affecting women worldwide, presents a significant public health challenge. This review explores the emerging frontiers of research focused on deciphering the intricate interplay between BC cells and the immune microenvironment. Understanding the role of the immune system in BC is critical as it holds promise for novel therapeutic approaches and precision medicine strategies. This review delves into the current literature regarding the immune microenvironment's contribution to BC initiation, progression, and metastasis. It examines the complex mechanisms by which BC cells interact with various immune cell populations, including tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs). Furthermore, this review highlights the impact of immune-related factors, such as cytokines and immune checkpoint molecules. Additionally, this comprehensive analysis sheds light on the potential biomarkers associated with the immune response in BC, enabling early diagnosis and prognostic assessment. The therapeutic implications of targeting the immune microenvironment are also explored, encompassing immunotherapeutic strategies and combination therapies to enhance treatment efficacy. The significance of this review lies in its potential to pave the way for novel therapeutic interventions, providing clinicians and researchers with essential knowledge to design targeted and personalized treatment regimens for BC patients.