Newly developed gas-assisted sonodynamic therapy in cancer treatment

Ultrasound-Activated Theranostic Materials and Their Bioapplications

Ultrasound (US) is a promising external excitation modality for bioapplications, offering significant advantages over X-rays or lasers due to its low cost, high biosafety, and ideal tissue penetration depth. US-activated theranostic materials, comprising organic, inorganic, and hybrid-based compounds, hold particular value in synergistic cancer therapeutic and diagnostic applications. These materials exhibit excellent imaging properties, high drug delivery and release efficiency, and enhanced reactive oxygen species (ROS) production, making them suitable for clinical diagnostic imaging and therapeutic interventions. This review summarizes recent research on the design, performance, and optimization of US-mediated molecules/nanosystems for a wide range of biomedical applications. Additionally, the multifunctional use of these sonosensitizers in imaging, drug delivery, and sonodynamic therapy, especially in combination with other treatments, could pave the way for innovative strategies in disease therapy. Finally, an overview of this field's challenges and potential future directions is provided, highlighting pathways to promote clinical translation and application.

Tumor microenvironment-responsive diagnosis and treatment of integrated drug-loaded CdTe quantum dots for treatment tumors

The acidic tumor microenvironment is a common feature of tumors, and boric acid-functionalized quantum dots (BA-QDs) exhibit pH-sensitive boron affinity effects and fluorescence emission characteristics. In this study, CdTe QDs were prepared using the water phase synthesis method. Additionally, BA-QDs were prepared by modifying QDs with 4-mercaptophenylboric acid. Hesperetin, baicalein, quercetin, and other model drugs were used, with QDs and BA-QDs serving as carriers, to create a drug-loaded system of QDs with tumor microenvironment-responsive drug release performance. The physical and chemical properties were characterized using dynamic light scattering (DLS), Fourier transform infrared spectroscopy, transmission electron microscopy, x-ray diffraction, etc. Our findings showed that the synthesis of drug-loaded QDs with a uniform particle size was successful. The experiments involved studying the adsorption kinetics of the QDs and the degree of dissolution of the drug-loaded QDsin vitro. BA-QDs exhibited pH-responsive drug release and fluorescence emission properties.In vitrocell experiments were conducted to examine the uptake and imaging effects of QDs and BA-QDs at the cell level. The results showed that both QDs and BA-QDs exhibited effective imaging at the cell level. Moreover, the three drug-loaded BA-QDs inhibited HepG2 cancer cells by about 80%, indicating a significant inhibitory effect on cancer cells. Here, we developed a universal new technology for tumor diagnosis and treatment, provided innovative approaches for targeted cancer diagnosis and treatment, and broadened the application scope of nanofluorescence technology.

An oxygen-independent therapeutic nanosystem for fighting against hypoxic and antioxidant microenvironment of tumor

The innate hypoxic and antioxidant defendant microenvironment are the main obstacles for improving reactive oxygen species (ROS) based therapeutic efficacy against cancer. Herein, bismuth tungstate (BWO) nanoparticles (NPs) were fabricated for ultrasound activated hydroxyl radical (OH•) production through being reacted with water in an oxygen-independent manner due to their more positive potential of valent band position than that of OH• generation. For relieving antioxidant defense, BWOST NPs were designed through loading L-buthionine sulfoximine into hollow BWO NPs to inhibit the synthesis of glutathione (GSH), and coating pH-responsive tannic acid-Fe complex on the surface to prevent drug leakage. Both in vitro and in vivo assessments demonstrated that BWOST NPs could effectively lower intracellular GSH levels, inducing apoptosis of cancer cells and eliminating tumors. Therefore, BWOST NPs showed an amplified sonodynamic therapy efficacy through lower antioxidant defense and oxygen-independent OH• generation, which provided an effective strategy for improving ROS based cancer therapy.

Stimuli-responsive peptide-based nanodrug delivery systems for tumor therapy

Compared to free chemotherapeutic drugs, nano-sized drug delivery systems exhibit enhanced therapeutic effects and reduced in vivo toxicity. Peptide-based drug delivery systems have garnered significant attention due to the advantageous properties of peptides, including their excellent biocompatibility, diverse side-chain functionalities, and ability to form stable secondary structures. Incorporating stimuli-responsive amino acid residues or specific responsive moieties within their side chains endows these peptide-based drug delivery systems with unique stimuli-responsive characteristics. In this review, we summarize recent advancements and mechanisms in peptide-based nanodrug delivery systems that are capable of responding to one or multiple stimuli as well as conclude with a concise overview of the challenges that lie ahead in this field.

Modifications of biological membranes, fat globules and liposomes promoted by cavitation processes. Consequences and applications

Cavitation-based technologies, such as ultrasound (or acoustic cavitation, AC) and hydrodynamic cavitation (HC), are gaining interest among green processing technologies due to their cost effectiveness in operation, toxic solvent use reduction, and ability to obtain superior processed products, compared to conventional methods. Both AC and HC generate bubbles, but their effects may differ and it is difficult to make comparisons as both are based on different phenomena and are subject to different operational variables. AC is one of the most used techniques in extraction and homogenization processes at the laboratory level. However, upscaling to an industrial level is hard. On the other hand, HC is based on the passage of the liquid through a constriction (orifice plate, Venturi, throttling valve), which causes an increase in liquid velocity at the expense of local pressure, forcing the pressure around the contraction below the threshold pressure that induces the formation of cavities. Some applications of cavitation technologies, such as the production of liposomes or lipid nanoparticles (LNPs) allow the generation of delivery systems for biomedical applications.Many others (inactivation of pathogenic viruses, bacteria and algae for water purification, extraction procedures, third generation of biofuel production, green extractions) are based on the disruption of lipid membranes. There are also applications aimed at the modification of membranes (like the milk fat globule) for the development of innovative products. Process parameters, such as cavitation intensity, duration and temperature define the impact of the process on the physical, chemical, and biological characteristics of the membranes. Thus, the adequate implementation of cavitation processes requires understanding of interactions and synergistic mechanisms in complex systems and of their effects on membranes at the microscopic or molecular level. In the present work, the use of cavitation technologies for the generation of LNPs or nanostructured lipid carriers, and the effects of AC and HC treatments on several types of membrane systems (liposomes, solid lipid nanoparticles, milk fat globules, algae and bacterial membranes) are discussed, focusing on the structural and chemical modifications of lipidic structures under cavitation.

Ultrasound-Targeted Microbubble Destruction Enhances the Inhibitory Effect of Sonodynamic Therapy against Hepatocellular Carcinoma

Purpose: To assess the anticancer effect of microbubbles (MBs) in combination with sinoporphyrin sodium (DVDMS)-mediated sonodynamic therapy (SDT) for the in vitro and in vivo treatment of hepatocellular carcinoma (HCC). Methods: HepG2 cells were used for in vitro experiments. Reactive oxygen species (ROS) production was detected using 2',7'-dichlorodihydrofluorescein diacetate and singlet oxygen sensor green in vitro and in solution, respectively. Cytotoxicity was evaluated using a Cell Counting Kit 8 assay and the calcein AM/PI double-staining method. Annexin V-FITC/PI staining was employed to analyze the rate of cell apoptosis. Cell surface calreticulin exposure, high mobility group box 1 release, and adenosine triphosphate secretion were measured to detect immunogenic cell death (ICD). The anticancer effect of the combination therapy was further assessed in Hepa1-6 tumor-bearing mice. Results: Compared with SDT alone, ROS production in the MBs + SDT group was enhanced 1.2-fold (p < 0.0001). The cytotoxic effect of DVDMS-mediated SDT on HepG2 cells was concentration-dependent, and the additional application of MBs increased cytotoxicity. Additionally, MBs augmented the SDT-induced apoptosis rate from 33.26 ± 13.48 to 72.95 ± 7.95% (p < 0.01). Notably, our results demonstrated that MBs can enhance SDT-induced ICD. In in vivo experiments, SDT combined with MBs significantly reduced tumor volume, with negligible differences in mouse body weight. Furthermore, MBs effectively enhanced SDT-induced tumor tissue destruction. Conclusion: The present study indicates that MBs can markedly improve the anticancer effects of SDT in HCC.

Recent Advances and Future Directions in Sonodynamic Therapy for Cancer Treatment

Deep-tissue solid cancer treatment has a poor prognosis, resulting in a very low 5-year patient survival rate. The primary challenges facing solid tumor therapies are accessibility, incomplete surgical removal of tumor tissue, the resistance of the hypoxic and heterogeneous tumor microenvironment to chemotherapy and radiation, and suffering caused by off-target toxicities. Here, sonodynamic therapy (SDT) is an evolving therapeutic approach that uses low-intensity ultrasound to target deep-tissue solid tumors. The ability of ultrasound to deliver energy safely and precisely into small deep-tissue (>10 cm) volumes makes SDT more effective than conventional photodynamic therapy. While SDT is currently in phase 1/2 clinical trials for glioblastoma multiforme, its use for other solid cancer treatments, such as breast, pancreatic, liver, and prostate cancer, is still in the preclinical stage, with further investigation required to improve its therapeutic efficacy. This review, therefore, focuses on recent advances in SDT cancer treatments. We describe the interaction between ultrasound and sonosensitizer molecules and the associated energy transfer mechanism to malignant cells, which plays a central role in SDT-mediated cell death. Different sensitizers used in clinical and preclinical trials of various cancer treatments are listed, and the critical ultrasound parameters for SDT are reviewed. We also discuss approaches to improve the efficacies of these sonosensitizers, the role of the 3-dimensional spheroid in vitro investigations, ultrasound-controlled CAR-T cell and SDT-based multimodal therapy, and machine learning for sonosensitizer optimization, which could facilitate clinical translation of SDT.

Deciphering the hydrodynamics of lipid-coated microbubble sonoluminescence for sonodynamic therapy

Sonodynamic therapy (SDT) is a minimally invasive targeted cancer therapy that uses focused low-intensity ultrasound (<10 MPa, <10 W/cm2) to activate sonosensitizer drugs. Once activated, these chemical compounds generate reactive oxygen species (ROS) to damage and kill cancer cells. A Phase I clinical trial has shown promising results for treating glioblastoma with SDT. We hypothesize that the efficacy of SDT can be improved by introducing lipid-coated microbubbles that produce a sonochemical effect that enhances ROS production. We investigate the hydrodynamics of a U.S. Food and Drug Administration (FDA)-approved microbubble, Lumason®, and a phospholipid-coated oxygen microbubble to predict the ultrasound parameters that induce sonoluminescence onset in biophysically relevant medium (e.g., water and blood) under clinical SDT conditions. The threshold pressures and frequencies for sonoluminescence with these therapeutic agents lie between 20 kHz - 1 MHz and 0.05 MPa - 1 MPa, respectively. The lipid-coated oxygen microbubble exhibits stronger sonoluminescence than the Lumason® microbubble, suggesting its use for improving SDT efficacy.

Recent advances in reactive oxygen species (ROS)-responsive drug delivery systems for photodynamic therapy of cancer

Reactive oxygen species (ROS)-responsive drug delivery systems (DDSs) have garnered significant attention in cancer research because of their potential for precise spatiotemporal drug release tailored to high ROS levels within tumors. Despite the challenges posed by ROS distribution heterogeneity and endogenous supply constraints, this review highlights the strategic alliance of ROS-responsive DDSs with photodynamic therapy (PDT), enabling selective drug delivery and leveraging PDT-induced ROS for enhanced therapeutic efficacy. This review delves into the biological importance of ROS in cancer progression and treatment. We elucidate in detail the operational mechanisms of ROS-responsive linkers, including thioether, thioketal, selenide, diselencide, telluride and aryl boronic acids/esters, as well as the latest developments in ROS-responsive nanomedicines that integrate with PDT strategies. These insights are intended to inspire the design of innovative ROS-responsive nanocarriers for enhanced cancer PDT.

Biodegradable persistent ROS-generating nanosonosensitizers for enhanced synergistic cancer therapy by inducing cascaded oxidative stress

Sonodynamic therapy (SDT) is gaining popularity in cancer treatment due to its superior controllability and high tissue permeability. Nonetheless, the efficacy of SDT is severely diminished by the transient generation of limited reactive oxygen species (ROS). Herein, we introduce an acid-activated nanosonosensitizer, CaO2@PCN, by the controllable coating of porphyrinic metal-organic frameworks (PCN-224) on CaO2 to induce cascaded oxidative stress in tumors. The PCN-224 doping can generate ROS during SDT to induce intracellular oxidative stress and abnormal calcium channels. Meanwhile, the ultrasound also promotes extracellular calcium influx. In addition, CaO2@PCN sequentially degrades in the tumor cell lysosomes, releasing Ca2+ and H2O2 to induce further abnormal calcium channels and elevate the levels of Ca2+. Insufficient catalase (CAT) in tumor cells promotes intracellular calcium overload, which can induce persistent ROS generation and mitochondrial dysfunction through ion interference therapy (IIT). More importantly, PCN-224 also protects CaO2 against significant degradation under neutral conditions. Hence, the well-designed CaO2@PCN produces synergistic SDT/IIT effects and persistent ROS against cancer. More notably, the acidity-responsive biodegradability endows CaO2@PCN with excellent biosafety and promising clinical potential.

Recent Advances in Silica-Based Nanomaterials for Enhanced Tumor Imaging and Therapy

Cancer remains a formidable challenge, inflicting profound physical, psychological, and financial burdens on patients. In this context, silica-based nanomaterials have garnered significant attention for their potential in tumor imaging and therapy owing to their exceptional properties, such as biocompatibility, customizable porosity, and versatile functionalization capabilities. This review meticulously examines the latest advancements in the application of silica-based nanomaterials for tumor imaging and therapy. It underscores their potential in enhancing various cancer imaging modalities, including fluorescence imaging, magnetic resonance imaging, computed tomography, positron emission tomography, ultrasound imaging, and multimodal imaging approaches. Moreover, the review delves into their therapeutic efficacy in chemotherapy, radiotherapy, phototherapy, immunotherapy, gas therapy, sonodynamic therapy, chemodynamic therapy, starvation therapy, and gene therapy. Critical evaluations of the biosafety profiles and degradation pathways of these nanomaterials within biological environments are also presented. By discussing the current challenges and prospects, this review aims to provide a nuanced perspective on the clinical translation of silica-based nanomaterials, thereby highlighting their promise in revolutionizing cancer diagnostics, enabling real-time monitoring of therapeutic responses, and advancing personalized medicine.

Engineering Sonosensitizer-Derived Nanotheranostics for Augmented Sonodynamic Therapy

Sonodynamic therapy (SDT), featuring noninvasive, deeper penetration, low cost, and repeatability, is a promising therapy approach for deep-seated tumors. However, the general or only utilization of SDT shows low efficiency and unsatisfactory treatment outcomes due to the complicated tumor microenvironment (TME) and SDT process. To circumvent the issues, three feasible approaches for enhancing SDT-based therapeutic effects, including sonosensitizer optimization, strategies for conquering hypoxia TME, and combinational therapy are summarized, with a particular focus on the combination therapy of SDT with other therapy modalities, including chemodynamic therapy, photodynamic therapy, photothermal therapy, chemotherapy, starvation therapy, gas therapy, and immunotherapy. In the end, the current challenges in SDT-based therapy on tumors are discussed and feasible approaches for enhanced therapeutic effects are provided. It is envisioned that this review will provide new insight into the strategic design of high-efficiency sonosensitizer-derived nanotheranostics, thereby augmenting SDT and accelerating the potential clinical transformation.

Recent breakthroughs in graphene quantum dot-enhanced sonodynamic and photodynamic therapy

Water-soluble graphene quantum dots (GQDs) have recently exhibited considerable potential for diverse biomedical applications owing to their exceptional optical and chemical properties. However, the pronounced heterogeneity in the composition, size, and morphology of GQDs poses challenges for a comprehensive understanding of the intricate correlation between their structural attributes and functional properties. This variability also introduces complexities in scaling the production processes and addressing safety considerations. Light and sound have firmly established their role in clinical applications as pivotal energy sources for minimally invasive therapeutic interventions. Given the limited penetration depth of light, photodynamic therapy (PDT) predominantly targets superficial conditions such as dermatological disorders, head and neck malignancies, ocular ailments, and early-stage esophageal cancer. Conversely, ultrasound-based sonodynamic therapy (SDT) capitalizes on its superior ability to propagate and focus ultrasound within biological tissues, enabling a diverse range of therapeutic applications, including the management of gliomas, breast cancer, hematological tumors, and modulation of the blood-brain barrier (BBB). Considering the advancements in theranostic and precision therapies, reevaluating these conventional energy sources and their associated sensitizers is imperative. This review introduces three prevalent treatment modalities that harness light and sound stimuli: PDT, SDT, and a synergistic approach that integrates PDT and SDT. This study delineated the therapeutic dynamics and contemporary designs of sensitizers tailored to these modalities. By exploring the historical context of the field and elucidating the latest design strategies, this review underscores the pivotal role of GQDs in propelling the evolution of PDT and SDT. This aspires to stimulate researchers to develop "multimodal" therapies integrating both light and sound stimuli.

Manipulation of protein corona for nanomedicines

Nanomedicines have significantly advanced the development of diagnostic and therapeutic strategies for various diseases, while they still encounter numerous challenges. Upon entry into the human body, nanomedicines interact with biomolecules to form a layer of proteins, which is defined as the protein corona that influences the biological properties of nanomedicines. Traditional approaches have primarily focused on designing stealthy nanomedicines to evade biomolecule adsorption; however, due to the intricacies of the biological environment within body, this method cannot completely prevent biomolecule adsorption. As research on the protein corona progresses, manipulating the protein corona to modulate the in vivo behaviors of nanomedicines has become a research focus. In this review, modern strategies focused on influencing the biological efficacy of nanomedicines in vivo by manipulating protein corona, along with their wide-ranging applications across diverse diseases are critically summarized, highlighted and discussed. Finally, future directions for this important yet challenging research area are also briefly discussed. This article is categorized under: Nanotechnology Approaches to Biology > Nanoscale Systems in Biology Therapeutic Approaches and Drug Discovery > Emerging Technologies Biology-Inspired Nanomaterials > Protein and Virus-Based Structures.

Integrin αvβ3-targeted self-assembled polypeptide nanomicelles for efficacious sonodynamic therapy against breast cancer

Sonodynamic therapy (SDT) is an advanced non-invasive cancer treatment strategy with moderate tissue penetration, less invasiveness and a reliable curative effect. However, due to the low stability, potential bio-toxicity and lack of tumor targeting capability of most sonosensitizers, the vast clinical application of SDT has been challenging and limited. Therefore, it is desirable to develop a novel approach to implement sonosensitizers to SDT for cancer treatments. In this study, an amphiphilic polypeptide was designed to effectively encapsulate rose bengal (RB) as a model sonosensitizer to form peptido-nanomicelles (REPNs). The as-fabricated REPNs demonstrated satisfactory tumor targeting and fluorescence performances, which made them superb imaging tracers in vivo. In the meantime, they generated considerable amounts of reactive oxygen species (ROS) to promote tumor cell apoptosis under ultrasound irradiation and showed excellent anti-tumor performance without obvious side effects. These engineered nanomicelles in combination with medical ultrasound may be used to achieve integrin αvβ3-targeted sonodynamic therapy against breast cancer, and it is also a promising non-invasive cancer treatment strategy for clinical translations.

Advances in Nanodynamic Therapy for Cancer Treatment

Nanodynamic therapy (NDT) exerts its anti-tumor effect by activating nanosensitizers to generate large amounts of reactive oxygen species (ROS) in tumor cells. NDT enhances tumor-specific targeting and selectivity by leveraging the tumor microenvironment (TME) and mechanisms that boost anti-tumor immune responses. It also minimizes damage to surrounding healthy tissues and enhances cytotoxicity in tumor cells, showing promise in cancer treatment, with significant potential. This review covers the research progress in five major nanodynamic therapies: photodynamic therapy (PDT), electrodynamic therapy (EDT), sonodynamic therapy (SDT), radiodynamic therapy (RDT), and chemodynamic therapy (CDT), emphasizing the significant role of advanced nanotechnology in the development of NDT for anti-tumor purposes. The mechanisms, effects, and challenges faced by these NDTs are discussed, along with their respective solutions for enhancing anti-tumor efficacy, such as pH response, oxygen delivery, and combined immunotherapy. Finally, this review briefly addresses challenges in the clinical translation of NDT.

Nanomedicine/materdicine-enabled sonocatalytic therapy

The advent of numerous treatment modalities with desirable therapeutic efficacy has been made possible by the fast development of nanomedicine and materdicine, among which the ultrasound (US)-triggered sonocatalytic process as minimal or non-invasive method has been frequently employed for diagnostic and therapeutic purposes. In comparison to phototherapeutic approaches with inherent penetration depth limitations, sonocatalytic therapy shatters the depth limit of photoactivation and offers numerous remarkable prospects and advantages, including mitigated side effects and appropriate tissue-penetration depth. Nevertheless, the optimization of sonosensitizers and therapies remains a significant issue in terms of precision, intelligence and efficiency. In light of the fact that nanomedicine and materdicine can effectively enhance the theranostic efficiency, we herein aim to furnish a cutting-edge review on the latest progress and development of nanomedicine/materdicine-enabled sonocatalytic therapy. The design methodologies and biological features of nanomedicine/materdicine-based sonosensitizers are initially introduced to reveal the underlying relationship between composition/structure, sonocatalytic function and biological effect, in accompany with a thorough discussion of nanomedicine/materdicine-enabled synergistic therapy. Ultimately, the facing challenges and future perspectives of this intriguing sonocatalytic therapy are highlighted and outlined to promote technological advancements and clinical translation in efficient disease treatment.

Nanomaterials augmented bioeffects of ultrasound in cancer immunotherapy

Immunotherapy as a milestone in cancer treatment has made great strides in the past decade, but it is still limited by low immune response rates and immune-related adverse events. Utilizing bioeffects of ultrasound to enhance tumor immunotherapy has attracted more and more attention, including sonothermal, sonomechanical, sonodynamic and sonopiezoelectric immunotherapy. Moreover, the emergence of nanomaterials has further improved the efficacy of ultrasound mediated immunotherapy. However, most of the summaries in this field are about a single aspect of the biological effects of ultrasound, which is not comprehensive and complete currently. This review proposes the recent progress of nanomaterials augmented bioeffects of ultrasound in cancer immunotherapy. The concept of immunotherapy and the application of bioeffects of ultrasound in cancer immunotherapy are initially introduced. Then, according to different bioeffects of ultrasound, the representative paradigms of nanomaterial augmented sono-immunotherapy are described, and their mechanisms are discussed. Finally, the challenges and application prospects of nanomaterial augmented ultrasound mediated cancer immunotherapy are discussed in depth, hoping to pave the way for cancer immunotherapy and promote the clinical translation of ultrasound mediated cancer immunotherapy through the reasonable combination of nanomaterials augmented ultrasonic bioeffects.

Lipid bilayer-based biological nanoplatforms for sonodynamic cancer therapy

Sonodynamic therapy (SDT) has been developed as a promising alternative therapeutic modality for cancer treatment, involving the synergetic application of sonosensitizers and low-intensity ultrasound. However, the antitumor efficacy of SDT is significantly limited due to the poor performance of conventional sonosensitizers in vivo and the constrained tumor microenvironment (TME). Recent breakthroughs in lipid bilayer-based nanovesicles (LBBNs), including multifunctional liposomes, exosomes, and isolated cellular membranes, have brought new insights into the advancement of SDT. Despite their distinct sources and preparation methods, the lipid bilayer structure in common allows them to be functionalized in many comparable ways to serve as ideal nanocarriers against challenges arising from the tumor-specific sonosensitizer delivery and the complicated TME. In this review, we provide a comprehensive summary of the recent advances in LBBN-based SDT, with particular attention on how LBBNs can be engineered to improve the delivery efficiency of sonosensitizers and overcome physical, biological, and immune barriers within the TME for enhanced sonodynamic cancer therapy. We anticipate that this review will offer valuable guidance in the construction of LBBN-based nanosonosensitizers and contribute to the development of advanced strategies for next-generation sonodynamic cancer therapy.