Thanthai Roever College of Pharmacy,Perambalur, The Tamil Nadu Dr. M.G.R. Medical University.
The new and combined way of treating cancer and monitoring its progress is called theranostic nanomedicine as this therapy pivots the diagnostic and therapeutic functions into a single nanoparticle. The strategy enables monitoring the disease progression at real-time, target delivery of drugs, and assessment of therapeutic response, which enhances accuracy and individual oncology. The nanoproducts Multifunctional nanocarriers are now available owing to the development of nanotechnology; these nanocarriers can be used to generate tumor images, chemotherapy, and photothermal therapy (PTT) simultaneously. In particular, near-infrared (NIR)-presented photothermal therapy with chemotherapy has been demonstrated to have greater anticancer efficacy, higher tumor specificity and reduced systemic toxicity, through the use of preclinical models. There are a number of nanomaterials that have been shown to have potentials in multimodal imaging and controlled drug delivery, including magnetic nanoparticles, quantum dots, and mesoporous silica nanoparticles. Despite the encouraging preclinical outcomes, the control over the passage to the clinical phase remains pale due to safety, biocompatibility, pharmacokinetic, scalability, and regulatory endorsement concerns. Chemo-photothermal theranostic nanomedicine has not been fulfilled therapeutically in the treatment of cancer unless additional optimization, extensive toxicological studies and clinical trials are undertaken
Theranostics is a novel paradigm of cancer treatment that combines both diagnostic imaging and therapeutic interventions on a system provided by nanomedicine. This idea has become one of the effective approaches to the individualized treatment of cancer, which can track the evolution of the disease and identify the response to treatment in real time [1]. Nanomedicine has advanced to a point where multifunctional nanoplatforms can deliver drugs, tumor imaging, and targeted therapy at the same time, making it complementary therapies and improving the quality of treatment and clinical results [2].Nanophotothermal therapy (PPT) has also been given a lot of interest due to its complementary therapeutic benefits. Nominal chemotherapy is normally associated with lack of tumor specificity and systemic toxicity, but PTT permits localized tumor destruction, the creation of heat by heating near-infrared radiation [3]. The combination of these two modalities into nanocarrier-delivered theranostic systems allows achieving the synergistic anticancer effect, improved drug delivery to tumor cells, reduced side effects, and improved treatment outcomes in general [4]. There is an increasing amount of evidence on preclinical and translational research that indicates that theranostic nanomedicine will be able to transform precision and individualized treatment of cancer.
Overview of Theranostic Nanomedicine
Definition and principles of theranostic nanomedicine
Theranostic nanomedicine is a novel technologically progressive biomedical method, which involves incorporation of diagnostic and therapeutic properties in one nanoscale platform, allowing diagnostic and treatment of diseases at the cellular and molecular level. The rationale behind this integrated approach is that the nanoparticles, which are usually 1 to 1000 nm in diameter, have the ability to adsorb, conjugate, or entrap diagnostic and therapeutic molecules within a single carrier system to better treatment precision, therapeutic outcomes, and personalized medicine.Strong evidence supporting this concept has been reported in various scientific reviews[5] defined theranostic nanomedicine as colloidal nanoparticles, which are capable of adsorbing, conjugating or encapsulating diagnostic and therapeutic mole In further underlining its patient-centered nature, [6] noted the importance of theranostic platforms to provide personalized medicine, specifically by enabling pre-screening of patients, targeted therapy and diagnosis to diseased tissues, and monitoring therapeutic response in real-time.The key principles that govern theranostic nanomedicine are that it allows prolonged systemic circulation with proper avoidance of host defense mechanisms, targeted therapy and diagnosis of diseased tissues and real-time monitoring of treatment responses. Although it has a significant potential, much of the existing evidence is mostly preclinical or theoretical, which is why it is necessary to conduct extensive clinical validation as a prerequisite to widespread clinical translation.
Advantages over conventional cancer therapies
The new cancer treatment modalities offer significant benefits compared to the old methods in terms of precision, toxicity and target therapy.Reduced systemic toxicity is one of such benefits. Novel treatment methods like nanomedicine and immunotherapy have the benefit of allowing more selective and precise intervention, minimizing side effects, compared to traditional therapies, which frequently destroy healthy cells [8]. The other benefit is increased selectivity and control. Furthermore, these treatments support individualized treatment methods including CAR-T cell therapy and molecularly targeted modalities with the capability to specifically target cancer cells and spare normal tissues hence less collateral damage [9]. Some of the newer techniques include drug resonance chemotherapy where interventions are custom-designed based on the unique characteristics of the tumor, and it promises to yield more effective and less toxic treatment plans [10].This combined with other newer techniques represent a shift in the paradigm of traditional methods of cancer therapy that looks at it as a one-size-fits-all approach, meaning that the treatment is not designed to be as effective as possible and can cause minimal harm to the individual cancer patient [11].
Role of nanoparticles in simultaneous diagnosis and therapy
Nanoparticles have proved to be a potent development platform of theranostic applications to facilitate the diagnosis and treatment of disorders in the same nanoscale system through the combination of various functional capabilities. Particularly promising are the use of nanoparticles in cancer therapy, where localization and time-resolved measurements are essential; the ability to combine imaging and therapeutic functions onto a unified platform [12] and a high target to tumor ratio with surface conjugation to specific biological ligands that increase accumulation at tumor sites [13]Nanoparticles can also alleviate systemic toxicity and optimize drug delivery, which minimizes the damage to healthy tissues [14]Specifically, tumor-homing chitosan nanoparticles with the integrated therapy[15]. The research is still developing at a fast rate as nanoparticles are now being used to enable a more tailored approach to medicine where the therapeutic responses can be monitored in real-time and adaptive treatment plans are made [16].
Nanomaterials Used in Theranostic Applications
Nanomaterials have proven to be extremely useful and highly promising in conducting diagnostic and therapeutic functions simultaneously in diverse diseases. Various studies have identified several important classes of nanomaterials of critical theranostic value, including magnetic nanoparticles, quantum dots, upconversion nanoparticles, mesoporous silica nanoparticles, carbon-based nanoparticles, organic dye-based nanoparticles and lanthanide-based nanomaterials [17].These nanomaterials show tremendous possibilities in advanced imaging modalities, including PET, SPECT, and MRI, and at the same time, they enable targeted drug release, real-time tracking of therapeutic response [18] .Their special physicochemical characteristics such as small size, large surface area and adjustable surfaces enable them to perform in multifunctional purposes which has seen them being used especially in cancer theranostics. These nanomaterials open up the prospects of more personalized, efficient, and accurate treatment approaches by combining diagnostic and therapy functions into one platform.
Mechanism of Chemotherapy Delivery Using Nanocarriers
Nanocarriers are now considered to be very useful in the delivery of chemotherapy with high accuracy, whereby the targeted and stimuli-responsive mechanisms ensure drug efficiency without causing excessive side effects in the system. Firstly, nanocarriers arrive on the greater permeability and retention (EPR) effect in which therapeutic agents are concentrated at the tumor sites with preference [19]. Second, nanocarriers can be stimuli-responsive that is, they need to be designed to release their drugs only in the tumor microenvironment e.g. pH-sensitive biomaterials, which is induced to change in conformational state in acidic tumor conditions [20]. Also, these nanocarriers can respond to a wide range of stimuli, including pH, temperature, and the enzymatic activity and allow delivering drugs in a specific place and in a controlled manner [21]. Nanocarriers that respond to stimuli have the potential of transforming the chemotherapy process by eliminating significant problems affecting chemotherapy such as lack of specificity during targeting of drugs, systemic toxicity, and multidrug resistance [22].
Principles of Photothermal Therapy (PTT)
Photothermal Therapy (PTT) has become a promising approach to cancer therapy, which entails application of light-responsive nanoparticles to localize the heat to tumors, irradiation with the near infrared light (usually 650-900 nm), and conversion of lights energy to heat to trigger the process of cancer cells apoptosis or necrosis [23].Photothermal Therapy (PTT) is a nascent approach to cancer therapy which involves three essential components, that is, the localization of light-responsive nanoparticles and the conversion of light energy into heat to induce cancer cell apoptosis or necrosis [24].Recent evidence and numerous reviews have shown that Photothermal Therapy (PTT) is a promising treatment concept in cancer management that can be employed to support the traditional approach to treatment and increase the overall rate of treatment response [25].Photothermal Therapy (PTT) has been promising to be useful as an effective treatment modality that has several important variables, including the successful delivery of light absorbing nanoparticles to tumors, light into heat conversion, and the capability of regulating the temperature to provide the therapeutic effect desired; i.e. kill the cancer cells and spare normal tissues[26].
Integration of Chemotherapy and Photothermal Therapy
Combining chemotherapy and photothermal therapy (PTT) is one of the promising synergistic methods of cancer treatment, which allows delivering both chemotherapeutic agents and localized thermal ablation. A number of studies have made it clear that this dual methodology is expected to achieve maximum therapeutic effect at minimum systemic toxicity and incomplete ablation of tumors. Although traditional chemotherapy has been associated with unwanted off-target side effects and PTT alone might not eradicate tumours in a single treatment, a combination of the two has shown to yield a better and more tolerable treatment model in more than 85% of animal models [27].The main supporting fact towards the use of the strategy is shown by [28] who showed that after a single combined treatment, both local and distant tumours could be eliminated in over 85% of the animal models [27]. On the same note, [29] showed no recurrence of tumor after one dose of combined therapy. The authors of the given article focused on the fact that nanomaterials can be used as drug carriers and heat-generating agents, which can be stimulated by NIR radiation, thereby destroying tumors with high precision and specificity, and this method of cancer treatment is rather advanced and allows a more focused approach to the treatment of tumors, only NIR radiation can be used as a stimulus.
Diagnostic (Imaging) Capabilities of Theranostic Nanoparticles
Theranostic nanoparticles are also remarkable in their diagnostic imaging features in different modalities allowing the definite disease detection and characterization. The accumulation of nanoparticles selectively in diseased tissue can be used to report biochemical and morphological phenomena in a variety of applications in imaging (magnetic resonance imaging (MRI), optical imaging, ultrasound, computed tomography (CT), and nuclear imaging (PET/SPECT)) to provide sensitive and versatile diagnostic measures [31]. Accumulation of nanoparticles in diseased tissue can be utilized to report bio chemical and morphological phenomena at a high level of sensitivity and hence accurately estimate the disease condition [32]. Specifically, theranostic nanoparticles can find their way in the sphere of personalized medicine in the future due to the integration of diagnostics and therapeutic functionalities in a single platform, they can monitor therapeutic response and in real-time evaluate the effectiveness of the treatment [33].Specifically, the application of theranostic nanoparticles as diagnostic and therapeutic agents in one platform, in particular, in cancer treatment, is particularly promising in the future as it allows real-time non-invasive imaging of the tumor phenotype and progression with signal strength correlating to the latter [34].
Targeting Strategies in Theranostic Nanomedicine
The theranostic nanomedicine targeting strategies utilize advanced methods to obtain the diagnosis and treatment of diseases simultaneously through designing nanoparticles with specific molecular recognition properties. These methods aim to display higher therapeutic efficacies as well as reduce off-target effects One of the ways is to surface decorate nanocarriers with targeting moieties, including ligands, antibodies, peptides or aptamers, that are highly affinity towards particular tumor cell membrane receptors. The measure enhances the selectivity of drugs to malignant cells and has gone much further in minimizing the side effects of the healthy tissues [35]. More advanced targeting systems extend the ability of the theranostic systems. These are stimulus-responsive drug delivery systems, combination therapies, and specific intracellular compartment targeting which allow the delivery of therapeutic and diagnostic agents to be controlled and effective and thus promote personalized medicine because it allows real-time monitoring of nanoparticle biodistribution, drug release and a therapeutic response in diverse disease settings [36].The high-impact studies substantiate the effectiveness of these targeting systems[37] and suggest that they can be used to advance personalized medicine by providing the capability to monitor biodistribution of nanoparticles, drug release and ther Taken together, these strategies highlight the transformative nature of the targeting strategies in the clinical translation of theranostic nanomedicine.
Preclinical and Clinical Applications
Theranostic nanomedicine has a great potential in transforming the process of treating cancer since it incorporates both diagnostic and therapeutic capabilities in a single technology especially in chemotherapy and photothermal therapy. Recent developments indicate the promise of nanomedicine to increase the precision, efficacy, and outcomes in treating patients. Indicatively, the study by [37] had shown that nanotheranostic systems were capable of enhancing the accumulation of the drug specifically to tumors and real-time imaging of therapeutic responses was possible. The phototheranostic strategies have been developed in cancer treatment and therapy by integrating imaging and light-controlled therapies [38] reported that these systems can provide precise localization of the tumor and the ability to control the activation of photothermal effects or photodynamic effects thereby minimizing the damage of the adjacent healthy tissues. Nonetheless, nanocarriers that are designed as theranostic vehicles have demonstrated to enhance drug delivery efficiency, tumor targeting, and reduce systemic toxicity, which has been demonstrated in the work [39]. However, the clinical translation of nanotheranostic preparations is still very limited. Indeed, as noted by [40], there is no currently approved nanotheranostic platform by the FDA, which is in large part because of issues to do with biocompatibility, long-term safety, large-scale production, and regulatory burden. Consequently, the nanoparticle now is at a desperate transition stage and research is continuing within the fields of harnessing nanoparticles to their fullest and overcoming the bridging aspect of preclinical success and clinical applicability.
Safety, Toxicity, and Pharmacokinetic Considerations
Theranostic nanomedicine has a significant therapeutic potential, but its clinical implementation should be performed after careful consideration of safety and toxicity profiles. As indicated by a growing body of evidence, the safety of nanomaterials depends heavily on a wide range of key parameters, such as, particle size, shape, surface charge, and exposure duration. [41] had previously illustrated that diverse physicochemical parameters can significantly modify the absorption, biodistribution, metabolism, and elimination of nanoparticles, subsequently affecting the efficacy and toxicity of nanoparticles in the treatment of human disease. In order to overcome these issues, scientists propose a strategic safe-by-design process of theranostic nanomedicine development. This design involves rational nanoparticle design principles including surface functionalization, size and shape optimization and low biological persistence to reduce the negative interactions with normal tissues on the long-term basis [43]. In spite of the enormous potential of theranostic nanomedicine as a means of personalized medicine and targeted cancer therapy, a full and standard spectrum of toxicological studies is still necessary in order to diminish any possible risk on health and facilitate approval by the regulatory authorities.
Advantages and Limitations of Theranostic Nanomedicine
Theranostic nanomedicine is a new approach to medicine that entails applying both diagnostic and therapeutic functionalities in the same nanoplatform, which presents a lot of potential in personalized and precision medicine. Through the ability to detect disease simultaneously, deliver drugs to specific target locations, and monitor the effects of the therapeutic drug in real-time, the theranostic systems have gained considerable interest, especially in oncology.[37] highlighted that therapeutic applications of nanoparticles can be used to deliver imaging agents and therapeutic drugs simultaneously, leading to improved clinical outcomes. It was shown that these multifunctional nanoparticles allow localization of tumors and controlled treatment effect of tissues reducing off-target effects [44]. Although these have these benefits, there are multiple key limitations to clinical translation of theranostic nanomedicine. The main concerns are that some nanomaterials like quantum dots can be toxic, high production and scale-up costs, utilisation of non-biodegradable materials, and that nanoparticle design and characterisation is complex. The latter, in combination with the high levels of regulatory requirements, have made theranostic nanoparticles unable to fully pass the clinical test, as noted by [45] as well.To this end, although theranostic nanomedicine is in its experimental stages, the current advances in nanotechnology, material science and regulatory systems have a lot of potential in the future application of theranostic nanomedicine particularly in cancer diagnostics and therapy.
Recent Advances and Emerging Trends
Theranostic nanomedicine is a new paradigm of cancer therapy, where the diagnostic and therapeutic procedure is integrated into a unified nanostructure, and some of the most promising interventions are photothermal therapy and photodynamic therapy. According to recent reports, there has been a lot of advancements in the creation of multifunctional nanoparticles, which can be utilized in delivery of targeted drugs and control therapeutic release. According to [46], these nanoplatforms allow targeting of the tumor and improving the therapeutic effects by utilizing spatiotemporally regulated activation of drugs. Phototheranostic systems that contain photothermal agents can be used to produce local cytotoxic effects that are highly selective when light is used to activate the systems, hence reducing destruction of healthy tissues. As pointed out by [47], these nanocarriers are more specific to tumors and precise to the treatment than the traditional treatment modalities. Moreover, [48] highlighted that phototheranostic applications have the potential to enhance patient survival by overcoming several major challenges of conventional cancer diagnostics and treatments which are low selectivity, lack of response to treatment, and activation of various treatment modalities, including chemotherapy, immunotherapy, and light-based therapies in one platform. However, even with the promising preclinical results, clinical translation is still unachieved because of the factors of complexity in the synthesis of nanoparticles, lack of tissue penetration of light-based therapy, and scalability issues that are observed by [46] Further optimization and clinical translation are thus necessary to achieve the full clinical potential of theranostic nanomedicine in cancer therapy.
FUTURE PERSPECTIVES
The field of theranostic nanomedicine has an extraordinary potential in changing the treatment of cancer patients by bringing the diagnostic and therapeutic systems into one platform. The use of chemo-photothermal therapy is one of the brightest future perspectives of the application of nanoparticles. Several researchers have shown that it has a great potential to support treatment outcomes. An example would be to stress phototheranostic strategies can be used to open the door to future research, enhance patient quality of life, and increase the time cancer patients have to live. Otherwise, [47] note the benefits of using chemotherapy along with near-infrared (NIR) photothermal therapy, which has been shown to provide better treatment effect and become least invasive. Irrespective of these strengths, there are still serious challenges. [48] warns that effective clinical translation requires a detailed design of nanomaterials, which consider the intricate pharmacodynamic and pharmacokinetic processes. These issues will be critical to realising the full clinical potential of chemo-photothermal theranostic nanomedicine.
CONCLUSION
Theranostic nanomedicine is a paradigm shift in the treatment of cancer as it combines diagnosis, targeted treatment and monitoring of drug therapy in one nanoscale platform. Chemotherapy combined with photothermal therapy has synergistic effects against cancer cells, induces better localization of the treatment and less systemic toxicity compared with the traditional treatment methods. The design of nanomaterials, targeting approaches and imaging have shown high preclinical potential of precision and tailor-made cancer treatment. Safety, scalability, regulatory approval, and clinical translation issues are, however, still important. Further interdisciplinary studies and stringent clinical validation of theranostic nanomedicine are needed to maximize clinical potential of theranostic nanomedicine in the future oncology practice.
ACKNOWLEDGMENT
The authors gratefully acknowledge the constant guidance, encouragement, and support extended by the Principal, Vice-Principal, and faculty members of Thanthai Roever College of Pharmacy, which greatly assisted in the successful completion of this article.
REFERENCES
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