Cancer Metastasis Alert and Prevention Center, and Pharmaceutical Photocatalysis of State Key Laboratory of Photocatalysis on Energy and Environment, College of Chemistry, Fujian Provincial Key Laboratory of Cancer Metastasis Chemoprevention and Chemotherapy, Fuzhou University, Fuzhou, Fujian 350116, China.
Cancer Metastasis Alert and Prevention Center, and Pharmaceutical Photocatalysis of State Key Laboratory of Photocatalysis on Energy and Environment, College of Chemistry, Fujian Provincial Key Laboratory of Cancer Metastasis Chemoprevention and Chemotherapy, Fuzhou University, Fuzhou, Fujian 350116, China.
Acta Biomater. 2018 Aug;76:257-274. doi: 10.1016/j.actbio.2018.06.034. Epub 2018 Jun 28.
UNLABELLED: Although novel molecular targeted drugs have been recognized as an effective therapy for non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) activating mutations, their efficacy fails to meet the expectation due to the acquired resistance in tumors. Up-regulation of the anti-apoptotic protein Survivin was shown to contribute to the resistance to EGFR tyrosine kinase inhibitors (TKI) in EGFR mutation-positive NSCLC. However, the unorganized tumor blood vessels impeded drug penetration into tumor tissue. The resulting insufficient intracellular drug/gene delivery in drug-resistant cancer cells remarkably weakened the drug efficacy in NSCLC. In this work, a multi-functional drug delivery system AP/ES was developed by using anti-EGFR aptamer (Apt)-modified polyamidoamine to co-deliver erlotinib and Survivin-shRNA. Chloroquine (CQ) was used in combination with AP/ES to normalize tumor vessels for sufficient drug/gene delivery to overcome drug resistance in NSCLC cells. The obtained AP/ES possessed desired physicochemical properties, good biostability, controlled drug release profiles, and strong selectivity to EGFR-mutated NSCLC mediated by Apt. CQ not only enhanced endosomal escape ability of AP/ES for efficient gene transfection to inhibit Survivin, but also showed strong vessel-normalization ability to improve tumor microcirculation, which further promoted drug delivery and enhanced drug efficacy in erlotinib-resistant NSCLC cells. Our innovative gene/drug co-delivery system in combination with CQ showed a promising outcome in fighting against erlotinib resistance both in vitro and in vivo. This work indicates that normalization of tumor vessels could help intracellular erlotinib/Survivin-shRNA delivery and the down-regulation of Survivin could act synergistically with erlotinib for reversal of erlotinib resistance in EGFR mutation-positive NSCLC. STATEMENT OF SIGNIFICANCE: NSCLC patients who benefited from EGFR-TKIs inevitably developed acquired resistance. Previous research focused on synthesis of new generation of molecular targeted drugs that could irreversibly inhibit EGFR with a particular gene mutation to overcome drug resistance. However, they failed to inhibit EGFR with other gene mutations. Activation of bypass signaling pathway and the changes of tumor microenvironment are identified as two of the mechanisms of acquired resistance to EGFR-TKIs. We therefore constructed multifunctional gene/drug co-delivery nanocomplexes AP/ES co-formulated with chloroquine that could target the both two mechanisms. We found that chloroquine not only enhanced endosomal escape ability of AP/ES for efficient gene transfection to inhibit Survivin, but also showed strong vessel-normalization ability to improve tumor microcirculation, which further promoted drug delivery into tumor tissue and enhanced drug efficacy in erlotinib-resistant NSCLC.
非小细胞肺癌(NSCLC)患者受益于表皮生长因子受体(EGFR)酪氨酸激酶抑制剂(TKI)治疗,但不可避免地会产生获得性耐药。研究表明,抗凋亡蛋白 Survivin 的上调有助于 EGFR 突变阳性 NSCLC 对 EGFR 酪氨酸激酶抑制剂(TKI)的耐药。然而,肿瘤组织中紊乱的血管阻碍了药物渗透到肿瘤组织中。耐药癌细胞中细胞内药物/基因传递不足,显著降低了 NSCLC 的药物疗效。在这项工作中,通过使用抗 EGFR 适体(Apt)修饰的聚酰胺胺来共递给药,开发了一种多功能药物递送系统 AP/ES。氯喹(CQ)与 AP/ES 联合使用,以实现肿瘤血管正常化,从而充分输送药物/基因,克服 NSCLC 细胞的耐药性。所得到的 AP/ES 具有理想的物理化学性质、良好的生物稳定性、控制的药物释放曲线以及由 Apt 介导的对 EGFR 突变型 NSCLC 的选择性。CQ 不仅增强了 AP/ES 的内体逃逸能力,从而有效地转染基因以抑制 Survivin,而且还显示出很强的血管正常化能力,可改善肿瘤微循环,从而进一步促进药物递送至耐药 NSCLC 细胞,并增强药物疗效。我们的新型基因/药物共递药系统与 CQ 联合使用,在体外和体内均显示出对抗厄洛替尼耐药的良好效果。这项工作表明,肿瘤血管正常化有助于细胞内厄洛替尼/Survivin-shRNA 的传递,下调 Survivin 与厄洛替尼联合使用可协同逆转 EGFR 突变阳性 NSCLC 的厄洛替尼耐药。
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