Wang Shasha, Lv Jing, Meng Shanshan, Tang Jianxin, Nie Liming
Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, P. R. China.
State Key Laboratory of Molecular Vaccinology and Molecular Diagnosis & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, 361102, P. R. China.
Adv Healthc Mater. 2020 Mar;9(6):e1901541. doi: 10.1002/adhm.201901541. Epub 2020 Feb 7.
Early diagnosis, standardized treatment, and regular monitoring are the clinical treatment principle of rheumatoid arthritis (RA). The overarching principles and recommendations of treat-to-target (T2T) in RA advocate remission as the optimum aim, especially for patients with very early disease who are initiating therapy with anti-RA medications. However, traditional anti-RA drugs cannot selectively target the inflammatory areas and may cause serious side effects due to its short biological half-life and poor bioavailability. These limitations have significantly driven the research and application of nanomaterial-based drugs in theranostics of RA. Nanomedicines have appropriate sizes and easily modified surfaces which can enhance their biological compatibility and prolong circulation time of drug-loading systems in vivo. Traditional T2T regimens cannot evaluate the efficacy of drugs in real time, while clinical drug nanosizing can realize the integration of diagnosis and treatment of RA. This review bridges clinically proposed T2T concepts and nanomedicine in an integrated system for RA early-stage diagnosis and treatment. The most advanced progress in various nanodrug delivery systems for theranostics of RA is summarized, establishing a clear path and a new perspective for further optimization of T2T. Finally, the key facing challenges are discussed and prospects are addressed.
早期诊断、规范治疗和定期监测是类风湿关节炎（RA）的临床治疗原则。RA治疗达标（T2T）的总体原则和建议提倡将缓解作为最佳目标，尤其是对于刚开始使用抗RA药物治疗的极早期患者。然而，传统抗RA药物不能选择性地作用于炎症部位，且由于其生物半衰期短和生物利用度差，可能会导致严重的副作用。这些局限性极大地推动了基于纳米材料的药物在RA诊疗中的研究与应用。纳米药物具有合适的尺寸和易于修饰的表面，可增强其生物相容性并延长载药系统在体内的循环时间。传统的T2T方案无法实时评估药物疗效，而临床药物纳米化可实现RA的诊断与治疗一体化。本综述在一个用于RA早期诊断和治疗的综合系统中，将临床提出的T2T概念与纳米医学联系起来。总结了用于RA诊疗的各种纳米药物递送系统的最新进展，为进一步优化T2T建立了清晰的路径和新的视角。最后，讨论了面临的关键挑战并展望了前景。
