12

Polymeric Nanoparticles for

Tumor-Targeted Drug Delivery
Tania Betancourt, Amber Doiron,
and Lisa Brannon-Peppas
CONTENTS
12.1 Introduction ........................................................................................................................215
12.2 Targeting to Cancer............................................................................................................216
12.3 Passive Targeting and the EPR Effect ...............................................................................217
12.4 Targeting to Angiogenesis .................................................................................................218
12.4.1 Targeting Using Vascular Endothelial Growth Factor Receptors...................... 218
12.4.2 Targeting Using Integrins ................................................................................... 218
12.4.2.1 Integrins as Targets for Imaging.........................................................220
12.5 Targeting Using Folate Receptors .....................................................................................220
12.5.1 Antibodies and Folate Receptors ........................................................................ 221
12.5.2 Folate-Targeted Nanoparticles for Gene Delivery ............................................. 222
12.6 Approaches for Cancer Targeting to Specic Cancer Types ............................................223
12.6.1 Prostate Cancer.................................................................................................... 224
12.7 Targeted Nanoparticles and Imaging of Cancer ................................................................225
12.8 Other Targets for Cancer ...................................................................................................225
12.9 Avidin and Biotin Targeting ..............................................................................................226
12.10 Conclusions ........................................................................................................................226
References.....................................................................................................................................226
12.1 INTRODUCTION
Cancer is a disease that affects millions of people across the globe every year. The World Health
Organization estimated that more than 10 million people developed a malignant tumor and more
than 6.5 million people died from this disease during the year 2000.
1
In the United States, cancer is
the second cause of deaths from disease after heart disease, accounting for more than half a million
deaths every year. According to the American Cancer Society (ACS) cancer statistics, the overall
cost for cancer for the United States in 2004 was $189.8 billion: $69.4 billion for direct medical
costs, $16.9 billion for indirect morbidity costs, and $103.5 billion for indirect mortality costs.
2
Furthermore, while mortality rates of other major chronic diseases, such as heart and cerebro-
vascular disease, decreased signicantly in the past half-century, cancer mortality rates have
remained approximately constant.
2
This is a troubling fact because it suggests that recent detection
and treatment options have not been able to improve mortality rates substantially.
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Research in the past decade has focused on using unique characteristics of cancer cells and the
vasculature surrounding those cells to deliver imaging agents, chemotherapeutic drugs, gene
therapy, and other active agents directly and selectively to cancerous tissues. Many of these new
formulations (described elsewhere in this volume) are liposomes, prodrugs, polymer conjugates,
micelles, and dendritic systems. This chapter will concentrate on polymeric nanoparticles that have
been studied as targeted systems for treatment and detection of cancer.
12.2 TARGETING TO CANCER
Nanoparticles may be targeted to the growing vasculature serving the growing cancer or to the
cancer cells themselves. Targeted delivery utilizes unique phenotypic features of diseased tissues
and cells in order to concentrate the drug at the location where it is needed. Targeted delivery can be
divided into passive and active targeting. Passive targeting tries to minimize nonspecic
interactions between the drug carrier and nontarget sites in the body by detailing the physiochem-
ical properties of the aberrant tissue such as size, morphology, hydrophilicity, and surface charge.
3
When targeting tumor tissue, the enhanced permeability and retention effect (EPR) is an example of
passive targeting approach; it allows passage of drug carriers ranging in size from 10 to 500 nm
through the highly permeable blood vessels that supply growing tumors and leads to entrapment of
large molecules as a result of decient lymphatic drainage.
35
In fact, it has been reported that the
intra-cellular openings in vascular endothelium of tumor blood vessels can be up to 2 mm in
diameter and that the vessel leakiness in tumor vasculature can be up to an order of magnitude
higher than that of normal blood vessels.
5
Active targeting utilizes biologically specic interactions
including antigenantibody and ligandreceptor binding and may seek drug uptake by receptor-
mediated endocytosis through association of the drug or drug carrier with such antigen or ligand.
3
Receptor-mediated endocytosis commonly occurs through clathrin-coated vesicles and is carried
out in mammalian cells continuously for the uptake of nutrients and for modulation of signal
transduction through the up- or down-regulation of signaling receptors.
6
Targeted delivery
avoids the need for high systemic drug levels for the drug to be effective and consequently
offers a more economic alternative for treatment. Not only is it useful for therapeutic purposes;
it is also benecial in diagnosis. Recent research has pointed to its ability to concentrate imaging or
contrast agents for the detection of malignancies and for monitoring the effects of therapeutic
agents.
7,8
To date, most systems for targeted delivery have utilized drug conjugates, liposomes
or micelles.
911
Targeting of particulate systems has focused more often on passive targeting based
on size than on active targeting. But systems that combine both methods, starting with passive
targeting through EPR and enhancing the targeting through specic interactions are beginning to
show great promise.
While it is challenging to deliver a drug or imaging agent-containing nanoparticle directly and
selectively to a cancerous cell or tissue, the additional challenges of then having that particle and/or
its contents being transported into the targeted cell have often been overlooked. Couvreur presented
some of these challenges at the 11th International Symposium on Recent Advances in Drug
Delivery Systems and also summarized that presentation in a recent publication.
12
The tumor
resistance can be due to the deliverance of nanoparticles to the tumor as well as to resistance to
the active agent being delivered. In this article, many different pathways are described and the
enhancement of drug delivery due to the presence of nanoparticles, especially polycyanoacrylate
nanoparticles, is evaluated and summarized. The enhancement of drug permeability into cells due
to interactions with biodegradation byproducts as well as the effect of nanoparticle surface charge
is discussed.
In this chapter, we will rst review recent work on targeting to the two most promising targets
for cancer: Angiogenesis and folate receptors. We will then describe other potential targets for
cancer imaging and therapy with nanoparticles, including antibodies strategies using biotin.
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12.3 PASSIVE TARGETING AND THE EPR EFFECT
Although active targeting may be achieved through targeting to folate receptors, angiogenesis, or
targets more specic to the cancer being treated, some enhancement of treatment to cancers on
account of the EPR effect cannot be ignored and should be utilized until more specic targeting
systems can be developed. Preparation of nanoparticle systems that can avoid uptake by the
reticuloendothelial system (RES) is essential, and such particles are often referred to as
stealth nanoparticles.
The most effective polymer used as a coating on nanoparticles to avoid detection by the RES is
poly(ethylene glycol).
13
The latter can be achieved by adsorption of the PEG-containing polymer
onto the surface of nanoparticles, direct conjugation of the PEG to the nanoparticles, or inclusion of
PEG in the polymeric backbone that makes up the nanoparticles. The PEG itself may then also be
modied to give targeting capabilities and to avoid uptake by the RES. The PEG works to mask the
surface of the nanoparticles by reducing the plasma and protein adsorption to the particles, reducing
the complement activation and hence the recognition of the PEG as a foreign substance in the blood
stream. The longer circulation time afforded PEGylated nanoparticles allows them time to be
targeted, whether passively or actively, to cancerous tissues.
Extended circulation time and enhanced tumor targeting were seen for poly(ethylene oxide)-
modied poly(epsilon-caprolactone) nanoparticles in mice with tumors of MDA-MB-231, a human
breast carcinoma.
14
These particles were loaded with [
3
H]-tamoxifen. The amount of labeled
tamoxifen at the tumor site, 6 h after injection, for those particles with PEO modication was at
least twice that of particles without modication and four times that of labeled tamoxifen injection.
The amount of labeled tamoxifen found in the blood stream at 6 h after injection was also at least
twice that of the injection or unmodied nanoparticle formulations.
The stability and circulation of PLGAmPEG nanoparticles containing cisplatin was investi-
gated. It was found that while the mPEG content affected the drug release rate, the drug loading
level had no effect on the drug release rate for in vitro studies.
15
The release was more that 60%
completed within the rst 12 h in all cases. Data for blood levels was only presented for 3 h, so it is
hard to draw any valid conclusions from this information.
Nanoparticles of PLA and PEGPPGPEG were prepared containing irinotecan, a prodrug of
an analogue of camptothecin.
16
Although little characterization beyond the average particles size
(231 nm) was presented here and no in vitro studies were described, the in vivo studies are quite
interesting. In this study, there was a modest increase in survival time in mice with M5076 tumors
(early liver metastatic stage) after a single injection and more pronounced increases in survival time
after either two or three repeat injections. It is noteworthy that the greatest survival times (20%
survival at 45 days at the end of the study) were seen with two injections at days three and ve after
the implantation of the tumor.
Polycyanoacrylate nanoparticles have long been studied by Couvreur and collaborators as
biodegradable nanoparticles for a variety of applications and therapies which are not limited to
treatment of cancer.
17
A recent work describes the effectiveness of these nanoparticles as delivery
systems for brain tumor targeting. Here they studied uncoated and PEG-coated nanoparticles and
found that both types of particles showed accumulation in a well-established 9L gliosarcoma in rat
studies. The PEG-coated particles showed the highest accumulation, with a tumor-to-brain ratio
of 11.
Poly(butyl cyanoacrylate) nanoparticles containing doxorubicin were prepared with no surface
modications; the in vivo distribution of
99m
Tc labeled nanoparticles was evaluated in mice inocu-
lated with Daltons lymphoma tumor cells.
18
The nanoparticles were administered by subcutaneous
injection and the concentration in a number of organs was followed for 48 hours and compared with
that for
99m
Tc labeled doxorubicin alone. When compared with the amount of doxorubicin alone,
the amount of radioactivity in the tumor was higher at all times tested, with a 13-fold increase seen
at 48 h.
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While the majority of work on targeted nanoparticles has been carried out with polylactides,
polyglycolides and polycyanoacrylates, those are not the only materials that can be used in nano-
particles. Some recent work with radiolabeled gelatin nanoparticles modied with poly(ethylene
glycol) showed that adding the PEG to the surface of these nanoparticles increased the circulation
time in mice with double the amount of PEG-modied nanoparticles in the blood stream 3 h after
injection compared to the amount of control nanoparticles.
19
In addition, there was a four-fold
increase in the amount of PEG-modied gelatin nanoparticles found in the tumor 4 h after injection
and later when compared to the number of nonmodied gelatin nanoparticles.
12.4 TARGETING TO ANGIOGENESIS
A recently explored and potentially promising target of cancer drug and gene nanoparticle therapy
is tumor angiogenesis. It is now well established that tumor growth is dependent on new capillary
inltration from surrounding, preexisting vasculature.
20,21
This is an important control point in
cancer as much research has proven that tumors cannot effectively grow past a small size or
metastasize without blood supply.
2224
Except for the cases of menstruation, wound healing, and
tissue regeneration, capillaries do not increase in size or number under normal physiological
conditions. Tumor growth is an exception to this physiological rule.
Tumors are typically unable to affect angiogenesis when they are small and surrounded by
healthy tissue. However, at the point in growth where nutrients, oxygen, and growth factors can no
longer reach the cancer cells, blood ow is required to allow further growth of the tumor. After what
is occasionally a substantial time period, the tumor may abruptly induce angiogenesis into the
tissue.
23
Because understanding this step in the progression of cancer is thought to be of great
importance, much research has been and continues to be focused on pinpointing the progression of
cancer and on targeting the event for therapy.
Much research has focused on targeted therapy of either chemotherapeutic agents to sites of
tumor angiogenesis or of angiogenesis-inhibiting drugs to tumors with the goal of directly combat-
ting the proliferation of newly forming capillaries in the tumor. Angiogenesis is a complex, multi-
component process that involves many cell types, cytokines, growth factors and receptors,
proteases, and adhesion molecules.
25
As a result, there are many potential targets for anti-angiogenic
or chemotherapeutic therapy. Some recent advances in targeting approaches for nanoparticle drug
delivery are discussed below.
12.4.1 TARGETING USING VASCULAR ENDOTHELIAL GROWTH FACTOR RECEPTORS
Vascular endothelial growth factor (VEGF) is particularly important in the process of angiogenesis
and has been shown to greatly affect tumor growth in animal models.
2628
The VEGF receptors have
been used as a means to target the vascular bed in many instances. VEGF receptor-2 (VEGFR-2)
has recently been used to target nanoparticles to tumor vascular beds by Li et al in mice with
K1735-M2 tumors.
29
A succinyl-dextran-polymerized nanoparticle conjugated to rat anti-mouse
VEGFR-2 antibody and radioisotope
90
Y caused a signicant tumor growth delay compared to
conventional radiolabeled antibody and other controls. Additionally, anti-CD31 staining showed
a decreased vessel density and damage to tumor vessels after treatment with the anti-VEGFR-
2-
90
Y nanoparticles.
12.4.2 TARGETING USING INTEGRINS
The integrins represent another important cell surface molecule group for angiogenesis targeting
because some integrins, such as a
v
b
3
and a
v
b
5
, are upregulated on the endothelial cell surface of
neovasculature.
30,31
The a
v
b
3
integrin is expressed on numerous tumor cell types; it is highly
expressed on neovascular endothelial cells. Hood and collaborators used 40-nm diameter
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cationic-lipid-based nanoparticles coupled to an organic a
v
b
3
ligand that was shown to be specic
for a
v
b
3
in cell studies. These nanoparticles, which contained a luciferase reporter plasmid, were
injected into mice with the a
v
b
3
-negative cell line M21-L. The nanoparticles targeted to the
neovasculature within the tumor (but not to the tumor cells themselves) with no expression else-
where in the mice as detected by luciferase expression. In order to test therapeutic efcacy, NPs
were conjugated to a mutant Raf gene that blocks angiogenesis. Systemic injection in the M21-L
tumor-expressing mice rapidly induced apoptosis of endothelial cells within the tumor. Tumor
regression was seen within 10 days.
32
In the same study with VEGFR-2 targeting discussed above, Li and collaborators also demon-
strated targeting of the radioisotope
90
Y using nanoparticles targeted to the integrin a
v
b
3
with a
small molecule integrin agonist.
29
In mice with K1735-M2 tumors, a
v
b
3
-targeted
90
Y-nanoparticles
signicantly delayed tumor growth compared to untreated tumors. TUNEL staining of tumor
sections showed widespread apoptosis in tumors treated with these targeted nanoparticles. The
authors have postulated that this targeted nanoparticle radiotherapy has the potential to be used
to treat a variety of solid tumors. They have also postulated that the use of nanoparticles increases
efcacy due to the high payload delivered by the carriers.
Additionally, PEGylated polyethyleneimine (PEI) nanoplexes with a cyclic disulde bond
constrained ArgGlyAsp (RGD) peptide ligand at the distal end have been used to target
integrin-expressing tumor neovasculature to deliver siRNA. Integrins are receptors for extracellular
matrix components that contain a tripeptide RGD sequence. Therefore, RGD containing peptide
sequences can target to cell surface integrins that are upregulated on neovasculature. The siRNA
used inhibited angiogenesis by inhibiting VEGFR-2 expression. Intravenous injection of nanopar-
ticles into nude mice with N2A tumors showed tumor uptake of the siRNA, inhibition of protein
synthesis in the tumor, and inhibition of angiogenesis and tumor growth.
33
This study demonstrates
tumor selective delivery through both the targeting ligand and gene pathway by using siRNA.
In another a
v
b
3
targeting approach using an RGD peptide, Kopelman has created multifunc-
tional nanoparticles of 3060 nm for the treatment of gliomas.
34
The nanoparticles are able to kill
cancer cells by bombarding them with externally released reactive oxygen species created by
photodynamic agents activated by laser light. The particles also contain superparamagnetic iron
oxide and enhance imaging by magnetic resonance. The photodynamic sensitizer and MRI contrast
agents are entrapped within a polyacrylamide core, the surface of which is coated with PEG chains
and targeting RGD moieties. The particles containing photodynamic agents were shown to produce
sufcient singlet oxygen to kill cells in vitro. Additionally, these nanoplatforms were injected into
an in vivo rat intracerebral 9L tumor model, and diffusion MRI was performed at various times to
evaluate the tumor diffusion, tumor growth, and tumor load. The gliomas treated with the nano-
particles and irradiated with laser light caused regional necrosis and signicant shrinkage of tumor
mass, a shrinkage that lasted for 12 days. The authors postulate that the light activated release of
reactive oxygen from photosensitizer-containing nanoparticles is a viable approach for brain tumor
treatment. Also, the incorporation of MRI contrast agents allows for monitoring of treatment and
tumor progression in vivo.
Carbohydrate based nanoparticles have also been used to target drugs to neovasculature via an
a
v
b
3
/cyclic RGD peptide interaction. Inulin multi-methacrylate formed the core of the nanoparti-
cles and was attached to the RGD targeting moiety with a PEG linker. Doxorubicin was loaded in
the nanoparticles via covalent and noncovalent linkages. The pharmacokinetics and biodistribution
of the doxorubicin loaded nanoparticles were studied over ve days in female Balb/cJ mice with
metastatic mammary tumor clone-66. A bi-exponential x with a terminal half-life of 5.99 h was
observed; decreasing drug concentrations with time in the heart, lungs, kidney, and plasma was also
observed. Conversely, increasing drug accumulation was observed in the liver, spleen, and in the
tumor where there was also the presence of high levels of doxorubicin metabolite. The presence of
the high metabolite levels in the tumorsuggests nothing more than tumor-specic nanoparticle
degradation and release of drug.
35
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12.4.2.1 Integrins as Targets for Imaging
In an effort to image angiogenesis, Mulder and collaborators have created MR-detectable and
uorescent liposomes that are targeted to a
v
b
3
integrin on neovasculature.
36
The MR contrast
agent Gd-DTPA-bis(stearylamide) was incorporated into PEGylated liposomes covalently
coupled to RGD peptide. It was observed that the liposomes effectively brought about an increase
in signal on T
1
-weighted images. Injection of these lipidic nanoparticles in nude mice with subcu-
taneously implanted LS174 human colon adenocarcinoma led to the ability to specically image the
vascular endothelial cells in the tumor. Ex vivo uorescence conrmed that RGD liposomes
specically interacted with tumor endothelium associated with neovasculature.
In a study reported by Lanza, paramagnetic molecular imaging of angiogenesis was accom-
plished in vivo with a
v
b
3
-targeted lipid encapsulated peruorocarbon nanoparticles of about
250 nm.
37
A Vx-2 carcinoma tumor in New Zealand rabbits was imaged with a 1.5-T MRI
system with either nontargeted or a
v
b
3
-targeted nanoparticles. An eight-fold greater contrast
enhancement was achieved with the targeted nanoparticles. In the second part of the study, pacli-
taxel loaded nanoparticles were targeted to tissue factor (TF) proteins on vascular smooth muscle
cells with a specic TF antibody. The TF-targeted paclitaxel particles inhibited cell proliferation
while delivery of nanoparticles to targeted cells was conrmed with uorine spectroscopy.
12.5 TARGETING USING FOLATE RECEPTORS
During the past few decades, there has been great interest in the utilization of folate receptors for the
targeted delivery of therapeutic and imaging agents. A number of delivery systems have been
utilized for this purpose, including drug conjugates,
3840
liposomes,
41
micelles,
42
viral vectors,
43
and nanoparticles.
Folate (vitamin B-9) is essential for the synthesis of nucleotides and amino acids. Two main
groups of molecules are responsible for transport of folate molecules in vivo. Most cells in the body
express a folate anion transporter with micro-molar afnities for folates that participates in the
transport of coenzyme 5-methyltetrahydrofolate, the physiologic circulating reduced form of folate.
Folate receptors (FR), by contrast, are members of the glycosylphosphatidylinositol (GPI)-linked
membrane glycoprotein family and have high afnity for folic acid, an oxidized form of folate, and
5-methyltetrahydrofolate, with binding afnities being in the nanomolar range (K
D
!1!10
K9
M)
for the a isoform of FR.
4446
It has been observed with few exceptions that only cells involved in
pathologic conditions, including cancer cells, express the high afnity folate receptors. These
receptors are able to transport folic acid, folate-bound molecules, and even particles through
receptor-mediated endocytosis.
47,48
FR are known to be overexpressed in various epithelial cancer cells, such as those of ovarian,
mammary gland, colon, lung, prostate, and brain epithelial cancers, and in leukemic cells.
4961
Folate receptor overexpression has been correlated to poor prognosis. In addition, metastasized
cancer cells have been found to overexpress the folate receptor to a larger degree than localized
tumor cells.
62
This nding is of great importance. The only nonpathological tissues where FR is
expressed are choroid plexus, placenta, lungs, thyroid, and kidney.
46,63
FR expression is limited to
the apical (luminal) side of polarized epithelial cells, except for the cells of the proximal tubules in
the kidney. As a consequence, FR is practically inaccessible to blood-borne folate-linked
systems.
44,45
These characteristics make folate receptors very advantageous for targeted delivery
of nanoparticles with high payloads of therapeutic agents, imaging agents, and even genes for
the treatment, detection, and monitoring of cancer. What is more, the macromolecular size of
nanoparticles will prevent gromerular ltration and the consequent exposure of kidney tissue to
folate-targeted nanoparticles.
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12.5.1 ANTIBODIES AND FOLATE RECEPTORS
The most common targeting moieties utilized for FR targeting include monoclonal antibodies to FR
and folic acid.
46
To date, monoclonal antibodies to FR have not been utilized for targeted delivery
of nanoparticles although successful experiences have been reported for radiopharmaceuticals.
64
The benets of targeting with folic acid are many: it is small in size, has high stability, lacks
immunogenicity, and costs very little.
62
Folic acid conjugation at its g-carboxyl group is necessary
for maintaining binding afnity to FR. The structure of folic acid is shown in Figure 12.1. Cellular
uptake of drug carriers bound to folic acid is believed to be mediated by receptor mediated
endocytosis although this process is not currently completely understood. A number of hypotheses
have been proposed for this process, including clathrin and caveolar pathways.
63
It has been shown
that folate-bound molecules are able to escape endosomes after receptor-mediated endocytosis
because the process of endosomal acidication results in a conformational change in the receptor
that facilitates folate ligand release. Consequently, folate-bound molecules provides a great oppor-
tunity for the delivery of pH-sensitive biopharmaceuticals.
45,62
In most drug delivery systems investigated thus far, folic acid is incorporated to the drug
delivery system through conjugation to a poly(ethylene glycol) (PEG) spacer utilizing well-
known dicyclohexylcarbodiimide/N-hydroxysuccinimide (DCC/NHS) mediated chemistry. Such
design aims to minimize steric hindrance for optimal folate recognition. This conjugation tech-
nique, however, can activate both the g- and the a-carboxylic acids of folic acid. It should be said,
though, that the g group is more reactive and is responsible for most of the linkages.
Numerous attempts at nanoparticle targeting to the folate receptor have been reported. Many
groups have formulated nanospheres of amphiphilic block copolymers including PEG. Park and
collaborators reported in vitro results of the preparation and evaluation of methoxy poly(ethylene
glycol) (PEG)-poly(3-caprolactone) (PCL) block copolymer nanospheres loaded with paclitaxel in
which folic acid was conjugated to a modied amino-terminated PCL with a carbodiimide-
mediated reaction.
65
Dialysis was used to create these nanospheres that ranged in diameter from
50 to 120 nm, depending on the ratio of the block copolymers. Paclitaxel loading efciencies of up
to 55% were reported with this system, thus signicantly increasing the effective solubility of this
agent in aqueous systems like the body. Because the folate moiety was conjugated to the hydro-
phobic end of the block copolymer, it is expected that upon nanosphere formation it will
be localized in the inner core of the particles. However, XPS characterization demonstrated the
presence of nitrogen-containing molecules at the surface which could only be attributed to the
folate linker. Although the targeting effectiveness of these particles was not determined, cyto-
toxicity studies revealed that encapsulation of paclitaxel into the nanospheres reduced its
HO
N
N
N
N
NH
2
NH
NH
O
O
HO
O
OH
FIGURE 12.1 Chemical structure of folic acid. Conjugation to folic acid for folate targeting is commonly
done at the g-carboxyl group.
Polymeric Nanoparticles for Tumor-Targeted Drug Delivery 221
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cytotoxicity. Consequently, encapsulation offered a safe alternative to direct administration of this
chemotherapeutic agent. Further studies should evaluate whether conjugation of folic acid to
hydrophobic end of the block copolymer results in sufcient surface availability of this
targeting agent.
Another approach to folate targeting of nanoparticles has been the modication of surface
properties of polymeric nanoparticles with polymer conjugates including the targeting agent. For
example, Kim reported on the modication of anionic poly(lactic-co-glycolic acid) (PLGA) nano-
particles prepared by emulsication and solvent evaporation with a cationic poly(L-lysine)-
poly(ethylene glycol)-folate (PLLPEGFOL) copolymer.
66
In this design, the polycation PLL
block attaches to the PLGA nanoparticle through ionic interactions. Surface coating is achieved
by simple incubation in an aqueous solution containing the PLLPEGFOL copolymer. The PEG-
folate end of the copolymer is oriented toward the outer aqueous phase for better interaction
between folate and the targeted cell membrane receptor. XPS characterization demonstrated the
presence of nitrogen from folic acid on the surface of the coated nanoparticles. In vitro cellular
studies with FITC-labeled nanoparticles revealed an increase in uptake of coated nanoparticles with
increased conjugate-to-nanoparticle ratio in KB cells. Since a decrease in uptake was seen upon
addition of free folic acid in the medium, the transport of nanoparticles into the cells was attributed
to endocytosis mediated by the folate receptor.
Dendritic polymer systems of polyamidoamine (PAMAM) with folic acid as the targeting agents
and drug and imaging agent (methotrexate or tritium and uorescein or 6-carboxytetramethylrho-
damine) were prepared and tested in mouse models.
67
It was found that targeted systems, as opposed
to nontargeted systems, slowed the rate of tumor growth and even showed a complete cure in one
mouse. This study was conducted with twice-weekly tail vein injections. The biodistribution studies
showed that, for a single targeted injection of nanoparticles, a very high amount of the nanoparticles
accumulated within the tumor by day 1; this level remained high through at least day 4.
Nanometric particles prepared from drug-polymer conjugates have also been reported. In one
notable study, Yoo and collaborators reported on the formulation of doxorubicin-PEG-folate nano-
aggregates encapsulating additional doxorubicin in their core.
11
These aggregates are formed
spontaneously when an organic phase containing the copolymer and solubilized doxorubicin is
dispersed into an aqueous phase containing triethylamine. The basic aqueous environment results in
deprotonation of doxorubicin, causing it to form aggregates with the hydrophobic copolymer. The
average aggregate diameter was approximately 200 nm. In vitro cellular studies showed increased
uptake of the nano aggregates in cells expressing the folate receptor when folic acid was absent
from cell media and increased cytotoxicity (anti-tumor efcacy) of the aggregates compared to the
free drug in cells expressing the FR. In vivo studies in mouse xenografts (KB cells) showed that
the nanoaggregates had superior therapeutic efcacy than both doxorubicin aggregates without the
folic acid ligand and free doxorubicin in solution.
Nanoparticles of temperature-responsive hydrogels conjugated to folic acid have also
been studied with the purpose of delivering chemotherapeutic agents. Nayak reported on poly
(N-isopropylacrylamide) (pNIPAM) nanoparticles that exhibit lower critical solution temperature
(LCST) behavior.
68
Fluorescent agents were included in the core of these nanoparticles to facilitate
with tracking; amine comonomers were incorporated into the other pNIPAM shell for conjugation
to folic acid. These nanoparticles swell when their temperature falls under their LCST. Indeed, the
nanoparticle size increased from w50 nm at 378C to w135 nm at 258C. In vitro cell uptake studies
showed a 10-fold increase in the intake of nanoparticles conjugated to folic acid compared to those
without the targeting agent in KB cells (FRC).
12.5.2 FOLATE-TARGETED NANOPARTICLES FOR GENE DELIVERY
The use of folate-targeted nanoparticles for gene delivery has also been studied. In gene delivery,
tissue targeting is very important for the efcacy and safety of treatment. To date, the transfection
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efciency offered by synthetic gene delivery systems is very low compared to that of viral vectors.
This is also true for nanoparticle-based systems. Extensive research is being done in the area to
improve transfection efciencies by designing better delivery systems with improved targeting
ability, DNA stabilization, and cellular interaction.
Mansouri reported on the formulation of nanoparticles through the complex coacervation of
chitosan-folic acid conjugates with DNA.
69
Chitosan is a biocompatible polycation that joins to
form a complex with DNA through electrostatic interactions and provides protection against
nuclease degradation. Complex coacervation is an optimal preparation technique for the encapsu-
lation of DNA because it avoids the use of organic solvents and high-energy ultrasonication.
Results revealed that the integrity of plasmid DNA in the particles was maintained and that
conjugation of chitosan to folic acid did not interfere with the electrostatic interaction between
chitosan and DNA. As expected, the ratio of chitosan to DNA, and consequent charge ratio, had an
effect on particle size and zeta potential. Nanoparticles smaller than 200 nm were obtained with a
chitosan amino group to DNA phosphate group ratio of more than 2. The use of these nanoparticles
consequently offers a promising alternative for nonviral gene therapy for the treatment of cancer
and other diseases in which folate receptors are overexpressed.
Nanoparticles with a poly(L-lactic acid) (PLL) core and a polyethyleneimide (PEI) surface
conjugated to folate were utilized for delivery of plasmid DNA.
70
Folic acid was conjugated to
the N-terminal amino group of PEI. PEI is a polycation that has been used in the past for DNA
condensation and delivery because it protects DNA from degradation through an endosomal escape
mechanism. Here nanoparticles were prepared through the self-assembly of the amphiphilic folate-
PEIPLL copolymer with DNA in an aqueous medium. Nanoparticles of approximately 100
150 nm in diameter and spherical shape were produced. In vitro luciferase transfection studies
revealed that this system actually resulted in lower luciferase expression than
PEIDNA complexes.
In a separate report, folate-polyethyleneglycoldistearoylphophatidylethanolamine conjugate
(f-PEGDSPE), 3([N-(N
0
,N
0
-dimethylaminoethane)-carbamoyl] cholesterol, and Tween 80 were
used to complex with DNA into cationic nanoparticles of 100200 nm in diameter with a modied
ethanol injection method.
71
The formulation was carried out by dissolving the lipids in ethanol and
then removing the solvent through evaporation in the presence of water. The folate moiety, which is
conjugated to the PEG end of one of the lipid conjugates, naturally localizes at the surface of the
nanoparticles because of PEG migration toward the water phase. Tween 80, a nonionic surfactant,
and PEG were incorporated with the purpose of improving the in vivo stability of the cationic
nanoparticles through steric hindrance. The size of the nanoparticles with higher PEG content was
maintained in the presence of serum. This suggests that these nanoparticles are better able to
maintain their structural integrity in the presence of anionic competitors present in blood. Folate
targeting enhanced association and transfection efcacy of nanoparticles complexed with a luci-
ferase-encoding plasmid on FR(C) KB cells. The association and efcacy were reduced when folic
acid was present in the medium, thus revealing the involvement of the folate receptor in the
transport of the plasmid DNA into the cells.
A possible limitation of folate targeting is the noted variability of FR expression levels not only
between patients, but also within a single tumor.
44
In addition, it has been reported that expression
of FR in cancerous cell lines is not representative of those one sees in vivo.
44
Consequently,
screening protocols for FR expression will need to be utilized clinically in order to determine if
folate-targeted therapies are appropriate.
12.6 APPROACHES FOR CANCER TARGETING TO SPECIFIC CANCER TYPES
In a recent review, Kim and Nie describe passive and active targeting methods and then go into
detail on a number of active targeting techniques.
72
The active target combinations they mention
Polymeric Nanoparticles for Tumor-Targeted Drug Delivery 223
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are lectincarbohydrate, ligandreceptor and antibodyantigen. One limitation of using these
targeting strategies is that the lectincarbohydrate targeting systems are usually targeted to
whole organs, making them inappropriate for targeting a cancerous part of a particular organ or
tissue. New antibody systems show a great deal of promise. Unfortunately, they also have poten-
tially harmful side effects such as advanced gastric adenocarcinoma. The latter arises when one
attempts to target breast cancer on account of the fact that antigen-positive normal cells to the
antibody BR96 in gastric mucosa, small intestine, and pancreas. Some of the aspects of angiogenic
targeting mentioned here have already been covered elsewhere in this chapter. Specic targeting
systems that are in use as cancer therapeutics are shown in Table 12.1.
8,72
12.6.1 PROSTATE CANCER
Recently, aptamers have been used to target nanoparticulate systems to prostate-specic membrane
antigen, a known prostate cancer tumor marker. A model drug, rhodamine-labeled dextran, was
encapsulated in PEGylated poly(lactic acid) nanoparticles, which were subsequently surface
modied with a prostate specic RNA aptamer (A10). Binding of the aptamer nanoparticles to
LNCaP cells expressing prostate specic membrane antigen in vitro was signicantly enhanced
when compared to a control of nontargeted particles. Additionally, very low binding was seen on
nonprostate specic membrane antigen expressing cells (PC3). The nanoparticles were shown to
both target and be taken up by the prostate cancer epithelial cells. This evidence points to the
conclusion that this novel aptamer-based, targeted nanoparticle delivery approach can be effective.
73
Gao and collaborators report the use of quantumdots (QD) for in vivo targeting of prostate cancer
and imaging of tumors.
7
The core-shell CdSeZnS quantum dots contain tri-n-octylphosphine
oxide (TOPO) that binds to a covering of high molecular weight ABC triblock copolymer of
polybutylacrylate, polyethylacrylate, polymethacrylic acid, and an 8-carbon alkyl side chain.
The complex is functionalized with PEG molecules and monoclonal antibodies to prostate-specic
membrane antigen. Specic binding was shown for prostate cancer lines whereas low binding was
seen to normal cells. The QD-antibody formulations were studied in vivo in a mouse model human
prostate cancer. The nanoparticles were shown to target to the tumor both by passive and active
antibody targeting. Sensitive and multicolor uorescence imaging of cancer cells in vivo was
TABLE 12.1
Targeting Systems Utilizing Antibodies Currently in Use to Treat Cancer
Mechanism
Antibody
Target Trade Name
Agonist activity CD40, CD137 Various
Antagonist activity CTLA4 MDX-010
Angiogenesis inhibition VEGF Avastine
Antibody-dependent cell-mediated cytotoxicity CD20 Rituxan
w
, HuMax-CD20, Zevalin
w
Inhibition of binding of extracellular growth signals HER-2/neu Herceptin
Receptor blockage EGF receptor HuMax-EGFr
Toxin-mediated killing CD33 Mytotarg
w
Disruption signaling HER-2/neu Pertuzumab (2C4)
Complement-dependent cytotoxicity CD20 Rituxan
w
, HuMax-CD20
Blockage ligand binding EGF receptor Erbutixe
Antibody-dependent lysis of leukemic cells following
cell binding
CD52 Campath
w
Inhibits phosphorilation of tyrosine kinases EGF receptor Iressa
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accomplished in this study. Nonspecic uptake was seen in the liver and spleen with little or no
uptake in other organs.
12.7 TARGETED NANOPARTICLES AND IMAGING OF CANCER
Hofmann and collaborators have evaluated the ability of super paramagnetic iron oxide nanoparti-
cles (SPION) to interact with human melanoma cells in such a way that these particles could be
selectively targeted to tumor cells ands then imaged using MRI.
74
They varied the coating placed on
these particles and found that when comparing particles coated with poly(vinyl alcohol) (PVA), a
vinyl alcohol/vinyl amine copolymer (amine-SPION), PVA with randomly distributed carboxylic
groups or PVAwith randomly distributed thiol groups, human cells in culture would interact strongly
only with the amine-SPION particles. Furthermore, these particles showed the lowest cytotoxicity.
This human study involved intravenous administration of Combidex (Advanced Magnetics,
Inc., ferumoxtran-10, a molecular imaging agent of iron oxide nanoparticles and a dense packing of
dextran derivatives) to 18 men ages 2146 with diagnosed testicular cancer.
75
The Combidex was
imaged using MRI. From this study, it seems evident that those lymph nodes with a higher signal
were classied as being malignant. However, based on the information from Advanced Magnetics,
these particles should accumulate selectively in noncancerous lymph node tissue. The particles are
still experimental and rightly so.
Although treatment of cancer with targeted nanoparticles is an important goal, more accurate
imaging of cancer is needed to allow for the optimal treatment for each patient. Towards that end,
a considerable amount of research is underway with various imaging techniques to establish more
accurate determination of the presence and extent of cancer growth and metastases. Because magnetic
resonance imaging (MRI) is a widely used imaging technique, much work is currently being done to
develop targeted imaging agents for MRI. Some of these involve paramagnetic and superparamag-
netic iron oxides due to their ability to affect water relaxation times T
1
and T
2
. Gasco and collaborators
have prepared solid lipid nanoparticles containing Endorem, superparamagnetic iron oxide nanopar-
ticles (Guebert and Advanced Magnetics), using either a multiple emulsion technique or an oil in
water emulsion technique.
76
Although the loading rates achieved were less than 1 wt% iron, it was
possible to detect and image in vivo in rats. Incorporation of the Endorem in the SLNallowed passage
across the blood brain barrier, passage which was not possible with Endorem alone.
Often development of nanoparticle systems is a two-pronged approach involving both drug and
imaging agent. If a targeting system is successful, one should be able to enhance the imaging of a
cancer and then kill it with the same system. One such study involved the preparation of glycol
chitosan nanoaggregates to which either uorescein isothiocyanate (FITC) or doxorubicin (Dox)
was conjugated.
12
Based on a single tail-vein injection of FITC-conjugates, levels remained high for
eight days and gradually increased in the tumors of rats with II45 mesothelioma cells, in the kidney,
and to a lesser extent in the spleen. Meanwhile, levels decreased in other organs. The liver showed
some accumulation at day 3 but was signicantly lower at day 8 relative to days 1 and 3. The
performance of these systems, as evidenced by a decrease in tumor volume, was excellent with a
consistent decrease in tumor volume after day 13 when a tail-vein injection of Dox-nanoaggregates
is given at days 13 and 19.
12.8 OTHER TARGETS FOR CANCER
A new approach to targeting is the use of lectins, which are plant proteins that specically recognize
cell surface carbohydrates. The latter function as selective cancer-cell-targeting agents. PLGA
nanoparticles of mean diameter 331 nm incorporating isopropyl myristate were used to deliver
paclitaxel to malignant A549 and H1299 and normal CCL-186 pulmonary cells in vitro by means of
wheat germ agglutinin lectin as the targeting molecule. The in vitro cytotoxicity against A549 and
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H1299 cells was signicantly increased with wheat germ agglutinin-conjugated PLGA nanoparti-
cles containing IPM and paclitaxel compared to controls.
77
In a subsequent study, Mo and Lim
evaluated in vivo efcacy of the same nanoparticles in a SCID mouse model injected with an A549
tumor nodule.
78
One injection of wheat germ agglutinin-conjugated PLGA nanoparticles
containing IPM and a paclitaxel dose of 10 mg/kg inhibited tumor growth without appreciable
weight loss. Tumor doubling was increased to 25 days compared to 11 days for conventionally
formulated paclitaxel.
12.9 AVIDIN AND BIOTIN TARGETING
Although it is by far the most widely utilized polymer for surface modication of nanoparticles,
PEG is not the only compound that can be included at the surface of nanoparticles. Nor is it
necessary to achieve active targeting. Saltzman has recently reported a method for incorporating
avidin-fatty acid conjugates into the surface of PLGA nanoparticles.
79
This method resulted in
avidin at the surface of the nanoparticles that remained active for weeks. The ability of these
nanoparticles to target to biotin was veried by targeting of the nanoparticles to biotinylated
agarose beads. Not only could this system be used for targeted delivery; it can also be utilized to
selectively modify surfaces for tissue engineering.
In another such example, Hunziker has prepared biotin-functionalized (poly(2-methyl-
oxazoline)-b-poly(dimethylsiloxane)-b-poly(2-methyl-oxazoline) triblock copolymers.
80
The
biotinylated targeting agents were added using streptavidin as a coupling agent. Uptake of these
nanocontainers was seen in the presence of the target receptor, the macrophage scavenger
receptor SRA1, but not in the absence of this target.
12.10 CONCLUSIONS
The amount of research in targeted, polymeric nanoparticles for cancer imaging and therapy has
increased dramatically in the past 510 years. Seeing actual products using targeted therapies has
no doubt fueled that work. In the next decade, we will certainly see products, whether with
polymeric nanoparticles or some other type of delivery system, using folate receptors and carrying
imaging agents. All of these technologies, driven by the elds of fundamental immunology,
biochemistry, polymer chemistry, and biomedical engineering, are bringing us closer to the time
when cancer may be treated on an individual basis. One patients diagnosis and treatment will be
unique to her condition and will be the most effective treatment possible for her. Until other
scientists determine how to stop cancer from occurring, those mentioned in this chapter and
many more besides them are doing their best to eliminate cancer.
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