1. Introduction
Breast cancer remains one of the most common cancers in women. It is the second most common cancer among American women, with 13% of the entire female population facing the risk of cancer development some time in their lives [
1]. The receptor status of breast cancers is used in clinics to identify the subtypes and subsequent treatment plans [
2]. For example, epidermal growth factor 2 (ERBB2/HER2) is a transmembrane receptor tyrosine kinase that is overexpressed in approximately 20% of all breast cancer patients. ERBB2-targeted therapies such as anti-ERBB2 antibodies (such as trastuzumab or pertuzumab) or tyrosine kinase inhibitors (such as lapatinib and neratinib) have been successfully used against these types of breast cancers [
2,
3]. Nevertheless, for patients that are diagnosed with triple-negative subtypes—those that do not express genes for estrogen, progesterone, and ERBB2 receptors—the anticipated outcome and overall survival (OS) remains much lower (OS of 10–13 months vs. 5 years for
ERBB2+) due to the lack of tumor-specific markers and their aggressive nature [
2,
4]. The standard of care for triple-negative breast cancer is neoadjuvant chemotherapy, in which drugs such as doxorubicin (DOX) are administered prior to the surgical removal of the tumor [
2,
5,
6]. However, these cytotoxic drugs fail to discriminate between normal and cancerous cells, preventing the use of a large dose due to potential systemic toxicity.
Nanoparticle formulations such as liposomal doxorubicin (Doxil) and albumin-bound paclitaxel (Abraxane) have been developed to overcome such issues. In particular, Abraxane has gained great interest because it was the first commercialized nanoformulation that utilized fully biocompatible, nontoxic, and nonimmunogenic serum proteins for enhancing the therapeutic index. As such, since the advent of albumin nanoparticles, different groups have investigated various methods of albumin nanoparticle formulation [
7]. Of such methods, the desolvation method had gained wide popularity due to the simplicity in production with predictable outcomes [
8,
9]. During the desolvation process, albumins are crosslinked with agents such as glutaraldehyde (GTA) to yield uniform, spherical nanoparticles with negative surface charges. In addition to using GTA as a crosslinker, carbodiimides [
10] and thiolated albumins that form additional disulfide crosslinking [
11] have been also evaluated. Nevertheless, the presence of open-armed crosslinkers such as the free aldehyde group present on GTA may elicit potential toxicity or non-specific interactions, preventing the full release of the therapeutic payload. Therefore, we have developed a modified albumin nanoparticle with a reduced surface, which still maintains the important qualities associated with albumin nanoparticles as a vehicle while minimizing active functional groups to eliminate the potential complications described above.
Based on a meta-analysis, less than 0.7% of the administered nanoparticle dose is found to be delivered to the tumor of interest [
12]. Therefore, not only is developing a biocompatible drug delivery platform that can selectively release the cargo at the target of interest important, but implementing a method to improve the drug and nanoparticle accumulation at the target to further complement the enhanced permeability and retention (EPR) effect is just as important. To address this issue, the use of focused ultrasound as a method to enhance drug delivery has gained great interest in recent years. This technique has been used to temporarily disrupt the blood–brain barrier (BBB), creating vascular fenestrations for small molecules to extravasate and enter the central nervous system (CNS) [
13,
14]. In addition, this concept of creating temporary openings has been applied to internal tumors with poor vascularization and high interstitial pressure, allowing the better accumulation of drugs and nanoparticles of interest at the target [
15,
16,
17].
In this study, we developed acid-sensitive DOX-loaded albumin nanoparticle formulations combined with focused ultrasound treatment for preferential accumulation at the target of interest and competent drug release. Unlike conventional desolvation-based albumin nanoparticles, our reduced albumin nanoparticles fully release the therapeutic cargo at acidic pH as found in the tumor microenvironment and intracellular compartments such as the lysosome. By enhancing the EPR effect, we were also able to increase the accumulation of nanoparticles at the tumor site, which resulted in an improved therapeutic index.
3. Discussion
Many chemotherapies that are used in clinics today are flawed due to the potential toxicity associated with them. Anthracyclines such as doxorubicin that intercalate between the DNA base pairs and prevent DNA replication are extremely efficient in exerting cytotoxic effects against cancerous cells, but they are indiscriminative and damage normal cells as well [
20,
21]. The known side-effects of doxorubicin include dose-dependent cardiac toxicity from dilated cardiomyopathy, which can lead to congestive heart failures [
21,
22,
23]. Accordingly, various efforts have been combined to address two central aims in drug-mediated therapies: maximizing drug specificity by enhancing the amount of drug exposure only at the target of interest, and minimizing drug toxicity by reducing the amounts of drugs that reach non-targeted regions (i.e., normal cells) and elicit non-specific damage. Nanoparticle formulations based on organic materials such as phospholipids, polymers, or proteins have been used in the past, but many of these formulations were based on weak interactions between the constituents, leaving their stability to be questioned [
24,
25]. Those that use covalent crosslinking to enhance the stability of the nanoparticles have been also researched, but the extent to which crosslinkers could have potential non-specific interactions have not been considered. The amine groups present on DOX have been often utilized as a target for stable crosslinking onto nanoformulations [
26,
27,
28]. However, while this covalent bonding would be useful for stability, the efficacy and toxicity profiles of the drug would then need to be re-evaluated completely because the molecular characteristics would change dramatically.
To address these challenges, we present a novel combination of albumin-based nanoparticle formulations with focused ultrasound treatment to greatly improve both efficacy and toxicity profiles. Such nanoformulations are first reacted with sodium borohydride to reduce active aldehyde groups on the surface to alcohols, minimizing their potential toxicity and reactivity. As the active aldehyde groups are eliminated, the amine group on DOX will not react covalently with the particles’ surface, ensuring that the loaded DOX is bound on the reduced nanoparticles mainly by the reversible electrostatic forces, unlike for the regular albumin nanoparticles. Such a reduction step could therefore allow the improved controlled release of the therapeutic payload upon specific triggers such as acidic pH without altering the structure of the contents themselves involved in the breakdown of covalent bonds. The release of DOX from the albumin nanoparticles, especially from the reduced ones, was therefore maximized when the pH of the environment was acidic—as found in tumor microenvironments, where the pH is reported to be <6.5 [
29]—but not in regions with physiological conditions, as described in
Figure 3. The data from confocal microscopy also support this hypothesis, as it was observed that stronger fluorescence signals were observed with rDOX at 2 h post-incubation than with sDOX, which we speculate to be induced by the improved release of the drug. Cardiotoxicity, including changes in myocardial structure and function to severe cardiomyopathy, is a major side-effect associated with the administration of DOX at high doses. One of the clinical symptoms associated with such heart conditions is cardiac enlargement, which can cause heart failure. Based on our organ-based toxicity data, cardiac enlargement was observed in the mice with one-time administration of 10 mg/kg of free DOX, but not in the mice that received 75 mg/kg DOX loaded on albumin nanoparticle formulations. In addition, the rAlb-NP vehicle itself did not cause any significant changes in the survival, overall body mass, individual organs, or observable behavioral patterns at up to 400 mg/kg, suggesting that the albumin nanoparticles themselves are not toxic.
We also employed focused ultrasound to enhance the accumulation of nanoparticles where the local release of DOX would be facilitated. The use of ultrasound to improve local drug delivery is a relatively well-established technique that is currently being applied in numerous preclinical and clinical models, including brain, breast, and pancreatic cancers. By temporarily disrupting the endothelial linings by microbubble-assisted cavitation, focused ultrasound can further augment the enhanced permeability and retention effects and increase the number of nanoparticles available locally, as observed from the IVIS Spectrum-based fluorescence data. Combining both the enhanced localization and improved control of DOX release, we observed a significant improvement in the anti-cancer activities when rDOX was used in combination with focused ultrasound, compared to standalone DOX therapies or rDOX therapies. However, unlike rDOX vs. Rdox + US, we did not observe a statistically significant increase in anti-cancer effects for DOX vs. DOX+US or sDOX vs. sDOX + US. We hypothesized two potential explanations for the observed phenomena based on experimental evidence: (1) Ultrasound-mediated drug delivery is most effective against tumors with low permeability [
30,
31]. Because DOX molecules themselves were effective (i.e., able to reach the tumor to elicit anti-cancer effects) in the mouse models used in this study, introducing ultrasound treatment to enhance permeability was not as effective as in other models such as pancreatic cancer models [
15] reported in the literature. (2) Nanoparticles are much bigger than the drug molecules themselves; therefore, using ultrasound to introduce extra fenestrations in the vasculature for extravasation into the tumor interstitial space would be much more beneficial for the nanoparticles than the drugs, as observed in rDOX vs. rDOX + US. Nevertheless, because sDOX has poor release profiles when compared to rDOX, not all sDOX molecules that reach the tumor microenvironment may fully release their payload, reducing their therapeutic efficacy. Nevertheless, the tremendous increase in the therapeutic efficacy and toxicity profiles presented by rDOX and its synergistic effects with focused ultrasound shows promise for the next generation of drug delivery platforms using fully biocompatible albumin-based nanoparticles in combination with an external stimulus. Further studies on optimizing the therapeutic conditions, including the drug dose, schedule, ultrasound parameters, drug combinations, and potential resistance, are required to maximize such potential and introduction into clinical settings.
4. Materials and Methods
4.1. Reagents and Equipment
Human serum albumin (HSA) was acquired from SK Chemicals (SK Chemicals, Seongnam, Korea). Doxorubicin (DOX) was acquired from Boryung Pharmaceutical (Boryung Pharmaceutical, Seoul, Korea). Sodium borohydride (NaBH4), sodium cyanoborohydride (NaCNBH3), silver nitrate solution, and glutaraldehyde (GTA) were purchased from Sigma Aldrich (St. Louis, MO, USA). SonoVue® microbubbles (MB) were acquired from Bracco (Bracco, Italy). Zolazepam (Zoletil®) was obtained from Virbac (Virbac, Carros, France), and xylazine hydrochloride (Rompun 2%) was acquired from Bayer (Bayer Korea, Seoul, Korea). The 1260 Infinity II LC system was acquired from Agilent Technologies (Agilent Technologies, Santa Clara, CA, USA). The VIFU 2000® was acquired from Alpinion Medical Systems (Alpinion Medical Systems Co., Ltd., Seoul, Korea).
4.2. Preparation of Albumin Nanoparticles
Human serum albumin nanoparticles (Alb-NPs) were synthesized based on a modified desolvation protocol [
18]. One gram of HSA was added to 340 mL of distilled water, and 2000 μL of 1 M sodium hydroxide (NaOH) was added dropwise to adjust the pH. To induce the agglomeration of HSA, ethanol was added dropwise under stirring conditions (500 rpm) at room temperature until turbidity of the solution was obtained. Excess 8% GTA solution (1000 μL) was added to the HSA aggregates and reacted for 24 h under stirring conditions to ensure complete crosslinking. After crosslinking was completed, the solution was centrifugated at 15,000 rpm for 15 min at 4 °C, and the pellet was re-dispersed with distilled water three times to remove unbound chemicals and then kept in a refrigerator until further use.
4.3. Preparation of Reduced Alb-NPs (rAlb-NPs)
One hundred micrograms of Alb-NPs was added to 20 mL of ethanol, and 100 μL of reducing agent (sodium borohydride and sodium cyanoborohydride, respectively) was added under stirring (500 rpm) overnight. The pH was adjusted to 7.5~8.5 with 1 M sodium hydroxide. The solution was centrifugated at 15,000 rpm for 15 min at 4 °C, and the pellet was re-dispersed with distilled water three times to remove unbound chemicals and then kept in a refrigerator until further use. In addition, the rAlb-NPs were checked for purity using the ICP-AES methodology.
4.4. Characterization of the Alb-NPs and rAlb-NPs
The hydrodynamic size, polydispersity, and zeta potential of the prepared nanoparticles were measured using the dynamic light scattering (DLS) method (Zetasizer Nano ZS90; Malvern Instruments, Malvern, UK). The detection of free aldehyde in both groups was performed using Tollens’ reagent according to the manufacturer’s protocol. In short, 0.3 M NaOH solution was added dropwise to 0.3 M silver nitrate solution until a silver precipitate formed, to which 3 M ammonia solution was added dropwise until the solution’s color became transparent. Ten milliliters of the prepared Tollens’ reagent was added to 10 mL of 1 mg/mL of Alb-NPs or rAlb-NPs (reduced by NaBH4 or NaCNBH3) and reacted for 6 or 24 h, and the change in color was observed. The detection of boron was evaluated using ICP-AES at the National Center for Inter-University Facilities (Seoul National University, Korea). The morphology and size of the nanoparticles were further studied with transmission electron microscopy (TEM) and scanning electron microscopy (SEM) for further analysis at the National Center for Inter-University Facilities, Seoul National University (South Korea). Last, the stability of the nanoparticles was analyzed by characterizing the stored nanoparticles every month.
4.5. Preparation of DOX-Loaded Albumin Nanoparticles
We have evaluated three different methods of loading DOX onto the albumin nanoparticles. The first method involved encapsulating DOX before ethanol addition during the desolvation process. DOX was added in weight ratios of 1:3, 1:5, and 1:10 of DOX to HSA. The HSA–DOX mixture was stirred for an hour; then, ethanol was added dropwise until the mixture turned turbid. GTA (8%) was added, and the reaction was performed for 24 h under stirring conditions (500 rpm). After the crosslinking of the HSA and DOX mixture was completed, the solution was centrifuged at 15,000 rpm for 15 min at 4 °C and the pellet was re-dispersed with distilled water three times to remove unbound chemicals. The supernatants from each wash were collected and analyzed with HPLC to calculate the loading efficiency for DOX. The albumin nanoparticles encapsulating DOX were termed cDOX.
The second and the third methods of loading DOX involved first synthesizing albumin nanoparticles based on the desolvation and reduction methods outlined previously and then coating the Alb-NPs with DOX. A 90 mg amount of the albumin nanoparticles in 5 mL of solution (prepared according to
Section 4.2 and
Section 4.3) was reacted with DOX at different weight ratios (
w/
w% of 1:1, 1:2, 1:3, 1:5, and 1:10 DOX/albumin nanoparticles) for 24 h at room temperature in the dark under stirring conditions (500 rpm). The DOX–albumin nanoparticle mixtures were topped up to 10 mL using deionized water and adjusted to pH 8.5 to prevent aggregation during the reaction. The solution was centrifugated at 18,000 rpm for 15 min at 4 °C, and the pellet was re-dispersed with distilled water three times to remove unbound chemicals. The supernatants from each wash were collected and analyzed with HPLC to calculate the loading efficiency for DOX. The albumin nanoparticles coated with DOX were termed sDOX and rDOX (reduced).
4.6. In Vitro Kinetics of DOX Release from Albumin Nanoparticles
cDOX, sDOX, and rDOX were added at 50 mg/mL into membrane dialysis bags (cutoff Molecular Weight (MW), 2000), which were transferred into beakers containing 50 mL of buffer solutions prepared at various pHs (pH 7.4, 6.5, and 5.5). The solutions were incubated at 37 °C while under mechanical stirring. At each time point (1, 3, 6, 9, and 24 h after addition), 1 mL aliquots of the solutions were transferred to 1.5 mL Eppendorf tubes and centrifuged at 15,000 rpm for 30 min at 4 °C to separate the released DOX from the nanoparticles. The amount of DOX released from the nanoparticles was measured by analyzing the supernatants with HPLC at 260 nm to quantify the amount of DOX released.
4.7. Cell Culture
Human triple-negative breast cancer cell line MDA-MB-231 and murine macrophage cell line Raw264.7 cells were acquired from the American Type Culture Collection (ATCC) and were cultured in Dulbecco’s Modified Eagle Medium (DMEM) supplemented with 10% heat-inactivated fetal bovine serum (FBS), 100 IU/mL penicillin, 100 mg/mL streptomycin, and 2 mM L-glutamine. Cultures were maintained in a humidified atmosphere with 5% CO2 at 37 °C and routinely tested for mycoplasma contamination. Cells were sub-cultured once they reached 80% confluency, determined by the trypan blue dye exclusion method.
4.8. Cell Viability Assay
The CellTiter 96® AQueous One Solution Cell Proliferation Assay (MTS) was used to assess the effects of nanoparticles on cell viability. MDA-MB-231 and Raw264.7 cells were seeded on 96-well plates at a density of 5 × 103 cells per well and incubated overnight. First, the effects of bare albumin nanoparticles on cell viability were evaluated by adding various concentrations of Alb-NPs and rAlb-NPs to both Raw264.7 and MDA-MB-231 cells. In addition, the cytotoxic effects of the drugs were examined by adding DOX, cDOX, sDOX, and rDOX into cells and incubating for up to 72 h. Cells were removed from the incubator at designated time points, and their viability was evaluated against the phosphate-buffered saline (PBS) controls using the MTS solution to derive approximate IC50 values.
4.9. Confocal Laser Scanning Microscopy
MDA-MB-231 cells were seeded on 8-well chamber slides (Nunc™ Lab-Tek™ II Chamber Slide™ System, Thermo Fisher Scientific, Waltham, MA, USA) at a density of 3 × 10
4 cells per well and incubated overnight. Albumin nanoparticles encapsulating Cy5.5-NHS ester dye (Lumiprobe, Hallandale Beach, FL, USA) were prepared by adding the fluorophore instead of DOX during the desolvation process described in
Section 4.2 (Cy5.5-Alb-NPs). On the next day, the cells were treated with various concentrations of Cy5.5-labeled and DOX-loaded albumin nanoparticles and were further incubated for a varying period. Once incubation was completed, the cells were fixed for 15 min with 4% formaldehyde and counter-stained with 4′,6-diamidino-2-phenylindole dyes (DAPI, Thermo Fisher Scientific, Waltham, MA, USA). During the fixation and staining processes, the cells were washed with fresh PBS. The images were acquired using a confocal microscope (Carl Zeiss, Inc., Oberkochen, Germany), using the excitation/emission wavelengths of 358/461, 470/595, and 684/710 nm for DAPI, DOX, and Cy5.5, respectively.
4.10. In Vivo Study
Immunocompetent female BALB/c mice and immunodeficient BALB/c nude mice that were 6–8 weeks old were purchased from Orient Bio (Seoul, Korea) for the toxicity and efficacy studies, respectively. The mice were acclimated for a week before the start of the study and were maintained at standard conditions in specific pathogen-free (SPF) environments: 25 ± 2 °C temperature, 50 ± 10% relative humidity, and 12 h light/12 h dark. All mice were fed with sterilized standard mouse chow and water ad libitum. After the acclimatization periods, 1 × 106 MDA-MB-231 cells suspended in Matrigel (Corning, Tewksbury, MA, USA) were injected into the right flank regions of the nude mice. Once the tumor volume had reached ~150 mm3, the mice were randomly sorted for the treatment. The tumor sizes were monitored with a digital caliper, and the volumes were calculated according to the formula width2 × length × 0.5. All the in vivo protocols (Approval Number: BA1906-275/046-01) were verified according to the guidelines of the Seoul National University Bundang Hospital.
4.11. Ultrasound Treatment Protocols
A focused ultrasound system (VIFU 2000®, Alpinion Medical Systems, Seoul, Korea) was used for focused ultrasound (FUS) treatments: a 1.1 MHz single-element, spherically focused transducer with a central circular opening of 40 mm in diameter, creating a focal zone of 1.3 × 1.3 × 9.2 mm with a center frequency of 1.1 MHz at −6 dB, was controlled with a 3D target position system and ultrasound guidance to precisely deliver therapeutic ultrasound to the target. A degassing chamber was used to ensure that gas levels in the system were kept to a minimum (≤4 ppm) during the treatment. After injecting the mice with therapeutic formulations (drug + microbubbles), pulsed FUS beams with the acoustic parameters of a 1.1 MHz frequency, 20 watts of power, a 40 Hz pulse repetition frequency, a 5% duty cycle, 5 s of ultrasound exposure per spot, and a 2 mm spot distance were applied at the tumor.
4.12. Biodistribution and IVIS Spectrum
Albumin nanoparticles encapsulating Cy5.5 dyes (Cy5.5-Alb-NPs) were prepared according to the protocol described in
Section 4.9. Four experimental groups—(i) negative control injected with saline, (ii) Cy5.5-Alb-NPs, (iii) Cy5.5-rAlb-NPs, and (iv) Cy5.5-Alb-NPs + MB + FUS—were prepared. For the treatments, 200 μL amounts were injected intravenously into the MDA-MB-231 tumor-bearing mice. After 24 h, the mice were sacrificed and the Cy5.5 fluorescence signals from the tumors were analyzed using the In Vivo Imaging System (PerkinElmer, Waltham, MA, USA).
4.13. Experimental Groups and Protocols for Efficacy Study
The experimental groups for the efficacy study were defined as follows: (i) negative control injected with saline, (ii) DOX (2 mg/kg), (iii) sDOX only (2 mg/kg), (iv) rDOX only (2 mg/kg), (v) MB + FUS, (vi) sDOX + MB + FUS, and (vii) rDOX + MB + FUS. Before the treatment, intraperitoneal general anesthesia was administered using a mixture of 30 mg/kg Zoletil and 10 mg/kg Rompun 2%. All experimental groups received their treatments intravenously, and those that concurrently received ultrasound treatment were additionally administered with 200 μL of SonoVue (1 × 108 MB/mL) immediately after the injection of the respective treatments. Each group received five treatments on Days 3, 7, 10, 14, and 17, and the tumor sizes were monitored biweekly for up to 4 weeks after the final treatment.
4.14. Experimental Groups and Protocols for Toxicity Study
The experimental groups for the acute toxicity study were defined as follows: (i) negative control injected with saline, (ii) DOX (10 mg/kg), (iii) DOX (20 mg/kg), (iii) DOX (30 mg/kg), (iv) rDOX (50 mg/kg DOX), (v) rDOX (75 mg/kg), (vi) rDOX (100 mg/kg), and (vii) rDOX (200 mg/kg). Each group received a single intravenous injection of 200 μL of the respective treatment. The mice were monitored for two weeks following the injection, and their weights and conditions were recorded at Days 2, 3, 7, 13, and 14 post-injection. At Day 14, the surviving mice were sacrificed, and their organs—liver, lungs, spleen, kidneys, and heart—were collected for further analysis.
4.15. Statistical Analysis
Data are expressed as mean ± standard deviation (SD). Nonlinear regression analysis was conducted to calculate the IC50 values, and one-way ANOVA with Tukey’s post hoc analysis was used to compare experimental groups (GraphPad Prism 5.0, San Diego, CA, USA). Probability (p) values of <0.05 were considered as statistically significant.