[A Case of Breast Cancer Complicated by Fibrous Dysplasia That Was Difficult to Differentiate from Bone Metastasis].

A 58-year-old woman with HER2-negative hormone-sensitive postmenopausal breast cancer underwent preoperative bone scintigraphy and CT to search for distant metastasis. Bone metastasis was suspected in the spinous process of the seventh cervical vertebra. MRI revealed a mass that was hypointense on T1- and T2-weighted images and hyperintense on diffusion- weighted images, with intense contrast enhancement, indicating bone metastasis at cT1N0M1, Stage Ⅳ(M: OSS). The patient underwent partial mastectomy and sentinel lymph node biopsy. The postoperative diagnosis was pT2N0cM1, Stage Ⅳ, with the status of bone metastasis being key to staging. PET-CT showed uptake in the spinous process of the seventh cervical vertebra but no other metastatic findings. However, solitary bone metastasis to the cervical spinous process is atypical. CT-guided needle biopsy confirmed benign fibrous dysplasia, and the final diagnosis was breast cancer at pT2N0M0, Stage ⅡA. Fibrous dysplasia is characterized by impaired osteogenesis leading to fibroplasia and commonly occurs in the skull, jaw bones, ribs, and limbs. Solitary fibrous dysplasia in the cervical spinous process is rare. The lesion was asymptomatic and pathologically benign, requiring no treatment. The patient underwent postoperative radiation therapy for the conserved breast and is followed up with endocrine therapy.

Programed Thermoresponsive Polymers with Cleavage-Induced Phase Transition.

A new programed upper critical solution temperature-type thermoresponsive polymer was developed using water-soluble anionic polymer conjugates derived from polyallylamine and phthalic acid with cleavage-induced phase transition property. Intrinsic charge inversion from anion to cation of the polymer side chain is induced through a side chain cleavage reaction in acidic aqueous media. With the progress of side chain cleavage under fixed external conditions, the polymer conjugates express a thermoresponsive property, followed by shifting a phase boundary due to the change in polymer composition. When the phase transition boundary eventually reached the examined temperature, phase transition occurs under fixed external conditions. Such new insight obtained in this study opens up the new concept of time-programed stimuli-responsive polymer possessing a cleavage-induced phase transition.

Hydrophilic Hyperbranched Polymer-Coated siRNA/Polyamidoamine Dendron-Bearing Lipid Complexes Preparation for High Colloidal Stability and Efficient RNAi.

RNA interference (RNAi) using siRNA has gained much attention for use in therapies for cancer and genetic disorders. To establish RNAi-based therapeutics, the development of efficient siRNA nanocarriers is desired. Earlier, we developed polyamidoamine dendron-bearing lipids able to form complexes with nucleic acids as gene vectors. Especially, dendron lipids with unsaturated alkyl chains (DL-G1-U2) induced efficient endosomal escape by membrane fusion, leading to efficient transfection in vitro. For this study, dendron lipids having oleyl/linoleyl groups (DL-G1-U3) were designed to increase membrane fusogenic activity further. Indeed, DL-G1-U3/siRNA complexes achieved higher membrane fusogenic activity and knockdown of the target gene more efficiently than conventional DL-G1-U2/siRNA complexes did. A hydrophilic polymer, hyperbranched polyglycidol lauryl ester (HPG-Lau), was modified further on the surface of DL-G1-U3/siRNA complexes to provide colloidal stability. Surface modification of HPG-Lau increased the colloidal stability in a physiological condition more than complexes without HPG-Lau. Importantly, HPG-Lau-coated DL/siRNA complexes showed identical RNAi effects to those of parental DL/siRNA complexes, whereas the RNAi activity of poly(ethylene glycol)-bearing lipid (PEG-PE)-modified DL/siRNA complexes was hindered completely. Introduction of unsaturated bonds into dendron lipids and selection of suitable hydrophilic polymers for nanocarrier modification are important for obtaining efficient siRNA vectors toward in vivo siRNA delivery.

Multifunctional Traceable Liposomes with Temperature-Triggered Drug Release and Neovasculature-Targeting Properties for Improved Cancer Chemotherapy.

Poor distribution of nanocarriers at the tumor site and insufficient drug penetration into the tissue are major challenges in the development of effective and safe cancer therapy. Here, we aim to enhance the therapeutic effect of liposomes by accumulating doxorubicin-loaded liposomes at high concentrations in and around the tumor, followed by heat-triggered drug release to facilitate low-molecular-weight drug penetration throughout the tumor. A cyclic RGD peptide (cRGD) was incorporated into liposomes decorated with a thermosensitive polymer that allowed precise tuning of drug release temperature (i.e., Polymer-lip) to develop a targeted thermosensitive liposome (cRGD-Polymer-lip). Compared with conventional thermosensitive liposomes, cRGD-Polymer-lip enhanced the binding of liposomes to endothelial cells, leading to their accumulation at the tumor site upon intravenous administration in tumor-bearing mice. Drug release triggered by local heating strongly inhibited tumor growth. Notably, tumor remission was achieved via multiple administrations of cRGD-Polymer-lip and heat treatments. Thus, combining the advantages of tumor neovascular targeting and heat-triggered drug release, these liposomes offer high potential for minimally invasive and effective cancer chemotherapy.

Chondroitin Sulfate-Based pH-Sensitive Polymer-Modified Liposomes for Intracellular Antigen Delivery and Induction of Cancer Immunity.

Induction of cancer-specific cytotoxic T lymphocytes is crucially important to complement therapeutic effects of immune checkpoint inhibitors and to achieve efficient cancer immunotherapy. To induce cancer-specific cytotoxic T lymphocytes, cancer antigen carriers must have multiple functions to deliver cancer antigens to antigen presenting cells, release antigens into cytosol, and promote the maturation of these cells. We earlier achieved cytosolic delivery of antigens and induction of antigen-specific cytotoxic T lymphocytes using carboxylated polyglycidol or polysaccharide derivative-modified liposomes that can induce membrane fusion with endosomes in response to weakly acidic pH. Furthermore, pH-sensitivity and adjuvant properties of these polymers were enhanced strongly by introduction of hydrophobic carboxylated units to dextran. Against our expectations, these polymer-modified liposomes only slightly induce cancer immunity, probably because of the high hydrophobicity of spacer units. This study used a polysaccharide with charged groups (chondroitin sulfate) instead of dextran as a backbone to reduce hydrophobicity. Chondroitin sulfate derivative-modified liposomes showed almost equal pH-sensitivity to that of dextran derivative-modified liposomes and achieved selective delivery to dendritic cells, whereas dextran derivative-modified liposomes were highly taken up by both dendritic cells and fibroblasts. Chondroitin sulfate derivative-modified liposomes delivered model antigenic proteins into cytosol of dendritic cells and promoted cytokine production from the cells, leading to tumor regression on tumor-bearing mice after subcutaneous administration. Results demonstrate that charged groups having polysaccharide as a backbone can be used in an effective strategy to balance strong hydrophobicity of spacer units with their utilization for immunity-inducing systems.

Hyaluronic Acid-Based pH-Sensitive Polymer-Modified Liposomes for Cell-Specific Intracellular Drug Delivery Systems.

For the enhancement of therapeutic effects and reduction of side effects derived from anticancer drugs in cancer chemotherapy, it is imperative to develop drug delivery systems with cancer-specificity and controlled release function inside cancer cells. pH-sensitive liposomes are useful as an intracellular drug delivery system because of their abilities to transfer their contents into the cell interior through fusion or destabilization of endosome, which has weakly acidic environment. We earlier reported liposomes modified with various types of pH-sensitive polymers based on synthetic polymers and biopolymers as vehicles for intracellular drug delivery systems. In this study, hyaluronic acid (HA)-based pH-sensitive polymers were designed as multifunctional polymers having not only pH-sensitivity but also targeting properties to cells expressing CD44, which is known as a cancer cell surface marker. Carboxyl group-introduced HA derivatives of two types, MGlu-HA and CHex-HA, which have a more hydrophobic side chain structure than that of MGlu-HA, were synthesized by reaction with various dicarboxylic anhydrides. These polymer-modified liposomes were stable at neutral pH, but showed content release under weakly acidic conditions. CHex-HA-modified liposomes delivered their contents into CD44-expressing cells more efficiently than HA-modified or MGlu-HA-modified liposomes or unmodified liposomes, whereas the same liposomes were taken up only slightly by cells expressing CD44 proteins less. Competition assay using free HA or other polymers revealed that HA derivative-modified liposomes might be recognized by CD44. Therefore, HA-derivative-modified liposomes are useful as cell-specific intracellular drug delivery systems.

Carboxylated phytosterol derivative-introduced liposomes for skin environment-responsive transdermal drug delivery system.

Transdermal drug delivery systems are a key technology for skin-related diseases and for cosmetics development. The delivery of active ingredients to an appropriate site or target cells can greatly improve the efficacy of medical and cosmetic agents. For this study, liposome-based transdermal delivery systems were developed using pH-responsive phytosterol derivatives as liposome components. Succinylated phytosterol (Suc-PS) and 2-carboxy-cyclohexane-1-carboxylated phytosterol (CHex-PS) were synthesized by esterification of hydroxy groups of phytosterol. Modification of phytosterol derivatives on 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) liposomes was confirmed by negatively zeta potentials at alkaline pH and the change of zeta potentials with decreasing pH. In response to acidic pH and temperatures higher than body temperature, Suc-PS-containing and CHex-PS-containing liposomes exhibited content release at intracellular acidic compartments of the melanocytes at the basement membrane of the skin. Phytosterol-derivative-containing liposomes were taken up by murine melanoma-derived B16-F10 cells. These liposomes delivered their contents into endosomes and cytosol of B16-F10 cells. Furthermore, phytosterol-derivative-containing liposomes penetrated the 3 D skin models and reached the basement membrane. Results show that pH-responsive phytosterol-derivative-containing DMPC liposomes are promising for use in transdermal medical or cosmetic agent delivery to melanocytes.

PAMAM dendrimers with an oxyethylene unit-enriched surface as biocompatible temperature-sensitive dendrimers.

A novel type of temperature-sensitive dendrimer was synthesized using one-step terminal modification of polyamidoamine dendrimers (PAMAM) with various alkoxy diethylene glycols such as methoxy diethylene glycol, ethoxy diethylene glycol, and propoxy diethylene glycol. The obtained dendrimers exhibited tunable lower critical solution temperature (LCST), depending on PAMAM generation and terminal alkoxy groups. These dendrimers were shown to be taken up by HeLa cells through endocytosis and were trapped in intracellular compartments such as endosomes and lysosomes. Cellular uptake of the dendrimers was enhanced by increasing their incubation temperature above the LCST. In addition, the in vitro cytotoxicity of temperature-sensitive dendrimers at incubation temperatures below and above LCST was much lower than that of their parent PAMAM dendrimers. Results indicate that the dendrimers with oxyethylene unit-enriched surface might be promising to construct intelligent drug delivery systems.

The synthesis and evaluation of polymer prodrug/collagen hybrid gels for delivery into metastatic cancer cells.

Metastatic cancer cells degrade extracellular matrix containing collagen. In this study, a variety of different polymer prodrugs have been synthesized and embedded in collagen gels for application in a metastasis-associated drug delivery system (DDS). Dendrimer-doxorubicin (Dox) prodrugs were prepared with different surfaces, including collagen peptides and polyethylene glycol. Furthermore, Dox was conjugated to linear poly(glutamic acid) (poly-Glu) instead of the dendrimer. The cytotoxicities of each of these polymer prodrug systems against the poorly invasive MCF-7 and highly invasive MDA-MB-231 cells were similar. The highly invasive MDA-MB-231 cells, however, were more sensitive than the MCF-7 cells to the polymer prodrugs-embedded collagen gels, suggesting that these polymer prodrugs/collagen hybrid gels would be useful for the development of metastasis-associated DDSs. The cytotoxicities of the polymer prodrugs were dependent on their chemical compositions. The collagen peptide-conjugated dendrimer prodrug/collagen hybrid gel demonstrated in vivo anticancer effects in an orthotopic metastatic mouse model. FROM THE CLINICAL EDITOR: In this study, a variety of polymer prodrugs have been synthesized and embedded in collagen gels to be used in a metastasis-associated drug delivery system, demonstrating in vivo anticancer effects in an orthotopic metastatic mouse model.

Carboxy-functionalized pH responsive capsule polymer particles fabricated by particulate interfacial photocrosslinking.

pH-responsive capsule particles show promise for various applications, such as self-healing materials, micro/nanoreactors, and drug delivery systems. Herein, carboxy-functionalized capsule polymer particles possessing neutral-alkaline pH responsive controlled release capability were newly fabricated by interfacial photocrosslinking of spherical photoreactive polymer [poly(2-carboxyethyl acrylate-co-2-cinnamoylethyl methacrylate): P(CEA-CEMA)] particles and a subsequent encapsulation process. Using P(CEA-CEMA) particles, the shell-crosslinked hollow polymer particles were fabricated by the particulate interfacial photocrosslinking procedure. Furthermore, the encapsulation of sulforhodamine B as a model dye into the hollow particles was also performed. Under acidic pH conditions, encapsulated molecules were stably retained in the P(CEA-CEMA) capsules with negligible release of sulforhodamine B. However, the encapsulated sulforhodamine B was gradually or drastically released from the capsule particles under neutral or basic conditions, respectively, indicating that the neutral-alkaline pH responsive controlled release from the capsules was successfully achieved by regulating the release kinetics. These results demonstrate that the fabrication routes of hollow and capsule particles based on particulate interfacial photocrosslinking can be successfully applied to carboxy-functionalized photoreactive polymer particles, and the capsule polymer particles possessing pH-responsive release properties under neutral-basic conditions were successfully fabricated.

Dual signal-responsive liposomes for temperature-controlled cytoplasmic delivery.

For production of a new type of functional liposome whose destabilization can be triggered by a combination of a temperature signal and acidic pH signal, we prepared liposomes modified with hyperbranched poly(glycidol) derivatives having N-isopropylamide and carboxyl groups. HeLa cells incubated with the dual signal-responsive liposomes encapsulating a water-soluble fluorescent dye pyranine at 28 °C displayed punctate fluorescence of pyranine, indicating that the liposomes were trapped in endosome. However, after heating at 45 °C for 15 min, the same cells exhibited diffuse fluorescence of pyranine, indicating that destabilization of the liposomes in endosome with an acidic environment in combination with the brief heating caused efficient transfer of the contents into cytosol. The dual signal-responsive liposomes might have usefulness for site-specific delivery of membrane-impermeable molecules, which exhibit bioactivities in the intracellular spaces, such as siRNA and proteins.

Interfacial Photo-Cross-Linking: Simple but Powerful Approach for Fabricating Capsule Polymer Particles with Tunable pH-Responsive Controlled Release Capability.

Herein, we describe capsule polymer particles with precisely controlled pH-responsive release properties prepared directly via the interfacial photo-cross-linking of spherical poly(2-diethylaminoethyl methacrylate-co-2-cinnamoylethyl methacrylate) (P(DEAEMA-CEMA)) particles. In the interfacial photo-cross-linking, photoreactive cinnamoyl groups in the polymer particles were cross-linked via [2π + 2π] cycloaddition reactions at the polymer/water interface, showing that the shell-cross-linked hollow polymer particles can be directly prepared from spherical polymer particles. The approach has fascinating advantages such as using minimal components, simplicity, and not requiring sacrificial template particles and toxic solvents. The following important observations are made: (I) encapsulated materials were stably retained in the capsule particles under neutral pH conditions; (II) encapsulated materials were released from the capsule particles under acidic pH conditions; (III) the release kinetics of encapsulated materials were controlled by the pH conditions; i.e., immediate and sustained release was achieved by varying the acidity of the aqueous media; (IV) the photoirradiation time did not significantly affect the release kinetics under different pH conditions; and (V) the pH-responsive release properties were regulated by changing the polymer composition in P(DEAEMA-CEMA). Furthermore, by exploiting the pH-responsiveness, capsule particles are successfully obtained via an all-aqueous process from spherical polymer particles. The advantages of the all-aqueous encapsulation process allowed the water-soluble biomacromolecules such as DNA and saccharides to be successfully encapsulated in the P(DEAEMA-CEMA) hollow particles. With this simple interfacial photo-cross-linking strategy, we envision the ready synthesis of sophisticated particulate materials for broad application in advanced research fields.

pH-Sensitive branched ß-glucan-modified liposomes for activation of antigen presenting cells and induction of antitumor immunity.

Induction of cellular immunity is important for effective cancer immunotherapy. Although various antigen carriers for cancer immunotherapy have been developed to date, balancing efficient antigen delivery to antigen presenting cells (APCs) and their activation via innate immune receptors, both of which are crucially important for the induction of strong cellular immunity, remains challenging. For this study, branched ß-glucan was selected as an intrinsically immunity-stimulating and biocompatible material. It was engineered to develop multifunctional liposomal cancer vaccines capable of efficient interactions with APCs and subsequent activation of the cells. Hydroxy groups of branched ß-glucan (Aquaß) were modified with 3-methylglutaric acid ester and decyl groups, respectively, to provide pH-sensitivity and anchoring capability to the liposomal membrane. The modification efficiency of Aquaß derivatives to the liposomes was significantly high compared with linear ß-glucan (curdlan) derivatives. Aquaß derivative-modified liposomes released their contents in response to weakly acidic pH. As a model antigenic protein, ovalbumin (OVA)-loaded liposomes modified with Aquaß derivatives interacted efficiently with dendritic cells, and induced inflammatory cytokine secretion from the cells. Subcutaneous administration of Aquaß derivative-modified liposomes suppressed the growth of the E.G7-OVA tumor significantly compared with curdlan derivative-modified liposomes. Aquaß derivative-modified liposomes induced the increase of CD8+ T cells, and polarized macrophages to the antitumor M1-phenotype within the tumor microenvironment. Therefore, pH-sensitive Aquaß derivatives can be promising materials for liposomal antigen delivery systems to induce antitumor immune responses efficiently.

PEG-attached PAMAM dendrimers encapsulating gold nanoparticles: growing gold nanoparticles in the dendrimers for improvement of their photothermal properties.

Recently, we demonstrated that loading of HAuCl(4) in poly(ethylene glycol) (PEG)-attached poly(amidoamine) (PAMAM) G4 dendrimers and subsequent reduction with NaBH(4) yield dendrimers encapsulating gold nanoparticles (Au NPs), which have photoinduced heat-generating properties. This study was undertaken to enhance photothermal properties of the Au NP-incorporated PEG-attached dendrimers by growing Au NPs in the dendrimers. Repeated loading of HAuCl(4) in the PEG-attached dendrimers and subsequent reduction with NaBH(4) enhanced the surface plasmon resonance, indicating that Au NPs were grown in the PEG-attached dendrimers using that procedure. Transmission electron microscopy (TEM) analysis revealed that the size of Au NPs formed in the dendrimers increased with the number of repetitions of HAuCl(4) loading and subsequent reduction in the dendrimers, although the size distribution of the Au NPs remained narrow. The photoinduced-heat generation capability of the Au NPs-encapsulating dendrimers increased as the Au NPs grew. These dendrimers with Au NPs exhibited strong cytotoxicity against HeLa cells under visible light irradiation. The result demonstrates that PEG-attached dendrimers encapsulating the grown Au NPs might be useful as devices for target-specific therapy when used with light irradiation.

Effective tolerance to serum proteins of head-tail type polycation vectors by PEGylation at the periphery of the head block.

To improve the stability of a head-tail type polycation (PAMAM dendron-PLL), which is composed of a polyamidoamine (PAMAM) dendron head and poly(l-lysine) (PLL) tail blocks, as a gene vector against serum proteins, the PEGylation of the PAMAM dendron head was examined using physicochemical and transfection experiments. The PEGylation of the PAMAM dendron-PLL polyplexes neutralized the zeta-potential, indicating that the PEG brushes surround the surface of the polyplexes. The PEGylated PAMAM dendron-PLL polyplexes had higher tolerance against incubation with serum proteins when compared with non-PEGylated PAMAM dendron-PLL polyplexes. In addition, the transfection efficiency of the PEGylated PAMAM dendron-PLL polyplexes increased with increasing incubation periods, leading to an increase in the amount of pDNA uptaked by HeLa cells. Furthermore, effective stabilization of the PAMAM dendron-PLL polyplexes through PEGylation of the PAMAM dendron block was confirmed by the transfection experiments after preincubation with serum proteins and the PEGylated PAMAM dendron-PLL polyplexes showed a comparable level of transfection efficiency with polyethyleneimine polyplexes.

X-ray computed tomography contrast agents prepared by seeded growth of gold nanoparticles in PEGylated dendrimer.

Gold nanoparticles (Au NPs) are a potential x-ray computed tomography (CT) contrast agent. A biocompatible and bioinactive surface is necessary for application of gold nanoparticle to CT imaging. Polyethylene glycol (PEG)-attached dendrimers have been used as a drug carrier with long blood circulation. In this study, the Au NPs were grown in the PEGylated dendrimer to produce a CT contrast agent. The Au NPs were grown by adding gold ions and ascorbic acid at various equivalents to the Au NP-encapsulated dendrimer solution. Both size and surface plasmon absorption of the grown Au NPs increased with adding a large number of gold ions. The x-ray attenuation of the Au NPs also increased after the seeded growth. The Au NPs grown in the PEG-attached dendrimer at the maximum under our conditions exhibited a similar CT value to a commercial iodine agent, iopamidol, in vitro. The Au NP-loaded PEGylated dendrimer and iopamidol were injected into mice and CT images were obtained at different times. The Au NP-loaded PEGylated dendrimer achieved a blood pool imaging, which was greater than a commercial iodine agent. Even though iopamidol was excreted rapidly, the PEGylated dendrimer loading the grown Au NP was accumulated in the liver.

Preparation of photothermal-chemotherapy nanohybrids by complexation of gold nanorods with polyamidoamine dendrimers having poly(ethylene glycol) and hydrophobic chains.

The combination of anticancer drugs and laser hyperthermia could lead to efficient cancer treatment with less-adverse effects. This study combined anticancer drug-loaded functional dendrimers and light-responsive gold nanorods to fabricate nanohybrids that can provide anticancer-drug delivery and subsequent heat generation under near-infrared laser irradiation. A condensation reaction was used to conjugate poly(ethylene glycol)-modified polyamidoamine dendrimers to carboxylated gold nanorod surfaces. Oleoyl groups were incorporated into dendrimers to improve the drug loading capacity. Doxorubicin loading capacity was improved by incorporation of oleoyl chains into dendrimers in the nanohybrid, indicating increased hydrophobic interaction between anticancer drugs and nanohybrids. The nanohybrids exhibited heat generation properties under near infrared laser irradiation. They released anticancer drugs over time. The combination of doxorubicin-loaded nanohybrids and laser irradiation showed markedly better cytotoxicity than that of the nanohybrids used with lasers and drug-loaded nanohybrids without the use of lasers. After intravenous or intratumoral injection of nanohybrids to tumor-bearing mice, a sharp temperature increase was observed at the tumor site under laser irradiation. Especially, intratumorally injected doxorubicin-loaded nanohybrids showed almost complete tumor growth suppression under laser irradiation. The results demonstrate that functional dendrimer-gold nanorod nanohybrids are promising as multi-functional nanomaterials to achieve synergistic effects of anticancer drugs and heat ablation to support effective cancer treatments.

Synthesis and characterization of hyperbranched poly(glycidol) modified with pH- and temperature-sensitive groups.

Hyperbranched poly(glycidol)s with varying degrees of polymerization were modified by reaction with succinic anhydride and isopropylamine to obtain novel pH- and thermosensitive polymers. These polymers exhibited phase transitions in response to decreasing pH and/or increasing temperature, depending on the degree of polymerization and the ratio of succinyl group to N-isopropylamide. It was possible to harvest a bioactive molecule, rose bengal, from solution using the phase transition of thermosensitive hyperbranched poly(glycidol).

Osteonecrosis associated with short-term oral administration of bisphosphonate.

Orally administered bisphosphonates are generally considered a first-line medication for treatment of osteoporosis. As a side effect of bisphosphonates, osteonecrosis of the jaws (ONJ) has been reported worldwide. Most reports of osteonecrosis are attributed to the use of bisphosphonates administered intravenously for the treatment of bone disorders such as multiple myeloma. However, osteonecrosis has also been diagnosed in patients receiving oral bisphosphonates. The management of a patient with spontaneous removable partial denture prosthesis-related ONJ associated with short-term oral administration of bisphosphonate is described.

[Alendronate for treatment of osteoporoses].

Alendronate halves osteoporotic fractures in the spine regardless of the risk and in the proximal femur in the high-risk population. The long-term results are excellent, too. Concerning the safety, the risk of the bisphosphonate-associated osteonecrosis of the jaw is apparently low.