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Drug-loaded PCL electrospun nanofibers as anti-pancreatic cancer drug delivery systems

Mitxelena-Iribarren, Oihane; Riera-Pons, Marc; Pereira Arenas, Sheila; Calero-Castro, Francisco José; Castillo Tuñón, Juan Manuel; Padillo Ruiz, Francisco Javier; Mujika, Maite; Arana, Sergio

Abstract

Cancer is one of the main causes of death worldwide, being pancreatic cancer the second deadliest cancer in Western countries. Surgery, chemotherapy and radiotherapy form the basis of pancreatic cancer’s current treatment. However, these techniques have several disadvantages, such as surgery complications, chemotherapy systemic side effects and cancer recurrence. Drug delivery systems can reduce side effects, increasing the effectivity of the treatment by a controlled release at the targeted tumor cells. In this context, coaxial electrospun fibers can increase the control on the release profile of the drug. The aim of this study was to encapsulate and release different anticancer drugs (5-Fluorouracil and Methotrexate) from a polymeric fiber mat. Different flows and ratios were used to test their effect on fiber morphology, FTIR spectrum, drug encapsulation and release. Good integration of the anticancer drugs was observed and the use of a desiccator for 24 h showed to be a key step to remove solvent remanence. Moreover, the results of this study demonstrated that the polymeric solution could be used to encapsulate and release different drugs to treat cancers. This makes coaxial electrospinning a promising alternative to deliver complex chemotherapies that involve more than one drug, such as FOLFIRINOX, used in pancreatic cancer treatment.

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Vol.:(0123456789) Polyme Bulle in h ps://doi.o g/10.1007/s00289-022-04425-6 1 3 ORIGINAL PAPER D ug‑loaded PCL elec ospun nano ibe s asan i‑panc ea ic cance d ug deli e y sys ems OihaneMi xelena‑I iba en1,2 · Ma cRie a‑Pons1,2· SheilaPe ei a3,4· F anciscoJoséCale o‑Cas o3,4· JuanManuelCas illoTuñón5· Ja ie Padillo‑Ruiz3,4,6· Mai eMujika1,2· Se gioA ana1,2 Recei ed: 14 Ma ch 2022 / Re ised: 24 July 2022 / Accep ed: 3 Augus 2022 © The Au ho (s) 2022 Abs ac Cance is one o he main causes o dea h wo ldwide, being panc ea ic cance he second deadlies cance in Wes e n coun ies. Su ge y, chemo he apy and adio he - apy o m he basis o panc ea ic cance ’s cu en ea men . Howe e , hese ech- niques ha e se e al disad an ages, such as su ge y complica ions, chemo he apy sys emic side e ec s and cance ecu ence. D ug deli e y sys ems can educe side e ec s, inc easing he e ec i i y o he ea men by a con olled elease a he a - ge ed umo cells. In his con ex , coaxial elec ospun ibe s can inc ease he con- ol on he elease p o ile o he d ug. The aim o his s udy was o encapsula e and elease di e en an icance d ugs (5-Fluo ou acil and Me ho exa e) om a poly- me ic ibe ma . Di e en lows and a ios we e used o es hei e ec on ibe mo - phology, FTIR spec um, d ug encapsula ion and elease. Good in eg a ion o he an icance d ugs was obse ed and he use o a desicca o o 24h showed o be a key s ep o emo e sol en emanence. Mo eo e , he esul s o his s udy demon- s a ed ha he polyme ic solu ion could be used o encapsula e and elease di e en d ugs o ea cance s. This makes coaxial elec ospinning a p omising al e na i e o deli e complex chemo he apies ha in ol e mo e han one d ug, such as FOL- FIRINOX, used in panc ea ic cance ea men . Keywo ds D ug deli e y· Elec ospinning· An icance · 5- luo ou acil· Me ho exa e Oihane Mi xelena-I iba enand Ma c Rie a-Pons ha e con ibu ed equally o his wo k. * Oihane Mi xelena-I iba en omi x[email p o ec ed] Ex ended au ho in o ma ion a ailable on he las page o he a icle Polyme Bulle in 1 3 In oduc ion Cance is one o he deadlies diseases wo ldwide. One o he wo s p ognoses o his disease is o he panc ea ic cance , as only he 4% o he pa ien s su i e a e 5yea s o he diagnosis da e[1, 2]. I is also he second mos deadly can- ce - ela ed cause in Wes e n coun ies[3]. Su ge y, chemo he apy such as FOL- FIRINOX o Gemci abine, and adio he apy a e he mos common ea men s used o ea his illness [1, 4–6]. Howe e , hey ha e s ong disad an ages such as chemo he apy sys emic side e ec s, limi a ions o echniques and ecu ence due o es s o cance no emo ed du ing he ea men , among o he s [7, 8] These disad an ages and limi a ions can be educed i d ug deli e y sys ems (DDSs) a e used du ing he healing p ocess[9]. The main ad an age o hese ech- nologies is a ocalized and mo e e icien deli e y, which de i es on a educ ion in he side e ec s and umo ecu ence[10]. Polyme s a e he main ehicles used o DDS because o he wide ange o mac omolecules ha can be used. Each o hem has a speci ic biodeg ada ion p o ile[11], which can p o ide a con olled deli e y as he deg ada ion kine ics will desc ibe he d ug elease p o ile[12]. Fo example, polycap olac one (PCL) is a biodeg adable polyme widely used as DDS, e en wi h encapsula ed an icance d ugs [13–16]. DDS can be di ided in o wo g oups, depending on he libe a ion p o ile hey ha e: hey can do i sys ema ically (such as he case o nanopa icles) o locally (as in he case o elec ospun ibe s, ilms o hyd ogels)[17]. Sys emic deli e y sys ems can be injec ed o in oduced o ally[18]. The main ad an ages o hese sys ems a e hei nanome ic size, speci ici y and low in asi eness, as he ehi- cles can each smalle essels and can be enginee ed o ecognize ce ain ecep- o s and no su ge y is equi ed o he ea men [19–21]. On he o he hand, some imes hese pa icles a e ha d o unc ionalize o can lose hei speci ici y due o he lack o molecules ha can iden i y he a ge and he in e ac ions in he deli e y p ocess[22]. Local d ug deli e y sys ems elease he d ug in a speci ic si e, loco- egionally, by di usion o deg ada ion mainly[23]. These sys ems can ake se e al o ms, such as oams, hyd ogels o ibe s among o he s[10, 24, 25]. This echnology has a s ong backg ound, as i has been in he ma ke since 1995 when GLIA- DEL® wa e s we e comme cialized o ea b ain cance s. The main disad an age o hyd ogels o oams is ha he d ug is deli e ed by di usion[10], which is a as occu ing phenomenon ha eleases he d ug in a sho pe iod o ime[26]. E en mo e, he a ge o local DDS is no accessible wi hou su ge y. Tha is why hese de ices a e mean o be complemen a y o con en ional su ge y, in o de o ensu e ha he en i e umo is emo ed. Elec ospinning is a ab ica ion p ocess o ob ain a local DDS. This me hod is easy o use and e sa ile, i gene a es high su ace- o- olume a io meshes, and i usually is a low-cos p ocess[27]. The gene a ed sca olds a e o med by ibe s, which ha e a mixed deli e y p o ile, as bo h di usion and deg ada ion ela ed elease occu [19, 25]. The shape and size o he ibe s play an impo an ole in he d ug eleasing p o ile. The e o e, he e a e se e al pa ame e s ha can be 1 3 Polyme Bulle in al e ed o modi y he size o hose elec ospun ibe s in o de o con ol he d ug elease, such as po en ial di e ence, nozzle–collec o dis ance, polyme ic solu- ion low, polyme concen a ion and conduc i i y[28–31]. One limi a ion o his echnique is ha he ibe has he same p ope ies ac oss i s whole s uc u e and a bu s d ug elease can occu , as he molecule is o ally blended wi h he ibe [16]. This can be sol ed i wo solu ions a e injec ed a he same ime by coaxial elec- ospinning, inc easing he e sa ili y and he con ol on he coaxial ibe p op- e ies, composi ion and d ug loading and elease[32, 33]. B ie ly, coaxial elec- ospinning is a modi ica ion o he con en ional elec ospinning p ocess, whe e mo e han one solu ion is elec ospun [34]. The spinne e s con aining he di e - en solu ions sha e an axis. This allows he injec ion o one solu ion in o he o he a he needle ip: he co e luid is d awn wi hin he ou e one o p oduce con inu- ous illed nano ibe s. Ac ual chemo he apy ea men s use a ious d ugs, such as 5-Fluo ou acil (5F), i ino ecan, oxalipla in and olinic acid a he same ime o ea panc ea ic cance cells[35–37]. In addi ion, including o he d ugs such as painkille s in he ea men could imp o e he pa ien ’s li e quali y. The e o e, es ing PCL o encapsula e d ugs ela ed o gene al cance ea men , such as Me ho exa e (MTX), is a equi ed s ep o keep DDS on he same oad ha chemo he apy is unde going. Fo his eason, in o de o ob ain an al e na i e ea men o panc ea ic cance , PCL was used o encapsula e and elease di e en an ineoplas ic molecules by coaxial elec ospin- ning. PCL-blended nano ibe s loaded ei he wi h 5F o MTX we e in es iga ed in his esea ch. Va ious PCL p opo ions and ab ica ion pa ame e s we e used o p o- duce di e en elec ospun nano ibe s. The e ec o hose speci ica ions in nano ibe cha ac e is ics and d ug elease was s udied in his wo k. Me hods Ma e ials Polycap olac one (PCL, Mw = 100 000 g/mol), 99% chlo o o m, 100% me hanol, 98–100% o mic acid and 99% ace ic acid we e pu chased om Sigma Li e Sci- ences, USA. 5-Fluo ou acil (5F) was pu chased om AK Scien i ic Inc, USA, and Me ho exa e (MTX) was kindly p o ided by D . A. Aldaz, om he Depa men o Pha macy o Clínica Uni e sidad de Na a a, Spain. Elec ospinning o PCL nano ibe s Elec ospinning solu ions we e p epa ed by dissol ing 14 w .% o PCL in o mic acid/ace ic acid/chlo o o m wi h a a io o 47.5: 47.5: 5 ( / / ), espec i ely. The solu ion was s i ed a oom empe a u e o e nigh and used wi hin he i s 72h. A second solu ion was p epa ed o each d ug, 5F and MTX, by adding 28mg/mL o 8.4mg/mL, espec i ely, o he o iginal polyme ic solu ion. Polyme Bulle in 1 3 Once he solu ions we e eady, coaxial elec ospinning was used o elec ospun he nano ibe s (Fig.1a). The se up consis ed o a coaxial nozzle wi h an inne gauge o 26G and an ou e gauge o 18G (Ramé-Ha Ins umen Co, USA; Fig. 1b), wo sy inge pumps (KD Scien i ic Inc, USA) and a high- ol age DC powe sup- ply (Heinzinge , Ge many). A schema ic o he coaxial elec ospinning is shown in Fig.1c Th ee di e en con igu a ions we e used o ab ica e he ibe s. The pa ame e s used o each con igu a ion es ed a e shown in Table 1. These pa ame e s we e based on he s udy o Iqbal e al. (2017). The sca olds ab ica ed only wi h he poly- me ic solu ion we e used as con ol and iden i ied wi h he code CoPP. The d ug- loaded ibe s we e ab ica ed using ei he o he d ug-solu ions in he inne ube and he polyme ic solu ion in he ou e one. The ibe s loaded wi h 5F we e iden i ied as P5F and he ones loaded wi h MTX as PMTX. Cha ac e iza ion o nano ibe s Su ace mo phology To assess he mo phology o he nano ibe s, scanning elec on mic oscopy (SEM, Phenom G2 P o, USA) was used. The diame e o he ibe s was measu ed by using ImageJ so wa e (Na ional Ins i u e o Heal h). A o al o 4 images pe sca old we e analyzed by measu ing he diame e o 25 ibe s pe ame. The e o e, he diam- e e o 100 ibe s was measu ed andomly in each sample and he a e age diame e Fig. 1 a) Coaxial elec ospinning se -up; b) coaxial nozzle o Ramé-Ha Ins umen Co; c) schema ic o he coaxial elec ospinning p ocess Table 1 Elec ospinning ab ica ion pa ame e s o he h ee di e en con igu a ions, wi h and wi hou d ug Sample code Collec o -nozzle dis- ance (cm) Powe supply (kV) Ou e low (mL/h) Inne low (mL/h) CoPP1/P5F1/PMTX1 13.5 21 0.20 0.05 CoPP2/P5F2/PMTX2 13.5 21 0.15 0.05 CoPP3/P5F3/PMTX3 13.5 21 0.10 0.05 1 3 Polyme Bulle in was epo ed. Nano ibe ma s po osi y and po e size we e measu ed also by image analysis, using Diame e J, an ImageJ package. The ob ained alues a e exp essed as mean alue ± s anda d de ia ion. Sol en emanence Fou ie ans o m in a ed spec oscopy (FTIR) was unde aken on pu e PCL pel- le s and he h ee sol en s ( o mic acid, ace ic acid and chlo o o m), as well as on all he elec ospun ma samples by he FTIR Spec um 100 wi h he ATR (Pe ki- nElme , USA). The scanning ange es ed goes om 650 o 4000 cm−1 wi h a o al amoun o 8 accumula ions. In o de o pe o m he FTIR analysis, solid samples we e comp essed whe eas liquid samples we e no . Ma samples we e analyzed jus a e being ab ica ed o a e 24h. In he case o he la e , he elec ospun ma s we e ei he s o ed o e nigh a oom empe a u e o desicca ed in a desicca o o he 24h. D ug loading e iciency Di e en ial Scanning Calo ime y (DSC) Di e en ial scanning calo ime y was used o e alua e he d ug in eg a ion inside he ibe s (DSC, 4000 Pe kinElme ). Samples wi h a mass be ween 5 and 20mg we e used o he analyses. PCL pelle s we e used wi hou any u he modi ica ion, whe eas sca old pieces we e cu and weigh ed in o de o no malize he esul s. The analyzed empe a u e anged om 20 o 100°C, wi h a empe a u e inc ease o 10°C/min. FTIR analysis D ug loading was semiquan i a i ely assessed by FTIR analysis o he d ug-loaded sca olds. A comp essed sample o each d ug-loaded ma was analyzed once he sol- en was ully e apo a ed om he ibe s. The same equipmen , ange, and num- be o accumula ions as in sol en pe du abili y cha ac e iza ion we e used in hese analyses. In i o d ug elease The d ug elease o he di e en ma ypes was de e mined by imme sing he loaded nano ibe s in PBS. The p ocedu e was as ollows: h ee samples om each con igu- a ion o bo h 5F and MTX ma s we e cu in o 2.25 cm2 squa es and subme ged o 2h in MiliQ wa e , in o de o emo e he ma e ials ha could be ou side he ibe s. The ma s we e hen d ied and weigh ed, be o e being in oduced in 15mL o PBS (pH = 7.4) o wo weeks a 37°C on an o bi al shake (Polymax 1040 om Hei- dolph, Ge many). Du ing his pe iod, spec opho ome y was used o cha ac e ize d ug elease: 100µl o he imme sing PBS we e aken o abso bance eading e e y Polyme Bulle in 1 3 24 h. In o de o de e mine he eleased d ug amoun , he espec i e calib a ion cu e was ob ained o each d ug. Bee -Lambe equa ions we e used o calcula e d ug concen a ion a λ = 270nm and λ = 350nm o 5F and MTX espec i ely. The i ed line o calib a ion o 5F in PBS is acco ding o Eq.1 and he amoun o R2 is 0.9411. On he o he hand, MTX calib a ion ollowed Eq.2, wi h a R2 o 0.9164. S a is ical analysis To end up wi h he s a is ical analysis, independen S uden ’s es was pe o med o compa e he e ec o d ugs and di e en elec ospinning con igu a ions on ibe diame e . The s a is ical signi icance c i e ion was he same o all he analyses. S a- is ical di e ence was de e mined as no signi ican (p- alue > 0.05), signi ican (0.01 < p- alue < 0.05), e y signi ican (0.001 < p- alue < 0.01) o ex emely sig- ni ican (p- alue < 0.001). RESULTS ANDDISCUSSION Su ace mo phology SEM was used o obse e he nano ibe s mo phology and diame e o he di e - en con igu a ions es ed wi h and wi hou he d ugs. The images ob ained by SEM (Fig.2) showed ha all con igu a ions p oduced nano ibe s, which had a g ea su - ace o olume a io. No d ug c ys als o o he de o ma ions such as beads we e obse ed in any o he images ob ained, as all polyme ic ma s p esen ed homogene- ous ibe s o di e en diame e s. All ibe s we e in he nano ibe ange as he maxi- mum a e age diame e s we e less han 400 mic ons. The ma s wi h g ea e diam- e e s we e he ones wi hou d ug encapsula ion (Table2), as all h ee samples had hicke ibe s han any o he ma s blended wi h d ug. These di e ences we e p ob- ably caused due o he conduc i i y di e ences be ween PCL and he d ugs[38]. In addi ion, he ibe dis ibu ions o he sca olds we e o e all a Gaussian dis ibu- ion posi i ely skewed. Howe e , he his og ams o he con igu a ions CoPP2 and PMTX1 looked like an in e se amped dis ibu ion a he han a Gaussian. Signi ican di e ences we e obse ed in he ibe diame e when ou e low was dec eased om 0.20mL/h o 0.15mL/h in he case o con ol sca olds, as CoPP1 ma s s CoPP2 ones showed a p- alue = 2.40 × 10–20. In addi ion, educing he ou e low om 0.15 o 0.10 mL/h, signi ican ly educed he ibe diame e , be ween CoPP2 and CoPP3 (p- alue = 8.07 × 10–14). When he polyme ic solu ions we e blended wi h 5F, no signi ican di e ences we e obse ed i he ou e low was educed om 0.20 o 0.15mL/h no om 0.15 o 0.10mL/h. On he o he hand, in oducing 5F in o he ma s signi ican ly educed he ibe diame e wi h espec (1) Y=3.5564x0.0086 (2) Y=6.9286x+3.8287 1 3 Polyme Bulle in o he con ol sca olds: when he homologous samples we e compa ed, ex emely signi ican di e ence was obse ed in he h ee cases wi h p- alues o 6.84 × 10–13, 4.76 × 10–20 and 4.17 × 10–4 o CoPP1 e sus P5F1, CoPP2 e sus P5F2 and CoPP3 e sus P5F3, espec i ely. Simila beha io s we e obse ed in he case o he MTX sca olds, as all he MTX-blended ibe s had ex emely signi ican smalle diam- e e han he pu e polyme ic ones (p- ales < 0.001). Mo eo e , as o he con ol Fig. 2 SEM images wi h hei co esponding his og am o he di e en elec ospun con igu a ions: a CoPP1; b CoPP2; c CoPP3; d PMTX1; e PMTX2; PMTX3; g P5F1; h P5F2; i P5F3 Table 2 Resul s o SEM images analysis on mo phology (U = uni o m, B = beaded), ibe diame e and po osi y, acco ding o con igu a ion and blended d ug Code Mo phology Diame e (µm) Po osi y (%) Con ol 5F MTX Con ol 5F MTX Con ol 5F MTX 1 U U U 0.26 ± 0.11 0.16 ± 0.06 0.20 ± 0.09 68.87 63.18 50.75 2 U U U 0.37 ± 0.18 0.16 ± 0.05 0.17 ± 0.06 56.25 50.27 60.24 3 U U U 0.20 ± 0.08 0.17 ± 0.04 0.15 ± 0.05 75.33 64.10 56.52 Polyme Bulle in 1 3 polyme ic sca olds, a ela ionship be ween he o al low a e and he ibe diame e was obse ed in MTX-loaded sca olds. In his case, educing he ou e low om 0.20 o 0.10mL/h signi ican ly educed he ibe diame e (p- alue = 1.27 × 10–6). This e ec , which was no obse ed only in he case o 5F, could be due o solu ion conduc i i y. MTX is less pola han 5F [39, 40]. The e o e, i was mo e likely o beha e as PCL, ending up in a ibe dec easing e ec o he polyme ic low. Po osi y was also e alua ed, ob aining po osi ies in he ange o 50–75%. The d ug loaded ma s had o e all less po ous sca olds, as wo o he highes po osi- ies ob ained belonged o he con ol g oup (Table2). This oge he wi h he su - ace- o- olume a io imp o ed he d ug exposi ion and enhanced he in e ac ion wi h he en i onmen by an easy luid low h ough he sca old. These esul s oge he wi h he ibe uni o mi y obse ed in his esea ch ma ched wi h he esul s ha Iqbal e al.[16] ob ained in hei s udy. Sol en emanence The non-desicca ed ma s did no show exac ly he same spec um as he pelle , as hey showed wo peaks a 1509 and 1545 cm−1, which co espond o he ca boxyl g oup o he acids p esen in he sol en s (Fig.3a). This mean ha he sol en was no comple ely emo ed du ing he ab ica ion. The e o e, in oducing he sca old in o a body igh a e being elec ospun could cause se e al p oblems, as he sol en s we e no ully e apo a ed. Fig. 3 FTIR spec um o : a) coaxial polyme ic ma s wi hou d ug analyzed igh a e being elec ospun (Co 0h) o le a oom condi ions o 24h be o e pe o ming he FTIR (Co 24h), ace ic acid and o mic acid; b) he PCL pelle and a coaxial polyme ic ma desicca ed o 24h (Co 24h Desicca ed) 1 3 Polyme Bulle in Inc easing he wai ing ime o 24h educed no o iously he sol en p esence, as he dep h o he peak was mo e p onounced in he ma analyzed jus a e he elec- ospinning p ocess han in he ma le 24h unde oom condi ions be o e pe o m- ing he FTIR. Ne e heless, he sol en - ela ed peaks we e s ill no iceable. Howe e , he sol en p esence was comple ely e ased a e he ma was desic- ca ed o 24h, as he cu e o e lapped exac ly he same peaks o he cu e o he pu e polyme pelle (Fig. 3b). This is possible because o he low-p essu e en i- onmen gene a ed in he desicca o . The e o e, i was p o en ha his widely used me hod was comple ely necessa y o ge id o he sol en s used in he elec ospin- ning p ocess[16, 41, 42]. D ug loading The di e en ial scanning calo ime y pe o med on PCL showed he mel ing ansi- ion o he polyme . No majo di e ences we e obse ed be ween a PCL ma agains a pelle (Fig. 4a), as bo h samples unde wen a solid o liquid ansi ion a ound 65 °C. The only obse able di e ence was he mel ing empe a u e and he hea low, as he mel ing empe a u e was g ea e o he pelle han he ma : 66.1°C and 63.7°C, espec i ely. The hea low o he pelle was o e all highe . These alues concu wi h he ones obse ed in he li e a u e[43–45]. On he o he hand, bo h pu e MTX and 5F did no show any ansi ion in he analyzed ange (Fig.4b and c), as he cu es we e comple ely la . The sca olds blended wi h hese molecules showed a peak ha was no p esen in he DSC pe - o med on PCL, a ound 5°C. This peak was mo e no able in he ma s blended wi h MTX. The obse ed mel ing poin o he ma s blended wi h MTX and 5F was be ween 62.9–66.0°C and 62.4–64.1, espec i ely. The obse ed di e ence be ween he con ol and he loaded sca olds could sugges he p esence o he d ug in he ma s. In addi ion o he DSC analyses, o u he con i m he p esence, he in a ed spec um was used o obse e he d ug loading o MTX and 5F in he ibe s (Fig.5), as shown in he li e a u e[12]. Acco ding o hese FTIR esul s, i was concluded ha a highe a io o inne /ou e low in bo h MTX and 5F-loaded sca olds was ela ed o a g ea e d ug concen a ion. As he ou e solu ion did no con ain he an icance d ug, a educ ion o he ou e low ela ed o he o al solu ion low induced a g ea e d ug low, which mean a highe d ug encapsula ion. This end was clea e in he ibe s blended wi h 5F a 1661 cm−1 and be ween 3000 and 3300 cm−1, belonging ha peak o he C = O s e ching and he band o he N–H s e ching, espec i ely. In he case o MTX-loaded sca olds, he wo anges in which his d ug p esence was obse able we e om 1525 o 1617 cm−1 and om 3000 o 3500 cm−1, also due o he C = O s e ching and he N–H s e ching. Conside ing ha no d ug c ys als no de o ma ions on he ibe s we e obse ed in he SEM images, and he d ug p esence obse ed wi h bo h he DSC and FTIR anal- yses, i was depic ed ha he d ug was success ully encapsula ed du ing he coaxial elec ospinning p ocess pe o med in his s udy. Polyme Bulle in 1 3 Au ho s and A ilia ions OihaneMi xelena‑I iba en1,2 · Ma cRie a‑Pons1,2· SheilaPe ei a3,4· F anciscoJoséCale o‑Cas o3,4· JuanManuelCas illoTuñón5· Ja ie Padillo‑Ruiz3,4,6· Mai eMujika1,2· Se gioA ana1,2 1 CEIT-Basque Resea ch andTechnology Alliance (BRTA), Manuel La dizábal 15, 20018Donos ia-SanSebas ián, Spain 2 Uni e sidad de Na a a, Manuel La dizábal 13, 20018TecnunDonos ia-SanSebas ián, Spain 3 Depa men o Gene al Su ge y, Hospi al Uni e si y Vi gen del Rocio, CSIC, IBiS, Uni e si y o Se ille, Se ille, Spain 4 Oncology Su ge y, Cell The apy, andO gan T ansplan a ion G oup, Ins i u e o Biomedicine o Se ille (IBiS), Vi gen del Rocio Uni e si y Hospi al, Uni e si y o Se ille, Se ille, Spain 5 Depa men o Hepa obilia y andPanc ea ic Su ge y andLi e T ansplan a ion, Uni e si y Hospi al o Badajoz, Badajoz, Spain 6 Su ge y Depa men , Uni e si y o Se ille, Se ille, Spain