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Polymer-based nanocarriers to transport therapeutic biomacromolecules across the blood-brain barrier

Abstract

We acknowledge the financial support of “Innovative Tools to Treat and Model Complex Cancer Environments” project, TheraTools (Ref. 101073404. HORIZON-MSCA-2021-DN-01 call). MC received funding of Basque Government (projects 2023333010, 2023333023, PIBA2023-1-0043), the University of the Basque Country (projects COLLAB22/05 and GIU21/033), IKERBASQUE-Basque Foundation for Science, the Ministry of Science and Innovation of the Government of Spain (grant PID2022-142739OB-I00 funded by MICIU/AEI/ 10.13039/501100011033 and by FEDER, UE; 'María de Maeztu' Programme for Center of Excellence in R&D, grant CEX2023-001303-M funded by MICIU/AEI/10.13039/501100011033). AB acknowledges the Spanish Research Agency (PID2022-142128NB-I00 and CNS2023-145416 funded by MCIN/AEI/10.13039/501100011033/ and by the "European Union NextGenerationEU/PRTR"; RYC2018-025923-I from RyC program - MCIN/AEI /10.13039/501100011033 and FSE "invierte en tu futuro"; “María de Maeztu” Programme for Center of Excellence in R&D, grant CEX2023-001303-M funded by MICIU/AEI/ 10.13039/501100011033), and IKERBASQUE-Basque Foundation for Science. AS thanks the support of the Tamara and Harry Handelsman Academic Chair. AL and JMU are thankful for funds from the Basque Government, Department of Education (IT1766-22). SMS was supported by the IKUR Strategy of the Basque Country. ERB was supported by «Investigo Programme» of the Recovery, Transformation and Resilience Plan, funded by the European Union-NextGeneration EU, with reference 2022/IKER/000006.

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Polymer-based nanocarriers to transport therapeutic biomacromolecules across the blood-brain barrier

Author: Romero Ben, Elena,Goswami, Upashi,Soto Cruz, Jackeline,Mansoori-Kermani, Amirreza,Mishra, Dhiraj,Martín Saldaña, Sergio,Muñoz Ugartemendia, Jone,Sosnik, Alejandro,Calderón, Marcelo,Beloqui Elizazu, Ana,Larrañaga Espartero, Aitor
Publisher: Elsevier
Year: 2025
DOI: 10.1016/j.actbio.2025.02.065
Source: https://addi.ehu.eus/bitstream/10810/73102/1/1-s2.0-S174270612500162X-main.pdf
Re iew a icle
Polyme -based nanoca ie s o anspo he apeu ic biomac omolecules
ac oss he blood-b ain ba ie
Elena Rome o-Ben
a
, Upashi Goswami
a,b
, Jackeline So o-C uz
a
,
Ami eza Mansoo i-Ke mani
b,c,d
, Dhi aj Mish a
a,e
, Se gio Ma in-Salda˜
na
a
,
Jone Mu˜
noz-Uga emendia
b
, Alejand o Sosnik
e
, Ma celo Calde ´
on
a,
, Ana Beloqui
a,
,
Ai o La a˜
naga
b,*
a
POLYMAT, Applied Chemis y Depa men , Facul y o Chemis y, Uni e si y o he Basque Coun y UPV/EHU, Paseo Manuel de La dizabal 3, Donos ia-San Sebas i´
an
20018, Spain
b
Depa men o Mining-Me allu gy Enginee ing and Ma e ials Science, POLYMAT, Bilbao School o Enginee ing, Uni e si y o he Basque Coun y (UPV/EHU), Plaza
To es Que edo 1, Bilbao 48013, Spain
c
Is i u o I aliano di Tecnologia, Sma Bio-In e aces, Viale Rinaldo Piaggio 34, Pon ede a 56025, I aly
d
Scuola Supe io e San ’Anna, The Bio obo ics Ins i u e, Viale Rinaldo PIaggio 34, Pon ede a 56025, I aly
e
Labo a o y o Pha maceu ical Nanoma e ials Science, Depa men o Ma e ials Science and Enginee ing, Technion - Is ael Ins i u e o Technology, Hai a 3200003,
Is ael
IKERBASQUE, Basque Founda ion o Science, Plaza Euskadi 5, Bilbao 48009, Spain
ARTICLE INFO
Keywo ds:
Biomac omolecules
Blood-b ain ba ie anspo
Polyme ic nanopa icles
Neu ological diso de s
ABSTRACT
The apeu ic biomac omolecules such as gene ic ma e ial, an ibodies, g ow h ac o s and enzymes ep esen a
no el he apeu ic al e na i e o neu ological diseases and diso de s. In compa ison o adi ional he apeu ics,
which a e mainly based on small molecula weigh d ugs ha add ess he symp oms o hese diso de s, he a-
peu ic biomac omolecules can educe undesi ed side e ec s and a ge speci ic pa hological pa hways, hus
pa ing he way owa ds pe sonalized medicine. Howe e , hese biomac omolecules unde go deg ada ion/
dena u a ion p ocesses in he physiological en i onmen and show poo capaci y o c oss he blood-b ain ba ie
(BBB). Consequen ly, hey a ely each he cen al ne ous sys em (CNS) in hei ac i e o m. He ein, we c i -
ically o e iew se e al polyme ic nanoca ie s ha can p o ec and deli e he apeu ic biomac omolecules
ac oss he BBB. Polyme ic nanoca ie s a e i s ca ego ized based on hei a chi ec u e (biodeg adable solid
nanopa icles, nanogels, dend ime s, sel -assembled nanopa icles) ha ul ima ely de e mines hei physico-
chemical p ope ies and unc ion. The a ailable polyme ic o mula ions a e hen ho oughly analyzed, placing
pa icula a en ion on hose s a egies ha ensu e he s abili y o he biomac omolecules du ing hei encap-
sula ion p ocess and p omo e hei passage ac oss he BBB by con olling hei physical (e.g., mechanical
p ope ies, size, su ace cha ge) and chemical (e.g., su ace unc ional g oups, a ge ing mo i s) p ope ies.
Acco dingly, his e iew gi es a unique pe spec i e on polyme ic nanoca ie s o he deli e y o he apeu ic
biomac omolecules ac oss he BBB, ep esen ing a concise, comple e and easy- o- ollow guide, which will be o
high in e es o chemis s, ma e ial scien is s, pha macologis s, and biologis s. Besides, i also p o ides a c i ical
pe spec i e abou he limi ed clinical ansla ion o hese sys ems.
S a emen o signi icance: The inc easing incidence o cen al ne ous sys em diso de s is a majo heal h conce n.
The use o he apeu ic biomac omolecules has been placed in he spo ligh o many in es iga ions. Howe e ,
eaching he apeu ic concen a ion le els o biomac omolecules in he cen al ne ous sys em is es ic ed by he
blood-b ain ba ie and, hus, his ep esen s he main clinical challenge when de eloping e icien he apies.
He ein, we p o ide a c i ical discussion abou he use o polyme ic nanoca ie s o deli e he apeu ic bio-
mac omolecules in o he cen al ne ous sys em, highligh ing po en ial u u e di ec ions o o e come he cu en
challenges.
* Co esponding au ho .
E-mail add ess: [email p o ec ed] (A. La a˜
naga).
Con en s lis s a ailable a ScienceDi ec
Ac a Bioma e ialia
jou nal homepage: www.else ie .com/loca e/ac bio
h ps://doi.o g/10.1016/j.ac bio.2025.02.065
Recei ed 16 Sep embe 2024; Recei ed in e ised o m 20 Feb ua y 2025; Accep ed 28 Feb ua y 2025
Ac a Bioma e ialia 196 (2025) 17–49
A ailable online 1 Ma ch 2025
1742-7061/© 2025 The Au ho s. Published by Else ie Inc. on behal o Ac a Ma e ialia Inc. This is an open access a icle unde he CC BY-NC-ND license
(
h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/ ).
1. In oduc ion
In he las hi y yea s, he e has been a subs an ial ise in he global
occu ence and dea h a es associa ed o neu ological diso de s,
cu en ly ep esen ing a majo cause o mo bidi y and mo ali y
wo ldwide. This phenomenon can be asc ibed o he expansion and
ma u a ion o he wo ld popula ion, along wi h inc easing ulne abili y
o en i onmen al, me abolic, and li es yle haza ds. Acco ding o he
“Global Bu den o Disease, Inju ies, and Risk Fac o s S udy (GBD) 2021
″
,
a ound 3.4 billion people wo ldwide expe ienced a ne ous sys em
diso de in 2021 [1]. These include, among o he s: (i) neu odegene a-
i e diseases, namely Alzheime ’s disease (AD), Pa kinson’s disease
(PD), and Hun ing on’s disease (HD); (ii) au oimmune diseases like
mul iple scle osis (MS); (iii) b ain cance , pa icula ly glioblas oma
mul i o me (GBM); (i ) ce eb o ascula acciden s (e.g., ischemic
s oke); ( ) auma ic b ain inju y (TBI); and ( i) o he diseases (e.g.,
epilepsy, ansien ischemic a ack, and ce eb al palsy) a ec ing he
cen al ne ous sys em (CNS). In he u u e, i is an icipa ed ha b ain
diso de s will eme ge as a signi ican global heal h conce n, posing
subs an ial mo ali y a es and inancial bu dens [2].
To ace his challenge, g ea e o s a e being cu en ly in es ed in
de eloping ea men s ha no only alle ia e he symp oms o hese
diseases bu also ea he unde lying pa hology. Se e al ac o s
con ibu e o he ailu e o cu en medica ion ea men s (mainly based
on small molecula weigh (MW) d ugs) o b ain diseases, including he
equi emen o la ge he apeu ic doses and p olonged and highly
in asi e in a en icula injec ions [3]. These a iables s ongly impac
he medioc e esul s e ealed by s anda d ea men op ions in he clinic
[4,5]. The use o biomac omolecules such as oligopep ides, monoclonal
an ibodies, g ow h ac o s, an ioxidan enzymes o nucleic acids, ep-
esen s a no el he apeu ic al e na i e and has ga ne ed conside able
a en ion om esea che s, p omp ing ex ensi e endea o s o acili a e
hei ansla ion in o clinical applica ions. This new class o he apeu ics
o e s highe speci ici y and can g ea ly educe o - a ge e ec s
(Table 1).
Al hough signi ican ad ances in molecula biology pe mi s now he
la ge-scale syn hesis o such delica e biomac omolecules, hei use as a
he apy s ill aces unme challenges. The cell memb ane has e ol ed
o e billions o yea s o accu a ely con ol he mo emen o molecules
in o and ou o he cy osol, p o ec ing he in acellula en i onmen
om ex acellula dis u bance. Hence, he high MW and he hyd ophilic
na u e o mos o he biomac omolecules esul s in a limi ed pe me-
abili y h ough biological ba ie s like cell memb anes [29]. Besides,
mac omolecula s uc u es can unde go con o ma ional changes due o
he dis up ion o na i e non-co alen in e ac ions and he clea age o
pep ide bonds, esul ing in impai ed he apeu ic agen s. Fu he mo e,
deli e ing biomac omolecules o he b ain sys emically aces di e se
challenges such as: insu icien d ug adminis a ion, deg ada-
ion/dena u a ion in he bloods eam, i s -pass clea ance, immune
esponse, oxici y o no mal issues, and es ic ions imposed by he
blood-b ain ba ie (BBB); mos o he biomac omolecules a e unable o
nonin asi ely c oss he BBB and en e he b ain pa enchyma [30].
The seek o s a egies o he e icien espassing o bio-
mac omolecules h ough he BBB has opened new esea ch oppo u-
ni ies in which s a e-o - he-a echnologies a e me ged wi h enginee ed
deli e y sys ems. Thus, new app oaches encompass he dis up ion o he
BBB ia he u iliza ion o magne ic esonance-guided ocused ul asound
[31] o he lipidiza ion o wa e -soluble d ugs [32]. In his ega d,
nano echnology could p o ide sophis ica ed s a egies o design and
o mula e nanoma e ials loaded wi h biomolecules, signi ican ly
enhancing pa ien p ospec s and achie ing posi i e pha maco-economic
esul s [33,34]. A clea example is he applica ion o an ioxidan s [35] in
he managemen o b ain inju ies and neu odegene a ion, whe ein
an ioxidan enzymes such as supe oxide dismu ase (SOD1) migh
Table 1
Cu en medica ions and biomac omolecules unde esea ch o he ea men o CNS diso de s o b ain cance [3].
Neu ological
diso de
Cha ac e is ic Cu en medica ions Common side e ec s S udies wi h biomac omolecules
Alzheime ’s
disease (AD)
G adually ad ancing demen ia
accompanied by memo y impai men .
Cholines e ase inhibi o s, NMDA
an agonis s.
Nausea, omi ing,
dia hea, dec eased
appe i e, dizziness,
headache, con usion.
Monoclonal an ibody agains Aβ agg ega es
[6] (Aducanumab [7], Lecanemab [8] and
Donanemab [9]).
Pa kinson´s
disease (PD)
Pa hological degene a ion o
nig os ia al dopamine neu ons
cha ac e ized by mo o igidi y, es ing
emo , and b adykinesia.
Le odopa, dopamine agonis ,
Monoamine oxidase-B inhibi o s,
ca echol o-me hyl ans e ase (COMT)
inhibi o s, su gical he apies.
Dyskinesias, nausea,
omi ing, o hos a ic
hype ension,
hallucina ions, li e
damage, in ec ions.
Neu o ophic ac o s (glial cell-de i ed
neu o ophic ac o (GDNF) and b ain-
de i ed neu o ophic ac o (BDNF)) [10,11],
monoclonal an ibodies agains
α
-synuclein
(Snca) (P asinezumab) [12,13], shRNA
a ge ing Snca [14].
Hun ing on’s
disease (HD)
Au osomal neu odegene a i e
diso de . Pa ien s exhibi a ange o
symp oms, including cho ea, men al
dis u bances, and cogni i e
de e io a ion.
Cho ea and an ipsycho ic medica ion,
an idep essan s (Selec i e se o onin
eup ake inhibi o s), mood s abilize s.
D owsiness,
pa kinsonism, dep ession,
insomnia, anxie y,
aka hisia, excess weigh
gain and dyslipidemia.
Di alen small in e e ing RNA (siRNA)
silencing he hun ing in gene [15].
Chape one p o eins o comba he
neu odegene a i e e ec [16].
Mul iple
scle osis
(MS)
Demyelina ing disease cha ac e ized
by he immune sys em’s a ack on he
myelin shea h su ounding ne e
ibe s, esul ing in communica ion
impai men s be ween he b ain and he
body.
gamma-aminobu y ic acid analogs,
ac i a ion o
α
2-ad ene gic ecep o s,
mi ochond ial dihyd o-o o a e
dehyd ogenase (DHODH) inhibi o s,
immunomodula o s (Gla i ame
ace a e).
Dia hea, nausea, li e
p oblems, weakness,
hallucina ions,
hypo ension, inc eased
isk o in ec ions.
Neu o ophic ac o s (BDNF) [17].
Remyelina ion-p omo ing p o eins
(Insulin-like g ow h ac o 1 (IGF-1)) [18].
Monoclonal an ibodies (Na alizumab) [19].
S oke Neu ological de iciency a ibu ed o a
se e e ocal lesion o he cen al
ne ous sys em (CNS) due o a ascula
disease, including ce eb al in a c ion,
suba achnoid hemo hage (SAH), and
in ace eb al hemo hage (ICH).
Se ine p o ease issue- ype plasminogen
ac i a o .
Nausea, omi ing,
hypo ension, dizziness,
alle gic eac ions.
Neu o ophic ac o s (NGF) [20]. RNAi
a ge ing umo nec osis ac o (TNF)-
α
o
in e leukin (IL)-1β o educe pos -ischemic
in lamma ion [21]. miR-124, which
p omo es human neu ogenesis [22]. siRNAs
a ge ing caspase [23].
Glioblas oma Mos common and agg essi e umo
among glial neoplasms.
Radia ion he apy, emozolomide
adminis a ion (chemo he apy DNA
base alkyla ion), and su ge y.
Ce eb al edema,
con ulsions, a igue,
omi ing, skin damage,
alopecia, bone ma ow
supp ession.
Monoclonal an ibodies: Be acizumab ha
selec i ely binds o ascula endo helial
g ow h ac o (VEGF) [24], Ce uximab and
Pani umumab ha a ge he mu a ed
epide mal g ow h ac o ecep o (EGFR) III
a ian , common in glioblas oma [25,26],
siRNA agains Bcl-2 [27] o miR-124 [28].
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
18
assume a pi o al ole. None heless, due o hei limi ed s abili y and
adminis a ion, he li e a u e lacks ele an s udies. The po en ial o
clinical ans e a ises solely when u ilized in conjunc ion wi h nano-
ca ie s [36–38].
O e he yea s, signi ican ad ancemen s ha e been made in he
de elopmen o ailo ed nanoca ie s, wi h special a en ion o lipid
nanopa icles as deli e y sys ems o enhance he e ec i eness o hese
he apeu ics [39–41]. Howe e , he body ecognizes hese nanopa icles
as o eign ma e ials and ac i a es he inna e immuni y, he eby in lu-
encing adap i e immuni y [42]. In such si ua ions, polyme nano-
pa icles may o e supe io cha ac e is ics such as educed
immunogenici y, inc eased s abili y, and enhanced ep oducibili y
[43–45]. In e es ingly, hese p omising nanoca ie s, when combined
wi h cell-pene a ing echniques, can add ess he challenges associa ed
wi h he deli e y o biomac omolecules o he ea men o CNS dis-
o de s [46,47].
In his e iew, we emphasize he sophis ica ed a chi ec u es a ail-
able in he ecen li e a u e (i.e., ~60% o he e e ences used in his
e iew belong o s udies pe o med in he las 5 yea s) o he ab ica ion
o polyme ic nanoca ie s capable o c ossing he BBB om he blood-
s eam, oge he wi h he cu en app oaches o encapsula ing he a-
peu ic biomac omolecules (Fig. 1). This e iew does no aim solely o
p o ide examples o polyme ic nanoca ie s ha deli e bio-
mac omolecules ac oss he BBB, which a e summa ized in Table 2.
Ins ead, ou goal is o o e a c i ical pe spec i e on he ea u es ha
make hese polyme ic nanoca ie s ideal o his pu pose, as well as o
Fig. 1. Gene al illus a ion ha summa izes he main polyme ic nanoca ie s desc ibed in his e iew o anspo he apeu ic biomac omolecules in o he b ain. (A)
Biodeg adable solid nanopa icles encompass nanopa icles ha p esen (i) a b oad o syn he ic al e na i es o deco a e hei su ace wi h speci ic ligands o enhance
an ac i e a ge deli e y, and (ii) allow wo main encapsula ion app oaches, such as double wa e in-oil-wa e o nanop ecipi a ion echniques o encapsula e
biomac omolecules. (B) Nanogels a e so polyme ic nanopa icles, ha (i) pe mi he use o a b oad mul i- esponsi e c osslinke s o lead di e en s imuli- esponsi e
nanoma e ials and also (ii) allow he encapsula ion o biomac omolecules media ed by di e en echniques such as he o ma ion o sel -assembled complex, UV
polyme iza ion in liposomes, a om ans e adical polyme iza ions (ATRP) in in e se micelles and in si u adical polyme iza ion leading single enzyme nanogels. (C)
Dend i ic polyme s ha e a con olled syn hesis in mul i-b anched a chi ec u es, ha opens he possibili y o expose mul i alen ly speci ic g oups on hei su ace o
enhance ligand- ecep o s in e ac ions, and, a he same ime, modula e he su ace cha ge o encapsula e biomac omolecules as nucleic acids by elec os a ic
in e ac ion inside hei in e nal po es. (D) Sel -assembled polyme ic nanopa icles can be syn he ized h ough spon aneous in e ac ion o molecules (physic o ces) o
o m o ganized s uc u es ha acili a e he implemen a ion o encapsula ion app oaches. Bio ende has been used o c ea ing he desc ip i e image.
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
19
highligh he ad an ages o using ce ain ypes o polyme ic sys ems
o e o he s. Addi ionally, i highligh s clinical ansla ion, explo es
cu en challenges, and o e s insigh s in o u u e p ospec s in his ield.
This app oach allows he eade o d aw hei own conclusions,
conside ing ha each nanosys em possesses impo an ea u es o
di e en po en ial applica ions.
2. The blood-b ain ba ie issue o he apy design
2.1. Physiology o he blood-b ain ba ie
The BBB se es as a p o ec i e, semi-pe meable memb ane ha
in ica ely egula es he exchange o essen ial nu ien s, oxygen, and
ions om he bloods eam in o he CNS, while i p e en s he in ac ion
by exogenous subs ances, oxins, and pa hogens [69,70]. Ana omically,
he BBB is a complex and in eg a ed ne wo k o endo helial, neu al, and
immune cells, known as he neu o ascula uni [71–73]. The endo helial
cells, ep esen ing he main componen o he BBB, o m he inne line o
b ain capilla y walls wi h la ges su ace a ea. They a e pola ized wi h
nega i e su ace cha ge and no enes a ions, p e en ing he apid
di usion and exchange o nega i ely-cha ged molecules be ween he
blood and he b ain [69,70]. P ima ily, endo helial cells a e allied wi h
one ano he by igh junc ions (TJs), which is dis inc i e o endo helial
cells o CNS along wi h adhe ens junc ion, which oge he o m a obus
physical ba ie [72]. Unde he endo helial cells lies he basemen
memb ane. I consis s o ex acellula ma ix p o eins like collagen,
hepa in, laminin, nidogen, and pe lecan [69,70,72,73]. Wi hin he
basemen memb ane, pe icy es (a ype o mu al cells) g ow abluminal o
endo helial cells, and co e 90% o capilla y beds [73]. Pe icy es a e
esponsible o main aining he diame e o he essels and egula e he
speci ic gene exp ession o endo helial cells om BBB, essen ial o
main aining he TJs [71,74]. Due o hei close associa ion wi h endo-
helial cells, hey play a pi o al ole in egula ing BBB in eg i y, ho-
meos asis, and in con olling ce eb al blood low in capilla ies along
wi h exchange o ions and me aboli es be ween hem [69,75,76].
Addi ionally, hey a e also impo an in ascula de elopmen , egula-
ion o in lamma o y esponse by con olling leucocy e in il a ion,
sec e ion o in lamma o y media o s, and neu o oxin emo al [75,76].
A he in e ace be ween neu ons and endo helial cells a e he as o-
cy es, a ype o glial cells connec ed wi h he end walls o endo helium.
They co e mos o he CNS and gi e in eg i y by s eng hening he TJs,
while p o iding biological suppo o he cells [69,71]. They play a
majo ole in egula ion o ascula unc ion, exp ession o anspo e s
such as P-glycop o ein (P-gp) and glucose anspo e -1 (GLUT-1), wa e
and ion homeos asis, pH egula ion, neu o ascula coupling (as as o-
cy es a e he cen al link be ween mic o ascula u e and neu al
ne wo k), and p o ide ene gy- ich subs a es and insula ion o he
neu ons [70,71,76]. Acco dingly, close associa ion o as ocy es wi h
endo helial cells and pe icy es holds con ol o e pe meabili y ac oss
he BBB [69,77]. Mic oglia ac s as he mac ophages o he CNS,
mig a ing o pa hologically a ec ed egions o phagocy ose ne ous
issue [77]. Mic oglia a e igilan , and ensu e p ope esponse o any
Table 2
Polyme -based nanoca ie s ha anspo he apeu ic biomac omolecules ac oss he BBB o ea CNS diso de s o b ain cance .
Classi ica ion D ug deli e y sys em Ca go Disease BBB Pene a ion Re e ence
Biodeg adable solid
nanopa icles
(NPs)
Poly(lac ic-co-glycolic acid) PLGA NPs Enzyme galac osylce amidase K abbe disease Angiopep-2 (Ang2), g7 and
ans e in (T ).
[48]
PLGA NPs Small in e e ing RNA (siRNA) T auma ic b ain
inju y
Polyso ba e 80, poloxame 188,
DSPE- PEG-glu a hione, and
DSPE-PEG-T .
[49]
PLGA NPs Vi amin D-binding p o ein Alzheime ´s Disease
(AD)
- [50]
PLGA NPs Epide mal g ow h ac o
ecep o siRNA
Gliomas Ang2. [51]
Nanogels PLA-PEG-PLA NGs Ri uximab (RTX) Non-Hodgkin
lymphoma
2-me hac yloyloxye hyl
phospho ylcholine (MPC).
[52]
PLA-PEG-PLA NGs Ne e g ow h ac o and RTX Cen al ne ous
sys em (CNS)
diseases
MPC. [53]
Poly(N-(3-aminop opyl) me hac ylamide-
co-me hac yloyloxy e hyl
phospho ylcholine) and MMP sensi i e
pep ide sequence as c osslinke
Nimo uzumab and as uzumab B ain umo s MPC. [54,55]
Poly(e hylene glycol)-b-poly(me hac ylic
acid) (PEG-b-PMAA) diblock copolyme
Cispla in T ea men o glioma Monoclonal an ibodies agains
Cx43 and BSAT1.
[56]
Dend i ic polyme s Polyamidoamine dend ime Heme oxygenase-1 (HO-1)
plasmid
In lamma o y
diseases including
ischemic s oke
- [57]
Dend i ic polyglyce ol sul a e.
Dend i ic polyglyce olamine.
Pep idomime ic o he an i-
angiogenic p o ein
h ombospondin-1 (TSP-1 PM)
mic oRNA-34a (miR-34a)
Glioblas oma
Glioma
T . [58,59]
Ca bosilane dend ime . Lac o e in bea ing
polyp opylenimine dend iplex
siRNA.
2G-(SNMe3I)11-FITC.
Neu ological
diso de s
Lac o e in. [60,61]
Sel -assembled
pa icle
Ca ionic micelles assembled om i amin E
succina e g a ed
ε
-polylysine polyme s
TRAIL plasmids (pDNA) Gliomas Apolipop o ein E (ApoE). [62]
Glucosyla ed-polyion complex polyme ic
micelle
An isense oligonucleo ide (ASO) Cen al ne ous
sys em (CNS)
diso de s
Glucose coa ing (GLUT-1-
media ed anspo s a egy).
[63]
Chime ic polyme somes siRNA Glioblas oma Ang2. [64]
Chime ic polyme somes Sapo in Glioblas oma (ApoE) pep ide. [65]
O he polyme ic
ca ie s
Chi osan-PMMA-PAA NPs Topoisome ase I inhibi o SN-38 B ain umo s Re oenan io pep ide shu le H-
pw pswmpp h -NH2.
[66]
Chi osan NPs G een Fluo escen P o ein
(GFP)- agged plasmid in
HEK293–293
B ain cance - [67]
Hyalu ona e Nanopa icles Neu oglobin S oke - [68]
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
20
inju y, in ec ion, and in lamma ion o main aining CNS homeos asis
[76]. These highly complex, dynamic, and selec i e ea u es o he BBB
a e o u mos impo ance o he co ec homeos asis o he CNS. Un-
de s anding he ole o BBB anspo e s o main aining homeos asis is
e y c ucial, since hey go e n he ansloca ion o a ious molecula
en i ies ac oss he BBB (Fig. 2a).
2.2. Blood-b ain ba ie dis up ion unde pa hological condi ions
The BBB unde goes dis inc i e changes in a ious neu ological dis-
o de s and diseases [70,71,77,78]. The pa hology o BBB in ol es
s uc u al, molecula , and unc ional modi ica ions o BBB cons i uen s,
ha impac he o e all physiological in eg i y and unc ion o he ba -
ie . E en hough he p ime cause o di e en diseases impac ing BBB
di e s, he p ima y ocus o BBB pa hology cen e s on i s pe meabili y.
In no mal condi ions, BBB is selec i ely pe meable (Fig. 2b), bu mos o
hese diso de s esul in inc eased pe meabili y due o al e a ions o
endo helial cells (sh inkage), loss o TJs p o eins, augmen ed anspo
o molecules ( anscy osis), and al e a ion in anspo (pa acellula and
anscellula ) sys ems [69,78]. Addi ionally, BBB b eakdown is e iden
by he loss o basemen memb ane, enhanced leucocy e ac i i y, de e-
io a ion o pe icy es esul ing in impai men o ascula ne wo k, and
de ached as ocy es, as desc ibed in Fig. 2c [71,76]. The o he hallma k
o BBB pa hogenesis is he elease o in lamma o y media o s such as
in e leukin (IL)-1β, in e e on (IFN)-γ, umou nec osis ac o (TNF)-
α
,
oxida i e compounds (e.g., NO, H
2
O
2
), lipid media o s (p os aglandin
E2 and F2a), asogenic agen s (e.g., his amine), and enzymes (e.g.,
ma ix me allop o einases) by bo h local and in il a ing immune cells
[77,78].
2.3. S a egies o blood-b ain ba ie c ossing
2.3.1. Physical and chemical dis up ion o he blood-b ain ba ie
Ex e nal s imuli-media ed me hods ha can egula e BBB pe me-
abili y o deli e y o he apeu ic agen s ha e been widely explo ed, and
hey showed high e ec i eness. They in ol e physical and biochemical
app oaches (Fig. 3).
Physical dis up ion: Ex e nal physical app oaches, like ocused ul a-
sound, magne ic esonance imaging, high pulse elec ic ields, lase s,
and elec o acupunc u e, ha e been used o p omo e he pe meabili y o
he BBB and he ollowing deli e y o he apeu ic agen s and (bio)
mac omolecules in he b ain issue [69,79–82]. Focused ul asound,
along wi h mic obubbles (gas- illed), in ol es high- equency sound
wa es ha a e p ecisely a ge ed o a speci ic a ea wi hin he b ain o
igge mic obubbles in he blood o ca i a ion [77]. This mechanical
in e ac ion esul s in empo a y and e e sible dis up ion o he BBB,
allowing he deli e y o he apeu ic agen s in CNS. The e ha e been
ecen ad ancemen s in using his app oach, some o which a e unde -
going clinical ials [83]. Addi ionally, ocused ul asound has been
coupled wi h magne ic esonance imaging and mic obubbles o p ecise
a ge ing o d ugs [78,80,83]. Low- and high-pulsed elec ical ields
ha e also been used o anspo small molecules by dis up ing he TJs o
he BBB [81]. Recen ly, lase s imula ion has been explo ed o modu-
la ing BBB pe meabili y. Fo his, plasmonic gold nanopa icles (AuNPs)
we e conjuga ed wi h an ibody BV11 (AuNPBV11) o a ge ing junc-
ional adhesion molecule A (JAM-A) and we e injec ed o mice
Fig. 2. (A) Schema ic ep esen a ion o a ious anscy osis pa hways o blood-b ain ba ie (BBB) ha egula es he anspo a ion o di e en molecules, bio-
mac omolecules and ions. Small lipophilic molecules passi ely di use h ough BBB ia anscellula lipophilic pa hway whe eas hyd ophilic molecules pass ia a
pa acellula pa hway. Essen ial nu ien s and ions along wi h glucose, i amins, elec oly es, amino acids, and nucleosides c oss he BBB h ough ca ie media ed
anscy osis (CMT) ia glucose anspo e iso o m 1 (GLUT-1) and la ge neu al amino acid anspo e 1 (LAT1). La ge biomac omolecules like p o eins, lipo-
p o eins, o pep ides, c oss he BBB h ough anscy osis mechanisms ia in e ac ion wi h speci ic ecep o s and is known as ecep o media ed anscy osis (RMT).
This in ol es ans e in ecep o (T R), insulin ecep o (IR), lipop o ein ecep o s, and lac o e in (L ) ecep o . Adso p i e media ed anscy osis (AMT) allows
anscy osis o la ge biomac omolecules (e.g., pep ides) and is based on elec os a ic in e ac ions be ween he posi i ely-cha ged subs a es and he nega i ely-
cha ged plasma memb ane. (B) Schema ic ep esen a ion o ans e se sec ion o BBB wi h i s componen s and unc ion du ing heal hy s a e, and (C) a e BBB
b eakdown. Bio ende has been used o c ea ing he desc ip i e image.
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
21

in a enously. One-hou pos -adminis a ion, 532 nm picosecond lase
was applied ansc anially, leading o ac i a ion o AuNPBV11. This
esul ed in he enhancemen o BBB pe meabili y, acili a ing he de-
li e y o immunoglobulins, adeno-associa ed i al ec o s, and lipo-
somes [82]. The e ec o i adia ion on he b ain is in ica ely associa ed
wi h powe and i adia ion ime, along wi h he dis ance be ween he
sou ce and he a ge ed a ea. No ably, nea in a ed ligh wa eleng h in
he ange om 700 o 1600 nm has ga ne ed p o ound in e es due o i s
abili y o pene a e deep issues and has been used o egula e BBB
pe meabili y. Recen s udies ha e applied nea in a ed i adia ion o
imp o e he abili y o ligh -sensi i e d ug deli e y sys ems wi h pho-
o he mal e ec s o pene a e BBB, o e ec i e ea men o dep ession
[69]. The use o elec oacupunc u e o imp o ing he pe meabili y o
BBB has also gained in e es . One o he s udies highligh s he
augmen a ion o BBB pe meabili y h ough he applica ion o elec o-
acupunc u e a ge ing he GV20 and GV26 acupoin s in a models [69].
Chemical dis up ion: The mos commonly used chemical eagen s o
dis up he in eg i y o he BBB, oge he wi h hei wo king condi ions,
applica ions, ad an ages and disad an ages a e summa ized in Table 3.
[69,77,78,80,84–92] Some o he pha maceu ical biological compounds
like zonula occludens oxins, Ce epo (a syn he ic pep ide analog o
b adykinin), LipoB idge (a nonimmunogenic o mula ion con aining
sho -chain oligoglyce olipids), ascula endo helial g ow h ac o
(VEGF), and chemical compounds such as oleic acid, lysophospha idic
acid, cyclodex ins, and sodium dodecyl sul a e a e also in ol ed in
ansien opening o he BBB [77,78,86].
The i uses also se e as s imula ing biological agen s ha help in
he opening o TJs by up egula ing chemokines. As example, s udies on
human b ain mic o ascula endo helial cells highligh ed he in ol e-
men o he human immunode iciency i us (HIV) ype 1 gp 120 i us in
enhancing BBB pe meabili y by deg ading TJs [78]. Addi ionally,
adeno-associa ed i us and Wes Nile i us also exhibi ed p omising
abili y o a ge CNS, wi hou dis up ing he BBB [78,95].
2.3.2. In asi e s a egies
Di ec injec ion/implan a ion: Di ec injec ions in ol e localized de-
li e y o he apeu ics o hei sus ained elease ia implan s in o he
b ain. This is used o ea condi ions such as cance s, s oke, neu o-
logical and men al diso de s [96]. Su gically placed implan s can p o-
ide sus ained elease o d ugs by opening he skull. The
ca mus ine-loaded biodeg adable implan s (Gliadel® wa e ), app o ed
by he Food and D ug Adminis a ion (FDA), placed du ing umou
esec ion, ha e shown imp o ed su i al a es in pa ien s acing GBM.
Also, nica dipine- eleasing solid implan s ha e been success ully used o
p e en neu ological diso de s ollowing s okes [96]. A he same ime,
long- e m (5 mon hs) deli e y sys ems ha e been explo ed o schizo-
ph enia o add ess ea men adhe ence issues associa ed wi h men al
diso de s [96].
In ace eb o en icula adminis a ion: In his app oach, he he a-
peu ics a e deli e ed in o he ce eb ospinal luid, speci ically in he
la e al en icle sys em o he b ain, ia an ou le ca he e o in a-
ce eb o en icula po implan ed unde he scalp o by pump [77,88].
Ou o his, he use o pumps is mo e p e alen , as i main ains con in-
uous and ele a ed d ug concen a ions in ce eb ospinal luid [77].
In ace eb o en icula implan s ha e been used o deli e chemo he -
apeu ics o b ain cance , opioids o pain managemen , and d ugs o
he ea men o neu ological diso de s like lysosomal s o age diso de s
(LSD), mucopolysaccha idosis, and o diso de s associa ed wi h ce e-
b al palsy (e.g., baclo en) [90]. Addi ionally, clinical ials a e going on
o amyo ophic la e al scle osis (ALS) and PD by adminis e ing VEGF
and pla ele -de i ed g ow h ac o s, espec i ely [88,90].
In a hecal adminis a ion: He e, he he apeu ics a e di ec ly injec ed
in o he space su ounding he spinal co d by lumba punc u e and a e
deli e ed o CNS pa enchyma ia ce eb ospinal luid. This app oach has
been app o ed o he deli e y o an isense oligonucleo ide o he
ea men o spinal muscula a ophy. Clinical ials a e going on o ALS
and HD [77,90].
2.3.3. Non-in asi e s a egies
Non-in asi e s a egies o he deli e y o he apeu ics ely on
pha macological app oaches ha exploi he endogenous anspo
mechanisms o enhanced BBB pe meabili y. These s a egies, ha
include chemical modi ica ion o he he apeu ic d ugs, anspo ca -
ie s, chime ic pep ides, nanoca ie s, T ojan ho se, e c., ha e
Fig. 3. Schema ic ep esen a ion o he mos common s a egies o blood-b ain ba ie (BBB) c ossing. Physical/chemical dis up ion includes ansien opening o
he BBB o acili a e he deli e y o he apeu ics. In asi e s a egies in ol e di ec implan a ion/injec ion o he apeu ics ei he di ec ly in he b ain o h ough he
ce eb ospinal luid (CSF). Non-in asi e s a egies equi e he use o ca ie s capable o deli e ing he apeu ics ac oss he BBB. Bio ende has been used o c ea ing
he desc ip i e image.
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
22
Table 3
Summa y o a ious chemical eagen s used o BBB dis up ion.
Agen s Examples Mechanism Wo king Condi ion Applica ion Ad an ages/Disad an ages
Hype osmo ic
Agen s
Manni ol [77,78,80,
84,87–89]
Osmo ic p essu e g adien c ea ed,
which leads o sh inkage o
endo helial cells and dis up ion o
igh junc ion, and esul ing in
empo a y opening o he blood-
b ain ba ie (BBB)
A e ial Injec ion/in usion
(25%)
D ug Deli e y,
(chemo he apeu ics,
imaging agen s)
Ad an ages: Clinically
app o ed, enhanced
pe meabili y, non-in asi e,
apid ac i i y, b oad ange o
agen s, cos e ec i e
Disad an ages: Non selec i e,
inconsis en ba ie dis up ion,
neu ological oxici y
Glyce ol [80,85]Neu ological S udy, d ug
deli e y
Ad an ages: A ailabili y, low
cos
Disad an ages: Lowe
e icacy, Immunogenic isks
A abinose [77,78,80,
87,89,93]
In a enous adminis a ion D ug Deli e y Ad an ages: Biodeg adable,
e ec i e a low concen a ion,
used o hyd ophilic and
lipophilic d ugs
Disad an ages: Limi ed
in o ma ion,
isk o me abolic imbalances
Saline [89,90,93] In a enous adminis a ion
(23.4%)
Used in p eclinical models
o d ug deli e y and
con as agen s o CNS
Ad an ages: Cos e ec i e,
a ailabili y, easy
adminis a ion
Disad an age: Edema, issue
damage, hype na emia (high
sodium le els)
U ea [85,89,90,93]Used in p eclinical s udies
o d ug deli e y
Ad an ages: Cos e ec i e,
dis up s BBB a con olled
doses
Disad an ages: Sho li ed
dis up ion, elec oly e
imbalance
F uc ose [85] In a enous adminis a ion Used in p eclinical s udies
o d ug deli e y and
con as agen s
Ad an ages: Less oxic,
biocompa ible
Disad an ages: Limi ed
In o ma ion, me abolic
imbalances
Vasoac i e
Compounds
His amine [77,80,89,
90]
Binds wi h B2 ecep o s o
endo helial cells leading o
dis up ion o igh junc ion and
enhanced d ug pe meabili y
In a enous (10 o 100 µM) Used in p eclinical models
o d ug deli e y
Ad an ages: Minimal oxici y
Disad an ages: sho du a ion
o ac ion, non-speci ic
B adykinine [77,80,
87,88,88,90]
In a enous o
in ace eb al
adminis a ion
D ug deli e y (enhanced
deli e y o
chemo he apeu ics, small
molecules)
Ad an ages: Selec i e,
minimal oxici y
Disad an age: Sho du a ion
o ac ion, limi ed e icacy o
la ge molecules, cos
RMP-7 (analogues o
b andykinin [88,89]
Ad an ages: Mo e po en and
speci ic o B2 ecep o s han
b adykinin, highe hal -li e as
esis an o deg ada ion
Alkylglyce ols (e.g., 1-
O-pen ylglyce ol [80,
88,89]
In aca o id injec ion (200
mM)
D ug Deli e y
(Chemo he apeu ics)
Ad an ages: Re e sible,
inc ease in BBB pe meabili y
Disad an ages: Limi ed
e ec i eness, side e ec s
Leuco ienes (e.g.,
cys einyl leuko ienes)
[88,89]
Binds o he G-p o ein coupled
ecep o s CysLTR1 and CysLTR2,
igge ing he con ac ion o
endo helial cells and dis up ing igh
junc ion esul ing in enhanced
pe meabili y
In ace eb o e–n icula
injec ion (6pmol)
D ug Deli e y Ad an ages: Immune esponse
acili a ion
Disad an ages: Tissue
damage, long e m oxici y
Tumo nec osis ac o
A (TNF-A)/in e e on
c (INF-c) [94]
Tigh junc ion p o eins a e al e ed
ia in lamma o y cy okines
Sys emic o local
adminis a ion
D ug Deli e y,
neu oin lamma ion and
CNS esea ch
Ad an ages: Ta ge speci ic,
mechanis ic insigh s
Disad an ages: Sys emic side
e ec s, isk o
neu oin lamma ion
Chemical
compounds
Oleic Acid [77,78] I changes p o ein kinase C-induced
p o ein phospho yla ion, esul ing in
e e sible opening o BBB
In aca o id in usion Used in p eclinical s udies
o d ug deli e y
Ad an ages: Mild and
e e sible e ec
Disad an ages: Low
speci ici y, limi ed in o ma ion
Lysophospha idic acid
[77,78]
In a enous Injec ion Ad an ages: Re e sible e ec
Disad an ages: Limi ed
in o ma ion, isk o
neu oin lamma ion
Sodium lau yl
sulpha e [77,78]
Dis up s endo helial cell memb ane
by al e ing lipid bilaye
Di ec In usion on BBB D ug Deli e y and BBB
s udies
Ad an ages: Cos , Dose
dependen
(con inued on nex page)
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Ac a Bioma e ialia 196 (2025) 17–49
23
demons a ed p omising esul s wi h minimal ad e se e ec s. This e-
iew ocusses on he T ojan ho se app oach, and highligh s hei mode
o ac ion and he po en ial applica ion in he deli e y o bio-
mac omolecules ac oss he BBB.
Molecula T ojan ho ses a e designed o deli e he apeu ic mole-
cules (e.g., small-molecule d ugs, ecombinan p o eins, and genes)
ac oss he BBB by mimicking na u al biological p ocesses and s uc u es.
This s a egy in ol es non-in asi e app oaches, using an ibodies, pep-
ides, cells, and nanopa icles as T ojan ho ses, a ge ing endogenous
BBB ecep o s such as ecep o -media ed anscy osis (RMT) and
adso p i e-media ed anscy osis (AMT) o anscy osis o he apeu ic
biomac omolecules [97–99]. Examples o some o he T ojan ho se ap-
p oaches o BBB pene a ion a e desc ibed below (Fig. 3).
An ibody T ojan ho ses: This echnique uses gene ic enginee ing o
he apeu ics (neu o ophins, he apeu ic an ibodies, enzymes and decoy
ecep o s) wi h monoclonal an ibodies (mAb) (IgG domain) ha ing
speci ici y owa ds ans e in ecep o (T R) and human insulin e-
cep o (HIR) o gi e T RmAb and HIRmAb. These ac as a T ojan ho se
o deli e y o a ached d ugs ia RMT [100,101]. Fo example, T ojan
ho se Pabina usp al a, enginee ed by usion o idu ona e 2-sul a ase
(lysosomal enzyme) and hea y chain o T RmAb, has been used o
he Hun e synd ome and ecei ed ma ke app o al o he ea men o
b ain diso de s in Japan [100,102].
Pep ide T ojan ho ses: Angiopep-2 pep ide (Ang2) is a low-densi y
lipop o ein ecep o (LPR1)- a ge ing pep ide, ha enhances he BBB
pene a ion o an i-human epide mal g ow h ac o -2 mAb [103].
Simila ly, a no el de i a i e o pacli axel wi h Ang2 (ANG1005)
e ealed imp o ed d ug up ake in gliomas and is unde clinical ial [99,
104]. TAT is a posi i ely-cha ged cell pene a ing pep ide (CPP) de i ed
om he ansac i a o o ansc ip ion p o ein o he HIV. I has been
ound ha many ca ionic pep ides a e aken up by he cells h ough AMT
in i o. Howe e , poo b ain pe meabili y was obse ed in i o [98,
103]. Con a ily, ano he CPP, SynB pep ides, de i ed om a na u al
mammalian an imic obial pep ide, ha e shown be e deli e y o pola
biomolecules such as mo phine-6-glucu onide o he b ain in a clinical
ial, bo h in i o and in i o [78]. Addi ionally, SynB3 conjuga ed wi h
a ious low b ain-pene a ing chemo he apeu ic d ugs like doxo ubicin,
benzylpenicillin, pacli axel, and dala gin has demons a ed signi ican
b ain pene a ion and can be a po en ial s a egy o b ain cance
ea men [78].
Func ionaliza ion o nanopa icles: The apies based on app o ed
nanoca ie s (e.g., liposomes and polyme ic nanopa icles) and associ-
a ed echnologies (in asi e and non-in asi e) a e cu en ly being
in es iga ed o ea CNS diseases [99]. In his con ex , liposomes wi h
high biocompa ibili y, biodeg adabili y, and in insic compe ence o
BBB ha e been ex ensi ely explo ed as T ojan ho ses. Liposomes unc-
ionalised wi h polye hylene glycol (PEG) and biomolecules (T and
insulin) ha e been used o he deli e y o DNA encoding lysosomal
enzyme o he b ain o he ea men o mucopolysaccha idosis [105].
PEGyla ed liposomes u he unc ionalised wi h glu a hione (GSH) o
a ge ing GSH anspo e s o deli e y o doxo ubicin, me hylp ednis-
olone, and iba i in a e in p eclinical s udies [99]. Fo example,
PEGyla ed doxo ubicin-loaded liposomes a ge ing GSH anspo e s
ha e shown posi i e ou comes in e ms o an i umou ac i i y, and ha e
eached phase I/II clinical ials. The ea men was ound o be sa e and
well- ole a ed [105]. Simila ly, ea men wi h GSH PEGyla ed lipo-
somal me hylp ednisolone o phase I ials on 42 pa ien s, was deemed
sa e and well ole a ed a he apeu ic doses o MS [105]. In he case o
in a enous adminis a ion o iba i in encapsula ed GSH PEGyla ed
liposome, a ou old inc emen o he d ug in b ain mic odialysa es was
obse ed [99]. Two o he liposome-based T ojan ho se sys ems, SGT-53
(wi h T Ab and plasmid p53), and doxo ubicin-loaded PEGyla ed li-
posomes wi h ce uximab a e in phase I and phase II clinical ials o
GBM [105].
Cellula ca ie s: Inno a i e pa adigms, whe ein he immune cells
(monocy es, neu ophils, and mac ophages) a e ha nessed o BBB
he apeu ic in e en ions, ha e gained in e es in ecen imes. In his
app oach, cells a e used as T ojan ho ses. Cells a e ei he gene ically
modi ied o p oduce he apeu ically ac i e pep ides and RNA mole-
cules/p o eins o can ca y he apeu ics a ge ing BBB [99]. Immune
cells ha e inhe en p ope ies o ansmig a e ac oss BBB by changing
hei shape (diapedesis) and ha e been used o b ain deli e y in dis-
eases in ol ing in lamma ion. Enginee ed mac ophages exp essing glial
cell line-de i ed neu o ophic ac o (GDNF) in a PD model demon-
s a ed long- e m neu op o ec i e e ec s a he onse o disease p o-
g ession and educed b ain in lamma ion [99]. Fu he , neu al
p ecu so s em cells and hema opoie ic s em cells can also in e ac wi h
BBB cells unde in lamma ion. In ecen s udies, neu al p ecu so s em
cells and hema opoie ic s em cells we e enginee ed o exp ess he
an i umou biomolecule umou -selec i e p oapop o ic dea h ecep o
ligand (TRAIL), esul ing in ea ing me as a ic b ain umou [99]. In
ano he se o cell-media ed d ug deli e y examples, magne ic lipo-
somes loaded wi h he d ug diclo enac and unc ionalised wi h he
pep ide mo i RGD (a ginylglycylaspa ic acid) we e able o a ge
monocy es and neu ophils in an IL-1β induced b ain in lamma ion a
model. In ha s udy, RGD ac ed as a a ge ing ligand o in eg in
Table 3 (con inued)
Agen s Examples Mechanism Wo king Condi ion Applica ion Ad an ages/Disad an ages
Disad an ages: Nonspeci ic,
Side e ec s
Sodium dodecyl
sul a e [77,78]
In e ac s wi h lipid and p o ein o
cell memb ane
  Ad an ages: Dose dependen ,
e e sible
Sodium cap a e (C10)
[89,91]
In eg a es in o he lipid bilaye o
endo helial cells which inc eases
memb ane luidi y and loosening he
igh junc ion a o ing pa acellula
anspo s
In aca o id adminis a ion
(5–25 mM)
D ug Deli e y Ad an ages: Re e sible,
e ec i e o bo h small and
la ge molecules
Disad an ages: Limi ed
in o ma ion, non-selec i e,
in lamma ion
Cyclodex ins [78] BBB dis up ion by ex ac ing
choles e ols om endo helial cells
In a enous (1mM-10 mM) D ug Deli e y
(hyd ophobic d ugs)
Ad an ages: Biodeg adable,
selec i e ac ion on cell
memb ane
Disad an ages: Limi ed
e icacy o hyd ophilic d ugs,
side e ec s
A oma ic
subs ances
Bo neol [84] Re e sibly disassembles he igh
junc ion p o eins (claudins and
occludins), ansien ly dis up ing he
BBB in eg i y
D ug Deli e y,
neu op o ec ion
Ad an ages: Re e sible e ec ,
na u al o igin, b oad
applicabili y
Disad an ages: Concen a ion
dependen oxici y,
nonspeci ic, limi ed ac i i y
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
24
ecep o s exp essed on monocy es and neu ophils, which enhanced he
up ake o diclo enac-loaded liposomes by he cells. As a esul , i was
obse ed 9.1 old inc emen o d ug eaching he b ain. Table 4 sum-
ma izes he di e en s a egies o BBB c ossing desc ibed in his sec ion,
highligh ing he ad an ages and disad an ages o each app oach [69,77,
84,87,88,90,93,94,106–109].
Among he s a egies explained abo e, we will conside he ein he
use o polyme ic nanoca ie s o deli e he apeu ic biomac omolecules
(e.g., enzymes, g ow h ac o s, genes) ac oss he BBB om he blood-
s eam. The molecula s uc u e o polyme s can be inely adjus ed
du ing he syn he ic app oach o ia pos -polyme iza ion app oaches,
esul ing in polyme ic nanoca ie s wi h uneable mechanical, physi-
cochemical, and su ace p ope ies. The wide a ie y o a ailable poly-
me s (e.g., syn he ic s. na u al, biodeg adable s. non-biodeg adable,
s imulus- esponsi e) allows he ab ica ion o a ple ho a o nano-
o mula ions ha ha e shown p omising esul s ega ding he p o ec-
ion o sensi i e biomac omolecules om ex e nal condi ions (e.g.,
p esence o p o einases, changes in pH and ionic s eng h) and BBB
c ossing.
3. Polyme -based nanoca ie s o c oss he blood-b ain ba ie
In he p esen e iew, he a ious polyme ic nanoca ie s a e o ga-
nized acco ding o hei a chi ec u e, which ul ima ely dic a es hei
physicochemical p ope ies and unc ionali y. In his con ex , biode-
g adable solid nanopa icles a e no able o hei compac ness, hyd o-
phobici y, and unable biodeg adabili y; nanogels a e dis inguished by
hei so , h ee-dimensional s uc u e and en i onmen al adap abili y;
dend ime s a e ecognized o hei well-de ined, monodispe se, highly
b anched, and symme ical a chi ec u e; and sel -assembled nano-
pa icles/nanocapsules a e cha ac e ized by hei e sa ili y in e ms o
syn he ic app oaches, enabling he encapsula ion o sensi i e
biomac omolecules.
3.1. Biodeg adable solid nanopa icles
Biodeg adable solid nanopa icles a e mainly o mula ed by using
alipha ic polyes e s. In his con ex , biocompa ible and biodeg adable
nanopa icles based on FDA-app o ed poly(
ε
-cap olac one) (PCL), poly
(lac ide) (PLA), and i s copolyme s wi h glycolide (PLGA) ha e ecei ed
pa icula a en ion as ma e ials o he ab ica ion o b ain- a ge ed
d ug deli e y sys ems. A wide a ie y o ca gos, mainly based on
small MW d ugs, ha e been success ully encapsula ed in o hese
nanopa icles o add ess neu odegene a i e diseases such as AD, PD, and
o he diseases and diso de s o he CNS [110]. Mo eo e , hese nano-
pa icles ha e been p o ed o be p omising nanoca ie s o deli e (bio)
mac omolecules ac oss he BBB. Hence, hey a e pos ula ed as po en ial
en i ies o enzyme eplacemen he apies (ERT) [48], small in e e ing
RNA (siRNA) he apies [49,51], b ain-de i ed neu o opic ac o he -
apies (BDNF) [111] and i amin D-binding p o ein (DBP) [50] o LSDs,
GBM, o TBI, among o he s.
As (bio)mac omolecule nanoca ie s, PCL, PLA, and PLGA nano-
pa icles p esen ce ain ad an ages o e o he deli e y sys ems. They
a e comme cially a ailable, easy o manu ac u e, and o e e sa ile
nanopa icle o mula ions wi h adjus ed physical, chemical, and me-
chanical p ope ies. The MW, as well as he co-monome cons i uen s
and a io, di ec ly a ec he iscosi y, solubili y, glass ansi ion em-
pe a u e (T
g
), c ys allini y deg ee, and phase beha io o he polyme
[112,113]. Amo phous ma ices acili a e a mo e uni o m dis ibu ion o
he ac i e/ he apeu ic compounds and endow he polyme wi h highe
deg ada ion a es. In his sense, he PLA componen (i.e., lac ide) plays
an impo an ole. The c ys alline phase can be supp essed by modi ying
he s e eochemis y o lac ide: while s e eo egula PLA (pu e D- o
L-lac ide) is c ys allizable, he s e eo-i egula PLA (D,L-lac ide) is
amo phous [114]. The e o e, (co)polyme s based on D,L-lac ide, such as
poly(D,L-lac ide) (PDLLA), poly(D,L-lac ide-co-
ε
-cap olac one)
(PDLCL), and poly(D,L-lac ide-co-glycolide) PDLLGA (usually epo ed
in bibliog aphy and comme cialized as PLGA) a e he mos sui able
candida es o his d ug deli e y applica ions. Among hese polyme s,
PLGAs a e he mos epo ed and used as s anda d nanopa icles. In
gene al, he biodeg ada ion kine ics o hese nanopa icles, which is
essen ial o ca go elease, is easily p edic ed by adjus ing he MW and
he composi ion o he copolyme s. The inc ease in MW and D,L-lac ide
uni s gene ally educes he biodeg ada ion a e in PLGA copolyme s.
This ea u e allows he design o nanopa icles wi h con olled and
ailo able elease p o iles o ac i e agen s anging om mon hs o yea s
o deg ada ion imes. Mo eo e , MW and he co-monome a io play an
impo an ole in uning nanopa icle elas ici y. This pa ame e has been
epo ed o be an impo an condi ion o con ol he biological in-
e ac ions o nanopa icles wi h he b ain endo helium, he eby ha ing a
di ec impac on hei anspo ac oss he BBB. In his sense, high MW
and lac ide- ich polyme s will exhibi highe s i ness, which acco ding
o epo ed s udies, migh p omo e highe associa ion wi h endo helial
cells and anspo h ough hem [115,116].
The ab ica ion echnique is essen ial o design speci ic nanopa icles
wi h he abili y o ca y hyd ophilic (bio)mac omolecules o he b ain
Table 4
Compa a i e analysis o di e en s a egies o BBB c ossing, highligh ing he ad an ages and disad an ages o each s a egy.
S a egies Examples Ad an ages Disad an ages
Physical
Dis up ion
Focused Ul asound (FUS) [77,84,87,88,
93]
P ecise a ge ing, non-in asi e, empo a y opening,
con olled and adjus able pa ame e s.
Tissue damage, equi emen o high-end equipmen ,
ope a ional expe ise, cos .
High Pulse Elec ic Field [94] Pe meabili y h ough elec opo a ion, e e sible. Cellula damage, p ecise deli e y, limi ed esea ch.
Lase s and Elec opunc u e [69,94] Non-in asi e, adjus able pa ame e s. Cellula damage, side e ec s, limi ed clinical da a,
echnical challenges.
Chemical
Dis up ion
Hype osmo ic Agen s [84,90] Clinically app o ed, enhanced pe meabili y, non-
in asi e, apid ac i i y, b oad ange o agen s, cos
e ec i e.
Non- a ge ing, cellula damage, ansien and
inconsis en he apeu ic e ec , sys emic oxici y,
egula o y and sa e y conce n.
In asi e
S a egies
Di ec Injec ion/Implan a ion [84,88,90,
106]
Localized deli e y, ci cum en ing BBB, highe d ug
concen a ion, educed sys emic oxici y.
In asi e, limi ed d ug dis ibu ion, ad e se local
eac ions, echnical complexi y, cos .
In ace eb o en icula and In a hecal
Adminis a ion [77,88,90,93,106,109]
Di ec CNS deli e y, ci cum en ing BBB, uni o m
d ug dis ibu ion wi h enhanced he apeu ic
e iciency.
In asi e, p ocedu e ela ed complica ions, echnical
complexi y, side e ec s.
Non-In asi e
S a egies
An ibody and Pep ide T ojan Ho se [103,
108,109]
Ta ge ed deli e y, high selec i i y and speci ici y,
educed sys emic oxici y, high anscy osis,
e sa ili y in payload.
Complex enginee ing and op imiza ion, immune
esponse, a iable BBB pene a ion, p oduc ion and
scalabili y, s abili y issue, cos .
Func ionaliza ion o Nanopa icles [69,77,
88,90,107,109]
Ta ge ed deli e y, speci ici y, imp o ed pene a ion,
con ol-led elease, e sa ili y, mul i unc ional.
Ba ch o ba ch a iabili y, oxici y and clea ance, s abili y
issues.
Cellula Ca ie s [77,88,90,107,109] Ta ge ed deli e y, educed immunogenici y,
biodeg adable, mul i unc ional, e sa ili y, e icien
gene deli e y.
Pa hogenici y, s abili y, cul u ing and main enance,
scalabili y, limi ed payload, egula o y and e hical issues.
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
25
3.4. Sel -assembled polyme ic nanopa icles
Inspi ed by biology and combining sup amolecula chemis y wi h
nano echnology, sel -assembled nanoca ie s can be p oduced h ough
spon aneous in e ac ion o molecules o o m o ganized s uc u es
[181–183]. The e a e a ious sel -assembled nanoca ie s ha ha e
been s udied o c oss he BBB, such as liposomes [62,184], niosomes
(using solu e ca ie anspo e s) [185], lipid nanoca ie s [186],
polyme ic micelles [187], polyme somes (polyme esicles) [188], and
laye -by-laye (LbL) capsules, among o he s. As he ocus o he p esen
e iew is on polyme -based nanoca ie s, he ein we elabo a e upon
h ee sel -assembled polyme ic nanoca ie s: polyme ic nanopa icles
based on amphiphilic block and g a copolyme s, polyme somes, and
LbL capsules.
Amphiphilic block and g a copolyme s ep esen a no able ca ego y
o polyme ic nanopa icles, ea u ing dis inc hyd ophilic and hyd o-
phobic polyme blocks chemically linked o c ea e s uc u es wi h
excep ional sel -assembly capabili ies. These blocks can ei he be
neu al polyme s (hyd ophilic o hyd ophobic) o polyelec oly es
(anionic, ca ionic, o zwi e ionic) [189–191]. In an aqueous en i on-
men , hese amphiphilic block copolyme s sel -assemble o o m poly-
me ic micelles abo e hei c i ical micelle concen a ion (CMC). Abo e
his concen a ion, he hyd ophobic inne co e o he copolyme comes
close o agg ega e and dis ances i sel om wa e molecules [192].
These a e gene ally made o biocompa ible, non-immunogenic, biode-
g adable blocks such as polyes e s, poly(p opylene oxide), o poly
(amino acids) linked o biologically compa ible co ona- o ming blocks
like PEG [193,194] and display a co e-shell nanos uc u e. In addi ion,
g a copolyme s p oduced by he hyd ophobiza ion o hyd ophilic
polyme ic backbones (e.g., polysaccha ides, polyols) can gi e place o
mo e complex nanos uc u es such as mul imicella sys ems ha enable
g ea e EE [195]. Thei ease o unc ionaliza ion makes hem an e icien
nanosys em o b ain a ge ing by bo h in a enous and in anasal
adminis a ion [196,197]. Howe e , depending on he adminis a ion
s a egy, nanoca ie ea u es such as size and su ace mus be p ope ly
enginee ed. Fo example, he g oup o Sosnik de eloped chi osan-based
sel -assembled nanoca ie s ha we e su ace-modi ied wi h shu le
pep ides and inc eased he deli e y o small-molecule an icance d ugs
o he CNS [66,198]. Thei in es iga ion in he CNS deli e y o (bio)
mac omolecules is cu en ly being in es iga ed. Va ious app oaches
used o he unc ionaliza ion o polyme micelles o b ain a ge ing a e
shown in (Fig. 8) [199]. Plu onic® block copolyme s, also known as
poloxame s, exempli y his phenomenon and ha e ga ne ed signi ican
in e es due o hei abili y o impede d ug e lux anspo e s, such as
he inhibi ion o P-gp exp essed on he BBB, hus enhancing d ug de-
li e y o he CNS [200,201]. Plu onic® a e poly(e hylene oxide)-poly
(p opylene oxide)-poly(e hylene oxide) (PEO-PPO-PEO) iblocks,
o ming an amphiphilic copolyme . The manipula ion o he numbe o
hyd ophilic EO and hyd ophobic PO uni s p o ides a e sa ile means o
ailo ing hese copolyme s o speci ic applica ions [200,202]. Wi h
o e 50 Plu onic® molecules comme cially a ailable om BASF Co p.
(Pa sippany, NJ, USA), each cha ac e ized by di e en
hyd ophilic-lipophilic balance (HLB) and CMC, hese copolyme s o e a
spec um o possibili ies o ailo ing pa icle size, d ug loading, s a-
bili y, and d ug elease p o iles in he pu sui o op imized he apeu ic
ou comes.
The classi ica ion o Plu onic® copolyme s in o ou ca ego ies based
on di e ences in HLB and hyd ophobic PPO chain leng h u he elu-
cida es hei di e si y [203]. The i s class includes hyd ophilic Plu -
onic® wi h an HLB o 20–29, such as F68, F108, and F127, whe e F
means ha he p oduc is supplied in he o m o lakes [190,204,205].
These no only exhibi good hyd ophilici y bu also boas excellen
biocompa ibili y [206], con ibu ing o d ug accumula ion and p o-
longed blood ci cula ion ime [207]. The second class comp ises
Fig. 8. Schema ic ep esen a ion o polyme ic micelles o d ug deli e y. The image illus a es mul i unc ional polyme ic micelles wi h a ious modi ica ions o
enhanced d ug deli e y. The co e is hyd ophobic, consis ing o polyme s like PCL (polycap olac one), PLA (polylac ic acid), and PPO (polyp opylene oxide), while
he co ona is hyd ophilic, o med by PEG (polye hylene glycol), PVP (poly inylpy olidone), o PEO (polye hylene oxide). Modi ica ions include co e c oss-linking
o s abili y, ligand a ge ing ecep o s (e.g., ans e in, ola e) o ecep o -media ed a ge ing, and s imuli- esponsi e elemen s o con olled d ug elease.
Addi ional ea u es such as luo opho es and imaging agen s allow in i o acking, cell-pene a ing pep ides enhance cellula up ake, and c oss-linked co onas
imp o e s uc u al in eg i y. Ap ame s a e used o speci ic a ge ing, and su ace cha ge modi ica ions op imize in e ac ions wi h biological memb anes. These
micelles encapsula e d ugs, siRNA, p o eins, and o he agen s o a ge ed and e icien he apeu ic deli e y. Adap ed wi h pe mission om [199]. Copy igh ©
2022 Else ie .
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
32

Plu onic® wi h a lowe HLB and sho e PPO chain, ep esen ed by
liquid L64 [208], L44 [209], and L35 [210], which impa s nano-
s uc u es wi h he abili y o sel -assemble in aqueous media, o e ing a
mo e sui able size (10–100 nm) and s able s uc u e [211]. The hi d
class ea u es Plu onic® wi h a lowe HLB and a PPO chain leng h
anging om 30 o 60 and in pas e o m a oom empe a u e, including
P85 [212], P105 [213], and L61 [214], which exhibi dissolu ion and
sel -assembly p ope ies in wa e , making hem sui able o loading
hyd ophobic d ugs. Addi ionally, hese copolyme s consume adenosine
iphospha e (ATP) in mul id ug- esis an cance cells, inhibi ing P-gp
and p olonging d ug ci cula ion ime [215,216]. The ou h class o
Plu onic® wi h a lowe HLB and a PPO chain exceeding 60, ea u ing
P123 and L121, wi h he longes PO chain, is widely used o loading
d ugs due o i s g ea e hyd ophobici y [217,218].
The encapsula ion o (bio)mac omolecules wi hin sel -assembled
nanoca ie s is a challenge ha can be o e come by ha nessing he
ad an ages o sel -assembled nanopa icles and s a egically binding
biomac omolecules h ough en apmen , adso p ion, o co alen
a achmen , ans o ming hese copolyme s in o T ojan ho ses, acili-
a ing he enhanced anspo and deli e y o he apeu ic payloads o
he b ain. Ce ain amphiphilic nanopa icles modi ied wi h p o eins,
pep ides, RNA, and d ugs ha e shown he abili y o c oss he BBB. Fo
ins ance, Poly(β-L-malic acid- i leucine)-copolyme has been used o
anspo miRNA ac oss he BBB. This sys em u ilizes he LRP-1 ans-
cy osis pa hway and amyloid be a (Aβ) pa hway by conjuga ing a D-
con igu ed (D3)-pep ide as a ec o o speci ic a ge ing, achie ing
neu on-selec i e deli e y o miRNA in an AD mouse model [219].
Ano he no able example in ol es he use o Lep in-Plu onic® 85 (P85)
conjuga es. This amphiphilic copolyme a ge s he lep in anspo e
and has shown p omising esul s as an an i-obesi y d ug. I s bene i s
include enhanced pe iphe al bioa ailabili y, inc eased b ain up ake,
and he abili y o c oss he BBB independen ly o he lep in anspo e
[220]. Fu he mo e, he T R-T12-PEG-PLGA and TATH7-PEG-PLGA
sys ems u ilize T R o anspo he T R-T12 pep ide, TATH7 pep ide,
and pacli axel ac oss he BBB. The s a egy in ol es conjuga ion wi h
he T R-T12 and TATH7 pep ide shu le, and in i o pha macodynamic
e alua ion demons a ed a po en an i- umo e ec in subcu aneous and
no mo opic glioma models, signi ican ly ex ending he li e cycle o
umo -bea ing mice [221].
On he o he hand, while amphiphilic copolyme s can c oss he BBB,
speci ic a ge ing o desi ed b ain egions emains challenging. S a e-
gies like conjuga ion wi h b ain-speci ic ligands o an ibodies a e c ucial
o maximizing e icacy and minimizing o - a ge e ec s. E icien
encapsula ion and con olled elease o (bio)mac omolecules wi hin
amphiphilic copolyme s emain key challenges. Op imizing polyme
a ios, inco po a ing s imuli- esponsi e elease mechanisms, and
explo ing co-assembly wi h o he polyme s a e p omising s a egies.
Ex ensi e p eclinical and clinical s udies a e necessa y o es ablish
sa e y and e icacy o egula o y app o al. Despi e hese di icul ies,
amphiphilic copolyme s hold immense po en ial o anspo ing bio-
mac omolecules ac oss he BBB. Con inued esea ch e o s ocused on
add essing hese limi a ions and explo ing inno a i e design s a egies
can help o mo e close he echnology o ea ing a ious neu ological
diso de s.
Polyme somes a e syn he ic esicles composed o amphiphilic block
copolyme s, wi h a hyd ophobic bilaye memb ane and g ea e deg ee
o complexi y in compa ison o he a o emen ioned co e-shell polyme ic
micelles (Fig. 9a). Polyme somes a e usually ab ica ed using diblock,
iblock o mul iblock copolyme s by ollowing di e en me hods o
induce hei sel -assembly including sol en -swi ch (o mic o luidic
me hod), pH- uning, polyme ehyd a ion, polyion complex esicles
(PICsomes) ab ica ion app oach, a combina ion o sel -assembly/
polyme iza ion (i.e., polyme iza ion-induced sel -assembly), and
cen i uga ion me hod. A e hei sel -assembly, sonica ion, memb ane
ex usion, o al e na i e me hods can be used o pu i y and/o adjus
hei size [222]. Some ypical polyme s o p oduce polyme somes o
nanomedicine a e PEG [223], diblock copolyme s o dex an and PLGA
(DEX–PLGA), poly(bu adiene)(PBd)-PEG [224], and diblock copolyme s
o PEG and PCL [225,226]. Compa ed o liposomes, polyme somes ha e
a hicke bilaye s uc u e, which imp o es hei physical s abili y and
inc ease hei blood ci cula ion [224]. Con a ily o polyme ic micelles,
ha a e usually limi ed o he encapsula ion o hyd ophobic d ugs,
polyme somes can accommoda e bo h hyd ophilic and hyd ophobic
ca gos in hei s uc u e. Polyme somes ha e gained a en ion in cance
nanomedicine and d ug deli e y sys ems due o hei ad an ageous
p ope ies, such as g ea s abili y, e sa ili y in design, and unable ca-
pabili ies o e ec i e ca go encapsula ion and con olled elease o
an icance he apeu ics [222].
Rega ding he use o polyme somes o deli e he apeu ic agen s in
he b ain en i onmen , se e al a emp s ha e been desc ibed in li e a-
u e. Yu e al. unc ionalized he su ace o 100 nm PEG-PLGA poly-
me somes wi h lac o e in o c oss he BBB and imp o e he deli e y o
luo escen 6-couma in and S14G-humanin (a neu op o ec i e pep ide)
o he b ain issue. Pha macokine ic s udies ollowing in a enous in-
jec ion sugges ed ha 101 lac o e in ligands pe polyme some was he
op imized numbe o p omo e he pe meabili y o he polyme somes
ac oss he BBB and ensu e b ain- a ge ed deli e y [223]. Geo gie a e al.
p esen ed a o mula ion o PBd-b-PEG polyme somes, which we e
deco a ed wi h pep ide G23 o inc ease hei capaci y o a ge gangli-
oside GM1 o ca eolae-media ed endo helial anscy osis. P elimina y
in i o s udies o hese polyme somes in an endo helial T answell®
model showed ha he polyme somes we e capable o pene a ing he
BBB h ough e icien endo helial cells anscy osis [224]. In addi ion, in
i o biodis ibu ion s udies a e in a enous injec ion in mice showed
ha G23- unc ionalized polyme somes accumula e in he b ain pa en-
chyma [227]. This is an ad an age o G23- unc ionalized polyme somes
o e some epo ed T - a ge ed sys ems, which mainly accumula e in he
b ain capilla y and do no each o he pa enchyma egion.
Ac i e a ge ing s a egies enable he nanoca ie s o c oss he BBB
by means o an in e ac ion h ough he speci ic ligands and hey ha e
been applied o bo h polyme ic micelles and polyme somes, aiming o
imp o e he up ake o he nanoca ie s by endo helial cells. One ac i e
a ge ing s a egy is o a e se he nanoca ie s in he BBB using ca ie
p o eins, such as GLUT-1, which is speci ically and highly exp essed on
endo helial cells o he BBB. Su Min e al. de eloped glucosyl-poly
(e hylene glycol)-b-poly(L-lysine) modi ied wi h 3-me cap op opyl
amidine and 2- hiolaneimine (Glu-PEG-PLL(MPA/IM)) polyme ic mi-
celles. As explained be o e, polyme ic micelles a e also ob ained by sel -
assembly o amphiphilic polyme s [228]. These glucosyla ed-polyion
complex polyme ic micelles we e loaded wi h an isense oligonucleo-
ide (ASO) ha we e unc ionalized wi h di e en quan i ies o glucose
o s udy he e ec o he ligand densi y and he accumula ion o nano-
pa icles in b ain. A g oup o nanoca ie s ha was coa ed wi h 52
glucose ligands pe nanopa icle showed 17 imes highe accumula ion
in he b ain compa ed o he g oup wi hou glucose coa ing, indica ing
he g ea po en ial o GLUT-1-media ed anspo s a egy [63]. Shi
Yanan e al. disco e ed a new me hod o enhance he clinical use o RNAi
in glioblas oma he apy. This me hod in ol es he de elopmen o an
Ang2 pep ide-deco a ed chime ic polyme some (ANG-CP), which
e ec i ely packs and p o ec s an i-PLK1 siRNA (siPLK1). In i o s udies
indica e ha ANG-CP may e icien ly a e se he immo alized mouse
b ain endo helial cell line (bEnd.3) monolaye , acili a e he anspo o
siRNA in o he cy oplasm o U-87 MG glioma umo cells h ough he
LRP-1-media ed pa hway, and ma kedly silence PLK1 mRNA and i s
associa ed oncop o ein in U-87 MG cells [64]. In his way, Jiang Yu e al.
sugges using a chime ic polyme some (CP) deco a ed wi h ApoE
ins ead o Ang2 as a a ge ed p o ein he apy o ea ing glioblas oma.
This showed be e pene a ion h ough he bEnd.3 monolaye in in
i o BBB models [65].
Among sel -assembled polyme ic nanoca ie s, mul ilaye polyme
capsules ha e a ac ed inc easing a en ion in ecen yea s. Mul ilaye
polyme capsules a e usually ab ica ed ia he LbL app oach, which
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
33
Fig. 9. (A) Schema ic illus a ion o polyme some s uc u es, which a e ob ained by sel -assembly o amphiphilic block copolyme s. (B) A schema ic illus a ion o
laye -by-laye (LbL) deposi ion o opposi ely cha ged polyelec oly es on a nega i e co e o sac i icial empla e. Final LbL nanopa icle wi h blood-b ain ba ie
(BBB)- a ge ed ex e nal laye o acili a e he passage o nanopa icles h ough he BBB and deli e i s ca go in o he b ain. Bio ende has been used o c ea ing he
desc ip i e image. (C) Up ake o LbL nanopa icles wi h h ee co es (lipo: liposomes, PLGA: poly (lac ic-co-glycolic acid), PS: ca boxyla ed polys y ene), which we e
deposi ed by one laye o poly-L-a ginine (PLR) polyca ion and inal laye o di e en polyanions (CMDex: ca boxyme hyldex an, HA: hyalu onic acid, PLD: polyL-
aspa ic acid, PLE: poly-L-glu amic acid, and PSialA: polysialic acid). The up ake by he monolaye s ha we e g own in T answell shows supe io i y o liposome co e
o e o he s i e co es. (D) Pe meabili y o he LbL nanopa icles wi h di e en co es bu wi h he same las laye o PLD in he mice BBB demons a es mo e
pe meabili y o LbL nanopa icles wi h liposomal co e. (E) BBB pe meabili y o ba e liposomes and liposome-based LbL nanopa icles wi h di e en su ace unc-
ionaliza ion in mice showed ha he pe meabili y o LbL nanopa icles wi h hyalu onic acid (HA) ex e nal laye ac oss mice BBB was he g ea es . Adap ed wi h
pe mission om [243]. Copy igh © 2023 John Wiley & Sons. Bio ende has been used o c ea ing he desc ip i e image.
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
34
elies on he al e na e deposi ion o opposi ely-cha ged polyme s on o a
empla e (Fig. 9b) [229]. The s epwise p ocess in he LbL app oach al-
lows he p ecise con ol o e he su ace p ope ies (i.e., cha ge and
unc ionali ies) and he size o he capsule [181,230]. LbL capsules ha e
been acco dingly conside ed as po en ial d ug deli e y and he anos ic
nanosys ems o a wide a ie y o biomedical applica ions [229,
231–233]. Beyond d ugs o small MW, LbL (nano)capsules ha e
demons a ed hei capaci y o deli e he apeu ic biomac omolecules,
such as genes and enzymes [234–237]. As an illus a ion o his e sa-
ili y and mul i- unc ionali y associa ed o LbL sys ems, Boehnke e al.
in oduced click chemis y in o LbL nanopa icles, which enables hem
o combine a biosensing pep ide and a a ge ing pep ide wi hin he same
ca ie . This mul i unc ional sys em demons a ed a sensi i e de ec ion
o h ee di e en ypes o cance s and simul aneous gene silencing as a
esul o success ul siRNA deli e y [232]. This s udy highligh s he po-
en ial o LbL nanopa icles o load high amoun s o a ious la ge bio-
mac omolecules, such as siRNA and pep ides, in a single o mula ion.
One o he impo an aspec s o a ge ed d ug deli e y o b ain
issue is ha nanopa icles a e no clea ed ou om he blood s eam ia
phagocy osis and he ecogni ion o immune sys em. The e a e some
s a egies ha ha e been implemen ed o a oid he up ake by mac o-
phages, such as cell hi chhiking, su ace modi ica ion o nanopa icles,
and he modula ion o he physiological en i onmen [238]. Łukasie-
wicz e al. de eloped 100 nm LbL nanocapsules loaded wi h clozapine
and unc ionalized wi h PEG o in es iga e hei po en ial o c oss he
BBB [239]. Resul s demons a ed ha he p oposed su ace modi ica ion
s a egy dec eased hei phagocy osis and up ake by mac ophages, bu
did no dec ease he endo helial cells up ake. Mo eo e , all he g oups
we e able o c oss he BBB in an in i o BBB T answell® model, and PEG
unc ionaliza ion imp o ed he anscy osis and educed he cy o ox-
ici y o clozapine-encapsula ed nanocapsules. In addi ion, hei inhibi-
ion s udies indica ed ha ca eolae-dependen anscy osis played a ole
in he in e naliza ion o nanocapsules by endo helial cells [239].
Ano he s a egy o BBB anspo elies on acili a ing anscy osis
in BBB endo helial cells h ough a mechanism media ed by low-densi y
lipop o ein ecep o - ela ed p o eins, such as LRP1 [188,240]. S aehla
e al. ab ica ed LbL nanocapsules using liposomes as a empla e and
p opa gyl-modi ied poly(L-aspa ic acid) as he ex e nal laye , which
was u he modi ied wi h Ang2 pep ide [241]. They used hese nano-
pa icles o cispla in deli e y in a mic o luidic BBB-GBM. In compa i-
son wi h ba e liposomes and non- unc ionalized LbL nanopa icles, he
LbL nanocapsules unc ionalized wi h Ang2 we e p e e en ially accu-
mula ed in mic o ascula ne wo k nea GBM sphe oids. Thus,
Ang2- unc ionalized LbL nanopa icles showed mo e e ec i eness in
GBM umo cell killing wi h espec o ba e liposomes and ee cispla in.
These ou comes demons a ed he supe io i y o Ang2- unc ionalized
nanopa icles, pene a ing he BBB by LRP1-media ed anscy osis.
This wo k also demons a ed he inc eased exp ession o LRP1 in he
ascula ne wo k in p esence o GBM sphe oids.
Addi ionally, he in insic mechanical p ope ies o he LbL pa i-
cles/capsules can also de e mine hei capaci y o c oss he BBB. I was
shown ha he s i ness and de o mabili y o LbL nanopa icles is mainly
dependen on he co e a he han on su ace unc ionali ies. Kong e al.
we e able o une he s i ness o LbL nanopa icles by al e ing he
choles e ol con en in liposome syn hesis, which was used as a co e. This
s udy epo s ha mo e de o mable, luid, and complian LbL nano-
pa icles we e ob ained by choles e ol addi ion o liposomal co e.
Compa ed o s i LbL nanopa icles, complian LbL ones can pene a e
il e memb anes (wi h 100 nm po e size) mo e easily, which could also
ha e be e BBB pene a ion [242]. In a simila s udy, Lamson e al.
ocused on he e ec o co e s i ness and su ace unc ionaliza ion o
LbL nanopa icles on hei anspo h ough he BBB. To his end, hey
in es iga ed h ee di e en nega i ely-cha ged co es, i.e., liposomes,
PLGA, and ca boxyla ed polys y ene, and modi ied he las laye o he
nanopa icles by using di e en polyanions such as ca boxyme hyldex-
an, hyalu onic acid (HA), poly(L-aspa ic acid), poly(L-glu amic acid,)
and poly(sialic acid). Thei esul s e ealed ha liposome-based LbL
nanopa icles showed he highes o simila anspo in T answell®
assay and he highes up ake in b ain mic o ascula endo helial cell line
(hCMEC/D3) monolaye associa ion (Fig. 9c) compa ed o he nano-
pa icles wi h s i e co e. I was also e ealed ha he su ace chemis y
o he LbL nanopa icles de e mines he mechanism by which nano-
pa icles a e anspo ed in acellula ly. A e e alua ing he anspo
in he BBB o mice, liposomal nanopa icles exhibi ed he highes
pe meabili y compa ed o o he LbL nanopa icles wi h he same ou e
laye (Fig. 9d). Finally, liposome-based nanopa icles wi h he las laye
o HA showed he highes pe meabili y in mice BBB compa ed o o he
su ace modi ica ions (Fig. 9e) [243]. Al hough his wo k p o ides
insigh ul esea ch on he e ec o co e s i ness and su ace chemis y
on he capaci y o LbL nanopa icles o c oss he BBB, i is no exac ly
clea why HA unc ionaliza ion imp o ed pe meabili y in i o.
Despi e p e ious a emp s, he e a e ew esea ch wo ks on sel -
assembled nanopa icles ocusing on ca ying biomac omolecules and
c ossing he BBB. The e o e, many mo e s udies a e needed o in es i-
ga e di e en p ospec i e o mula ions using a ious empla es and
su ace chemis ies, de e mine hei e ec i eness, and unco e he eal
po en ial o sel -assembled polyme ic nanoca ie s. Co e emo al a e
laye deposi ion could esul in nanopla o ms wi h mo e elas ic and
luid memb ane ha can pene a e h ough he ba ie [244]. All he
men ioned examples show he e sa ili y and po en ial o sel -assembled
nanoca ie s, including polyme ic micelles, polyme somes, and LbL
nanopa icles/nanocapsules, o combine a ious unc ionali ies in one
sys em o e ec i e deli e y o he apeu ic molecules ac oss he bio-
logical ba ie s, such as he BBB.
3.5. O he polyme ic ca ie s
Nanopa icles based on na u al polyme s like polysaccha ides o
p o eins ha e been explo ed o hei po en ial use in a ge ing BBB and
deli e he apeu ic biomac omolecules [95,245–247]. The p esence o
la ge su ace a eas con aining unc ional g oups (e.g., hyd oxyl,
ca boxyl, amino) allows ailo ing he physicochemical p ope ies o
polyme ic nanoca ie s o enhancing biomolecule conjuga ion and
a ge ing ecep o s o c ossing he BBB. Along wi h his, he size, aspec
a io (shape), su ace cha ge and ligands o he pa icles can also be
modula ed, which also ha e an impo an ole in BBB pene a ion
[248–250]. In his sec ion, we discuss examples o some o he nano-
ca ie s de i ed om na u al polyme s o a ge ed deli e y o d ugs and
s a egies o imp o e hei abili y o c oss he BBB.
Chi osan: Chi osan (CS) is a na u al linea ca ionic copolyme de i ed
om chi in and is a widely used ma e ial o nanoca ie ab ica ion
ha ing p o ound applica ion in many CNS diso de s [251,252]. CS
consis s o β-(1,4)-linked d-glucosamine and N-ace yl-d-glucosamine
g oups. Owing o i s good biocompa ibili y, i is classi ied as ‘gene ally
ecognized as sa e’ (GRAS) by he FDA. CS nanopa icles can be ab i-
ca ed by a ious me hods including ionic gela ion, emulsi ica ion, and
chemical c osslinking [253]. The ionic gela ion me hod was ollowed o
encapsula e me ho exa e, dopamine, and si aglip in d ug o he
ea men o GBM, PD, and AD, espec i ely [251,254,255]. Recen ly,
p oline-loaded CS nanopa icles, syn hesized by ion c osslinking
me hod, ha e been used o deli e p oline, esul ing in neu op o ec ion
a e ischemic inju y [256]. Addi ionally, due o poo pene a ion o
mos o he CNS associa ed d ugs, CS was used o deco a e PLGA and
PCL nanopa icles o a ge ing he d ugs ac oss BBB [251]. The posi i e
su ace-cha ge o he nanopa icles shows high a ini y owa ds he
endo helial cells o enhanced b ain deli e y and cellula adso p ion, ia
AMT. Fo his, CS is modi ied wi h me hyl iodide and glycidyl e he s o
gene a e N- ime hyl CS (TMC) and alkylglyce yl-modi ied CS, espec-
i ely [249]. TMC imp o es mucoadhesion, solubili y (in a
pH-independen manne ), enhances d ug loading and abso p ion e i-
ciency wi h espec o na i e CS. Fo example, nanopa icles o mula ed
wi h TMC loaded wi h an an i-neu oexci a ion pep ide displayed
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35
e ec i e BBB pene a ion, and ha e been used o epilepsy ea men
[251,257]. In case o alkylglyce yl CS, ini ially he p ima y hyd oxyl
unc ionali ies o he low MW CS we e modi ied h ough selec i e
g a ing wi h alkylglyce yl g oups [249,257]. Following his, he
nanopa icles we e syn hesized using ionic gela ion me hod and he
esul ing nanopa icles displayed enhanced pe meabili y o he apeu ics
ac oss BBB [257]. Fu he mo e, he su ace modi ica ion o CS nano-
pa icles wi h PEG has also eme ged as a p omising s a egy o enhance
he b ain a ge ing e iciency o he he apeu ics [257]. To u he
op imize his app oach, he PEG-modi ied nanopa icles we e unc-
ionalized wi h a ge ing an ibodies like OX26 mAb o an i-T R [257].
This a ge ed deli e y s a egy has been used o deli e Z-DEVD-FMK
pep ide and an isense oligonucleo ides, showing imp o ed he apeu ic
e icacy ia RMT [252]. Fo a a ie y o he apeu ic applica ions, CS
nanopa icles ha e also shown p omise o ca y biomac omolecules
ac oss BBB. As an illus a ion, dual an ibody a ge ing siRNA-loaded CS
nanopa icles we e enginee ed o block HIV eplica ion in he CNS [95].
The wo an ibodies T and b adykinin B2 speci ically bind wi h he T R
and b adykinin B2 ecep o , espec i ely, acili a ing siRNA deli e y
in o as ocy e a ge cells. This esul ed in inhibi ion o exp ession o
p o eins such as SART3 and hCycT1 ha a e associa ed wi h HIV
eplica ion [258]. In a simila wo k, CS nanopa icles we e used o in
i o ans ec ion o GFP- agged plasmids on HEK293 (human emb y-
onic kidney cells) and MG-U87 (b ain cance ) cells on mu ine models
[67]. The wo k highligh s he e ec i e BBB pene a ion o CS
nanopa icles.
Algina e: Algina e is a linea unb anched anionic and hyd ophilic
na u al polysaccha ide ob ained om b own seaweed. S uc u ally, i is
composed o a copolyme o
α
-1-gulu onic acid and β-D-mannu onic
acid linked by 1,4-glycosidic moie ies. FDA classi ied algina e as GRAS
due o i s e y good biocompa ibili y and hus, i has widesp ead ap-
plica ions in he ield o d ug and gene deli e y, wound healing, and
issue enginee ing [249]. Repo s ha e shown ha pH- esponsi e algi-
na e nanopa icle o ma ion in ol es me hods like ionic gela ion,
emulsi ica ion-sol en e apo a ion, emulsi ica ion-gela ion, wa e /oil
emulsion me hod, in e -chain c osslinking, o by mixing wi h o he
polyme s [259]. Fo example, algina e nanopa icles ha e been ecen ly
p epa ed along wi h CS o deli e small pep ide SpBMP-9 de i ed om
neu al g ow h ac o BMP-9. This p omo es he di e en ia ion o
choline gic neu ons and inac i a e GSK3be a which a e p omising ou -
comes in he ea men o b ain degene a i e diso de s, such as AD
[260]. The widely used ionic gela ion me hod has been applied o p e-
pa e enla axine-loaded algina e nanopa icles, which ha e been u i-
lized as an i-dep essan s [261]. Following his app oach, an in anasal
ca ie sys em was de eloped, exploi ing elec os a ic in e ac ion o
algina e and doxo ubicin o gi e algina e-doxo ubicin nanocomplex,
which was inco po a ed in o CS nanopa icles. The wo k highligh s he
e icien deli e y o doxo ubicin o b ain issue wi h a a ge ing e i-
ciency o 480%, signi ying a p omising s a egy o in anasal a ge ed
deli e y o he b ain [262]. In ano he example, sodium algina e along
wi h doxo ubicin and hodamine we e emulsi ied in o dioc yl sodium
sul osuccina e [Ae osol OT (AOT)]–algina e nanopa icles and we e
able o o e come P-gp media ed d ug esis ance in umou cells [263].
In ecen p og essions wi hin egene a i e medicine, he ea men o
PD encompasses he deli e y o he apeu ic cells and neu o ophic ac-
o s capable o eleasing dopamine o he b ain. The app oach o
deli e ing cells aims o eplace los neu ons and acili a e unc ional
einne a ion by eleasing dopamine ha sec e es neu o ophic ac o s.
Howe e , clinical ials e ealed high a es o cell dea h pos implan-
a ion. To o e come his, algina e has been used o make dual laye
beads along wi h HA o slow and sus ained elease o he apeu ic cells
SH-SY5Y (neu oblas oma cell line) and immunosupp essan FK506
compound showing p olonged cell su i al and unc ionali y o PD
ea men [264].
Hyalu onic Acid: HA is a wa e soluble, biocompa ible linea poly-
saccha ide composed o D-glucu onic acid and N-ace yl-D-glucosamine
uni s ound in he ex acellula ma ix o a ious issues. The p esence o
hyd oxyl g oups makes i hyd ophilic, whe eas ca boxyl, hyd oxyl, and
ace amido g oups in i s s uc u e can be exploi ed o chemical modi-
ica ion [265]. HA has been ex ensi ely u ilized in d ug deli e y sys ems
due o i s a ini y owa ds CD44 ( ans-memb ane glycop o ein) e-
cep o s ha a e o e exp essed in b eas , lung and me as a ic b ain
cance [266,267]. The syn hesis o nanopa icles in ol es elec os a ic
in e ac ions be ween anionic HA and ca ionic CS, which we e used o
deli e cu cumin and neu oglobin in he b ain o GBM and s oke
ea men [68,268]. Va ious HA-based modi ied nanopla o ms, like
PEGyla ed HA, HA wi h lipoic acid- lysine, HA wi h i amin E succina e
copolyme s, HA wi h glycy he inic acid, doxo ubicin, and sodium i-
polyphospha e nanopa icles ha e been used o doxo ubicin deli e y
o an icance he apy and o e coming chemo esis ance [269]. Fo
enhanced a ge ed he apy o GBM, a hyb id HA nanoca ie sys em
was unc ionalized wi h pep ide HRK-19, con aining RGD and NGR o
bind
α
β3 and aminopep idase-N (CD13) ecep o s o e exp essed in
glioma cells and/o angiogenic essels. Wi h limi ed in es iga ion on he
po en ial use o algina e nanoca ie s, he e is plen y o oom o imp o e
hese nanoca ie s o biomac omolecule deli e y ac oss BBB. Bo h
algina e and HA nanopa icles, being easily designable, and wi h long
ci cula ion ime in he sys emic bloods eam, can be easily modula ed o
achie e enhanced BBB pe mea ion [249–270].
Besides, na u al p o eins a e in ended o se e as ca ie s o a ge ing
moie ies o enhance he anspo o d ugs and he apeu ic agen s o he
CNS [271,272]. P o eins ha ing high s abili y and ac i i y wi h low
enzyma ic deg ada ion, immunogenici y, phagocy osis, enal clea ance,
leading o inc ease in hal -li e o he d ug, has shown p omising ou -
comes [271].
Gela in: Among all na u al polyme s, gela in has been ex ensi ely
used o he deli e y o biomac omolecules o he b ain. The syn hesis o
gela in nanopa icles in ol es emulsi ica ion sol en e apo a ion, des-
ol a ion, nanop ecipi a ion, and mic o luidic de ices me hods [245].
Ideally, gela in needs c osslinking agen s o o e come i s limi a ions o
low mechanical in eg i y and apid decomposi ion. Fo CNS diso de s,
s a egies like ca ionic cell pene a ion based on he pep ide-media ed
endocy osis a e conduc ed o ans e se he BBB. Fo example, a
b ain-pene a ing pep ide conjuga ed wi h PEG and TAT pep ide has
been used o modi ica ion o gela in–siloxane nanopa icles o
enhancing hei e iciency in c ossing BBB [245–252]. Fu he , gela in
nanopa icles ha e demons a ed hei e ec i eness as a eliable ca ie
o RNA deli e y in he b ain en i onmen , along wi h anspo o
g ow h ac o s, mic oRNAs, and siRNA o di e en ia e s em cells and
silence genes [245]. The in anasal deli e y o inducible ni ic oxide
syn hase siRNA and os eopon in pep ide inc eased i s e icacy o he
ea men o ischemic s oke by inducing s ong neu op o ec i e e ec
[245–252]. Recen ly, gela in nanopa icles loaded wi h neu opep ide
Subs ance P deli e ed in CNS enhanced he dopamine gic neu on e-
co e y in hemipa kinsonian a s and can be an e ec i e he apy o PD
[273].
Human Se um Albumin: Human se um albumin (HSA) is a globula
p o ein commonly used o imp o e he solubili y and anspo o hy-
d ophobic d ugs ac oss he BBB. D ug-albumin complexes can inc ease
d ug s abili y and p olong ci cula ion ime, enhancing hei po en ial o
each he CNS. The syn hesis in ol es chemical (emulsion and complex
coace a ion), physical (elec osp ay and nano sp ay), and sel -assembly
(desol a ion) me hods. HSA has eac i e amino, hiol and ca boxylic
g oups on i s su ace, which a ou co alen ligand and su ace modi-
ica ions whe eas hey also a ou non-co alen in e ac ions o a ious
d ugs and pep ides. Albumin nanopa icles unc ionalised wi h he
p o ein ApoE could a ge endo helial cells by ecep o media ed
endocy osis, whe eas nanopa icles wi hou ApoE we e incapable o
eaching b ain issues. Fu he , albumin pa icles can be modi ied wi h
cell pene a ing pep ides like low MW p o amine (LMWP) and b ain
pene a ion enhance s based on adi ional Chinese medicines like
bo neol, muscone o men hol o imp o e BBB pene a ion [274,275]. As
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Ac a Bioma e ialia 196 (2025) 17–49
36
an illus a ion, BSA nanopa icles and LMWP-modi ied BSA nano-
pa icles we e ab ica ed based on sel -assembly o LMWP and BSA wi h
hyd ophobic d ugs pacli axel and en e inide (Fig. 10a). Bo h ypes o
nanopa icles esul ed in a es ing umou g ow h in bo h subcu aneous
and o ho opic glioma models. In he o ho opic glioma model, he
whole-body imaging da a e ealed up ake o bo h ypes o nanopa icles
(Fig. 10b). No ably, LMWP-modi ied BSA nanopa icles demons a ed
apid and subs an ial accumula ion in b ain wi h highe luo escence
signals (Fig. 10c). In compa ison, he up ake o BSA nanopa icles was
no ably lowe han ha o he LMWP (Figs. 10c and e). The esul s a e
u he co obo a ed wi h ex i o imaging o he dissec ed o gans om
mice (Fig. 10d). A majo disad an age o his model is he lack o BBB.
Cu en ly, o GBM, clinical ials a e going on wi h FDA app o ed
Ab axane (albumin bound pacli axel) along wi h ca bopla in and
implan ed ul asound emi e s de ice [246]. Fu he , albumin is used o
modi y he su ace o polyme ic nanopa icles o enhancing BBB
ansloca ion [246].
Fu he , modi ica ions o nanopa icles wi h na u al ligands/
Fig. 10. Blood-b ain ba ie (BBB) pene a ing low molecula weigh p o amine (LMWP) bo ine se um albumin (BSA) nanopa icles (L-BSA-NPs) and BSA-NPs
de eloped wi h sel -assembly o LMWP and BSA along wi h hyd ophobic d ugs pacli axel (PTX) and en e inide(4-HPR). Cha ac e iza ion o he syn hesized BSA-
NPs and L-BSA-NPs. (A) T ansmission elec on mic og aphy and he pa icle size dis ibu ion o he BSA-NPs and L-BSA-NPs. (B) In i o imaging o mice bea ing
U87 xenog a umou s showing in e umo al pene a ion abili y o BSA-NPs and L-BSA-NPs. Full body imaging showing biodis ibu ion o BSA-NPs and L-BSA-NPs,
wi h p og essi e ise in luo escen in ensi y om 2 o 8 h, wi h L-BSA-NPs displaying enhanced umo accumula ion compa ed o BSA-NPs. (C) Quan i ica ion o he
a e age luo escence e iciency in i o a he umo si e. (D) Ex i o imaging o he majo dissec ed o gans, whe e umo shows highe luo escence in ensi y. (E)
Quan i ica ion o luo escence in ensi y o only umou s om D. Adap ed wi h pe mission om [274]. Copy igh © 2016 Ame ican Chemical Socie y.
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
37

p o eins like T , lac o e in, apolipop o ein, and melanoT ha e been
success ully used o a ge he exp essed ecep o s on endo helial cells
and imp o e BBB anscy osis [249,252]. T is a glycop o ein ha in-
e ac s wi h T R o e exp essed on he su ace o BBB h ough
ligand- ecep o ecogni ion. Addi ionally, nanoca ie made om na -
u al i on s o age p o ein, e i in, exhibi s BBB- a e sing and he
glioma- a ge ing p ope ies. Fe i in nanoca ie s along wi h hei
modi ica ion wi h in eg in
α
2β1 a ge ing ligand (DGEAGGDGEA) ha e
been used o deli e doxo ubicin o enhanced o ho opic glioma he -
apy [276].
Ad ances in ma e ial chemis y ha e sugges i ely augmen ed he
polyme ic nanoca ie s o mula ions and i s usage in CNS deli e y. The
na u ally occu ing polyme s owing o i s less oxici y, biocompa ibili y,
a ge ed d ug deli e y, e sa ili y, biodeg adabili y, a ailabili y, and
low cos o e g ea p omise o imp o ing d ug deli e y ac oss he BBB.
Howe e , due o hei low mechanical s eng h, polyme ic nanoca ie s
ha e poo s abili y and s uc u al in eg i y du ing ci cula ion and d ug
leakage compa ed o syn he ic polyme s. Fu he , challenges like apid
clea ance, ba ch o ba ch a iabili y, lowe d ug encapsula ion and
po en ial immunogenici y should be ca e ully conside ed in he a ional
designed o s a egies o acili a e d ug anspo a ion ac oss he BBB o
po en ial long- e m and clinical applica ion.
4. Clinical ansla ion
Basic and applied neu oscience has b ough o ligh new echnolo-
gies and he disco e y o new he apeu ic in e en ions wi h po en ial o
o e come some o he majo CNS diso de s. Fu he mo e, an inc easing
in-dep h unde s anding and desc ip ion o new molecula a ge s o CNS
diso de s is also enhancing he oolbox o he design o new he apies.
Hence, bo h academia and indus y e o s a e ocused on he wo ldwide
bu den o he neu ological diso de s in he las decades, which ep esen
he leading cause o disabili y and he second leading cause o dea h
[277]. Cases o b ain cance as well as he p e alence o CNS diso de s
a e inc easing due o he longe li e-expec ancy acco ding o Wo ld
Heal h O ganiza ion. Howe e , some p ac ical challenges emain in
es ablishing no el d ugs and biologicals when mo ing om he bench o
in i o s udies o in o he clinical use. Eme ging app oaches, such as
in anasal deli e y, a e being implemen ed as a non-in asi e op ion o
he d ug deli e y o he CNS while educing pe iphe al exposu e, mos ly
a a basic esea ch le el. Thus, de eloping new s a egies o each he
CNS, while limi ing sys emic e ec s is s ill one o he main clinical
challenges due o he inhe en high complexi y o he BBB. Decades o
neu oscience esea ch ha e led o he de elopmen o biologic d ugs
ha ha e gi en clinicians and pa ien s enewed hope o imp o ed
ea men op ions o complex diseases like MS, AD, PD, o b ain can-
ce s, among o he s. The de elopmen and use o biomac omolecules a e
blossoming in he las yea s due o hei abili y o a ge speci ic pa h-
ways, which educes undesi ed side e ec s, also allowing o pe sonal-
ized ea men ha add esses he pa ien ’s pa icula condi ion.
Al hough he a ailabili y o biologic ea men s o CNS diso de s is
limi ed, he e is no denying ha he exis ing adi ional d ugs unda-
men ally change symp oms o hese diseases bu do no change he
ch onic onse o he diso de . Mos o he a ailable he apeu ic bio-
mac omolecules in he ma ke a e an ibodies, such as LEMTRADA®
(alem uzumab), TYSABRI® (na alizumab), o OCREVUS® (oc elizu-
mab) o he ea men o MS, Aduhelm® (aducanumab) o AD, and
Be acizumab o Naxi amab-gqgk o b ain cance . Rega dless o he
pa hology, clinical ials ha e ailed o a mul i ude o easons, such as
se e e ad e se e ec s, minimal o no change in disease onse o poo
bioa ailabili y due o he inhe en complexi y o he diso de s and he
BBB c ossing abili y [278]. Howe e , he inc easing numbe o people
a ec ed by CNS diso de s and b ain umo s poin ou he need o new
de elopmen s o ackle his global bu den, especially in low and
mid-income coun ies. Fu he mo e, abou one hi d o he FDA ap-
p o als in 2022 we e biologics, pushing hem ahead o small molecules
o he i s ime, wi h new app oaches such as an ibody–d ug conju-
ga es, bispeci ic p o eins, and cell and gene he apies [279]. This end is
e idenced wi h mo e han 300 en ies o “Alzheime ’s Disease and
enzymes”, 34 en ies o “mul iple scle osis and g ow h ac o s”, 127
en ies o “neu oblas oma and an ibody”, o 63 en ies o “GBM and
an ibodies”, in he websi e clinical ials.go among o he s. When
sea ching o ials in ol ing “nanopa icles”, he numbe s dec ease
d ama ically, being mos ly ocused on he use o me allic nanopa icles
and liposomes (Table 5). The i s liposomal based d ug, Doxil, was
app o ed by he FDA in 1995, while he i s polyme ic nanopa icle,
Ab axane, go he app o al in 2005 bo h using small molecules as hei
ca goes [280]. Two decades la e , he FDA app o ed a nanome ic
ca ie based on Lipid and Nucleic acids, called ONPATTRO®. In addi-
ion, PEGyla ion echnology has been widely applied o e he las 30
yea s o imp o e he pha macokine ics and pha macodynamics o
di e en he apeu ic modali ies such as small molecules, pep ides, o
p o eins, which leads o o e 30 PEGyla ed d ugs cu en ly used in he
clinic [281]. Fu he mo e, some clinical ials a e ocused on he use o
Ab axane o Doxil on d ug epu posing app oaches nowadays (Table 5).
O e all, i is expec ed ha he endency o using biomac omolecules
ollow up o he use o polyme ic nanoca ie s loading hem o o e come
hei inhe en ly poo physicochemical p ope ies in he upcoming yea s.
5. Pi alls and u u e pe spec i es
As explained along his e iew, a ge ed nanopa icles ha e shown
p omise o o e come he BBB. Howe e , hey also accumula e and
elease he ca go in o - a ge body si es, which o en esul s in sys emic
side e ec s. Nasal adminis a ion was ini ially u ilized o local d ug
deli e y in he ea men o alle gic condi ions and sys emic adminis-
a ion in he so-called ansnasal ou e [282]. Fo example, calci onin
salmon nasal sp ay is used o ea pos menopausal os eopo osis. The
ansnasal deli e y o o he biologicals such as he human g ow h ac o
and oxy ocin has been also in es iga ed [283,284]. The ansnasal ou e
bypasses hepa ic i s -pass me abolism and could lead o sys emic
bioa ailabili y compa able o he in a enous and he in amuscula
injec ions. An adminis a ion s a egy ha capi alizes on di ec ans-
po mechanisms be ween he ol ac o y nasal epi helium and he CNS,
namely he in anasal o nose- o-b ain ou e, was in oduced by P o . W.
H. F ey II in he 1990s o he deli e y o pep ides and o he he apeu ic
molecules [285–288]. Majo ad an ages a e he quick onse o ac ion, no
hepa ic i s -pass me abolism, and pa ien compliance. Daun less e o s
ha e been de o ed o un a el he molecula and cellula pa hways
in ol ed in he nose- o-b ain anspo , which a e s ill unde scien i ic
deba e [289]. The anspo is an in e play among di e en in acellula
and ex acellula mechanisms wi h a le el o con ibu ion ha depends
on he p ope ies o he d ug (in solu ion o as a nanopa icle) and he
o mula ion. O e all, he e is b oad ag eemen ha he ol ac o y egion
in gene al and he ol ac o y neu ons in pa icula play a key ole [290,
291]. Also b anches o he igeminal ne e a e ele an playe s as
neu ons om hese b anches connec he nasal mucosa wi h he ol ac-
o y bulb. In addi ion, he apeu ic compound can access he b ain ia
he blood ascula u e and he lympha ic sys em. The possible ole o
mic oglia in he nose- o-b ain anspo o di e en ypes o nano-
pa icles has been ecen ly epo ed [292,293]. I is wo h s essing ha
he egion o he CNS in which he nanopa icles accumula e depends on
ea u es such as size and su ace chemis y [197]. Thus, a mo e
comp ehensi e in es iga ion o his pa hway has o be ca ied ou o
which he de elopmen o clinically ele an in i o and ex i o models
ha will enable he sc eening o he mos p omising p o o ypes is a
c ucial s age [197–294].
The de elopmen o in i o models ha ai h ully ecapi ula e he
complexi y o he BBB and allow a apid sc eening o he apeu ics has
been also placed in he spo ligh o many in es iga ions. These models
a e belie ed o ci cum en , o a leas minimize, he need o in i o
models in he nea u u e, being in line wi h he 3R p inciples ( eplace,
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
38
Table 5
Ongoing clinical ials using nanopa icles o ea CNS diso de s o b ain cance .
S udy Ti le Phase Sys em Disease G oups Pa icipan s P ima y Ou come S a us Iden i ie
High-Field MRI I on-
Based Con as -
Enhanced
Cha ac e iza ion o
Mul iple Scle osis and
Demyelina ing
Diseases
NA Fe aheme
( e umoxy ol)
RRMS In e en ions: D ug:
Fe aheme
D ug: Gadolinium-based
con as
NA Numbe and loca ion o
enhancing b ain lesions
seen on 7 esla MRI
ollowing Fe aheme
adminis a ion.
Wi hd awn NCT01973517
In Vi o Cha ac e iza ion
o In lamma ion Wi h
Fe umoxy ol, an
Ul asmall
Supe pa amagne ic
I on Oxide
Nanopa icle, on 7
Tesla Magne ic
Resonance Imaging
1 Fe umoxy ol, an
Ul asmall
Supe pa amagne ic
I on Oxide
Nanopa icle
MS Expe imen al:
Fe umoxy ol
A 510 mg dose (17 mL) o
e umoxy ol dilu ed in
50 mL o 0.9% no mal
saline will be
in a enous
14 To de e mine he
change in g adien -echo
T2*-weigh ed signal in
an i on- ich b ain
s uc u e, he globus
pallidus [Time F ame: 6
mon hs ollowing
e umoxy ol
adminis a ion]
de e mine i
e umoxy ol induces
long-las ing b ain signal
in ensi y changes in HV
and MS
Comple ed NCT02511028
No el Imaging Ma ke s
in SPMS
1 Fe umoxy ol SPMS D ug: Fe umoxy ol
in usion
D ug: Gado e idol
Diagnos ic Tes : MRI
B ain and Ce ical Spine
10 To de e mine a signal
change on T1-weigh ed
and 3D UTE MRI b ain
(and uppe ce ical
co d) be o e and 96
hou s (±24 hou s) a e
e umoxy ol
adminis a ion [Time
F ame: 96 hou s ±24
hou s]
Rec ui ing NCT05357833
31P-MRS Imaging o
Assess he E ec s o
CNM-Au8 on
Impai ed Neu onal
Redox S a e in
Mul iple Scle osis.
(REPAIR-MS)
2 CNM-Au8 (Gold
Nanoc ys als)
MS
PD
In e en ions: D ug: gold
nanoc ys als
Expe imen al: 60mg
CNM-Au8
60mg suspension o
clean-su aced, ace ed,
gold nanoc ys als in
120ml o sodium
bica bona e bu e ed
wa e
In e en ions: D ug: gold
nanoc ys als
NA The change om
baseline o week 12 in
CNS me abolic changes,
based on 31P-MRS
Redox Ra io. [Time
F ame: A 12 Weeks]
Rec ui ing
Comple ed
NCT03993171
NCT03815916
The apeu ic
Nanoca alysis o Slow
Disease P og ession o
Amyo ophic La e al
Scle osis (ALS)
(RESCUE-ALS)
2 CNM-Au8 ALS D ug: CNM-Au8
D ug: Placebo
45 Elec omyog aphy
measu es o disease
p og ession. [Time
F ame: 36 weeks]
Comple ed NCT04098406
S udy o APH-1105 in
Pa ien s Wi h Mild o
Mode a e Alzheime ’s
Disease
2 APH-1105 (Alpha
Sec e ase Modula o )
AD D ug: APH-1105
O he : Placebo
NA Sa e y: Incidence o
T ea men -eme gen
Ad e se E en s [Time
F ame: Baseline
h ough 30 days pos
inal ea men dose up
o day 60]
E icacy: Cogni ion
Change [Time F ame:
Baseline - day 60]
Change in Alzheime ’s
Disease Assessmen
Scale-Cog (ADAS-COG)
o al sco e om
baseline o pos inal
ea men dose.
No ye
ec ui ing
NCT03806478
Radiosensi iza ion o
Mul iple B ain
Me as ases Using
AGuIX Gadolinium
Based Nanopa icles
(NANO-RAD)
1 AGuIX®
Gadolinium chela ed
polysiloxane based
nanopa icles wi h
Magne ic Resonance
B ain
Cance
In e en ions: D ug:
AGuIX
Radia ion: whole b ain
adia ion he apy
15 Maximum- ole a ed
dose (MTD) o
polysiloxane
gadolinium-chela es
based nanopa icles
(AGuIX) gi en
concu en ly o he
whole b ain adia ion
he apy o he
Comple ed NCT02820454
(con inued on nex page)
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
39
Table 5 (con inued)
S udy Ti le Phase Sys em Disease G oups Pa icipan s P ima y Ou come S a us Iden i ie
ea men o mul iple
b ain me as ases [Time
F ame: 18 mon hs]
E alua ing AGuIX®
Nanopa icles in
Combina ion Wi h
S e eo ac ic Radia ion
o B ain Me as ases
(NANOSTEREO)
2 AGuIX®B ain
Cance
D ug: AGuIX
2 IV injec ions (100 mg/
Kg/injec ion) a day 4
and day 8 +S e eo ac ic
Radia ion om day 8 o
day 15 as pe s anda d
p ac ice.
1 Ra e o local con ol
[Time F ame: 1 yea ]
The p ima y endpoin is
he a e o local con ol
de ined as he
p opo ion o pa ien s
wi h a comple e
esponse, a pa ial
esponse o a s able
disease.
Te mina ed NCT04094077
S e eo ac ic B ain-
di ec ed Radia ion
Wi h o Wi hou
Aguix Gadolinium-
Based Nanopa icles
in B ain Me as ases
2 AGuIX®B ain
Cance
Radia ion: S e eo ac ic
Radia ion
D ug: AGuIX
gadolinium-based
nanopa icles
Radia ion: S e eo ac ic
Radia ion
O he : Placebo
134 Local Recu ence [Time
F ame: F om
en ollmen o 6 mon hs]
Assessed wi h Response
Assessmen in Neu o-
Oncology (RANO) -
B ain Me as asis
Guidelines Time o local
ailu e on a pe
me as asis basis will be
pe o med using he
log- ank es .
Rec ui ing NCT04899908
Radio he apy o
Mul iple B ain
Me as ases Using
AGuIX®
(NANORAD2)
2 AGuIX®B ain
Cance
In e en ions: D ug:
AGuIX®
Radia ion: Whole B ain
Radia ion The apy
In e en ions: Radia ion:
Whole B ain Radia ion
The apy
NA E alua ion o b ain
me as ases esponse,
acco ding o RECIST
1.1 c i e ia (o
modi ied RECIST) by
MRI, wi h MRI
cen alized eading
Rec ui ing NCT03818386
Pemb o+Chemo in
B ain Me s
2 Nab-Pacli axel B ain
Cance
Pemb olizumab wi h
s anda d o ca e
chemo he apy
ea men : Pa ien s will
ecei e 200mg o 400mg
o Pemb olizumab
(s anda d o ca e dosing
a he disc e ion o
ea ing physician) e e y
h ee o six weeks wi h
s anda d o ca e
chemo he apy ea men
(ca bopla in,
peme exed, pacli axel,
nab-pacli axel).
In e en ions: D ug:
Pemb olizumab
D ug: Nab pacli axel
D ug: Pacli axel
D ug: Peme exed
D ug: Ca bopla in
NA Disease con ol a e
[Time F ame: 6 mon hs
(baseline o 6 mon hs)]
In ac anial bene i
de ined as s able
disease, pa ial
esponse, and comple e
esponse
Rec ui ing NCT04964960
Lapa inib and Pacli axel
in T ea ing Pa ien s
Wi h Ad anced Solid
Tumo s
1 Ab axane B ain
Cance
D ug: lapa inib
D ug: pacli axel
albumin-s abilized
nanopa icle o mula ion
Ab axane
28 Maximum ole a ed
dose (MTD) o lapa inib
in cou se 1 [Time
F ame: es ima ed o be
12 weeks]
Comple ed NCT00313599
MTX110 by Con ec ion-
Enhanced Deli e y in
T ea ing Pa icipan s
Wi h Newly-
Diagnosed Di use
In insic Pon ine
Glioma (PNOC015)
1 and
2
MTX110 (panobinos a
nanopa icle
o mula ion)
B ain
Cance
In e en ions: D ug:
Panobinos a
Nanopa icle
Fo mula ion MTX110
D ug: Con ec ion-
Enhanced Deli e y
(CED)
7 Ad e se e en s and
clinically signi ican
labo a o y
abno mali ies which
mee G ade 3, 4, o 5
c i e ia acco ding o
Common Te minology
C i e ia o Ad e se
E en s (CTCAE)
Comple ed NCT03566199
CED o MTX110 Newly
Diagnosed Di use
Midline Gliomas
1 MTX110 B ain
Cance
In e en ions: D ug:
In usa e wi h MTX110
and gadolinium
De ice: Con ec ion-
Enhanced Deli e y
(CED)
NA Sa e y o epea ed
con ec ion-enhanced
deli e y (CED) o
MTX110 will be
epo ed by
summa izing he
incidence a e o
ad e se e en s obse ed
o epo ed.
Rec ui ing NCT04264143
(con inued on nex page)
E. Rome o-Ben e al.
Ac a Bioma e ialia 196 (2025) 17–49
40
educe, e ine) and acili a ing he p e-clinical selec ion o BBB-
pe meable he apeu ics [295]. As explained along his e iew, he BBB
is a he e ocellula ba ie , in which he c oss alk be ween he di e en
cell ypes and he cha ac e is ics o he ex acellula ma ix play an
impo an ole. Thus, esembling his complex scena io in i o is
challenging. Mos o he s udies epo ed in li e a u e ely on he use o
wo-dimensional models. The complexi y o hese wo-dimensional
models can be u he expanded by including a ious cell ypes (e.g.,
pe icy es, as ocy es, neu ons) ei he p ima y, es ablished cell lines o
de i ed om induced plu ipo en s em cells (iPSCs) [296,297]. These
models ha e gained popula i y hanks o hei simplici y and possibili y
o ob ain p elimina y esul s in a ela i ely sho pe iod o ime. How-
e e , hey poo ly ep esen he mo phological ea u es o b ain capil-
la ies in e ms o geome y and s uc u al o ganiza ion. Besides, he
semipo ous memb ane is made ou o igid polyme s (e.g., poly-
ca bona e o polye hylene e eph hala e) wi h mechanical s i ness a
abo e he ones obse ed in he ex acellula ma ix. The e o e, e-
sea che s a e ying o combine he simplici y o hese wo-dimensional
models wi h mo e biomime ic memb anes o achie e pe meabili y
alues close o he in i o scena io [298]. The use o mic o luidics has
eme ged as a po en ool o de elop mo e clinically ele an BBB models.
Mic o luidic de ices usually con ain in e connec ed compa men s ha
allow he cocul u e o di e en cell ypes in indi idual chambe s.
Mo eo e , hese compa men s can be illed wi h cell-laden gels, hus
c ea ing a 3-dimensonal en i onmen ha be e ep esen he physio-
logical cell o ganiza ion [299,300]. The use o mic o luidic de ices,
oge he wi h he es ablishmen o imp o ed in i o cul u e p o ocols,
he use o human iPSCs and he possibili y o mimic physiological
condi ions (e.g., luid shea s ess, blood-like iscosi y) a e allowing he
de elopmen o obus in i o pla o ms ha ep esen a eal al e na i e
o in i o models. As an illus a ion, Pa k e al. epo ed a mic o luidic
chip ha main ained human BBB unc ion (i.e., low ba ie pe me-
abili y, exp ession o e lux pumps, high le els o TJs) o up o one week
in i o, and showed in i o-like selec i e anscy osis o pep ides and
an ibodies [301]. Al e na i e models exploi he capaci y o cells o
sel -assemble in o h ee-dimensional essel a chi ec u es. Fo example,
he cocul u e o human endo helial cells, as ocy es and pe icy es wi hin
ib in gels esul ed in he o ma ion o a mic o ascula ne wo k ha
shows gene exp ession p o iles and pe meabili y alues simila o hose
obse ed in i o [302,303].
As explained be o e, his e iew examines a ious polyme ca ie s
sui able o deli e ing biomac omolecules o he b ain. These ca ie s
ha e been de eloped using a ial-and-e o -based app oach, which is
cu en ly a signi ican bo leneck in he de elopmen o polyme ic
Table 5 (con inued)
S udy Ti le Phase Sys em Disease G oups Pa icipan s P ima y Ou come S a us Iden i ie
Maximum Tole a ed
Dose (MTD) o MTX110
[Time F ame: 14 days]
A S udy o E alua e he
Sa e y, Tole abili y
and Immunogenici y
o EGFR(V)-EDV-Dox
in Subjec s Wi h
Recu en GBM
(Ce eb alEDV)
1 EGFR(V)-EDV-Dox
((V)EDVDox con ains
doxo ubicin (Dox)
wi hin he minicells
and a ge s EGFR
h ough Vec ibix)
B ain
Cance
GBM
In e en ions: D ug:
EGFR(V)-EDV-Dox
NA Sa e y measu es will be
conduc ed om S udy
Day 1 as pe s udy
schedule o sa e y
ollow-up isi 30 (+5
days) pos las dose.
Unknown NCT02766699
AGuIX Nanopa icles
Wi h Radio he apy
Plus Concomi an
Temozolomide in he
T ea men o Newly
Diagnosed GBM
(NANO-GBM)
1 and
2
AGuIX®GBM Expe imen al: AGuIX +
chemo adio he apy
( adio he apy +
emozolomide)
Sham Compa a o :
chemo adio he apy
( adio he apy +
emozolomide)
NA The ecommended dose
(phase I) o AGuIX in
combina ion wi h TMZ
and and adio he apy
du ing he adio-
chemo he apy pe iod
[Time F ame: du ing 6
weeks a e he i s
injec ion o AGuIX]
6-mon h P og ession
F ee Su i al (PFS) a e
(phase II) [Time F ame:
6 mon hs om he s a
o ea men ]
Rec ui ing NCT04881032
Phase II S udy o
Combined
Temozolomide and
SGT-53 o T ea men
o Recu en GBM
2 SGT-53 (a complex o
ca ionic liposome
encapsula ing a no mal
human wild ype p53
DNA sequence in a
plasmid backbone)
GBM In e en ions: Gene ic:
SGT-53
D ug: Temozolomide
1 Tumo Response [Time
F ame: 6 mon hs]
The 6-mon h
p og ession- ee
su i al (PFS) was
e alua ed using RANO
Response C i e ia.
Te mina ed NCT02340156
NU-0129 in T ea ing
Pa ien s Wi h
Recu en GBM o
Gliosa coma
Unde going Su ge y
1 NU-0129 (gold base
sphe ical nucleic acid
(SNA) nanoconjuga e
a ge ing BCL2L12)
GBM Expe imen al: T ea men
(NU-0129)
8 To e alua e he sa e y o
in a enous NU-0129 in
pa ien s wi h ecu en
GBM o GS.
Comple ed NCT03020017
A Phase I T ial o
Nanoliposomal CPT-
11 (NL CPT-11) in
Pa ien s Wi h
Recu en High-G ade
Gliomas
1 NL CPT-11 GBM In e en ions: D ug:
Nanoliposomal CPT-11
34 To assess he sa e y and
pha macokine ics o NL
CPT-11 in pa ien s wi h
ecu en malignan
glioma s a i ied based
on UGT1A1 geno yping.
[Time F ame: 1–2
yea s]
Comple ed NCT00734682
(Da a om: h ps://clinical ials.go ). T ials wi h jus expec ed numbe o pa icipan s we e conside ed as no applicable (NA). Abb e ia ions: MS, Mul iple Scle osis;
RRMS, Relapsing Remi ing Mul iple Scle osis; SPMS, Seconda y p og essi e Mul iple Scle osis; PD, Pa kinson’s Disease; ALS, Amyo ophic La e al Scle osis; AD,
Alzheime ’s Disease.
E. Rome o-Ben e al.
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