Immunoliposome therapy is a targeted drug delivery method that involves the use of liposomes (artificial lipid bilayer vesicles) coupled with monoclonal antibodies to deliver therapeutic agents to specific sites or tissues in the body. The antibody modified liposomes target tissue through cell-specific antibodies with the release of drugs contained within the assimilated liposomes. Immunoliposome aims to improve drug stability, personalize treatments, and increased drug efficacy. This form of therapy has been used to target specific cells, protecting the encapsulated drugs from degradation in order to enhance their stability, to facilitate sustained drug release and hence to advance current traditional cancer treatment.
History Alec D. Bangham discovered liposomes in the 1960s as spherical vesicles made of a phospholipid bilayer that houses hydrophilic cores. The liposomes were then studied to uncover the properties of biological membranes and a hydration method was discovered to prepare artificial liposomes from 1968 to 1975. Since then, multiple methods of preparing liposomes have been utilized and their characteristics (physical and chemical) have been studied.
Monoclonal antibodies are proteins that stick to specific antigens that tag specific cells and can be synthesized in the lab. They were first generated in 1975 and have since advanced to being used for immunotherapy.
Immunolipsomes were developed utilizing both of these components. The first anticancer drug made with this method was doxorubicin (DOX) in the 1990s.
Composition and structure
The core structure of immunoliposomes is a lipid bilayer. This lipid bilayer forms a hydrophilic core, which provides stable encapsulation for a therapeutic payload. Common lipids used are phosphatidylcholine (PC), phosphatidylethanolamine (PE), and cholesterol. The lipid bilayer is surface modified through conjugation using monoclonal antibodies for specific recognition of the target cells or tissues of interest. The core of the immunoliposome contains the therapeutic payload, which can be anything from small drugs, nucleic acids, peptides, or imaging agents.
There are often stabilizers and excipients present for formulation, stability, and functionality. Some include polyethylene glycol (PEG), antioxidants to prevent degradation of lipids, and buffering agents for optimal pH.
Synthesis Immunoliposomes are created when antibodies are conjugated to liposomes. One way to do this is through covalent bonds between the antibody (or its fragment) and the lipid. Another way is through chemical modification of antibodies so they have a higher affinity for the liposome. "In general, the conjugation methodology is based on three main reactions; a reaction between activated carboxyl groups and amino groups which yields an amide bond, a reaction between pyridyl dithiols and thiols which yields disulfide bonds, and a reaction between maleimide derivatives and thiols, which yields thioether bonds."
Conjugation via carboxyl and amino residues
Amine groups are found throughout an antibody and are used as a target due to their easy steric accessibility and modification. An overview of this reaction is found in Figure 2. Most often amine groups found on lysine are covalently bonded to carboxyl groups of glutamic and aspartic acid on formed liposomes using certain agents. A two step process is utilized where the first step uses 1-ethyl-3-[3-dimethylaminopropyl] carbodiimide to create an amine reactive product from the carboxyl group. This product is a target for a nucleophilic attack by the amine but it hydrolyzes quickly, so EDC is added to stabilize it. As seen in the Figure 2, the intermediate can lead to the desired stable amide bond by chance or the recreation of a carboxyl group. To create more of the desired carboxyl-amine bond, N-hydroxysulfosuccinimide (sulfo-NHS) is added to form another intermediate that is an NHS ester. The second step to this reaction is for the antibodies to use the N-terminus of the lipid to covalently conjugate by creating an amide bond via displacement of sulfo-NHS groups. This leads to the final product of an antibody conjugated to a liposome to create an immunoliposome. This process is highly efficient and effective while maintaining the biological activity of the antibody.
Conjugation via thiol group Another process of creating immunoliposomes is by using a thiol group and creating a thioether bond. The sulfhydryl group is a key player can is found in cysteine bridges on proteins and reagents like Traut's reagents, SATA, and Sulfo-LC-SPDP. The reduction or hydrolysis of these groups generates thiol groups that create antibody conjugation to lipids. There are multiple methods of this process, and one uses the crosslinking agent SATA as shown in Figure 3. The ester end of SATA reacts with amino groups in proteins to form an amide link and a molecule with a protected sulfhydryl group. In order to continue the reaction, this group must be freed which is done by adding hydroxylamine. The following step is to add a chemical that can be an anchor between the lipid and the thiol group. Some examples of molecules that are capable of being this anchor are maleimide, iodoacetyl groups or 2-pyridyldithiol groups. Ultimately, these steps create an antibody-enzyme conjugate that has been formulated using a thiol group.
Mechanism of action Immunoliposomes use similar functionality as liposomes with the added measure of conjugating monoclonal antibodies and their fragments to the liposomes. The use of antibodies allow for easy targeting as they can recognize many different types of antigens. Diseased cells typically contain more antigens than healthy cells, which is how antibodies are able to appropriately target certain extracellular domains (depending on antigen overexpression) and kill diseased cells. Liposomal drug delivery combined with antibodies as a targeting ligand are what help immunoliposomes function as an effective drug carrier.
Once the immunoliposomes deliver the appropriate drugs to the targeted cells, they can enter the cell using either selective uptake of liposomes by endocytosis or liposome release near the targeted cell. Because of antibody conjunction, the cellular uptake amount is increased for immunoliposomes allowing greater drug entry into diseased cells. To control when a drug is released, immunoliposomes are being developed that can sense stimuli. This stimuli can come from the microenvironment of a tumor using factors such as reduced pH, temperature, and enzyme levels. External stimuli like light, heat, magnetic fields, or ultrasound can also act as a trigger for drug release.
Immunoliposomes can target a wide variety of cell options. This can be split into two main types commonly known as intravascular and extravascular space as seen in Figure 4. Intravascular cells are more accessible during circulation and include erythrocytes, myeloid cells, lymphocytes, neutrophils, etc. Extravascular cells are located on tissue parenchymal or stromal cells. Because immunoliposomes have many antibody copies, they contain a higher avidity than just one antibody alone allowing for effective targeting against cancer cells and some drug resistant cells.
Applications Immunoliposome applications use its ability to act as a drug delivery system and release specific drug components to target cells. This mechanism can be specifically highlighted in cancer cell targeting and through nutrient delivery systems.
Cancer cell targeting The most common use of immunoliposomes is to target cancer cells using different antibodies. Folate receptors and transferrin receptors are typically overexpressed on cancer cells, so immunoliposomes will target these corresponding ligands. Folate receptors dictate tumor cell specificity and have been seen to be expressed in multiple inflammatory diseases including psoriasis, Crohn's disease, atherosclerosis, and rheumatoid arthritis making folate-targeted immunoliposomes an efficient drug carrier to deliver antiinflammatory drugs. Transferrin receptors help with the iron demand in proliferating cancer cells and allow for formation of transferrin receptor-targeted anticancer therapies. EGFR (epidermal growth factor) is a tyrosine kinase receptor overexpressed in solid tumors such as colorectal, non small-cell lung cancer, squamous cell carcinoma, and breast cancer making it another target receptor for immunoliposomes. Some cancers create tumors that have multiple different receptors being overexpressed or utilize cancer stem cells, which allow for differentiation of numerous cancer types, so to combat this, dual-targeting immunoliposomes are being created to target multiple ligands and increase therapeutic efficacy. A study provides a promising preclinical demonstration of the effectiveness and ease of preparation of Valrubicin-loaded immunoliposomes (Val-ILs) as a novel nanoparticle technology. In the context of hematological cancers, Val-ILs have the potential to be used as a precise and effective therapy based on targeted vesicle-mediated cell death.
Nutrient delivery system Immunoliposomes can also be used as nutrient delivery systems to help stimulate brain activity. The effective transport of certain nutrients to the hypothalamus in order to regulate brain activity is currently a huge problem. The leptin gene is used to regulate feedback loops and send signals from the adipose tissue to the hypothalamus. Using this physiological function of leptin, immunoliposome nutrient delivery systems can be integrated into the body to help with nutrition transport to the brain as seen in Figure 5. Transferrin receptors have high expression at the BBB (blood brain barrier) and can be used as targets for immunoliposomes to transport p-glycoprotein substances.
Advantage and limitations Immunoliposomes have many possible applications as described above and have certain advantages in new research and ideas. Some advantages being researched include immunoliposomes targeting specific molecules in the body. In preclinical testing, they can be environmentally responsive to specific conditions of temperature, pH, enzymes, redox reactions, magnetic energy, and light to release drugs. This conditional ability allows immunoliposomes to focus on specific target areas which can be beneficial for drug delivery. Increased targeting allows the possibility for decreased systemic toxicity while increasing drug concentration at a certain site. Even with this advantage of immunoliposomes, there are some challenges in their application.