In the race to design ever more effective therapy with ever more focused and controlled actions, nanomedicine and phototherapy seem to be two allies of choice. Indeed, the use of nanovectors making it possible to transport and protect genetic material is becoming increasingly important. In addition, the use of a method allowing the release of genetic material in a controlled way in space and time is also a strategy increasingly studied thanks to the use of lasers. In parallel, the use of interfering RNA and, more particularly, of small-interfering RNA (siRNA) has demonstrated significant potential for gene therapy.
1. Introduction on Cancer and Treatments
Currently, cancer stands out as the first cause of death in the world after heart disease
[1]. The increase in aging and population, as well as the changes in the distribution of the main risk factors, lead to rapid growth in cancer incidence and mortality. In 2020, 19.3 million new cases worldwide were identified, a number that is expected to increase to 28.4 million cases in 2040
[2].
Surgery, chemotherapy, radiotherapy, and hormone therapy are the main commonly used treatments despite the limitations of the specificity toward cancerous tissues, which lead to the key setbacks in cancer therapy as metastasis, tumor recurrence, and resistance to the treatments
[3]. Therefore, there is an urgent need to develop new strategies to effectively kill cancer cells with little or no damage to healthy tissue.
Nanomedicine opens new hopes in solving many medical problems by developing several nanomaterials of organic or inorganic natures. The intrinsic properties of these nanomaterials, such as their nanometric size and large surface-to-volume ratio, open up many possibilities to explore their potential for the biomedical applications, especially for drug delivery, overcoming the chemotherapy limitations as systemic toxicity and multi-drug resistance mechanisms (MDR)
[4].
Nowadays, several nanomedicines, a term that includes all nanomaterials used for biomedical applications
[5], such as liposomes and albumin-based nanoparticles, are clinically approved for the treatment of cancer. Many others are in clinical trials and show great promises such as chemotherapy delivery systems, hyperthermia agents, and genetic or ribonucleic acid interference (RNAi) delivery systems
[6].
2. Ribonucleic Acid Interference (RNAi) Technology
RNAi is a natural mechanism in eukaryotes for post-transcriptional gene silencing through (i) chromatin remodeling, (ii) inhibition of protein translation, or (iii) direct degradation of messenger RNA (mRNA)
[7]. It was first discovered in 1998 by Fire and Mello research on
Caenorhabditis elegans [8] and it serves as epigenetic regulator and defense mechanism against exogenous genes (e.g., viral or bacterial genes) and endogenous genes (e.g., transposons)
[9][10][11][9,10,11]. In addition, it is considered as a promising strategy for treatment of cancer, primarily by specifically targeting key molecules involved in the molecular pathways of carcinogenesis
[12][13][12,13]. RNAi mediates its action through non-coding short double-stranded RNA (nc-sdRNA) such as small-interfering RNA (siRNA) and microRNAs (miRNA). Single miRNA can inhibit the expression of several target genes simultaneously; however, to trigger gene silencing; siRNA is considered more efficient and specific than miRNA
[14].
Here,
rwe
searchers focus on siRNA; thus, a description of the mechanism of action, siRNA-based cancer therapies, and barriers to siRNA delivery will be discussed in the following paragraphs.
2.1. Mechanism of Action of siRNA
The biogenesis of siRNA starts with the presence of long dsRNA, which originates from different sources (e.g., viral, bacterial and synthetic RNA) in the cytoplasm (
Figure 1). An enzyme called Dicer, a dsRNA-specific endoribonuclease from the RNase III protein family, cleaves the long dsRNA to about 21 nucleotides (nt) dsRNA called siRNA with 19 nt of complementary bases and a 2-nt overhang at each 3′-end. Afterwards, the formed siRNA duplex is loaded into a multiprotein RNA-induced silencing complex (RISC), in which a catalytic engine called the Argonaut protein (Ago-2) cleaves the passenger strand, keeping the active RISC with the guide strand. The siRNA guide strand recruits the RISC to complementary sequences in target mRNAs. A perfect siRNA base-pairing with mRNA causes direct mRNA cleavage by the catalytic RNase H domain of Ago-2, resulting in gene silencing, an effect that could last up to 7 days in rapidly divided cells and several weeks in nondividing cells
[15][16][15,16].
Figure 1. Representation of gene expression leading to protein synthesis in “normal conditions” in comparison with mechanism leading to mRNA degradation before protein synthesis in the presence of siRNA.
2.2. siRNA-Based Cancer Therapies
Recently, siRNA has emerged as a promising therapy for the treatment of several disorders, including cancer
[17][18][17,18]. Its essential therapeutic strategy stems from its ability to suppress oncogenes and mutated tumor suppressor genes, as well as genes involved in MDR mechanism, resulting in the sensitization of cancer cells to treatment
[19][20][19,20]. Anticancer siRNA targets can be categorized into (i) molecules involved in carcinogenesis, including molecules involved in oncogenic pathways, regulation of cell cycle, and apoptosis pathway; (ii) molecules involved in tumor–host interaction such as in cell adhesion, tumor extracellular matrix, tumor immune evasion, angiogenesis, invasion, and metastasis; and (iii) molecules participated in tumor resistance to chemotherapy, such as MDR and DNA repair proteins
[14].
The first human clinical trial of siRNA encapsulated in targeted cyclodextrin polymer-based nanoparticles (CALAA-01) was started in 2008 by Calando Pharmaceuticals (Pasadena, CA, USA) for solid tumor cancer treatment. This phase I study was terminated in 2012
[21].
Table 1 summarizes siRNA-based cancer therapeutics in clinical trials.
Table 1.
Anticancer siRNA-based therapeutics in clinical trials.
Name/Sponsor |
Route of Administration |
Delivery System |
Targeting Moiety |
Target Gene |
Disease |
Clinical Trail Number (ClinicalTrials.gov) |
Phase/Status |
Period |
Ref |
CALAA-01/Calando Pharmaceuticals |
i.v. |
Cyclodextrin polymer-based nanoparticle |
Transferrin |
RRM2 |
Solid tumors (Melanoma, gastrointestinal, prostate, etc.) |
NCT00689065 |
Phase I/Terminated |
2008–2012 |
[21] |
siG12D LODER/Silenseed Ltd. |
Endoscopic intervention |
Biodegradable Polymeric matrix |
----- |
KRAS(G12D) and G12X mutations |
Locally advanced pancreatic cancer |
NCT01188785 |
Phase I/Completed |
2011–2013 |
[22] |
siG12D-LODERs plus chemotherapy (Gemcitabine + nab-Paclitaxel or Folfirinox or modified Folfirinox) /Silenseed Ltd. |
Endoscopic intervention |
Biodegradable Polymeric matrix |
----- |
KRAS(G12D) and G12X mutations |
Locally advanced pancreatic cancer |
NCT01676259 |
Phase II/Recruiting |
2018–Est.2023 |
[23] |
ALN-VSP02/Alnylam Pharmaceuticals |
i.v. |
Lipid nanoparticle |
----- |
VEGF KSP |
Solid tumors with liver involvement. |
NCT00882180 NCT01158079 |
Phase I/Completed |
2009–2011 2010–2012 |
[24] |
TKM-PLK1 (TKM-080301)/National Cancer Institute (NCI) |
Hepatic Intra-Arterial Administration |
Lipid nanoparticle |
----- |
PLK1 |
Primary or secondary liver cancer. |
NCT01437007 |
Phase I/Completed |
2011–2012 |
[25] |
Arbutus Biopharma Corporation |
i.v. |
|
|
|
Cancer, neuroendocrine tumors, adrenocortical carcinoma |
NCT01262235 |
Phase I/II/Completed |
2010–2015 |
Arbutus Biopharma Corporation |
i.v. |
|
|
|
Hepatocellular Carcinoma |
NCT02191878 |
Phase I/II/Completed |
2014–2016 |
DCR-MYC/Dicerna Pharmaceuticals, Inc. |
i.v. |
EnCore | TM | lipid nanoparticle |
----- |
MYC |
Solid tumors, multiple myeloma, lymphoma |
NCT02110563 |
Phase I/Terminated |
2014–2016 |
[26] |
NBF-006/Nitto BioPharma, Inc. |
|
Lipid nanoparticle |
|
GSTP |
Non-Small cell lung, pancreatic and colorectal Cancers |
NCT03819387 |
Phase I/Recruiting |
2019–Est.2023 |
[27] |
Atu027/Silence Therapeutics GmbH |
i.v. |
Liposomes |
----- |
PKN3 |
Advanced Solid Cancer |
NCT00938574 |
Phase I/Completed |
2009–2012 |
[28] |
Atu027-I-02 (Atu027 plus gemcitabine)/Silence Therapeutics GmbH |
i.v. |
Liposomes |
----- |
PKN3 |
Advanced or Metastatic Pancreatic Cancer |
NCT01808638 |
Phase I/II/Completed |
2013/2016 |
[29] |
EphA2-targeting DOPC-encapsulated siRNA/M.D. Anderson Cancer Center |
i.v. |
Liposomes |
----- |
EphA2 |
Advanced or recurrent solid tumors |
NCT01591356 |
Phase I/Active, not recruiting |
2015–Est.2024 |
[30] |
Mesenchymal Stromal Cells-derived Exosomes with KRAS(G12D) siRNA/M.D. Anderson Cancer Center |
|
MSC exosome |
CD47 |
KRAS(G12D) |
Metastatic pancreatic ductal adenocarcinoma with KrasG12D mutation |
NCT03608631 |
Phase I/Recruiting |
2021–Est.2023 |
[31] |