# Patent

## Title
Early cancer detection and enhanced immunotherapy

## Abstract

A method of therapy for a tumor or other pathology by administering a combination of thermotherapy and immunotherapy optionally combined with gene delivery. The combination therapy beneficially treats the tumor and prevents tumor recurrence, either locally or at a different site, by boosting the patient's immune response both at the time or original therapy and/or for later therapy. With respect to gene delivery, the inventive method may be used in cancer therapy, but is not limited to such use; it will be appreciated that the inventive method may be used for gene delivery in general. The controlled and precise application of thermal energy enhances gene transfer to any cell, whether the cell is a neoplastic cell, a pre-neoplastic cell, or a normal cell.

## Background
This application is a continuation-in part of co-pending application Ser. No. 14/976,321 filed Dec. 21, 2015 which is expressly incorporated by reference herein in its entirety.


Various factors may lead one to suspect the presence of a small cancerous or neoplastic tumor in a patient. Such factors include the patient's genetic history, environmental conditions to which the patient is or has been exposed, the presence of biomarkers in the patient's blood, or the presence of a lesion on a patient's skin or mucosal surface. A small neoplasm, however, is often not recognized unless and until it produces some clinical symptom.
In a patient having a genetic mutation indicating a predisposition to cancer, prophylactic surgical intervention, such as a bilateral mastectomy performed in a patient having a genetic mutation indicating a predisposition to breast cancer, is seldom performed. Additionally, a genetic predisposition to one type of cancer may not lead to that type of cancer, e.g. breast cancer, but it may lead to another unsuspected type of cancer, e.g. malignant melanoma. Even if the other type of cancer is suspected, because of the finding of biomarkers in the blood, a small internal lesion may not be seen on radiography, or may not be accessible by surgery, or the collateral complications may not be acceptable. It may not suffice to just know the biomarker for a tumor, because this information may not indicate whether the tumor is a primary site or a metastatic site, the tissue of its origin, and/or its location. It is appreciated that some treatment techniques such as surgery or radiation may be useful, but only if the tumor is tissue specific. Radiation and chemotherapy also have their own side effects, and may not destroy the tumor completely. Larger tumors present a much complex problem, e.g., mutations in one area of the tumor are usually different from mutations in another area of the same tumor.
It is clearly preferable, then, to manage small early neoplasms that have not progressed to a larger tumor to provide the patient an improved clinical prognosis.
The invention includes a method of therapy for a non-surgically accessible tumor by administering a combination of thermotherapy and immunotherapy combined with gene delivery. The combination therapy beneficially treats the tumor and prevents tumor recurrence, either locally or at a different site, by boosting the patient's immune response both at the time or original therapy and/or for later therapy as a “booster” to the original therapy. With respect to gene delivery, the inventive method may be used in cancer therapy, but is not limited to such use; it will be appreciated that the inventive method may be used for gene delivery in general. For example, the inventive method facilitates cellular gene uptake by current methods that lack a thermal energy component, such as electroporation, quantum dot delivery, etc. The controlled and precise application of thermal energy enhances gene transfer to any cell, whether the cell is a neoplastic cell, a pre-neoplastic cell, or a normal cell.
The inventive method provides in vitro and in vivo precision immunotherapy to decrease or eradicate a malignant neoplasm at an early stage of the disease. This method provides a vaccination effect to prevent at least the same kind of cancer or recurrences.
One embodiment is a method for evaluating treatment outcome in a patient having a genetic predisposition for a malignant neoplasm before clinical manifestation of the neoplasm can be seen radiographically. The method permits visualization of any tumor, whether located externally on a patient's body or located internally in the body, and as small as 2 mm in diameter, producing a biomarker, either a biomarker specific for the tumor or a general biomarker.
In general, a biomarker indicates a disease process. As subsequently described, a biomarker can be a protein, antigen, enzyme, hormone, carbohydrate, toxin, DNA, an organism such as bacteria, tumor cell, exosome, or indirectly an antibody, present in a liquid biopsy specimen. It can be produced by the plasma cells, against a tumor antigen, etc.
The method uses antibodies conjugated with nanoparticles which include but are not limited to quantum dots, with the conjugated form collectively termed functionalized nanoparticles, that are heated under specified conditions to produce a photoacoustic signal that is then visualized to locate the tumor to which the nanoparticles are attached. Nanoparticles may be used for qualitative and quantitative assessment of an analyte in the blood or other tissue using photoacoustic technology, U.S. Pat. No. 8,554,296. As previously stated, as used herein, unless specifically stated otherwise, nanoparticles include but are not limited to quantum dots.
Early stage small neoplastic cells produce biomarkers that are either specific to the tumor cells or that represent the body's response to the tumor as an antibody. The biomarkers can be proteomic, genetic, epigenetic or glycomic biomolecules. These biomolecules can be recognized in the patient's tissue samples or in the blood. Their existence can be demonstrated thus far chemically using, e.g., immunoassay or PCR methods. Quantitation of these biomarkers is also important to determine disease progression and prognosis of the disease.
Biomarkers for many diseases are found in the blood. As subsequently disclosed, biomarkers detected in a liquid biopsy sample are used to generate antibodies against them using known methods in the art. The anti-tumor antibodies are used to coat nanoparticles in the inventive method, where a lesion can be imaged regardless of the lesion size or location in the body. The method is not limited to tumor detection and/or therapy. As only one example, detecting an antibody against anti-beta-amyloid protein present in Alzheimer's disease in a liquid biopsy specimen, the method renders the plaque visible with the nanoparticles and accessible to the inventive treatment. As another example, the method can also be used to detect and/or treat inflammatory processes, etc.
The inventive method is applicable to any processes or diseases that produce a biomarker detectable in a liquid biopsy specimen. It is applicable to a lesion including an abscess, an ulcer, a tumor either benign or malignant, an ischemic area of a stroke and/or an area of the brain affected by a stroke whether visible or microscopically.
Well over a thousand proteins are differentially expressed in human cancers and thus may serve as biomarkers. Such proteins play a role in cancer-related processes such as angiogenesis, apoptosis, cell differentiation, cell signaling, hematopoiesis, hormonal control, immune reactions, etc. Exemplary biomarkers include, but are not limited to, CEA for both malignant pleural effusion and peritoneal cancer dissemination; HER-2/neu for stage IV breast cancer; bladder tumor antigen for urothelial cell carcinoma; thyroglobulin for thyroid cancer metastasis; α-fetoprotein for hepatocellular carcinoma; PSA for prostate cancer; CA 125 for non-small cell lung cancer; CA 19.9 for pancreatic cancer; CA 15.3 for breast cancer; the combination of leptin, prolactin, osteopontin, and IGF-II for ovarian cancer; the combination of CD98, fascin, sPIgR, and 14-3-3 eta for lung cancer; troponin I for myocardial infarction, and B-type natriuretic peptide for congestive heart failure. While the previous nine proteins are the only approved markers for cancer testing to date, they are but a small fraction of the total number of available biomarkers, and their sensitivity and specific vary.
Other common biomarkers include the estrogen receptor/progesterone receptor (ER/PR), HER-2/neu, and ESFR for breast cancer, and TIMP-1-associated with serum HER2-positive breast cancer; KRAS and UGT1A1 for colorectal cancer; HER-2/neu for gastric cancer, c-KIT, CD20 antigen, CD30, and FIP1L1-PDGRF alpha, and PDGFR for GIST; Philadelphia Chromosome (BCR/ABL)/PML/RAR alpha and TPMT/UGT1A1/ALK EGFR for leukemia/lymphoma; KRAS/EGFR for lung cancer, and BRAF and S100 for melanoma.
Other examples of biomarkers include tumor suppressors that are lost in cancers, such as BRCA1, BRCA2; RNA such as mRNA, microRNA; proteins found in body fluids or tissue such as prostate specific antigen and CA-125; gene and protein based biomarkers; and nonspecific biomarkers such as glycosaminoglycans in body fluids; alkaline phosphatase and urinary hydroxyproline in skeletal involvement; hyaluronic acid excretion and urinary hydroxyproline in bone disease, and combinations thereof.
In malignancies, the biomarkers may be released into the circulation either prior to or after the tumor has grown sufficiently to become metastatic. Small tumors (less than about 2 mm) seldom have any clinical manifestations, however even such small tumors can release chemical and/or biomarkers into the circulation.
The existence of biomarkers in the circulation has been known, but has not met the threshold for locating tumor cells that could not be imaged radiographically or by ultrasound as long as the tumors were asymptomatic. Available imaging methods such as x-ray, magnetic resonance imaging (MRI), functional MRI, computed tomography (CT) scans, CT ultrasound, etc. may not permit visualization of lesions smaller than about 3 mm in diameter. This has been the case for most malignant tumors, or when a malignant tumor is created from a benign precursor lesion such as nevus, breast unspecific cyst or unspecific scar, prostate tumors along with benign prostate hypertrophy, or uterus cancer inside the uterus fibroma, melanoma inside a skin nevus or in a seborrheic keratosis, etc. Moreover, it is often difficult to follow a cancerous tumor which has been irradiated but may still harbor malignant cells, and that can start growing with time and metastasize before it shows a local growth that is detected by conventional imaging or other methods.
The diagnosis of a malignant tumor may be extremely difficult, even when a tumor is visible clinically or radiologically, e.g. a uterus fibroma that may have some malignant transformation. Moreover, a diagnosis also affects the decision whether or not and also how to remove the tumor. As one example, accessing the uterus through a small incision, and removing the tumor piece by piece using an endoscope and a cutting probe, has a fast post-operative recovery. Such a method is in contrast to completely removing the uterus with the tumor intact out of caution that the tumor may harbor neoplastic cells, but using a large incision with significantly higher operative risks and post-operative complication probabilities. Another, more problematic example, is the decision for a woman having genetic disposition to breast cancer without any physical or radiological manifestation. The woman must endure the stress and fear not knowing if or when she may develop breast cancer, and must consider prophylactic removal of both breasts. As another example, a personal decision whether or not to undergo radiation therapy when a nevus is discovered under the retina, and biopsy results that often do not provide definitive information because of the diversity of the cells in the entire area of the tumor.
When the tumor site is unknown, locating a biomarker in the circulation may be akin to finding a needle in a hay stack. For any particular tumor or cancer, not all biomarkers are even known. Similarly, finding a micro DNA in the circulation may not provide an answer when the tumor is either invisible or has already metastasized. An example of this occurs in patients with uveal melanomas, having a mortality rate of about 50%, even if the tumors undergoes radiation, at the time the ophthalmologist discovers the tumor. This points to the fact that a malignant tumor can metastasize very early, at times even when the size of the tumor is about 2 mm in diameter which is equal to about one million cells. In general, these lesions do not have any symptoms.
The inventive method makes it possible to evaluate a patient with genetic predisposition of a malignant neoplasm before its clinical manifestation can be seen radiographically.
In one embodiment, the presence of one or more biomarkers is evaluated in any body fluid or organ. Exemplary bodily fluids include, but are not limited to, urine, blood, cerebrospinal fluid (CSF), eye cavity fluid, tear film, sputum, fluid obtained from the trachea, bronchi, abdominal cavity, vagina, uterus etc. The biomarkers are analyzed in vitro by methods known in the art, e.g., immunoassays including enzyme-linked immunoassay (ELISA), Western blots, fluorescence in situ hybridization (FISH), polymerase chain reaction (PCR), etc. The biomarkers are then conjugated with functionalized antibody coated nanoparticles and/or quantum dots, as known in the art.
In one embodiment one obtains a liquid biopsy sample. Such a sample may be obtained from, e.g., blood, urine, cerebrospinal fluid (CFS), aqueous or vitreous or abdominal cavity fluid, lymph node fluid, bladder fluid, milk duct fluid, sputum, gastric fluid, bile duct fluid, sinus fluid, etc. The patient may or may not have any clinical symptom. The patient may or may not have history of a family disposition for tumors in and/or cancer of the breast, brain, lung, prostate, ovary, pancreas, etc., or a genetic abnormality leading to progression in diseases such as, e.g., Alzheimer's, Parkinson's, post traumatic brain syndrome, brain tumor, other neurological disease, age related macular degeneration, an infectious disease, an immune response, etc. The method evaluates the components of the sample for cell free nucleic acid-based biomarkers including but not limited to micoRNA and microDNA; protein-based biomarkers, extracellular vesicle (EV)-based biomarkers that are contained within exosomes, extracellular vesicles, or microvesicles, and circulating tumor cell (CTC)-based biomarkers. The method uses methodologies such as next generation sequencing (NGS) or recombinant affinity reagents fabricated into nanostructures such as carbon nanotubes, nanowires, quantum dots, or gold nanoshells, to enhance their detection with the use of, e.g., surface-enhanced Raman scattering (SERS), as known in the art.
For example, if a known tumor exists and there is a known biomarker for the tumor, one may have or prepare an antibody against the tumor to be used in both imaging and therapy. Large tumors with symptoms can be imaged, but before the inventive method, there was a problem when a biomarker was present in a liquid biopsy specimen but the tumor was invisible, e.g., an early stage of a tumor, and there was no symptomatic or radiographic evidence of the tumor.
Detecting a tumor biomarker, typically a protein or a glycoprotein, in a liquid biopsy specimen is facilitated by the inventive method. Once detected, an antibody against that tumor biomarker can be prepared. The antitumor biomarker antibody is used to located the tumor. Antibody production is a well-known method in the art, and it will be appreciated that the antibody against either or both of the tumor biomarker and the tumor cell may be recombinant, monoclonal, polyclonal, or an aptamer. The prepared antitumor cell antibodies are conjugated with nanoparticles and administered to a patient, where they target the tumor cells and can be detected and/or treated. Detection is by photoacoustic imaging technology. Treatment is at least by one of thermal energy. The photoacoustic detection and thermal treatment is described herein.
In one embodiment, any specific tumor related biomarker may be used. One example uses trastuzumab or herceptin, a recombinant monoclonal antibody, against the oncogene HER-2, previously mentioned, which is a member of the human epidermal growth factor receptor (HER/EGFR/ERBB) family. Other examples of known monoclonal antibodies or biologics include, but are not limited to, rituximab, cetuximab, racotunomab, obinotuzumab, pertuzumab, belaniatumomab, bevacizumab, nivolumab, ofatumumab, botezomib, daratumumab, ipilumumab, pembrolizumab, and daratumumab.
In one embodiment, in the absence of a specific biomarker, antibodies against biomarkers that are shared by a number of the tumors may be used. Such biomarkers include glycosaminoglycan, which is specific for a group of cancers such as bladder, gastrointestinal, glioblastoma, etc. Antibodies against such biomarkers are then conjugated with nanoparticles, termed functionalized nanoparticles. The term “functionalized” indicates nanoparticles that have been coated to render them soluble, biocompatible, and/or targeted by conjugating them with a biomolecule such as an antibody.
In one embodiment the nanoparticle may be one or more of the following compounds or contain one or more of the following components: quantum dots, nanowires, nanotubes, nanoshells, nanocages, perovskites, nanoparticles that are magnetic such as iron or iron oxide, paramagnetic, or nanoparticles that are non-magnetic such as gold, gold-silica, gold-iron, silica coated gold nanospheres and nanorods, ferritic, quartz, graphene, carbon, zinc oxide, piezoelectric, etc. Any of these nanoparticles, alone or in combination, may be conjugated or otherwise associated with the biomarkers' antibodies, using methods known in the art.
In another embodiment, self-assembling bio/nano hybrid material consisting of two constituents at the nanometer or molecular level composed of inorganic and organic compounds, having amphiphilic characteristics, i.e., hydrophilic and lipophilic components or micelles, which may be radioactive (e.g., Cu64) or radioactive (e.g., tin) are prepared with biocompatible coatings and administered in the body for both therapy and imaging.
In one embodiment, the functionalized nanoparticles travel in the body and attach to receptors of desired cells, e.g., tumors, Alzheimer's plaque, drusen of the retina, etc. These nanoparticles are imaged by applying external thermal energy and/or by applying a reversible or alternating magnetic field. The thermal energy causes the nanoparticles to expand, producing an ultrasound wave in the tissue. The ultrasound wave can be detected by an ultrasonic receiver which is imaged in two to three dimensional formats as a tomogram. In another embodiment the plaques in Alzheimer's disease, and the drusen in age related macular degeneration, are rendered visible using silica coated nanoparticles <2 nm in diameter administered with turmeric, glycosaminoglycan, amyloid antibody, or percolan, etc. and are quantified. In another embodiment, the nanoparticles are conjugated with antibodies, medications, sterols, antibiotics, antifungals, antibacterials, antiproliferative agents, etc. that can be released from silica coated gold nanoparticles when coated with thermosensitive polymers, e.g., chitosan coated nanoparticles heated to 40° C.-42° C., to treat various diseases including bacteria, fungi, parasites, plaque, drusen, etc. In another embodiment, the plaques and drusen can be quantified by imaging using light, MRI, photoacoustic technology imaging, etc.
In another embodiment, the functionalized anti-biomarker-conjugated nanoparticle, ranges in size from 1 nm to 900 nm. In another embodiment, the functionalized biomarker ranges in size from 1 nm to 8 nm, chosen to enhance their elimination through the kidney for facilitated clearance.
In one embodiment, the nanoparticles are rendered magnetic by coating with a thin film of iron oxide prior to their conjugation with biomarkers' antibodies.
In one embodiment, the nanoparticles are rendered more biocompatible by coating with a compound, including but not limited to the following: (poly)ethylene glycol, cell penetrating peptide (CPP), activating CPP (ACPP), biotin, streptavidin, etc., as known in the art, prior to their injection in the body.
Thermal energy in the form of electromagnetic radiation, ultrasound, or an alternating magnetic field is applied, under the control of a photoacoustic imaging system, to the organ suspected of potentially harboring an as yet invisible neoplasm. The thermal energy applied increases the temperature of the exposed nanoparticle, and creates a photoacoustic image or tomogram of the accumulated heated nanoparticles. This image or tomogram represents a suspected neoplasm in that organ, and is compared to an image taken without the thermal application radiographically.
In one embodiment, one administers functionalized antibody-coated nanoparticles that, once attached to tumor cells, become visible with a photoacoustic imaging unit that corroborates with an image obtained or not seen with other technology such as ultrasound, MRI, PET, CT scan, etc. In one embodiment, the images obtained with other instruments are either overlapped using a processor or are taken simultaneously during photacoustic imaging. In one embodiment, after administration of the antibody-coated nanoparticle, an MRI image is overlapped with the photoacoustic image and compared by a processor to verify the changes in the imaged area.
In one embodiment, the nanoparticles are incorporated in liposomes. In this embodiment, they may contain medications that, upon attainment of a specific tumor temperature, are released. The type of medication is not limited, and can include anti-bacterial, anti-viral, anti-fungal, antineoplastic, antiinflammatory such as acetyl cycline, anti-beta-amyloid protein, other antibodies, non-steroidal antiinflammatory drugs, immune stimulating agents, anti-VEGF agents, anti-aggregation agents such as sterols, etc.
In another embodiment, antibody-coated nanoparticles conjugated with thermosensitive polymers such as chitosan, carrying any medication including but not limited to sterol, squalamine, lanosterol, is administered to a patient having a neurologic pathology such as Alzheimer's disease, Parkinson's disease, or age related retinal drusen, etc. In this embodiment, administration is either intravenous or local in the cerebrospinal fluid or vitreous cavity, respectively, or at another local site. After controllably increasing the temperature of the functionalized nanoparticle to between 40° C.-43° C. by increased energy delivery through a delivery source, under the control of the photoacoustic imaging system and a processor, the temperature-sensitive coating polymers such as chitosan melts and release medications specific to the pathology. For example, a medication to dissolve amyloid plaques would be administered to a patient with Alzheimer's disease; a medication to remove retinal drusen would be administered to a patient with age related retinal disease, etc.
In one embodiment, the functionalized nanoparticle, e.g., a nanoshell, nanocage, etc., is combined with biodendrimers that are conjugated with biomarkers and monoclonal antibodies and/or genes, e.g., siRNA, mRNA, etc., for simultaneous visualization and therapy.
In another embodiment, after thermal imaging one increases the temperature of the functionalized nanoparticles. This is achieved by increased energy delivered by a thermal delivery source under the control of the photoacoustic imaging system connected to a processor. The energy delivery unit increases the temperature of the functionalized nanoparticles to 42° C.-43° C. to melt the temperature-sensitive coating polymers such as chitosan and release anticancer medications, or inhibitory genes, siRNA, miRNA, or checkpoint inhibitors, or introduce missing genes, or add any other genes for gene editing from the thermosensitive coating of the nanoparticles along with a CRISPR complex to modify the genetic composition of the tumor cells, etc. In another embodiment, the temperature of the functionalized nanoparticles is increased, by the thermal delivery unit via a processor under the control of the photoacoustic imaging unit to image the temperature and control it to 45° C.-47° C., to 47° C., or to 50° C. to kill the suspected tumor to which the antibody-coated nanoparticles are attached.
In one embodiment, one synthetizes hybrid, very small (1 nm-8 nm) gold silica nanoparticles that have a dual function, the nanoparticles antibody coated for imaging, and having photovoltatic and magnetic properties, to release one or more gene(s) or medication(s) at certain temperatures, creating a photoacoustic response for imaging in the body by light stimulation in the eye for simultaneous imaging and therapy.
In one embodiment, using antibody coated quantum dots and light of a specific wavelength that is absorbed by the quantum dot and emits light of a different wavelength, one can render the moving tumor cells and extracellular vesicle visible attached to the quantum dots in the retinal or choroidal vessels, or vessels and tumors of the skin, or tumors located beneath the skin and their feeding vessels, by light absorbed by the quantum dots circulating in the vessels, as is done in fluorescence angiography with appropriate filters and camera.
In another embodiment, a gold quantum dot in a mesoporous silica shell or cage is coated with an antibody or a biomarker to any cell, e.g., neuronal or tumor cells, retinal drusen, Alzheimer plaques, etc. for delivering medication or gene to an organ, e.g., retina or brain.
In another embodiment, the extent of plaque or drusen, as an indicator of disease progression in the brain or eye, respectively, can be evaluated by conjugating nanoparticles with antibodies to glycosaminoglycan, heparin sulfate, glycosaminoglycan, and/or heparin sulfate proteoglycan, and injecting the composition into the body or locally to adhere to plaques or drusen for diagnosis, quantitation, and/or therapy with antibodies and medication.
In another embodiment the nanoparticles are used for simultaneous imaging and thermotherapy of very small tumors. The nanoparticles are heated to a temperature ranging from 41° C.-43° C., releasing anti-cancer medication, along with inhibitory siRNA, or modify a gene using the CRISPR/cas9 system or another CRISPR system, additionally releasing checkpoint inhibitors such as CTLA-4 or PD-1 along with tumoricidal vectors, etc.
In one embodiment, the nanoparticles are rendered radioactive by coating with alpha or beta radiators that are antibody specific or nonspecific biomarkers of the tumor. The nanoparticles can also be coated with heat sensitive polymers, including but not limited to chitosan, PEG, poly amino esters, etc.
In one embodiment, checkpoint inhibitors defined as immune system components that act as co-stimulatory or co-inhibitory molecules, poisons such as bee or snake venom, or other toxic agents that damage tumor cell membranes, or genes that inhibit tumor growth, siRNA, siDNA, mi RNA, mDNA along with the CRISPR/cas 9 complex or variations of these may be used.
In one embodiment, the nanoparticles are coated with a specific or a nonspecific biomarker such as glycosaminoglycan and injected into the circulation, into a body fluid such as the lymphatic system or cerebrospinal fluid (CSF), or inside a body cavity. Examples of injection sites include, but are not limited to, eye, sinuses, abdominal cavity, bladder, uterus, etc. The nanoparticles may also be injected into the breast ducts, e.g., through the nipple, inside the brain, into the prostate or other organ, or may even be applied topically. The injected nanoparticles circulate and seek cells bearing a receptor to their antibody, or perhaps cells with specific receptors or biomolecules, and readily attach within minutes or hours.
In one embodiment, specific or non-specific biomarkers' antibodies are conjugated with nanoparticles and injected either into circulation or locally into a body cavity. The nanoparticles travel and seek cells bearing specific receptors or biomolecules, and attach within a few hours. The patient's body or organ is then scanned, with the thermal energy producing radiation or an alternating or reversible magnetic field to heat the nanoparticles. Using photoacoustic technology, the sound wave generated by the thermal expansion of the nanoparticle induced by absorption of the thermal energy is recorded. The sound wave signals may originate from any part of the body, or from a specific organ.
In one embodiment, an alternating magnetic field produces heat in magnetic nanoparticles as a result of rapid circular or semicircular motion of the nanoparticles. The patient's body is scanned within the reversible magnetic field, and the photoacoustic sound is recorded as a temperature profile of the site of the nanoparticle/cell membrane imaged and location of the lesion is verified.
In another embodiment, other source of thermal energy are used. Such sources include, but are not limited to, electromagnetic radiation, visible light, invisible light, infrared radiation, microwaves, or radiofrequency waves, etc. The nanoparticles are heated from body temperature of 37° C. to 40° C. or 43° C., or if needed to 45° C. At the desired temperature, e.g., 41° C.-43° C., the heat sensitive coating of the nanoparticle melts, releasing its cargo of, e.g., medication, gene, etc., thus facilitating or enhancing passage of these compounds through the membrane of the neoplastic cells.
In another embodiment, use of a photoacoustic technology unit controls the thermal delivery unit and the thermal energy delivered to the nanoparticles to maintain or reach a predetermined temperature for a desired time.
In one embodiment, the temperatures rise of the nanoparticles expands them, producing a photoacoustic sound wave. This photoacoustic sound wave is recorded by one or multiple ultrasonic receivers located on the patient's skin. The signal can be obtained from any part of the body, or from a specific organ, since the signal travels through the body as a wave. The signal or sound pulse is converted to an electric pulse in the receiver, then is amplified and imaged on a monitor. A processor produces a two- or three-dimension image of the lesion, localizing the location of the sound and indicating the size of a lesion and its temperature by the amplitude of the sound pulse.
In one embodiment, photoacoustic imaging is used for a very early stage diagnosis of cancerous lesion that are less than 2 mm in diameter, which are radiographically invisible without knowing their exact location in the body.
In one embodiment using photoacoustic technology and a specific or non-specific tumor biomarker, a very small lesion (<2 mm in diameter) is imaged in the body when the tumor has not caused any clinical symptom. The inventive method thus is used to differentiate a malignant lesion from a benign lesion, even if the cancerous lesion is inside a begin lesion. It is noteworthy that biopsy of these very small tumors, even when the lesion is visible, e.g., on skin or under the retina, may not yield malignant cells if the biopsy is performed on a part of the lesion that contains benign cells. With tumors in the brain, it is most often the case that the tumors will not be noted absent a neurological symptom.
In one embodiment, the inventive method is used with specific biomarkers of a tumor such as breast cancer, prostate cancer, glioma, pancreatic malignancies, along with nonspecific biomarkers. The location and size of a malignant tumor in any organ is imaged in a patient with a genetic propensity to develop a tumor. The thermal energy may also be applied, if desired, to treat the lesion simultaneously with providing the photoacoustic effect. Subsequent evaluation of the level of these biomarkers in the blood indicate if the lesion was damaged or eliminated by the method, including use of medicaments and/or other treatment agents delivered by the method as cargo in the nanoparticles.
In one embodiment, a combination of biomarkers can be used in an early stage. For example, specific or nonspecific bio-markers such as glycosaminoglycans can be used in imaging a malignant lesion using antibody-coated nanoparticles to photoacoustically image the presence of a very small early stage tumor anywhere in the body.
In another embodiment, the inventive method is employed to determine residual tumor cells that may have left at the site of a tumor resection or elsewhere in the body, and to treat or eliminate the residual tumor cells.
In another embodiment, the functionalized nanoparticles are conjugated with one of the recombinant, monoclonal, or polyclonal antibodies or aptamers known in the art and administered along with either one or more toxin(s) or antibodies, along with a medication that is provided at a much lower dose systemically to kill the already compromised tumor cells. Monoclonal antibodies that may be used include, but are not limited to, those shown in Table 1, e.g., rituximab, obinuzumab, oftumumab, etc.












TABLE 1





Name
Trade name
Type
Source
Target
Use







3F8

mab
mouse
GD2
neuroblastoma


8H9

mab
mouse
B7-H3
neuroblastoma,







sarcoma, metastatic







brain cancers


Abagovomab

mab
mouse
CA-125 (imitation)
ovarian cancer


Abciximab
ReoPro
Fab
chimeric
CD41 (integrin
platelet aggregation






alpha-IIb)
inhibitor


Abituzumab

mab
humanized
CD51
cancer


Abrilumab

mab
human
integrin α4β7
inflammatory bowel







disease, ulcerative







colitis, Crohn's disease


Actoxumab

mab
human
Clostridium difficile
Clostridium difficile







infection


Adalimumab
Humira
mab
human
TNF-α
Rheumatoid arthritis,







Crohn's Disease,







Plaque Psoriasis,







Psoriatic Arthritis,







Ankylosing Spondylitis,







Juvenile Idiopathic







Arthritis, Hemolytic







disease of the newborn


Adecatumumab

mab
human
EpCAM
prostate and breast







cancer


Aducanumab

mab
human
beta-amyloid
Alzheimer's disease


Afelimomab

F(ab′)2
mouse
TNF-α
sepsis


Afutuzumab

mab
humanized
CD20
lymphoma


Alacizumab pegol

F(ab′)2
humanized
VEGFR2
cancer


ALD518

?
humanized
IL-6
rheumatoid arthritis


Alemtuzumab
Campath,
mab
humanized
CD52
Multiple sclerosis



MabCampath


Alirocumab

mab
human
NARP-1
hypercholesterolemia


Altumomab pentetate
Hybri-ceaker
mab
mouse
CEA
colorectal cancer







(diagnosis)


Amatuximab

mab
chimeric
mesothelin
cancer


Anatumomab

Fab
mouse
TAG-72
non-small cell lung


mafenatox




carcinoma


Anetumab ravtansine

mab
human
MSLN
cancer


Anifrolumab

mab
human
interferon α/β
systemic lupus






receptor
erythematosus


Anrukinzumab

mab
humanized
IL-13
?


(=IMA-638)


Apolizumab

mab
humanized
HLA-DR ?
hematological cancers


Arcitumomab
CEA-Scan
Fab′
mouse
CEA
gastrointestinal







cancers (diagnosis)


Ascrinvacumab

mab
human
activin receptor-like
cancer






kinase 1


Aselizumab

mab
humanized
L-selectin (CD62L)
severely injured







patients


Atezolizumab

mab
humanized
CD274
cancer


Atinumab

mab
human
RTN4
?


Atlizumab
Actemra,
mab
humanized
IL-6 receptor
rheumatoid arthritis


(=tocilizumab)
RoActemra


Atorolimumab

mab
human
Rhesus factor
hemolytic disease of







the newborn[citation







needed]


Bapineuzumab

mab
humanized
beta amyloid
Alzheimer's disease


Basiliximab
Simulect
mab
chimeric
CD25 (α chain of IL-
prevention of organ






2 receptor)
transplant rejections


Bavituximab

mab
chimeric
phosphatidylserine
cancer, viral infections


Bectumomab
LymphoScan
Fab′
mouse
CD22
non-Hodgkin's







lymphoma (detection)


Begelomab

mab
mouse
DPP4
?


Belimumab
Benlysta,
mab
human
BAFF
non-Hodgkin



LymphoStat-B



lymphoma etc.


Benralizumab

mab
humanized
CD125
asthma


Bertilimumab

mab
human
CCL11 (eotaxin-1)
severe allergic







disorders


Besilesomab
Scintimun
mab
mouse
CEA-related antigen
inflammatory lesions







and metastases







(detection)


Bevacizumab
Avastin
mab
humanized
VEGF-A
metastatic cancer,







retinopathy of







prematurity


Bezlotoxumab

mab
human
Clostridium difficile
Clostridium difficile







infection


Biciromab
FibriScint
Fab′
mouse
fibrin II, beta chain
thromboembolism







(diagnosis)


Bimagrumab

mab
human
ACVR2B
myostatin inhibitor


Bimekizumab

mab
humanized
IL17A and IL17F
?


Bivatuzumab

mab
humanized
CD44 v6
squamous cell


mertansine




carcinoma


Blinatumomab

BiTE
mouse
CD19
cancer


Blosozumab

mab
humanized
SOST
osteoporosis


Bococizumab

mab
humanized
neural apoptosis-
dyslipidemia






regulated proteinase 1


Brentuximab vedotin

mab
chimeric
CD30 (TNFRSF8)
hematologic cancers


Briakinumab

mab
human
IL-12, IL-23
psoriasis, rheumatoid







arthritis, inflammatory







bowel diseases,







multiple sclerosis


Brodalumab

mab
human
IL-17
inflammatory diseases


Brolucizumab

mab
humanized
VEGFA
?


Brontictuzumab

mab
Notch 1
cancer


Canakinumab
Ilaris
mab
human
IL-1?
rheumatoid arthritis


Cantuzumab

mab
humanized
mucin CanAg
colorectal cancer etc.


mertansine


Cantuzumab

mab
humanized
MUC1
cancers


ravtansine


Caplacizumab

mab
humanized
VWF
thrombotic







thrombocytopenic







purpura, thrombosis


Capromab pendetide
Prostascint
mab
mouse
prostatic carcinoma
prostate cancer






cells
(detection)


Carlumab

mab
human
MCP-1
oncology/immune







indications


Catumaxomab
Removab
3funct
rat/mouse hybrid
EpCAM, CD3
ovarian cancer,







malignant ascites,







gastric cancer


cBR96-doxorubicin

mab
humanized
Lewis-Y antigen
cancer


immunoconjugate


Cedelizumab

mab
humanized
CD4
prevention of organ







transplant rejections,







treatment of







autoimmune diseases


Certolizumab pegol
Cimzia
Fab′
humanized
TNF-α
Crohn's disease


Cetuximab
Erbitux
mab
chimeric
EGFR
metastatic colorectal







cancer and head and







neck cancer


Ch.14.18

mab
chimeric
???
neuroblastoma


Citatuzumab bogatox

Fab
humanized
EpCAM
ovarian cancer and







other solid tumors


Cixutumumab

mab
human
IGF-1 receptor
solid tumors


Clazakizumab

mab
humanized
Oryctolagus
rheumatoid arthritis






cuniculus


Clenoliximab

mab
chimeric
CD4
rheumatoid arthritis


Clivatuzumab
hPAM4-Cide
mab
humanized
MUC1
pancreatic cancer


tetraxetan


Codrituzumab

mab
humanized
glypican 3
cancer


Coltuximab ravtansine

mab
chimeric
CD19
cancer


Conatumumab

mab
human
TRAIL-R2
cancer


Concizumab

mab
humanized
TFPI
bleeding


Crenezumab

mab
humanized
1-40-β-amyloid
Alzheimer's disease


CR6261

mab
human
Influenza A
infectious






hemagglutinin
disease/influenza A


Dacetuzumab

mab
humanized
CD40
hematologic cancers


Daclizumab
Zenapax
mab
humanized
CD25 (α chain of IL-
prevention of organ






2 receptor)
transplant rejections


Dalotuzumab[39]

mab
humanized
insulin-like growth
cancer etc.






factor I receptor


Dapirolizumab pegol

mab
humanized
CD40 ligand
?


Daratumumab

mab
human
CD38 (cyclic ADP
cancer






ribose hydrolase)


Dectrekumab

mab
human
IL-13
?


Demcizumab

mab
humanized
DLL4
cancer


Denintuzumab

mab
humanized
CD19
cancer


mafodotin


Denosumab
Prolia
mab
human
RANKL
osteoporosis, bone







metastases etc.


Derlotuximab biotin

mab
chimeric
histone complex
recurrent glioblastoma







multiforme


Detumomab

mab
mouse
B-lymphoma cell
lymphoma


Dinutuximab

mab
chimeric
ganglioside GD2
neuroblastoma


Diridavumab

mab
human
hemagglutinin
influenza A


Dorlimomab aritox

F(ab′)2
mouse
?
?


Drozitumab

mab
human
DR5
cancer etc.


Duligotumab

mab
human
HER3
?


Dupilumab

mab
human
IL4
atopic diseases


Durvalumab

mab
human
CD274
cancer


Dusigitumab

mab
human
ILGF2
cancer


Ecromeximab

mab
chimeric
GD3 ganglioside
malignant melanoma


Eculizumab
Soliris
mab
humanized
C5
paroxysmal nocturnal







hemoglobinuria


Edobacomab

mab
mouse
endotoxin
sepsis caused by







Gram-negative







bacteria


Edrecolomab
Panorex
mab
mouse
EpCAM
colorectal carcinoma


Efalizumab
Raptiva
mab
humanized
LFA-1 (CD11a)
psoriasis (blocks T-cell







migration)


Efungumab
Mycograb
scFv
human
Hsp90
invasive Candida







infection


Eldelumab

mab
human
interferon gamma-
Crohn's disease,






induced protein
ulcerative colitis


Elgemtumab

mab
human
ERBB3
cancer


Elotuzumab

mab
humanized
SLAMF7
multiple myeloma


Elsilimomab

mab
mouse
IL-6
?


Emactuzumab

mab
humanized
CSF1R
cancer


Emibetuzumab

mab
humanized
HHGFR
cancer


Enavatuzumab

mab
humanized
TWEAK receptor
cancer etc.


Enfortumab vedotin

mab
human
AGS-22M6
cancer expressing







Nectin-4


Enlimomab pegol

mab
mouse
ICAM-1 (CD54)
?


Enoblituzumab

mab
humanized
B7-H3
cancer


Enokizumab

mab
humanized
IL9
asthma


Enoticumab

mab
human
DLL4
?


Ensituximab

mab
chimeric
5AC
cancer


Epitumomab cituxetan

mab
mouse
episialin
?


Epratuzumab

mab
humanized
CD22
cancer, SLE


Erlizumab

F(ab′)2
humanized
ITGB2 (CD18)
heart attack, stroke,







traumatic shock


Ertumaxomab
Rexomun
3funct
rat/mouse hybrid
HER2/neu, CD3
breast cancer etc.


Etaracizumab
Abegrin
mab
humanized
integrin αvβ3
melanoma, prostate







cancer, ovarian cancer







etc.


Etrolizumab

mab
humanized
integrin α7 β7
inflammatory bowel







disease


Evinacumab

mab
human
angiopoietin 3
dyslipidemia


Evolocumab

mab
human
PCSK9
hypercholesterolemia


Exbivirumab

mab
human
hepatitis B surface
hepatitis B






antigen


Fanolesomab
NeutroSpec
mab
mouse
CD15
appendicitis







(diagnosis)


Faralimomab

mab
mouse
interferon receptor
?


Farletuzumab

mab
humanized
folate receptor 1
ovarian cancer


Fasinumab

mab
human
HNGF
acute sciatic pain


FBTA05
Lymphomun
3funct
rat/mouse hybrid
CD20
chronic lymphocytic







leukaemia


Felvizumab

mab
humanized
respiratory syncytial
respiratory syncytial






virus
virus infection


Fezakinumab

mab
human
IL-22
rheumatoid arthritis,







psoriasis


Ficlatuzumab

mab
humanized
HGF
cancer etc.


Figitumumab

mab
human
IGF-1 receptor
adrenocortical







carcinoma, non-small







cell lung carcinoma







etc.


Firivumab

mab
human
influenza A virus
?






hemagglutinin


Flanvotumab

mab
human
TYRP1(glycoprotein
melanoma






75)


Fletikumab

mab
human
IL 20
rheumatoid arthritis


Fontolizumab
HuZAF
mab
humanized
IFN-γ
Crohn's disease etc.


Foralumab

mab
human
CD3 epsilon
?


Foravirumab

mab
human
rabies virus
rabies (prophylaxis)






glycoprotein


Fresolimumab

mab
human
TGF-β
idiopathic pulmonary







fibrosis, focal







segmental







glomerulosclerosis,







cancer


Fulranumab

mab
human
NGF
pain


Futuximab

mab
chimeric
EGFR
?


Galiximab

mab
chimeric
CD80
B-cell lymphoma


Ganitumab

mab
human
IGF-I
cancer


Gantenerumab

mab
human
beta amyloid
Alzheimer's disease


Gavilimomab

mab
mouse
CD147 (basigin)
graft versus host







disease


Gemtuzumab
Mylotarg
mab
humanized
CD33
acute myelogenous


ozogamicin




leukemia


Gevokizumab

mab
humanized
IL-1β
diabetes etc.


Girentuximab
Rencarex
mab
chimeric
carbonic anhydrase
clear cell renal cell






9 (CA-1X)
carcinoma[81]


Glembatumumab

mab
human
GPNMB
melanoma, breast


vedotin




cancer


Golimumab
Simponi
mab
human
TNF-α
rheumatoid arthritis,







psoriatic arthritis,







ankylosing spondylitis


Gomiliximab

mab
chimeric
CD23 (IgE receptor)
allergic asthma


Guselkumab

mab
human
IL23
psoriasis


Ibalizumab

mab
humanized
CD4
HIV infection


Ibritumomab tiuxetan
Zevalin
mab
mouse
CD20
non-Hodgkin's







lymphoma


Icrucumab

mab
human
VEGFR-1
cancer etc.


Idarucizumab

mab
humanized
dabigatran
reversal of







anticoagulant effects of







dabigatran


Igovomab
Indimacis-125
F(ab′)2
mouse
CA-125
ovarian cancer







(diagnosis)


IMAB362

mab
human
CLDN18.2
gastrointestinal







adenocarcinomas and







pancreatic tumor


Imalumab

mab
human
MIF
cancer


Imciromab
Myoscint
mab
mouse
cardiac myosin
cardiac imaging


Imgatuzumab

mab
humanized
EGFR
cancer


Inclacumab

mab
human
selectin P
?


Indatuximab ravtansine

mab
chimeric
SDC1
cancer


Indusatumab vedotin

mab
human
GUCY2C
cancer


Infliximab
Remicade
mab
chimeric
TNF-α
rheumatoid arthritis,







ankylosing spondylitis,







psoriatic arthritis,







psoriasis, Crohn's







disease, ulcerative







colitis


Intetumumab

mab
human
CD51
solid tumors (prostate







cancer, melanoma)


Inolimomab

mab
mouse
CD25 (α chain of IL-
graft versus host






2 receptor)
disease


Inotuzumab

mab
humanized
CD22
cancer


ozogamicin


Ipilimumab
Yervoy
mab
human
CD152
melanoma


Iratumumab

mab
human
CD30 (TNFRSF8)
Hodgkin's lymphoma


Isatuximab

mab
chimeric
CD38
cancer


Itolizumab

mab
humanized
CD6
?


Ixekizumab

mab
humanized
IL-17A
autoimmune diseases


Keliximab

mab
chimeric
CD4
chronic asthma


Labetuzumab
CEA-Cide
mab
humanized
CEA
colorectal cancer


Lambrolizumab

mab
humanized
PDCD1
antineoplastic agent


Lampalizumab

mab
humanized
CFD
?


Lebrikizumab

mab
humanized
IL-13
asthma


Lemalesomab

mab
mouse
NCA-90
diagnostic agent






(granulocyte






antigen)


Lenzilumab

mab
human
CSF2
?


Lerdelimumab

mab
human
TGF beta 2
reduction of scarring







after glaucoma surgery


Lexatumumab

mab
human
TRAIL-R2
cancer


Libivirumab

mab
human
hepatitis B surface
hepatitis B






antigen


Lifastuzumab vedotin

mab
humanized
phosphate-sodium
cancer






co-transporter


Ligelizumab

mab
humanized
IGHE
severe asthma and







chronic spontaneous







urticarial


Lilotomab satetraxetan

mab
mouse
CD37
cancer


Lintuzumab

mab
humanized
CD33
cancer


Lirilumab

mab
human
KIR2D
?


Lodelcizumab

mab
humanized
PCSK9
hypercholesterolemia


Lokivetmab

mab
veterinary
Canis lupus
?






familiaris IL31


Lorvotuzumab

mab
humanized
CD56
cancer


mertansine


Lucatumumab

mab
human
CD40
multiple myeloma, non-







Hodgkin's lymphoma,







Hodgkin's lymphoma


Lulizumab pegol

mab
humanized
CD28
autoimmune diseases


Lumiliximab

mab
chimeric
CD23 (IgE receptor)
chronic lymphocytic







leukemia


Lumretuzumab

mab
humanized
ERBB3
cancer


Mapatumumab

mab
human
TRAIL-R1
cancer


Margetuximab

mab
humanized
ch4D5
cancer


Maslimomab

?
mouse
T-cell receptor
?


Mavrilimumab

mab
human
GMCSF receptor α-
rheumatoid arthritis






chain


Matuzumab

mab
humanized
EGFR
colorectal, lung and







stomach cancer


Mepolizumab
Bosatria
mab
humanized
IL-5
asthma and white







blood cell diseases


Metelimumab

mab
human
TGF beta 1
systemic scleroderma


Milatuzumab

mab
humanized
CD74
multiple myeloma and







other hematological







malignancies


Minretumomab

mab
mouse
TAG-72
tumor detection (and







therapy?)


Mirvetuximab

mab
chimeric
folate receptor alpha
cancer


soravtansine


Mitumomab

mab
mouse
GD3 ganglioside
small cell lung







carcinoma


Mogamulizumab

mab
humanized
CCR4
cancer


Morolimumab

mab
human
Rhesus factor
?


Motavizumab
Numax
mab
humanized
respiratory syncytial
respiratory syncytial






virus
virus (prevention)


Moxetumomab

mab
mouse
CD22
cancer


pasudotox


Muromonab-CD3
Orthoclone
mab
mouse
CD3
prevention of organ



OKT3



transplant rejections


Nacolomab tafenatox

Fab
mouse
C242 antigen
colorectal cancer


Namilumab

mab
human
CSF2
?


Naptumomab

Fab
mouse
5T4
non-small cell lung


estafenatox




carcinoma, renal cell







carcinoma


Narnatumab

mab
human
RON
cancer


Natalizumab
Tysabri
mab
humanized
integrin α4
multiple sclerosis,







Crohn's disease


Nebacumab

mab
human
endotoxin
sepsis


Necitumumab

mab
human
EGFR
non-small cell lung







carcinoma


Nemolizumab

mab
humanized
IL31RA
?


Nerelimomab

mab
mouse
TNF-α
?


Nesvacumab

mab
human
angiopoietin 2
cancer


Nimotuzumab
Theracim,
mab
humanized
EGFR
squamous cell



Theraloc



carcinoma, head and







neck cancer,







nasopharyngeal







cancer, glioma


Nivolumab

mab
human
PD-1
cancer


Nofetumomab
Verluma
Fab
mouse
?
cancer (diagnosis)


merpentan


Obiltoxaximab

mab
chimeric
Bacillus anthracis
Bacillus anthracis






anthrax
spores


Obinutuzumab
Gazyva
mab
humanized
CD20
Chronic lymphatic







leukemia


Ocaratuzumab

mab
humanized
CD20
cancer


Ocrelizumab

mab
humanized
CD20
rheumatoid arthritis,







lupus erythematosus







etc.


Odulimomab

mab
mouse
LFA-1 (CD11a)
prevention of organ







transplant rejections,







immunological







diseases


Ofatumumab
Arzerra
mab
human
CD20
chronic lymphocytic







leukemia etc.


Olaratumab

mab
human
PDGF-Rα
cancer


Olokizumab

mab
humanized
IL6
?


Omalizumab
Xolair
mab
humanized
IgE Fc region
allergic asthma


Onartuzumab

mab
humanized
human scatter factor
cancer






receptor kinase


Ontuxizumab

mab
chimeric/humanized
TEM1
cancer


Opicinumab1

mab
human
LINGO-1
multiple sclerosis


Oportuzumab monatox

scFv
humanized
EpCAM
cancer


Oregovomab
OvaRex
mab
mouse
CA-125
ovarian cancer


Orticumab

mab
human
oxLDL
?


Otelixizumab

mab
chimeric/humanized
CD3
diabetes mellitus type 1


Otlertuzumab

mab
humanized
CD37
cancer


Oxelumab

mab
human
OX-40
asthma


Ozanezumab

mab
humanized
NOGO-A
ALS and multiple







sclerosis


Ozoralizumab

mab
humanized
TNF-α
inflammation


Pagibaximab

mab
chimeric
lipoteichoic acid
sepsis







(Staphylococcus)


Palivizumab
Synagis,
mab
humanized
F protein of
respiratory syncytial



Abbosynagis


respiratory syncytial
virus (prevention)






virus


Panitumumab
Vectibix
mab
human
EGFR
colorectal cancer


Pankomab

mab
humanized
tumor specific
ovarian cancer






glycosylation of






MUC1


Panobacumab

mab
human
Pseudomonas
Pseudomonas






aeruginosa
aeruginosa infection


Parsatuzumab

mab
human
EGFL7
cancer


Pascolizumab

mab
humanized
IL-4
asthma


Pasotuxizumab

mab
chimeric/humanized
folate hydrolase
cancer


Pateclizumab

mab
humanized
LTA
TNF


Patritumab

mab
human
HER3
cancer


Pembrolizumab

mab
humanized
PDCD1
cancer etc.


Pemtumomab
Theragyn
?
mouse
MUC1
cancer


Perakizumab

mab
humanized
IL17A
arthritis


Pertuzumab
Omnitarg
mab
humanized
HER2/neu
cancer


Pexelizumab

scFv
humanized
C5
reduction of side







effects of cardiac







surgery


Pidilizumab

mab
humanized
PD-1
cancer and infectious







diseases


Pinatuzumab vedotin

mab
humanized
CD22
cancer


Pintumomab

mab
mouse
adenocarcinoma
adenocarcinoma






antigen
(imaging)


Placulumab

mab
human
human TNF
?


Polatuzumab vedotin

mab
humanized
CD79B
cancer


Ponezumab

mab
humanized
human beta-amyloid
Alzheimer's disease


Priliximab

mab
chimeric
CD4
Crohn's disease,







multiple sclerosis


Pritoxaximab

mab
chimeric
E. coli shiga toxin
?






type-1


Pritumumab

mab
human
vimentin
brain cancer


PRO 140

?
humanized
CCR5
HIV infection


Quilizumab

mab
humanized
IGHE
asthma


Racotumomab

mab
mouse
N-glycolylneuraminic
cancer






acid


Radretumab

mab
human
fibronectin extra
cancer






domain-B


Rafivirumab

mab
human
rabies virus
rabies (prophylaxis)






glycoprotein


Ralpancizumab

mab
humanized
neural apoptosis-
dyslipidemia






regulated proteinase 1


Ramucirumab
Cyramza
mab
human
VEGFR2
solid tumors


Ranibizumab
Lucentis
Fab
humanized
VEGF-A
macular degeneration







(wet form)


Raxibacumab

mab
human
anthrax toxin,
anthrax (prophylaxis






protective antigen
and treatment)


Refanezumab

mab
humanized
myelin-associated
recovery of motor






glycoprotein
function after stroke


Regavirumab

mab
human
cytomegalovirus
cytomegalovirus






glycoprotein B
infection


Reslizumab

mab
humanized
IL-5
inflammations of the







airways, skin and







gastrointestinal tract


Rilotumumab

mab
human
HGF
solid tumors


Rinucumab

mab
human
platelet-derived
neovascular age-






growth factor
related macular






receptor beta
degeneration


Rituximab
MabThera,
mab
chimeric
CD20
lymphomas,



Rituxan



leukemias, some







autoimmune disorders


Robatumumab

mab
human
IGF-1 receptor
cancer


Roledumab

mab
human
RHD
?


Romosozumab

mab
humanized
sclerostin
osteoporosis


Rontalizumab

mab
humanized
IFN-α
systemic lupus







erythematosus


Rovelizumab
LeukArrest
mab
humanized
CD11, CD18
haemorrhagic shock







etc.


Ruplizumab
Antova
mab
humanized
CD154 (CD40L)
rheumatic diseases


Sacituzumab govitecan

mab
humanized
tumor-associated
cancer






calcium signal






transducer 2


Samalizumab

mab
humanized
CD200
cancer


Sarilumab

mab
human
IL6
rheumatoid arthritis,







ankylosing spondylitis


Satumomab pendetide

mab
mouse
TAG-72
cancer (diagnosis)


Secukinumab

mab
human
IL-17A
uveitis, rheumatoid







arthritis psoriasis


Seribantumab

mab
human
ERBB3
cancer


Setoxaximab

mab
chimeric
E. coli shiga toxin
?






type-2


Sevirumab

?
human
cytomegalovirus
cytomegalovirus







infection


Sibrotuzumab

mab
humanized
FAP
cancer


SGN-CD19A

mab
humanized
CD19
acute lymphoblastic







leukemia and B-cell







non-Hodgkin







lymphoma


SGN-CD33A

mab
humanized
CD33
Acute myeloid







leukemia


Sifalimumab

mab
humanized
IFN-α
SLE, dermatomyositis,







polymyositis


Siltuximab

mab
chimeric
IL-6
cancer


Simtuzumab

mab
humanized
LOXL2
fibrosis


Siplizumab

mab
humanized
CD2
psoriasis, graft-versus-







host disease







(prevention)


Sirukumab

mab
human
IL-6
rheumatoid arthritis


Sofituzumab vedotin

mab
humanized
CA 125
ovarian cancer


Solanezumab

mab
humanized
beta amyloid
Alzheimer's disease


Solitomab

mab
mouse
EpCAM
?


Sonepcizumab

?
humanized
sphingosine-1-
choroidal and retinal






phosphate
neovascularization


Sontuzumab

mab
humanized
episialin
?


Stamulumab

mab
human
myostatin
muscular dystrophy


Sulesomab
LeukoScan
Fab′
mouse
NCA-90
osteomyelitis (imaging)






(granulocyte






antigen)


Suvizumab

mab
humanized
HIV-1
viral infections


Tabalumab

mab
human
BAFF
B-cell cancers


Tacatuzumab
AFP-Cide
mab
humanized
alpha-fetoprotein
cancer


tetraxetan


Tadocizumab

Fab
humanized
integrin αIIbβ3
percutaneous coronary







intervention


Talizumab

mab
humanized
IgE
allergic reaction


Tanezumab

mab
humanized
NGF
pain


Taplitumomab paptox

mab
mouse
CD19
cancer[citation needed]


Tarextumab

mab
human
Notch receptor
cancer


Tefibazumab
Aurexis
mab
humanized
clumping factor A
Staphylococcus aureus







infection


Telimomab aritox

Fab
mouse
?
?


Tenatumomab

mab
mouse
tenascin C
cancer


Teneliximab

mab
chimeric
CD40
?


Teplizumab

mab
humanized
CD3
diabetes mellitus type 1


Teprotumumab

mab
human
CD221
hematologic tumors


Tesidolumab

mab
human
C5
?


TGN1412

?
humanized
CD28
chronic lymphocytic







leukemia, rheumatoid







arthritis


Ticilimumab

mab
human
CTLA-4
cancer


(=tremelimumab)


Tildrakizumab

mab
humanized
IL23
immunologically







mediated inflammatory







disorders


Tigatuzumab

mab
humanized
TRAIL-R2
cancer


TNX-650

?
humanized
IL-13
Hodgkin's lymphoma


Tocilizumab[6] (=
Actemra,
mab
humanized
IL-6 receptor
rheumatoid arthritis


atlizumab)
RoActemra


Toralizumab

mab
humanized
CD154 (CD40L)
rheumatoid arthritis,







lupus nephritis etc.


Tosatoxumab

mab
human
Staphylococcus
?






aureus


Tositumomab
Bexxar
?
mouse
CD20
follicular lymphoma


Tovetumab

mab
human
CD140a
cancer


Tralokinumab

mab
human
IL-13
asthma etc.


Trastuzumab
Herceptin
mab
humanized
HER2/neu
breast cancer


TRBS07
Ektomab
3funct
?
GD2
melanoma


Tregalizumab

mab
humanized
CD4
?


Tremelimumab

mab
human
CTLA-4
cancer


Trevogrumab

mab
human
growth
muscle atrophy due to






differentiation factor 8
orthopedic disuse and







sarcopenia


Tucotuzumab

mab
humanized
EpCAM
cancer


celmoleukin


Tuvirumab

?
human
hepatitis B virus
chronic hepatitis B


Ublituximab

mab
chimeric
MS4A1
cancer


Ulocuplumab

mab
human
C—X—C chemokine
hematologic






receptor type 4
malignancies


Urelumab

mab
human
4-1BB
cancer etc.


Urtoxazumab

mab
humanized
Escherichia coli
diarrhoea caused by E. coli


Ustekinumab
Stelara
mab
human
IL-12, IL-23
multiple sclerosis,







psoriasis, psoriatic







arthritis


Vandortuzumab

mab
humanized
STEAP1
cancer


vedotin


Vantictumab

mab
human
Frizzled receptor
cancer


Vanucizumab

mab
humanized
angiopoietin 2
cancer


Vapaliximab

mab
chimeric
AOC3 (VAP-1)
?


Varlilumab

mab
human
CD27
?


Vatelizumab

mab
humanized
ITGA2
?


Vedolizumab

mab
humanized
integrin α4β7
Crohn's disease,







ulcerative colitis


Veltuzumab

mab
humanized
CD20
non-Hodgkin's







lymphoma


Vepalimomab

mab
mouse
AOC3 (VAP-1)
inflammation


Vesencumab

mab
human
NRP1
?


Visilizumab
Nuvion
mab
humanized
CD3
Crohn's disease,







ulcerative colitis


Volociximab

mab
chimeric
integrin α5β1
solid tumors


Vorsetuzumab

mab
humanized
CD70
cancer


mafodotin


Votumumab
HumaSPECT
mab
human
tumor antigen
colorectal tumors






CTAA16.88


Zalutumumab
HuMax-EGFr
mab
human
EGFR
squamous cell







carcinoma of the head







and neck


Zanolimumab
HuMax-CD4
mab
human
CD4
rheumatoid arthritis,







psoriasis, T-cell







lymphoma


Zatuximab

mab
chimeric
HER1
cancer


Ziralimumab

mab
human
CD147 (basigin)
?


Zolimomab aritox

mab
mouse
CD5
systemic lupus







erythematosus, graft-







versus-host disease









In another embodiment using photoacoustic technology, the circulating tumor, exosomes, or extracellular vesicles in the blood are quantified non-invasively by having a thermal energy source such as laser microwave, RF, or other unit mounted on the patient's wrist, neck, etc. and a receiver to count and record the sound wave generated by circulating cells to which the antibody-coated nanoparticles are attached.
In another embodiment, the ultrasonic receiver of the photacoustic unit is an array of ultrasonic receivers mounted on a hand held probe. The hand held probe contacts the patient's skin via a gel placed over the area suspected to contain a tumor or lesion. It simultaneously records multiple photoacoustic signals from the lesion during thermal energy application. Thermal energy applied pulses can range from one per second to a million times or more per second. Each time a thermal pulse reaches the nanoparticles, the nanoparticles expand and create a photoacoustic response that is recorded by the photoacoustic receiver.
The probe can be moved in any direction, e.g., up and down, side to side, etc., over the skin while recording the sound waves from the nanoparticles. Using a processor in the photoacoustic unit, one uses the photoacoustic response data to construct a two- or three-dimensional image of the tumor. The hand held probe permits scanning any bodily surface, including but not limited to breast, eye, CNS, spinal cord, extremities, internal organs, eye, nose, chest, trachea, throat, abdomen, and urogenital organs. The data from the ultrasonic array probe of the photoacoustic unit is stored in a computer during the probe's motion, permitting video construction showing tumor shape, structure, location, etc. for video presentation, evaluation, and archiving.
In one embodiment, the unit is capable of storing vast quantities of data from photoacoustic signals. The unit is also capable of storing vast quantities of data from non-stationary tissues, e.g., circulating tumor cells and exosomes in blood vessels, that have accumulated antibody coated nanoparticles on their cell membranes. The targeted cells can also be any normal or abnormal circulating cell in the blood or lymphatic system. The photoacoustic unit reproduces signals from these mobile cells and/or exosomes as photoacoustic cinematography/angiography or video.
In one embodiment, the cinematography or video recording is done by the photoacoustic unit recording at least 30 frames/second of photoacoustic signals, and converting them into an image of a moving object. A cinematography or video is performed by obtaining at least 30 frames of photos of a moving object per second. In photoacoustic videography or photoacoustic angiography, 30 or more frames of pulse signals from the heated nanoparticles per second are needed to reproduce or convert the still images to a moving object, e.g., blood flow, etc. by the unit. Use of such a system is known: Peyman et al. Ophthalmic Surg Laser Imaging 43 (2012) 143-51 doi: 10.3928.15428877-20120105-01 showing, however, lower resolution because no nanoparticles or photoacoustic imaging system was employed, and expressly incorporated by reference herein in its entirety.
In one embodiment the photoacoustic processor converts the microscopic still images to a video or photoacoustic angiography; since the only moving parts in the vessels that are targeted with antibody coated nanoparticles are the circulating tumor cells or exosomes, extracellular vesicles or bubbles covered with antibody coated nanoparticles that are heated by a pulse of thermal energy produces an internal ultrasonic pulse signal recorded by the photoacoustic receiver. A moving image of the cells and exosomes can be created by the unit whether the cells are on the tumor interior or exterior.
Nanoparticle assisted photoacoustic video-angiography or nanoparticle assisted photoacoustic cinematography is novel and inventive. All “photoacoustic” terminology has previously been used for describing tissue heating or the difference in the temperature between two tissues, vessels vs. skin, and has been done with light alone, not in combination with nanoparticles. In one embodiment, the method is performed for therapy by providing the patient with at least one antibody-coated functionalized nanoparticle having a detectable property, with the antibody targeting the functionalized nanoparticle to a specific patient site, then heating the nanoparticles to generate a photoacoustic signal, i.e., thermal therapy, and imaging to visualize any localized nanoparticle at the site. The ultrasonic receiver of the photoacoustic unit is an array of ultrasonic receivers mounted on a hand held probe simultaneously recording multiple photoacoustic signals from the lesion during thermal energy application which in one embodiment is pulsating. The array of ultrasonic receivers of the photoacoustic unit mounted on a hand held probe simultaneously records multiple photoacoustic signals from the lesion or vessels during thermal energy application, reproducing motion of moving nanoparticles and/or cells as a nanoparticle assisted photoacoustic video-angiography or nanoparticle assisted photoacoustic cinematography.
In another embodiment, software associated with the photoacoustic unit can enhance either or both the photoacoustic signals and resulting images. Enhancement may facilitate differentiating exosomes from circulating cells due to the smaller exosome size. All exosomes or other types of extracellular vesicles are less than one micron; in contrast, tumor cells are five to twenty times larger than exosomes. The inventive system for the first time permits in vivo observation and separation of exosomes from tumor cells, and separation of circulating tumor cells from a tumor mass. The separated cells or cell structures can be observed, counted, and quantified to assess the therapeutic effect of a procedure on tumor cells.
In another embodiment, after imaging and therapy, the biomarkers are collected from liquid biopsies and compared with those obtained prior to therapy in different post-operative periods to confirm the therapeutic effect of the procedure and prognosticate the condition.
In another embodiment, the antibody coated nanoparticles are conjugated and administered with checkpoint inhibitors along with known immune therapy agents and vaccines to facilitate circulating killer cells attack and removal of tumor cells.
In another embodiment, polymeric nanoparticles or polysaccharide or synthetic polymers conjugated with biomarkers are administered to enhance a vaccination effect and are taken up by antigen presenting cells.
In one embodiment, genetic analysis of the patient is performed to determine a sequence of the gene that is mutated. A sample of the patient's blood is analyzed for any of the following indicia of the presence or a neoplasm or a predisposition to a neoplasm: specific tumor biomarker(s), non-specific tumor biomarker(s), extravascular vesicles, circulating tumor cells, tumor micro RNA, micro DNA, or any other tumor indicator. RNA sequencing reflects the dynamic nature of gene expression for detection of RNA fragments, including mRNA, noncoding RNA, chimeric RNA, pathogen RNA, extracellular RNA, etc.
Examples of biomarkers have been previously disclosed. Other biomarkers include DNA hypermethylation, the presence of ZNF154 in colon, lung, breast, stomach, and endometrial tumor, and the stem cell marker NANOG, a mitochondrial oxidative phosphorylation/fatty acid oxidation molecule in highly malignant tumor-initiating stem-like cells (TICs) that reprograms mitochondrial metabolism.
Use of results from a patient's genetic analysis advantageously permits selection of a therapeutic agent, along with antibody-coated nanoparticles conjugated with thermosensitive polymers and thermotherapy, to provide the greatest efficacy against cancers that are smaller than 4 mm in diameter. In general, such cancers have not grown to a size whereby they show genetic differentiation of the cancer cells. Treatment of these small cancer cells can thus include treatment of the cancer stem cell(s). In one embodiment, nanoparticles activated by electromagnetic radiation, either in vitro or in vivo, enhance both gene transfer and cell proliferation of any desired cell, including stem cells
In one embodiment, the patient's blood is processed to isolate the patient's own natural killer (NK) cells, i.e., a type of lymphocyte that is part of the patient's innate immune system, and dendritic cells, i.e., immune cells that process antigen material and present it on the cell surface to T cells of the immune system). NK cells and dendritic cells are isolated from a patient's blood using commercially available kits known in the art, e.g., EasySepTM and RosetteSepTM STEMCELL Technologies Inc., Tukwila Wash.; NK Cell Isolation Kit, Meltinyi Biotech, Bergisch Gladbach Germany. The natural killer cells/dendritic cells are rendered sensitized to the tumor in vitro. Sensitization is accomplished by co-culturing the patient's natural killer cells and/or dendritic cells with IL-2 and the antibody-coated nanoparticles containing the optional penetration-enhancing agents and/or thermosensitive polymers as previously described. The patient's sensitized natural killer cells/dendritic cells are then administered to the patient at intervals to provide a booster immune therapy, much as a vaccine booster injection does. IL-2 is a protein produced by the T cells. When conjugated with the thermosensitive antibody coated nanoparticle, upon controllable temperature release, IL-2 is systemically available to enhance a T-cell response in the patient by cell sensitization and proliferation.
Thermal damage to the tumor cell membrane as a part of nanoparticle assisted thermotherapy releases antigens that, in vivo, activate and stimulate a dendritic cell immunogenic response. The activated dendritic cells induce a signal that additionally activates T cell-driven tumor cell damage or killing.
In one embodiment, the medium used to culture NK/dendritic cells contains viral like particles (VLP). The NK/dendritic cells pick up the VLP and enhance sensitization against the tumor. If tumor cell biopsy specimens are available, NK cells/dendritic cells are cultured from these biopsy specimens which additionally contain tumor lysate, killed circulating tumor (CT) cells, and their extracellular vesicles (ECV). In one embodiment, nanoparticles with thermosensitive polymers and conjugated with tumor antibody and VLP are administered to the patient intravenously, as the first step of tumor vaccination and therapy. The nanoparticles become attached to the tumor cells within a few minutes after administration.
In one embodiment, the tumor biomarkers from a patient's blood are identified, and anti-tumor antibodies are prepared, using conventional antibody techniques known in the art. The antibodies may be monoclonal, polyclonal, humanized, etc.; tumor antibodies also includes aptamers (oligonucleotide or peptides that bind to a specific target). The antibodies/aptamers are then coated on diagnostic or therapeutic nanoparticles or quantum dots, which are then systemically administered to the patient. In vivo, the tumor-antibody-coated nanoparticles seeks the tumor cells via the specificity of the anti-tumor antibody component. In one embodiment, adding a cell penetration enhancing agent to the polymer or other coating facilitates penetration of the tumor-antibody-coated nanoparticles into a tumor cell. Cell-penetration enhancing agents render the nanoparticle complex more biocompatible, and have been previously disclosed; they include cell penetrating peptide (CPP), activated CPP (APCC), (poly)ethylene glycol (PEG), biotin streptavidin, etc.
In one embodiment, as previously disclosed, the tumor-antibody-coated nanoparticles are also coated with a thermosensitive polymer that dissolves at a particular temperature, e.g., a polymer such as chitosan that dissolves at a temperature of 40° C.-43° C., and/or an arginine rich polymer, etc.
This coating, in addition to its thermosensitive properties, and include one or more medicaments, genes, etc. thus providing additional therapy to the patient upon administration and thermotherapy. In one embodiment, adding a phospholipase, anti-phospholipid antibody, toxin (snake, scorpion, bee venom, etc. to the polymer or other coating enhances the damage to the cell membrane from an anti-tumor antibody coated nanoparticle. This beneficially increases the hyperthermal damage to cancer and other undesirable cells due to toxin release from the nanoparticles' coating of thermosensitive polymer at 40° C.-43° C.
In one embodiment, genes are provided that have a stimulatory action in response to light or ultrasound. An example of such a gene is the opsin gene and members of the opsin family. In this embodiment, such genes are provided to regulate cell membrane polarization and depolarization. Such genes can thus controllably create an action potential in the membrane of an excitable cell, such as a retinal cell, or a non-excitable cell such as a tumor cell. Controllable regulation may drive a permanent depolarization state to render the cells accessible to a desired medicament for cell destruction.
In one embodiment, combinations of genes can be used for controllable regulation. As an example, genes responding to light to produce action potential, combined with genes that can modifying a defective gene(s) in the cells of an organ, e.g., eye, brain, lung, spinal cord, peripheral nerve, lung, digestive tract, can be used in combination to facilitate regulation of actions including swallowing, breathing, gland secretion, etc., to restore the normal function of the organ. As another example, genes responding to light to produce an action potential, combined with inhibitory genes such as siRNA, RNAi, microRNA, can be used to inhibit tumor function by simultaneous depolarization of the tumor cells. These genes can additionally be combined with chemotherapeutic agent to work synergistically and damage the tumor cells.
Systemic administration of tumor antibody coated nanoparticles, coated with thermosensitive polymers and a cell penetration facilitating agent, targets the nanoparticles toward the tumor cell membrane. External energy is applied by a thermal delivery device that uses energy (electromagnetic radiation, microwave radiation, radiofrequency waves, an alternating magnet, focused ultrasound, etc.) to increase the temperature of the nanoparticle. The heated nanoparticle absorbs more energy than the tissue surrounding the nanoparticle. The temperature increase causes the nanoparticles to expand. Expansion of the nanoparticles creates a photoacoustic, thermoacoustic, or ultrasound wave, whose sound wave amplitude correlates with the amount of the temperature increase, i.e., the degree of the temperature rise.
In one embodiment, the ultrasound wave is recorded by a transducer and is transmitted to a unit to image the nanoparticle increase in temperature as one-, two- or three-dimensional images. This unit is connected to the thermal delivery device via a computer to maintain the amount of thermal energy needed for the time required to heat the nanoparticles to the desired temperature and for the desired time period and thus release medicament(s), gene(s), VLP, etc. These agents may also be against microorganisms, e.g., bacterial, viral, fungal, or parasitic agents, that have developed resistance to the therapeutic agents. For example, heated bacteria become more permeable to diffusion of appropriate medication; in contrast, non-heated bacteria remain resistant.
In one embodiment, nanoparticles coated with the desired antibody (e.g., anti-tumor antibody, anti-bacterial protein antibody, etc.) are administered to the patient to assure that the antibody-nanoparticle complex is in contact with the appropriate cells or tissues. It will be appreciated that the appropriate cells or tissues may include both circulating cells (e.g., ECV, endosomes, leukemic cells, etc.) and non-circulating cells (e.g., solid tumor).
In one embodiment, a small hand held photoacoustic unit with a small thermal delivery unit e.g. laser, microwave, or radiofrequency unit is placed externally over a subcutaneously located vessel to deliver a pulse of energy and to heat the nanoparticles attached to the circulating tumor cells and create a photoacoustic sound as they heat up. This records the sound wave each time a tumor cell passes by the external hand held unit, adjusts the temperature from 37° C.-43° C., thus assessing and quantifying non-invasively the circulating tumor cells using the hand held thermal imaging device.
In one embodiment, photoacoustic technology imaging is controlled to a low temperature of 37° C.-43° C., thus assessing and non-invasively measuring circulating cells using a hand held thermal imaging device. Imaging may be used in combination with any standard method, including but not limited to radiography, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, positron and other molecular imaging devices.
In one embodiment, nanoparticles are conjugated with VLP derived from plant viruses. In this embodiment, the VLP are used for cancer therapy by carrying sRNA, RNAi, etc. The host of these viruses are plants e.g. tobacco mosaic virus (TMV), bean yellow dwarf virus (BeYDV), etc., which cannot infect the patient. Thermal application of the antibody coated nanoparticles provides the control over when and where these particles are released to provide maximum benefit in immunotherapy. The VLP are generally immunogenic and do not require adjuncts to induce an immune response. These modified viruses are devoid of genetic components and cannot replicate in the body. However, if a specific gene of a specific protein e.g. an antibody, is conjugated with them and injected in the plant, the modified viruses produce large amounts of the antibody or protein in the plant, which can subsequently be extracted and used in human infective or non-infective diseases or to produce a vaccine to treat e.g. Alzheimer's disease etc. Once the antibody is produced, it can be used in diagnosing or guiding treatyment to the affected area in combination with nanoparticles and drug delivery.
With respect to a gene(s) present in the polymer coating, e.g., an inhibitory gene such as siRNA, siDNA, RNAi, or an appropriate checkpoint inhibitor, may be used. Checkpoint inhibitors enhance cellular immune responses to tumor specific proteins in the cancer cells, as previously disclosed. In one embodiment, a checkpoint inhibitor such as nivolumab is combined with nanoparticle-assisted targeted immunotherapy as an adaptive T-cell transfer mechanism. These, along with the a CRISPR/cas9 or CRISPR interference (CRISPRi) complex, may perturb or modify the tumor genes.
With respect to a medicament(s) present in the polymer coating, the medicament(s) would be released locally. For a medicament that is a biologic, local release permits agents to be concentrated at the desired site without resulting in systemic toxicity the medicament may otherwise cause. As one example, anti VEGF agents, TNF inhibitors, antineoplastic medications such as taxol, antimetabolites, antiinflammatory agents, steroids, antibiotics antiviral agent, etc. can localize at a tumor or other site at significantly higher concentrations to stop tumor neovascular growth, without causing the known systemic complications such as heart attack, intestinal bleeding, kidney disease, liver disease, etc. As another example, release of phospholipase enzymes can create a hole in the membrane of tumors or other cells to provide or facilitate entry of a medicament(s) and/or gene(s) entry into a cell.
In the inventive precision nanoparticle assisted thermotherapy imaging (NATTI), the temperature of the tumor cell to which the nanoparticle is conjugated is controllably precisely increased. The temperature increases (a) releases a medicament(s) and/or gene(s) from a thermosensitive coating on the nanoparticle, and (b) enhances penetration of the medicament(s) and/or gene(s) through the open pores of the tumor cell membrane. NATTI technology includes a computer-controlled thermal energy delivery unit to ensure attainment of a desired increased temperature of the tumor for achieving the therapeutic goal. Controlling thermal energy delivery to achieve a temperature from 38° C. to 42° C. for drug delivery or more in the tumor-nanoparticle complex to a tumor, or to another tissue affected by a disease as directed by antibody binding to a corresponding antigen. It will be appreciated that the increased temperature may be maintained at the controlled desired level for any desired time interval, e.g., up to 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 minutes, or even longer, depending upon the need.
Typically, normal healthy cell membranes are comprised of the phospholipids phosphatidylserine (PS) and phosphatidylethanolamine (PE), which are located within the inner membrane and oriented toward the cell interior. However, for cancer cells, the orientations of PS and PE are flipped, so each oriented toward the cell exterior. The melting point of PS and PE is about 65° C.-70° C. degree. When the nanoparticles are heated to this temperature, the exposed PS and PE lipids of the cell membrane melt, and create a dehiscence in the cell membrane through which chemotherapeutic agents can freely flow into the tumor cell, killing the tumor cell.
For a medicament that is a chemotherapeutic agent, local release permits a higher concentration of a chemotherapeutic agent to be contained in the polymer coating, i.e., a supratherapeutic concentration, because it is confined to a localized site and would not result in systemic toxicity, yet still would achieve a higher therapeutic level at the tumor site. In one embodiment, a known existing antitumor chemotherapeutic agent is administered at a concentration that exceeds that of a concentration that would be administered under typical therapy, yet that does not result in patient toxicity. Similarly, one can use a toxic medicament(s) to locally perturb a cellular metabolic pathway or a specific cell cycle, e.g., local tumor cell perturbation. Such agents are generally not administered intravenously or orally because of their serious or fatal systemic toxicity and side effects. The concentration of the chemotherapeutic medicament(s) delivered by the inventive method is, in general, high locally, but less the 1/1000 of the concentration that would be required if the medicament(s) were to be effective if delivered systemically.
Use of precision nanoparticle assisted thermotherapy and imaging (NATTI) may be used to fine-tune the approach to perturb survival mechanisms of tumors or other pathological cells. It will be thus appreciated that the inventive method may be used as a rapid en mass treatment of a cancer or an organ. For example, it may be used as a preliminary treatment in advance of other therapies that in general have severe debilitating systemic complications such as immune suppression, etc. and which may take longer to obtain approval for their administration. Thus, nanoparticle assisted thermotherapy and drug delivery NATTI avoids the chemotherapy complication of damaging the patient's immune system as a result of one or multiple chemotherapeutic agents used in these late metastatic cancer patients.
The nanoparticle assisted thermoacoustic imaging technology, along with thermal energy, drives the medicament(s), gene(s), VLP into the cancer cell, with simultaneous generation of an immune response to the cancer cell and inhibition of cancer cell proliferation by including siRNA, siDNA, etc., along with simultaneously enhancing gene therapy by conjugating a CRISPR/cas9 or CRISPRi complex to the nanoparticle to correct or inhibit a genetic component of a tumor. Once inside a cell, e.g., a tumor cell or the cell of an organ, the gene(s), along with the CRISPR/cas9 complex or CRISPRi, enter the cell nucleus or mitochondria and precisely modify the gene pool of those cells. The RNA-guided bacterial endonuclease Cas9 is the effector protein of the type II CRISPR/Cas9 system that detects and subsequently generates a double-strand break (DSB) in target DNA. This may treat a disease caused by a gene deficiency, or add a new useful gene(s), or remove and possible replace a gene, in the cell nucleus or the mitochondria.
The gene(s) and/or medicaments(s) may be delivered to a specific site, but not released in the circulation from the nanoparticles until reaching the required elevated temperature and after attaching to the tumor or other desired cells or desired location. It will be appreciated that the inventive method can be used in therapy for non-neoplastic diseases. As one example, the amyloid plaques present in Alzheimer's disease may be used to produce anti-amyloid plaque antibodies and treated by the inventive method. As another example, bacteria in patients with severe sepsis refractory to standard antibiotic therapy, e.g., patients with methicillin-resistant Staphylococcus aureus (MRSA) etc., may be used to produce anti-bacterial antibodies and treated by the inventive method. In this example, the method may be combined with extracorporeal treatment of blood, using a thermal energy delivery unit to provide electromagnetic radiation, radiofrequency waves, microwaves, focused ultrasound, an alternating magnetic field, etc., under the control of the described NATTI unit, to controllably achieve a temperature of 42° C.-45° C. to kill the bacteria prior to cooling the blood to the normal 37° C. prior to reinfusion to the patient.
In addition, increasing the temperature of the nanoparticles incrementally from 37° C.-43° C. allows precision nanoparticle assisted thermotherapy and imaging (NATTI) to release a gene(s) or medicament(s) from the nanoparticles. It will be appreciated that the method beneficially permits imaging a tumor or other desired cells, such as Alzheimer's plaques, that are present in a small lesion otherwise invisible by conventional imaging methods such as radiography.
The immune response is generated by two different mechanisms. One mechanism is by releasing the VLP, which then stimulate a cellular immune response at the site of the tumor. The other mechanism is by the thermotherapy-damaged tumor cells releasing their antigenic material in and beyond the surrounding tissues, creating a more active cellular immune response due to the additional tumor antigens present, and drawing the patient's immune cells, dendritic cell, T-lymphocytes, B-lymphocytes, macrophages, etc., to the tumor location. This mechanism also advantageously provides immune memory functioning as an internal vaccination method. Specifically, local release of antigens from damaged tumor cells enhances a patient's immune response to a large amount of other tumor cell associated antigens, creating a form of in vivo vaccination. Such vaccination can be provided as needed, e.g., annually, at specific intervals, upon specific events, etc. to prime the patient's immune cells against any future tumor cells, and protects against reappearance of any tumors with similar antigenic components. For example, vaccination may be administered annually or biannually or between annual and biannual administration indefinitely, unless new biomarkers are discovered in the patient, necessitating additional and/or earlier therapy.
In addition, the inflammatory process created as a result of the immune therapy and cellular response increases the temperature of the tissue involved, which is also recorded using photoacoustic technology imaging to image the tumor location and its potential metastatic lesions anywhere in the body.
This embodiment results in precise, local, internally-induced immunotherapy and simultaneous vaccination. The antigen, e.g. VLP, is delivered intravenously with thermosensitive polymers conjugated with antitumor antibody coated nanoparticles. The VLP are released from these nanoparticles only when the temperature of the nanoparticle is increased, and the nanoparticles are localized only at the tumor site, due to the specificity of the anti-tumor antibody with which the nanoparticles are conjugated.
As previously disclosed, various nanoparticle types, compositions, configurations, etc. are possible, including the following non-limiting examples: organic, synthetic, metallic, non-metallic, magnetic, non-magnetic, paramagnetic, etc., configurations such as a nanosphere, nanotube, nanoshell, nanocage, nanocarbon, etc., including quantum dots, dendrimers, liposomes, piezoelectric nanoparticles, etc.
In one embodiment, piezoelectric nanoparticles are stimulated by an ultrasonic unit, providing a therapeutic effect by inducing an electric current in cells. Depending upon the frequency, this exposure can kill cells on one hand, or it can enhance growth of specific cells on the other hand. Application of thermal energy at a frequency in the range of 1 Hz-20 Hz promotes cell growth. Application of thermal energy at a frequency greater than about 60 Hz damages cells. Cell death is desirable for treating pathologies such as cancer. However, cell proliferation is desirable to facilitating tissue regeneration. For example, in this embodiment, a patient with a stroke, or a myocardial infarction, or a spinal cord injury, may be treated to regenerate brain, heart, nerve tissue respectively. In this embodiment, the antibody used is targeted to the damaged cells, i.e., neurons, cardiac cells, etc., and treatment is with a pulsed frequency of 1 Hz-20 Hz or more is provided for 1 min-10 min. It will be appreciated that this embodiment permits stem cells to be controllably either stimulated or inhibited.
In one embodiment, the nanoparticle stimulates proliferation of in vitro cultured cells when the nanoparticle is exposed to and absorbs light pulses of low frequency, i.e., frequencies in the range of 1 Hz-20 Hz. Conversely, in one embodiment, the nanoparticle inhibits cell proliferation when the nanoparticle is exposed to and absorbs light pulses of very high frequency, i.e., frequencies in the range of >30 Hz-100 Hz). Thus, selecting the frequency of the thermotherapy, and thus the frequency to which the tumor antibody-coated nanoparticles are exposed, adds to the mechanisms of therapy the patient receives if the light pulses are at low frequencies, i.e., no higher than about 20 Hz.
In one embodiment, after sensitization of the immune cells with the tumor antigen, functionalized quantum dots with antibody coated against cell membrane of immune cells is added so that the cell membranes of the immune cells carry a marker that can be made visible with specific wavelength of light extracorporally.
In one embodiment, antibody coated nanoparticles are conjugated with thermosensitive polymers containing VLP/medication/genes, and intravenously administered to a patient. The VLP are released from the thermosensitive nanoparticles by thermal application at temperatures of 41° C.-43° C. The increase in temperature is achieved using, e.g., activation by light, electromagnetic radiation, microwave radiation, radiofrequency waves, focused ultrasound, or alternating magnetic field to preferentially heat the nanoparticles because of their high surface to volume ratio, and because the selected molecular composition of the nanoparticles preferentially absorbs more thermal energy than the surrounding normal cells. The tumor cells to which the nanoparticles are attached are also heated.
In one embodiment, the increase in the temperature of the nanoparticles results in their thermal expansion. Thermal expansion of the nanoparticles produces an ultrasonic wave that passes through the body, is captured by a receiver, the ultrasonic pulse is converted and amplified by an ultrasonic, photoacoustic, or thermoacoustic unit, imaged as a thermoacoustic signal or as nanoparticle assisted thermoacoustic signal, and converted by a computer to images, in one-, two-, or three-dimensions, of the temperature and the lesion.
In one embodiment, the photoacoustic or nanoparticle assisted thermoacoustic unit controls the thermal energy delivery unit via a processor to maintain the temperature of the nanoparticles at a predetermined temperature as a closed circuit once the nanoparticles have attached to the tumor cells. An increase in the temperature to which the nanoparticles are exposed, i.e., at the nanoparticle level, from 37° C. to 41° C.-43° C. melts the thermosensitive polymers coating the nanoparticles, releasing under control the conjugated VLP, medication/gene which are attached to the thermosensitive antibody coated nanoparticles locally at the desired site. This method is particularly effective in small tumors, i.e., tumors less than 4 mm in diameter, because the tumor stem cells are still present at the original tumor site and can be simultaneously killed and eliminated before metastasis has occurred.
In one embodiment, a plurality of the antibody-coated nanoparticles are injected into a patient's circulation with the cultured and tumor-sensitized NK cells/dendritic cells to target the tumor. It will be appreciated that such thermal damage to tumor cells, and a NK cellular response, generates and releases relatively large quantities of lytic enzymes and other cellular contents. In the case of smaller tumors, the released substances are of smaller quantities, but for larger tumors it become necessary to remove these substances released into a patient's circulation, which may be thought of as cellular debris or detritus, to prevent an immunogenic storm in the body.
In one embodiment, the patient receiving the inventive therapy undergoes plasmapheresis to remove, e.g., such cytokines, enzymes, dead cells, etc. from the circulation. Plasmaphoresis is a known method to remove components from blood plasma. Because the patient's plasma is treated extracorporeally, then reinfused, in contrast to reinfusing only cellular components of the patient's blood, plasmaphoresis also beneficially detoxifies the patient's plasma without compromising blood volume and with minimal or no fluid loss. This technique avoids the serious complications and side effects of simply returning the cellular components of the blood to the patient. Additionally, all precautions are observed to avoid hypotension and loss of calcium ions in the process of citrate anticoagulation that this procedure requires. The patient can be treated initially with presently available anticoagulants such as heparin, coumadin, etc., which can be immediately neutralized post-procedure. Neutralization uses standard techniques known in the art, such as calcium, etc. Hemofiltration treatment is performed with activated carbon, treatment on non-ionic exchange resins, etc. for removing free toxin and also toxin bound with plasma proteins, etc. as in renal dialysis methods. The process may be instituted or repeated as needed, e.g., if the tumor reappears.
In one embodiment, to prevent a severe autoimmune response after tumor immunotherapy, one uses extracorporeal plasmapheresis. A strong pulse of light energy is applied to a tube containing blood cells to achieve a temperature up to 60° C. to kill immune cells containing quantum dots. The blood is then passed through a dielectrophoresis system to characterize and remove dead or live T-cells, sensitized killer cells, and tumor cells, prior to re-infusing the same blood or performing a blood transfusion in the patient while simultaneously administering immunosuppressive agents, including a biologic, to reduce the severe autoimmune response often seen after tumor immunotherapy.
The size of the nanoparticle may vary, and may vary depending on the site of therapy and imaging as well as other factors. In one embodiment, the nanoparticle size ranges from 1 nm to 999 nm or more. In one embodiment, the nanoparticle size ranges from 1 nm to 20 nm, which is ideal for use in the eye and central nervous system to permit the nanoparticle access to the intercellular space, and also ideal for renal clearance without generating systemic side effects. Nanoparticles having a size less than 10 nm in diameter, and not bound to a tumor, i.e., nanoparticles that are free in the circulation, undergo rapid renal elimination from the body within a few hours of administration. Only nanoparticles attached to the tumor cells remain in the body. This results in a novel form of simultaneous local thermotherapy and vaccination.
The localized thermotherapy component of the method damages the tumor cells, thus disseminating tumor cell-associated antigens into the circulation, generating a cellular response to the various tumor biomarkers that were originally present. This dual thermotherapy and cellular response augments the effect of both immunotherapy and thermotherapy. The inventive method augments immunotherapy methods that relied on T-cells that had been sensitized to just a few tumor markers, or that relied only on checkpoint inhibitors to prevent the tumor cells' sequestration from T-lymphocytes. Previous methods of tumor vaccination used intradermal or subcutaneous antigen administration, with the antigen taken up by antigen presenting cells, e.g., dendritic cells, to generate specific killer cells only at a location remote from the specific tumor site. The inventive method augments previous thermotherapy methods by combining immunotherapy to act synergistically with thermotherapy, providing additional therapeutic mechanisms to attack the tumor.
In one embodiment, cultured killer cells sensitized to a tumor are administered simultaneously with the anti-tumor antibody coated nanoparticle-conjugated VLP to attack the tumor cells and remove the dead tumor cells. For example, an intradermally administered antitumor antibody-coated nanoparticle with VLP can be administered in subsequent rounds of therapy during a postoperative period to induce an immune response as needed. This embodiment decreases the likelihood of or prevents potential recurrences of the tumor.
In one embodiment for use in larger tumors of a sufficient size for biopsy, an antibody directed to the tumor lysate (TL) is used as a source of tumor-associated antigens (TAAs), and is conjugated with the nanoparticles for generating therapeutic anti-tumor immune responses. One can generate in vivo immunity against multiple TAA simultaneously from the killed or damaged tumor cells during the thermotherapy. This embodiment broadens the repertoire of TAA-specific T-cell clones available for activation to a given tumor.
In one embodiment, after an initial thermotherapy procedure, a blood sample is obtained from the patient. This blood sample contains released tumor antigens that are recoverable prior to treatment by the inventive method using various immunoassays or methods of searching for biomarkers. The tumor antigens are then used to generate, in vitro, additional T-cells that are sensitized to many TAA for future use in, along with VLP for vaccination of, the same patient.
In one embodiment, immunostimulatory oligonucleotide-loaded cationic graphene oxide, carbon nanotube, gold/iron, iron/zinc oxide, or cadmium sulfate nanoparticles are combined with photothermally enhanced immunogenicity to achieve combined thermo-immune therapy. In one embodiment, RNA oligonucleotides/graphene or graphene oxide, or long double stranded RNA/graphene oxide induces a controlled immunostimulation in combination with oncogene silencing RNAi.
Nanoparticles, dendrimers, carbon nanotubes, lipid-based carriers, micelles, gold nanoshells/nanocages, PLGA, chitosan, PEI cationic lipid, and cationic polymers are useful gene therapy, gene delivery, and immuno therapy. These have the advantages of being easily prepared, biodegradable, non-immunogenic, non-toxic, and water soluble.


EXAMPLE 1
T cells and dendritic cells are obtained from a patient's blood, and grown in culture along with a tumor or other antigen, plus nanoparticles coated with thermosensitive polymers conjugated with antigen and VLP using culture methods known in the art.
The nanoparticle complex is injecting them along with checkpoint inhibitors and IL-2. The inventive method is applied, killing tumor cells, and increasing the response of T-cells and dendritic cell.
The patient's blood is assessed for new biomarkers from the dead cells.
The cultured T-cells and dendritic cells are harvested, along with the nanoparticle-coated antigen plus VLP or RNA or DNA phages. These are stored under appropriate conditions, and reinjected into the patient with low dose coated nanoparticles or systemic medicaments to be administered as needed, e.g., semi-annually, annually, biannually, etc. with repetition as needed. This is followed up with administering free circulating DNA and exosomes of circulating cells.
EXAMPLE 2
A checkpoint inhibitor is added to a thermosensitive polymer coating a nanoparticle for controlled release of the checkpoint inhibitor using the inventive NATTI to treat a patient with breast, colorectal, pancreatic, and/or ovarian cancer. A checkpoint inhibitor such as nivolumab is combined with nanoparticle assisted targeted immunotherapy for adaptive T-cell transfer to overcome the limitations of standard immunotherapy.
EXAMPLE 3
Nanoparticles are conjugated with a chimeric receptor, a CD19 protein that is found only on B cells, along with the T-cells cultured in vitro that expresses a chimeric antigen receptor (chimeric antigen receptor T (CAR T)-cells) to target abnormal B cells seen in leukemia. The reappearance of new biomarkers as neoantigens in these patients can be also treated in the postoperative period using the inventive method.
Plasmaphoresis is simultaneously performed or performed after treatment.
This example treats acute and chronic hematologic malignancies such as acute lymphoblastic leukemia, non-Hodgkin lymphoma, chronic lymphocytic leukemia, chronic myelogenous leukemia, etc.
EXAMPLE 4
Nanoparticles are conjugated with all-trans retinoic acid (ATRA) and arsenic trioxide to target leukaemia cells in acute promyelocytic leukemia and used in the inventive method. The all-trans retinoic acid is released at the site of the tumor without exposing the entire body to the toxic medication, simultaneously, plasmophoresis is performed to clear all toxin released in the blood, along with leukemic cells. It is appreciated that other blood cell cancers are removed in the same session.
EXAMPLE 5
In a patient with a hematologic malignancy that is resistant to chemotherapeutic agents or immune therapy, NATTI is performed with gene delivery, along with chemotherapeutic agents, to target all immune cells initially without subjecting the patient to systemic heavy chemotherapy, followed by bone marrow transplantation, without exposing the entire body to systemic chemotherapy.
EXAMPLE 6
Nanoparticles are conjugated with RNA that contains an aptamer, ribosomes, and siRNA in a thermosensitive polymer and administered to using NATTI to target specific tumor cells.
EXAMPLE 7
The microenvironment of the cancer cell is modified by delivering medicaments that block the uptake of exosomal signals and prevent the uptake of ECV. Such medications include choloroquine, heparin, cytochalasin D, and ethyl-isopropyl amiloride. These medications are approved for patient use. The medicaments are provided using NATTI in conjunction with chemotherapeutic agents.
EXAMPLE 8
The inventive method provides nanoparticle assisted localized immunothermotherapy and thermotherapy for delivery of customized vaccines to target core mutations in a patient. The immune cells or T-cells that can attack those core mutations are identified via a cancer biomarker. The immune cells or T-cells are then cultured with the nanoparticles coated with thermosensitive particles and VLP and IL-2. The nanoparticles are injected into the patient, controllably heated using a thermal energy source, and imaged, for specific patient therapy.
EXAMPLE 9
Nanoparticles are conjugated with RNA phage VLP, which is generally stable up to about 50° C. VLPs of the related RNA phage PP7 are crosslinked with inter-subunit disulfide bonds, rendering them significantly more stable. They exhibit high immunogenicity. Such nanoparticles complement the inventive NATTI technology and can be employed in anti-cancer and antibacterial treatment. Lytic phages attach to receptors on the bacterial surface, inject their genetic material through the bacterial membrane, and overtake the bacterium's transcription and translation machinery to synthesize new phages.
EXAMPLE 10
To prevent a severe autoimmune response after tumor immunotherapy, one uses after or before extracorporeal plasmapheresis, the nanoparticle assisted thermotherapy and imaging system to apply heavy thermal energy to a tube containing blood cells and to achieve a temperature as high as 60° C. to kill the sensitized immune cells containing nanoparticles. Blood is then passed through a dielectrophoresis system to characterize and remove dead or live T-cells, sensitized killer cells, and tumor cells prior to re-infusing blood in the patient while simultaneously administering immunosuppressive agents, including biologics. This reduces the severe autoimmune response often seen after tumor immunotherapy.
The embodiments shown and described in the specification are only specific embodiments of the inventor who is skilled in the art and are not limiting in any way. Therefore, various changes, modifications, or alterations to those embodiments may be made without departing from the spirit of the invention in the scope of the following claims. The references cited are expressly incorporated by reference herein in their entirety.

## Claims

1. A cancer therapeutic method comprising administering to a patient having an early stage tumor a combination of thermotherapy and immunotherapy, where
thermotherapy comprises systemically administering a tumor-antibody-coated nanoparticle coated with a thermosensitive polymer, the thermotherapy further comprises heating the tumor-antibody-coated nanoparticle using an energy source at the site of the tumor so as to damage one or more tumor cell membranes and release antigenic material in vivo that activates and stimulates an immunogenic response of the patient at the site of the tumor; and
immunotherapy comprises systemically administering the patient's natural killer (NK) cells/dendritic cells pre-sensitized in vitro to the tumor, the immunotherapy further comprises administering NK cells/dendritic cells containing viral like particles (VLP) to the patient.

2. The method of claim 1 where immunotherapy is administered at intervals to the patient after the initial therapy acting as a booster to the original immunotherapy and reduce or prevent tumor recurrences at a same or different site.

3. The method of claim 1 where the tumor-antibody-coated nanoparticles coated with the thermosensitive polymer are further conjugated with viral like particles (VLP), and the heating of the tumor-antibody-coated nanoparticles using the energy source further releases the viral like particles (VLP) at the site of the tumor so as to further stimulate the immunogenic response of the patient at the site of the tumor.

4. The method of claim 1 where immunotherapy further comprises obtaining NK cells/dendritic cells grown in culture under light pulses with a tumor biomarker from blood or a tumor biopsy specimen containing tumor lysate, killed circulating tumor cells (ct cell), and tumor extracellular vesicles (ECV).

5. The method of claim 1 where thermotherapy includes exposing the tumor-antibody-coated nanoparticle to a light pulse at a frequency in the range of 20 Hz-60 Hz to decrease proliferation of the tumor cell.

6. The method of claim 3 where the tumor-antibody-coated nanoparticle comprises a plurality of tumor-antibody-coated nanoparticles, and where the step of heating the tumor-antibody-coated nanoparticle using the energy source comprises using a thermoacoustic unit to control a thermal energy delivery unit using a processor to maintain the tumor-antibody-coated nanoparticles at a predetermined temperature as a closed circuit once the tumor-antibody-coated nanoparticles have attached to the tumor cells, then controllably increasing the temperature to which the tumor-antibody-coated nanoparticles are exposed from 37° C. to 41° C.-43° C. for a predetermined desired time period resulting in melting the thermosensitive polymer coating the tumor-antibody-coated nanoparticles, releasing under control conjugated VLP, and a medication or gene, which are attached to the thermosensitive tumor-antibody-coated nanoparticles locally at the desired site.

7. The method of claim 1 where the anti-tumor antibody is specific for at least one tumor biomarker in the patient's blood.

8. The method of claim 6 where the polymer contains an inhibitory gene(s) and a CRISPR/cas9 complex to stimulate or modify tumor genes at the desired site upon release from the polymer at a desired temperature that is obtained by incremental increase from 37° C. to 43° C. permitting precision nanoparticle assisted thermotherapy and imaging (NATTI) to release the gene(s) and optional medicament(s) and/or checkpoint inhibitor(s) from the nanoparticles.

9. The method of claim 1 further comprising performing precision nanoparticle assisted thermotherapy and generating a photoacoustic image of the cells to which the nanoparticles bind the cells having a size less than four millimeters.

10. The method of claim 1, wherein the tumor-antibody-coated nanoparticle further comprises an agent that facilitates penetration of the tumor-antibody-coated nanoparticle into the cells of the tumor.

11. The method of claim 1, further comprising performing extracorporeal plasmapheresis on the patient by performing the steps of:
applying light energy to a tube containing the patient's blood cells post-therapy to achieve a temperature up to 60° C. to kill immune cells containing nanoparticles,
passing the pulsed blood cells through a dielectrophoresis system to characterize and remove dead or live T-cells, sensitized killer cells, and tumor cells, and re-infusing the dielectrophoresis treated blood into the patient while simultaneously administering immunosuppressive agents.