# Multifunctional Therapeutic Approach of Nanomedicines against Inflammation in Cancer and Aging

Authors: Md. Mominur Rahman; Fahadul Islam; Sadia Afsana Mim; Md. Shajib Khan; Md. Rezaul Islam; Md. Anamul Haque; Saikat Mitra; Talha Bin Emran; Abdur Rauf
Journal: Journal of Nanomaterials
 (2022)

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## Abstract

Cancer is a fatal disorder that affects people across the globe, yet existing therapeutics are ineffective. The development of submicrometer transport for optimizing the biodistribution of systemically provided medications is the focus of nanomedicine. Nanoparticle- (NP-) based treatments may enable the development of novel therapeutic approaches to combat this deadly disorder. In multifunctional, multimodal imaging, and drug delivery carriers, NPs generally play a major role. They have emerged as potential strategies for the invention of innovative therapeutic procedures in the last decade. The exponential growth of nanotechnologies in recent years has increased public awareness of the application of these innovative therapeutic approaches. Many tumor-targeted nanomedicines have been studied in cancer therapy, and there is clear evidence for a significant improvement in the therapeutic index of antineoplastic drugs. Age-related factors such as metabolic and physiological alterations in old age and inadequate animal models are currently understudied in nanomedicine and pharmacology. This review highlighted the most important targeting approaches, as well as public awareness, therapeutic advancements, and future prospects in age-related metabolic variations, and tumor-targeted nanomedicine studies.


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## Body

## 1. Introduction

The area of “nanomedicine” is concerned with the development of all nanosized tools for clinical diagnosis, prevention, and treatment [1, 2]. Nanomedicine is described by the European Medicines Agency (EMA) as purposefully designed systems for medical applications, with at least one element at the nanoscale size, with definable particular properties and characteristics linked to the nanotechnology application, along with the expected clinical advantages of nanoengineering, and must meet the criteria of a therapeutic agent as defined by the European legislation [3]. While the Food and Drug Administration (FDA) does not have its own concept, it has adopted the widely used terminology as possessing at least one dimension in the 1–100 nm size range and recommends that assessments should consider any specific characteristics that the application of nanotechnology may confer [4]. Nanoparticles (NPs) have the potential for theranostics because of their large surface-area-to-volume ratio, which allows for high therapeutic and imaging agent loading, surface functionalization with targeting ligands, and compact scale, which allows for extravasation into leaky vessels [5, 6]. They can be programmed to modulate release in response to environmental factors such as pH, temperature, enzymes, and redox potential [6]. Surface functionalization of NPs with a hydrophilic polymer, such as polyethylene glycol (PEG), can improve blood circulation times [6, 7]. Targeted delivery combined with a high therapeutic and imaging payload can improve therapeutic and imaging effectiveness while lowering off-site toxicity [8].Cancer is a disease marked by the abnormal division of dysfunctional cells that can infect and spread to other tissues, resulting in metastases. Proliferative signaling, growth suppressor evasion, cell death resistance, replicative immortality, angiogenesis induction, and invasion and metastasis activation are all characteristics of neoplastic disorders [9–11]. Using NPs in anticancer therapies, imaging, diagnosis, and drug delivery has revolutionized the sector. The latest NP-based drug delivery techniques seek to develop conventional drug delivery modalities and improve administrative procedures for multiple cancer therapies. The ability of NPs to administer drugs directly to cancerous cells is their most noteworthy attribute, as opposed to chemotherapeutic drugs [12–14]. This technique confers promising benefits, including better medication efficacy and fewer side effects, protecting therapeutic drugs from the harsh microenvironment (such as elevated acidity in the stomach and high levels of enzymes and proteases in the bloodstream) until they reach targeted tumor cells, regulated drug distribution over a time span with required doses, and low exposure of contaminants [15, 16]. Nanomedicine is the use of nanotechnology in medicine to solve the limitations of traditional pharmaceuticals and improve their medicinal value. In contrast to their traditional medicinal formulations, anticancer drug-loaded NPs have already shown a stronger pharmacokinetic profile (half-life, controlled release) and tumor aggregation. Furthermore, the NP-based method facilitates multidrug coencapsulation and codelivery, which decreases toxicity and drug resistance [17, 18].Alzheimer’s and Parkinson’s diseases (AD and PD), stroke, amyotrophic lateral sclerosis (ALS), Hutchinson’s disease (HD), and HIV-1-associated dementia (HAD) are some most debilitating diseases of the twenty-first century [19]. This group of diseases has little to do with host biology and more to do with advancing age, environmental cues, and/or a disordered immune system [20–24]. Theranostical nanomedicine has emerged as a major and promising disease prevention approach because of its ability to combine diagnosis and therapy [25, 26]. NPs migrate through the BBB (blood-brain barrier) owing to a pathway called receptor-mediated endocytosis. Multiple NPs can quickly cross the BBB by interacting with proteins and protein-related receptors, owing to functionalization and alteration. NPs engineered with surfactants like polysorbate 80 also assist drug passage through BBB, as altered NPs have been shown to absorb particular plasma proteins [27]. In the presence of electromagnetic fields, gold nanoparticles (AuNPs) have been shown to stimulate the generation of induced dopamine neurons for PD care [28]. Functionalized single-walled carbon nanotubes (SWNTs) have been shown to restore natural autophagy defects in lysosomal proteolysis, thus promoting the removal of autophagic substrates, implying that SWNTs could become novel neuroprotective nanomedicine for AD therapy [29–32].Thus, the present review is focused on the recent advancements based on NPs for cancer and aging therapeutics. Some potential future opportunities, clinical studies, and patents in the field of cancer and aging disorders nanomedicine are also reviewed.


## 2. Sources and Modulators of Inflammation in Tumor and Aging

Maturing and aggravation work at different degrees of intricacy influencing numerous tissues and organs just as the insusceptible framework and our connected biological systems (gut microbiota). Both of these variables are thought to prompt the fundamental incendiary condition, through the unevenness of favorable to provocative as well as mitigating go-betweens [33–36].


### 2.1. Immunosenescence

Many progressions in inborn and procured insusceptibility have been distinguished and considered unsafe in the older, subsequently the term immunosenescence. Maybe then, a basic unidirectional decrease in safe capacity, immune senescence, is an intricate cycle including various reorganizational and normatively controlled changes. Then again, in the older, certain immunological boundaries are regularly fundamentally diminished and great capacity is contrarily connected to the wellbeing status. Albeit intrinsic resistance is moderately very much saved in the older, and gained insusceptibility is more helpless because of both the utilitarian decrease related with age and the antigen weight to which an individual has been uncovered during their lives. This constant antigenic pressure, which influences the resistant framework during life and prompts a reformist actuation of macrophages and related cells, assists with evaluating the fiery status. This outcome is an increment in incendiary middle-person movement, which is connected to the presence of persistent diseases [34, 35, 37].


### 2.2. Cellular Senescence

Cell senescence is described by a condition of perpetual cell-cycle capture because of openness to distressing boosts like telomere disintegration, oncogene initiation, reactive oxygen species (ROS), synthetics, and ionizing radiation [38]. As a result, cell senescence is widely regarded as a cancer component; however, evidence linking this interaction to hyperplastic and progressive disorders through continuous exacerbation is still being developed [37, 38]. In spite of their development capture, senescent cells are metabolically and transcriptionally dynamic and they set up a complex crosstalk with their microenvironment through the combination of an assortment of secretory proteins [39, 40]. A senescence-associated secretory phenotype (SASP) is a vital component in our present comprehension of the connection between cell senescence, aggravation, and malignancy improvement [41].


### 2.3. Self-Debris Triggers of Inflammaging

Attributable to expanded turn of events and additionally lacking expulsion, maturing is related to a continuous amassing of harmed macromolecules and cells (self-flotsam and jetsam). These byproducts are delivered because of cell/organelle injury and are gotten from cell and metabolic cycles. Self-garbage, as endogenous threat-related sub-atomic examples, can emulate bacterial items and damage-associated molecular patterns (DAMPs). Therefore, intrinsic invulnerability receptors perceive weakened cell and organelle components, ROS, and metabolites (for example, ATP, unsaturated fats, urate gems, ceramides, cardiolipin, amyloid, succinate, peroxidized lipids, progressed glycation finished results, modified N-glycans, and HMGB1) [40, 42]. The upregulation of irritation-related pathways and middle people are set off by the Toll-like receptor family (TLR), intracellular NOD-like receptors (NLRs), and cytosolic DNA sensors. TLRs, specifically, cause irritation by initiating NF-κB and activator protein 1 (AP-1) by means of Myd88. The initiation of NLRs (especially Nlrp3) by DAMPs brings about the development of an inflammasome and the resulting emission of a few proinflammatory arbiters. The natural invulnerable reaction to DAMPs gets tenacious and maladaptive as self-trash gathers, prompting inflammation [43].


### 2.4. Gut Microbiota

The gut microbiota bacterial populace contains the greater number and convergence of organisms in the human body, and it has appeared to assume a part in an assortment of physiological and neurotic cycles. The advantageous capacity of this environment comprised of microbiota, gut-associated lymphoid tissue (GALT), and intestinal mucosa is dependent on a physiological poor-quality irritation to look after homeostasis. The microbial organization of the gut microbiota fluctuates with age, with pervasiveness of Bacteroides in the older contrasted with a higher presence of Firmicutes in more youthful grown-ups. A few investigations have likewise discovered an association between microbial variety, feebleness evaluations, and natural elements in old individuals, like dietary examples. In this sense, changes in gut microbiota arrangement have all the earmarks of being inseparably connected to the maturing-related, long-haul changes in the gastrointestinal parcel (for example, decrease of intestinal motility, helpless dentition, and adjustment of salivary qualities). Critically, changes to the gut microbiota in the older will rush the beginning of dysbiosis and increment the commonness of pathogenic species in the intestinal microbial synthesis, which has been connected to raised degrees of the foundational support of provocative markers (IL-6, IL-8, TNF-α, and CRP). The connection between gut dysbiosis and malignant growth is in this way not restricted to a direct pathogenic pretended by explicit microorganisms on the intestinal epithelium, yet additionally to general environment insanity that has foundational outcomes through provocative pathways [44–51].


### 2.5. Obesity, Nutrition, and Metaflammation

Numerous individuals, particularly in Western nations, partner maturing with an increment in instinctive fat, which adds to weight and insulin opposition [52]. Moreover, epidemiological proof proposes an association between a high body mass index (BMI) and an assortment of malignancies, including pancreatic disease, prostate disease, colon malignant growth, postmenopausal bosom malignancy, and numerous others [53, 54]. Notwithstanding the way that the subatomic associations among stoutness and malignant growth are as yet being investigated, it is presently commonly concurred that corpulence causes a constant incendiary state [55]. Metainflammation is a second-rate, constant fiery condition coordinated by metabolic cells in light of an overabundance of supplements and energy in weight-actuated aggravation [56]. Hefty irritation is described by the way that it is set off by metabolic signals and happens inside metabolic cells, for example, the adipocyte. Extreme supplement admission, particularly glucose and free unsaturated fats, causes pressure, which actuates provocative intracellular flagging pathways. C-jun N-terminal kinase (JNK), IκB kinase (IKK), and protein kinase R (PKR) are the primary intracellular supporters of the initiation of aggravation in metabolic tissues [57].


## 2.1. Immunosenescence

Many progressions in inborn and procured insusceptibility have been distinguished and considered unsafe in the older, subsequently the term immunosenescence. Maybe then, a basic unidirectional decrease in safe capacity, immune senescence, is an intricate cycle including various reorganizational and normatively controlled changes. Then again, in the older, certain immunological boundaries are regularly fundamentally diminished and great capacity is contrarily connected to the wellbeing status. Albeit intrinsic resistance is moderately very much saved in the older, and gained insusceptibility is more helpless because of both the utilitarian decrease related with age and the antigen weight to which an individual has been uncovered during their lives. This constant antigenic pressure, which influences the resistant framework during life and prompts a reformist actuation of macrophages and related cells, assists with evaluating the fiery status. This outcome is an increment in incendiary middle-person movement, which is connected to the presence of persistent diseases [34, 35, 37].


## 2.2. Cellular Senescence

Cell senescence is described by a condition of perpetual cell-cycle capture because of openness to distressing boosts like telomere disintegration, oncogene initiation, reactive oxygen species (ROS), synthetics, and ionizing radiation [38]. As a result, cell senescence is widely regarded as a cancer component; however, evidence linking this interaction to hyperplastic and progressive disorders through continuous exacerbation is still being developed [37, 38]. In spite of their development capture, senescent cells are metabolically and transcriptionally dynamic and they set up a complex crosstalk with their microenvironment through the combination of an assortment of secretory proteins [39, 40]. A senescence-associated secretory phenotype (SASP) is a vital component in our present comprehension of the connection between cell senescence, aggravation, and malignancy improvement [41].


## 2.3. Self-Debris Triggers of Inflammaging

Attributable to expanded turn of events and additionally lacking expulsion, maturing is related to a continuous amassing of harmed macromolecules and cells (self-flotsam and jetsam). These byproducts are delivered because of cell/organelle injury and are gotten from cell and metabolic cycles. Self-garbage, as endogenous threat-related sub-atomic examples, can emulate bacterial items and damage-associated molecular patterns (DAMPs). Therefore, intrinsic invulnerability receptors perceive weakened cell and organelle components, ROS, and metabolites (for example, ATP, unsaturated fats, urate gems, ceramides, cardiolipin, amyloid, succinate, peroxidized lipids, progressed glycation finished results, modified N-glycans, and HMGB1) [40, 42]. The upregulation of irritation-related pathways and middle people are set off by the Toll-like receptor family (TLR), intracellular NOD-like receptors (NLRs), and cytosolic DNA sensors. TLRs, specifically, cause irritation by initiating NF-κB and activator protein 1 (AP-1) by means of Myd88. The initiation of NLRs (especially Nlrp3) by DAMPs brings about the development of an inflammasome and the resulting emission of a few proinflammatory arbiters. The natural invulnerable reaction to DAMPs gets tenacious and maladaptive as self-trash gathers, prompting inflammation [43].


## 2.4. Gut Microbiota

The gut microbiota bacterial populace contains the greater number and convergence of organisms in the human body, and it has appeared to assume a part in an assortment of physiological and neurotic cycles. The advantageous capacity of this environment comprised of microbiota, gut-associated lymphoid tissue (GALT), and intestinal mucosa is dependent on a physiological poor-quality irritation to look after homeostasis. The microbial organization of the gut microbiota fluctuates with age, with pervasiveness of Bacteroides in the older contrasted with a higher presence of Firmicutes in more youthful grown-ups. A few investigations have likewise discovered an association between microbial variety, feebleness evaluations, and natural elements in old individuals, like dietary examples. In this sense, changes in gut microbiota arrangement have all the earmarks of being inseparably connected to the maturing-related, long-haul changes in the gastrointestinal parcel (for example, decrease of intestinal motility, helpless dentition, and adjustment of salivary qualities). Critically, changes to the gut microbiota in the older will rush the beginning of dysbiosis and increment the commonness of pathogenic species in the intestinal microbial synthesis, which has been connected to raised degrees of the foundational support of provocative markers (IL-6, IL-8, TNF-α, and CRP). The connection between gut dysbiosis and malignant growth is in this way not restricted to a direct pathogenic pretended by explicit microorganisms on the intestinal epithelium, yet additionally to general environment insanity that has foundational outcomes through provocative pathways [44–51].


## 2.5. Obesity, Nutrition, and Metaflammation

Numerous individuals, particularly in Western nations, partner maturing with an increment in instinctive fat, which adds to weight and insulin opposition [52]. Moreover, epidemiological proof proposes an association between a high body mass index (BMI) and an assortment of malignancies, including pancreatic disease, prostate disease, colon malignant growth, postmenopausal bosom malignancy, and numerous others [53, 54]. Notwithstanding the way that the subatomic associations among stoutness and malignant growth are as yet being investigated, it is presently commonly concurred that corpulence causes a constant incendiary state [55]. Metainflammation is a second-rate, constant fiery condition coordinated by metabolic cells in light of an overabundance of supplements and energy in weight-actuated aggravation [56]. Hefty irritation is described by the way that it is set off by metabolic signals and happens inside metabolic cells, for example, the adipocyte. Extreme supplement admission, particularly glucose and free unsaturated fats, causes pressure, which actuates provocative intracellular flagging pathways. C-jun N-terminal kinase (JNK), IκB kinase (IKK), and protein kinase R (PKR) are the primary intracellular supporters of the initiation of aggravation in metabolic tissues [57].


## 3. Immunity and Inflammatory Mechanisms in Aging

Maturing is connected to insusceptible framework changes that increment powerlessness to irresistible illnesses, malignancy, and immune system sicknesses, just as the inability to help wound recuperating and immunization reaction. Maturing influences both versatile and inborn invulnerable capacities and is brought about by a blend of changes in safe framework cells, lymphoid organs, and circling solvent factors that impact insusceptible cells and their microenvironment. The bit-by-bit-expanded weakness to incendiary illnesses seen with maturing is because of a gentle enactment of aggravation, which is a sign of maturing. The combined impacts of typical maturing lead to the marvel known as “immunosenescence,” which alludes to the reformist debilitating of the safe framework [58].Despite the fact that our comprehension of old-enough-related changes in the versatile safe reaction is genuinely best in class [59], our comprehension of maturing measures including the intrinsic resistant framework actually requires further examination. We are principally inspired by the dysfunctions of the inborn safe reaction as they add to maturing measures. Monocytes, macrophages, neutrophils, dendritic cells (DC), and natural killer (NK) cells are intrinsic invulnerable framework cells that experience huge phenotypic and practical changes as they develop. It is accounted for by changes in the complete number of circling inborn-resistant cells or the overall level of various subpopulations. Old-style (CD14++/CD16), nontraditional (CD14+/CD16++), and moderate (CD14++/CD16+) monocyte subsets can be recognized as dependent on the general articulation of CD14 and CD16 [60, 61].


## 4. Pathways Linking Innate Immunity, Inflammation, and Cancer

Aggravation and malignancy are two cycles that are connected. The possibility that irritation and disease are connected traces all the way back to Virchow in the nineteenth century. The connection between irritation and malignant growth can be considered as far as two pathways. Irritation and malignancy are two cycles that are connected. The possibility that irritation and malignancy are connected traces all the way back to Virchow in the nineteenth century [61]. The connection between irritation and disease can be considered as far as two pathways. Predominant and latent qualities drive neoplastic cell change, which causes irritation in tumors that aren’t related to an excess of aggravation (for example, bosom carcinoma and gliomas). The development of an incendiary microenvironment is organized by malignant growth causing hereditary occasions [62]. In created danger, the incendiary parts fluctuate significantly among tumors and seething, nonsettling irritation drives harmful movement [63]. The tumor microenvironment (TME) is presently perceived as a significant factor in the advancement of neoplasia. We pulled back from a pervasive malignancy cell-driven perspective on the idea of disease [62, 64, 65] regarding general malignant growth standards. Provocative cells, especially macrophages, add to the advancement of an immunosuppressive microenvironment as well as cooperating with tumor cells and stroma. Immunosuppressive particles like cytokines (IL-10 and TGF) and designated spot barricade triggers like PDL1 are accessible to mononuclear phagocytes [66].


## 5. Tools of Nanotechnology

The equipment, programming, and supplies used to gauge and control structures on the nanoscale are known as nanotechnology apparatuses and instruments. Magnifying lens, tests, lithography situation, control and creation frameworks, programming, and different extras are among the things accessible. These instruments are seldom selective to nanotechnologies. Most of them came from different ventures, particularly semiconductors and chipmaking, where submicron producing standards fueled the correspondences blast. Science, physical science, and materials science have all had an impact, and nanotechnology is exceptional in its interdisciplinarity. This BCC report centers around nanotechnology devices and instrumentation, or the advances, items, and applications that permit researchers and laypeople to accomplish nanotechnology work. The capacity of instruments and apparatuses to quantify, sense, create, and control matter at the nanoscale is basic to each part of essential nanoscale science just as business nanotechnology advancement [67].


## 6. Nanotechnology in Cancer

Nanotechnology has the greatest advantage on cancer diagnosis and therapy over other function. There are several numbers of ongoing researches including the designing of nanodevices against cancer which have the ability to detecting tumor at the early stage of cancer and also the location within the body that will further be helpful for delivering chemotherapy or drug on the record location where malignant cells are being developed. Recent research shows that nanotechnology is being developed for detecting tumor and as well as developing nanodevices that will lead to cancer treatment. The best cure for cancer can be possible by diagnosing tumor and taking required steps for prevention. Nanodevices such as nanowires have special features like specificity and selectivity through which it can easily detect molecules of malignant cells, and protein produced by cancer cells resulting in diagnosis of tumor can be achieved. Having detected the tumor, it can be destructed by nano-shell-assisted photo-thermal therapy that can absorb light of the near-infrared region (NIR) and penetrate tissues. It works by producing heat that aids to destruct tumor. The greatest advantages of thermal therapy are destroying tumor cells that cannot be destroyed by surgery [68].


### 6.1. Aptamer Nanomedicines for Cancer Therapy

Aptamer can be a special tertiary structure that can detect small molecules like protein as well as cells [69–71], although it has similarity to antibody [72] and because of this its high molecular weight hampered to penetrate into solid tumor but it is significant in cancer therapeutics. There has some strong evidence that aptamer nanomedicines have promising effects on gene therapy, drug therapy, and tumor imaging. Typically, aptamer nanomedicines work by inhibiting the growth of tumor cells. However, there have been some barriers on the designing and application of aptamer at the desired target. In that case, SELEX is the significant aspect to produce aptamer for required target cells [73, 74]. Aptamer is screened from a library that is composed of different molecules. By some intermediary process, the target-specific candidate can be elucidated which will further be enhanced by PCR (DNA) or RT-PCR (RNA). The exaggerated candidate can be activated by isolation or transcription for the selection process. These processes should be continued until the best performing aptamer can be achieved by the SELEX process which will make capable the aptamer for target recognition. But in some cases, these aptamers are unable to stimulate or inhibit the target. So in that case, the researcher should obtain a specialized process to generate aptamer or conjugate aptamer which can produce desired therapeutic outcomes [75]. Aptamers are significantly potential because they are designed as safe, well-controlled, and robust delivery systems [76].


### 6.2. Lipid-Based Nanostructure for Cancer

Lipid-based nanomedicines have promise to exert potential effects on the special drug delivery system of cancer treatment [77]. They contain therapeutic agents inside. Lipid nanoparticles like liposome have cationic groups on the head that binds to an ionic nucleic acid and hydrophobic drug containing the liquid membrane and inside contains hydrophilic drugs [78] resulting in unfortunate virus. To improve liposome-mediated gene transduction, it requires combining potent promoters such as multilamellar vesicle (MLV) liposomes with a transcriptional activator like HMG-1, 2 protein that can increase the response of cationic liposomal genes. Liposome-mediated gene expression can be strong by the combination of the Egr-1 promoter and radioisotope [79]. Lipid-based magnetic nanomedicines have promising effects on both drug delivery and early detection of the disease condition and also treatment and diagnosis [80].


### 6.3. Approach of Nanomedicine in Gut Cancer Axes

Nanotechnology as well as nanomedicine greatly is impacted by gut bacteria. Gut bacteria can enhance carcinogenesis by toxic metabolites [81] or by attachment of bacteria to the tumor microenvironment [82]. These carcinogenic bacteria can be induced from undigested food or toxins like colibactin, lipopolysaccharides, and hepatic bile metabolites. Various types of dietary habits can produce carcinogenic or class in a protective metabolism that can stimulate and prevent intestinal carcinogenesis (Figure 1(a)) [83]. Gut microbiota such as Fusobacterium nucleatum can interfere on the chemotherapy of cancer [84]. Especially induce chemoresistance instead of apoptosis on colorectal carcinoma [85] by activating autophagy. Another research suggests that gut bacteria like E. coli have the tendency to direct mutation on human intestinal colorectal carcinoma [86, 87]. The gut liver axes facilitate the movement of toxic metabolites from the gut to the extraintestinal part resulting in hepatocellular carcinoma [88, 89]. Bile acids are transformed into toxic intermediates that can attack the cell wall of bacteria though it will be further converted to secondary bile acids that can ultimately induce carcinogenesis [90].Figure 1
The link between the gut microbiota and cancer and cancer treatment strategies using nanotechnology. (a) Bacteria induce chemotherapy resistance and carcinogenesis by activating the lipopolysaccharide-TLR4 signaling pathway and causing genotoxicity material. (b) Gut microbiota migrates to the lymph nodes, spleen, and tumors and elicits an antitumor immune response. (c) A nanomedicine strategy that regulates gut bacteria for cancer treatment [93].Undoubtedly, gut microbiota can aid in pathogenesis and progression of bacteria while cyclophosphamide altered the microbial cell as well as biotransformation (Figure1(b)) [91] on the small intestine that will restrict the tumor and induce anticancer effects. NPs decompose the gut microbiota in molecular and cellular levels that can inhibit hepatocellular carcinoma and colorectal cancer (Figure 1(c)) [92].


## 6.1. Aptamer Nanomedicines for Cancer Therapy

Aptamer can be a special tertiary structure that can detect small molecules like protein as well as cells [69–71], although it has similarity to antibody [72] and because of this its high molecular weight hampered to penetrate into solid tumor but it is significant in cancer therapeutics. There has some strong evidence that aptamer nanomedicines have promising effects on gene therapy, drug therapy, and tumor imaging. Typically, aptamer nanomedicines work by inhibiting the growth of tumor cells. However, there have been some barriers on the designing and application of aptamer at the desired target. In that case, SELEX is the significant aspect to produce aptamer for required target cells [73, 74]. Aptamer is screened from a library that is composed of different molecules. By some intermediary process, the target-specific candidate can be elucidated which will further be enhanced by PCR (DNA) or RT-PCR (RNA). The exaggerated candidate can be activated by isolation or transcription for the selection process. These processes should be continued until the best performing aptamer can be achieved by the SELEX process which will make capable the aptamer for target recognition. But in some cases, these aptamers are unable to stimulate or inhibit the target. So in that case, the researcher should obtain a specialized process to generate aptamer or conjugate aptamer which can produce desired therapeutic outcomes [75]. Aptamers are significantly potential because they are designed as safe, well-controlled, and robust delivery systems [76].


## 6.2. Lipid-Based Nanostructure for Cancer

Lipid-based nanomedicines have promise to exert potential effects on the special drug delivery system of cancer treatment [77]. They contain therapeutic agents inside. Lipid nanoparticles like liposome have cationic groups on the head that binds to an ionic nucleic acid and hydrophobic drug containing the liquid membrane and inside contains hydrophilic drugs [78] resulting in unfortunate virus. To improve liposome-mediated gene transduction, it requires combining potent promoters such as multilamellar vesicle (MLV) liposomes with a transcriptional activator like HMG-1, 2 protein that can increase the response of cationic liposomal genes. Liposome-mediated gene expression can be strong by the combination of the Egr-1 promoter and radioisotope [79]. Lipid-based magnetic nanomedicines have promising effects on both drug delivery and early detection of the disease condition and also treatment and diagnosis [80].


## 6.3. Approach of Nanomedicine in Gut Cancer Axes

Nanotechnology as well as nanomedicine greatly is impacted by gut bacteria. Gut bacteria can enhance carcinogenesis by toxic metabolites [81] or by attachment of bacteria to the tumor microenvironment [82]. These carcinogenic bacteria can be induced from undigested food or toxins like colibactin, lipopolysaccharides, and hepatic bile metabolites. Various types of dietary habits can produce carcinogenic or class in a protective metabolism that can stimulate and prevent intestinal carcinogenesis (Figure 1(a)) [83]. Gut microbiota such as Fusobacterium nucleatum can interfere on the chemotherapy of cancer [84]. Especially induce chemoresistance instead of apoptosis on colorectal carcinoma [85] by activating autophagy. Another research suggests that gut bacteria like E. coli have the tendency to direct mutation on human intestinal colorectal carcinoma [86, 87]. The gut liver axes facilitate the movement of toxic metabolites from the gut to the extraintestinal part resulting in hepatocellular carcinoma [88, 89]. Bile acids are transformed into toxic intermediates that can attack the cell wall of bacteria though it will be further converted to secondary bile acids that can ultimately induce carcinogenesis [90].Figure 1
The link between the gut microbiota and cancer and cancer treatment strategies using nanotechnology. (a) Bacteria induce chemotherapy resistance and carcinogenesis by activating the lipopolysaccharide-TLR4 signaling pathway and causing genotoxicity material. (b) Gut microbiota migrates to the lymph nodes, spleen, and tumors and elicits an antitumor immune response. (c) A nanomedicine strategy that regulates gut bacteria for cancer treatment [93].Undoubtedly, gut microbiota can aid in pathogenesis and progression of bacteria while cyclophosphamide altered the microbial cell as well as biotransformation (Figure1(b)) [91] on the small intestine that will restrict the tumor and induce anticancer effects. NPs decompose the gut microbiota in molecular and cellular levels that can inhibit hepatocellular carcinoma and colorectal cancer (Figure 1(c)) [92].


## 7. Novel Prospects in Nanomedicine for Enhanced Tumor Treatment

Through passive targeting NPs works on tumor over several NPs occur on healthy organ. So, the active targeting process facilities the way of functioning of nanoparticles on active areas along with binding to specific receptors on tumor or other endothelium and accumulation on tumor [94]. Folate has the high affinity to the folic acid receptor that can be overexpressed at 100–300-fold in specific tumor [95]. The folate-functionalized PEGylated dendrimers have shown the higher accumulation rate to tumor that is resulting in the reduction on tumor growth. Active-targeted topotecan, a topoisomerase-I inhibitor, showed twofold higher anticancer efficacy against breast cancer with anti-HER2 scFv F5 antibody in comparison with passive-targeted liposomes [96]. The current research works for controlled release from nanoparticles that will functionalize better against tumor cells compared with others in which circumstance ultrasound and increased temperature aid to induce the drug release in tumor [97].


### 7.1. Tumor-Specific Profiling of the Accumulation of Nanomedicines

For the diagnostic approach, nanoparticles first select the tumor and magnetic nanoparticles (MNPs) can be imaged that will classify tumors in a specific corresponding group according to MNP accumulation and further associated to therapeutic nanoparticles (TNPs). The buildup of high level of MNP in tumor tends to accumulation of high-level of TNP which slows tumor growth. There is a significant difference in cellular level distribution between TNPs and MNPs. MNPs do not have the same cellular level distribution as TNPs that depends on enhanced permeability and retention (EPR) of tumor. MNPs have comparatively strong affinity to tumors than TNPs (Figure2) [98, 99].Figure 2
MNP can accumulate in tumors and be imaged in the same way that TNPs can, but not free medications [98].


### 7.2. Impact of Nanoparticle Properties in Tumors

For solid tumor treatment, nanomedicines are administered through systemically and they accumulated to the tumor according to the EPR level [94, 95, 100, 101]. Multiple biological steps lie on the systemic delivery of nanoparticles which will be also affected by the EPR levels like NP-protein binding, blood circulation, extravasation tumor tissue penetration, and tumor cell internalization. Several properties of nanoparticles such as size, stiffness, geometry, surface charge, porosity, elasticity, surface hydrophobicity, and roughness can influence their biological systems which estimate EPR effects and therapeutic results. Having entered to the biological steps like in blood and intestinal fluid, immediately, it forms corona by covering with several biomolecules (Figure 3) [102–105]. So, the NP-protein interaction basically is depending on the physical chemical properties of NPs.Figure 3
Nanoparticle (NP) properties can be affected by the interaction with serum protein. Extravasation intracellular peddling takes place into tumor tissue through leaky tumor vessels [100, 106].


## 7.1. Tumor-Specific Profiling of the Accumulation of Nanomedicines

For the diagnostic approach, nanoparticles first select the tumor and magnetic nanoparticles (MNPs) can be imaged that will classify tumors in a specific corresponding group according to MNP accumulation and further associated to therapeutic nanoparticles (TNPs). The buildup of high level of MNP in tumor tends to accumulation of high-level of TNP which slows tumor growth. There is a significant difference in cellular level distribution between TNPs and MNPs. MNPs do not have the same cellular level distribution as TNPs that depends on enhanced permeability and retention (EPR) of tumor. MNPs have comparatively strong affinity to tumors than TNPs (Figure2) [98, 99].Figure 2
MNP can accumulate in tumors and be imaged in the same way that TNPs can, but not free medications [98].


## 7.2. Impact of Nanoparticle Properties in Tumors

For solid tumor treatment, nanomedicines are administered through systemically and they accumulated to the tumor according to the EPR level [94, 95, 100, 101]. Multiple biological steps lie on the systemic delivery of nanoparticles which will be also affected by the EPR levels like NP-protein binding, blood circulation, extravasation tumor tissue penetration, and tumor cell internalization. Several properties of nanoparticles such as size, stiffness, geometry, surface charge, porosity, elasticity, surface hydrophobicity, and roughness can influence their biological systems which estimate EPR effects and therapeutic results. Having entered to the biological steps like in blood and intestinal fluid, immediately, it forms corona by covering with several biomolecules (Figure 3) [102–105]. So, the NP-protein interaction basically is depending on the physical chemical properties of NPs.Figure 3
Nanoparticle (NP) properties can be affected by the interaction with serum protein. Extravasation intracellular peddling takes place into tumor tissue through leaky tumor vessels [100, 106].


## 8. Nanomedicine Strategies for the Treatment of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease in which the joint tissues develop severe inflammatory microenvironments. Congenital and high infiltrations are found in inflammatory joints. Self-antigen-specific adaptive immune cells induce hyperplasia and increased inflammatory cytokine levels lead to cartilage and bone breakdown, be it irreversible [107].With the formation of nanoparticles, the development of nanomedicines in RA has increased rapidly. It efficiently accumulates in the inflammatory microenvironment of arthritic joints. It features neovascularization and an abnormal peripheral lymphatic system. Synthetic and biological DMARD delay the development of RA by interfering with the inflammatory cascade in various immune cells. The known mechanism of action is to downregulate production of inflammatory cytokines and inhibit leukocyte migration [108]. Long-term treatment of this disease with antirheumatic drug may cause toxicity on various organs of the patient’s body like gastrointestinal, kidney, skin, and immune suppression-mediated infection. For the treatment of RA, nanomedicine has developed as a potential therapeutic technique for efficiently localizing medicines in inflamed joints [109].


### 8.1. Delivery Strategies to Inflamed Joints

Antigen-presenting cells such as dendritic cells activate autoantigen-specific lymphocytes which infiltrate into joint tissues and cause an inflammatory response and leukocyte recruitment as a result of the inflammatory status increase. Normally, a lining in the synovial joint is formed by synovial cells but it abnormally proliferates and results in hypoxic and nutrient-deficient microenvironments and angiogenesis [110, 111]. That makes the vasculature leaky with large fenestration up to 600 nm [112–114] and permits the diffusion of the macromolecules into the inflamed joint tissues. Selectively, accumulation of the intravenously administered nanomedicine is caused by this leaky vasculature by passive targeting. The delivery efficacy is significantly enhanced compared with intravenous injection of free drugs in that technique. The mononuclear phagocytic system (MPS) such as the liver and spleen also clears a significant amount of nanomedicine [115, 116]. It is also believed that the threshold for renal clearance is around 5 nm [117]. That is why the quick excretion of nanotherapeutic delivery systems below this size limit can be achieved by this route after intravenous injection. The size and charge are considered to be key factors for nanomedicine generally to elude the MPS and renal clearance.Efficient delivery of nanomedicine to the inflamed joints can be achieved by following the recommended optimal size range which is around 200 nm [118, 119], and for the minimization of the interaction between nanomedicine and macrophages, zwitterionic surface charge is preferred rather than negative or positive surfaces [120, 121]. A functional surface coating can also enhance the delivery of nanomedicine to the inflamed joints. For minimizing the macrophage uptake and prolonging of the blood circulation, coating of stealth polymers such as poly (ethylene glycol) (PEG) was used [121, 122]. Drugs like NSAIDs (indomethacin), [123], corticosteroids (prednisolone, methyl prednisolone, budesonide, dexamethasone, and betamethasone), DMARDs (methotrexate), siRNAs (NF-κB siRNA, TNFα siRNA, and Mcl-1 siRNA), therapeutic peptides, and other drugs (camptothecin) [109] are administered by that method to the inflamed joints. Corticosteroid derivatives which are water soluble like prednisolone phosphate [124, 125] and budesonide phosphate [126] were formulated with the PEGylated liposomal formulation where insoluble corticosteroids were formulated with PEGylated micelles [127, 128] or polymer-based NPs [129]. PEGylated liposomes [130, 131] or polymeric a hybrid nanoparticle [132, 133] was also used to administer methotrexate and in order to increase the therapeutic efficacy and reduce the systemic toxicity.Particularly, the positively charged PEGylated lipid NPs were used for siRNA encapsulation for effective cytosolic delivery. PEG-free liposomes were developed to minimize the allergic reactions against PEG and prolong the therapeutic efficacy of dexamethasone in the inflamed joint [134, 135].Coating of NPs with biological self-materials like albumin can also result in prolonged blood circulation as it will be recognized to the MPS system as self-material and blood clearance will be reduced. DMARDs, methotrexate, and IL-1 receptor agonist were coated with albumin to facilitate drug delivery efficiently to the inflamed joints [136–138]. Red blood cell membrane-coated nanoparticles were developed for increasing the blood residence time. Another way for increasing the accumulation of circulating drugs in the specific region of the body is the magnetic drug delivery system. An external magnetic field is used to localize the administered drugs in the specific region of the body in the magnetic drug delivery system.


### 8.2. Therapeutic Strategies

Although the accumulation of nanomedicine in the inflamed joints can be enhanced by passive delivery strategies via a leaky vasculature, the drugs release and diffuse to every cell in the articular cavity which tends to reduce the therapeutic efficacy of the drugs. That is why it was suggested to use targeted delivery of nanomedicine to the inflamed joint-associated molecules and cells for improving the therapeutic efficacy of the antirheumatic drugs. The proinflammatory cytokines and cells like macrophages and synoviocytes are the main therapeutic target in the arthritic joints as pathological progression of RA is strongly related to proinflammatory cells. For the therapeutic target, the proinflammatory cells including macrophages, T cells, and FLSs and their cytokines have been actively studied [109].


### 8.3. Nanomedicine and Osteoarthritis

Although, there are many advance technologies and ways in the cartilage biology for the better diagnosis and treatment of bone and joint decade, a new and advance way with the nanomedicine technology for the diagnosis and treatment of osteoarthritis (OA) has been developed.


#### 8.3.1. Oxidative DNA Damage Contributes to Aging and Degeneration of Articular Cartilage

It has been found that at the time of development of OA, mechanical and chemical stresses on articular cartilage make the cellular activity of chondrocytes unstable and give rises to excess amounts of ROS and also proinflammatory cytokines and chemokines. Recent studies have shown that in degenerated articular cartilage, there is significant accumulation of ROS and chondrocyte aging. Studies have also disclosed that there is significant involvement of 8-oxyguanine (oxidative form of guanine) accumulation and impairment of mitochondrial DNA repair enzymes in the pathogenesis of OA and ROS is the major causative agent of 8-oxoguanine production in both DNA and nucleotide pools [139].


#### 8.3.2. Application of Nanotechnology to Chondroprotection

According to a recent study, C60 fullerene which is water soluble has potential to work against the catabolic stress-induced degeneration of articular cartilage bothin vivo and in vitro OA models. The study has also highlighted that C60 fullerene can also stimulate the expression of mitochondrial DNA repair enzymes and their functions in osteoarthritis. So, water-soluble fullerene nanoparticles can be used as potential therapeutic for the protection of articular cartilage in OA [139].


## 8.1. Delivery Strategies to Inflamed Joints

Antigen-presenting cells such as dendritic cells activate autoantigen-specific lymphocytes which infiltrate into joint tissues and cause an inflammatory response and leukocyte recruitment as a result of the inflammatory status increase. Normally, a lining in the synovial joint is formed by synovial cells but it abnormally proliferates and results in hypoxic and nutrient-deficient microenvironments and angiogenesis [110, 111]. That makes the vasculature leaky with large fenestration up to 600 nm [112–114] and permits the diffusion of the macromolecules into the inflamed joint tissues. Selectively, accumulation of the intravenously administered nanomedicine is caused by this leaky vasculature by passive targeting. The delivery efficacy is significantly enhanced compared with intravenous injection of free drugs in that technique. The mononuclear phagocytic system (MPS) such as the liver and spleen also clears a significant amount of nanomedicine [115, 116]. It is also believed that the threshold for renal clearance is around 5 nm [117]. That is why the quick excretion of nanotherapeutic delivery systems below this size limit can be achieved by this route after intravenous injection. The size and charge are considered to be key factors for nanomedicine generally to elude the MPS and renal clearance.Efficient delivery of nanomedicine to the inflamed joints can be achieved by following the recommended optimal size range which is around 200 nm [118, 119], and for the minimization of the interaction between nanomedicine and macrophages, zwitterionic surface charge is preferred rather than negative or positive surfaces [120, 121]. A functional surface coating can also enhance the delivery of nanomedicine to the inflamed joints. For minimizing the macrophage uptake and prolonging of the blood circulation, coating of stealth polymers such as poly (ethylene glycol) (PEG) was used [121, 122]. Drugs like NSAIDs (indomethacin), [123], corticosteroids (prednisolone, methyl prednisolone, budesonide, dexamethasone, and betamethasone), DMARDs (methotrexate), siRNAs (NF-κB siRNA, TNFα siRNA, and Mcl-1 siRNA), therapeutic peptides, and other drugs (camptothecin) [109] are administered by that method to the inflamed joints. Corticosteroid derivatives which are water soluble like prednisolone phosphate [124, 125] and budesonide phosphate [126] were formulated with the PEGylated liposomal formulation where insoluble corticosteroids were formulated with PEGylated micelles [127, 128] or polymer-based NPs [129]. PEGylated liposomes [130, 131] or polymeric a hybrid nanoparticle [132, 133] was also used to administer methotrexate and in order to increase the therapeutic efficacy and reduce the systemic toxicity.Particularly, the positively charged PEGylated lipid NPs were used for siRNA encapsulation for effective cytosolic delivery. PEG-free liposomes were developed to minimize the allergic reactions against PEG and prolong the therapeutic efficacy of dexamethasone in the inflamed joint [134, 135].Coating of NPs with biological self-materials like albumin can also result in prolonged blood circulation as it will be recognized to the MPS system as self-material and blood clearance will be reduced. DMARDs, methotrexate, and IL-1 receptor agonist were coated with albumin to facilitate drug delivery efficiently to the inflamed joints [136–138]. Red blood cell membrane-coated nanoparticles were developed for increasing the blood residence time. Another way for increasing the accumulation of circulating drugs in the specific region of the body is the magnetic drug delivery system. An external magnetic field is used to localize the administered drugs in the specific region of the body in the magnetic drug delivery system.


## 8.2. Therapeutic Strategies

Although the accumulation of nanomedicine in the inflamed joints can be enhanced by passive delivery strategies via a leaky vasculature, the drugs release and diffuse to every cell in the articular cavity which tends to reduce the therapeutic efficacy of the drugs. That is why it was suggested to use targeted delivery of nanomedicine to the inflamed joint-associated molecules and cells for improving the therapeutic efficacy of the antirheumatic drugs. The proinflammatory cytokines and cells like macrophages and synoviocytes are the main therapeutic target in the arthritic joints as pathological progression of RA is strongly related to proinflammatory cells. For the therapeutic target, the proinflammatory cells including macrophages, T cells, and FLSs and their cytokines have been actively studied [109].


## 8.3. Nanomedicine and Osteoarthritis

Although, there are many advance technologies and ways in the cartilage biology for the better diagnosis and treatment of bone and joint decade, a new and advance way with the nanomedicine technology for the diagnosis and treatment of osteoarthritis (OA) has been developed.


### 8.3.1. Oxidative DNA Damage Contributes to Aging and Degeneration of Articular Cartilage

It has been found that at the time of development of OA, mechanical and chemical stresses on articular cartilage make the cellular activity of chondrocytes unstable and give rises to excess amounts of ROS and also proinflammatory cytokines and chemokines. Recent studies have shown that in degenerated articular cartilage, there is significant accumulation of ROS and chondrocyte aging. Studies have also disclosed that there is significant involvement of 8-oxyguanine (oxidative form of guanine) accumulation and impairment of mitochondrial DNA repair enzymes in the pathogenesis of OA and ROS is the major causative agent of 8-oxoguanine production in both DNA and nucleotide pools [139].


### 8.3.2. Application of Nanotechnology to Chondroprotection

According to a recent study, C60 fullerene which is water soluble has potential to work against the catabolic stress-induced degeneration of articular cartilage bothin vivo and in vitro OA models. The study has also highlighted that C60 fullerene can also stimulate the expression of mitochondrial DNA repair enzymes and their functions in osteoarthritis. So, water-soluble fullerene nanoparticles can be used as potential therapeutic for the protection of articular cartilage in OA [139].


## 8.3.1. Oxidative DNA Damage Contributes to Aging and Degeneration of Articular Cartilage

It has been found that at the time of development of OA, mechanical and chemical stresses on articular cartilage make the cellular activity of chondrocytes unstable and give rises to excess amounts of ROS and also proinflammatory cytokines and chemokines. Recent studies have shown that in degenerated articular cartilage, there is significant accumulation of ROS and chondrocyte aging. Studies have also disclosed that there is significant involvement of 8-oxyguanine (oxidative form of guanine) accumulation and impairment of mitochondrial DNA repair enzymes in the pathogenesis of OA and ROS is the major causative agent of 8-oxoguanine production in both DNA and nucleotide pools [139].


## 8.3.2. Application of Nanotechnology to Chondroprotection

According to a recent study, C60 fullerene which is water soluble has potential to work against the catabolic stress-induced degeneration of articular cartilage bothin vivo and in vitro OA models. The study has also highlighted that C60 fullerene can also stimulate the expression of mitochondrial DNA repair enzymes and their functions in osteoarthritis. So, water-soluble fullerene nanoparticles can be used as potential therapeutic for the protection of articular cartilage in OA [139].


## 9. Nanomedicines for Treating Neurodegenerative Disorder

### 9.1. Alzheimer’s Disease (AD)

AD is defined clinically by a progressive deterioration in cognition and histologically by the development of intracellular neurofibrillary tangles and extracellular amyloid plaques in the brain [140, 141]. Currently, there is no efficient therapy for AD. More than 98% of available drugs cannot transfer from the blood to the brain, which is protected by a cellular fence, the blood-brain barrier (BBB) [142]. Currently, there are five drugs approved by the FDA for AD treatment and they are tacrine, donepezil, rivastigmine, galantamine, and memantine. One of the major problems for the drugs of AD treatment is the blood-brain barrier (BBB) crossing. NPs are being thought as a solution to overcome that problem. There are several types of NPs which can be used for AD treatment. They are polymer-based nanoparticles in which polymers like poly lactic acid (PLA) and poly glycolic acid (PGA) are used in polymer-based nanoparticles as they are biodegradable and biocompatible and have longer shelf life and stability during storage [143].Polymer-based NP examples of drugs are curcumin, rivastigmine, estradiol, neuroprotective peptide, etc. Lipid-based nanoparticles are preferred due to high lipid solubility and high circulation and retention time, for example, aqueous phosphatidylcholines and solid lipid-based nanoparticles which are based on glyceride mixture. Solid lipid-based nanoparticles have advantages for the hydrophobic drugs as it has a suitable environment for the entrapment of drugs and release. Examples of liposomal or lipid-based NPs are curcumin, phosphatidic acid, cardiolipin, etc. Piperine is the example of solid lipid-based NPs. Tacrine is employed as a drug for various NPs such as albumin NPs, magnetic NPs, and chitosan NPs. And for gold NPs, Aβ-binding peptides are used [142]. In the amyloidogenic pathway, continuous cleaving of the amyloid precursor protein by β- and γ-secretases releasing amyloid beta (Aβ) peptide and aggregation of Aβ monomers leads to the formation of oligomers and fibrils. Oligomer formation is considered as the main toxic event in AD, which can cause neuronal dysfunction and death. Properly functionalized NPs can interfere in Aβ production or clearance. Moreover, properly functionalized NPs may also affect Aβ aggregation features or block its aggregation. Thus, NPs reduce Aβ levels [142].Among all other NPs, liposomes and PEG-PLA NPs are being the mostly used NPs as they are known for the lack of toxicity, low immunogenicity, and full biodegradability [144, 145]. For example, curcumin, phosphatidic acid cardiolipin, and XO4 are used. PEGylated polymeric NPs are also used due to their ability to increase half-life which leads to increase interaction with the peptide [142].


### 9.2. Parkinson’s Disease (PD)

The capacity of a medication to penetrate the BBB and meet the target region, as well as the duration of drug delivery to prevent concentration changes, has been a major challenge in the development of successful treatments for PD. When compared to other therapeutic fields, medication development for the treatment of brain disorders has the lowest success rate [146]. Drug development for CNS disorders often takes significantly longer than drug development for non-CNS disorders. As a result, the creation of disposable nanoparticles that can readily pass across the BBB has been prioritized in the development of novel carriers for anti-Parkinsonian drugs [147, 148]. Dopamine is a chemical messenger in the brain that serves a variety of tasks in the body, and when dopamine levels in the body drop, the body is assaulted by PD [149].Drug delivery into CNS has become a problem that has to be addressed, and polymeric NPs have proven to be a potential solution. Several studies have been conducted to see if polymer may be used to transport drugs to the brain. Bone marrow macrophages (BMM) are macrophage cells that are derived from bone marrow cells. Haney and colleagues synthesized BMM NP with a polymer composition (PEI-PEG) and catalyzed BMM NP to promote neuroprotection and reduce neuroinflammation. An NP with PEG corona and enzyme linked to a polyion complex is formed by the formulation. 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), intoxication, and 6-OHPA were used to induce brain inflammation in C57BL/6 mice [150]. Investigators are considering developing NP-based formulation for PD patients to deliver DA to the brain. Yang and colleagues developed a sustained-release formulation comprising levodopa methyl ester (LDME) or benserazide-loaded polymeric (PLGA) NPs, which they tested on rats that had dyskinesia caused by levodopa (LD) injection. Dyskinesia in rats produced by LD is linked to the quantity of phosphorylated dopamine and cyclic adenosine monophosphate-regulated phosphoprotein (pDARPP-32), phosphorylated extracellular signal-regulated kinases 1/2 (p-ERK1/2), and fos protein. Furthermore, LD therapy caused rats to acquire aberrant involuntary reflexes [151].Metallic NPs are widely utilized in the cure of different illnesses, such PD, cancer, and rheumatoid arthritis, to name a few. Magnetic NPs, gold NPs (AuNPs), silver NPs (AgNPs), and cerium oxide NPs (CeO2NPs) are some of the metallic NPs that are utilized in the treatment of ailments [152]. Qiao et al. [153] synthesized Fe3O4 magnetic NPs and subsequently coupled them with lactoferrin, which functions as a brain MRI-guided delivery probe. Gao et al. [154] developed gold nanoclusters for the treatment of PD. Because of the two major features (particle size and redox properties), CeO2NPs are also gaining increasing interest in the treatment or prevention of neurodegenerative disorders (Table 1) [23, 155–163]. Dillon et al. [164] synthesized CeO2NPs and tested their antioxidant efficacy in a PD animal model caused by MPTP.Table 1
Therapeutic application of NPs in neurodegenerative disorders.
NanoparticleTherapeutic outcomesCell entryDiseaseReferenceSilverUpregulation of hydrogen sulphide (H2S) and Ag2S reduces neurotoxicitySilver’s natural properties cross the BBBPD[165]SilverAs a plant-based anti-Alzheimer medication, it has anticholinesterase and antioxidant actionSilver’s natural properties cross the BBBAD[166]GoldSuppression of Aβ42 aggregationEndocytosis of chiral nanoparticles across the BBBAD[167]GoldApoptosis of dopaminergic neurons in the substantia nigra striatum is inhibited by PC12 cellsNerve growth factor (NGF) endocytosisPD[168]SeleniumIn AD lesions, there is a reduction in amyloid plaquesCurcumin’s capacity to form intermolecular hydrogen bonds with amyloid b and iron in plaques without the need for supplementary chemical linkersAD[169]


### 9.3. Huntington’s Disease (HD)

HD is a neurodegenerative disorder which is characterized by an autosomal dominant mutation in the Huntingtin gene (HTT) that produces CAG trinucleotide repetitions at the 5′ end, leading to abnormal Huntingtin protein production and segmentation, which leads to neuronal damage and cytotoxicity [170]. This disease has a significant impact on the physical and psychological wellbeing of both the patients and health care providers and the socioeconomic level of the suffering persons and their families. HD strikes people primarily in their adulthood, when they are approximately 45 years old (on average), gradually overtaking the victim’s motor and cognitive capabilities while also affecting their behavioral responses [171]. Its autosomal dominant character is both a benefit and a drawback, as it has the most phenotypic penetrance and is monogenic, making it possible to target effectively compared to other neurodegeneratives, which are caused by a complicated network of biochemical processes [172]. The sole licensed medicine for HD is tetrabenazine, and most contemporary therapy approaches are symptom based [173]. Targeted activation of the cAMP respond element binding protein, as well as the usage of coenzyme Q and Creatine, are among the other ways now being investigated. Grip force (Q motor), HD-CAB (cognitive), caudate volume (MRI), cortical activity electroencephalogram, amounts of neurofilament and mutant Huntingtin in cerebrospinal fluid (CSF), and other biomarkers are used in several clinical studies for the evaluation of HD [170].Changes in neurochemical pathways including the dopamine, adenosine, and glutamate receptors, as well as oxidative damage and mitochondrial abnormalities, are all major contributors to HD pathophysiology. Sandhir et al. [174] employed solid-lipid NPs conjugated with curcumin to modify complex II activity in order to target mitochondrial abnormalities as a form of HD treatment. They also found that 3-nitropropionic acid increased the levels of Nrf2 mRNA. Bhatt et al. [175] tried every possible method, creating solid-lipid NPs conjugated with rosmarinic acid (RA) to target HD, relying on RA’s high-brain-targeting efficacy. Cong et al. [176] recently demonstrated the use of selenium (Se) in a targeted delivery method for HD. Se and selenoproteins have been linked to brain malfunctioning, mutant Huntingtin aggregation, and elevated numbers of oxidized glutathione. Se insufficiency in the brain has been linked to brain abnormalities, mutant Huntingtin aggregation, and higher levels of oxidized glutathione. Se NPs have been proven to be the least hazardous and have the greatest potential to prevent oxidative damage of all the numerous therapeutic forms of Se that have been examined, even at concentrations lower than 0.5×10−3M. The scientists also demonstrated that Se NPs can attenuate neurotoxicity and alleviate cognitive disruptions in a Caenorhabditis worm’s model of HD, even at doses lower than 2×106M. Due to exceptional qualities like the ability to control HDAC (histone deacetylase) activity and diminish poly Q aggregation, which is one of the characteristics of HD pathophysiology, Se and its application represent significant potential in the potential implementation of anti-HD treatments.


### 9.4. Amyotrophic Lateral Sclerosis (ALS)

People are diagnosed with ALS, a devastating category of NDs that causes the death of motor neurons in the spinal cord and brain. ALS is caused by genetic mutations in the superoxide dismutase 1 (SOD1) gene, which codes for the superoxide dismutase enzyme. SOD1 mutations generate harmful free radicals and inhibit proteasome and/or chaperone action, leading in protein misfolding and insufficient clearance [177]. Several clinical studies for the management of ALS have been unsuccessful in the past 10 years due to numerous limitations in traditional therapy techniques. The United States Food and Drug Administration (USFDA) has recognized riluzole as the only glutamate antagonist for the therapy of ALS. This eloquently demonstrates the critical desire for a new novel therapeutic strategy to the awful disease [178, 179]. To this purpose, nanomedicine, as we have shown, can represent a critical role in the development of innovative ALS treatment strategies. Bond et al. [180], for example, established riluzole administration utilizing solid-lipid NPs for the therapy of ALS with high drug encapsulation and improved clinical efficacy.


### 9.5. Epilepsy

Epilepsy is a noncommunicable chronic condition caused by fast neuronal exoneration and uncontrolled electrical discharges in certain brain cells. These can be classified as status epilepticus; however, they may appear with few or no behavioral symptoms [181–184]. Epilepsy affects around fifty million people worldwide, according to the World Health Organization (WHO) estimates, making it the fourth most common neurodegenerative condition. Early death, wounds related with seizures and fractures, and greater grades of psychiatric problems such as depression and stress are all anticipated in individuals with this ailment [185–187]. Examining the patient’s medical history, inspecting the nervous system, comprehensive blood chemistries, thyroid function tests, an electroencephalogram, and a brain investigation are only a couple of minor basic methods for detecting epilepsy. In recent years, improved diagnostic methods including as magnetic resonance imaging (MRI), positron emission tomography (PET), and single-photon emission computed tomography (SPECT) have been used for epilepsy biological imaging and detection. There is no approved remedy for epilepsy at the moment, and only a few antiepileptic drugs (AEDs) are frequently used to control the condition [188, 189]. Drug delivery technologies based on nanomedicine provide a diverse framework for epilepsy treatment. Liposomes, dendrimers, polymeric NPs, carbon-based NPs, micelles, AuNPs, and other drug delivery systems are being employed to treat epilepsy [189–193]. Thyrotropin-releasing hormone (TRH) containing polymeric NPs, for example, has been injected into the amygdala of epilepsy-prone rats [194, 195]. In animal studies of seizures, Yusuf et al. [196] found that poly D-lactic acid (PLGA) NPs of the β-carotene surface coated with polysorbate-80 increased antioxidant and anticonvulsant effects. Furthermore, Musumeci et al. [197] found that oxcarbazepine-loaded PLGA NPs increased the action of parent oxcarbazepine in epileptic seizures in mice when compared to parent oxcarbazepine.


### 9.6. Neuro-Acquired Immunodeficiency Syndrome (NeuroAIDS)

In the early stages of infection, human immunodeficiency virus 1(HIV 1) reaches the CNS, giving rise to NeuroAIDS, which encompasses both viral and neurological pathogenetic processes. About 15–30% of AIDS patients have neurological and neurocognitive problems, with dementia and encephalopathy affecting 7.3–11.3% and 30–60% of patients, respectively. BBB disturbance is not really the major cause of NeuroAIDS; activated endothelial cells with reduced barrier permeability, as well as CD 163, Glut5, and ISG15 genes, have been linked to the disease [198–202]. Because there are presently no viable vaccinations or specialized pharmacological therapies for NeuroAIDS, a significant advance to nanotechnology has offered light on new treatment options for HIV infection. In the management of NeuroAIDS, nanoformulated antiretroviral therapy (ART) was found to increase blood-brain penetration. In the HIV-1 encephalitis (HIVE) area of the brain, indinavir (IDV) NP-loaded murine bone marrow macrophages (BMM) promote lower HIV-1 replication [203, 204]. Their findings also showed that NP-loaded BMM can be used to explore targeted migration and antiviral reactions. Highly active antiretroviral therapy (HAART) based on nanotechnology also performed an important role in the treatment of psychosis. Polybutyl cyanoacrylate (PBCA), methyl methacrylate–sulfopropyl methacrylate (MMSPM), polylactide (PLA), and PLGA were nanoformulated with zidovudine, delavirdine, saquinavir, and lamivudine to raise BBP 10–20 times [205, 206]. In comparison to typical antiretroviral drug (ARV) medication treatment, liposome-loaded zalcitabine has been found to have enhanced efficacy and a longer half-life [207]. Solid lipid NP-loaded ARV medicines have recently gained attention. In NeuroAIDS, SLN-coated delavirdine and saquinavir ARV drugs replaced MMSPM-coated ARV drugs due to their large surface area and efficiency [203].


### 9.7. Stroke

Because it is hard to overcome the limitations of neuroregeneration in injured brain areas, stroke is the major cause of protracted impairment [208]. Angiogenesis and nerve proliferation are significantly suppressed with the development of ischemia, which is accompanied by an increased immune response, culminating in an ischemic cavity in the brain. Ischemia is responsible for roughly 87% of strokes, while hemorrhage is responsible for the rest [209, 210]. Ischemic stroke and behavioral abnormalities are caused by a lack of blood in the brain, which damages neurons and neuronal pathways. BBB breakdown and cerebral edema are linked to vascular endothelial growth factor levels [209]. The PEG NP-linked recombinant tissue plasminogen activator (rtPA) enhances the half-life of rtPA and reduces infarct volume during thrombosis [211]. Ceria NPs as antioxidants inhibit free radical proliferation in the initial stages of acute cerebral ischemia-reperfusion and so minimize the primary harm caused by ischemic stroke. When compared to free enzyme, solid polymer nanoparticles packed SOD as nanozyme lowers the volume of infarct regions in mouse models of stroke by over 50% [212, 213]. The sensor, which comprises of magnetic disks and a swellable hydrogel with high sensitivity to pH, has the potential to reduce the extent of ischemic stroke by improving brain tissue, protecting the BBB, and reducing neurotoxicity [214]. Biomimetic nanobubbles produced from platelet membranes can not only be used as a sensor to track the dynamic progression of a stroke using real-time contrast-enhanced ultrasound imaging but also be used for precise targeting and microvascular bioremodeling in the lesion [215].


## 9.1. Alzheimer’s Disease (AD)

AD is defined clinically by a progressive deterioration in cognition and histologically by the development of intracellular neurofibrillary tangles and extracellular amyloid plaques in the brain [140, 141]. Currently, there is no efficient therapy for AD. More than 98% of available drugs cannot transfer from the blood to the brain, which is protected by a cellular fence, the blood-brain barrier (BBB) [142]. Currently, there are five drugs approved by the FDA for AD treatment and they are tacrine, donepezil, rivastigmine, galantamine, and memantine. One of the major problems for the drugs of AD treatment is the blood-brain barrier (BBB) crossing. NPs are being thought as a solution to overcome that problem. There are several types of NPs which can be used for AD treatment. They are polymer-based nanoparticles in which polymers like poly lactic acid (PLA) and poly glycolic acid (PGA) are used in polymer-based nanoparticles as they are biodegradable and biocompatible and have longer shelf life and stability during storage [143].Polymer-based NP examples of drugs are curcumin, rivastigmine, estradiol, neuroprotective peptide, etc. Lipid-based nanoparticles are preferred due to high lipid solubility and high circulation and retention time, for example, aqueous phosphatidylcholines and solid lipid-based nanoparticles which are based on glyceride mixture. Solid lipid-based nanoparticles have advantages for the hydrophobic drugs as it has a suitable environment for the entrapment of drugs and release. Examples of liposomal or lipid-based NPs are curcumin, phosphatidic acid, cardiolipin, etc. Piperine is the example of solid lipid-based NPs. Tacrine is employed as a drug for various NPs such as albumin NPs, magnetic NPs, and chitosan NPs. And for gold NPs, Aβ-binding peptides are used [142]. In the amyloidogenic pathway, continuous cleaving of the amyloid precursor protein by β- and γ-secretases releasing amyloid beta (Aβ) peptide and aggregation of Aβ monomers leads to the formation of oligomers and fibrils. Oligomer formation is considered as the main toxic event in AD, which can cause neuronal dysfunction and death. Properly functionalized NPs can interfere in Aβ production or clearance. Moreover, properly functionalized NPs may also affect Aβ aggregation features or block its aggregation. Thus, NPs reduce Aβ levels [142].Among all other NPs, liposomes and PEG-PLA NPs are being the mostly used NPs as they are known for the lack of toxicity, low immunogenicity, and full biodegradability [144, 145]. For example, curcumin, phosphatidic acid cardiolipin, and XO4 are used. PEGylated polymeric NPs are also used due to their ability to increase half-life which leads to increase interaction with the peptide [142].


## 9.2. Parkinson’s Disease (PD)

The capacity of a medication to penetrate the BBB and meet the target region, as well as the duration of drug delivery to prevent concentration changes, has been a major challenge in the development of successful treatments for PD. When compared to other therapeutic fields, medication development for the treatment of brain disorders has the lowest success rate [146]. Drug development for CNS disorders often takes significantly longer than drug development for non-CNS disorders. As a result, the creation of disposable nanoparticles that can readily pass across the BBB has been prioritized in the development of novel carriers for anti-Parkinsonian drugs [147, 148]. Dopamine is a chemical messenger in the brain that serves a variety of tasks in the body, and when dopamine levels in the body drop, the body is assaulted by PD [149].Drug delivery into CNS has become a problem that has to be addressed, and polymeric NPs have proven to be a potential solution. Several studies have been conducted to see if polymer may be used to transport drugs to the brain. Bone marrow macrophages (BMM) are macrophage cells that are derived from bone marrow cells. Haney and colleagues synthesized BMM NP with a polymer composition (PEI-PEG) and catalyzed BMM NP to promote neuroprotection and reduce neuroinflammation. An NP with PEG corona and enzyme linked to a polyion complex is formed by the formulation. 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), intoxication, and 6-OHPA were used to induce brain inflammation in C57BL/6 mice [150]. Investigators are considering developing NP-based formulation for PD patients to deliver DA to the brain. Yang and colleagues developed a sustained-release formulation comprising levodopa methyl ester (LDME) or benserazide-loaded polymeric (PLGA) NPs, which they tested on rats that had dyskinesia caused by levodopa (LD) injection. Dyskinesia in rats produced by LD is linked to the quantity of phosphorylated dopamine and cyclic adenosine monophosphate-regulated phosphoprotein (pDARPP-32), phosphorylated extracellular signal-regulated kinases 1/2 (p-ERK1/2), and fos protein. Furthermore, LD therapy caused rats to acquire aberrant involuntary reflexes [151].Metallic NPs are widely utilized in the cure of different illnesses, such PD, cancer, and rheumatoid arthritis, to name a few. Magnetic NPs, gold NPs (AuNPs), silver NPs (AgNPs), and cerium oxide NPs (CeO2NPs) are some of the metallic NPs that are utilized in the treatment of ailments [152]. Qiao et al. [153] synthesized Fe3O4 magnetic NPs and subsequently coupled them with lactoferrin, which functions as a brain MRI-guided delivery probe. Gao et al. [154] developed gold nanoclusters for the treatment of PD. Because of the two major features (particle size and redox properties), CeO2NPs are also gaining increasing interest in the treatment or prevention of neurodegenerative disorders (Table 1) [23, 155–163]. Dillon et al. [164] synthesized CeO2NPs and tested their antioxidant efficacy in a PD animal model caused by MPTP.Table 1
Therapeutic application of NPs in neurodegenerative disorders.
NanoparticleTherapeutic outcomesCell entryDiseaseReferenceSilverUpregulation of hydrogen sulphide (H2S) and Ag2S reduces neurotoxicitySilver’s natural properties cross the BBBPD[165]SilverAs a plant-based anti-Alzheimer medication, it has anticholinesterase and antioxidant actionSilver’s natural properties cross the BBBAD[166]GoldSuppression of Aβ42 aggregationEndocytosis of chiral nanoparticles across the BBBAD[167]GoldApoptosis of dopaminergic neurons in the substantia nigra striatum is inhibited by PC12 cellsNerve growth factor (NGF) endocytosisPD[168]SeleniumIn AD lesions, there is a reduction in amyloid plaquesCurcumin’s capacity to form intermolecular hydrogen bonds with amyloid b and iron in plaques without the need for supplementary chemical linkersAD[169]


## 9.3. Huntington’s Disease (HD)

HD is a neurodegenerative disorder which is characterized by an autosomal dominant mutation in the Huntingtin gene (HTT) that produces CAG trinucleotide repetitions at the 5′ end, leading to abnormal Huntingtin protein production and segmentation, which leads to neuronal damage and cytotoxicity [170]. This disease has a significant impact on the physical and psychological wellbeing of both the patients and health care providers and the socioeconomic level of the suffering persons and their families. HD strikes people primarily in their adulthood, when they are approximately 45 years old (on average), gradually overtaking the victim’s motor and cognitive capabilities while also affecting their behavioral responses [171]. Its autosomal dominant character is both a benefit and a drawback, as it has the most phenotypic penetrance and is monogenic, making it possible to target effectively compared to other neurodegeneratives, which are caused by a complicated network of biochemical processes [172]. The sole licensed medicine for HD is tetrabenazine, and most contemporary therapy approaches are symptom based [173]. Targeted activation of the cAMP respond element binding protein, as well as the usage of coenzyme Q and Creatine, are among the other ways now being investigated. Grip force (Q motor), HD-CAB (cognitive), caudate volume (MRI), cortical activity electroencephalogram, amounts of neurofilament and mutant Huntingtin in cerebrospinal fluid (CSF), and other biomarkers are used in several clinical studies for the evaluation of HD [170].Changes in neurochemical pathways including the dopamine, adenosine, and glutamate receptors, as well as oxidative damage and mitochondrial abnormalities, are all major contributors to HD pathophysiology. Sandhir et al. [174] employed solid-lipid NPs conjugated with curcumin to modify complex II activity in order to target mitochondrial abnormalities as a form of HD treatment. They also found that 3-nitropropionic acid increased the levels of Nrf2 mRNA. Bhatt et al. [175] tried every possible method, creating solid-lipid NPs conjugated with rosmarinic acid (RA) to target HD, relying on RA’s high-brain-targeting efficacy. Cong et al. [176] recently demonstrated the use of selenium (Se) in a targeted delivery method for HD. Se and selenoproteins have been linked to brain malfunctioning, mutant Huntingtin aggregation, and elevated numbers of oxidized glutathione. Se insufficiency in the brain has been linked to brain abnormalities, mutant Huntingtin aggregation, and higher levels of oxidized glutathione. Se NPs have been proven to be the least hazardous and have the greatest potential to prevent oxidative damage of all the numerous therapeutic forms of Se that have been examined, even at concentrations lower than 0.5×10−3M. The scientists also demonstrated that Se NPs can attenuate neurotoxicity and alleviate cognitive disruptions in a Caenorhabditis worm’s model of HD, even at doses lower than 2×106M. Due to exceptional qualities like the ability to control HDAC (histone deacetylase) activity and diminish poly Q aggregation, which is one of the characteristics of HD pathophysiology, Se and its application represent significant potential in the potential implementation of anti-HD treatments.


## 9.4. Amyotrophic Lateral Sclerosis (ALS)

People are diagnosed with ALS, a devastating category of NDs that causes the death of motor neurons in the spinal cord and brain. ALS is caused by genetic mutations in the superoxide dismutase 1 (SOD1) gene, which codes for the superoxide dismutase enzyme. SOD1 mutations generate harmful free radicals and inhibit proteasome and/or chaperone action, leading in protein misfolding and insufficient clearance [177]. Several clinical studies for the management of ALS have been unsuccessful in the past 10 years due to numerous limitations in traditional therapy techniques. The United States Food and Drug Administration (USFDA) has recognized riluzole as the only glutamate antagonist for the therapy of ALS. This eloquently demonstrates the critical desire for a new novel therapeutic strategy to the awful disease [178, 179]. To this purpose, nanomedicine, as we have shown, can represent a critical role in the development of innovative ALS treatment strategies. Bond et al. [180], for example, established riluzole administration utilizing solid-lipid NPs for the therapy of ALS with high drug encapsulation and improved clinical efficacy.


## 9.5. Epilepsy

Epilepsy is a noncommunicable chronic condition caused by fast neuronal exoneration and uncontrolled electrical discharges in certain brain cells. These can be classified as status epilepticus; however, they may appear with few or no behavioral symptoms [181–184]. Epilepsy affects around fifty million people worldwide, according to the World Health Organization (WHO) estimates, making it the fourth most common neurodegenerative condition. Early death, wounds related with seizures and fractures, and greater grades of psychiatric problems such as depression and stress are all anticipated in individuals with this ailment [185–187]. Examining the patient’s medical history, inspecting the nervous system, comprehensive blood chemistries, thyroid function tests, an electroencephalogram, and a brain investigation are only a couple of minor basic methods for detecting epilepsy. In recent years, improved diagnostic methods including as magnetic resonance imaging (MRI), positron emission tomography (PET), and single-photon emission computed tomography (SPECT) have been used for epilepsy biological imaging and detection. There is no approved remedy for epilepsy at the moment, and only a few antiepileptic drugs (AEDs) are frequently used to control the condition [188, 189]. Drug delivery technologies based on nanomedicine provide a diverse framework for epilepsy treatment. Liposomes, dendrimers, polymeric NPs, carbon-based NPs, micelles, AuNPs, and other drug delivery systems are being employed to treat epilepsy [189–193]. Thyrotropin-releasing hormone (TRH) containing polymeric NPs, for example, has been injected into the amygdala of epilepsy-prone rats [194, 195]. In animal studies of seizures, Yusuf et al. [196] found that poly D-lactic acid (PLGA) NPs of the β-carotene surface coated with polysorbate-80 increased antioxidant and anticonvulsant effects. Furthermore, Musumeci et al. [197] found that oxcarbazepine-loaded PLGA NPs increased the action of parent oxcarbazepine in epileptic seizures in mice when compared to parent oxcarbazepine.


## 9.6. Neuro-Acquired Immunodeficiency Syndrome (NeuroAIDS)

In the early stages of infection, human immunodeficiency virus 1(HIV 1) reaches the CNS, giving rise to NeuroAIDS, which encompasses both viral and neurological pathogenetic processes. About 15–30% of AIDS patients have neurological and neurocognitive problems, with dementia and encephalopathy affecting 7.3–11.3% and 30–60% of patients, respectively. BBB disturbance is not really the major cause of NeuroAIDS; activated endothelial cells with reduced barrier permeability, as well as CD 163, Glut5, and ISG15 genes, have been linked to the disease [198–202]. Because there are presently no viable vaccinations or specialized pharmacological therapies for NeuroAIDS, a significant advance to nanotechnology has offered light on new treatment options for HIV infection. In the management of NeuroAIDS, nanoformulated antiretroviral therapy (ART) was found to increase blood-brain penetration. In the HIV-1 encephalitis (HIVE) area of the brain, indinavir (IDV) NP-loaded murine bone marrow macrophages (BMM) promote lower HIV-1 replication [203, 204]. Their findings also showed that NP-loaded BMM can be used to explore targeted migration and antiviral reactions. Highly active antiretroviral therapy (HAART) based on nanotechnology also performed an important role in the treatment of psychosis. Polybutyl cyanoacrylate (PBCA), methyl methacrylate–sulfopropyl methacrylate (MMSPM), polylactide (PLA), and PLGA were nanoformulated with zidovudine, delavirdine, saquinavir, and lamivudine to raise BBP 10–20 times [205, 206]. In comparison to typical antiretroviral drug (ARV) medication treatment, liposome-loaded zalcitabine has been found to have enhanced efficacy and a longer half-life [207]. Solid lipid NP-loaded ARV medicines have recently gained attention. In NeuroAIDS, SLN-coated delavirdine and saquinavir ARV drugs replaced MMSPM-coated ARV drugs due to their large surface area and efficiency [203].


## 9.7. Stroke

Because it is hard to overcome the limitations of neuroregeneration in injured brain areas, stroke is the major cause of protracted impairment [208]. Angiogenesis and nerve proliferation are significantly suppressed with the development of ischemia, which is accompanied by an increased immune response, culminating in an ischemic cavity in the brain. Ischemia is responsible for roughly 87% of strokes, while hemorrhage is responsible for the rest [209, 210]. Ischemic stroke and behavioral abnormalities are caused by a lack of blood in the brain, which damages neurons and neuronal pathways. BBB breakdown and cerebral edema are linked to vascular endothelial growth factor levels [209]. The PEG NP-linked recombinant tissue plasminogen activator (rtPA) enhances the half-life of rtPA and reduces infarct volume during thrombosis [211]. Ceria NPs as antioxidants inhibit free radical proliferation in the initial stages of acute cerebral ischemia-reperfusion and so minimize the primary harm caused by ischemic stroke. When compared to free enzyme, solid polymer nanoparticles packed SOD as nanozyme lowers the volume of infarct regions in mouse models of stroke by over 50% [212, 213]. The sensor, which comprises of magnetic disks and a swellable hydrogel with high sensitivity to pH, has the potential to reduce the extent of ischemic stroke by improving brain tissue, protecting the BBB, and reducing neurotoxicity [214]. Biomimetic nanobubbles produced from platelet membranes can not only be used as a sensor to track the dynamic progression of a stroke using real-time contrast-enhanced ultrasound imaging but also be used for precise targeting and microvascular bioremodeling in the lesion [215].


## 10. Clinical Trials and Patent

The nanomedicine agency’s prospects for cancer and aging therapy are still quite positive. It is commonly acknowledged and experimentally demonstrated that such formulations tend to improve the efficacy of anticancer as well as aging medications by allowing for more precise and selective drug distribution. Clinical studies and patents addressing the investigation of NPs for the treatment of cancer and aging are included in Tables2 and 3.Table 2
Latest clinical trials relating to the use of NPs in cancer and aging therapy.
Study titleNCT no.Place of intended studyPhaseReferenceCurcumin in combination with 5FU for colon cancerNCT02724202Baylor Research InstitutePhase 1[216]Curcumin in preventing colorectal cancer in patients undergoing colorectal endoscopy or colorectal surgeryNCT00973869University of LeicesterPhase 1[217]Nanocurcumin for prostate cancer patients undergoing radiotherapy (RT)NCT02724618Shahid Beheshti University of Medical SciencesPhase 2[218]A clinical trial to study the effects of nanoparticle-based paclitaxel drug, which does not contain the solvent cremophor, in advanced breast cancerNCT00915369Fresenius Kabi Oncology Ltd.Phase 1[219]Paclitaxel albumin-stabilized nanoparticle formulation in treating patients of different ages with metastatic breast cancerNCT00609791City of Hope Medical CenterPhase 2[219]Nanoparticle albumin-bound (Nab) paclitaxel/cyclophosphamide in early-stage breast cancerNCT00629499SCRI Development Innovations, LLCPhase 2[219]Nab-paclitaxel and bevacizumab followed by bevacizumab and erlotinib in metastatic breast cancerNCT00733408University of WashingtonPhase 2[219]31P-MRS imaging to assess the effects of CNM-Au8 on impaired neuronal redox state in multiple sclerosis (REPAIR-MS)NCT03993171Clene NanomedicinePhase 2[220]A phase 1 SAD and MAD clinical trial of CNM-Au8 in healthy male and female volunteersNCT02755870Clene NanomedicinePhase 1[221]Table 3
Latest patents relating to the use of NPs in cancer and aging therapy.
Patent no.TitleYearReferencesCN110841073Preparation method of CPZ-coupled MS2 protein nanoparticles and application thereof in breast cancer resistance2020[222]WO/2020/018049Lipid nanoparticles loaded with ceranib-2 as anticancer agent2020[222]US20190328677Decreased adhesivity receptor-targeted nanoparticles for Fn14-positive tumors2020[222]CN 106265624Pharmaceutical composition for treating breast cancer, medicine transferring system, and preparation method thereof2017[223]US20170258929 A1Cancer treatment combination compositions, methods, and uses2017[223]WO 2020 023530A3The invention claims effective administration of a composition comprising a therapeutically effective amount of anti-Aβ protofibril antibody for the treatment of AD. The focus of invention is to convert amyloid-positive subjects to negative in the early Alzheimer case2019[224]WO 2018 081460A1The novel antibody composition (at a dose ranging from 2.5 mg/kg to 10 mg/kg) is used for treating, preventing, and/or delaying the onset and/or development of AD2018[224]


## 11. Conclusion and Future Prospects

The therapeutic methods that integrate tumor-targeted nanomedicines with other clinical therapies have acquired a positive response. Furthermore, current research advances are focusing on the creation of systems that can respond to externally applied stimuli and can be activated to release their payload. These techniques are expected to be utilized to target medicines other than traditional antineoplastic drugs, such as anti-inflammatory medications to suppress tumor-associated inflammation or siRNA to lower the expression of proteins that are important for tumor growth. Because of the growing incidence and mortality of cancer, additional research is needed to discover innovative diagnostic and therapeutic approaches for treating this cancer successfully. The majority of neurological diseases, such as brain tumors, degenerative AD, PD, and those with an inflammatory component, have a significant impact on human health. Because of the BBB’s strict protection, conventional therapeutics have limited access and so are therapeutically ineffective. NPs might be a promising technique for enhancing cancer prognosis and treatment choices. Imaging, efficient transport, and administration of medicines to particular target locations are both possible with NPs. As a result, NPs can be used as delivery vehicles to improve the therapeutic and pharmacological properties of cancer-fighting drugs. The incorporation of NPs into therapeutic molecules helps preserve the medication against degradation while also ensuring consistent targeting and release. NPs have the capacity to cross the BBB and influence drug reactions at the cellular level due to their small size.However, addressing the challenge of how nanotechnology can be used industrially while maintaining health, safety, and environmental protection remains a key challenge. Efforts have been made to create techniques that will allow many industrial processes to scale up, with new ways becoming safer and easier to maintain. The industry may anticipate a variety of new products for both enterprises and consumers, which will create doors for other industries where the relationship between strength and weight balance is important. We explored the possible applications of NPs for cancer and aging treatment in this article. Therapeutic studies will be needed to assess the clinical effectiveness of these NP solutions in the treatment of cancer and aging.



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