Abstract
Cancer is still a global public health problem. Although remarkable success has been achieved in cancer diagnosis and treatment, the high recurrence and mortality rates remain severely threatening to human lives and health. In recent years, peptide nanomedicines with precise selectivity and high biocompatibility have attracted intense attention in biomedical applications. In particular, there has been a significant increase in the exploration of peptides and their derivatives for malignant tumor therapy and diagnosis. Herein, we review the applications of peptides and their derivatives in the diagnosis and treatment of bladder cancer, providing new insights for the design and development of novel peptide nanomedicines for the treatment of bladder cancer in the future.
Introduction
One recent report from the World Health Organization’s International Agency for Research on Cancer (IARC) released the latest global cancer burden data, showing that 4.57 million cancer cases and 3 million resultant deaths increased in 2020 in China. Among them, bladder cancer is one of the common urinary malignancies and ranks among the top ten cancers in terms of morbidity and mortality. Bladder cancer is one of the most expensive cancers to cure because of its high recurrence rate (). Although new techniques involving radiotherapy, immunotherapy, chemotherapy, etc., are blossoming in the treatment of bladder cancer (; ; ), their toxic side effects and high costs limit their broad applications in clinical applications. Early diagnoses, including the examination of circulating tumor cells, CT scan, magnetic resonance imaging, positron emission tomography, bone scan, chest X-ray, etc., are crucial for the diagnosis and treatment of bladder cancer (; ; ), but their disadvantages, such as nonspecificity, heterogeneity, and excessive detection, still limit their potential clinical applications (). Cystoscopic biopsy can improve the diagnostic accuracy, but it is difficult to identify superficial mucosal lesions such as carcinoma in situ, and it is invasive. Abscission cytology is a standard non-invasive test for the diagnosis and monitoring of bladder cancer. It has the disadvantage of being insensitive to low-grade tumors and depends on accurate diagnosis by the pathologist ().
The primary purpose of drug delivery is to send enough drug payloads to the lesion sites while minimizing their exposure to healthy tissues. To improve the specificity and pharmacokinetics of anticancer drugs and avoid the side effects of traditional therapies, two main strategies involving drug carriers and covalent modifications are widely used. Drug carriers such as nanoparticles and hydrogels can protect drugs from the external environment before on-demand release when they reach lesion sites. Meanwhile, the physical and chemical properties of the drug carriers significantly determine their biological distributions (; ). Covalent modifications enable temporarily masking or limiting the bioactivity of the drugs and confer them with the desired pharmacokinetics (; ; ). It is noteworthy that both the abovementioned strategies can alleviate the burden of drug metabolism and improve the therapeutic effects of the original drugs. Among numerous drug molecules, peptides are highly competitive candidates for the treatment of bladder cancer because of their small sizes, high specificity, low systemic toxicity, etc. In addition, the diagnosis of bladder cancer mainly depends on pathology and imaging examinations, while the detection accuracy is still low. Using specific biomarkers on bladder tumor cells, peptide nanotechnology can significantly improve the sensitivity and specificity for the diagnosis of bladder cancer. (; ).
Peptide-Instructed Tumor Diagnosis
Magnetic resonance imaging (MRI) is a noninvasive technique for tumor diagnosis in current clinical medicine. Although it has been shown that MRI has the ability to display three-dimensional anatomical details without injury and provide high spatial resolution without invasiveness, MRI is still less sensitive than fluorescence imaging for monitoring tiny tissue damage, cellular activity, molecular activity, etc (Chandra et al., 2010; ). Therefore, the development of new contrast agents is expected to enable the improvement of the detection accuracy of MRI. Paramagnetic Gd3+ complexes and superparamagnetic iron oxide (SPIO) nanoparticles are two widely used contrast agents in MRI detection. Compared with the paramagnetic Gd3+ complex, SPIO is a better alternative to MRI contrast agents, of which the signal contrast is several orders of magnitude higher than that of the traditional Glacki contrast agent (). In a study of human bladder tumors, the researchers reported that 1.5T magnetic resonance imaging using SPIO as the contrast agent realized in situ detection of malignant tumors with a small size to ∼4 mm, while it was unable to effectively distinguish the depth of tumor invasion into the bladder walls (). The main reason is that the cellular internalization levels of SPIO are limited, and less than 1% of SPIO is internalized by nonspecific endocytosis pathways (). Due to the great promise of SPIO in MRI applications, researchers have endeavored to develop a variety of SPIO conjugates to enhance its cellular uptake ratio, in which cell-penetrating peptides (CPPs), such as R11, are considered to be one of the best transporters to improve the active internalization of nanoparticles into target cells (; ). Ding et al. recently also developed an SPIO nanoparticle whose surfaces are unctionalized with bladder cancer-specific fluorescein isothiocyanate (FITC) labeled cell-penetrating peptide (CPP) -polyarginine peptide (R11) for active targeting and imaging for bladder cancer, respectively. Their study showed that SPIO-R11 nanoparticles can be internalized by T24 cells in a dose-dependent manner, and that SPIO-R11 internalized dose is higher than that of SPIO itself, since R11 is a cell-permeable peptide that enables efficient drug delivery. Transmission electron microscopy (TEM) results indicated that SPIO-R11 is mainly located in cellular vesicles and lysosomes, but no signals in the nucleus were found. Due to the cellular specificity of SPIO-R11, the uptake of nanoparticles into bladder cancer cells was significantly higher than that of immortalized bladder epithelial cells. In addition, SPIO-R11 had a lower T2 relaxation time in MRI than SPIO. These results suggested that SPIO-R11 has great potential as a targeted contrast agent for the diagnosis and treatment of bladder cancer ().
Tumor cells are mutated from normal cells, of which the signal transduction pathways are significantly different from those of normal cells. Therefore, many signaling regulators or regulatory proteins are overexpressed in tumor cells and can be used as specific targets for tumor diagnosis (; ). Recently, targeted peptides have attracted intense attention because they can specifically bind with receptors on tumor cells. By conjugating with radioactive or fluorescent probes, scientists have prepared a variety of peptide probes to specifically orient and image tumors (; ; ; ; ). For instance, Wei et al. recently constructed a loaded nanoscale oxygen generator (PLZ4@SED) by conjugating superparamagnetic iron oxide nanoparticles (SPIOns) with peptide motifs specific to bladder cancer cells. PLZ4@SED showed good tumor targeting and permeability to patient-derived bladder cancer cells. Meanwhile, they illustrated that the presence of PLZ4@SED can improve the contrast of MRI and promote chemotherapeutic efficacy by producing oxygen through the Fenton reaction to relieve hypoxia. It was also reported that PLZ4@SED presented great potential in the diagnosis and treatment of bladder cancer (). demonstrated one successful application of mesoporous silica nanoparticles (MSN), which are functionalized using a bladder cancer-specific peptide CyC6, as the magnetic resonance contrast agent. Due to the effective binding of the modified MSN to tumor cells, tumor boundaries were much clearer in the T1-and T2-weighted MRI and fluorescence cystoscopic inspections compared to the traditional technique.
Cystoscopy is one gold standard for the diagnosis of bladder cancer. However, cystoscopy is an invasive and costly technique, and it is difficult to detect flat malignancies using this technique. Meanwhile, urine cytology is low-sensitivity for detecting low-grade lesions, of which the detection accuracy is highly dependent on the experience of the cytopathologists (; ; ). Recently, several potential biomarkers have been identified that could potentially provide noninvasive and objective approaches for the detection of bladder cancers (). Lee et al. presented one peptide conjugate consisting of fluorescein and the peptide sequence of CSNRDARRC. They reported that the peptide conjugate can specifically bind to bladder cancer tissue using frozen sections. Meanwhile, the peptide conjugate could selectively bind to bladder tumor epithelial cells when it was injected into the bladder cavity using a tumor-bearing rat model. Furthermore, Lee et al. found that the peptide conjugate had the ability to indicate bladder tumor cells in urine, presenting great potential to be exploited as a real-time diagnostic probe to detect bladder cancer (). Prothrombin activators (TSPs) can prevent angiogenesis in a variety of pathological conditions. Some structural domains and peptide derivatives of TSP-2 enable the promotion of angiogenesis in BC tissues. 4N1K (KRFYVVMWKK), derived from the C-terminal cell-binding domain of TSP-2, plays an important role in the pathology and prognosis of bladder cancer. Using the hematoxylin-eosin (H&E) staining technique to examine tumor tissues from bladder cancer patients, Nakamura et al. verified that 4N1K was significantly correlated with the tumor apoptosis index and microvascular density but negatively related to T stage, metastasis and tumor grade; promising 4N1K may be a useful biomarker and a new therapeutic target for UC-UUT patients ().
Peptide-instructed Local Chemotherapy
Transurethral resection combined with chemotherapeutic infusion is the standard treatment protocol for nonmuscular invasive bladder cancer. However, the low bioavailability () and short retention period of the current chemotherapeutic drugs (; ) restricted their exposure time at the lesion sites. Along with the advancement of nanotechnology, nanocarrier drug delivery systems show advantages in solving these problems. designed and synthesized a kind of positively charged intelligent peptide nanocarrier cross-linked with disulfide bonds [i.e., PLL-P (LP-co-LC). They prepared one nanogel system (NG/HCPT) using this nanocarrier by artificially loading 10-hydroxycamptothecin (10-HCPT). Compared with free 10-HCPT, NG/HCPT not only has a higher drug loading rate, longer retention time, and stronger tissue penetration ability but can also accurately and rapidly release 10-HCPT into bladder cancer cells, significantly enhancing the corresponding antitumor effects and reducing the side effects (Figure 1). In 2020, Guo et al. further synthesized a new R9-polyethylene glycol poly (L-phenylalanine-L-cysteine) nanogel (R9-PEG-P (LP-co-LC)] based on NG/HCP, which can improve the adhesion and permeability of chemotherapeutic drugs. They prepared the R9NG/HCPT nanogel using 10-HCPT as a model drug. The morphology of R9NG/HCPT is similar to that of an octopus with a spear. Highly positively charged R9 with strong membrane penetrability can help R9NG/HCPT pass across the bladder walls and enhance its cellular adhesion interactions through nonspecific and electrostatic interactions, thus enabling prolonged exposure to chemotherapeutic drugs at the lesion sites. This system significantly improved the tumor suppression efficiencies of 10-HCPT in both in situ mice and rat tumor models, suggesting great potential in the local chemotherapy of bladder cancer (Guo et al., 2020).
FIGURE 1
Polymeric micelles constructed using amphiphilic block copolymers have been widely explored in recent decades due to their high drug loading efficiency, long cycle time, well-controlled release ability, and good targeting properties (
The combination usages of two or more drugs showed great advantages in cancer treatments involving improving therapeutic efficacy, lowering side effects, and preventing drug resistance, which are promising strategies for the treatment of refractory cancers. The positively charged adhesive chitosan-polymethacrylic acid (CM) nanocapsules loaded with DOX and cisplatin modified with peptide (Pt-Aly) presented high drug loading efficiency and sustained drug release properties. Meanwhile, CM nanocapsules can be firmly attached to the surface of the bladder cavity, prolong the retention time of the payload in the bladder, and have the effect of synergistically killing UMUC3 bladder cancer cells. In addition, CM nanocapsules have no obvious damage to the urothelium, which is expected to cooperate with intravesical chemotherapy in the treatment of non-muscle invasive bladder cancer (
Peptide-assisted Systemic Chemotherapy
Systemic chemotherapy is one of the dominant techniques used to treat musculoskeletal invasive bladder cancer (
FIGURE 2

(A) The molecular structure of HCPT-FF-GFLG-EEYSAYPDSVPMMS; (B) The illustration of the bladder tumor cell targeting, intracellular fibrillation and drug release of HCPT-FF-GFLG-EEYSAYPDSVPMMS(Zeng et al., 2021a).
Peptide-instructed Gene Therapy
Gene therapy is a revolutionary technique that directly uses therapeutic genes to treat various diseases. As one alternative to traditional treatments (
Epidemiological data have shown that more than 50% of human malignancies, including bladder cancer, are related to mutations in the p53 gene (Hainaut et al., 1997). Mutant p53 protein enables the acceleration of tumor formation and metastasis and is associated with resistance to radiotherapy and chemotherapy, as well as poor prognosis (
Peptide-mediated Photothermal Therapy
Photothermal therapy (PTT) is a highly promising strategy to defeat malignancies that mainly utilizes photothermal materials to convert light energy into heat in situ, finally raising the local temperature to result in cell apoptosis and tumor killing (
FIGURE 3

Schematic illustration of synthesizing BBTD + GA/PEG-cRGD nanoparticles for photohyperthermia therapy of MIBC(Zeng et al., 2021a).
Therapeutic Peptides
Mitochondria play an important role in apoptotic death (
FIGURE 4

Bld-1-KLA destroys the mitochondrial membrane and induces apoptosis.
Fibroblast cytokine 9 (FGF9) is overexpressed in many cancer cells (
Conclusion
In recent decades, significant success has been achieved in the diagnosis, treatment, and prevention of bladder cancer. However, bladder cancer is characterized by polycentricity, multiple occurrences, and recurrence, suggesting great challenges for its clinical treatment. With the development of modern biosynthesis technology, peptide nano drugs have become one of the hot spots in drug research. Compared with monoclonal antibody drugs, recombinant protein drugs and small molecule drugs, peptide nano drugs have the characteristics of simple spatial structure, significant curative effect and high safety, and have been widely used in the diagnosis and treatment of tumors. With the continuous progress of related technologies, the clinical application of peptide nano drugs is more and more in-depth, and the development space is broad. Peptides are promising for intracellular delivery of chemical drugs, DNA, siRNA, fluorescent molecules and nanoparticles. Compared with other chemical entities, peptides have the advantages of low molecular weight, low cost and good stability. At the same time, polypeptides can be easily modified to attach and enter tumor cells, and finally transport the goods to the desired and desired places. In general, peptide nanodrugs can improve tumor targeting and permeability, reduce systemic toxicity, reduce and prevent recurrence, shorten treatment time and reduce treatment cost. They are of great value for the clinical application of bladder cancer. Peptide drugs have outstanding advantages. With the continuous progress of biotechnology and peptide synthesis technology, peptide drugs have broad market development space and are expected to become one of the main drugs for cancer diagnosis and treatment (
Statements
Author contributions
SZ and XF wrote the manuscript. SX, ZX, and ZM collected references. QL supervised the whole work. All the authors approved this manuscript.
Funding
This work was financially supported by the General Project of Tianjin Natural Science Foundation (21JCYBJC00220), Tianjin Health Science and technology project (ZC20162) and Tianjin Key Medical Discipline (Specialty) Construction Project.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Summary
Keywords
peptide, bladder cancer, diagnosis, treatment, nanomedicines
Citation
Zeng S, Feng X, Xing S, Xu Z, Miao Z and Liu Q (2022) Advanced Peptide Nanomedicines for Bladder Cancer Theranostics. Front. Chem. 10:946865. doi: 10.3389/fchem.2022.946865
Received
18 May 2022
Accepted
13 June 2022
Published
05 August 2022
Volume
10 - 2022
Edited by
Fan Huang, China Academy of Chinese Medical Sciences, China
Reviewed by
Jingyu Wang, Tianjin Medical University, China
Shenglu Ji, Xinxiang Medical University, China
Ruoyao Zhang, Beijing Institute of Technology, China
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Copyright
© 2022 Zeng, Feng, Xing, Xu, Miao and Liu.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Qian Liu, simomlq@163.com
† These authors have contributed equally to this work
This article was submitted to Nanoscience, a section of the journal Frontiers in Chemistry
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