Abstract
Nanomedicines are considered one of the promising strategies for anticancer therapy; however, the low targeting efficiency of nanomedicines in vivo is a great obstacle to their clinical applications. Camouflaging nanomedicines with either platelet membrane (PM) or platelet would significantly prolong the retention time of nanomedicines in the bloodstream, enhance the targeting ability of nanomedicines to tumor cells, and reduce the off-target effect of nanomedicines in major organs during the anticancer treatment. In the current review, the advantages of using PM or platelet as smart carriers for delivering nanomedicines to inhibit tumor growth, metastasis, and recurrence were summarized. The opportunities and challenges of this camouflaging strategy for anticancer treatment were also discussed.
Introduction
A drug delivery system based on nanoparticles (NPs) is considered a promising strategy for cancer treatment, which could bring an anticancer drug to a specific targeted tumor site, increase the drug concentration in cancer cells, and avert toxicity in normal cells in vivo (). Although nanoparticles could protect the anticancer drug from degradation and clearance in the body, most of the nanoparticles would be removed by the reticuloendothelial system (RES) in the liver and spleen when they are transported through the body after intravenous injection (). Chan et al. found that only about 0.7% of the intravenous trastuzumab-coated nanoparticles could reach the tumor site in mice (). The low targeting efficiency caused by nanoparticle–biological interactions is a fatal challenge for the application of nanomedicines in the clinic. For understanding the journey of nanoparticles from the intravenous injection site to the tumor site, the CAPIR (circulation, accumulation, penetration, internalization, and release) cascade rule is illustrated in early research (), which includes circulation in the blood compartments, accumulation in the tumor, penetration deep into the tumor tissue, internalization by tumor cells, and intracellular drug release (Figure 1). Therefore, much higher targeting efficiency for nanomedicines toward cancer cells would be achieved if these nanoparticles efficiently complete the CAPIR cascade (–). The nanoparticles that fulfill the rule would be the most excellent drug carriers in the drug delivery system. However, the design of CAPIR-capable nanocarriers is still a tough challenge in the drug delivery field because the required functions for nanocarriers would be different or even opposite in different CAPIR steps (). For example, the surface of nanomedicines should be neutral, the size should be large, and the stability should be excellent in the circulation step, while the surface of nanomedicines should be positive for effective cell-membrane binding, the size should be small enough for deep tumor penetration, and the nanomedicines could easily be disassembled to release the drug in tumor cell in the other steps (, ). Thus, how to design nanomedicines to effectively accomplish the CAPIR cascade is a very hot issue in drug delivery research (, ).
Figure 1
Recently, living cells have been considered attractive drug delivery vehicles for cancer therapy due to their high biocompatibility, natural targeting capability, high drug-loading capacity, and good ability to cross biological barriers (
Table 1
| Nanomedicine delivery carriers | Therapeutic methods | Therapeutic agents | Release condition | Ref. |
|---|---|---|---|---|
| PM-coated core–shell nanovehicle | Immunotherapy/chemotherapy | TRAIL/Dox | pH | ( |
| PM-coated silica particle | Immunotherapy | TRAIL | ─ | ( |
| PM-coated porous CS-PLGA | Chemotherapy | Bufalin | pH | ( |
| PM-coated PLGA | Chemotherapy | DTX | ─ | ( |
| PM-coated PLGA | PTT/chemotherapy | IR780/Dox | pH | ( |
| PM-coated liposome | PDT | Ce6 | NIR laser | ( |
| RGD peptide-modified PM | PTT/chemotherapy | MNPs/Dox | NIR laser | ( |
| Platelet | Immunotherapy | aPDL1 | Platelet activation | ( |
| Liposome-coated platelet in situ | Immunotherapy | TRAIL | ─ | ( |
| Platelet | PTT | AuNRs | Platelet activation | ( |
| Platelet | Immunotherapy/PTT | R837/NDI-BT | Platelet activation | ( |
| Nanodiamond-loaded platelet | Chemotherapy | Dox | Platelet activation/pH | ( |
| Platelet | PTT/chemotherapy | IR-820/PDA@Dox | NIR laser | ( |
PM and platelet for nanomedicine delivery.
PM, platelet membrane; CS, chitosan oligosaccharide; PLGA, poly(lactic-co-glycolic acid); NIR, near-infrared; MNPs, melanin nanoparticles; PTT, photothermal tumor therapy; PDT, photodynamic therapy; TRAIL, tumor necrosis factor-related apoptosis-inducing ligand; Dox, doxorubicin.
Functions of platelet
Platelets, derived from megakaryocytes (MKs), are well known for the functions of preventing bleeding, wound healing, and vessel repairing. When the vasculature is damaged or ruptured, platelets could be activated and undergo dramatic shape changes for adhesion to the site of injury, forming a “platelet plug” and blood clotting for hemostasis (31, 32). Regardless of the normal functions, platelets are also known to be involved in tumor angiogenesis (
Figure 2

Platelets stimulate tumor angiogenesis, enhance vascular permeability, and promote the formation of metastatic tumors. Platelets stimulate tumor angiogenesis through the release of angiogenesis regulator factors, such as vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF), after activation in the tumor site; platelets trigger epithelial–mesenchymal transition (EMT) activation to enhance vascular permeability of tumor cell; circulating tumor cells (CTCs) binding with platelets are protected from shear stress and immune elimination.
Platelet membrane coating nanomedicines
Recently, the PM-coating strategy is considered one of the promising techniques for drug delivery in anticancer therapies (
Figure 3

Preparation of platelet membrane (PM)-coated nanomedicines used for inhibiting tumor growth and metastasis. The isolated platelets from whole blood were fragmented by freeze–thaw cycles assisted by sonication and purified by centrifugation to give the desired PM (
In 2015, Gu’s group (
It is known that porous nanoparticles could more efficiently load and release drugs for cancer treatment (71). In 2019, porous poly(lactic-co-glycolic acid) (PLGA) polymer nanoparticles coated with PM were reported for anticancer drug bufalin (Bu) delivery (
PM could also help photosensitizers transport to the tumor vicinity for photodynamic therapy (PDT). Chlorin e6 (Ce6) was loaded into liposome to form Ce6-loaded liposome (Lps/Ce6) (73). PM was mixed with the Lps/Ce6 to fabricate PM/Lps/Ce6 system. After intravenous injection into 4T1 tumor-bearing mice, the PM/Lps/Ce6 showed long retention time in the bloodstream, low toxicity, and specific targeting ability to tumor tissue. After near-infrared (NIR) irradiation, the Ce6 was released in the tumor site, and enough reactive oxygen species (ROS) was generated for efficient PDT treatment for breast cancer (
PM could be modified with some biomaterials to improve its targeting property. RGD (Arg-Gly-Asp) peptides could randomly link to the PM proteins to form RGD peptide-modified nanoscale platelet vesicles (RGD-NPVs) that could specifically bind to αvβ3 integrin to improve targeting effect to cancer cells and tumor vasculature (
Platelet loading nanomedicines
Platelets could also be used as an excellent drug delivery carrier for targeting and releasing drugs in cancer treatment (Figure 4). The medicines could be loaded into the platelet through electroporation (
Figure 4

Platelet-loaded nanomedicine for inhibiting tumor growth and metastasis through chemotherapy, immunotherapy, or photothermal tumor therapy (PTT). Purified platelets were obtained from the whole blood by centrifugation. Then the nanomedicines were loaded into the platelet through electroporation methods to form a platelet-loaded nanomedicine system. After intravenous injection, the platelet-loaded nanomedicines would interact with tumor cells through adhesion and activation, and the loaded medicines are released for inhibiting tumor growth and metastasis through chemotherapy, immunotherapy, or PTT.
In 2017, a cancer immunotherapy model using antibodies against programmed-death ligand 1 (aPDL1)-conjugated platelets was reported for the prevention of cancer recurrence and metastasis after surgery (
Usually, the platelet-based drug delivery system needs to get purified platelets first and then load them with nanomedicines to fabricate the delivery system. That is not very convenient for clinical applications. King’s group reported that engineered nanoscale liposomes could bind to human platelets in situ under physiological shear conditions ex vivo (
Platelets could not only facilitate the anticancer drugs transport to tumor cells but also efficiently transport photosensitive nanoparticles to tumor tissues for PTT. Gold nanorods (AuNRs) were loaded on murine platelets to prepare the platelet-AuNRs (PLT-AuNRs) with long retention time, specifically cancer targeting and effective photothermal properties. The temperature of the tumor surface could be increased with each laser irradiation after 24 h post-injection of PLT-AuNRs; better PTT effects could be achieved in mouse models with head and neck squamous cell carcinoma (HNSCC). Moreover, the authors found that PLT-AuNRs displayed a better performance than platelet membrane-coated AuNRs in immune evasion and PTT (
Moreover, platelets could also load different components for the combination of anticancer therapies. In 2021, Ma et al. developed a good anticancer strategy that exhibited combined photothermal immunotherapy for cancer treatment (
Concluding remarks and prospects
Platelet or its membrane camouflaging strategy is a promising approach for targeted nanomedicine delivery in anticancer treatment. Platelets and PM could protect nanomedicines from shear stress and send a “don’t eat me” signal to the immune system for escaping immunosurveillance (82) during the circulation process in the bloodstream. The proteins in the platelet membrane could specifically target tumor cells that effectively enhance the accumulation of nanomedicines in tumor tissues and greatly reduce the off-target side effect of nanomedicines. All these results illustrated that the PM or platelet camouflaged nanomedicines had effectively achieved the CAP process and displayed higher targeting efficiency for anticancer therapy than unprotected nanomedicines. Moreover, combined anticancer therapies could be performed by loading two different agents, for example, loading chemotherapeutic drugs and photothermal agents for combined chemo-photothermal treatment (
However, the PM or platelet camouflaging strategy is still far away from the clinical application. For example, 1) the source of the platelet is the first issue that should be considered. Platelets from the donors are not enough to meet patient demand, which greatly limits large-scale applications. 2) The integrity of PM should be considered for PM-coating nanomedicines. The PM structure and protein sequence may be changed, and some fragments would be lost when treated with a lysis buffer during the preparation process, which would result from unexpected side effects in circulation. 3) Platelet activation would cause dramatic shape changes and lead to the release of intracellular content (83). Undesired activation of platelet-related nanomedicines should be avoided in storage and circulation (84). 4) Moreover, the camouflaging nanomedicines that showed long retention time in the bloodstream, high targeting ability to tumor tissue, and deep tumor penetration are still sequestered in the spleen and liver, and only a small portion of nanomedicines would reach the tumor sites (
The PM or platelet camouflaging nanomedicines demonstrated long circulation time in the bloodstream, efficient tumor accumulation, and deep tumor penetration for the inhibition of tumor growth, metastasis and recurrence, However, more efforts and multi-field collaborations are required for clinical applications of these camouflaging nanomedicines. It is time to develop easily prepared, visible, and smart carriers to efficiently deliver medicine to tumor tissues. For example, artificial platelets released from human-induced pluripotent stem cell-derived MKs could be a sufficient resource for clinical applications in the near future (85), and we could also expect that, with the help of gene editing and chemical editing, the membrane protein expression level on the artificial platelets would be precisely regulated to let the artificial platelets become smarter for targeting tumor tissues and decorated with fluorescent materials at the same time to make the artificial PM and platelets visible while being monitored during the ex vivo generation procedure. As a result, the man-made artificial PM and platelets with bright fluorescence and specific ligands targeting the overexpressed receptors on tumor cells will widely be used as smart carriers for drug delivery. Meanwhile, nanomedicines as well as some tumor microenvironment (TME) modulators will be coated with either artificial PM or artificial platelets to form visible and smart nanosystems for anticancer treatment. After intravenous injection, the nanosystems, which could be visible through fluorescence imaging, would show a long blood circulation to give time for tumor accumulation, because the PM or platelets could protect the nanomedicines from the shear stress and immunosurveillance efficiently. Moreover, the nanosystems would be accumulated in the tumor site due to the EPR and mainly based on the TCIPA and the specific ligand–receptor interaction. As the nanomedicines and TME modulators are released in the tumor site, the TME modulators would normalize the TME to enhance nanomedicine penetration (86), and the nanomedicines would penetrate the tumor easily and become positively charged as acidity increases, efficiently triggering fast cellular uptake. As a result, the combination of state-of-the-art nanotechnology, biotechnology, and material science would achieve efficient chemotherapy, immunotherapy, PTT, PDT, or combined therapies by using PM or platelet camouflaging strategy for anticancer treatment.
Funding
This work was supported by grants from the National Natural Science Foundation of China (82020108025, 81770197, and 81903838), Young talents program of Chongqing (T03010008), and Natural Science Foundation of Chongqing, China (cstc2020jcyj-msxmX0051 and 2022NSCQ-MSX4384).
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.
Statements
Author contributions
XL: writing–review and editing. LH: writing—review. CT: writing—review. XW: writing—review. QR: supervision. LC: supervision and editing. ZL: supervision and editing. All authors contributed to the article and approved the submitted version.
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.
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Summary
Keywords
platelet membrane, platelet, nanomedicine, delivery system, anticancer therapy
Citation
Li X, Hu L, Tan C, Wang X, Ran Q, Chen L and Li Z (2022) Platelet-promoting drug delivery efficiency for inhibition of tumor growth, metastasis, and recurrence. Front. Oncol. 12:983874. doi: 10.3389/fonc.2022.983874
Received
01 July 2022
Accepted
20 September 2022
Published
06 October 2022
Volume
12 - 2022
Edited by
Kevin Ni, St. George Hospital Cancer Care Centre, Australia
Reviewed by
Xing Zhou, Chongqing University of Technology, China; Rong Xu, Monash University, Australia
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Copyright
© 2022 Li, Hu, Tan, Wang, Ran, Chen and Li.
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: Li Chen, chenli200401@163.com; Zhongjun Li, johnneyusc@gmail.com
This article was submitted to Molecular and Cellular Oncology, a section of the journal Frontiers in Oncology
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