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<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Molecular Medicine Reports</journal-id>
<journal-title-group>
<journal-title>Molecular Medicine Reports</journal-title>
</journal-title-group>
<issn pub-type="ppub">1791-2997</issn>
<issn pub-type="epub">1791-3004</issn>
<publisher>
<publisher-name>D.A. Spandidos</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3892/mmr.2019.10218</article-id>
<article-id pub-id-type="publisher-id">mmr-20-01-0005</article-id>
<article-categories>
<subj-group>
<subject>Review</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Advances in nanomaterials for use in photothermal and photodynamic therapeutics</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author"><name><surname>Yang</surname><given-names>Zhizhou</given-names></name>
<xref rid="af1-mmr-20-01-0005" ref-type="aff">1</xref>
<xref rid="fn1-mmr-20-01-0005" ref-type="author-notes">&#x002A;</xref></contrib>
<contrib contrib-type="author"><name><surname>Sun</surname><given-names>Zhaorui</given-names></name>
<xref rid="af1-mmr-20-01-0005" ref-type="aff">1</xref>
<xref rid="fn1-mmr-20-01-0005" ref-type="author-notes">&#x002A;</xref></contrib>
<contrib contrib-type="author"><name><surname>Ren</surname><given-names>Yi</given-names></name>
<xref rid="af1-mmr-20-01-0005" ref-type="aff">1</xref></contrib>
<contrib contrib-type="author"><name><surname>Chen</surname><given-names>Xin</given-names></name>
<xref rid="af1-mmr-20-01-0005" ref-type="aff">1</xref></contrib>
<contrib contrib-type="author"><name><surname>Zhang</surname><given-names>Wei</given-names></name>
<xref rid="af1-mmr-20-01-0005" ref-type="aff">1</xref></contrib>
<contrib contrib-type="author"><name><surname>Zhu</surname><given-names>Xuhui</given-names></name>
<xref rid="af1-mmr-20-01-0005" ref-type="aff">1</xref>
<xref rid="af2-mmr-20-01-0005" ref-type="aff">2</xref></contrib>
<contrib contrib-type="author"><name><surname>Mao</surname><given-names>Zongwan</given-names></name>
<xref rid="af3-mmr-20-01-0005" ref-type="aff">3</xref></contrib>
<contrib contrib-type="author"><name><surname>Shen</surname><given-names>Jianliang</given-names></name>
<xref rid="af4-mmr-20-01-0005" ref-type="aff">4</xref>
<xref rid="af5-mmr-20-01-0005" ref-type="aff">5</xref></contrib>
<contrib contrib-type="author"><name><surname>Nie</surname><given-names>Shinan</given-names></name>
<xref rid="af1-mmr-20-01-0005" ref-type="aff">1</xref>
<xref rid="c1-mmr-20-01-0005" ref-type="corresp"/></contrib>
</contrib-group>
<aff id="af1-mmr-20-01-0005"><label>1</label>Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, P.R. China</aff>
<aff id="af2-mmr-20-01-0005"><label>2</label>Department of Epidemiology and Microbiology, Huadong Medical Institute of Biotechniques, Nanjing, Jiangsu 210002, P.R. China</aff>
<aff id="af3-mmr-20-01-0005"><label>3</label>MOE Key Laboratory of Bioinorganic and Synthetic Chemistry, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, P.R. China</aff>
<aff id="af4-mmr-20-01-0005"><label>4</label>State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China</aff>
<aff id="af5-mmr-20-01-0005"><label>5</label>Wenzhou Institute of Biomaterials and Engineering, Chinese Academy of Science, Wenzhou, Zhejiang 325001, P.R. China</aff>
<author-notes>
<corresp id="c1-mmr-20-01-0005"><italic>Correspondence to</italic>: Dr Shinan Nie, Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu 210002, P.R. China, E-mail: <email>shn_nie@sina.com</email></corresp>
<fn id="fn1-mmr-20-01-0005"><label>&#x002A;</label><p>Contributed equally</p></fn>
</author-notes>
<pub-date pub-type="ppub"><month>07</month><year>2019</year></pub-date>
<pub-date pub-type="epub"><day>09</day><month>05</month><year>2019</year></pub-date>
<volume>20</volume>
<issue>1</issue>
<fpage>5</fpage>
<lpage>15</lpage>
<history>
<date date-type="received"><day>21</day><month>03</month><year>2018</year></date>
<date date-type="accepted"><day>23</day><month>10</month><year>2018</year></date>
</history>
<permissions>
<copyright-statement>Copyright: &#x00A9; Yang et al.</copyright-statement>
<copyright-year>2019</copyright-year>
<license license-type="open-access">
<license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivs License</ext-link>, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.</license-p></license>
</permissions>
<abstract>
<p>Nanomaterials play crucial roles in the diagnosis and treatment of diseases. Photothermal and photodynamic therapy, as two minimally invasive therapeutic methods, have promising potential in the diagnosis and prevention of cancer. Recently, many photothermal materials (such as noble metal material, transition metal sulfur oxides, carbon material and upconversion nanomaterial) and photodynamic materials (such as phthalein cyanogen, porphyrins and other dye molecules) have been applied in photothermal therapy (PTT) and photodynamic therapy (PDT). Moreover, as nanomaterials have suitable biocompatibility, these materials have been applied in cancer therapy. In the present review, we summarized the effects of different material types, synthesis methods, material morphologies and surface modifications on the outcomes of cancer therapy. The application of nanomaterials in PTT and PDT was introduced and the advantages and disadvantages of PTT and PDT in the prevention of cancer were discussed. Finally, we discussed the application of nanomaterials in the combination of PTT and PDT in cancer treatment.</p>
</abstract>
<kwd-group>
<kwd>nanomaterial</kwd>
<kwd>cancer</kwd>
<kwd>photothermal therapy</kwd>
<kwd>photodynamic therapy</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec sec-type="intro">
<label>1.</label>
<title>Introduction</title>
<p>Cancer is the second leading cause of human mortality. In phototherapy, specific wavelengths of light are adopted to treat diseases including both cancer and infection (<xref rid="b1-mmr-20-01-0005" ref-type="bibr">1</xref>&#x2013;<xref rid="b4-mmr-20-01-0005" ref-type="bibr">4</xref>). To date, photothermal therapy (PTT) and photodynamic therapy (PDT) are the two most common phototherapy methods for treating cancer (<xref rid="b5-mmr-20-01-0005" ref-type="bibr">5</xref>). In PTT, a photothermal (PT) agent is stimulated by both specific band light and vibrational energy/heat release to selectively target abnormal tissues and cells (<xref rid="b6-mmr-20-01-0005" ref-type="bibr">6</xref>). In PDT, photosensitizer (PS) drugs which are photoactivated molecules or materials, generate reactive oxygen species (ROS) through a series of photochemical reactions. As a result, the triggered oxidative stress in target cells is able to induce intracellular lipid peroxidation, DNA injury and protein damage, ultimately leading to cell death (<xref rid="b7-mmr-20-01-0005" ref-type="bibr">7</xref>,<xref rid="b8-mmr-20-01-0005" ref-type="bibr">8</xref>). Recently, nanomaterials have garnered much attention and have been extensively studied (<xref rid="b9-mmr-20-01-0005" ref-type="bibr">9</xref>&#x2013;<xref rid="b11-mmr-20-01-0005" ref-type="bibr">11</xref>). Many effective photothermal and photodynamic nanomaterials have been applied in the diagnosis and treatment of cancer (<xref rid="b12-mmr-20-01-0005" ref-type="bibr">12</xref>,<xref rid="b13-mmr-20-01-0005" ref-type="bibr">13</xref>). The discrepancies, for example, size, structure and morphology, existing between PTT and PDT materials may affect the effectiveness of phototherapy. This review predominantly summarizes the effects produced by different types, formulations, morphologies and modifications on the photothermal or photodynamic properties of materials. Moreover, we compared the effectiveness of distinct nanomaterials in cancer phototherapy and discussed the advantages and disadvantages of PTT and PDT. In addition, we introduce the application of the assembly of nanomaterials in cancer phototherapy. Thus, the present study aimed to i) summarize PT and PD materials, ii) present their properties and iii) discuss their relevance in cancer therapy.</p>
</sec>
<sec>
<label>2.</label>
<title>Application of nanometer materials in PTT</title>
<sec>
<title/>
<sec>
<title>Precious metal nanomaterials</title>
<p>Recently, Au (gold) nanocages, a novel class of nanomaterials, have been reported to be potential photothermal transducers and drug carriers for mainstream clinical practice in the near future (<xref rid="b14-mmr-20-01-0005" ref-type="bibr">14</xref>). Au nanocages have attracted great attention in regards to cancer imaging, diagnosis and treatment (<xref rid="b15-mmr-20-01-0005" ref-type="bibr">15</xref>,<xref rid="b16-mmr-20-01-0005" ref-type="bibr">16</xref>). Wang <italic>et al</italic> (<xref rid="b17-mmr-20-01-0005" ref-type="bibr">17</xref>,<xref rid="b18-mmr-20-01-0005" ref-type="bibr">18</xref>) and Shrestha <italic>et al</italic> (<xref rid="b19-mmr-20-01-0005" ref-type="bibr">19</xref>) showed that Au nanostructures were able to absorb near infrared light and convert light to heat. Among Au nanorods, Au nanocages and Au nanohexapods, the effect of Au nanohexapods was found to be highly outstanding and it exhibited the highest cell uptake and the lowest cytotoxicity <italic>in vitro</italic> (<xref rid="b18-mmr-20-01-0005" ref-type="bibr">18</xref>). Moreover, in athymic mice (Nude-Foxn1nu nude) bearing breast tumors (the tumors were generated through an subcutaneous injection of MDA-MB-435 cells in the right flanks of mice), the PEGylated Au nanohexapods displayed significant blood circulation. Additionally, this study also showed that the accumulation of nanoparticles (passive target effect) in the tumor site was elevated due to the enhanced penetration effect of the nanoparticles (<xref rid="b18-mmr-20-01-0005" ref-type="bibr">18</xref>). Thus, heat was produced to dampen target cancer cells in PTT based on the PEGylated Au nanostructures (<xref rid="b18-mmr-20-01-0005" ref-type="bibr">18</xref>). These results indicated the biocompatibility of the Au nanostructures <italic>in vivo</italic>, pointing to the potential application of Au nanostructures in the clinic. Furthermore, the temperature around the tumor region was higher in the PEGylated Au nanohexapods than temperatures in other PEGylated Au nanostructures (<xref rid="f1-mmr-20-01-0005" ref-type="fig">Fig. 1A and B</xref>). In this way, the tumors absorbed more heat through the PEGylated Au nanohexapods, therefore helping realize the goal of detecting and treating the cancer. Researchers have reported that as a new class of branched Au nanostructures, Au nanohexapods are more effective in drug loading and photothermal conversion in comparison to those with smoother surfaces (<xref rid="b20-mmr-20-01-0005" ref-type="bibr">20</xref>,<xref rid="b21-mmr-20-01-0005" ref-type="bibr">21</xref>). Therefore, we conclude that Au nanohexapods are a promising candidate material for the diagnosis and treatment of cancer.</p>
</sec>
<sec>
<title>Transition metal sulfide materials</title>
<p>Although precious metal nanomaterials have attracted much attention in PTT due to their strong absorption of near infrared light (<xref rid="b22-mmr-20-01-0005" ref-type="bibr">22</xref>), transition metal sulfide materials that have the effect of surface plasma resonance are gaining increased attention for their advantages of low-price, high efficiency of photothermal conversion and competent biocompatibility (<xref rid="b23-mmr-20-01-0005" ref-type="bibr">23</xref>,<xref rid="b24-mmr-20-01-0005" ref-type="bibr">24</xref>). One study reported that copper sulfide (CuS) nanoparticle-based drug delivery was effective in cancer treatment (<xref rid="b25-mmr-20-01-0005" ref-type="bibr">25</xref>). In this study, the CuS-based drug was not only taken up by MCF-7 cells and could effectively convert NIR light into heat, but also generated a large amount of reactive oxygen species (ROS) for photodynamic therapy. Moreover, the photothermal heating of Cu<sub>2-x</sub>Se nanocrystals after 5 min of laser irradiation at 33 W/cm<sup>2</sup> led to the cell destruction of human colorectal cancer HCT-116 cells, pointing to the possible viability of Cu<sub>2-x</sub>Se for PTT therapy (<xref rid="b26-mmr-20-01-0005" ref-type="bibr">26</xref>). Furthermore, tungsten oxide has also been confirmed to be pertinent to tumor CT imaging and PTT (<xref rid="b27-mmr-20-01-0005" ref-type="bibr">27</xref>).</p>
<p>The effect of W<sub>18</sub>O<sub>49</sub> nanowire in PTT has been explored in a previous study (<xref rid="b28-mmr-20-01-0005" ref-type="bibr">28</xref>). The results of the study showed that ultrathin PEGylated W<sub>18</sub>O<sub>49</sub> nanowire was formulated by heating WCl<sub>6</sub> with ethanol and PEG. Following this treatment method, the prepared blue aqueous dispersions with W<sub>18</sub>O<sub>49</sub> nanowires were able to enhance the absorption of near infrared light. Under the irradiation of a 980-nm laser (which is safe for humans when the power density is set to 0.72 W&#x00B7;cm<sup>2</sup>), the temperature of aqueous dispersions with the W<sub>18</sub>O<sub>49</sub> nanowires (0.25&#x2013;3.0 g/l) was increased by 12.2&#x2013;41.2&#x00B0;C within 5 min (<xref rid="b28-mmr-20-01-0005" ref-type="bibr">28</xref>). In the animal studies, severe combined immunodeficiency (SCID) mice were inoculated with K7M2 cells and were grouped into control and treatment groups. Mice in the treatment group were injected with W<sub>18</sub>O<sub>49</sub> nanowires (100 &#x00B5;l, 2 g/l) at the central region of the tumor with a depth of ~4 mm. Mice in the control and treatment groups were simultaneously irradiated for 10 min at 0.72 W/cm<sup>2</sup> by two similar 980-nm laser devices. Full-body thermographic images and temperature were recorded during the irradiation. It was observed that the temperature of tumor tissues was quickly elevated to 50.0&#x00B1;0.5&#x00B0;C within 120 sec of irradiation (<xref rid="b28-mmr-20-01-0005" ref-type="bibr">28</xref>) (<xref rid="f2-mmr-20-01-0005" ref-type="fig">Fig. 2</xref>). Hence, as a near-infrared laser-induced photothermal agent, the PEGylated W<sub>18</sub>O<sub>49</sub> nanowires exhibited superior efficiency in PTT and such an efficacy can be largely explained by their high efficiency of photothermal conversion and low cytotoxicity.</p>
</sec>
<sec>
<title>The influencing factors in PTT</title>
<p>The morphology of a nanomaterial has significant effects on its physical chemistry and biological properties (<xref rid="b29-mmr-20-01-0005" ref-type="bibr">29</xref>). The flower-like nano copper sulphide can be prepared by the hydrothermal method as previously described (<xref rid="b30-mmr-20-01-0005" ref-type="bibr">30</xref>). The light can be reflected in nano-flowered copper sulphide multiple times based on the mechanism of light reflection (<xref rid="f3-mmr-20-01-0005" ref-type="fig">Fig. 3A</xref>). As a result, the photoabsorption is increased and the photothermal conversion efficiency is enhanced. Researchers have confirmed that the photothermal conversion efficiency of flower-like nano copper sulphide is elevated by 50&#x0025; in comparison to ordinary hexagonal sulfide nanoparticles (<xref rid="b30-mmr-20-01-0005" ref-type="bibr">30</xref>). In addition, the temperature of a superstructure nano-CuS aqueous solution was found to be increased by 17.3&#x00B0;C within 5 min under irradiation with a low power density of 0.51 W&#x00B7;cm<sup>2</sup> by a 980-nm laser <italic>in vitro</italic> (<xref rid="f3-mmr-20-01-0005" ref-type="fig">Fig. 3B</xref>). These findings may inspire researchers to develop nanoparticles that can provide high photothermal conversion efficiency in PTT.</p>
<p>As reported by Tian <italic>et al</italic> (<xref rid="b31-mmr-20-01-0005" ref-type="bibr">31</xref>), the photothermal conversion efficiency of Cu<sub>9</sub>S<sub>5</sub> nanoparticles reached 25.7&#x0025;, which was higher than that of as-synthesized Au nanorods (23.7&#x0025; from 980 nm laser) and that of (Cu<sub>2&#x00D7;</sub>Se) nanocrystals (NCs) (22&#x0025; from an 808-nm laser). The temperature of Cu<sub>9</sub>S<sub>5</sub> NCs (40 ppm) reached 15.1&#x00B0;C within 7 min under the irradiation condition of a 980-nm laser with a power density of 0.51 W&#x00B7;cm<sup>2</sup>. Moreover, although semiconductor nanocrystals containing copper exhibit low cost and low toxicity, they have a high stability and high photothermal conversion efficiency (<xref rid="b32-mmr-20-01-0005" ref-type="bibr">32</xref>). Importantly, the cancer cells can be killed by the photothermal effects of the Cu<sub>9</sub>S<sub>5</sub> NCs under 980-nm laser irradiation with the conservative and safe power density over a short period (~10 min) (<xref rid="b31-mmr-20-01-0005" ref-type="bibr">31</xref>). A previous study demonstrated that the DNA-decorated Cu<sub>9</sub>S<sub>5</sub> nanoparticles could be used as NIR light responsive drug carriers in tumor chemo-phototherapy (<xref rid="b33-mmr-20-01-0005" ref-type="bibr">33</xref>). This indicated that the efficient photothermal effects produced by nanoparticles may contribute to killing cancer cells.</p>
<p>Thermal stability is a highly critical parameter for photothermal materials (<xref rid="b34-mmr-20-01-0005" ref-type="bibr">34</xref>). If the heating rate far exceeds the cooling rate, the heat will rapidly accumulate in the lattice. Therefore, a high temperature of nanoparticles will be reached at a specific area over a short period of time, and structural changes in terms of the shape or integrity of nanoparticles will result (<xref rid="b35-mmr-20-01-0005" ref-type="bibr">35</xref>). A previous study showed that core-shell nanomaterial-Fe<sub>3</sub>O<sub>4</sub>@Cu<sub>2-x</sub>S has high photothermal stability and super-paramagnetism (<xref rid="b36-mmr-20-01-0005" ref-type="bibr">36</xref>). This previous study also confirmed that as they had an intense absorption in the near infrared region of 960 nm, these core-shell nanomaterials could serve as a magnetic resonance imaging T2 contrast agent and were able to be employed in infrared thermal imaging. Furthermore, the photothermal effect of nanoparticles can be controlled by altering the content of Cu in the core-shell nanomaterials. The synergistic effect of magnetic and photothermal phenomena employed in this study may lay a solid foundation for the development of nanoprobes in multimode biomedicine application. In addition, the thermal stability of core-shell nanomaterials was also improved in the same study. From the transmission electron microscope laser scanning images, it was clearly observed that the shape of core-shell nanomaterials and the absorption of near infrared remained approximately the same after administration of 980-nm laser irradiation for 30 min (<xref rid="f4-mmr-20-01-0005" ref-type="fig">Fig. 4</xref>). This suggested that the thermal stability of nanomaterials is critical in biomedical application.</p>
</sec>
<sec>
<title>Carbon nanomaterials</title>
<p>Carbon nanotubes are able to absorb near-infrared light so as to efficiently convert light to heat (<xref rid="b37-mmr-20-01-0005" ref-type="bibr">37</xref>). Thus, carbon nanotubes could be used for thermal ablation, diagnosis and drug delivery in cancer for its high aspect ratio, ultra-light weight, high mechanical strength, high electrical conductivity and high thermal conductivity (<xref rid="b38-mmr-20-01-0005" ref-type="bibr">38</xref>). Ultra-small nano-reduced graphene has been demonstrated to possess acceptable performance in absorbing near-infrared light (<xref rid="b39-mmr-20-01-0005" ref-type="bibr">39</xref>). The size and surface compositions of graphene are in close relation to its thermal properties (<xref rid="b40-mmr-20-01-0005" ref-type="bibr">40</xref>). The average transverse dimension of graphene is approximately 20 nm. The modification with targeted peptides can increase the specificity of graphene in killing target cells (<xref rid="b41-mmr-20-01-0005" ref-type="bibr">41</xref>). As demonstrated by Yang <italic>et al</italic> (<xref rid="b40-mmr-20-01-0005" ref-type="bibr">40</xref>), the damage to cancer cells was dramatically augmented in raphene-based PTT. Nevertheless, the power density of the laser used in this study was 0.15 W&#x00B7;cm<sup>2</sup>, which is less than the power density used (0.5&#x2013;2 W&#x00B7;cm<sup>2</sup>) by most photothermal research institutes.</p>
<p>Liu <italic>et al</italic> (<xref rid="b42-mmr-20-01-0005" ref-type="bibr">42</xref>) developed graphene-iron oxide-gold nanoparticles (GO-IONP-Au), which efficiently combined the photothermal properties of graphene (the magnetic properties of iron oxide) and the properties of the surface plasma resonance of gold nanoparticles. Moreover, the folate receptor on GO-IONP-Au nanoparticles showed better performances in target cell killing and damage. Thus, GO-IONP-Au acquired both passive and active targeting prosperities. Moreover, GO-IONP-Au has magnetic properties and thus could be employed as an imaging agent for nuclear magnetic imaging in cancer therapy. Additionally, the surface plasma resonance effect produced by gold nanoparticles in GO-IONP-Au increased its photoabsorbtion and light-heat conversion efficiency. As an effective PTT agent, graphene in combination with gold nanoparticles also enhanced the effect of GO-IONP-Au in PTT. Furthermore, Liu <italic>et al</italic> also proved that PEG modifications enabled the GO-IONP-Au to be more biocompatible. GO-IONP-Au inhibited tumor growth and reduced the tumor size <italic>in vivo</italic> (<xref rid="f5-mmr-20-01-0005" ref-type="fig">Fig. 5</xref>). In summary, as graphene-based photothermal nanocomposites, GO-IONP-Au is a powerful and promising PTT agent that can be applied in dual mode imaging (nuclear magnetic imaging and thermal imaging) with its multi-functional magnetic, surface plasma resonant effects. This suggested that graphene-based multi-functional nanocomposite materials have great potential in the diagnosis and treatment of cancer.</p>
<p>For its suitable biocompatibility, the effect of PEG-BPEI-rGO nanocomposites in gene transfection has already been investigated (<xref rid="b43-mmr-20-01-0005" ref-type="bibr">43</xref>). In this previous study, the collapse of the endocytosis containing the transfection gene was regulated by heat, thereby controlling the time and site of gene release. This not only provided a simple, practical and highly efficient strategy for developing possible drugs and gene carriers, but also inspired a new insight for gene therapy.</p>
</sec>
</sec>
</sec>
<sec>
<label>3.</label>
<title>Application of nanometer materials in PDT</title>
<p>Combining photosensitizers and light irradiation, photodynamic therapy (PDT) is an emerging new treatment method for treating various diseases, including cancers (such as lung, breast, bladder and brain cancer) and non-cancer diseases (such as bacterial and fungal infections, premalignant conditions and inflammatory conditions) (<xref rid="b44-mmr-20-01-0005" ref-type="bibr">44</xref>). Nevertheless, most of the conventional PDT photosensitizers are stimulated by visible light (VIS), which cannot penetrate thick tissues or reach deep tumor tissue (<xref rid="b45-mmr-20-01-0005" ref-type="bibr">45</xref>). Thus, VIS can only be employed in treating skin or shallow tissues. A range of 700&#x2013;1,100 nm (<xref rid="b8-mmr-20-01-0005" ref-type="bibr">8</xref>,<xref rid="b46-mmr-20-01-0005" ref-type="bibr">46</xref>) has been accepted as the absorption window for most biomolecules. Therefore, near-infrared light (NIR) was adopted in PDT as NIR can penetrate deep tissue, eliminating cancer cells.</p>
<sec>
<title/>
<sec>
<title>Upconversion nanoparticles</title>
<p>Upconversion nanoparticles are able to convert light from long wavelengths to short wavelengths through the excitation of NIR light (<xref rid="b47-mmr-20-01-0005" ref-type="bibr">47</xref>). Upconversion nanoparticles with fine crystallinity and monodispersity have been successfully synthesized, with their sizes controlled within 100 nm (<xref rid="b48-mmr-20-01-0005" ref-type="bibr">48</xref>). A previous study reported that penetrated NIR light is converted into VIS by upconversion nanoparticles in a diseased site, therefore leading to the absorption of VIS by photosensitizers (<xref rid="b49-mmr-20-01-0005" ref-type="bibr">49</xref>). Finally, the cytotoxic reactive oxygen species (ROS) produced by the photosensitizers would attack the unwanted cells (<xref rid="f6-mmr-20-01-0005" ref-type="fig">Fig. 6</xref>) (<xref rid="b7-mmr-20-01-0005" ref-type="bibr">7</xref>,<xref rid="b49-mmr-20-01-0005" ref-type="bibr">49</xref>). These results point to the significance of upconversion nanoparticles in non-invasive deep tissue imaging, drug delivery and photomodynamics (<xref rid="b50-mmr-20-01-0005" ref-type="bibr">50</xref>,<xref rid="b51-mmr-20-01-0005" ref-type="bibr">51</xref>).</p>
<p>Qian <italic>et al</italic> (<xref rid="b52-mmr-20-01-0005" ref-type="bibr">52</xref>) and Chatterjee and Yong (<xref rid="b53-mmr-20-01-0005" ref-type="bibr">53</xref>) explored the effect of upconversion nanoparticles on PDT. Qian <italic>et al</italic> (<xref rid="b52-mmr-20-01-0005" ref-type="bibr">52</xref>) proved that the effect of two photosensitizers in combination produced better than that of the use of a signal one. Noticeably, the combined photosensitizers did not need the excitation of multiple wavelengths. In the two studies (<xref rid="f7-mmr-20-01-0005" ref-type="fig">Fig. 7</xref>), multiple upconversion nanomaterials (UCNs) with different colors and emissions were irradiated under a 980-nm laser to activate two types of photosensitizers, and therefore the effect of PDT was improved. Upconversion nanoparticles effectively converted the near-infrared light into visible light emission (<xref rid="b53-mmr-20-01-0005" ref-type="bibr">53</xref>). The wavelength of emitted visible light is matched with the maximum absorption wavelength of the photosensitizer, therefore activating the photosensitizer so as to produce the cytotoxic single line oxygen.</p>
<p>Mesoporous silica-coated upconversion nanoparticles with photosensitizers were loaded in B16-F0 melanoma-bearing C57BL/6 mice (<xref rid="b54-mmr-20-01-0005" ref-type="bibr">54</xref>). The tumor growth of the mice was examined under laser irradiation. Data from this study showed that the exposure of upconversion nanoparticles with 980-nm laser irradiation activated MC540 and ZnPc, which then enhanced the therapy effect of PDT. Moreover, upconversion nanoparticle modification by folic acid and PEG (FA-PEG-UCNs) has also been developed to increase the bio-application values. Furthermore, upconversion nanoparticles could be conjugated with multiple dopants and employed for target labeling and imaging (<xref rid="b55-mmr-20-01-0005" ref-type="bibr">55</xref>). A previous study demonstrated that FA-coupled up-converting nanophosphors (UCNPs) effectively targeted folate-receptor over-expressing HeLa cells <italic>in vitro</italic> and HeLa tumors <italic>in vivo</italic> (<xref rid="b56-mmr-20-01-0005" ref-type="bibr">56</xref>). Recently, upconversion nanoparticles have been coupled with fluorescence resonant energy transfer (FRET) technology to form efficient biological labels that were used for the diagnostics of diseases (<xref rid="b55-mmr-20-01-0005" ref-type="bibr">55</xref>). In this study, 7-nm gold nanoparticles, which were coupled with the UC Na (Y<sub>1.5</sub>Na<sub>0.5</sub>)F<sub>6</sub>:Yb<sup>3&#x002B;</sup>, Er<sup>3&#x002B;</sup> nanoparticles (energy donors), were formed into a FRET biosensor whose strong absorption of gold nanoparticles matches well with the upconversion emission. This suggested that the efficiency of the FRET system based upon upconversion nanoparticles was elevated. Such a finding will promote the progression of fluorescence imaging. In addition, Gd<sup>3&#x002B;</sup>-based upconversion nanoparticles have been formulated as magnetic resonance imaging (MRI) imaging agents. NaGd<sub>4</sub>:Yb/Er nanoparticles may be used as probes for bioimaging (<xref rid="b57-mmr-20-01-0005" ref-type="bibr">57</xref>,<xref rid="b58-mmr-20-01-0005" ref-type="bibr">58</xref>). Taken together, upconversion nanoparticles, which can convert near-infrared light to visible light in deep tissues, are promising in translating basic research concepts into clinical practice (<xref rid="b59-mmr-20-01-0005" ref-type="bibr">59</xref>).</p>
</sec>
</sec>
</sec>
<sec>
<label>4.</label>
<title>Combination of PTT and PDT</title>
<sec>
<title/>
<sec>
<title>Supramolecular polymers</title>
<p>Supramolecular polymers display great potentials for applications in the biomedical field for its special structural and physicochemical properties (<xref rid="b60-mmr-20-01-0005" ref-type="bibr">60</xref>,<xref rid="b61-mmr-20-01-0005" ref-type="bibr">61</xref>). The application of PDT was restricted for its oxygen-dependent characteristics (<xref rid="b62-mmr-20-01-0005" ref-type="bibr">62</xref>). Porphyrins belong to the class of four-pyrrole, which is a major component of hemoglobin and myoglobin (<xref rid="b63-mmr-20-01-0005" ref-type="bibr">63</xref>). The biological activity of porphyrins is indispensable to living organisms. These molecules are highly conjugated macrocyclic compounds and may contain a central metallic atom such as Mg<sup>2&#x002B;</sup> or Fe<sup>2&#x002B;</sup> (<xref rid="b64-mmr-20-01-0005" ref-type="bibr">64</xref>). Porphyrins is considered as long-wavelength-absorbing sensitizers (<xref rid="b65-mmr-20-01-0005" ref-type="bibr">65</xref>). Therefore, for its application in medical treatment (<xref rid="b66-mmr-20-01-0005" ref-type="bibr">66</xref>,<xref rid="b67-mmr-20-01-0005" ref-type="bibr">67</xref>), porphyrins have generated scientific interest worldwide. Differences between the distribution and photodegradation of hematoporphyrin can be used to distinguish noncancerous from cancerous human breast tissue in Raman spectroscopy (<xref rid="b68-mmr-20-01-0005" ref-type="bibr">68</xref>).</p>
<p>Porphysomes are similar to liposomes. The potential applications of this material have been discussed (<xref rid="b69-mmr-20-01-0005" ref-type="bibr">69</xref>). According to previous studies, porphysomes could be formulated by exploiting the mechanism of hydrophobic self-assembly (<xref rid="f8-mmr-20-01-0005" ref-type="fig">Fig. 8A</xref>) (<xref rid="b70-mmr-20-01-0005" ref-type="bibr">70</xref>&#x2013;<xref rid="b72-mmr-20-01-0005" ref-type="bibr">72</xref>). Zheng <italic>et al</italic> (<xref rid="b73-mmr-20-01-0005" ref-type="bibr">73</xref>) found that porphysomes, whose monodisperse diameter is 100 nm (<xref rid="f8-mmr-20-01-0005" ref-type="fig">Fig. 8B</xref>), could enhance its passive accumulation in tumor tissues through the osmotic cycle effect. Moreover, smaller nanoparticles with 30 nm diameter can be obtained by ultrasonic treatment in water. In addition, porphysomes with a diameter of 100 nm can be loaded with approximately 8&#x00D7;10<sup>4</sup> porphyrin molecules. Furthermore, porphysomes can be degraded in living cells (<xref rid="f8-mmr-20-01-0005" ref-type="fig">Fig. 8C</xref>). The fluorescence quenching test was performed to test the quenching property of porphysomes loaded with numerous porphyrin molecules in the same study (<xref rid="f9-mmr-20-01-0005" ref-type="fig">Fig. 9</xref>). The results showed that the quenching of porphysomes increased 1,200 times in comparison to the standard liposomes, generating a considerably stronger quenching than the common porphyrins. The fluorescence quenching could lead to the generation of heat and singlet oxygen production (<xref rid="b69-mmr-20-01-0005" ref-type="bibr">69</xref>). Researchers suggested that porphysomes have a high photothermal conversion efficiency. It was also confirmed that porphysomes accumulated in tumors induced photothermal tumor ablation under laser irradiation (<xref rid="b74-mmr-20-01-0005" ref-type="bibr">74</xref>). In addition, based on the tissue section and blood indicators, it can be observed that large doses of porphyrins did not cause liver and kidney injuries (<xref rid="b74-mmr-20-01-0005" ref-type="bibr">74</xref>), and that porphysomes were prone to enzymatic degradation (<xref rid="b74-mmr-20-01-0005" ref-type="bibr">74</xref>). Therefore, porphyrins may be used as a biodegradable, ultra-molecular photothermal therapy agents on account of their minimal toxicity and high photothermal conversion efficiency.</p>
<p>The effect of porphyrins and porphysomes in hypoxic/hyperoxic tumor tissues has previously been investigated. Huynh and Zheng pointed out that porphyrins exhibited acceptable performance in the treatment of hyperoxic tumors (<xref rid="b69-mmr-20-01-0005" ref-type="bibr">69</xref>). This finding is consistent with the mechanism of single line oxygen in PDT. Interestingly, porphysomes exhibited excellent effects both in the treatment of hyperoxic tumors and in the treatment of hypoxic tumors, and effectively compensated for the defects in PDT (<xref rid="f10-mmr-20-01-0005" ref-type="fig">Fig. 10</xref>). This result may inspire research associated with ultra-molecular assembly in PDT, which may promote the quenching of the materials and produce more heat to kill cancer cells.</p>
</sec>
</sec>
</sec>
<sec sec-type="conclusions">
<label>5.</label>
<title>Conclusions</title>
<p>As non-invasive methods of phototherapy, the clinical value of photothermal therapy (PTT) and photodynamic therapy (PDT) are of significance in the prevention of cancer. Photothermal materials (such as precious metal nanomaterials, transition metal sulfide, carbon nanomaterials and upconversion nanoparticles) and photodynamic materials (such as phthalocyanas, porphyrins and other dye molecules) have been extensively investigated in recent years. The effect of PTT and PDT are largely dependent on distinct materials, different preparation methods, morphologies and modification methods. These parameters of materials can be modified in terms of varied purposes and needs. Additionally, PTT and PDT have their own advantages and defects. However, the combination of PTT and PDT not only provides enough time to achieve an effective treatment temperature for PTT, but also overcomes the obstacle of oxygen dependence accompanied with PDT. Therefore, such an combination could achieve a complementary synergistic effect in cancer therapy. Thus, a natural progression of this work is to practically transform the combination of PTT and PDT from basic science to clinical application.</p>
</sec>
</body>
<back>
<ack>
<title>Acknowledgements</title>
<p>The authors express thanks for permission to reprint the figures from the relevant publication organizations. The permission and copyright are stated in the figure legends and proper documentation has been provided.</p>
</ack>
<sec>
<title>Funding</title>
<p>This study was supported by the National Natural Science Foundation of China (grant nos. 81701894 and 81401583), the Major Projects Foundation of General Logistics Department of PLA (grant no. CNJ14L002), the Social Development Projects of Jiangsu Province (grant no. BE2017720), the Jiangsu Provincial Medical Youth Talent (grant nos. QNRC2016908, QNRC2016909) and the Peking Union Farsighted Emergency Project (grant no. RE2016-002), the Startup Fund of Wenzhou Institute of Biomaterials and Engineering (grant no. WIBEZD2017001-03).</p>
</sec>
<sec>
<title>Availability of data and materials</title>
<p>The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.</p>
</sec>
<sec>
<title>Authors&#x0027; contributions</title>
<p>ZY conceived and designed the review, and drafted and revised the manuscript. ZS analyzed the previous research, and drafted and revised the review. YR and XC contributed to the literature search, data collection, and revisions. WZ, XZ, ZM and JS analyzed the previous research, and ZM and JS also revised the manuscript. SN designed and revised the review, and analyzed the previous research.</p>
</sec>
<sec>
<title>Ethics approval and consent to participate</title>
<p>Not applicable.</p>
</sec>
<sec>
<title>Patient consent for publication</title>
<p>Not applicable.</p>
</sec>
<sec>
<title>Competing interests</title>
<p>The authors state that they have no competing interests.</p>
</sec>
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<floats-group>
<fig id="f1-mmr-20-01-0005" position="float">
<label>Figure 1.</label>
<caption><p>(A) Thermographs indicating the temperature of tumor tissues in mice for different periods of time in PTT. The mice were intravenously injected with aqueous suspensions of PEGylated nanohexapods, nanorods, nanocages and saline. (B) The relation of average temperature within the tumor tissues and the irradiation time. Laser power density, 1.2 W&#x00B7;cm<sup>2</sup> (Reprinted from ref 18 with permission. Copyright 2013, American Chemical Society). PTT, photothermal therapy; nanohex, nanohexapods; nanor, nanorods; nanoc, nanocages.</p></caption>
<graphic xlink:href="MMR-20-01-0005-g00.tif"/>
</fig>
<fig id="f2-mmr-20-01-0005" position="float">
<label>Figure 2.</label>
<caption><p>Temperature of PEGylated W<sub>18</sub>O<sub>49</sub> nanowire <italic>in vivo</italic> and <italic>in vitro</italic>. Laser, 980 nm; power density, 0.72W&#x00B7;cm<sup>2</sup>. The concentration of W<sub>18</sub>O<sub>49</sub> nanowire PBS solution was 2 g/l (Reprinted from ref 28 with permission. Copyright 2013, John Wiley and Sons).</p></caption>
<graphic xlink:href="MMR-20-01-0005-g01.tif"/>
</fig>
<fig id="f3-mmr-20-01-0005" position="float">
<label>Figure 3.</label>
<caption><p>(A) Schematic diagram for mirror and photothermal transformation of superstructure nanoCuS. (B) The relation between temperature and superstructure nanoCuS for different periods of time. Laser, 980 nm; power density, 0.51 W&#x00B7;cm<sup>2</sup> (Reprinted from ref 30 with permission. Copyright 2011, John Wiley and Sons).</p></caption>
<graphic xlink:href="MMR-20-01-0005-g02.tif"/>
</fig>
<fig id="f4-mmr-20-01-0005" position="float">
<label>Figure 4.</label>
<caption><p>Photothermal stability comparison for (A and B) Fe<sub>3</sub>O<sub>4</sub>@Cu<sub>2-x</sub>S core-shell nanomaterials and (C and D) Au nanorods (50&#x00D7;15 nm). Laser, 980 nm; power density, 2 W&#x00B7;cm<sup>2</sup>; irradiation time, 30 min (Reprinted from ref 36 with permission. Copyright 2013, American Chemical Society).</p></caption>
<graphic xlink:href="MMR-20-01-0005-g03.tif"/>
</fig>
<fig id="f5-mmr-20-01-0005" position="float">
<label>Figure 5.</label>
<caption><p>(A) The formulation of PEGylated GO-IONP-Au. (B) The temperature for different periods of time in GO-PEG, GO-IONP-Au-PEG and saline. (C) The tumor growth curves of tumor-bearing mice in different periods of time (Reprinted from ref. 74 with permission. Copyright 2013, Elsevier Ltd. All rights reserved).</p></caption>
<graphic xlink:href="MMR-20-01-0005-g04.tif"/>
</fig>
<fig id="f6-mmr-20-01-0005" position="float">
<label>Figure 6.</label>
<caption><p>Schematic diagram for the application of upconversion nanoparticles in PDT (Reprinted from ref 7 with permission. Copyright 2011, Elsevier Ltd. All rights reserved). PDT, photodynamic therapy; NIR, near-infrared light; UCNP, up-converting nanophosphors.</p></caption>
<graphic xlink:href="MMR-20-01-0005-g05.tif"/>
</fig>
<fig id="f7-mmr-20-01-0005" position="float">
<label>Figure 7.</label>
<caption><p>(A and B) Scanning electron microscopy (SEM) images of NaYF<sub>4</sub>:Yb/Er upconversion nanoparticles coated with mesoporous-silica. (C) Photoluminescence spectroscopy of MC540, ZnPc and upconversion fluorescence of UCN (dashed lines indicate the curve of photosensitizer light absorption). (D) The treatment mechanism of MC540 and ZnPc (Reprinted from ref 53 with permission. Copyright 2012, Springer Nature). UCN, upconversion nanomaterials.</p></caption>
<graphic xlink:href="MMR-20-01-0005-g06.tif"/>
</fig>
<fig id="f8-mmr-20-01-0005" position="float">
<label>Figure 8.</label>
<caption><p>(A) The self-assembling mechanism of porphysomes. (B) Scanning electron microscopy (SEM) images of porphysomes. (C) The intracellular degradation mechanisms of the porphysome (Reprinted from ref 75 with permission. Copyright 2011, Springer Nature).</p></caption>
<graphic xlink:href="MMR-20-01-0005-g07.tif"/>
</fig>
<fig id="f9-mmr-20-01-0005" position="float">
<label>Figure 9.</label>
<caption><p>The application of porphysomes in the treatment of tumor-bearing mice. (A and B) Thermal images of mice-bearing tumor xenografts after being intravenously administered porphysomes or PBS and irradiated with a laser for photothermal therapy (PTT). (C) Quantification of increase in temperature in mice from A. (D) Resulting tumor response after PTT treatment at day 2 and 14. (E) Survival curve of mice receiving PTT (Reprinted from ref 75 with permission. Copyright 2011, Springer Nature).</p></caption>
<graphic xlink:href="MMR-20-01-0005-g08.tif"/>
</fig>
<fig id="f10-mmr-20-01-0005" position="float">
<label>Figure 10.</label>
<caption><p>The tumor volume at different periods of time in hypoxia/hyperoxia tumor tissues treated with porphyrins and porphysomes (Reprinted from ref 75 with permission. Copyright 2013, American Chemical Society). PTT, photothermal therapy; PDT, photodynamic therapy (PDT).</p></caption>
<graphic xlink:href="MMR-20-01-0005-g09.tif"/>
</fig>
</floats-group>
</article>