Introduction
Tuberculosis (TB), due to infection by the bacterial pathogen
Mycobacterium tuberculosis (
Mtb), represents one of the ten most potent killers and the deadliest disease due to a single pathogen, more than HIV/AIDS, totaling 5.8 million newly diagnosed cases and approximating 1.3 million deaths in 2020 [
1]. Isoniazid (INH) is employed to treat TB in combination with other anti-tubercular drugs such as rifampicin (RIF) and pyrazinamide (PZA) [
2]. TB treatment is intricate because non-compliant patients complain of adverse effects of current medications, regular doses, and prolonged treatment duration [
3]. Meanwhile, anti-TB drugs with low quality and limited bioavailability promote the occurrence of drug-resistant (DR), multidrug-resistant (MDR), and extensively drug-resistant (XDR) TB [
4].
Spinal tuberculosis (STB) comprises 50% of all bone and joint TB cases and is the commonest extrapulmonary TB, frequently and irreversibly causing neurological damage, which results in severe socioeconomic problems [
5]. STB was treated with first-line anti-TB therapeutics such as INH (H), RIF (R), and PZA (Z). Furthermore, the histopathology of TB, the pharmacokinetics of anti-TB drugs, and the drug resistance mechanism of
Mtb have been studied in depth [
6‐
16]. A significant difference was observed in the distribution of anti-TB drugs in STB. These drugs were at extremely low or undetectable levels in the vertebral sclerosis area and enclosed TB lesions. The conventional dosage forms of medications hardly persist in the lesion area for an extended period, making it difficult to maintain the effective drug concentration, the leading cause of prolonged recurrence observed in STB.
In the medical field, nanotechnology has led to significant improvements in cancer therapy [
17], diagnostic imaging of diseases [
18], tissue engineering [
19], and most importantly, drug and gene delivery systems [
20]. Although developing new TB molecules remains critical in curbing the TB epidemic, altering novel therapeutics in nanoparticle-based delivery systems represents a feasible, cost-effective, and readily available option [
21]. Hitherto, multiple nano delivery systems for administering anti-TB products to the lung have been widely assessed and suggested alternatives to conventional TB therapy. Nanoparticles can selectively deliver into macrophages, which primarily host TB, significantly increasing the therapeutic index by enabling high drug levels where
Mtb replicates while reducing systemic toxicity. An additional advantage is that nanoparticles for TB drugs shield them from liver catabolism and renal clearance; consequently, these products are safer and more effective than free medications, decreasing treatment time and drug resistance occurrence [
2,
4,
22‐
24]. Therefore, developing new dosage forms of high-efficiency anti-TB drugs, improving biodistribution in diseased vertebrae, and effectively killing
Mtb in the target tissue are critical measures for applying current anti-TB therapeutics in the treatment of STB.
In humans, transforming growth factor (TGF)-β1 plays an essential immunomodulatory role in TB [
25]. TGF-β1 with excessively high activity is found in lung lavages and macrophages in individuals suffering from pulmonary TB [
26,
27]. In addition, TGF-β1 potently deactivates macrophages, reducing their effectiveness in containing
Mtb [
28]. Furthermore, TGF-β1 and other cytokines (e.g., TNF-α) may be involved in tissue damage described in TB patients [
29,
30]. Thus, silencing the
TGF-β1 gene by the RNA interference (RNAi) technology [
31], reducing the secretion of the TGF-β1 protein in macrophages, and combining first-line anti-TB drugs to facilitate
Mtb clearance are tools that could increase the efficacy of anti-TB medications.
Here, an anti-TB nano delivery system was engineered employing nanoliposomes as the carrier for biocompatibility and biodegradability, impressive drug loading rate, organ targeting potential, slow-release, high oral bioavailability, and prolonged half-life in circulation [
32,
33]. Then, H, R, and Z were selected as first-line oral drugs for the treatment of TB. The positively-charged nanoliposomes loaded with HRZ (isoniazid/rifampicin/pyrazinamide) for the treatment of TB were successfully developed by reverse-phase evaporation and further bound to the negatively-charged siTGF-β1 to reduce the TB granuloma wrapped in
Mtb and increase the efficacy of the drugs. Finally, the particle size, zeta potential, particle shape, and encapsulation efficiency (EE) of nanoliposomes loaded with HRZ/siTGF-β1 were characterized, evaluating their in vitro cytotoxicity as a potential alternative for the treatment of STB.
Materials and methods
Preparation of HRZ-loaded nanoliposomes
2,3-dioleoyl-3-trimethylammonium-Propane(DOTAP) and 1, 2-distearoyl-sn-glycero-3-hosphoethanolamine-n-[methoxy (polyethylene glycol) 2000] (DSPE-PEG 2000) were provided by Sigma-Aldrich (USA). Cholesterol, INH, RIF, and PZA (> 98% purity) were manufactured by Tokyo Chemical Industry (Japan). RPMI 1640 medium, trypsin, and fetal bovine serum (FBS) were provided by Hyclone (USA). Anti-TGF-1 (Cat No. ab 92486) was from Abcam (UK). SYBR® Premix Ex Taq, PrimeScript™ RT reagent Kit with gDNA Eraser, and RNAiso Plus were manufactured by TaKaRa Biotechnology (Japan). 3-(4,5-dimethylthiazol-2-yl)-3,5-diphenyltetrazolium bromide salt (MTT) was provided by Biosharp (China). Annexin V-FITC/PI Apoptosis Detection kit and propidium iodide (PI) staining solution were provided by BD Biosciences (USA).
HRZ-loaded nanoliposomes were prepared by the thin film hydration method. Briefly, DOTAP (36 mg), DSPE-PEG2000 (50 mg), cholesterol (1 mg), INH (7.2 mg), RFP (10.9 mg), and PZA (1.8 mg) at the molar ratio 20:10:1:21:5.3:5.9 were solubilized in chloroform/methanol (4:1, v/v). After solvent evaporation (rotary evaporator, 37 °C), further drying was performed under vacuum for 1 h. The resulting inclusion complex was dissolved in 5 ml of deionized water, and a clear orange-red solution was obtained post-filtration.
The resulting nanoliposome solution was transferred into a 10 kDa ultrafiltration tube and subjected to ultrafiltration at 5000×g for 10 min and repeated 5 times until a colorless filtrate was obtained. The upper layer of the preserved orange-red liquid encompassed cationic liposomes containing the anti-TB drugs. Then, 10% mannitol was added to the liquid and lyophilized to obtain 67 mg of an orange-red oily HRZ-loaded nanoliposome product.
Conjugation of HRZ-loaded nanoliposomes with siTGF-β1
Biomics Biotechnologies manufactured the siRNA oligonucleotides targeting TGF-β1 (siTGF-β1), and their sequences were as follows: siTGF-β1: sense 5′-GGA GUC AGA UCC UCA GCA AGC-3′ and antisense 5′-UUG CUG AGG AUC UGA CUC CUG-3′; non-coding control siRNA (siNC), sense 5′-GAA GGC CCA TAG CCA GTG ACT-3′ and antisense 5′-AGU CAC UGG CUA UGG GCC UUC-3′. Cationic HRZ nanoliposomes were mixed with siTGF-β1 in weight ratios of 2:1, 5:1, 10:1, and 20:1, respectively, and further underwent incubation at ambient for 30 min. The binding efficiency of the HRZ nanoliposomes with siTGF-β1 was determined by the gel retardation assay using 1.5% agarose gel (Ultrapure™ agarose, Life Technologies).
Characterization of HRZ/siTGF-β1 nanoliposomes
The size and zeta potential of HRZ/siTGF-β1 nanoliposomes were assessed by dynamic light scattering (DLS) on a Malvern ZetasizerNano ZS (Malvern Instruments, UK) in triplicate at ambient, after dilution with double-distilled water.
The surface morphology of HRZ/siTGF-β1 nanoliposomes was assessed by transmission electron microscope (TEM) (TEM Jeol JEM-1400; JEOL, Japan). A 5:1 mass ratio of cationic nanoliposomes and siRNA was spread over a copper grid and air-dried for 30 min before detection to prepare TEM samples.
As reported previously, INH, RIF, and PZA loading in HRZ/siTGF-β1 nanoliposomes were assessed with slight modifications [
34]. Briefly, the mobile phase was formulated to an optimal concentration to detect the EE of HRZ/siTGF-β1 nanoliposomes on a high-performance liquid chromatography (HPLC) system (Agilent Technologies, USA). After the loading procedure, the suspensions were submitted to centrifugation at 16,873 g for 20 min (Centrifuge 5418; Eppendorf AG, Germany). Unencapsulated drugs that remained in the supernatant were quantitated by UV detection at 334.00 nm [
35].
Entrapment efficiency (%) was derived as [(weight of drug-loaded initially − the weight of unencapsulated drug)/weight of drug-loaded initially] × 100%
In-vitro cytotoxicity assays
Human monocytes THP-1 cells provided by American Type Culture Collection (ATCC) underwent culture at 2 × 105 cells/ml in RPMI 1640 medium containing 10% FBS, penicillin (100 U/ml), and streptomycin (100 g/ml). The media were replaced twice or thrice weekly, and the cells were sub-cultured until 80–90% confluency. THP-1 cell differentiation into adherent macrophages was performed with 100 nM phorbol 12-myristate 13-acetate (PMA) for 48 h in RPMI 1640 containing 10% FBS [
36]. Then, the PMA media were removed, followed by three PBS rinses, and incubated in a fresh medium for three hours. To evaluate the cytotoxic effect of the developed nanoliposomes on human macrophages, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was performed directed by the manufacturer. In brief, 5 × 10
3 THP-1 cells were added to each well of a 96-well plate and allowed to differentiate into macrophages by PMA induction at 100 ng/ml for 48 h. Then, they were incubated with HRZ/siTGF-β1 nanoliposomes at 0, 5, 10, 15, 20, 25, 30, 35, 40, 45, and 50 mg/ml at 37 °C in 5% CO
2 for 24 h. Subsequently, the medium was replaced by MTT containing culture medium. Incubation was carried out for an additional 4 h, and the reaction was stopped with an equivalent volume of DMSO for formazan crystal solubilization. Optical density was obtained at 570 nm. As described in a previous report, cell viability was quantitated, determining the percentages of viable cells and inhibitory potency (IC50) values [
37]. Triplicate assays were carried out.
Assessment of cell cycle distribution and apoptosis
Flow cytometry (FCM) was conducted to assess cell cycle distribution and apoptosis upon treatment with nanoliposomes. PMA-induced macrophages were added at 5 × 103 cells per well of a 96-well plate. Upon overnight incubation, the siNC group was treated with HRZ/siNC nanoliposomes, while the siTGF-β1 groups were administered various amounts of HRZ/siTGF-β1 nanoliposomes (35 and 40 mg/ml); the HRZ group was treated with HRZ nanoliposomes. On the other hand, control cells were administered an identical volume of cell culture medium. Upon treatment, the cells underwent trypsinization, centrifugation (1000 rpm, 5 min), and staining with Annexin V-FITC/PI double-labeling kit (eBioscience, USA) before analysis for cell apoptosis. Next, cell resuspension was performed in PBS with 40 µg/ml PI followed by a 30-min incubation at 37 °C away from light to assess cell cycle distribution. After filtering through 35 µm nylon meshes, FCM on FACSCalibur (BD Biosciences) was performed for analysis. Then, the rates of apoptosis in various cell cycle phases were determined.
Gene knockdown efficiency of TGF-β1 siRNA
THP1-derived macrophages were administered to different nanoliposomes containing HRZ, HRZ/siNC, and HRZ/siTGF-β1 (35 and 40 mg/ml) for 6 h. Total RNA from human macrophages was obtained using TRIzol, and reverse transcription was performed with PrimeScript Reverse Transcriptase Kit (TaKaRa), as directed by the manufacturer. RNA quality and amounts were assessed spectrophotometrically on a NanoDrop 1000 (Thermo Fisher Scientific). Then, qRT-PCR was carried out on an ABI PRISM Real-Time PCR system (Applied Biosystems) with the QuantiTect SYBR Green Master Mix kit (Qiagen). PCR was performed at 95 °C (10 min), followed by 40 cycles of 95 °C (5 s) and 60 °C (1 min), with the melting curve obtained at 95°. Fluorescence was collected at 60 °C every 0.3 °C until 95 °C. The primers employed were: TGF-β1, Forward 5′-GTC CTG GTG GAA TGG GTT ATA C-3′ and reverse 5′-GTT GAG TGT TCT TTG GCT TGA C-3′; GAPDH, Forward 5′‑GGT GTG AAC CAT GAG AAG TAT GA-3′ and reverse 5′-GAG TCC TTC CAC GAT ACC AAA G-3′. The 2
−ΔΔCq method [
38] was employed to analyze triplicate assays, normalizing the data to GAPDH expression.
TGF-β1 protein amounts were determined by Western blot assays. After the treatment of THP1-derived macrophages with nanoliposomes containing HRZ, HRZ/siNC, and HRZ/siTGF-β1 (35 and 40 mg/ml), respectively, total protein was obtained with the Total Protein Extraction Kit (Bestbio, China) and quantitated by the Bradford assay (Bio-Rad, USA) as described by the manufacturer. Equal amounts of total protein were resolved by 10% SDS-PAGE. First of all, the extracted protein is added to the electrophoresis tank for electrophoresis and mold rotation, and after the transfer is completed, the band is cut and blocked according to the molecular weight size of the target protein and the marker, Rabbit polyclonal anti-TGF-β1 (Abcam) and anti-GAPDH (Wuhan Boster Biological Technology, China) primary antibodies were reacted overnight at 4 °C, followed by incubation with secondary antibodies linked to horseradish peroxidase (HRP) (Wuhan Boster Biological Technology) at ambient for 2 h. Immunoreactive bands were detected with an enhanced chemiluminescence system (Sino-American Biotechnology, China) and quantitated with Image J version 1.441 (National Institutes of Health, USA).
Data analysis
Data are mean ± standard deviation (SD). Descriptive statistics and one-way analysis of variance (ANOVA) were performed for analysis. Independent sample Student’s t-test was carried out for group pair compassions. P < 0.05 indicated statistical significance.
Discussion
STB also termed Pott’s disease, encompasses 50% of all musculoskeletal TB cases [
46]. Left untreated causes paraspinal abscesses, spinal cord compression, spine deformities, and neurological defects [
46,
47]. Severe bone TB can be effectively treated by combining surgery with anti-TB drugs administered for an optimal duration [
48‐
50]. According to WHO guidelines, long-term administration of anti-TB multiple medicines is essential for treating bone TB [
51]. However, high dosages of anti-tubercular products are necessary to achieve effective concentrations at target sites due to limited permeability and metabolism [
52,
53]. Innovative anti-TB drug delivery biomaterials have tremendous potential for treating STB and could achieve high drug concentrations at the target site with reduced drug amounts throughout the body, markedly reducing toxicity [
54,
55]. Therefore, we developed nanoliposomes that encapsulated first-line anti-TB medicines, i.e., INH, RIF, and PZA, and conjugated them to TGF-β1 siRNA. Multiple properties verified the successful production of nanoliposomes, and the end-products were evaluated for drug encapsulation efficiency, cytotoxicity, and TGF-β1 siRNA silencing effects in THP-1-derived human macrophages.
Particle shape significantly affects cellular uptake, distribution within the cell, and cytotoxicity. Nanoparticles are taken up according to the following order based on shape: sphere > cube > rod > disk; this is likely because the cell membrane is flexible around low-aspect-ratio particles [
40,
56]. Microscopy revealed a spherical shape of the engineered nanoparticles, with the particle size ranging from 100 to 200 nm, which allows a wide distribution in most organs [
57]. Another critical parameter is zeta potential, which depicts the charge and stability of the prepared nanoparticles [
58]. Reportedly, a high surface charge reduces the aggregation of particles [
59]. The degree and rate of macrophage uptake show direct associations with particles’ net charge; the physiological compatibility of a negatively charged surface is greater than that of the positively charged counterpart [
40]. Moreover, localization in lysosomes, where
Mtb survives, is more pronounced in negatively charged particles than in positively charged ones [
60]. In the present study, the zeta-potential values of HRZ nanoliposomes and TGF-β1 siRNA were 28.13 and -18 mV, respectively, whereas those of HRZ/siTGF-β1 nanoliposomes with different weight ratios ranged from − 11.07 to 15.33 mV.
EE in liposomes is impacted by various parameters, including the preparative method and the features of liposomes and loaded molecules [
61]. Hydrophobic and hydrophilic substances have high (reaching 100%) and low EE values [
62]. Substances with intermediate hydrophilicity and lipophilicity generally distribute between the water and lipid phases, and any solubility alteration affects their partitioning, thereby modifying the EE [
61]. In this study, the 100.00–200.00 nm HRZ/siTGF-β1 nanoliposomes showed high drug encapsulation efficiencies of 90%, 88%, and 37% for INH, RIF, and PZA, respectively.
Nanoparticles have potential toxicity to the liver, kidney, neurons, and cardiovascular system, which would limit their application in the clinic. Therefore, reducing nanoparticle quantities is preferable, and low-toxicity or concentration particles should be utilized [
63]. The MTT assay and FCM indicated that HRZ/siTGF-β1 nanoliposomes had low cytotoxicity and were concentration-dependent in human macrophages. Interestingly, cell cycle distribution in THP-1-derived macrophages was unaltered upon drug administration at 35 mg/ml. In comparison, the cells treated with HRZ/siTGF-β1 at a 40 mg/ml concentration showed a higher apoptotic rate than untreated cells.
Macrophages are critical cells in the immune response against
mycobacteria and provide a niche for
Mtb replication [
64,
65]. Coordinated events among immune factors, especially macrophages and T cells, play essential roles in inhibiting TB infection [
26]. In addition, macrophages and T cell functions are regulated mainly by local cytokines, necessary for developing immune reactions against
Mtb. Several reports revealed that elevated TGF-β1 amounts suppress immune responses targeting
Mtb by modulating proliferation, differentiation, and functions in particular immune cells [
25]. In addition, TGF-β1 is expressed in non-necrotizing granulomas of sarcoidosis and TB granulomas [
27,
66,
67]. Thanks to TGF-β1’s essential function in TB pathogenesis, this infection could be controlled by TGF-β1 suppression while administering anti-TB drugs. Currently, siRNA-mediated gene knockdown is considered a robust approach for reducing aberrantly elevated amounts of target genes, rendering it putative for clinical therapy [
68]. The wide application of siRNAs for treatment is based on well-designed systems delivering siRNAs into target cells with high efficiency [
69]. Nanoliposomes efficiently carry and deliver siRNAs in vivo [
70]. In this study, TGF-β1 siRNA-mediated gene knockdown downregulated TGF-β1, decreasing the formation of tuberculous granulomas. The above data showed that the developed HRZ/siTGF-β1 nanoliposomes significantly reduced TGF-β1 mRNA and protein expression levels in THP-1-derived macrophages.
Collectively, HRZ (anti-TB drugs INH, RIF, and PZA)-loaded nanoliposomes with siTGF-β1 were successfully developed with high encapsulation efficacy and characterized by a spherical shape within nanometer size. These formulations had low cytotoxicity and potent TGF-β1 gene silencing, laying the foundation for in vivo studies.
In conclusion, the urgency of effective treatment of TB, which is among the nine leading causes of death worldwide, was tackled by developing nanoliposomes to deliver anti-TB drugs directly to the infection site. We successfully developed nanoliposomes loaded with HRZ, followed by TGF-β1 siRNA encapsulation in the present work. These nanoliposomes were in the nanometer range, with a diameter averaging 168 nm as determined by DLS. Additionally, they had elevated zeta potential, suggesting high physical stability. Morphologically, they were spherical and uniform, with a smooth surface. INH and RIF had elevated encapsulation percentages, with > 80% drug encapsulation efficiencies. Finally, the developed nanoliposomes had low cytotoxicity and affected the viability of THP-1-derived human macrophages in a concentration-dependent manner. Overall, the novel nanoliposomes exhibited potential as excellent vehicles for delivering drugs, e.g., antituberculous medicines. This system would significantly impact the design of therapeutic regimens, improving patient compliance. Nevertheless, these nanoliposomes should be further investigated in animal models to obtain supportive in vivo data for potential clinical applications in the future.
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