Doxorubicin, an anticancer agent of the anthracycline family, is one of the most popular anti-neoplastic drugs used for decades in the treatment of various cancer tumors, particularly breast and ovarian, leukemia, and lymphoma (
1). Nevertheless, doxorubicin (DOX) presents many unfavorable side effects due to its low specificity. Some of these side effects are induced vomiting with nausea, mucositis, myelosuppression, and dose-dependent cardiotoxicity. Cardiotoxicity can result in irreversible heart failure. Also, using the DOX regimen presents acquired multidrug-resistant (MDR) due to several biological mechanisms upon repeated chemotherapy cycles (
2,
3).
Multidrug resistance (MDR) is a multifactorial phenomenon and mostly mainly occurs due to various mechanisms with several cellular pathways, for instance, mutations in oncogenes (
4) and increased release of the drug outside the cells via ATP-binding cassette (ABC) transporters. P-glycoprotein (P-gp) is a member of the ABC family responsible for carrying DOX out of the cell (
5).
Nowadays, to cope with these challenges, controlled drug delivery systems (CDDS) have attracted attention due to improving chemotherapeutics’ performance, including decreasing dose frequency, improving drug efficacy, and reducing side effects (
6).
Among various drug delivery systems, organic-based nanocarriers have exhibited great successful systems. These systems are faced with a few disadvantages, such as entrapped drug leakage and premature degradation of the active agent. On the other hand, inorganic material-based nanocarriers can be used as promising alternative drug delivery systems (
7).
Since the first discovery of Mobil Composition of Matter No. 41 (MCM-41) materials in 1992 (
8,
9), mesoporous silica nanoparticles (MSNs) have been highlighted as a promising alternative drug carrier platform. It can be an efficient drug carrier due to tuneable pore diameter and particle sizes (2 - 10 nm), abundant surface functionalization sites (> 1000 m
2/g) (
10), superior biocompatibility (
11), reproducible synthesis procedure (
12), and versatile chemistry for further functionalization (
6,
13).
Furthermore, MSNs can accumulate preferably at the tumor site and improve the “enhanced permeability and retention” (EPR) effect. As a result, they have been widely evaluated for cancer diagnosis and therapy and other biomedical applications (
14).
Premature drug leakage from nanoparticles in uncoated MSNs could lead to fast dug release (
15). To solve these drawbacks, reversible capping was applied to the surface pores of MSNs, improving drug delivery capability. Moreover, improved controlled drug release could be provided by applying one or more stimuli to the cap structure (
16).
Stimuli-responsive DDS has developed with the ability to respond quickly to different external (light, ultrasound, magnetic field) or intra-tumoral (redox, pH, enzymes, temperature) initiatives (
17). These systems cannot only achieve better control over drug release but also maintain the effective concentration of drugs in targeted tissues for a longer period of time. Temperature is one of the most frequently used factors in stimuli-responsive systems. Body temperature is locally or generally affected by different conditions and environments. Moreover, the temperature is an easily controlled element during various experiments. These attributes make the temperature a convenient factor for designing responsive drug delivery systems (
18,
19).
For more than 20 years, numerous researchers have been intrigued by chipping away at the thermo-responsive hydrogels and polymers (
20). One of the most studied thermosensitive polymers is poly(N-isopropyl acrylamide) (PNIPAM). It was firstly synthesized in the 1950s (
21). Poly(N-isopropylacrylamide) is characterized by an “on” (adhesive) and “off” (non-adhesive) states. It can indirectly change bio-adhesiveness via extending the chain through hydration below the lower critical solution temperature (LCST) of 32°C and collapsing conformation above LCST. These conditions are known as “random coil” and “globular” conformations. Having an LCST nearby human body temperature makes PNIPAM suitable for assembling with MSNs as nanocarriers (
18,
22).
The grafting of PNIPAM on the silica nanoparticles can be fabricated by the atom transfer radical polymerization (ATRP) technique. Atom transfer radical polymerization is a living radical polymerization that relies on the equilibrium between dormant and active chains. This method allows narrow molecular weight dispersity of synthesized polymers, predictable chain length, and defined chain-ends (
23,
24).
In addition to temperature, redox-responsive behavior is an excellent choice for a better controlled drug delivery. It was demonstrated that various concentrations of glutathione (GSH) are present in different body sites, as it was found at approximately 10 mM in the intracellular matrix and below 0.02 mM in the plasma. Furthermore, in several studies, GSH is located in tumor cells at level 4 orders of magnitude or (at least) higher than normal cells. So, the disulfide bonds are relatively stable in extracellular fluid, whereas they can be cleaved in other environments (
25,
26).
Once the drug-loaded MSN-S-S-PNIPAM reached tumor sites, the PNIPAM chain in the outer layer would be collapsed first and then removed to release more DOX after decomposition of the disulfide cross-linker in the presence of glutathione.