Biomimetic Targeting Nanoadjuvants for Sonodynamic And Chronological Multi-Immunotherapy Against Holistic Biofilm-Related Infections.

Biofilm-related infections (BRIs) present significant challenges owing to drug resistance, adverse immune responses, and implant failure; however, current approaches inadequately cater to the diverse therapeutic requirements at different stages of infection. To address this issue, we proposed a multi-immunotherapy strategy in combination with sonodynamic therapy for the chronological treatment of BRIs. Macrophage membrane-decorated targeting sonosensitive nanoadjuvants were fabricated to load cytosine-phosphate-guanine oligodeoxynucleotide (CPG-ODN) or microRNA (miR)-21-5p. In the early stages of BRI (Stage I), CPG-ODN-loaded nanoadjuvants (CPG@HMPN@M) promoted the formation of neutrophil extracellular traps to capture and neutralize detached microbes. During the late stage of infection (Stage II), CPG-ODNs redirected macrophage polarization into the M1 phase to combat infections via TLR9/Myd88/TRAF6 pathway. During these stages, CPG@HMPN@M generated singlet oxygen through sonodynamic processes, eradicating the biofilms under US irradiation. Once the BRIs were eliminated, miR-21-5p-loaded nanoadjuvants (miR@HMPN@M) were delivered to the lesions to suppress excessive inflammation and promote tissue integration by evoking macrophage M2 polarization during the repair phase (Stage III) through PTEN/PI3K/Akt pathway. This innovative approach aimed to provide comprehensive treatment strategies for the chronological treatment of BRI by effectively eliminating infections, promoting tissue restoration, and implementing different immune regulations at different stages, thus demonstrating promising clinical value. This article is protected by copyright. All rights reserved.