Therapeutic synthetic polymers: a game of Russian roulette?

Synthetic polymer-based drug-delivery systems have been applied in drug delivery for the past 50 years. So why are there so few examples of these macromolecules being used successfully in the clinic? It is our view that many products are failing because of a neglect of the fundamental science surrounding the architectural control of the molecules present, their behaviour following in vivo administration and host response. Adverse events following parenteral administration of approved synthetic polymer-based systems have resulted in unpredictable and fatal responses in a significant number of individuals. Acceptance of the importance of immunotoxicological factors in response to the presence of these macromolecules must be addressed if emergent technologies, such as polymer-based gene-delivery systems, are going to succeed.