Advanced delivery systems for sodium thiosulfate in cisplatin otoprotection

Area of Science:

• Biomedical Engineering
• Nanotechnology
• Pediatric Oncology

Background:

• Cisplatin chemotherapy causes hearing loss in up to 60% of pediatric patients.
• Systemic sodium thiosulfate (STS) is an effective otoprotectant but requires a 6-hour delay post-cisplatin, leaving the ear vulnerable.
• This delay is necessary to prevent STS from reducing cisplatin's anti-cancer efficacy.

Purpose of the Study:

• To review engineering strategies for overcoming limitations of systemic STS delivery.
• To focus on nanotechnology and localized administration routes for STS otoprotection.
• To enable hearing preservation in pediatric cancer patients undergoing cisplatin treatment.

Main Methods:

• Review of engineering strategies for STS delivery, emphasizing nanotechnology and localized administration.
• Analysis of lipid- and polymer-based nanoparticles for round window membrane transport.
• Evaluation of in situ-forming hydrogels/microgels and transtympanic strategies for sustained, localized STS delivery.

Main Results:

• Localized STS delivery achieves high intracochlear concentrations without compromising cisplatin efficacy.
• Nanoparticle systems enhance STS transport across the round window membrane.
• Hydrogels, microgels, and permeation enhancers provide sustained release and targeted delivery, bypassing clearance mechanisms.

Conclusions:

• Localized delivery of STS via nanotechnology offers a promising strategy for otoprotection during cisplatin chemotherapy.
• This approach enables precise delivery during peak cochlear exposure, preserving hearing.
• Improved otoprotection can significantly enhance the quality of life for childhood cancer survivors.