In this study, pegylated pH-sensitive liposomes fused with EVs isolated from human breast cancer cells (MDA-MB-231) were prepared by the film hydration method [
10]. Kim and Evers used a similar method, hydrating the lipid film with an EV-containing aqueous solution [
20,
21]. Another study by Hu et al. promoted the fusion of EVs and liposomes using different methods, such as incubation followed by extrusion [
22]. Similarly to these studies, our results proved that the film hydration method could lead to the fusion of EVs and pegylated pH-sensitive liposomes. This fusion was confirmed by total protein quantification using BCA, and the identification of CD63 in our hybrid formulation. The tetraspanin CD63 is a common protein on the surface of EVs and was used as a marker to identify the presence of EVs in the hybrid nanosystem [
23,
24]. The HF-pHSL/EV-DOX hybrid displayed a monodisperse distribution with a mean diameter of 140.2 ± 2.7 nm, making it suitable for intravenous administration as intended. Liposome size has a significant impact on the in vivo formulation behavior. In cancer applications, it is desirable to have vesicles with a mean diameter near 100 nm to leak and/or be transported by the transendothelial transport from the bloodstream, and for retention in tumor interstitial fluid [
25,
26]. This nanosystem’s low zeta potential (PZ) value results from DSPE-PEG
2000 molecules in its lipid composition, which are responsible for reducing the electrophoretic mobility of the nanoparticles. Furthermore, DSPE-PEG
2000 molecules prevent particle aggregation due to the steric effects of the PEG chains, which justify the excellent storage stability of 90 days for HF-pHSL/EV-DOX [
11]. The encapsulation percentage of DOX obtained for the HF-pHSL/EV-DOX formulation was high, with a value of 88.9 ± 2.4%, similar to that obtained in other studies conducted by our research group using the ammonium gradient method [
10,
11]. The encapsulation method consists of a gradient between HBS outside the nanoparticles and ammonium sulfate in the nanoparticle core. There are two possible mechanisms to explain DOX encapsulation in liposomes using the ammonium sulfate gradient method. As discussed by Ansar and Mudalige (2019), and Haran et al. (1993), the mechanism of encapsulation can be due to the acidification of the intra-liposomal compartment and salting-out effects [
27,
28]. In the first case, the intra-liposomal (NH
4)
2SO
4 has a low permeability coefficient due to the charge of NH
4+ and SO
42- ions. Deprotonated DOX molecules penetrate the lipid bilayer, and once they are inside the hybrid nanosystem, they will be protonated. Thus, ammonia resulting from the reaction between the NH
4+ and –NH
2 functional group of DOX molecules permeates freely across the liposome membrane to the external medium. Protonated DOX molecules react with SO
42- anions, and crystallize as (DOX-NH
3)
2SO
4 [
27]. The other mechanism relies on the leakage of the neutral ammonia and protons efflux [
28]. The diffusion potential of ammonium ions created is responsible for the influx and accumulation of DOX inside the liposomes [
29]. The pH sensitivity of the hybrid formulation was assessed to verify if the incorporation of extracellular vesicles could change the pH-triggered release system. Previous studies carried out by our research group have shown a release of approximately 90% of DOX at pH 5.0 from pH-sensitive liposomes [
10,
30]. Gomes et al. (2022) showed that a similar hybrid system, consisting of exosomes isolated from the murine breast cancer cell line (4T1) and long-circulating pH-sensitive liposomes, achieved a maximum release of 96.6% at pH 5.0 and 70.1% at pH 7.4. In our study, HF-pHSL/EV-DOX had a release of DOX of 51.8 ± 3.9% at pH 5.0, and 29.2 ± 5.7% at pH 7.4 after 24 h of incubation. Additionally, the vesicle diameter increased significantly at pH 5.0 after 24 h of incubation, while no alterations were observed at pH 7.4. These results suggest that the arrangement of components in the proposed hybrid nanosystem may increase its rigidity, altering its permeation and reducing DOX release at both pH environments.
Breast cancer’s heterogeneous expression of immunohistochemical markers may influence patient treatment and prognosis. Therefore, the in vitro activity evaluation of the hybrid formulation, composed of extracellular vesicles isolated from a triple negative molecular subtype (ER-/PR-/HER2-), was performed on three cell lines with different molecular patterns: MDA-MB-231 (triple negative), MCF7 (ER+/PR+/HER2+), and SKBR3 (HER2+). The results reveal that the hybrid nanosystem containing DOX and EVs from MDA-MB-231 breast cancer cells can inhibit the growth and migration of breast cancer cells with distinct molecular profiles. The study of cell migration using the wound-healing assay enables an assessment of the influence of the analyzed treatments on reducing cellular motility in two-dimensional cultures of confluent cell monolayers, which is relevant to the initial stages of cell migration and invasion in the metastatic process [
17]. The wound-healing assay showed free DOX treatment could not inhibit cell migration in treated cells. However, adding EVs in the HF-pHSL/EV-DOX treatment allowed for significant inhibition of wound closure in the three subtypes of breast cancer cell lines. Considering that the metastatic process is a challenge in cancer prognosis, exploring this inhibited cellular motility induced by the association of tumor-isolated EVs and liposomes is crucial. This study emphasizes the potential benefits of this hybrid nanosystem for cancer therapy. This study of cellular DOX uptake also showed that the association of EVs in the lipid bilayer did not prevent DOX uptake by breast cancer cell lines. Kim and Evers [
20,
21] showed that the EV:liposome particle proportion alters some physicochemical properties and cellular uptake of the bioactive substance encapsulated. Evers showed that the cellular uptake of hybrid formulations was enhanced in the 1:50 EV:liposome proportion compared to the 1:100 EV:liposome proportion [
21]. Our hybrid formulation proposed a ratio of approximately 1:300 EV to the liposome. Future studies will be conducted by increasing the EVs/liposome particle ratio to improve cellular uptake of the hybrid nanosystem.
In this study, we also investigated the preliminary acute toxicity of HF-pHSL/EV-DOX. Leukopenia was observed in all groups treated with DOX, with a decrease in the agranulocyte count compared to the HBS treatment group. Similar results were observed in previous studies performed by our research group, where Balb/c mice treated with free DOX, long-circulating and pH-sensitive liposomes (SpHL-DOX), and folate-decorated long-circulating and pH-sensitive liposomes (SpHL-DOX-Fol) evidenced a significant difference in agranulocyte count compared to the saline control [
15]. The hepatotoxicity induced by the administration of DOX may be increased when encapsulated in nanoformulations due to its normal liver uptake. When adding human-derived extracellular vesicles to the immunocompetent Balb/c animals, this liver uptake may also increase as a process of antigen elimination, causing an increase in AST and ALT quantification. Further investigation of biodistribution and pharmacokinetics of HF-pHSL/EV-DOX is necessary to evaluate this process. Cardiotoxicity is DOX’s most concerning side effect, and its encapsulation in a hybrid nanosystem reduced the heart damage provoked by the administration of free DOX, as seen in histological analyses [
15]. All of these results indicate a perspective of success in the clinical application of HF-pHSL/EV-DOX due to its great cytotoxic activity for different molecular types of breast cancer associated with an excellent toxicity profile.