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<?covid-19-tdm?>
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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Endocrinol.</journal-id>
<journal-title>Frontiers in Endocrinology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Endocrinol.</abbrev-journal-title>
<issn pub-type="epub">1664-2392</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fendo.2022.872411</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Endocrinology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Zinc-Loaded Black Phosphorus Multifunctional Nanodelivery System Combined With Photothermal Therapy Have the Potential to Treat Prostate Cancer Patients Infected With COVID-19</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Li</surname>
<given-names>Linfeng</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Zhou</surname>
<given-names>Baotong</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Xu</surname>
<given-names>Haoyang</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Shi</surname>
<given-names>Hailin</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Gao</surname>
<given-names>Li</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1024231"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Ge</surname>
<given-names>Bo</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Department of Urology, Affiliated Hospital of Guilin Medical College</institution>, <addr-line>Guilin</addr-line>, <country>China</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>The Second Affiliated Hospital of Guilin Medical University</institution>, <addr-line>Guilin</addr-line>, <country>China</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: William Ka Fai Tse, Kyushu University, Japan</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Yuzhuo Wang, University of British Columbia, Canada; Xiaodong Fan, Tianjin Central Hospital for Gynecology and Obstetrics, China</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Li Gao, <email xlink:href="mailto:40407864@qq.com">40407864@qq.com</email>; Bo Ge, <email xlink:href="mailto:ge1123@sina.com">ge1123@sina.com</email>
</p>
</fn>
<fn fn-type="other" id="fn002">
<p>This article was submitted to Cancer Endocrinology, a section of the journal Frontiers in Endocrinology</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>31</day>
<month>03</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>13</volume>
<elocation-id>872411</elocation-id>
<history>
<date date-type="received">
<day>09</day>
<month>02</month>
<year>2022</year>
</date>
<date date-type="accepted">
<day>02</day>
<month>03</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2022 Li, Zhou, Xu, Shi, Gao and Ge</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Li, Zhou, Xu, Shi, Gao and Ge</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>Since 2019, coronavirus disease 2019 (COVID-19) has swept the world and become a new virus threatening the health of all mankind. The survey found that prostate cancer accounts for one in three male cancer patients infected with COVID-19. This undoubtedly makes prostate cancer patients face a more difficult situation. Prostate cancer is the second most harmful malignant tumor in men because of its insidious onset, easy metastasis, and easy development into castration-resistant prostate cancer even after treatment. Due to its high immunogenicity and a small number of specific infiltrating T cells with tumor-associated antigens in the tissue, it is difficult to obtain a good therapeutic effect with immune checkpoint blocking therapy alone. Therefore, in the current study, we developed a platform carrying Doxorubicin (DOX)-loaded black phosphate nanometer combined with photothermal therapy (PTT) and found this drug combination stimulated the immungentic cell death (ICD) process in PC-3 cells and DC maturation. More importantly, zinc ions have a good immunomodulatory function against infectious diseases, and can improve the killing ability of the nanosystem against prostate cancer cells. The introduction of Aptamer (Apt) enhances the targeting of the entire nanomedicine. We hope that this excellent combination will lead to effective treatment strategies for prostate cancer patients infected with COVID-19.</p>
</abstract>
<kwd-group>
<kwd>COVID-19</kwd>
<kwd>zinc</kwd>
<kwd>prostate cancer</kwd>
<kwd>black phosphorus</kwd>
<kwd>photothermal therapy</kwd>
<kwd>immungentic cell death</kwd>
</kwd-group>
<contract-sponsor id="cn001">National Natural Science Foundation of China<named-content content-type="fundref-id">10.13039/501100001809</named-content>
</contract-sponsor>
<contract-sponsor id="cn002">Science Fund for Distinguished Young Scholars of Guangxi Province<named-content content-type="fundref-id">10.13039/501100019534</named-content>
</contract-sponsor>
<contract-sponsor id="cn003">Science Fund for Distinguished Young Scholars of Guangxi Province<named-content content-type="fundref-id">10.13039/501100019534</named-content>
</contract-sponsor>
<counts>
<fig-count count="9"/>
<table-count count="0"/>
<equation-count count="0"/>
<ref-count count="54"/>
<page-count count="14"/>
<word-count count="6684"/>
</counts>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<title>Introduction</title>
<p>COVID-19 is a serious threat to the health of people around the world, especially cancer patients. Studies have highlighted the increased susceptibility of prostate cancer patients to COVID-19, leading to higher rates of hospitalization and mortality (<xref ref-type="bibr" rid="B1">1</xref>). This may be due to an imbalance in the&#xa0;immune system of cancer patients themselves, making it easier for COVID-19 to enter. According to the statistics released by the American Cancer Society in 2021, prostate cancer is the most common cancer in men, while it is the second place. Most common cause of cancer-related deaths  (<xref ref-type="bibr" rid="B2">2</xref>). Prostate cancer is often overlooked because its early symptoms are insidious. When diagnosed, most of the patients have passed the early stage where surgery would have been an option and can only be treated using the androgen deprivation therapy (ADT). However, most of the patients develop castration-resistant prostate cancer or even neuroendocrine prostate cancer after 18-24 months of ADT, thereby suggesting a failure of the treatment (<xref ref-type="bibr" rid="B3">3</xref>). This extremely malignant progression may result from the lineage plasticity induced by adeno-PCa (prostate cancer) after androgen receptor (AR)-targeted therapy (<xref ref-type="bibr" rid="B4">4</xref>). Common treatment methods involving chemotherapy drugs have the disadvantages of toxic side-effects, the occurrence of multidrug resistance, and a high recurrence rate after surgery. It is, therefore, urgent to develop new effective strategies for the treatment of prostate cancer.</p>
<p>Recently, immunotherapy has shown remarkable efficacy in the treatment of malignant tumors (<xref ref-type="bibr" rid="B5">5</xref>). For instance, Chimeric antigen receptor T cell (CAR-T) therapy, which is mature passive immunotherapy, transforms T cells from ordinary &#x201c;soldiers&#x201d; into &#x201c;super soldiers&#x201d;, but these &#x201c;super soldiers&#x201d; do not seem to work well for solid tumors, including prostate cancer (<xref ref-type="bibr" rid="B6">6</xref>). They lead to a risk of an immune storm (<xref ref-type="bibr" rid="B7">7</xref>). In contrast, Sipuleucel-T (Provenge), the world&#x2019;s only FDA-approved therapeutic vaccine for prostate cancer, is a classic example of active immunity (<xref ref-type="bibr" rid="B8">8</xref>). It has the disadvantages of weak anti-tumor reaction and poor universality, despite better overall survival (OS) (<xref ref-type="bibr" rid="B6">6</xref>). However, there is still hope for the development of a therapeutic vaccine for prostate cancer because prostate cancer has multiple tumor-associated antigens and is an indolent tumor, which provides sufficient time to stimulate an immune response (<xref ref-type="bibr" rid="B9">9</xref>).</p>
<p>Although prostate cancer has high immunogenicity, the tissue contains fewer infiltrating T cells specific to prostate cancer-associated antigens (<xref ref-type="bibr" rid="B10">10</xref>). Therefore, improving the presentation of prostate cancer-associated antigens by dendritic cells (DCs) and stimulating the body to produce more CD8+ T cells may be the key to successful immunotherapy. Studies have shown that chemotherapeutic drugs such as doxorubicin, photothermal therapy, and certain nanomaterials can induce immunogenic death (ICD) in tumor cells (<xref ref-type="bibr" rid="B11">11</xref>&#x2013;<xref ref-type="bibr" rid="B13">13</xref>). As a special case of apoptosis, the body can produce a specific immune response to the antigens associated with dead cells (<xref ref-type="bibr" rid="B11">11</xref>) and stimulate damage-related molecular patterns (DAMPs), such as calreticulin (CRT) membrane transposition, which is the &#x201c;eat me&#x201d; signal, reminding DCs to recognize and phagocytize them (<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B15">15</xref>). Subsequently, ATP and high mobility group box 1 protein (HMGB1) are released (<xref ref-type="bibr" rid="B16">16</xref>), which promote the maturation of dendritic cells and the infiltration of CD8<sup>+</sup> T cells into the tumor tissue (<xref ref-type="bibr" rid="B10">10</xref>).</p>
<p>DOX is the most widely used immunogenic death stimulant (<xref ref-type="bibr" rid="B14">14</xref>). However, the application of chemotherapy drugs alone has certain limitations, such as low induction efficiency and drug utilization rate (<xref ref-type="bibr" rid="B17">17</xref>). Therefore, we are trying to find a multifunctional drug carrier, which can not only enhance the ICD effect of chemotherapy drugs but also improve the target specificity.</p>
<p>A large number of studies have shown that nanocarriers have the advantages of large drug load, stable chemical properties, biological safety, and longer half-life in the blood (<xref ref-type="bibr" rid="B18">18</xref>, <xref ref-type="bibr" rid="B19">19</xref>). Therefore, we speculate that the combination of nanocarriers and chemotherapeutic drugs may be beneficial. Black phosphorus two-dimensional nanosheets are excellent candidates due to their low cost, good biocompatibility, photoresponsiveness, and high drug loading rate (<xref ref-type="bibr" rid="B20">20</xref>). More notably, black phosphorus was found to perform well as an adjuvant in tumor photoimmunotherapy (<xref ref-type="bibr" rid="B21">21</xref>, <xref ref-type="bibr" rid="B22">22</xref>). Photoimmunotherapy with black phosphorus as an adjuvant stimulates a stronger immune response <italic>in vitro</italic> and <italic>in vivo</italic> than monotherapy, inducing more cytokine release (<xref ref-type="bibr" rid="B23">23</xref>, <xref ref-type="bibr" rid="B24">24</xref>).</p>
<p>Photothermal therapy (PTT) has received a lot of attention in recent years due to its noninvasiveness and high efficiency, but more importantly, due to its ability to induce the ICD process (<xref ref-type="bibr" rid="B25">25</xref>). Therefore, combining the photosensitizer black phosphorus with PTT can synergistically promote the ICD process.</p>
<p>Although black phosphorus is photostable, it is easily degraded when exposed to air (<xref ref-type="bibr" rid="B26">26</xref>). Because black phosphorus exposes a lone pair of electrons, it easily combines with oxygen and is removed by water, resulting in the structural destruction of black phosphorus (<xref ref-type="bibr" rid="B27">27</xref>, <xref ref-type="bibr" rid="B28">28</xref>). The solution to this problem is to use an element to stabilize the lone pair (<xref ref-type="bibr" rid="B29">29</xref>). Zinc, as an easily available, non-toxic and low-cost raw material, is expected to be used as an excellent therapeutic adjuvant (<xref ref-type="bibr" rid="B30">30</xref>). Therefore, we added zinc ions to the nanosystem hoping that its occupation will improve the stability of black phosphorus. In addition, a large number of studies have found that the lack of trace element zinc has a loss of immune function. Adequate amounts of zinc maintain normal prostate function because it inhibits the activity of aconitase, thus depleting the energy of tumor cells (<xref ref-type="bibr" rid="B31">31</xref>). In our previous studies, it was confirmed that an increase in zinc ion levels has a killing effect on prostate cancer cells (<xref ref-type="bibr" rid="B32">32</xref>). However, the underlying killing mechanism is not clear.</p>
<p>Aptamer (APT) is a short oligonucleotide sequence or short polypeptide obtained <italic>via in vitro</italic> screening, can bind to the corresponding ligand with high affinity and strong specificity and has no immunogenicity (<xref ref-type="bibr" rid="B33">33</xref>, <xref ref-type="bibr" rid="B34">34</xref>). AS1411 is an aptamer containing guanine, which inhibits the growth of tumor cells and has a high affinity to nucleolins (<xref ref-type="bibr" rid="B35">35</xref>). Nucleolins are highly expressed on the plasma membrane of prostatic cells (<xref ref-type="bibr" rid="B36">36</xref>). Therefore, the introduction of aptamers into the whole nanodrug delivery system can not only improve the precise targeting of drugs but also the tumor cell killing effect.</p>
<p>In the current study, we used black phosphorus nanosheets loaded with DOX and combined them with photothermal therapy to enhance the probability of ICD induction in prostate cancer cells. The addition of zinc ions not only stabilized black phosphorus but also enhanced the killing effect of the whole system, and the adaptor enhanced the targeting power.</p>
</sec>
<sec id="s2" sec-type="materials|methods">
<title>Materials and Methods</title>
<sec id="s2_1">
<title>Materials</title>
<p>The bulk black phosphorus (BP) was purchased from Nanjing Two-dimensional Nanotechnology Co., LTD (Nanjing, China). 1-Methyl-2-pyrrolidinone (NMP) and tris-(2-carboxyethyl)-phosphine hydrochloride (TCEP) were purchased from Sigma-Aldrich (St. Louis, MO, USA). Zinc acetate was obtained from Aladdin (Los Angeles, CA, USA). Aptamer (APT) AS1411 (5&#x2019;-/SH/GGTGGTGGTGGTTGTGGTGTGGTGGTGG-3&#x2019;) was customized by Guangzhou Ruibo Biotechnology Co., LTD (Guangzhou, China). Doxorubicin (DOX) was purchased from APExBIO (Houston, USA). PC-3 cells were kindly provided by the Stem Cell Bank, Chinese Academy of Sciences (Shanghai, China). Cell Counting Kit-8 (CCK-8) was provided by Dojindo (Japan). Dulbecco&#x2019;s minimum essential medium (DMEM)/F12, penicillin-streptomycin liquid, and fetal bovine serum (FBS) were purchased from GIBCO (Grand Island, NY, USA). Alexa Fluor<sup>&#xae;</sup> 488 Anti-Calreticulin antibody was purchased from Abcam (Cambridge, England). Anti-HMGB1 was obtained from Cell Signaling Technology (Boston, USA). Human HMGB1 ELISA Kit was obtained from Arigo Biolaboratories (Taiwan, China). ATP content detection kit was obtained from Solarbio (Beijing, China). Dendritic cells (DCs) were obtained from AllCells (San Francisco, USA). FITC anti-human CD11c Antibody, Alexa Fluor<sup>&#xae;</sup> 647 anti-human CD80 Antibody, PE anti-human CD86 Antibody, and PerCP/Cyanine5.5 anti-human HLA-DR Antibody were provided by Biolegend (California, USA).</p>
</sec>
<sec id="s2_2">
<title>Preparation of Black Phosphorus Nanosheets (BP NSs)</title>
<p>Black phosphorus nanosheets were obtained using an optimized liquid stripping method and step-by-step centrifugal screening for a suitable size.</p>
<p>First, 8 mg black phosphorus crystal powder was added to 24 mL NMP. Then, the mixture was subjected to ultrasonic treatment (800 W, on/off cycle time was 4 s/6 s) using a probe for 12 h in an ice bath, and the resultant brown suspension was centrifuged at 4000 rpm for 15 min. The supernatant was collected and centrifuged at 12000 RPM for 12 min to collect the sediment and obtain BP NSs, which were stored at 4&#xb0;C.</p>
</sec>
<sec id="s2_3">
<title>Preparation of BP-P-Apt</title>
<p>About 1 mg Apt-SH was dissolved into 1 mL Tris buffer (tris: 10 mM, pH = 7.4). Then, 2 mg NH<sub>2</sub>-PEG-Mal and 50 &#x3bc;g TCEP was added and stirred in the dark for 5 h to obtain NH<sub>2</sub>-PEG-Apt. Then, 2 mg BP NSs were added to the solution. After ultrasonic treatment in an ice bath for 20 min and stirring for 8 h, centrifugation was performed at 10000 rpm for 15 min to obtain BP-P-APT, and it was washed twice with deionized water.</p>
</sec>
<sec id="s2_4">
<title>Preparation of BP-P-Apt-Zn</title>
<p>About 7 mg zinc acetate powder was added to 5 ml BP-P-APT suspension. The solution was subjected to ultrasound in an ice bath for 2 min, stirred for 1 hour, and centrifuged at 10000 rpm for 15 min, and the precipitate was washed with deionized water.</p>
</sec>
<sec id="s2_5">
<title>Preparation of BP-P-Apt-Zn/DOX</title>
<p>About 2 mg BP-P-Apt-Zn/NSs was mixed in 2 mL DOX solution (1.5 mg/mL). The solution was stirred in the dark for 8 h. The precipitate was obtained by centrifugation at 10000 rpm for 15 min. It was then washed with deionized water and freeze-dried.</p>
</sec>
<sec id="s2_6">
<title>Photothermal Conversion and Photostability</title>
<p>Temperature change and stability of black phosphorus were analyzed under different concentrations and laser powers using an infrared thermal imager (Ti400+, Fluke, USA). The concentrations of BP NSs and BP-P-Apt-Zn/Dox used were 50, 100, and 200 &#xb5;g/mL, and they were irradiated for 10 min with an 808-nm laser at 0.5, 1, and 2 W/cm<sup>2</sup> (Beijing Blueprint Photoelectric Technology Co., Ltd) to observe the temperature change. The irradiation was repeated 5 times for 10 min each time.</p>
</sec>
<sec id="s2_7">
<title>Uptake of Drugs by Cells</title>
<p>About 1 &#xd7; 10<sup>6</sup> cells were inoculated in 6-well plates and anti-slip slide cell crawl plates were placed at the bottom of the wells. Complete medium(89%DMEM/F12+10%FBS+1% penicillin-streptomycin liquid), DOX, BP-P-Zn/DOX, and BP-P-Apt-Zn/DOX (DOX: 3 &#xb5;g/mL) were added to separate wells. About 4 h later, the cells were washed with PBS thrice, fixed with 4% formaldehyde for 25 min, washed with PBS thrice again, stained with DAPI for 10 min, and observed using a fluorescence inverted microscope (Inverted fluorescence imaging microscope, Olympus, IX73 + DP80+ fluoview, Tokyo, Japan).</p>
</sec>
<sec id="s2_8">
<title>Cell Culture</title>
<p>Human prostate cancer PC-3 cells were cultured in a T25 culture bottle containing 10% FBS, 1% penicillin-streptomycin liquid, and 89% DMEM/F12. The culture was maintained at 5% CO<sub>2</sub> and 37&#xb0;C. The medium was changed every other day.</p>
</sec>
<sec id="s2_9">
<title>Cytotoxicity Assay</title>
<p>To evaluate the toxicity of zinc ion in PC-3 cells, PC-3 cells in the logarithmic phase were inoculated in 96-well plates (5 &#xd7; 10<sup>4</sup> cells per well) and then incubated with a medium containing zinc ions in different concentrations (1, 2.5, 5, 10, 20, and 30 &#xb5;g/mL), separately. After 24 h, the cell survival rate was calculated using the CCK-8 assay.</p>
<p>The same method was used to evaluate the toxicity of DOX in PC-3 cells. The concentrations of DOX used were 0.125, 0.25, 0.5, 1, 2.5, 5, and 10 &#xb5;g/mL.</p>
<p>To evaluate the killing effect of Apt and Zinc ions on PC-3, PC-3 cells were incubated with BP-P, BP-P-Apt, and BP-P-Apt-Zn at concentrations of 1, 10, 25, 50, 75, and 100 &#xb5;g/mL for 24 h separately, and the cell survival rate was detected using the method mentioned above. The toxicity of BP-P-Apt-Zn/DOX and BP-P-Apt-Zn/DOX + laser (DOX: 0.25&#xb5;g/mL;Zn:2.5&#xb5;g/mL) in PC-3 cells in the photothermal treatment group was analyzed using the same method. After 5 h of drug treatment, the cells were irradiated with a laser at 808 nm and 1 W/CM<sup>2</sup> for 12 min and then incubated. It is worth noting that because the absorbance of black phosphorus at 450 nm interferes with the OD value of the cells, 5 groups of drug-only media were used for normalization.</p>
</sec>
<sec id="s2_10">
<title>Western Blotting Assay</title>
<p>Western blotting was performed to detect the expression of HMGB1 in the supernatant of PC-3 cells after 24 h of drug treatment (DOX: 3 &#xb5;g/mL, BP-P: 40 &#xb5;g/mL, BP-P+ laser: 40 &#xb5;g/mL, BP-P-Apt-Zn/DOX: 40 &#xb5;g/mL, and BP-P-Apt-Zn/DOX + laser: 40 &#xb5;g/mL). The procedure was as follows: &#x3b2;-actin was used as the control protein. The supernatant was collected after 24 h of drug treatment and centrifuged at 12000 rpm for 15 min to remove cell debris. The samples were then mixed with SDS-PAGE protein loading buffer (Beyotime, China) and boiled for 5 min. About 20 &#xb5;L of the samples were subjected to SDS-PAGE gel electrophoresis and then transferred to nitrocellulose membranes. Nitrocellulose membranes were incubated with rabbit monoclonal antibody (1:1000, CST, Boston, USA) and gently shaken at 4&#xb0;C overnight. After 3 washes, the membranes were incubated with anti-Rabbit IgG and HRP-Linked Antibodies (1:2000, CST, Boston, USA) for 1 h at room temperature. After three washes, the HMGB1 protein bands were detected using Bio-RAD (California, USA), and the protein concentration was analyzed using ImageJ.</p>
</sec>
<sec id="s2_11">
<title>Human HMGB1 ELISA</title>
<p>The HMGB1 protein level in the supernatant was detected according to the instructions provided with the Human HMGB1 ELISA Kit (Arigo Biolaboratories, Taiwan, China). This assay employs the sandwich enzyme immunoassay technique for the detection of Human HMGB1 in cell culture supernatant samples. The specific steps were performed according to the protocol provided by the manufacturer.</p>
</sec>
<sec id="s2_12">
<title>Immunofluorescence Staining Assay</title>
<p>PC-3 cells were inoculated in 6-well plates at a density of 1 &#xd7; 10<sup>5</sup> per well. After 24 h, the drugs (DOX: 3 &#xb5;g/mL, BP-P:40 &#xb5;g/mL, BP-P+laser:40&#xb5;g/mL, BP-P-Apt-Zn/DOX: 40 &#xb5;g/mL, BP-P-Apt-Zn/DOX + laser: 40 &#xb5;g/mL) were added. After 24 h, the cells were rinsed thrice, fixed with 4% paraformaldehyde for 20 min, rinsed thrice again, sealed with 10% bovine serum for 30 min, and incubated with Alexa Fluor<sup>&#xae;</sup> 488 anti-calreticulin antibody (1:1000, Abcam, Cambridge, England) overnight, in the dark, at 4&#xb0;C. The cells were then washed thrice, their nuclei were stained with DAPI, and the cells were observed using a fluorescence inverted microscope (Inverted fluorescence imaging microscope, Olympus, IX73 + DP80 + fluoview, Tokyo, Japan). The whole process was performed on ice.</p>
</sec>
<sec id="s2_13">
<title>Flow Cytometry</title>
<p>PC-3 cells (1 &#xd7; 10<sup>5</sup>) were inoculated in 6-well plates. The next day, drugs were added and incubated for 24 h (DOX: 3 &#xb5;g/mL, BP-P:40 &#xb5;g/mL BP-P+laser:40&#xb5;g/mL, BP-P-Apt-Zn/DOX: 40 &#xb5;g/mL, BP-P-Apt-Zn/DOX +laser: 40 &#xb5;g/mL). After washing the cells thrice, they were digested with trypsin and washed again thrice with PBS containing 10% FBS. The precipitate was collected and incubated with Alexa Fluor<sup>&#xae;</sup> 488 anti-calreticulin antibody (1:100, Abcam, Cambridge, England), in the dark for 30 min at 4&#xb0;C. The samples were then washed thrice with PBS containing 10% FBS, centrifuged at 400 g for 5 min, resuspended in 500 &#xb5;l PBS containing 10% FBS, and placed on ice. Each sample was analyzed using a flow cytometer (BD FASC Aria III, Becton Dickinson, California, USA) to determine the concentration of CRT on the cell membrane.</p>
</sec>
<sec id="s2_14">
<title>ATP Release Assay</title>
<p>According to the manufacturer&#x2019;s instructions, the concentration of ATP in the cell culture medium after different treatments was determined using UV spectrophotometry. Briefly, ATP was extracted from the sample. Due to the characteristic absorption peak of NADPH at 340 nm and the content of NADPH being proportional to the content of ATP, NADPH content was used to calculate ATP content.</p>
</sec>
<sec id="s2_15">
<title>DCs Were Co-Incubated With Drug-Treated Cells</title>
<p>Human DCs were provided by AllCells (San Francisco, USA). After resuscitating the DCs, they were co-incubated with PC-3 cells treated with drugs for 24 h. Briefly, DCs were inoculated in 6-well plates with a density of 2 &#xd7; 10<sup>5</sup> cells per well, and then, drug-treated PC-3 cells with a density of 2 &#xd7; 10<sup>5</sup> per well were added and incubated for 30 h.</p>
</sec>
<sec id="s2_16">
<title>Detection of DC Maturation</title>
<p>About 30 h later, the cells were centrifuged at 1200 rpm for 5 min thrice, and resuspended in PBS containing 10% FBS. They were incubated with FITC anti-human CD11c Antibody, Alexa Fluor<sup>&#xae;</sup> 647 anti-human CD80 Antibody, PE anti-human CD86 Antibody, and PerCP/Cyanine5.5 anti-human HLA-DR Antibody (Biolegend, California, USA) at 1:100 (by volume) on ice for 30 min in the dark. After centrifugation thrice, they were suspended in 500 &#xb5;l PBS and the matured DCs were detected using a flow cytometer (BD FASC Aria III, Becton Dickinson, California, USA).</p>
</sec>
</sec>
<sec id="s3" sec-type="results">
<title>Results and Discussion</title>
<sec id="s3_1">
<title>Preparation and Characterization of BP-P-Apt-Zn/DOX</title>
<p>The detailed synthesis process BP-P-Apt-Zn/DOX is shown in <xref ref-type="fig" rid="f9">
<bold>Scheme 1</bold>
</xref>. First, the diameter of black phosphorus powder was changed to about 200 nm using an ultrasonic probe, Apt was loaded on BP nanosheets using electrostatic adsorption, then, the zinc ions were modified on BP-P-Apt using charge coupling, and finally, DOX was modified.</p>
<fig id="f9" position="float">
<label>Scheme 1</label>
<caption>
<p>schematic diagram showing the preparation of BP-P-Apt-Zn/DOX and the ICD induction process.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fendo-13-872411-g009.tif"/>
</fig>
<p>
<xref ref-type="fig" rid="f1">
<bold>Figures&#xa0;1A, B</bold>
</xref> show the Transmission Electron Microscopy (TEM) photos before and after modification of BP NSs. As shown in <xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1A</bold>
</xref>, BP NSs were transparent and thin, indicating that the liquid stripping method had stripped off the black phosphorus and the stripping effect was good. BP NSs were about 100-200 nm in diameter. <xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1B</bold>
</xref> shows the appearance after modification using Zn, Apt, and DOX. It can be seen that the surface is covered with a transparent substance and the size is changed to 200-300 nm, indicating that the drug was successfully loaded. This was consistent with dynamic light scattering (DLS) results (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1C</bold>
</xref>).</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>TEM images of <bold>(A)</bold> BP NSs, <bold>(B)</bold> BP-P-Apt-Zn/DOX. <bold>(C)</bold> Size distribution of BP and BP-Apt-Zn/DOX measured using DLS. <bold>(D)</bold> Zeta potentials of BP, BP-PEG-Apt, BP-PEG-Apt-Zn, and BP-PEG-Apt-Zn/DOX.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fendo-13-872411-g001.tif"/>
</fig>
<p>As shown in <xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1D</bold>
</xref>, the initial Zeta potential of unmodified BP was about &#x2212;17.8 mV, and after loading NH<sub>2</sub>-PEG-Apt, the Zeta potential changed to &#x2212;38.7 mV (due to a large amount of PEG). With the coupling of Zn<sup>2+</sup>, the Zeta potential changed to &#x2212;23.3 mV, and finally, when DOX was loaded, the Zeta potential changed to 16.7 mV.</p>
<p>The crystal structure of BP NSs was characterized using X-ray diffraction. As shown in <xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2A</bold>
</xref>, compared to the standard PDF card JCPDS#73-1358, it was found that all the peaks of the prepared material were consistent with those of ortho-crystalline black phosphorus in the pure phase, and the characteristic peaks were not offset. The results showed that the lattice structure of BP was not damaged during ultrasonic stripping.</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>
<bold>(A)</bold> X ray diffraction (XRD) of BP NSs. <bold>(B)</bold> Fourier Transform Infrared Spectroscopy (FTIR) of BP-P-Apt-Zn/DOX. <bold>(C)</bold> The high-angle annular dark-field (HAADF) SEM image of BP-P-Apt-Zn/DOX.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fendo-13-872411-g002.tif"/>
</fig>
<p>The surface group structure of BP-P-Apt-Zn/DOX was&#xa0;characterized using FTIR. As shown in <xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2B</bold>
</xref>, multiple peaks with high intensity appeared on the FTIR spectrum. At 3423.75 cm<sup>-1</sup>, multiple absorption peaks of hydrogen bond association formed by Apt, DOX, PEG, and NH<sub>2</sub>, including -OH stretching vibration absorption peak and -NH<sub>2</sub> stretching vibration absorption peak. The stretching vibration absorption peak of C-H was at 2923.93 cm<sup>-1</sup>. The stretching vibration absorption peak of P = O was at 1632.42 cm<sup>-1</sup>. The stretching vibration absorption peaks of the PO4 group were at 1102.21 cm<sup>-1</sup>, 1025.73 cm<sup>-1</sup>, and 945.95 cm<sup>-1</sup>. The bending vibration absorption peak of the PO<sub>4</sub> group was at 568.78 cm<sup>-1</sup>. PEG molecules chemically bind to BP by forming P-O-C bonds, which also led to the successful modification of BP surface with PEG.</p>
<p>To further identify the structure of BP-P-Apt-Zn/DOX, Scanning Electron Microscope (SEM) was used to analyze the nanostructure and characterize the element distribution in the nanostructure. The high-angle annular dark-field (HAADF) SEM image in <xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2C</bold>
</xref> shows the BP-P-Apt-Zn/DOX, and element mapping analysis was performed using the image. <xref ref-type="fig" rid="f2">
<bold>Figure 2C</bold>
</xref> show SEM-mapping elements of P, Zn, N, and O, respectively. The SEM element mapping analysis revealed that the compositional distributions of the four elements (P, Zn, N, and O) in the BP-P-Apt-Zn/DOX are uniform, revealing the BP-P-Apt-Zn/DOX structure. DOX:C<sub>27</sub>H<sub>29</sub>NO<sub>11</sub>, PEG: HO(CH<sub>2</sub>CH<sub>2</sub>O)NH.</p>
</sec>
<sec id="s3_2">
<title>Photothermal Conversion Properties</title>
<p>The photothermal properties of BP NSs and BP-P-Apt-Zn/DOX were observed at different 808-nm laser powers and concentrations. The process was monitored using an infrared thermal imager. <xref ref-type="fig" rid="f3">
<bold>Figures 3A&#x2013;C</bold>
</xref> respectively show the temperature change curve of BP-NSs at the concentration of 50, 100 and 200&#x3bc;g/mL.After five cycles of irradiation with an 808-nm laser, the temperature changes in BP NSs (24.73&#xb0;C ~ 25.09&#xb0;C) (<xref ref-type="fig" rid="f3">
<bold>Figure 3D</bold>
</xref>).</p>
<fig id="f3" position="float">
<label>Figure&#xa0;3</label>
<caption>
<p>
<bold>(A</bold>-<bold>C)</bold> show temperature of BP NSs at different powers (0.5, 1, and 2 W/cm<sup>2</sup>) and concentrations (50, 100, and 200 &#x3bc;g/mL). <bold>(D)</bold> BP NSs suspension (100 &#x3bc;g/mL) was irradiated using an 808-nm near-infrared laser with a power density of 1 W/cm<sup>2</sup>, and five laser switching cycles were performed.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fendo-13-872411-g003.tif"/>
</fig>
<p>
<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4A</bold>
</xref> shows the temperature changes at three powers when the concentration of BP-P-Apt-Zn /DOX is 50&#x3bc;g/mL. As shown in <xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4B</bold>
</xref>, when the concentration of BP-P-Apt-Zn/DOX is 100&#x3bc;g/mL and the power is 1W/cm2, the irradiation temperature can be increased by 28.03&#xb0;C.When the concentration of BP-P-Apt-Zn/DOX was 200&#x3bc;g/mL, the temperature could be increased by 39.3&#xb0;C (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4C</bold>
</xref>).It shows that the whole nanosystem has good photothermal conversion efficiency, and the increase of temperature is related to the concentration. Under the different powers, BP-P-Apt-Zn/ DOX at 100&#x3bc;g/mL could still reach 20.1&#xb0;C at a power of 0.5 W/cm2 (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4B</bold>
</xref>).When the power is 2W/cm2, BP-P-Apt-Zn/DOX can reach 49.1&#xb0;C (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4B</bold>
</xref>), and the increase of temperature is positively correlated with the power. As shown in <xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4D</bold>
</xref>, after five cycles of irradiation with an 808-nm laser, the temperature changes in BP-P-Apt-Zn/DOX (27.5&#xb0;C ~ 28.5&#xb0;C) were not significant, indicating good photostability.</p>
<fig id="f4" position="float">
<label>Figure&#xa0;4</label>
<caption>
<p>
<bold>(A</bold>-<bold>C)</bold> show temperature of BP-P-Apt-Zn/DOX at different powers (0.5, 1, and 2 W/cm<sup>2</sup>) at concentrations (50, 100, and 200 &#x3bc;g/mL). <bold>(D)</bold> BP-P-Apt-Zn/DOX suspension (100 &#x3bc;g/mL) was irradiated using an 808-nm near-infrared laser with a power density of 1 W/cm<sup>2</sup>, and five laser switching cycles were performed.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fendo-13-872411-g004.tif"/>
</fig>
</sec>
<sec id="s3_3">
<title>Cellular Uptake</title>
<p>To prove that the addition of Apt can improve the targeting efficiency of drugs, we used a fluorescence inverted microscope (Inverted fluorescence imaging microscope, Olympus, IX73 + DP80 + fluoview, Tokyo, Japan) to observe the uptake of DOX, BP-P-Zn/DOX, and BP-P-Apt-Zn/DOX by PC-3 cells. As shown in <xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5A</bold>
</xref>, compared with BP-P-Zn/DOX, the BP-P-Apt-Zn/DOX group showed stronger fluorescence, indicating that Apt-modified BP-P-Zn/DOX could be taken up in greater amounts by PC-3 cells. It is noteworthy that the fluorescence intensity of the only doxorubicin group was relatively high, probably due to the presence of the nuclear pore complex (<xref ref-type="bibr" rid="B37">37</xref>), which enables DOX to enter and exit cells efficiently. However, when only DOX is used, the long cycle capacity and biocompatibility of the nanodrug delivery platform is not achieved.</p>
<fig id="f5" position="float">
<label>Figure&#xa0;5</label>
<caption>
<p>
<bold>(A)</bold> Immunofluorescence of DOX, BP-P-Zn/DOX, and BP-P-Apt-Zn/DOX after 2 hours of treatment with PC-3 cells. <bold>(B</bold>, <bold>C)</bold> Cell survival rate of PC-3 cells treated with DOX, Zn at different concentrations after 24, 48, and 72 h. <bold>(D)</bold> Cell viability of PC-3 cells treated with different drugs. (**p &lt; 0.01; ***p &lt; 0.001).</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fendo-13-872411-g005.tif"/>
</fig>
</sec>
<sec id="s3_4">
<title>Cytotoxicity Assay</title>
<p>We first explored the toxicity of Zn<sup>2+</sup> and DOX alone in PC-3 cells. As shown in <xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5B</bold>
</xref>, the toxicity of DOX in PC-3 cells was time- and dose-dependent, with a survival rate of 33.7% at 72 h at a concentration of 5 &#x3bc;g/mL.</p>
<p>As shown in <xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5C</bold>
</xref>, the cytotoxicity of Zn<sup>2+</sup> in PC-3 was also time- and dose-dependent. After 48 h of treatment, Zn<sup>2+</sup> showed good cell destruction. When the concentration was only 5 &#xb5;g/mL, the survival rate was 43.8% at 48 hours.</p>
<p>As shown in the <xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5D</bold>
</xref>, we analyzed the lethality of the addition of various components to the whole nanosystem towards PC-3 cells. It was observed that BP showed no obvious lethality towards PC-3 cells, the addition of Apt reduced the survival rate of cells, and BP-P-Apt-Zn had a strong killing effect.</p>
<p>However, the BP-P-Apt-Zn/DOX irradiation group had a stronger destruction effect than the non-irradiation group. When the concentration of BP-P-Apt-Zn/DOX was 50&#xb5;g/mL, the survival rate of cells in the laser group was 32.6%, while that in the unlaser group was 41%.</p>
</sec>
<sec id="s3_5">
<title>Induced Exposure of DAMPs</title>
<sec id="s3_5_1">
<title>Release of HMGB1</title>
<p>Western blotting was used to analyze the level of HMGB1 released in the supernatant by the PC-3 cells after treatment with DOX, BP-P, BP-P+laser, BP-P-Apt-Zn/DOX, and BP-P-Apt-Zn/DOX+laser treatment for 24 h. As shown in <xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6A</bold>
</xref>, compared to the control group, the band strength in the DOX group increased and was 1.26 (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6B</bold>
</xref>) times that in the untreated group. The expression of HMGB1 in the laser-irradiated group was slightly higher than that in the non-irradiated group. Explain the effect of laser on the increase in the release of HMGB1. The band intensity of the BP-Apt-Zn/DOX + laser group was the strongest, which was 1.47 times that of the untreated PC-3 cells, indicating the synergistic effect of BP, DOX, and laser on the release of HMGB1 (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6B</bold>
</xref>). ser (*, p &lt; 0.05; **, p &lt; 0.01; ***, p &lt; 0.001).</p>
<fig id="f6" position="float">
<label>Figure&#xa0;6</label>
<caption>
<p>
<bold>(A, B)</bold> The expression of HMGB1 in the supernatant of PC-3 cells after treatment with DOX, BP-P, BP-P+laser, BP-Apt-Zn/DOX, and BP-P-Apt-Zn/DOX+ laser (**p &lt; 0.01; ****p &lt; 0.0001). <bold>(C)</bold> The concentration of HMGB1 in the cell culture medium measured using ELISA (**p &lt; 0.01). <bold>(D)</bold> Immunofluorescence assay of CRT in PC-3 cells after treatment.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fendo-13-872411-g006.tif"/>
</fig>
<p>The HMGB1 ELISA kit was used to measure the released HMGB1 in the supernatant of the PC-3 cells treated with DOX, BP-P, BP-P+laser, BP-P-Apt-Zn/DOX, and BP-P-Apt-Zn/DOX + laser. As shown in <xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6C</bold>
</xref>, the concentration of released HMGB1 in the control group was 0.36 ng/mL, and that in the DOX group was 1.771 ng/mL, suggesting that DOX significantly increased the release of HMGB1. Similarly, the expression of HMGB1 in the laser-irradiated group increased compared to the non-irradiated group, indicating the positive effect of laser on HMGB1. The concentration of the released HMGB1 in the supernatant of the PC-3 cells after the treatment with BP-P-Apt-Zn/DOX + laser was the highest (2.916 ng/mL). Consistent with western blotting results, BP-P-Apt-Zn/DOX + laser increased the release of HMGB1.</p>
</sec>
</sec>
<sec id="s3_6">
<title>CRT Membrane Transposition</title>
<p>The transfer of CRT to the cell membrane was observed using the immunofluorescence assay. There was no expression of CRT on the membranes of the cells in the BP-P and control groups (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6D</bold>
</xref>), indicating that BP alone had no effect on the expression of CRT on the membrane. Weak green fluorescence of CRT was observed on the membranes in the DOX group, and an increased green fluorescence of BP-PEG was observed in the laser-irradiated group compared to the non-irradiated group. The fluorescence intensity in the BP-P-Apt-Zn/DOX + laser group was slightly higher than that in the BP-P-Apt-Zn/DOX group, but the difference was not significant. The combined application of BP, laser, and DOX played the most significant role in the transfer of CRT to the cell membrane.</p>
<p>The average fluorescence intensity in CRT-positive cells was quantitatively analyzed using flow cytometry. As shown in <xref ref-type="fig" rid="f7">
<bold>Figure&#xa0;7A</bold>
</xref>, the CRT fluorescence intensity in the BP-Apt-Zn-Dox + laser group was about three times that in the control group. The laser-irradiated group also showed an excellent CRT fluorescence intensity (<xref ref-type="fig" rid="f7">
<bold>Figure&#xa0;7A</bold>
</xref>), which was consistent with the analysis of immunofluorescence. As can be seen in <xref ref-type="fig" rid="f7">
<bold>Figure&#xa0;7A</bold>
</xref>, the DOX group showed stronger fluorescence of CRT compared with the control group.</p>
<fig id="f7" position="float">
<label>Figure&#xa0;7</label>
<caption>
<p>
<bold>(A)</bold> Average fluorescence intensity of CRT on PC-3 cell surface after drug. <bold>(B)</bold> ATP expression in the cell culture medium after drug treatment. (*p &lt; 0.05; ***p &lt; 0.001). <bold>(C)</bold> PC-3 cells after treatment with drug and immature DCs for 24 h.(The red arrows indicate that immature DCs have developed &#x201c;dendritic&#x201d; structures, indicating that they have become mature DCs).</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fendo-13-872411-g007.tif"/>
</fig>
</sec>
<sec id="s3_7">
<title>Release of ATP</title>
<p>The release of ATP was measured using UV spectrophotometry. As shown in <xref ref-type="fig" rid="f7">
<bold>Figure&#xa0;7B</bold>
</xref>, the release of ATP in the extracellular fluid of PC-3 cells treated with DOX increased 5.5 times compared to that in the untreated group, while the release of ATP in the DOX group combined with the whole nanomedicine system increased 9.8 times, which was approximately consistent with the results of CRT and HMGB1. Similarly, the laser-irradiated group also showed significant enhancement.</p>
</sec>
<sec id="s3_8">
<title>Maturation of DC Cells</title>
<p>To explore whether the nanoparticle drug platform-induced apoptosis of PC-3 cells can promote the maturation of anthropogenic DC cells to further induce an immune response, drug-treated PC-3 cells were co-incubated with anthropogenic DCs for 24 h. The maturation of DCs before and after drug treatment and in different drug groups was observed using an inverted microscope. As shown in <xref ref-type="fig" rid="f7">
<bold>Figure&#xa0;7C</bold>
</xref>, immature human DCs in their original state are round and have no dendrite structure. However, several DC suspension cells with the dendritic structure were observed in the DOX, laser, and all nanodrug groups, suggesting that the laser effect and the whole nanodrug platform could stimulate DC maturation.</p>
<p>To further verify the maturation of DCs, flow cytometry was used to analyze the expression of related markers in dendritic cells after co-incubation. We first treated the cells with FITC anti-human CD11c to label the DCs, and then analyzed their CD80 and CD86 co-expression and HLA-DR expression. As shown in <xref ref-type="fig" rid="f8">
<bold>Figure&#xa0;8A</bold>
</xref>, the expression of CD80 and CD86 in the DOX group was significantly higher than that in the untreated group. There were no significant changes observed in the BP-P and BP-P+laser groups, while the expression of CD80 and CD86 in BP-P-Apt-Zn/DOX +laser and non-laser groups significantly increased by 62.2% and 60.3%, respectively. The expression of HLA-DR is shown in <xref ref-type="fig" rid="f8">
<bold>Figure&#xa0;8B</bold>
</xref>. Its expression in DOX and laser groups increased significantly, while there was no significant difference between the BP-P and untreated groups. <xref ref-type="fig" rid="f8">
<bold>Figures&#xa0;8C, D</bold>
</xref> shows the results of quantitative analysis of CD80 and CD86 are co-expressed and HLA-DR expression in dendritic cells. Flow cytometry analysis results were consistent with the microscopy results.</p>
<fig id="f8" position="float">
<label>Figure&#xa0;8</label>
<caption>
<p>
<bold>(A)</bold> The expression of CD80 and CD86 co-expressed DCs. <bold>(B)</bold> HLA-DR expression. <bold>(C)</bold>The expression of CD80 and CD86 co-expressed DCs. <bold>(D)</bold> HLA-DR expression. (*p &lt; 0.05; ***p &lt; 0.001; ns, no significance).</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fendo-13-872411-g008.tif"/>
</fig>
</sec>
</sec>
<sec id="s4" sec-type="discussion">
<title>Discussion</title>
<p>The COVID-19 pneumonia caused by SARS-COV-2 is severe. By February, 390 million cases were confirmed globally, with 2.44 million new cases reported daily. The economic losses and social burden caused by the epidemic are an unbearable disaster for every country, especially non-developed countries. The highly infectious and stealthy nature of the omicron variant makes COVID-19 more difficult to control (<xref ref-type="bibr" rid="B38">38</xref>). Multiple clinical studies have found significantly higher rates of hospitalization, morbidity and mortality in patients with solid tumors (prostate cancer) infected with COVID-19 (<xref ref-type="bibr" rid="B39">39</xref>). This may be due to abnormal immune status in solid tumor patients, coupled with radiotherapy and chemotherapy, the immunity is further reduced (<xref ref-type="bibr" rid="B40">40</xref>). Making it easier for COVID-19 to sneak in.</p>
<p>A large number of studies have confirmed the importance of trace element zinc for the development and maintenance of normal functions of immune system (<xref ref-type="bibr" rid="B41">41</xref>). Zinc deficiency can lead to a decrease in the number and function of immune cells, as well as an increased risk of tumors and infections (<xref ref-type="bibr" rid="B42">42</xref>). For prostate cancer patients with zinc deficiency, zinc ion supplementation can inhibit the activity of aconitase and inhibit the proliferation and invasion of tumor cells (<xref ref-type="bibr" rid="B43">43</xref>).</p>
<p>In the past decade, advances in tumor immunotherapy have changed the therapeutic landscape for solid malignancies. Prostate cancer, as a &#x201c;cold&#x201d; tumor, is challenging to diagnose and treat because of its indolence. Several Phase I and II trials evaluating programmed death receptor 1 (PD-1) inhibitors have shown a weak effect on metastatic castration-resistant prostate cancer (<xref ref-type="bibr" rid="B44">44</xref>). The only prostate cancer vaccine, Sipuleucel-T, was approved by the US FDA in 2010 for the treatment of asymptomatic or mild mCRPC, but it is not popular (<xref ref-type="bibr" rid="B45">45</xref>). Studies have shown that the ICD process of tumor cells and the release of DAMP can stimulate the anti-tumor immune response. CRT promotes the uptake of tumor cell membrane fragments by DCs. HMGB1 can bind toll-like receptor 4 (TLR4) to stimulate the immune response. ATP acts as a homing signal to activate the NLRP3 inflammasome (<xref ref-type="bibr" rid="B46">46</xref>).</p>
<p>Although DOX is not the most sensitive chemotherapy agent for prostate cancer, it is the most widely used immunogenic death stimulant (<xref ref-type="bibr" rid="B17">17</xref>). It certainly promotes ICD, a well-defined type of apoptotic process (<xref ref-type="bibr" rid="B47">47</xref>). Released DAMPs can be recognized by pattern recognition receptors (PRRs) and induce antigen-presenting cells(APC) to activate, differentiate, and mature (<xref ref-type="bibr" rid="B48">48</xref>). In addition, it promotes the release of interferon I, promotes the recruitment of antigen presenting cells and T cells, and further activates specific immune effects (<xref ref-type="bibr" rid="B49">49</xref>).</p>
<p>At present, there have been many milestone work on nanomedicine carriers. It is estimated that half of all drugs will be loaded with nanocarriers by 2050 (<xref ref-type="bibr" rid="B50">50</xref>, <xref ref-type="bibr" rid="B51">51</xref>). Patisiran (ONPATTRO&#x2122;), a double-stranded small interfering RNA encapsulated in lipid nanoparticles, is the first novel RNAi (interfering/silencing RNA) drug approved by the FDA for the treatment of amyloid multiple neuropathy (FAP) (<xref ref-type="bibr" rid="B52">52</xref>). However, it is prone to automatic oxidation, which leads to reduced fluidity of cell membrane and toxicity after aggregation and precipitation (<xref ref-type="bibr" rid="B53">53</xref>). As a kind of inorganic nanoparticles, Au NPs are more widely used in detection technology and biosensing. Due to the high cost of preparation, the application of Au Nps drug carrier cannot achieve universal applicability (<xref ref-type="bibr" rid="B54">54</xref>). The low cost, good biocompatibility, excellent photothermal conversion performance and good stability of modified black phosphorus made us choose it as our immune adjuvant. In the previous research, we developed DOX loaded black phosphorus nanomaterial and applied for relevant patents. Therefore, black phosphorus is still our first candidate material in this study. On the basis of previous research, the preparation process was optimized and its properties were more accurately characterized.</p>
<p>Our study introduced zinc ions into the nanodrug system, which not only improves immune function but also improves the ability to kill tumor cells. Moreover, BP-P-Apt-Zn/DOX combined with PTT promote ICD process and DCs maturation. Our findings are conducive to further activation of initial T cells, thus initiating, regulating, and maintaining the central link of the immune response.</p>
<p>Despite this initial success, there are a few shortcomings of our study because. Firstly, we used human PC-3 cells and human DCs and did not confirm our results in a prostate cancer model <italic>in vivo</italic>. In addition, we need to further study which specific pathway BP-P-Apt-Zn/DOX combined with PTT affects to induce the ICD process. Whether the ICD process can be further enhanced by attaching the nanodrug system to the anti-PD-1/PD-L1 antibody also needs to be further studied. Based on this study, we will use organoid or patient-derived xenotransplantation model (PDX) in the following plan to evaluate the exact efficacy of drugs <italic>in vivo</italic> and the ICD process.</p>
</sec>
<sec id="s5">
<title>Conclusion</title>
<p>In summary, we successfully prepared the Zn-loaded black phosphorus nanodrug platform. The results proved that the introduction of Zn<sup>2+</sup> improved the killing effect of the nanodrug system, the addition of Apt enhanced the drug targeting, and the combination of photothermal therapy further increased the killing effect of the whole nanodrug system. In addition, it was found that PTT combined with nanocarriers and loaded DOX not only enhanced toxicity but also promoted the ICD process and increased the maturation of DCs, thereby inducing an immune response. We hope this excellent combination will introduce prostate cancer vaccines to enhance their ability to activate the immune system. More importantly, it is hoped that the introduction of zinc will provide a new therapeutic strategy for prostate cancer patients infected with COVID-19.</p>
</sec>
<sec id="s6" sec-type="data-availability">
<title>Data Availability Statement</title>
<p>The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding authors.</p>
</sec>
<sec id="s7" sec-type="author-contributions">
<title>Author Contributions</title>
<p>LL as the first author of this paper was mainly responsible for the overall implementation of the experiment, data analysis, article writing and analysis of the experimental results. LG as the corresponding author was mainly responsible for the study design and experimental master plan as well as the review of the final paper. BG as the co-corresponding author, assisted LG to complete the overall planning of the whole experiment. BZ as the second author of this paper is mainly responsible for data processing. HX as the third author of this paper, mainly assisted LL in conducting experiments and analyzing data. HS as the fourth author was mainly responsible for assisting the experiment. All authors contributed to the article and approved the submitted version.</p>
</sec>
<sec id="s8" sec-type="funding-information">
<title>Funding</title>
<p>This work was financially supported by the Guangxi Natural Science Fund (2018GXNSFAA281270, 2019GXNSFAA185034, 2020GXNSFAA238002), the National Natural Science Foundation of China (82060146), and the Young and middle-aged faculty research ability Enhancement project of Guilin Medical College (2018glmcy033).</p>
</sec>
<sec id="s9" sec-type="COI-statement">
<title>Conflict of Interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s10" sec-type="disclaimer">
<title>Publisher&#x2019;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
</body>
<back>
<ack>
<title>Acknowledgments</title>
<p>The authors would like to thank all the reviewers who participated in the review and MJEditor (<uri xlink:href="http://www.mjeditor.com">www.mjeditor.com</uri>) for its linguistic assistance during the preparation of this manuscript.</p>
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