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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Oncol.</journal-id>
<journal-title>Frontiers in Oncology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Oncol.</abbrev-journal-title>
<issn pub-type="epub">2234-943X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fonc.2021.666017</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Oncology</subject>
<subj-group>
<subject>Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Nanozymes in Tumor Theranostics</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Ma</surname>
<given-names>Qiulian</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Liu</surname>
<given-names>Yanfang</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/745795"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Zhu</surname>
<given-names>Haitao</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/480065"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Zhang</surname>
<given-names>Lirong</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/510877"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Liao</surname>
<given-names>Xiang</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1227100"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Department of Medical Imaging, The Affiliated Hospital of Jiangsu University</institution>, <addr-line>Zhenjiang</addr-line>, <country>China</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>School of Medicine, Jiangsu University</institution>, <addr-line>Zhenjiang</addr-line>, <country>China</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>Department of Laboratory Medicine, The Affiliated Hospital of Jiangsu University</institution>, <addr-line>Zhenjiang</addr-line>, <country>China</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Meihua Yu, University of Queensland, Australia</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Juqun Xi, Yangzhou University, China; Kelong Fan, Institute of Biophysics (CAS), China</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Haitao Zhu, <email xlink:href="mailto:zhht25@163.com">zhht25@163.com</email>; Lirong Zhang, <email xlink:href="mailto:tianchen861@163.com">tianchen861@163.com</email>; Xiang Liao, <email xlink:href="mailto:liaoxiang025@126.com">liaoxiang025@126.com</email>
</p>
</fn>
<fn fn-type="equal" id="fn003">
<p>&#x2020;These authors have contributed equally to this work</p>
</fn>
<fn fn-type="other" id="fn002">
<p>This article was submitted to Pharmacology of Anti-Cancer Drugs, a section of the journal Frontiers in Oncology</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>19</day>
<month>10</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="collection">
<year>2021</year>
</pub-date>
<volume>11</volume>
<elocation-id>666017</elocation-id>
<history>
<date date-type="received">
<day>09</day>
<month>02</month>
<year>2021</year>
</date>
<date date-type="accepted">
<day>16</day>
<month>08</month>
<year>2021</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2021 Ma, Liu, Zhu, Zhang and Liao</copyright-statement>
<copyright-year>2021</copyright-year>
<copyright-holder>Ma, Liu, Zhu, Zhang and Liao</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>Nanozymes, a new generation of enzyme mimics, have recently attracted great attention. Nanozymes could catalyze chemical reactions as biological enzymes under physiologically mild conditions with higher-efficiency catalytic activities. Moreover, nanozymes could overcome the shortcomings of natural enzymes, such as easy inactivation, high cost, and low yield. With the development of more and more smart and multi-functional nanosystems, nanozymes display great achievement in tumor biology. In this review, we outline the recent advances of nanozymes in tumor and tumor microenvironment diagnosis, therapy, and theranostics. </p>
</abstract>
<kwd-group>
<kwd>nanozyme</kwd>
<kwd>tumor microenvironment</kwd>
<kwd>diagnosis</kwd>
<kwd>therapy</kwd>
<kwd>theranostics</kwd>
</kwd-group>
<counts>
<fig-count count="4"/>
<table-count count="1"/>
<equation-count count="0"/>
<ref-count count="114"/>
<page-count count="13"/>
<word-count count="5531"/>
</counts>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<title>Introduction</title>
<p>Despite the great achievement of traditional cancer treatment, such as chemotherapy and immunotherapy, tumors continue to be a major cause of morbidity and mortality. The crosstalk between tumor cells and the tumor microenvironment (TME) is a critical factor for therapy resistance, relapse, and metastasis (<xref ref-type="bibr" rid="B1">1</xref>). Therefore, it is important to explore novel strategies to enhance tumor treatment sensitivity by targeting both cancer cells and TME.</p>
<p>Nanomaterials have recently received great interest in enhancing the outcome of cancer therapy, especially nanozymes. Natural enzymes are the proteins or ribonucleic acid (RNA) with highly specific and catalytic ability to their substrates produced by living cells. However, the intrinsic characteristics of natural enzymes, such as storage difficulty, easy deactivation, and high cost, limit their further clinic application (<xref ref-type="bibr" rid="B2">2</xref>). With the unexpected discovery of horseradish peroxidase (HRP) activity of Fe<sub>3</sub>O<sub>4</sub> magnetic nanoparticles (Fe<sub>3</sub>O<sub>4</sub> MNPs) in 2007, the artificial nanozymes that display similar catalytic mechanism and efficiency to natural enzymes gradually become research hotspots (<xref ref-type="bibr" rid="B3">3</xref>). Nanozymes were firstly identified as nanomaterials possessing intrinsic enzyme-like activities (<xref ref-type="bibr" rid="B3">3</xref>). Recently, with the development of chemistry and biology, nanozymes are now termed inorganic or organic nanomaterials possessing intrinsic enzyme-like catalytic activities with abundant advantageous properties compared to natural enzymes, such as lower cost, more facile preparation, higher operational ability, and multi-functionalization (<xref ref-type="bibr" rid="B4">4</xref>&#x2013;<xref ref-type="bibr" rid="B7">7</xref>).</p>
<p>Based on the rapid development of nanotechnology, the majority of nanoparticles, such as magnetic nanomaterials, cerium oxide nanoparticles (nanoceria), carbon nanotubes (CNTs), graphene oxide (GO), and gold nanoparticles (Au NPs), have demonstrated their intrinsic redox catalytic activities (<xref ref-type="bibr" rid="B3">3</xref>, <xref ref-type="bibr" rid="B8">8</xref>&#x2013;<xref ref-type="bibr" rid="B16">16</xref>). Due to the unique properties of nanozymes and the specific characteristics of tumor and TME, deeper and wider applications of nanozymes in tumor diagnosis, therapy, and theranostics are becoming more and more possible. In this review, we firstly briefly summarize the classification of the most common nanozymes and then discuss the promising applications and challenges of nanozymes in the field of tumor theranostics.</p>
</sec>
<sec id="s2">
<title>Classification of Nanozymes</title>
<p>Nanozymes mainly include the following subtypes: peroxidase (POD), oxidase (OXD), catalase (CAT), and superoxide dismutase (SOD) (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1</bold>
</xref>). More importantly, great efforts must be devoted to the exploration of novel nanozymes. In this section, we discuss only a few parts of representative nanozymes based on their compositions.</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Nanozyme reaction formulas.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fonc-11-666017-g001.tif"/>
</fig>
<sec id="s2_1">
<title>Carbon-Based Nanozymes</title>
<p>Carbon-based nanomaterials, including carbon nanotubes (CNTs), graphene oxide (GO), carbon nanospheres, and carbon nanodots (C-Dots), have been proved as the POD mimic catalytic enzyme (<xref ref-type="bibr" rid="B11">11</xref>, <xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B17">17</xref>&#x2013;<xref ref-type="bibr" rid="B23">23</xref>), while fullerene and its derivatives perform the SOD-like activity (<xref ref-type="bibr" rid="B4">4</xref>).</p>
<p>Combining the ability of hemin to catalyze various oxidation reactions and the large open surface area and rich surface chemistry of graphene, the nanoplatform-modified hemin onto the surface of graphene through the &#x3c0;&#x2212;&#x3c0; stacking can serve as POD enzymes and display stable geometric support and efficient molecular loading ability (<xref ref-type="bibr" rid="B19">19</xref>, <xref ref-type="bibr" rid="B20">20</xref>).</p>
<p>The carboxyl-modified graphene oxide (GO-COOH) with the intrinsic POD property could catalyze the peroxidase substrate 3,3&#x2019;,5,5&#x2019;-tetramethylbenzidine (TMB) in the presence of hydrogen peroxide (H<sub>2</sub>O<sub>2</sub>) (<xref ref-type="bibr" rid="B15">15</xref>). The accompanying blue color reaction makes them capable to be developed for a cheaper and more sensitive glucose detection (<xref ref-type="bibr" rid="B15">15</xref>).</p>
<p>CNTs can be distinguished as single-wall carbon nanotubes (SWNTs) and multi-wall carbon nanotubes (MWNTs) according to the number of graphene layers (<xref ref-type="bibr" rid="B24">24</xref>). SWNTs could catalyze the substrate of TMB, which have been developed to target dsDNA efficiently (<xref ref-type="bibr" rid="B11">11</xref>). Moreover, it has been confirmed that the enzymatic activity of carbon nanotubes strongly depended on pH, temperature, and H<sub>2</sub>O<sub>2</sub> concentration (<xref ref-type="bibr" rid="B11">11</xref>).</p>
<p>Based on the superior enzyme activities of nitrogen-doped carbon nanomaterials (N-CNMs), N-doped porous carbon nanospheres (N-PCNSs) possess excellent mimic activities, including OXD-, POD-, CAT-, and POD-like activities (<xref ref-type="bibr" rid="B25">25</xref>). These activities are positively correlated with the concentration of N dopant and can also be tunable by pH and temperature (<xref ref-type="bibr" rid="B25">25</xref>, <xref ref-type="bibr" rid="B26">26</xref>). Additionally, the B/Fe-doped carbon nanoparticles can also function as POD catalysts (<xref ref-type="bibr" rid="B26">26</xref>, <xref ref-type="bibr" rid="B27">27</xref>).</p>
</sec>
<sec id="s2_2">
<title>Metal-Based Nanozymes</title>
<p>With the high glucose conversion ability, gold nanoparticles (Au NPs) have been discovered to perform POD- and OXD-like activities (<xref ref-type="bibr" rid="B13">13</xref>, <xref ref-type="bibr" rid="B14">14</xref>). Mesoporous silica nanoparticles (MSN) or bovine serum albumin (BSA) can be assembled on the surface of Au NPs for the detection of glucose or dopamine (DA) by the distinguished GOx- and POD-like activities of Au NPs (<xref ref-type="bibr" rid="B28">28</xref>, <xref ref-type="bibr" rid="B29">29</xref>). However, high temperature can result in the poor catalytic performance of Au NPs due to the instability of enzymatic product ABTS<sup>&#x2022;+</sup>, which can be improved by ionic liquid (<xref ref-type="bibr" rid="B30">30</xref>). The stable platinum nanoparticles (Pt NPs) have the ability to scavenge H<sub>2</sub>O<sub>2</sub>, superoxide anion <inline-formula>
<mml:math display="inline" id="im1">
<mml:mrow>
<mml:mo stretchy="false">(</mml:mo>
<mml:msubsup>
<mml:mtext>O</mml:mtext>
<mml:mn>2</mml:mn>
<mml:mo>&#x2212;</mml:mo>
</mml:msubsup>
<mml:mo stretchy="false">)</mml:mo>
</mml:mrow>
</mml:math>
</inline-formula>, and singlet oxygen (<sup>1</sup>O<sub>2</sub>), simulating CAT-, SOD-, and OXD-like activities. The specific catalytic enzyme activities of Pt NPs are tightly dependent on temperature and pH (<xref ref-type="bibr" rid="B31">31</xref>, <xref ref-type="bibr" rid="B32">32</xref>). Under the low pH environment, Pt NPs mostly possess POD-like activity, while Pt NPs exhibit CAT- and SOD-like activities under neutral conditions (<xref ref-type="bibr" rid="B31">31</xref>, <xref ref-type="bibr" rid="B32">32</xref>). Moreover, there is a positive correlation between enzyme activities and Pt content. Escapsulating apo-ferritin on the Pt NPs (PtNP@apo-ferritin), this system exhibited more outstanding SOD-like activity and longer-term stability (<xref ref-type="bibr" rid="B32">32</xref>, <xref ref-type="bibr" rid="B33">33</xref>).</p>
</sec>
<sec id="s2_3">
<title>Metal Oxide-Based Nanozymes</title>
<p>Nanoceria and iron oxide magnetic nanoparticles (Fe<sub>3</sub>O<sub>4</sub> MNPs) are the most widely utilized metal oxide catalysts among the metal oxide-based nanomaterials (<xref ref-type="bibr" rid="B5">5</xref>, <xref ref-type="bibr" rid="B8">8</xref>&#x2013;<xref ref-type="bibr" rid="B10">10</xref>, <xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B34">34</xref>, <xref ref-type="bibr" rid="B35">35</xref>). Nanoceria exists in a mixed valence state (Ce<sup>3+</sup>and Ce<sup>4+</sup>) (<xref ref-type="bibr" rid="B9">9</xref>, <xref ref-type="bibr" rid="B36">36</xref>&#x2013;<xref ref-type="bibr" rid="B38">38</xref>). The ratio of Ce<sup>3+</sup> and Ce<sup>4+</sup> determines the catalytic enzyme activity of nanoceria. Nanoceria mainly performs SOD-like activity with a high Ce<sup>3+</sup>/Ce<sup>4+</sup> ratio, while performing CAT-mimic activity with a low Ce<sup>3+</sup>/Ce<sup>4+</sup> ratio (<xref ref-type="bibr" rid="B7">7</xref>). Moreover, the activity of nanoceria and Fe<sub>3</sub>O<sub>4</sub> MNPs can be controlled by pH. Under the low pH environment, nanoceria possesses an intrinsic OXD-like activity (<xref ref-type="bibr" rid="B9">9</xref>). Fe<sub>3</sub>O<sub>4</sub> MNPs display a POD-like activity under acid conditions, while showing CAT-like activity in a neutral environment through the decomposed H<sub>2</sub>O<sub>2</sub> (<xref ref-type="bibr" rid="B39">39</xref>&#x2013;<xref ref-type="bibr" rid="B41">41</xref>). The manganic oxide nanoparticles (MnO NPs) behave as the SOD, CAT, and GOx enzymes, inducing the elimination of hydroxyl radical (&#xb7;OH), maintaining redox homeostasis, and protecting cells from neurotoxin-induced damage (<xref ref-type="bibr" rid="B42">42</xref>).</p>
</sec>
<sec id="s2_4">
<title>Metal Chalcogenide Nanozymes</title>
<p>Copper monosulfide (CuS) nanoparticles (CuS NPs) have been demonstrated to perform POD-mimic activity by catalyzing the peroxide substrate 3,3&#x2019;,5,5&#x2019;-TMB in the presence of H<sub>2</sub>O<sub>2</sub> (<xref ref-type="bibr" rid="B43">43</xref>&#x2013;<xref ref-type="bibr" rid="B47">47</xref>). Moreover, with the CuS NPs further covered on the graphene, the CuS-graphene nanosheets (CuS-GNSs) possess higher intrinsic POD- and GOx-like activity than CuS or graphene, respectively, which have been employed to detect H<sub>2</sub>O<sub>2</sub> concentration and monitor the human blood glucose level (<xref ref-type="bibr" rid="B44">44</xref>). CuS concave polyhedral superstructures (CuS CPSs) possess superior POD-like activity compared to either the initial formed spherical CuS superstructures or convex CuS microspheres, due to the fact that the concave structures constructed by the thinner nanoplates have a hollow/porous structure that led to a higher surface area (<xref ref-type="bibr" rid="B43">43</xref>, <xref ref-type="bibr" rid="B48">48</xref>).</p>
<p>It has been proved that several iron chalcogenides can serve as POD-mimic enzymes. FeS<sub>2</sub> nanosheets (FeS<sub>2</sub> NSs) possess the ability to oxidate the peroxide substrate TMB due to the Fe ion located in the active site (<xref ref-type="bibr" rid="B49">49</xref>). Simultaneously, the peroxidase activity of FeS<sub>2</sub> NSs can be tunable by pH and temperature (<xref ref-type="bibr" rid="B49">49</xref>). The FeS<sub>2</sub>/SiO<sub>2</sub> double mesoporous hollow spheres (DMHSs) not only exhibit a more outstanding POD-like activity than both Fe<sub>3</sub>O<sub>4</sub> NPs and FeS<sub>2</sub> NSs, but also are more susceptive to the detection of H<sub>2</sub>O<sub>2</sub> and glutathione (GSH) (<xref ref-type="bibr" rid="B50">50</xref>). The sulfur vacancies in magnetic greigite (SVs-Fe3S4) NSs have demonstrated a distinguished POD-mimic activity resulting from the abundant SVs, which have been developed for the colorimetric detection of glucose in human serum (<xref ref-type="bibr" rid="B51">51</xref>).</p>
<p>The MoS<sub>2</sub> nanosheets have been developed for the regulation of oxidation stress due to their intrinsic multi-enzyme-like activities under physiological conditions, including SOD-, CAT-, and POD-mimicking activities (<xref ref-type="bibr" rid="B52">52</xref>). MoS<sub>2</sub> nanosheets can efficiently remove several kinds of reactive oxygen species (ROS) through the Mo<sup>6+</sup>/Mo<sup>4+</sup> redox couple and accelerate the electron transfer between TMB and H<sub>2</sub>O<sub>2</sub> (<xref ref-type="bibr" rid="B52">52</xref>).</p>
<p>The reason why nanozymes are considered to have enzyme-like catalytic activities is that they own high catalytic activities and can catalyze the same chemical reactions as biological enzymes. In addition, compared to biological enzymes, nanozymes have superior biocompatibility, stability, and targeting ability, and play corresponding catalytic activities in different environments. The application of nanozymes in tumor diagnosis and treatment depends on their closer integration of nanotechnology and biomedicine for the.</p>
</sec>
</sec>
<sec id="s3">
<title>Nanozymes in Tumor Diagnosis, Therapy, and Theranostics</title>
<p>Solid tumors consist of cancer cells and their living environment, also termed tumor microenvironment (TME). Previously, traditional cancer therapy avenues were mostly focused on cancer cells. Recently, more and more lines of evidence have uncovered that the TME is also critical on tumor malignant behaviors. Therefore, targeting both cancer cells and TME is becoming a promising cancer therapy method. TME includes the various soluble substance and stromal cells, such as fibroblasts, immune and inflammatory cells, glial cells, and other cells, as well as nearby micro-vessels and various biological signal molecules (<xref ref-type="bibr" rid="B53">53</xref>, <xref ref-type="bibr" rid="B54">54</xref>). The &#x201c;interactive cooperation&#x201d; between stromal cells and cancer cells facilitates the progression of tumor and contributes to the dramatic dynamic changes and the heterogeneity of TME (<xref ref-type="bibr" rid="B53">53</xref>). In addition, cancer cells could also remodel the TME, ultimately resulting in the immune escape, metastasis, and even relapse of tumor (<xref ref-type="bibr" rid="B55">55</xref>). The characterized metabolism manner, rapid growth, and strong reproduction ability of cancer cells determine their higher demands for oxygen and glucose than normal cells. Cancer cells compete with stromal cells to take advantage of glucose for aerobic glycolysis. Also, abundant lactic acid secreted into the extracellular environment ultimately forms the acid and immunosuppressed TME (<xref ref-type="bibr" rid="B56">56</xref>&#x2013;<xref ref-type="bibr" rid="B58">58</xref>). The broken balance between oxygen consumption and supply resulted in the messy growth and irregular distribution of tumor vasculature systems, which, in turn, eventually enhanced the degree of permanent or temporary hypoxia and further increased the osmotic pressure of TME (<xref ref-type="bibr" rid="B59">59</xref>). Therefore, low pH, hypoxia, excessive H<sub>2</sub>O<sub>2</sub> and GSH, high osmotic pressure, and immunosuppressive microenvironment are the outstanding hallmarks of solid tumors (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2</bold>
</xref>) (<xref ref-type="bibr" rid="B53">53</xref>, <xref ref-type="bibr" rid="B56">56</xref>, <xref ref-type="bibr" rid="B58">58</xref>). These characteristics are mutually causal, finally contributing to the rapid progression of tumor. Targeting and normalizing TME seem to be a new and effective method for tumor diagnosis and treatment. Recently, more and more nanozymes have been constructed to target the diagnosis and treatment of TME.</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>The characteristic of tumor microenvironment.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fonc-11-666017-g002.tif"/>
</fig>
<sec id="s3_1">
<title>Nanozymes in Tumor Cells and Tumor Microenvironment Target Diagnosis</title>
<p>Nanotechnology-based tumor target diagnosis and therapy include passive target and active target. Active target greatly relies on the recognition of the specific receptors overexpressed on cancer cells and the ligand-directed binding on the surface of nanosystems (<xref ref-type="bibr" rid="B60">60</xref>). Loaded with special markers on the cancer cell surface, such as transferrin, growth factors, peptides, folate, antibodies, or antibody fragments, nanozyme systems not only recognize tumor more sensitively, but also result in drug delivery more specifically (<xref ref-type="bibr" rid="B61">61</xref>). The nanozymes modified with folic acid can actively target the folic acid receptors on the cancer cell surface and further can serve as oxidants to promote cancer cell death (<xref ref-type="bibr" rid="B9">9</xref>, <xref ref-type="bibr" rid="B17">17</xref>). Porous platinum nanoparticles on graphene oxide (Pt NPs/GO) can function as peroxidase mimetics. which enable them to detect cancer cells by the color reaction of TMB (<xref ref-type="bibr" rid="B62">62</xref>). Furthermore, by loading folic acid on the Pt NPs/GO, this nanosystem can distinguish a total of 125 cancer cells more broadly than naked-eye observation (<xref ref-type="bibr" rid="B62">62</xref>). Prostate-specific antigen (PSA), a special tumor biomarker, can be attached by the immune complexes based on the intrinsic POD-like activity of GO, and then the PSA concentration could be directly detected with the colorimetric reaction (<xref ref-type="bibr" rid="B63">63</xref>). Ultra-small gold nanoclusters (Au NCs) can serve as POD-like catalysts for disproportionation and decomposition of H<sub>2</sub>O<sub>2</sub>, which make them sensitive probes for tumor imaging <italic>in vivo</italic> (<xref ref-type="bibr" rid="B64">64</xref>). The multifunctional protease nanosensor constructed by Au NCS not only can determine whether the tissue is cancerous through the catalyzed reaction of Au NCS according to the color reaction, but also is non-toxic and can be completely eliminated by liver and kidney excretion (<xref ref-type="bibr" rid="B64">64</xref>). Furthermore, the magneto-ferritin nanoparticles (M-HFn) are composed of iron oxide and heavy-chain ferritin (HFn) shell (<xref ref-type="bibr" rid="B65">65</xref>). Due to the ability of targeting transferrin receptor 1 (TfR1) overexpressed on cancer cell surface and the color reaction in tumor site resulting from the POD-like activity of the iron oxide core that could catalyze the abundant H<sub>2</sub>O<sub>2</sub> in TME, M-HFn could visualize cancer tissues sensitively and specifically (<xref ref-type="bibr" rid="B65">65</xref>). Similarly, HFn-N-PCNSs-3 can also specifically identify the cancer cells and effectively reduce the tumor volume dependent on the special binding of TfR1 on cancer cell surface and the multi-enzyme mimic activities of N-PCNSs-3 (<xref ref-type="bibr" rid="B25">25</xref>). Besides, angiopep-2, a specific ligand of lipoprotein related protein-1 (LRP1), anchored on the surface of Au NPs can penetrate through the blood&#x2013;brain barrier (BBB) and further actively target glioma cancer cells (<xref ref-type="bibr" rid="B66">66</xref>, <xref ref-type="bibr" rid="B67">67</xref>).</p>
<p>Magnetic resonance imaging (MRI) contrast agents based on the ROS-stimulated responses, such as superoxide ions, H<sub>2</sub>O<sub>2</sub>, and hydroxyl radicals, have been promising tumor diagnostic and imaging markers due to their extensive accumulation and persistent presence in TME (<xref ref-type="bibr" rid="B68">68</xref>&#x2013;<xref ref-type="bibr" rid="B70">70</xref>). Prussian Blue nanoparticles (PBNPs, KFe<sup>3+</sup>[Fe<sup>2+</sup>(CN)<sub>6</sub>]) perform CAT-like activities under the neutral pH condition (<xref ref-type="bibr" rid="B71">71</xref>). The core Fe<sup>3+</sup> with water coordination can form paramagnetic oxygen bubbles, which are conducive to shorten the MRI T1-weighted image (T1WI) relaxation time and then enhance the MRI contrast (<xref ref-type="bibr" rid="B72">72</xref>). Based on the previous pioneering work of PBNPs, SPIO@GCS/acryl/biotin-CAT/SOD-gel (SGC), a dual-enzyme-loaded multifunctional hybrid nanogel probe, has been developed to strengthen the ultrasound imaging and the imaging contrast of T2WI (<xref ref-type="bibr" rid="B73">73</xref>). In recent years, the PB@Au core-satellite nanoparticles (CSNPs) have been constructed to explore multiple diagnostic and therapeutic strategies of tumors (<xref ref-type="bibr" rid="B72">72</xref>). CSNPs can achieve dual-model imaging due to the PB NPs that acted as MRI T1WI contrast agents and the enhanced computed tomography (CT) imaging efficiency by AuNPs (<xref ref-type="bibr" rid="B72">72</xref>). Besides, the MnO NPs exposed to the superoxide radicals could enhance the MRI signal and simultaneously treat the catalytic-induced tumor progression due to their intrinsic SOD-mimic ability (<xref ref-type="bibr" rid="B74">74</xref>). Moreover, the CAT-like nanoparticles are gradually utilized as coupling or contrast agents of ultrasound (US) and MRI owing to the enhanced catalyzed H<sub>2</sub>O<sub>2</sub> into O<sub>2</sub> molecules (<xref ref-type="bibr" rid="B71">71</xref>&#x2013;<xref ref-type="bibr" rid="B73">73</xref>).</p>
<p>Early diagnosis of tumor makes it possible to obtain outstanding tumor clearance and satisfactory clinical prognosis by local treatment. Nowadays, the early detection of tumor mainly depends on the blood tumor markers and imaging manifestations. However, the extremely low abscission rate of early tumor markers or the lack of specificity of imaging findings limits the accuracy and sensitivity of early tumor detection in clinical. The emergence of nanozymes provides new ideas and methods for the early diagnosis of tumor and the visualization of tumor tissues, which greatly improve the specificity and sensitivity of early diagnosis of tumor.</p>
</sec>
<sec id="s3_2">
<title>Nanozymes in Synergistic Tumor Therapy</title>
<p>Nanozymes can achieve anti-tumor effects by improving TME. For example, the highly ordered MnO<sub>2</sub>@PtCo nanoflowers are developed as a ROS generation nanoplatform for tumor therapy by targeting the hypoxia and the acidic pH of TME (<xref ref-type="bibr" rid="B75">75</xref>, <xref ref-type="bibr" rid="B76">76</xref>). Cooperating with the OXD-like activity of PtCo and the CAT-like activity of MnO<sub>2</sub>, the MnO<sub>2</sub>@PtCo nanozymes not only could supply O<sub>2</sub> to overcome the hypoxic TME, but also catalyze ROS formation, which further induces the admirable tumor apoptosis (<xref ref-type="bibr" rid="B75">75</xref>). Similarly, the DMSN-Au-Fe<sub>3</sub>O<sub>4</sub> composited nanoplatforms could make the TME-responsive tumor vanish owing to the GOx-mimic activity of Au NPs and the POD-like activity of the Fe<sub>3</sub>O<sub>4</sub> nanoparticles. The DMSN-Au-Fe<sub>3</sub>O<sub>4</sub> nanozymes are capable of catalyzing &#x3b2;-D-glucose oxidated into gluconic acid and subsequently produce high-toxic hydroxyl radicals for tumor regression (<xref ref-type="bibr" rid="B41">41</xref>). Based on the abundant GSH detained in TME, pyrite nanozymes and FeS<sub>2</sub> with ultrahigh H<sub>2</sub>O<sub>2</sub> affinity promote the glutathione oxidation due to their OXD-like activity and the generation of <sup>&#x2022;</sup>OH by their POD-like activity, resulting in the ferroptosis and apoptosis of tumor cells consequently (<xref ref-type="bibr" rid="B35">35</xref>). Recently, a novel nanosystem, polyethylene glycol (PEG)-ylated iron manganese silicate nanoparticles (IMSN) loaded with TGF-&#x3b2; inhibitor (TI) (IMSN-PEG-TI), has also been constructed to regulate the tumor immune microenvironment and advance the tumor therapeutic modality through the intrinsic POD- and CAT-like activities of IMSN nanozymes under the acidic TME (<xref ref-type="bibr" rid="B58">58</xref>).</p>
<p>Additionally, nanozymes can synergistically enhance the anti-tumor effects of tumor therapy avenues that deeply depend on the oxygen level, such as photodynamic therapy (PDT), photothermal therapy (PTT), sonodynamic therapy (SDT), radiotherapy (RT), and chemotherapy (<xref ref-type="bibr" rid="B1">1</xref>, <xref ref-type="bibr" rid="B77">77</xref>). Moreover, consumption of O<sub>2</sub> and tumor vasoconstriction can further exacerbate hypoxia and limit the efficiency of the above tumor therapies, which finally form a positive feedback (<xref ref-type="bibr" rid="B78">78</xref>&#x2013;<xref ref-type="bibr" rid="B81">81</xref>). Nanozymes are used more and more widely in enhancing the efficiency of these therapies.</p>
<sec id="s3_2_1">
<title>Nanozymes in Synergistic Phototherapy</title>
<p>Phototherapy relies on light radiation to induce the death of cancer cells, including PDT and PTT. PDT firstly transforms light energy to the surrounding O<sub>2</sub> and then produces a high concentration of cytotoxicity of ROS to further oxidize biomacromolecules and induces their dysfunction (<xref ref-type="bibr" rid="B77">77</xref>, <xref ref-type="bibr" rid="B82">82</xref>&#x2013;<xref ref-type="bibr" rid="B84">84</xref>). PTT induces the death of tumor cells depending on the local thermal damage (<xref ref-type="bibr" rid="B77">77</xref>, <xref ref-type="bibr" rid="B84">84</xref>, <xref ref-type="bibr" rid="B85">85</xref>). Although the photosensitizers and photothermal agents could enhance therapy efficiency and reduce the side effect of PDT and PTT under near-infrared (NIR) laser irradiation, they convert to excited single states and then return to the ground states by collisions between surrounding molecules. Accompanied by the increased kinetic energy, they consequently result in the heating of the surrounding microenvironment (<xref ref-type="bibr" rid="B77">77</xref>, <xref ref-type="bibr" rid="B85">85</xref>).</p>
<p>Although the metal-organic frameworks (MOFs) assembled with photosensitizers can induce the death of tumor cells by the conversion of oxygen into <sup>1</sup>O<sub>2</sub>, the efficiency of PDT is still limited owing to the hypoxia of the TME (<xref ref-type="bibr" rid="B80">80</xref>, <xref ref-type="bibr" rid="B81">81</xref>, <xref ref-type="bibr" rid="B86">86</xref>). The novel Pt nanozymes have been placed on the photosensitizers integrated with MOFs to break the limitation of hypoxia. This nanoplatform not only possesses higher stability, but also performs CAT-like activity leading to the additional <sup>1</sup>O<sub>2</sub> formation and further enhancing the efficiency of PDT (<xref ref-type="bibr" rid="B81">81</xref>).</p>
<p>CAT-mimicking Pt NPs are sandwiched into the dual-nanozyme-engineered porphyrin metal organic frameworks (PCN); furthermore, the outer GOx-mimicking Au NPs coordinate with folic acid (Pt@P-Au-FA) (<xref ref-type="bibr" rid="B87">87</xref>). The Pt@P-Au-FA NPs can enhance O<sub>2</sub> generation by catalyzing H<sub>2</sub>O<sub>2</sub>, which further enhances PDT efficiency. What is more, Au NPs strengthen the depletion of glucose and the self-produced H<sub>2</sub>O<sub>2</sub> serve as substrates of Pt NPs, cooperating with glucose depletion-induced starving therapy and achieving remarkable anti-tumor effects (<xref ref-type="bibr" rid="B87">87</xref>).</p>
<p>The nanozyme PEG/Ce-Bi@DMSN is constructed by dendritic mesoporous silica coated with uniform Bi<sub>2</sub>S<sub>3</sub> nanorods (Bi<sub>2</sub>S<sub>3</sub>@DMSN) and further by ultrasmall ceria placed into the large mesopores of Bi<sub>2</sub>S<sub>3</sub>@DMSN, which possesses dual mimic catalytic activities (including POD- and CAT-mimic activities) under primary acidic TME resulting in elevated oxidative stress and relieved hypoxia (<xref ref-type="bibr" rid="B88">88</xref>) (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3</bold>
</xref>). Additionally, PEG/Ce-Bi@DMSN allowed the enhanced GSH consumption to be overexpressed in TME. The NIR laser irradiation could strengthen the catalytic activities and GSH depletion of PEG/Ce-Bi@DMSN nanozymes, which further synergistically enhance the tumor ablation effect of PTT (<xref ref-type="bibr" rid="B88">88</xref>).</p>
<fig id="f3" position="float">
<label>Figure&#xa0;3</label>
<caption>
<p>Schematic illustration of the PEG/Ce-Bi@DMSN nanozymes enhancing the efficiency of PTT. Reproduced with permission (<xref ref-type="bibr" rid="B88">88</xref>). Copyright 2020, Wiley-VCH.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fonc-11-666017-g003.tif"/>
</fig>
<p>The platinum-doped Prussian blue (PtPB) nanozyme was developed to improve the photothermal property in a large wavelength range during the process of PTT (<xref ref-type="bibr" rid="B89">89</xref>). On the other hand, the PtPB nanozyme is endowed with superior CAT and SOD-like catalytic activities by Pt doped with PB nanotubes, which contributed to the relieved inflammation caused by PTT, along with significant tumor inhibition (<xref ref-type="bibr" rid="B89">89</xref>).</p>
</sec>
<sec id="s3_2_2">
<title>Nanozymes in Synergistic Sonodynamic Therapy</title>
<p>Ultrasound (US)-triggered sonodynamic therapy (SDT) consisting of a low-intensity ultrasound and a chemotherapeutic agent (sonosensitizer) is a promising alternative tumor therapeutic modality (<xref ref-type="bibr" rid="B90">90</xref>&#x2013;<xref ref-type="bibr" rid="B93">93</xref>). US not only is more accessible and noninvasive in reaching deep-seated tumor tissues, but also can activate sonosensitizers to produce toxic ROS molecules for tumor eradication (<xref ref-type="bibr" rid="B90">90</xref>, <xref ref-type="bibr" rid="B91">91</xref>, <xref ref-type="bibr" rid="B94">94</xref>). However, the therapeutic efficiency of SDT is still restricted by severe hypoxia in TME to a great extent (<xref ref-type="bibr" rid="B90">90</xref>, <xref ref-type="bibr" rid="B95">95</xref>).</p>
<p>The hollow Pt-CuS Janus can overcome the hypoxia environment due to the mimetic enzyme activity of Pt that decomposes the endogenous overexpressed H<sub>2</sub>O<sub>2</sub> into O<sub>2</sub> (<xref ref-type="bibr" rid="B47">47</xref>). The hollow Pt-CuS Janus has superior photothermal performance, which not only elevates the Pt enzyme activity for O<sub>2</sub> production, but also augments the SDT-induced tumor cell death by higher ROS level simultaneously (<xref ref-type="bibr" rid="B47">47</xref>). Hence, the synergistic efficiency of PTT and the catalysis-improved SDT can achieve complete tumor elimination.</p>
<p>The nanoprobe (CDP@HP-T), constructed by Pt-embedded hollow polydopamine (P@HP) nanoparticle, co-loaded with doxorubicin (DOX) and chlorine e6 (Ce6) and further modified with the mitochondrial-targeting molecule triphenyl phosphonium (TPP), can be used to achieve enhanced combination therapy of chemotherapy and SDT for tumors (<xref ref-type="bibr" rid="B94">94</xref>). As a pH-responsive nanoprobe, the CDP@HP-T could realize the abundant O<sub>2</sub> generation and alleviate the hypoxia of tumor sites responsible for the CAT-like activity of Pt and endogenous overexpressed H2O2 under weakly acidic TME, which further enhances the efficacy of SDT (<xref ref-type="bibr" rid="B94">94</xref>). Concomitantly, with DOX and TPP, this nanoprobe could achieve tumor eradication by inhibiting cellular DNA replication, further enhancing the combined therapeutic efficacy of chemotherapy and SDT (<xref ref-type="bibr" rid="B94">94</xref>).</p>
<p>Analogously, the ultrafine titanium monoxide (TiO<sub>1+x</sub>) nanorods modified with PEG (PEG-TiO<sub>1+x</sub> NRs) enable higher tumor elimination outcome in synergistic chemotherapy and SDT (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4</bold>
</xref>) (<xref ref-type="bibr" rid="B96">96</xref>). The TiO<sub>1+x</sub> NRs possess POD-like activity for the decomposition of H<sub>2</sub>O<sub>2</sub> in TME (<xref ref-type="bibr" rid="B96">96</xref>). Notably, the PEG-TiO<sub>1+x</sub> NRs could generate superior US-induced ROS due to the oxygen-deficient structures within TiO. On the other hand, the PEG-TiO<sub>1+x</sub> NRs could serve as Fenton-like agents for ROS generation in the presence of Ti<sup>3+</sup> (<xref ref-type="bibr" rid="B96">96</xref>).</p>
<fig id="f4" position="float">
<label>Figure&#xa0;4</label>
<caption>
<p>Schematic illustration of PEG-TiO<sub>1+x</sub> NRs that served as sonosensitizers in the synergistic chemotherapy and SDT. Reproduced with permission (<xref ref-type="bibr" rid="B96">96</xref>). Copyright 2020, American Chemical Society.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fonc-11-666017-g004.tif"/>
</fig>
</sec>
<sec id="s3_2_3">
<title>Nanozymes in Synergistic Radiotherapy</title>
<p>Radiotherapy (RT) has been widely used as the first-line treatment modality of various solid tumors in clinics (<xref ref-type="bibr" rid="B97">97</xref>&#x2013;<xref ref-type="bibr" rid="B101">101</xref>). However, the TME complex leads to the ultimate resistance to RT and even the recurrence and metastasis of tumors (<xref ref-type="bibr" rid="B98">98</xref>). Normalizing the TME to enhance the effectiveness of RT, to improve hypoxia and increase intratumoral oxygen concentration, and to further promote radiation-induced DNA damage is one of the most common strategies.</p>
<p>Several nanomaterials are designed to enhance tumor radiation sensitivity and attenuate hypoxia by catalyzing the generation of O<sub>2</sub> (<xref ref-type="bibr" rid="B102">102</xref>, <xref ref-type="bibr" rid="B103">103</xref>). The high reactivity, stability, and specificity of the albumin complex and MnO<sub>2</sub> NPs (A-MnO<sub>2</sub> NPs) towards H<sub>2</sub>O<sub>2</sub> could simultaneously modulate hypoxia and acidosis TME with regulated pH (<xref ref-type="bibr" rid="B102">102</xref>). Furthermore, A-MnO<sub>2</sub> NPs could normalize tumor blood vessels by the downregulated hypoxia-inducible factor-1&#x3b1; (HIF-1&#x3b1;) and vascular endothelial growth factor (VEGF) (<xref ref-type="bibr" rid="B102">102</xref>). Taking advantage of the engineered multifunctional A-MnO<sub>2</sub> NPs, the tumor response to radiation can be enhanced significantly (<xref ref-type="bibr" rid="B102">102</xref>).</p>
<p>Based on the perfect RT responsiveness of MnO<sub>2</sub>, gold and manganese dioxide (Au@MnO<sub>2</sub>) core-shell nanoparticles coated with PEG formed Au@MnO<sub>2</sub>-PEG (<xref ref-type="bibr" rid="B104">104</xref>). Au@MnO<sub>2</sub>-PEG, using the Au core, functioned as a RT sensitizer and MnO<sub>2</sub> shell as CAT mimics that mediate the decomposed H<sub>2</sub>O<sub>2</sub> could not only overcome tumor hypoxia but also enhance the tumor sensitivity to RT (<xref ref-type="bibr" rid="B75">75</xref>, <xref ref-type="bibr" rid="B104">104</xref>). More importantly, the Au@MnO<sub>2</sub>-PEG displays more satisfactory tumor inhibition than the outcome of Au-PEG or MnO<sub>2</sub>-PEG and has good biocompatibility and biosecurity (<xref ref-type="bibr" rid="B104">104</xref>).</p>
</sec>
<sec id="s3_2_4">
<title>Nanozymes in Synergistic Chemotherapy</title>
<p>Chemotherapy, as the most commonly applied cancer treatment modality, induces cancer cell death partly through regulating the formation of ROS (<xref ref-type="bibr" rid="B105">105</xref>). Abundant nanozymes loading chemotherapy drugs have been applied in tumor treatment depending on enhancing the generation of ROS (<xref ref-type="bibr" rid="B106">106</xref>).</p>
<p>Iron oxide nanoparticles (IONPs), with the POD-like activity, could decompose H<sub>2</sub>O<sub>2</sub> into hydroxyl radicals under acidic or neutral conditions (<xref ref-type="bibr" rid="B73">73</xref>). The super-paramagnetic iron oxide nanoparticles (SPION) with inherent POD-like activity are proved to reduce H<sub>2</sub>O<sub>2</sub> in human mesenchymal stem cells (hMSCs) in a dose-dependent manner, and further promote cell proliferation and growth (<xref ref-type="bibr" rid="B107">107</xref>). SPION can also be degraded in lysozymes and produce iron ions, which further accelerates the process of cell cycle (<xref ref-type="bibr" rid="B106">106</xref>). In addition, the combination of SPION with &#x3b2;-lapachone, an anticancer drug, significantly enhances the intracellular ROS levels and tumor-killing efficiency in non-small cell lung cancers (NSCLCs) (<xref ref-type="bibr" rid="B106">106</xref>).</p>
<p>Hollow Ru@CeO2 yolk shell nanozymes (Ru@CeO2 YSNs) loaded with anti-tumor drug ruthenium complex (RBT) and resveratrol (Res), and then modified with PEG, formed the Ru@CeO2-RBT/Res-PEG nanozyme system (<xref ref-type="bibr" rid="B108">108</xref>). Ru@CeO2-RBT/Res-DPEG could achieve oxygen supply <italic>in situ</italic> and enhance the anti-tumor responses of both chemotherapy and PDT. Moreover, it can also limit the metastasis and recurrence of tumors (<xref ref-type="bibr" rid="B108">108</xref>).</p>
</sec>
<sec id="s3_2_5">
<title>Nanozyme Systems for Tumor Theranostics</title>
<p>Based on the development of nanotechnology, more and more multi-functional nanozyme platforms are designed, with the ability of multi-model therapy, multi-model imaging, or simultaneously realizing tumor diagnosis and therapy.</p>
<p>The novel PtFe@Fe<sub>3</sub>O<sub>4</sub> nanozyme, with outstanding POD- and CAT-like activities in the acid TME, could overcome the hypoxia in tumor and enhance the effects of PDT. Moreover, PtFe@Fe<sub>3</sub>O<sub>4</sub> could be used as MRI T1WI negative contrast agents (<xref ref-type="bibr" rid="B41">41</xref>, <xref ref-type="bibr" rid="B109">109</xref>). The biomimetic hybrid nanozyme (rMGB), integrated with GOx and MnO<sub>2</sub>, could realize the self-catalytic reaction products under TME stimulation, resulting in enhanced O<sub>2</sub> generation and improving the efficiency of starvation therapy and PDT (<xref ref-type="bibr" rid="B110">110</xref>). Also, rMGB could be used as the MRI T1WI contrast agents.</p>
<p>Based on the POD-like and ROS-regulated activity of Au NPs under an acid environment, the carbon&#x2013;gold hybrid (OMCAPs@rBSA-FA@IR780) nanoprobes not only reveal excellent tumor-targeting imaging ability, but also offer outstanding tumor therapeutic performance (<xref ref-type="bibr" rid="B111">111</xref>). Besides, the Au<sub>2</sub>Pt-PEG-Ce6 nanoplatform was developed through Ce6 linked to Au<sub>2</sub>Pt nanozymes covalently (<xref ref-type="bibr" rid="B112">112</xref>). Contributing to the photosensitive characteristics of Ce6 and the dual CAT- and POD-like activities simultaneously of Au<sub>2</sub>Pt nanozymes, this nanosystem not only can relieve tumor hypoxia with O<sub>2</sub> generation but also enhance the efficiency of PDT and chemotherapy with the produced &#x2219;OH (<xref ref-type="bibr" rid="B112">112</xref>). Moreover, due to high-Z elements of Au and Pt, Au<sub>2</sub>Pt-PEG-Ce6 can be possible imaging contrast agents of CT (<xref ref-type="bibr" rid="B112">112</xref>, <xref ref-type="bibr" rid="B113">113</xref>).</p>
<p>With single-atom Ru incorporated into the Mn<sub>3</sub>[Co(CN)<sub>6</sub>]<sub>2</sub> MOF framework, followed by the biocompatible poly-vinylpyrrolidone (PVP) polymer further encapsulating organic ligand, metal ions, and photosensitized Ce6, the self-assembled single-atom enzyme (OxgeMCC-rSAE) was constructed (<xref ref-type="bibr" rid="B114">114</xref>). As Ru served as an endogenous oxygen-generating single-atom catalytic site, OxgeMCC-rSAE can degrade H<sub>2</sub>O<sub>2</sub> to generate oxygen, which further enhances the generation of ROS, ultimately enhancing PTT-induced cancer cell death (<xref ref-type="bibr" rid="B114">114</xref>). Meanwhile, due to the higher loading of the photosensitizer Ce6, the nanoparticles can selectively aggregate and be visualized in the tumor area by MRI (<xref ref-type="bibr" rid="B114">114</xref>).</p>
</sec>
</sec>
</sec>
<sec id="s4">
<title>Conclusion and Prospects</title>
<p>Since the hallmark ferromagnetic nanoparticles proved to be of use as POD natural enzymes in 2007, nanozymes have attracted unprecedented attention and applications, especially in oncology. Although nanozymes have achieved excellent progress in many areas, there are still many problems that cannot be ignored. Currently, most of the present nanozymes mainly focus on the activity of oxidoreductase and hydrolase activities, but the other enzyme activities such as transferase and lyase are still poorly understood. Therefore, it is necessary to explore new nanozyme materials and study their catalytic properties in depth. In addition, the catalytic mechanism of nanozymes is diverse and regulated by various factors. Moreover, different nanozymes may have a synergistic effect in the anti-tumor process. Therefore, it is necessary to establish completeness for different types of nanozyme catalytic systems. The current catalytic efficiency of nanozymes makes it hard to reach the level of natural enzyme <italic>in vivo</italic>, and their activities are still limited due to the complicated TME. Besides, the poor substrate selectivity of nanozymes persists. Modification of certain specific molecules with nanozymes may solve the problem and may improve the substrate specificity and target the tumor more sensitively and specifically. In addition, studies of nanozymes in tumor theranostics are still in the primary stage. The inherent toxicity and clearance rate of the materials also limit their wide applications. Moreover, various nanozymes have their own unique advantages and shortcomings. Therefore, constructing a nanosystem with good biocompatibility, high targeting efficiency, and multiple functions would be a crucial task.</p>
<p>With the continuous development of nanoscale science and technology, nanozymes show superior versatility, operability, and applicability, thus paving the way for new principles and technologies in disease diagnosis and treatment as well as efficient and precise new nanodrug applications in the biomedical field (<xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>).</p>
<table-wrap id="T1" position="float">
<label>Table&#xa0;1</label>
<caption>
<p>Nanozyme Classification and Applications.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="top" align="left">Nanozyme system</th>
<th valign="top" align="center">Mimetic activities</th>
<th valign="top" align="center">Applications</th>
<th valign="top" align="center">References</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">
<bold>Carbon-Based</bold>
</td>
<td valign="top" align="left"/>
<td valign="top" align="left"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left">SWNTs</td>
<td valign="top" align="left">POD</td>
<td valign="top" align="left">Drug delivery; Human SNP DNA detection</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B11">11</xref>, <xref ref-type="bibr" rid="B24">24</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">GO</td>
<td valign="top" align="left">POD</td>
<td valign="top" align="left">Tumor visual detection</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B63">63</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">GO-COOH</td>
<td valign="top" align="left">GOx; POD</td>
<td valign="top" align="left">Glucose detection</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B15">15</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">GFH</td>
<td valign="top" align="left">POD</td>
<td valign="top" align="left">Tumor detection</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B17">17</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">C-Dots</td>
<td valign="top" align="left">POD</td>
<td valign="top" align="left">Glucose detection</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B22">22</xref>)</td>
</tr>
<tr>
<td valign="top" rowspan="2" align="left">HFn-N-CNMs-3</td>
<td valign="top" align="left">POD; OXD (acidic pH values)</td>
<td valign="top" align="left">Tumor catalytic therapy</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B25">25</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">SOD; CAT (neutral pH values)</td>
<td valign="top" align="left">Anti-oxidant therapy</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B25">25</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">
<bold>Metal-Based</bold>
</td>
<td valign="top" align="left"/>
<td valign="top" align="left"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left">Au NPs</td>
<td valign="top" align="left">GOx</td>
<td valign="top" align="left">Self-limiting nanomedicine; Biomedical probe</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B111">111</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">EMSN-AuNPs</td>
<td valign="top" align="left">GOx; POD</td>
<td valign="top" align="left">Self-activated cascade catalysis</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B28">28</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">AuNCs</td>
<td valign="top" align="left">POD</td>
<td valign="top" align="left">Tumor detection</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B64">64</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">BSA-AuNCs</td>
<td valign="top" align="left">POD</td>
<td valign="top" align="left">A dual fluorometric and colorimetric sensor for dopamine</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B29">29</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Au/SiO<sub>2</sub> nanocomposites</td>
<td valign="top" align="left">POD</td>
<td valign="top" align="left">Realizing high-temperature catalytic reactions</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B30">30</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">AuNCs-NH<sub>2</sub>
</td>
<td valign="top" align="left">CAT</td>
<td valign="top" align="left">Enhancing PDT efficiency</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B83">83</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Carbon-gold hybrid nanoprobes</td>
<td valign="top" align="left">CAT</td>
<td valign="top" align="left">Real-time imaging, enhancing PTT and PDT efficiency</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B111">111</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Au<sub>2</sub>Pt-PEG-Ce6</td>
<td valign="top" align="left">CAT; POD</td>
<td valign="top" align="left">Synergistic chemotherapy and phototherapy</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B112">112</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Pt NPs</td>
<td valign="top" align="left">CAT</td>
<td valign="top" align="left">Enhancing RT efficiency</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B113">113</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Pt NPs/GO</td>
<td valign="top" align="left">POD</td>
<td valign="top" align="left">Tumor detection</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B62">62</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">PtPB</td>
<td valign="top" align="left">CAT; SOD</td>
<td valign="top" align="left">Enhancing PTT efficiency</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B89">89</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Pt-MOFs hybrid system</td>
<td valign="top" align="left">CAT</td>
<td valign="top" align="left">Enhancing PDT efficiency</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B81">81</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Pt-Carbon nanozyme</td>
<td valign="top" align="left">CAT</td>
<td valign="top" align="left">Enhancing PDT and PTT efficiency</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B84">84</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">P@Pt@P&#x2212;Au&#x2212;FA</td>
<td valign="top" align="left">CAT; GOx</td>
<td valign="top" align="left">Synergistic starving-like therapy and PDT</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B87">87</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Pd@Pt-T790</td>
<td valign="top" align="left">CAT</td>
<td valign="top" align="left">Enhancing SDT efficiency; anti-bacterial infection</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B92">92</xref>, <xref ref-type="bibr" rid="B93">93</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">CDP@HP-T</td>
<td valign="top" align="left">CAT</td>
<td valign="top" align="left">Synergistic chemotherapy and SDT</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B94">94</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">AFeNPs</td>
<td valign="top" align="left">Fenton reaction</td>
<td valign="top" align="left">Enhancing MRI contrast and chemotherapy effects</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B105">105</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Fe@BC</td>
<td valign="top" align="left">POD</td>
<td valign="top" align="left">Anti-bacterial infection</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B27">27</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Rh-PEG NDs</td>
<td valign="top" align="left">CAT</td>
<td valign="top" align="left">Anti-inflammation and anti-tumor</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B46">46</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">OxgeMCC-r SAE</td>
<td valign="top" align="left">CAT</td>
<td valign="top" align="left">Enhancing PDT efficiency</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B114">114</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">IMSN-PEG-TI</td>
<td valign="top" align="left">POD; CAT</td>
<td valign="top" align="left">Anti-tumor</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B58">58</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">
<bold>Metal Oxide-Based</bold>
</td>
<td valign="top" align="left"/>
<td valign="top" align="left"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" rowspan="2" align="left">Fe<sub>3</sub>O<sub>4</sub> MNPs/IONPs</td>
<td valign="top" align="left">POD (acidic pH values)</td>
<td valign="top" align="left">Detection of organophosphorus pesticide and nerve agent</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B3">3</xref>, <xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B39">39</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">CAT (neutral pH values)</td>
<td valign="top" align="left">Anti-oxidant</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B39">39</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">PtFe@Fe<sub>3</sub>O<sub>4</sub>
</td>
<td valign="top" align="left">POD; CAT</td>
<td valign="top" align="left">Synergistic tumor catalytic therapy and PTT</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B109">109</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">DMSN-Au-Fe<sub>3</sub>O<sub>4</sub> NPs</td>
<td valign="top" align="left">POD; GOx</td>
<td valign="top" align="left">Anti-tumor</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B41">41</xref>)</td>
</tr>
<tr>
<td valign="top" rowspan="2" align="left">Nanoceria</td>
<td valign="top" rowspan="2" align="left">SOD (neutral pH values)</td>
<td valign="top" align="left">Against radiation damage, oxidative stress and inflammation</td>
<td valign="top" rowspan="2" align="center"> (<xref ref-type="bibr" rid="B9">9</xref>, <xref ref-type="bibr" rid="B10">10</xref>, <xref ref-type="bibr" rid="B38">38</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Fluorogenic detection of cancer</td>
</tr>
<tr>
<td valign="top" align="left">Folate-conjugated Nanoceria</td>
<td valign="top" align="left">OXD (acidic pH values)</td>
<td valign="top" align="left">Cancer detection</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B9">9</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">PEG-CNPS</td>
<td valign="top" align="left">SOD</td>
<td valign="top" align="left">Radical scavenger with tunable redox chemistry</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B36">36</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">A-MnO<sub>2</sub> NPs</td>
<td valign="top" align="left">CAT</td>
<td valign="top" align="left">Modulating TME and enhancing RT responses</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B102">102</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">MnO NPs</td>
<td valign="top" align="left">SOD</td>
<td valign="top" align="left">Enhancing MRI contrast</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B74">74</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Au@MnO<sub>2</sub>-PEG</td>
<td valign="top" align="left">CAT</td>
<td valign="top" align="left">Enhanced RT <italic>via</italic> improving the tumor oxygenation</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B104">104</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Mn<sub>3</sub>O<sub>4</sub> NPs</td>
<td valign="top" align="left">SOD; CAT; GPx</td>
<td valign="top" align="left">Anti-inflammation</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B76">76</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">MnO<sub>2</sub>@PtCo</td>
<td valign="top" align="left">OXD; CAT</td>
<td valign="top" align="left">Anti-tumor</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B75">75</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">rMGB</td>
<td valign="top" align="left">CAT</td>
<td valign="top" align="left">Enhancing starvation and PDT against hypoxic tumor</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B110">110</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Ru@CeO<sub>2</sub>-RBT/Res-DPEG</td>
<td valign="top" align="left">CAT</td>
<td valign="top" align="left">Enhancing dual chemotherapy combined with PTT</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B108">108</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">PEG-TiO<sub>1+x</sub> NRs</td>
<td valign="top" align="left">POD</td>
<td valign="top" align="left">Enhancing dual chemotherapy combined with SDT</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B96">96</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">
<bold>Metal Chalcogenide</bold>
</td>
<td valign="top" align="left"/>
<td valign="top" align="left"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left">CuS-GNSs</td>
<td valign="top" align="left">POD; GOx</td>
<td valign="top" align="left">Detection of H<sub>2</sub>O<sub>2</sub> and human serum glucose level</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B44">44</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Hollow Pt-CuS Janus</td>
<td valign="top" align="left">POD</td>
<td valign="top" align="left">Synergistic PTT and SDT</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B47">47</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">DMHSs-FeS<sub>2</sub>/SiO<sub>2</sub>
</td>
<td valign="top" align="left">POD</td>
<td valign="top" align="left">Detection of H<sub>2</sub>O<sub>2</sub> and GSH for anti-tumor</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B50">50</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">SVs-Fe<sub>3</sub>S<sub>4</sub>
</td>
<td valign="top" align="left">POD</td>
<td valign="top" align="left">Detection of human serum glucose level</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B51">51</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">FeS<sub>2</sub>
</td>
<td valign="top" align="left">OXD; POD</td>
<td valign="top" align="left">Anti-tumor</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B35">35</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">PEG/Ce-Bi@DMSN</td>
<td valign="top" align="left">POD; CAT</td>
<td valign="top" align="left">Synergistic tumor catalytic therapy and PTT</td>
<td valign="top" align="center"> (<xref ref-type="bibr" rid="B88">88</xref>)</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s5">
<title>Author Contributions</title>
<p>QM and YL wrote the draft of the manuscript. HZ and LZ contributed to the conception of the work and organized the structure of the manuscript. XL performed the revision. All authors contributed to the article and approved the submitted version.</p>
</sec>
<sec id="s6" sec-type="funding-information">
<title>Funding</title>
<p>This work was supported by grants from the National Natural Science Foundation of China (grant number 82071984), the Young Medical Talents of Jiangsu (grant number QNRC2016833), the Six Talent Peaks Project of Jiangsu Province (grant number WSW-039), the Six for One Project of Jiangsu Province (grant number LGY2018093), the Project of Postgraduate Research &amp; Practice Innovation Program of Jiangsu Province (SJCX19_0577), and the Social Development Foundation of Zhenjiang City (grant number SH2021071).</p>
</sec>
<sec id="s7" 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="s8" 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>
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