Atherosclerosis, the leading cause of death in the elderly worldwide, is typically characterized by elevated
reactive oxygen species (ROS) levels and a chronic inflammatory state at the arterial plaques. Herein, pH-sensitive nanoparticles (HRRAP NPs) co-delivering
all-trans retinal (ATR), an
antioxidant linked to
hyaluronic acid (HA) through a pH-sensitive
hydrazone bond, and
rapamycin (RAP), an anti-atherosclerotic drug loaded into the nanoparticle core, are developed for targeted combination
therapy of
atherosclerosis. In this way, HRRAP NPs might simultaneously reduce ROS levels via ATR
antioxidant activity and reduce
inflammation via the anti-inflammatory effect of RAP. In response to mildly acidic conditions mimicking the lesional
inflammation in vitro, HRRAP NPs dissociated and both ATR and RAP were effectively released. The developed HRRAP NPs effectively inhibited pro-inflammatory macrophage proliferation, and displayed dose- and time-dependent specific internalization by different cellular models of
atherosclerosis. Also, HRRAP NP combination
therapy showed an efficient synergetic anti-atherosclerotic effect in vitro by effectively inhibiting the inflammatory response and oxidative stress in inflammatory cells. More importantly, HR NPs specifically accumulated in the
atherosclerotic plaques of
apolipoprotein E-deficient (
ApoE-/-) mice, by active interaction with HA receptors overexpressed by different cells of the plaque. The treatment with HRRAP NPs remarkably inhibited the progression of
atherosclerosis in
ApoE-/- mice which resulted in stable plaques with considerably smaller necrotic cores, lower
matrix metalloproteinase-9, and decreased proliferation of macrophages and smooth muscle cells (SMCs). Furthermore, HRRAP NPs attenuated RAP adverse effects and exhibited a good safety profile after long-term treatment in mice. Consequently, the developed pH-sensitive HRRAP NP represent a promising nanoplatform for
atherosclerosis combination
therapy.