Article(id=1316714455883436742, tenantId=1146029695717560320, journalId=1192105938417971205, issueId=1316714454184739470, articleNumber=null, orderNo=null, doi=10.13343/j.cnki.wsxb.20260174, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1772553600000, receivedDateStr=2026-03-04, revisedDate=null, revisedDateStr=null, acceptedDate=1778428800000, acceptedDateStr=2026-05-11, onlineDate=1791858789654, onlineDateStr=2026-10-13, pubDate=1791043200000, pubDateStr=2026-10-04, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1791858789654, onlineIssueDateStr=2026-10-13, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1791858789654, creator=13701087609, updateTime=1791858789654, updator=13701087609, issue=Issue{id=1316714454184739470, tenantId=1146029695717560320, journalId=1192105938417971205, year='2026', volume='66', issue='10', pageStart='4661', pageEnd='5310', issueExtLink='null', onlineDate='null', pubDate='1791043200000', pubDateStr='2026-10-04', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1791858789249, creator='13701087609', updateTime=1791885400527, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1316826070066774161, tenantId=1146029695717560320, journalId=1192105938417971205, issueId=1316714454184739470, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1316826070066774162, tenantId=1146029695717560320, journalId=1192105938417971205, issueId=1316714454184739470, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=4694, endPage=4707, ext={EN=ArticleExt(id=1316714456097346247, articleId=1316714455883436742, tenantId=1146029695717560320, journalId=1192105938417971205, language=EN, title=Research progress in anti-bacterial infection nano-delivery systems and their effects on the immune system, columnId=1192149543727808575, journalTitle=Acta Microbiologica Sinica, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Driven by the continuous pressure of antibiotic selection, bacteria continue to evolve through multidrug resistance mechanisms, resulting in the increasing ineffectiveness of conventional antibiotic treatment and posing a severe challenge of no drug availability in clinical practice. Nano-delivery systems breathe new life into antimicrobial therapy with their designable physicochemical properties and versatile integration characteristics. Nano-delivery systems are not limited to simple drug carriers, but can be developed into a multi-functional intelligent platform integrating precise delivery, microenvironment perception, and immune reprogramming through precision design. This review systematically expounds the construction strategy of antimicrobial nano-delivery systems, sorts out the development context from drug carrier, synergistic vector, intelligent response vector to intelligent biomimetic vector. Furthermore, this review discusses the targeted design and antimicrobial component loading strategy in detail, including conventional antibiotic synergy and new antimicrobial co-delivery. The core thesis of this paper is that the application of nano-delivery systems in specific infection scenarios (e.g., intracellular bacterial infection and biofilm-associated infection) has gone far beyond simple delivery, and instead actively regulates host immune homeostasis, synergistically enhancing antibacterial effects by regulating innate immunity (e.g., macrophage polarization and neutrophil function) and activating adaptive immunity. Finally, this paper makes an outlook on the challenges and future development directions of this field, emphasizing that through cross-scale design and multi-mechanism synergy, nano-delivery systems are expected to provide a new generation of therapeutic strategies that are efficient, safe, and less likely to induce drug resistance for drug-resistant bacterial infections.

, authors=Xiaojin LIU1, Yongqi TIAN1, Cong JIN1, Rui ZHU1, 2, Xiaojuan YOU1, 2, *, Yongwei LI1, 2, *, authorsList=Xiaojin LIU, Yongqi TIAN, Cong JIN, Rui ZHU, Xiaojuan YOU, Yongwei LI, authorCompany=null, correspAuthors=Xiaojuan YOU, Yongwei LI, authorNote=null, correspAuthorsNote=
*E-mail: LI Yongwei,
YOU Xiaojuan,
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在抗生素选择压力的持续驱动下,细菌通过多重耐药机制不断演化,导致传统抗生素治疗日益无效,临床面临无药可用的严峻挑战。纳米递送系统凭借其可设计的物理化学性质与多功能集成特性,为抗菌治疗注入新的活力。纳米递送系统不局限于单纯的药物载体,通过精密设计,可发展为集精准递送、微环境感知、免疫重编程于一体的多功能智能平台。本文系统阐述了抗菌纳米递送系统的构建策略,梳理了其从药物载体、协同效应型载体、智能响应型载体到智能仿生型载体的发展脉络,并详细讨论了其靶向设计及抗菌成分负载策略,包括传统抗生素增效与新型抗菌剂共递送。本文的核心论点是,纳米递送系统在特定感染场景(如胞内菌感染、生物膜相关感染)中的应用已远超单纯递送范畴,转而主动调节宿主免疫稳态,通过调控固有免疫(如巨噬细胞极化、中性粒细胞功能)与激活适应性免疫,协同增强抗菌效果。最后,本文展望了该领域面临的挑战与未来发展方向,强调通过跨尺度设计与多机制协同,纳米递送系统有望为耐药菌感染提供高效、安全且不易诱发耐药的新一代治疗策略。

, authors=刘晓金1, 田咏琪1, 金聪1, 朱芮1, 2, 有小娟1, 2, *, 李永伟1, 2, *, authorsList=刘晓金, 田咏琪, 金聪, 朱芮, 有小娟, 李永伟, authorCompany=null, correspAuthors=有小娟, 李永伟, authorNote=

作者贡献声明

刘晓金:初稿撰写、研究构思、数据采集及论文修改;田咏琪、金聪:研究设计和写作;朱芮:获取基金和审查;有小娟:框架设计、审阅、获取基金及论文修改;李永伟:监督指导和获取基金。

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抗细菌感染纳米递送系统及其对免疫系统影响的研究进展
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刘晓金 1 , 田咏琪 1 , 金聪 1 , 朱芮 1, 2 , 有小娟 1, 2, * , 李永伟 1, 2, *
微生物学报 | 综述 2026,66(10): 4694-4707
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微生物学报 |综述 2026 , 66 (10) : 4694 -4707
抗细菌感染纳米递送系统及其对免疫系统影响的研究进展
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刘晓金1, 田咏琪1, 金聪1, 朱芮1, 2, 有小娟1, 2, * , 李永伟1, 2, *
作者信息
  • 1.河南中医药大学第二临床医学院,河南中医药大学第二附属医院,河南 郑州
  • 2.河南省中医院(河南中医药大学第二附属医院)检验中心,河南省防治耐药菌感染中医药重点实验室,郑州市病原微生物与细菌耐药监测重点实验室,河南 郑州
通讯作者:
有小娟, 李永伟
作者简介:

作者贡献声明

刘晓金:初稿撰写、研究构思、数据采集及论文修改;田咏琪、金聪:研究设计和写作;朱芮:获取基金和审查;有小娟:框架设计、审阅、获取基金及论文修改;李永伟:监督指导和获取基金。

Research progress in anti-bacterial infection nano-delivery systems and their effects on the immune system
Xiaojin LIU1, Yongqi TIAN1, Cong JIN1, Rui ZHU1, 2, Xiaojuan YOU1, 2, * , Yongwei LI1, 2, *
Affiliations
  • 1.The Second Affiliated Hospital of Henan University of Chinese Medicine, The Second Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan, China
  • 2.Key Laboratory of Henan Province of Resistant Pathogen Infections Prevention and Therapy by Traditional Chinese Medicine, Zhengzhou Key Laboratory of Pathogenic Microorganisms and Bacterial Drug Resistance Monitoring, Inspection Center of Henan Province Hospital of Traditional Chinese Medicine (The Second Affiliated Hospital of Henan University of Chinese Medicine), Zhengzhou, Henan, China
  • Corresponding Author:
    *E-mail: LI Yongwei,
出版时间: 2026-10-04 doi: 10.13343/j.cnki.wsxb.20260174
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在抗生素选择压力的持续驱动下,细菌通过多重耐药机制不断演化,导致传统抗生素治疗日益无效,临床面临无药可用的严峻挑战。纳米递送系统凭借其可设计的物理化学性质与多功能集成特性,为抗菌治疗注入新的活力。纳米递送系统不局限于单纯的药物载体,通过精密设计,可发展为集精准递送、微环境感知、免疫重编程于一体的多功能智能平台。本文系统阐述了抗菌纳米递送系统的构建策略,梳理了其从药物载体、协同效应型载体、智能响应型载体到智能仿生型载体的发展脉络,并详细讨论了其靶向设计及抗菌成分负载策略,包括传统抗生素增效与新型抗菌剂共递送。本文的核心论点是,纳米递送系统在特定感染场景(如胞内菌感染、生物膜相关感染)中的应用已远超单纯递送范畴,转而主动调节宿主免疫稳态,通过调控固有免疫(如巨噬细胞极化、中性粒细胞功能)与激活适应性免疫,协同增强抗菌效果。最后,本文展望了该领域面临的挑战与未来发展方向,强调通过跨尺度设计与多机制协同,纳米递送系统有望为耐药菌感染提供高效、安全且不易诱发耐药的新一代治疗策略。

纳米递送系统  /  细菌耐药  /  协同抗菌  /  靶向释放  /  生物膜感染  /  免疫调节

Driven by the continuous pressure of antibiotic selection, bacteria continue to evolve through multidrug resistance mechanisms, resulting in the increasing ineffectiveness of conventional antibiotic treatment and posing a severe challenge of no drug availability in clinical practice. Nano-delivery systems breathe new life into antimicrobial therapy with their designable physicochemical properties and versatile integration characteristics. Nano-delivery systems are not limited to simple drug carriers, but can be developed into a multi-functional intelligent platform integrating precise delivery, microenvironment perception, and immune reprogramming through precision design. This review systematically expounds the construction strategy of antimicrobial nano-delivery systems, sorts out the development context from drug carrier, synergistic vector, intelligent response vector to intelligent biomimetic vector. Furthermore, this review discusses the targeted design and antimicrobial component loading strategy in detail, including conventional antibiotic synergy and new antimicrobial co-delivery. The core thesis of this paper is that the application of nano-delivery systems in specific infection scenarios (e.g., intracellular bacterial infection and biofilm-associated infection) has gone far beyond simple delivery, and instead actively regulates host immune homeostasis, synergistically enhancing antibacterial effects by regulating innate immunity (e.g., macrophage polarization and neutrophil function) and activating adaptive immunity. Finally, this paper makes an outlook on the challenges and future development directions of this field, emphasizing that through cross-scale design and multi-mechanism synergy, nano-delivery systems are expected to provide a new generation of therapeutic strategies that are efficient, safe, and less likely to induce drug resistance for drug-resistant bacterial infections.

nano-delivery system  /  bacterial drug resistance  /  synergistic antibacterial effect  /  targeted release  /  biofilm infection  /  immunomodulation
刘晓金, 田咏琪, 金聪, 朱芮, 有小娟, 李永伟. 抗细菌感染纳米递送系统及其对免疫系统影响的研究进展. 微生物学报, 2026 , 66 (10) : 4694 -4707 . DOI: 10.13343/j.cnki.wsxb.20260174
Xiaojin LIU, Yongqi TIAN, Cong JIN, Rui ZHU, Xiaojuan YOU, Yongwei LI. Research progress in anti-bacterial infection nano-delivery systems and their effects on the immune system[J]. Acta Microbiologica Sinica, 2026 , 66 (10) : 4694 -4707 . DOI: 10.13343/j.cnki.wsxb.20260174
全球细菌耐药性的暴发式增长已成为公共卫生领域面临的严峻挑战之一[1]。传统抗生素在临床上面临“研发速度滞后耐药进化”的困境,且在复杂感染中暴露出毒性强、组织渗透性差、对生物膜无效等缺陷[2-3]。纳米递送系统为突破上述瓶颈提供了核心支撑:(1)通过响应感染微环境的智能释药机制,实现“按需释药”,降低毒副作用;(2)突破生物屏障,可穿透生物膜、跨越细胞膜,加速药物渗入,将药物富集在感染部位;(3)实现“抗菌+免疫调节分子”的共递送,通过重塑宿主免疫应答增强杀菌效果,降低复发风险[4-6]。
本文旨在系统阐述抗菌纳米递送系统的最新进展,全文围绕精准递送、微环境调控与免疫重编程三大功能展开。首先将精准递送中的纳米载体分为递送增强型、功能协同型、环境响应型与仿生识别型4类,并结合主动、被动及多重靶向策略实现精准递送;其次通过抗生素纳米化、抗菌肽/噬菌体智能递送以及多成分(尤其是抗菌-免疫调节剂)共递送来调控感染微环境,重塑宿主免疫稳态;最后探讨免疫重编程,包括针对特定感染场景的精准干预,以及调控固有免疫(巨噬细胞、中性粒细胞)并激活适应性免疫,从而协同增强抗菌效果。最后,总结挑战与未来方向,从载体设计、负载策略、场景适配到免疫调控机制,全面阐述其如何通过多维度创新赋能抗感染治疗(图1),为耐药菌感染的精准干预提供新策略。
抗菌纳米载体并不是简单的材料迭代,而是围绕细菌的耐药性与突破屏障不断优化,其载体功能已从早期被动承载药物,演变为主动参与感染干预。依据抗菌纳米载体的功能,可将其划分为4类:以改善药代动力学为核心的“递送增强型”、兼具递送与抗菌作用的“功能协同型”、感知并响应病理微环境的“环境响应型”,以及模仿生物识别与运输机制的“仿生识别型”。这4种范式并非简单的线性替代,而是反映了层层精进且相互融合的设计策略。
递送增强型纳米载体本身不具备抗菌活性,主要作为递送平台,通过改善药物动力学以及生物利用度,提升药物活性成分的疗效[7-8]。本部分将围绕脂质体、聚合物纳米颗粒及生物源性天然囊泡这三种代表性的递送体系展开论述。
脂质体是此类载体的典型代表。脂质体凭借其与生物膜相似的双分子层结构,赋予两亲性药物包载能力,并通过膜融合、内吞等途径促进细胞摄取[9-10]。以脂质体递送妥布霉素(tobramycin, TOB)与N-乙酰半胱氨酸(N-acetylcysteine, NAC)[11]为例,其增效机制在于脂质体将二者共递送至生物膜微环境,再通过NAC破膜+TOB杀菌实现对耐药革兰氏阴性菌及其生物膜的“穿透-破坏-杀灭”一体化治疗,为临床难治性感染提供新思路。聚合物纳米颗粒是另一类重要的递送平台。例如,将左氧氟沙星(levofloxacin, LEV)包载于聚乳酸-羟基乙酸共聚物纳米颗粒[poly(lactic-co-glycolic acid) nanoparticles, PLGA NPs]/壳聚糖纳米粒(chitosan nanoparticles, CS NPs)中[7]可实现药物的缓慢释放,延长给药间隔,同时减少因频繁给药或血药浓度波动带来的全身毒副作用。此外,源自生物体的天然囊泡也逐渐受到关注。例如,Li等[8]从益生菌大肠埃希氏菌(Escherichia coli)中提取外膜囊泡(outer membrane vesicles, OMV),构建黄芩素纳米递送系统,展示了生物体的天然囊泡作为递送系统在提高难溶性药物生物利用度方面的潜力。
功能协同型载体兼具递送与抗菌双重功能,其自身即具备直接杀菌能力,负载药物后可形成协同增效。这类载体通常采用具有固有抗菌活性的无机或金属材料构建。
金属纳米颗粒是功能协同型载体的典型代表。金属纳米颗粒可通过离子释放、膜电位干扰、活性氧(reactive oxygen species, ROS)生成及物理性膜破坏等多重途径直接杀伤微生物,其作用不依赖于传统抗生素的生化靶点,为克服耐药提供了新路径[12-13]。金纳米颗粒(gold nanoparticles, AuNPs)作为载体时依靠表面吸附或化学偶联实现药物的控释与靶向递送;同时,其自身可通过表面等离子共振效应在光热条件下产生活性氧,形成光控的“载体-效应器”双重机制[14-16]。二氧化钛纳米管的递送更具空间特异性:其规整的纳米管阵列结构一方面通过拓扑效应物理性干扰细菌黏附与膜完整性,另一方面作为储库实现抗生素的局部长效缓释,从而在植入体界面构建“物理阻隔-化学杀菌”的双重防御机制[17]。磁性杂化系统如氧化石墨烯/钴铁氧体/银-环丙沙星复合物[18],兼具磁性分离、抗菌活性与药物递送功能,是一种典型的功能协同型载体;研究显示,该复合材料本身具有良好的广谱抗菌活性,在负载环丙沙星后,抗菌效果显著增强,表现出明显的协同抗菌效应。除上述金属及无机材料外,部分有机-无机杂化材料同样可作为功能协同型载体。聚乙二醇功能化氧化石墨烯纳米颗粒负载黑种草提取物的纳米递送系统[19]结合了氧化石墨烯的载药能力、诱导氧化应激与破坏细胞膜的作用,以及聚乙二醇的生物相容性与长循环特性,还可通过负载黑种草提取物协同发挥药物的特异性抗菌作用,显著增强对金黄色葡萄球菌(Staphylococcus aureus)和E. coli的抗菌活性,为抗菌药物递送提供了潜在的多功能平台。
环境响应型载体能感知感染微环境中的特定信号,达到药物在病灶部位“按需释放”的目的。根据响应信号的类型可分为单一刺激响应与多重刺激响应两大类。
单一刺激响应是环境响应的基础形式。在基于低频超声外部触发信号研究中,研究人员构建了一种超声响应型纳米递送系统,将抗菌剂十六烷基氯化吡啶包载于二氧化硅纳米粒中[20],该纳米递送系统仅在低频超声触发下释放药物,显著提高了对血链球菌(Streptococcus sanguinis)生物膜的抗菌效果。pH响应型纳米递送系统可通过感染灶的酸性微环境实现触发释放。例如,一种负载万古霉素的pH响应固体脂质纳米粒递送系统在酸性条件下(如感染部位)带正电,从而改变纳米粒的结构或脂质层稳定性,加速药物的释放,同时增强其与带负电细菌的结合能力;体外抗菌研究显示,该制剂在酸性环境下的最低抑菌浓度较生理pH条件下降低了98.44%[21]。除超声和pH响应外,研究也逐渐拓展至基于微环境中其他特异性信号的响应体系。感染微环境中谷胱甘肽(glutathione, GSH)释放增加,可协助细菌抵抗宿主免疫清除。基于此,研究人员构建了GSH响应的纳米递送系统,利用高浓度GSH触发一氧化氮(NO)释放,增强黏液穿透并可能促进生物膜分散,联合多黏菌素E与ε-聚赖氨酸的协同作用实现对多重耐药铜绿假单胞菌(multidrug-resistant Pseudomonas aeruginosa, MDR-PA)生物膜99.99%的清除率[22]。单一刺激响应体系虽设计简洁,但感染微环境的动态性与异质性常导致触发信号分布不均或浓度不足,限制了其疗效的稳定性和精准性。
多重刺激响应可弥补单重刺激响应的缺陷,通过整合2种及以上病理信号实现更精准、更具特异性的释放。其中内源性双信号响应针对感染或炎症病灶同时存在的多种特征信号(如高活性氧与低pH)设计可被协同激活的载体。例如,采用对ROS敏感的硫缩酮连接子与对pH敏感的聚多巴胺外壳共修饰的纳米颗粒,在同时满足“高ROS且低pH”的条件下触发药物释放,极大降低了对正常组织的脱靶毒性[23]。内源-外源协同响应策略融合内源性微环境信号与外源性物理刺激。内源性信号(如感染部位的低pH或特定酶)引导载体在病灶富集,并初步释放,起到“定位”作用;外源性刺激(如特定波长光照或超声)在需要的时候远程激活,精确控制治疗效果,起到触发作用。研究显示,一种酸/光双重响应的纳米递送系统利用酸性微环境促进载体在细菌周围的富集并提前释放一部分药物,再通过激光照射激活光敏剂,产生大量活性氧,实现协同杀菌效果[24]。
从单一刺激响应到多重刺激响应的演进,不仅是环境纳米递送系统在精准度上的提升,更是安全性上的重要改进。多重响应系统能够更精准地适应体内复杂环境,为抗感染治疗提供了更高效、更安全的策略。
仿生识别型载体通过模拟生物系统的组成、结构或功能,主动整合天然生物过程(如免疫逃逸、主动靶向、趋化迁移),使其在生物相容性与主动靶向性方面更具有优势。根据仿生策略的不同,可分为以下3类。
(1)基于细胞膜包覆技术的识别策略。将天然细胞膜包覆在纳米载体表面以躲避免疫系统的清除,同时膜表面保留的受体或者黏附分子实现主动靶向。例如,OMV包覆的载体借助其与同种属细菌膜结构的相似性实现同型靶向递送,显著增强抗生素在菌体内的富集,从而提高抗菌疗效[25]。在单膜包覆的基础上,杂合膜包覆如脂质纳米颗粒/杂合细胞膜囊泡纳米粒的纳米递送系统融合了不同细胞膜的靶向分子:中性粒细胞膜提供对炎症内皮细胞黏附分子的识别能力,而细菌OMV保留对同源菌的靶向性,从而实现对“感染微环境-病原菌”的双重靶向,显著增强了抗生素在感染部位的富集与抗菌疗效[26]。混合膜系统如TOB介导自组装的四面体框架核酸/中性粒细胞-血小板杂合膜纳米粒(tobramycin-loaded tFNAs encapsulated in neutrophil-platelet hybrid membrane nanoparticles,TTOB@NPM)进一步整合了中性粒细胞的炎症趋化机制与血小板的细菌黏附机制,使载体能够沿炎症趋化梯度迁移并有效结合于细菌表面,最终在细菌毒素作用下触发膜裂解释药,实现了“趋化-锚定-响应释药”的智能递送程序[27]。
(2)基于生物分子模拟的精准识别策略。该策略通过在纳米载体表面植入仿生配体,实现病原体或病变细胞与纳米递送系统的主动、高特异性靶向,其核心是模拟天然生物识别过程,进行“锁钥式”结合。例如,耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus, MRSA)大部分都有mecA基因编码产生的突变青霉素结合蛋白2a (penicillin-binding protein 2a, PBP2a),将PBP2a特异性抗体修饰在抗菌纳米载体表面,可使纳米递送系统与MRSA特异性结合,并将抗生素直接递送至菌体内部,从而绕过耐药机制,显著提升疗效[28]。另一类仿生配体是靶向肽,如模拟白细胞行为的γ3肽。在脓毒症等感染中,肺部炎症内皮会高表达特定黏附分子。经γ3肽修饰的递送系统能特异性识别这些标志物,实现“炎症内皮归巢”,达到了药物在感染部位高效蓄积的目的[29]。这类策略巧妙利用病理信号作为导航,实现了治疗剂的智能化递送。
(3)跨物种囊泡融合策略,在纳米载体上引入不同生物来源的纳米递送系统,例如植物-细菌杂化囊泡[30]。该系统利用植物囊泡的抗炎活性调节免疫微环境,同时借助细菌囊泡提供的病原相关分子模式(pathogen-associated molecular pattern, PAMP)激活或靶向特定免疫通路,实现协同作用。
根据单重靶向核心作用机制,可将其分为主动靶向与被动靶向两大类。
主动靶向策略的核心在于“主动识别”。该策略通过在纳米载体表面修饰高度特异性的识别分子(即配体),使其具备主动寻找靶标并与其特异性结合的能力[31]。例如,一项研究构建了修饰有肺炎链球菌特异性内溶素细胞壁结合域的纳米递送系统,该结构域能够高选择性识别细菌细胞壁的肽聚糖成分;在小鼠肺炎模型中,该策略使纳米颗粒在感染肺部的富集量显著提升,表现出优异的靶向性能和较低的脱靶效应[32]。然而,传统配体(如肽段、抗体)存在体内易降解、稳定性有限等问题,限制了其临床应用。
被动靶向策略利用纳米载体自身的物理化学特性(如粒径、表面电荷)与病变组织的病理生理学特征,实现药物的非特异性但相对富集的递送[33]。例如,基于镁基层状氢氧化物的纳米系统,其平均粒径约为107 nm,恰好适配高通透性和滞留效应(enhanced permeability and retention effect, EPR),从而通过被动靶向机制在病灶区域实现缓释递送[34]。
尽管单重靶向在特定场景下有效,但其单一的识别机制在面对复杂的体内微环境、靶点异质性或多重生物屏障时,常表现出递送效率不足、脱靶风险较高等局限性。
该策略通过整合2种以上靶向机制,在递送过程的不同阶段顺序或协同发挥作用,从而实现更高精度与效率的药物递送。
一类策略是双重主动靶向,即同时修饰2种及以上靶向配体,依次或协同作用于不同靶标。例如,针对肠道感染,可在载体表面修饰甘露糖以靶向E. coli菌毛,同时借助乳酸菌生物膜封装实现肠道组织归巢,从而同步增强病原体清除与肠道稳态恢复[35]。另一范例是利用预活化巨噬细胞膜的仿生纳米递送系统,借助膜蛋白的趋化性富集于结核肉芽肿病变部位,并利用膜上高表达的Toll样受体(Toll-like receptors, TLR) 2/4/6进一步识别并锚定其中的结核分枝杆菌(Mycobacterium tuberculosis),实现“病变组织-病原菌”的双重识别与精准干预[36]。
另一策略是主动-被动靶向协同。在此设计中,载体既保留其纳米尺寸与表面特性以利用EPR被动蓄积,又通过功能化修饰赋予其主动识别能力。例如,以细菌外膜囊泡包覆介孔硅纳米颗粒,既可通过纳米尺寸在感染部位被动富集,又可借助囊膜的同源识别作用主动促进细菌对其内吞,从而显著提升抗生素在菌体内的累积[25]。类似地,融合植物与合成细菌囊泡的杂化系统可同时利用炎症部位的血管通透性增加实现被动蓄积,并通过囊泡表面的PAMP主动靶向中性粒细胞,实现“搭车”递送至深部感染灶[30]。
从单一依赖载体理化性质或单一配体识别的单重靶向,发展到整合被动蓄积、主动识别乃至仿生趋化的多级靶向系统,标志着抗菌纳米递送策略向更精准、更高效、更适应复杂体内环境的深刻演进。多级靶向通过多机制协同与时空序贯控制,为克服感染微环境异质性、提升治疗指数提供了关键解决方案。
纳米包载技术为传统抗生素的“老药新用”开辟了新路径。通过载体设计,该技术系统性地克服了游离药物在溶解度、稳定性、靶向性及耐药性等方面的固有瓶颈[37]。其增效机制主要体现在以下3个维度:(1)克服生物膜屏障。纳米技术通过精确调控载体的尺寸与拓扑结构可显著增强药物对生物膜的渗透。例如,负载利福布汀的脂质体表现出相较于游离药物更强的抗生物膜活性[38]。(2)重塑抗生素的药代动力学行为。通过利用纳米颗粒的尺寸效应(如EPR)或进行表面功能化修饰可实现药物在感染病灶的主动蓄积与可控释放,从而延长作用时间、降低全身暴露。例如,PLGA NPs/CS NPs能维持LEV在病灶的有效浓度,降低全身给药剂量与毒性[10]。(3)协同增效与智能减毒。进一步结合仿生设计可大幅提升精准性。如TTOB@NPM,该纳米递送系统模拟免疫细胞趋化与靶向能力,显著降低抗生素用量(仅为常规剂量的1/8-1/10),同时实现高效杀菌并提升动物生存率[27]。
抗菌肽虽前景广阔,但面临体内易降解和膜毒性的巨大挑战[39]。纳米递送系统为其提供2种方案。(1)构建保护性纳米载体,例如,透明质酸修饰可提高纳米颗粒的稳定性与循环时间,避免被快速清除[40];壳聚糖纳米颗粒包载抗菌肽[41],则能在动物感染模型中实现高效的药物递送与缓释;上述纳米递送系统可通过包载或表面修饰,在一定程度上保护药物免受降解,增强体内稳定性。(2)递送编码抗菌肽的遗传指令。研究人员不再直接递送抗菌肽分子本身,而是利用LNP等载体将编码抗菌肽的mRNA递送至病灶处的宿主细胞[42],这些细胞在接收到“指令”后会在体内原位、持续地合成并分泌功能性的抗菌肽。这一策略的优势在于能够实现长效、可控的局部药物生产,避免了全身给药带来的毒副作用。
面对耐药菌感染的严峻挑战,噬菌体疗法正逐步从“替补”策略走向“精准治疗”的前台。凭借其特异性识别并裂解宿主菌的能力,噬菌体在多重耐药菌感染的治疗中展现出独特优势。研究表明,噬菌体疗法对耐碳青霉烯类肺炎克雷伯氏菌(carbapenem-resistant Klebsiella pneumoniae)[43]、耐碳青霉烯类鲍氏不动杆菌(carbapenem-resistant Acinetobacter baumannii)[44]及铜绿假单胞菌(Pseudomonas aeruginosa)[45]等临床重点耐药病原体均表现出显著的抗菌活性,为传统抗生素治疗失败的患者提供了新的治疗选择。更为重要的是,噬菌体作为天然的抗菌载体,其在裂解细菌过程中释放的PAMP可被宿主免疫细胞识别,进而调节局部免疫微环境[46],为构建“抗菌-免疫协同”的纳米递送系统提供了新的设计思路。然而,噬菌体治疗在临床应用仍面临体内稳定性差、易被免疫系统清除等核心瓶颈[47]。为提高噬菌体疗法的稳定性和靶向性,针对肠道感染可采用聚合物涂层包裹已被噬菌体感染的细菌单元[48],形成保护性微单元,保护噬菌体通过胃酸环境,将活性噬菌体精准递送至肠道并靶向释放。针对呼吸道感染,开发脂质体-噬菌体复合物,经雾化给药,可在维持噬菌体活性的同时,提升其肺部沉积率,并增强对胞内菌的清除能力[49]。
多成分协同共递送策略是抗感染纳米医学从“单一杀菌”向“生态重编程”演进的关键。通过单一纳米平台,同时实现病原体清除、宿主免疫稳态重建与病理微环境修复的协同效应,从而应对复杂、顽固的感染。初级协同策略聚焦于破解生物膜物理屏障。例如,将抗生物膜的银纳米粒子(silver nanoparticles, AgNPs)与TOB共递送,其增效机制不仅在于共递送本身,更在于AgNPs对生物膜物理屏障的破坏,为后续的抗生素渗透创造了条件,实现了针对生物膜微环境与病原体本身的初级协同[50]。类似地,利用姜黄素的光动力效应产生活性氧破坏生物膜结构,并与多西环素协同,显著增强了对P. aeruginosa生物膜的清除效果及肺部感染的治疗疗效[51]。这类策略本质上是针对病原体及其物理保护的联合攻击。然而,更加前沿的策略认识到,许多重症感染的根源在于失调的宿主免疫反应。因此,干预层次从“病原体”上升至“宿主免疫系统”。研究利用四面体框架核酸调控巨噬细胞极化[27],或将具有免疫调节功能的植物活性成分甘草酸[52]和鞣花酸[53]分别与抗生素共载,旨在逆转免疫抑制或过度炎症状态。上述研究共同实现了从“单纯杀菌”到“综合免疫修复”的治疗模式转变。基于这一设计理念,一项研究构建了仿生金属有机框架(biomimetic metal-organic frameworks, bio-MOF)纳米平台,将健康线粒体与抗炎性小RNA (microRNA, miRNA)拮抗剂共载[54],通过“代谢重编程+基因调控”双重机制修复巨噬细胞功能。这个策略标志着一个重要趋势:从对外部病原体或炎症介质的干预,深入到对免疫细胞内部功能状态的重编程。
纳米递送系统不仅通过剂型革新显著提升了传统抗生素的疗效与安全性,更通过智能递送新型抗菌剂(如抗菌肽、噬菌体)和设计多成分协同程序,为应对复杂、顽固的细菌感染提供了先进解决方案。
胞内寄生菌[如M. tuberculosis、肠沙门氏菌(Salmonella enterica)]利用巨噬细胞等免疫细胞形成“细胞内存留生态位”,这导致传统抗生素治疗基本无效[55]。为了解决以上难题,纳米递送系统提供了革命性策略。其抗菌策略为利用纳米载体的可设计性将抗菌药物高效递送至病原体藏匿的细胞内微环境。纳米递送系统通过以下策略实现精准干预。(1)细胞与亚细胞靶向。研究构建了负载阿米卡星与莫西沙星的PLGA NPs递送系统[56],该纳米颗粒粒径约300 nm、表面负电,易被巨噬细胞摄取,通过巨噬细胞的内吞作用将双靶向药物高效递送至M. tuberculosis寄生的胞内,并在胞内缓慢释放药物,实现双药协同抗菌,显著提高胞内药物浓度,从而有效杀灭耐多药结核菌。壳聚糖基纳米胶囊也是依照上述原理将负载的抗生素递送至巨噬细胞内部[57],从而实现杀菌作用。这种从亚细胞层面发起的“定点清除”,能极大提高局部药物浓度,同时减少对正常细胞器的损伤。(2)智能响应与功能一体化。研究构建了负载异烟肼的介孔二氧化硅纳米颗粒递送系统,并在表面修饰有pH响应纳米阀门[58],不仅实现了对巨噬细胞的主动靶向,且当纳米颗粒被巨噬细胞摄取并进入酸化的溶酶体后,能够响应低pH环境定点释放药物。相对于依赖“环境触发释放”的递送系统,有研究通过对抗菌肽的多功能域嵌合设计,使其自组装形成纳米颗粒/纳米棒结构[59],不仅增强抗菌活性,而且还具备高效穿透宿主细胞膜的能力,简化递送步骤并降低耐药风险,实现了对胞内S. aureus等胞内菌的精准靶向以及高效清除。
生物膜的致密胞外聚合物基质(extracellular polymeric substance, EPS)及内部特有的微环境是导致抗生素失效的关键。纳米系统主要采取2种策略。(1)增强药物在生物膜内的渗透与滞留。研究构建了蛋白质/多糖核壳冠状纳米递送系统,通过静电自组装在纳米核心表面分别修饰壳聚糖冠或牛血清白蛋白冠,赋予载体黏膜黏附或生物膜穿透的差异化功能[60]。同时,还有研究构建了脂质液晶纳米颗粒(liquid crystal nanoparticles, LCNPs)递送系统,该递送系统可显著增强TOB在P. aeruginosa生物膜中的穿透深度与分布均匀性,克服了游离TOB被EPS屏障吸附固定而无法深入菌群的局限[61]。(2)直接破坏生物膜结构。例如,研究构建了超声触发纳米炸弹的递送系统,该系统通过多黏菌素B靶向结合P. aeruginosa,在超声刺激下由携氧核心全氟溴代辛烷引发惯性空化,以机械力破坏生物膜EPS屏障,同时破裂释放IR780和氧气,缓解乏氧并产生活性氧杀灭暴露的细菌,实现物理化学协同清除[62]。该机制不依赖抗生素渗透,从而规避传统耐药机制。
为应对局部伤口感染,开发基于智能水凝胶的集成式纳米平台,可实现抗菌、抗炎、清除生物膜及促进组织再生等多功能时序控制释放,在高效清除感染的同时抑制瘢痕形成,促进功能性愈合[63-64]。对于全身性感染(如败血症),设计能够主动靶向感染灶的纳米递送系统,如利用LNPs向巨噬细胞递送编码抗菌肽的mRNA[65],在体内“重编程”巨噬细胞,使其获得更强的杀菌能力,从而在血液循环中有效清除病原菌,提高生存率。
巨噬细胞的极化受经典活化通路干扰素-γ (interferon-γ, IFN-γ)/脂多糖(lipopolysaccharide, LPS)驱动M1型杀菌与替代活化通路白细胞介素(interleukin, IL) 4/13驱动M2型促修复的共同调控,是固有免疫应答的核心环节[66-67]。纳米递送系统通过精准调控免疫细胞功能,将抗菌治疗从单纯的药物递送升级为“抗菌-免疫协同”的综合模式,兼具直接杀菌、重塑微环境及建立免疫记忆等多重功能(图2)。
固有免疫系统作为抵御病原体入侵的初始屏障,其核心效应细胞(如巨噬细胞、中性粒细胞)的功能状态直接决定了感染的走向。纳米系统可通过精准调控其核心效应细胞增强机体清除病原体的能力。
对巨噬细胞的极化调控中,纳米载体能够递送免疫调节分子,精确调控巨噬细胞的极化方向,从而实现抗菌与抗炎的时序协同。例如,研究人员构建了细菌膜囊泡包裹前药组装体的多功能纳米药物递送系统,该系统先诱导巨噬细胞极化为M1表型以增强杀菌;感染控制后,再缓释抗炎因子促使其向M2表型转换,以缓解炎症并促进组织修复[53]。这一过程模仿了机体天然免疫应答的理想进程。另一策略是递送具有免疫调节功能的核酸。例如,TTOB@NPM不仅调控巨噬细胞极化,还可降低髓源性抑制细胞的募集,逆转免疫微环境[27]。此外,还有研究通过纳米平台共递送免疫调节分子与代谢修复成分,实现“基因调控+代谢重编程”的双重干预。例如,有研究构建了bio-MOF纳米平台,将健康线粒体与抗炎性miRNA-127拮抗剂共载至炎症巨噬细胞[54],其中抗炎性miRNA-127拮抗剂驱动巨噬细胞从M1向M2表型转换,而健康线粒体则为这一转换提供代谢能量基础,实现了信号调控与代谢重塑的双重功能。研究人员以柠檬来源的细胞外囊泡为载体,通过负载人参皂苷和表面修饰环状RGD肽,构建了一种植物源纳米囊泡平台[68];该平台不仅可以调控巨噬细胞极化,提供固有抗炎属性,还可提供屏障保护,减轻组织损伤,在急性肺损伤模型中实现了抗炎、抗菌和组织修复的综合治疗效果。
对中性粒细胞的功能调控中,针对中性粒细胞在感染灶可能功能受损的问题,纳米系统可通过2种途径进行干预:(1)直接“赋能”,例如血红蛋白-萘替芬@红细胞膜纳米粒的递送系统[69],通过诱导细菌膜脂质过氧化增强其氧化敏感性,并通过供氧恢复中性粒细胞的呼吸爆发功能,实现协同抗菌,兼具高效杀菌、不易耐药、安全性好的优势。然而,直接“赋能”策略依赖全身给药后的被动扩散,纳米载体在感染部位的富集效率有限;仿生包覆策略则从递送源头入手,有效克服了这一局限。(2)利用仿生包覆,如中性粒细胞膜[26],使纳米载体模拟天然趋化与黏附行为,靶向富集于炎症部位,并在此过程中放大或调节局部免疫信号。
纳米递送系统为对抗细菌感染提供了“预防”与“治疗”的双重策略[70]。在预防层面,纳米颗粒是理想的多抗原展示平台,能高效激活适应性免疫,为机体建立前瞻性防御。例如,由细菌外膜与巨噬细胞膜融合制备的杂化纳米疫苗可同时呈递多种抗原,有效激活树突状细胞,进而驱动强烈的抗原特异性T细胞应答(Th1型)与抗体产生[高滴度免疫球蛋白(gimmunoglobulin G, IgG)],在P. aeruginosa感染模型中提供了显著保护[71]。黏膜纳米疫苗则能激发局部的分泌型免疫球蛋白A (secretory immunoglobulin A, sIgA)应答和全身性的IgG反应与Th1型细胞免疫,实现对呼吸道感染的双重防御[72]。在治疗层面,纳米递送系统通过靶向递送抗菌剂与重编程宿主免疫直接清除已建立的感染。纳米载体在感染部位释放抗生素杀灭细菌,被裂解的细菌释放的抗原可作为“内源性疫苗”,被局部抗原提呈细胞捕获和处理,进而激活特异性T细胞应答,有助于清除残余病原体并形成免疫记忆,降低复发风险[53]。
在细菌耐药危机与新型抗生素研发滞后的双重压力下,抗细菌感染纳米递送系统已从单纯药物载体发展为集精准递送、微环境调控与免疫重编程于一体的多功能平台。其核心进展体现在:载体设计智能化,通过有机/无机杂化与仿生修饰构建出具有主动靶向、长循环及免疫逃逸能力的复合体系;负载策略多样化,实现了从传统抗生素到新型抗菌剂(如抗菌肽、噬菌体)的高效包载与递送,并创新性发展了基于mRNA的“基因指令”递送模式,以及多组分协同共递送策略;场景适配精准化,针对胞内菌、生物膜、局部及全身感染等不同临床场景,开发了具有亚细胞靶向、生物膜穿透、时序控释等功能的专用纳米系统;免疫调控主动化,系统能够主动调节巨噬细胞极化、增强中性粒细胞功能,并协同激活适应性免疫,实现了从“单纯杀菌”到“抗菌-免疫协同”的治疗范式转变。
尽管纳米递送系统在抗菌治疗领域展现出广阔前景,但其临床转化仍面临多重挑战:纳米材料的长期体内代谢、潜在免疫原性及慢性毒性等生物安全性问题尚需系统评估;现有制备工艺在放大过程中易出现批次间一致性、稳定性及成本控制的困难,缺乏统一的质量标准;患者间感染微环境与免疫状态的差异显著影响纳米制剂的疗效,个性化适配能力亟待提升;此外,在深层穿透成熟生物膜、高效清除胞内菌、综合治疗混合感染等技术瓶颈方面仍有待进一步突破。
为此,未来纳米抗菌递送系统应聚焦于四大发展方向:(1)个性化精准医疗,借助多组学与实时监测技术构建可动态响应患者特定微环境的“按需释药”纳米系统;(2)诊疗一体化升级,打造集诊断、治疗、监测、反馈于一体的智能平台,实现闭环式精准抗感染治疗;(3)跨学科融合创新,融合合成生物学、微流控与人工智能技术,优化载体设计与生产工艺;(4)加速临床转化,建立完善的长期安全性评价体系与标准化生产流程,推动技术从实验室走向临床。通过多学科交叉与系统性创新,纳米递送系统有望成为克服细菌耐药性、提升感染治疗水平的关键核心技术手段。
  • 河南省高等学校重点科研项目(25A320042)
  • 河南省中医药科研专项联合共建课题(河南省中医院)(2025LHZX2067)
  • 河南省科技攻关项目(262102310215)
  • 河南省科技攻关项目(242102310148)
  • 吴阶平医学基金会科研专项资助基金(320.6750.2024-03-27)
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2026年第66卷第10期
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doi: 10.13343/j.cnki.wsxb.20260174
  • 接收时间:2026-03-04
  • 首发时间:2026-10-13
  • 出版时间:2026-10-04
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出版历史
  • 收稿日期:2026-03-04
  • 录用日期:2026-05-11
基金
Key Scientific Research Project of Henan Higher Education Institutions(25A320042)
河南省高等学校重点科研项目(25A320042)
Special Project for Research on Traditional Chinese Medicine in Henan Province (Jointly Supported by Henan Province Hospital of TCM)(2025LHZX2067)
河南省中医药科研专项联合共建课题(河南省中医院)(2025LHZX2067)
Henan Provincial Science and Technology Research Project(262102310215)
河南省科技攻关项目(262102310215)
河南省科技攻关项目(242102310148)
WU Jieping Medical Foundation Research Special Fund(320.6750.2024-03-27)
吴阶平医学基金会科研专项资助基金(320.6750.2024-03-27)
作者信息
    1.河南中医药大学第二临床医学院,河南中医药大学第二附属医院,河南 郑州
    2.河南省中医院(河南中医药大学第二附属医院)检验中心,河南省防治耐药菌感染中医药重点实验室,郑州市病原微生物与细菌耐药监测重点实验室,河南 郑州

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https://castjournals.cast.org.cn/joweb/wswxb/CN/10.13343/j.cnki.wsxb.20260174
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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