2.1 Synthesis and characterization of IALPs
To investigate the occurrence of the H-aggregated state of IR-1061 in ALPs and its mechanism, a total of 5 kinds of ALPs, named IALP-1 (2, 3, 4, 5), with different molar contents (compared with phospholipid) of IR-1061 (0.5, 1, 1.5, 2, and 2.5%) were synthesized and their optical spectral properties were analyzed. As shown in Fig. 1a, at the same solution concentration of IR-1061, the main absorption peak at 1061 nm gradually decreased with the increase of molar contents of IR-1061 in ALPs. On the contrary, another absorption peak appeared with continuous blue shift and intensity enhancement. The fluorescence spectra of IALPs showed that the main fluorescence emission peak at 1100 nm decreased corresponding to the absorption spectrum under the excitation of 1061 nm laser. There is no new shorter wavelength emission peak appeared under the excitation of 808 nm laser, demonstrating that the new absorption did not release energy in the form of fluorescence (Fig. 1b, c). The characteristics of the blue shift peak are completely consistent with that of the fluorophore under the H-aggregated state, meaning the increase of IR-1061 content in IALPs will increase its proportion in the H-aggregated state and reduce that of the free state [30]. Furthermore, the absorption spectra of IALPs at the same solution concentration of phospholipid showed that the absorbance of IR-1061 at 1061 nm increased at low molar contents, no longer increased over 1.5% molar content, and even began to decrease at 2.5% molar content (Fig. 1d). Whereas the absorbance at 890 nm increased more rapidly with the increase of IR-1061 content (Fig. 1e). The cessation of the increased absorption at 1061 nm demonstrated that the free state of IR-1061 could reach the maximum when the molar content of IR-1061 in IALPs is over 1.5%, and then the excess fluorophore might completely exist in the H-aggregated state. The results of fluorescence intensity of IR-1061 at 1061 nm with different concentrations were under our discussion (Fig. 1f).
In terms of the above experimental results, the anionic liposome with 1.5% IR-1061 (IALP-3) and 2% IR-1061 (IALP-4) will be considered as the optimal fluorescence liposomes. On the other hand, the higher the molar content of IR-1061 with an H-aggregated state exists in liposomes, the more excellent its photothermal performance presents. Thus, we believe that IALP-4 is more suitable for simultaneous PTT and NIR-II FI. Next, liposomes modified with three types of peptides (RGD, TAT48–60, and RR9) and encapsulated with carboplatin were named RIALP-C4, TIALP-C4, and RRIALP-C4, were for subsequent studies. Both absorption and fluorescence spectra of these liposomes illustrated that the modification of peptides and the encapsulation of carboplatin do not affect their optical properties (Additional file 1: Fig. S1). As shown in Fig. 1k, the mean hydrodynamic size of the IALP-C4, RIALP-C4, TIALP-C4, and RRIALP-C4 was 51 nm (with polymer dispersity index, PDI: 0.138), 48 nm (PDI: 0.154), 61 nm (PDI: 0.135), and 95 nm (PDI: 0.165), respectively, meaning that the modification of peptides will slightly increase the particle size of liposomes but not affect the uniform dispersion. TEM results presented the homogeneous distributed roughly spherical particles with liposomal characteristic bimolecular layer structure (Fig. 1g–j). The ζ potential confirmed the successful modification of different peptides as well as the change of liposome surface charges (Fig. 1L). Figure 1m showed the size changes of different modified types of IALP-C4 at 4 °C for 1 month. The results demonstrated that IALP-C4 possessed the best stability due to its negative charge on its surface, while RIALP-C4 possessed the worst stability because there is not enough positive charge on its surface. TIALP-C4 and RRIALP-C4 showed almost no size changes within 3 weeks and slight size changes within 1 month, indicating the positive charge modifications of IALP-C4 also provided excellent stability.
2.2 Evaluation of the molecular dynamics simulations of IALPs
To better understand the effect of phospholipid bilayer on the structure and spectral properties of IR-1061, we performed molecular dynamics simulations of IR-1061 with different concentrations in the phospholipid bilayer. In this work, three different number ratios of IR-1061 and DPPG molecules (1: 20, 1: 10, and 1: 5) were used to construct the bilayers to simplify the calculation (Fig. 2b). A total of 120 phospholipid molecules with a corresponding ratio of IR-1061 molecules were put into the system and operated for 90 ns. The operation process was shown in Fig. 2a. After placing the chaotic system in the cube in the initial setup, the hydrophobic and hydrophilic groups of DPPG began to separate within 0.6 ns and reached a plateau after 90 ns, showing the appearance of a classical phospholipid bilayer structure. Compared with the system with high IR-1061 concentration, the system with low IR-1061 concentration showed a smaller phospholipid bilayer gap and more uniform hydrophilic and hydrophobic layer separation. These results were also demonstrated in Fig. 2c, d. The mass density distribution of systems showed that the total thickness of the liposome bilayer was about 6 nm, and the thickness of the hydrophobic layer ranged from 3 to 3.5 nm. Among them, after the number of IR-1061 increased, the hydrophobic bilayer broadened and the central density increased. The charge density distribution of systems showed that the high concentration of IR-1061 increased the distribution space of the negative charge of DPPG, which proved that the increase of IR-1061 would interfere with the uniformity of the phospholipid hydrophilic layer.
Subsequently, the number and the proportion of IR-1061 in the H-aggregated state were evaluated in the molecular dynamics simulation results. The evaluation criteria of IR-1061 in the H-aggregated state is that 2 molecules are arranged face-to-face with a distance less than 5 Å. In the system with a 1: 5 ratio of IR-1061 to DPPG, 12 IR-1601 molecules were in the H-aggregated state after 90 ns of operation, accounting for 50% of the total number of IR-1061 molecules (Fig. 2e). In the other two systems, the proportion of IR-1061 in the aggregated state is 0% and 33% respectively (Additional file 1: Fig. S2). The results were consistent with our experimental results and made us observe the cause of this phenomenon more intuitively. The distribution space of the phospholipid bilayer enables only one IR-1061 molecule vertically distributed. Therefore, the vertical distribution space of IR-1061 is greatly limited, in turn forming a horizontal, face-to-face distribution. When the number of IR-1061 increased, the number of horizontally distributed IR-1061 layers also increased (shown in the dashed lines in Fig. 2e), and the molecular gaps and misplacement angles of IR-1061 became smaller and smaller, which eventually formed the H-aggregated state.
2.3 Evaluation of the photothermal performance of RRIAP-C4
The H-aggregated state of fluorophores will convert the light absorbed from a radiative state into a non-radiative state, which will induce the photothermal conversion [31]. Therefore, the photothermal properties of IALPs were examined by thermometry and thermal imaging. First, the heating curves of IALPs with different molar contents of IR-1061 were tested (Fig. 3a). The results showed that the heating capacity of IALPs was positively correlated with the molar content of IR-1061, which verified our previous conjecture. Next, more photothermal properties of the selected liposome RRILAP-C4 were detected to evaluate its PTT effect. As shown in Fig. 3b, c, the cooling curve and t − (− lnθ) plot of RRILAP-C4 were made to show a stable photothermal conversion efficiency (the R2 value of the straight-line fit was more than 0.99). The photothermal conversion efficiency of RRILAP-C4 was calculated to be 42% according to the curves, which was just a sight lower than RRIALP-C5, but much higher than another NIR fluorophore, IR-780 (Additional file 1: Figs. S3a−d, S4a). The photostability of RRIALP-C4 was also examined by cyclic lift temperature (Fig. 3e). Moreover, to prove the excellent photothermal performance of RRIALP-C4, we simultaneously prepared ICG-encapsulated ALP (ICG-ALP) and IR-780-loaded ALP (IR780-ALP), and tested their photothermal stability (Additional file 1: Figs. S3e, S4b). ICG is a clinical contrast agent and has been proved to possess photothermal properties. IR-780 was also reported to have good photothermal properties [32]. The results showed that RRIALP-C4 had a higher rising temperature and more cycle times, demonstrating that RRIALP-C4 possessed excellent photothermal property and stability far beyond ICG-ALP. Moreover, to test the IR-1061-loading stability of RRIALP-C4, we circulated the temperature of RRIALP-C4 for 0, 1, 2, 3, 4 times respectively, and measured its absorption after the liposome is dialyzed (Additional file 1: Fig. S5). The results showed extremely low leakage of IR-1061 and unreduced H-aggregated form under short-term temperature circulations.
Furthermore, to test the heating effect of RRIALP-C4 in cell experiments, RRIALP-C4 solutions with different concentrations (diluted by cell culture medium) were placed in 24-well plates and their temperature rise was monitored by the thermal imager. The pictures in Fig. 3f displayed that the temperature of RRIAP-C4 solution at 10 mg/mL increased from 27 to 59 °C within 300 s, which was significantly higher than that of the control group. Moreover, the different concentrations of RRIALP-C4 were also evaluated (Additional file 1: Fig. S6). The temperature could rise to the effective treatment temperature (over 42 °C) in a short time even when the phospholipid concentration of RRIALP-C4 was low to 1 mg/mL, indicating RRIALP-C4 have an effective PTT effect on tumor cells.
The simulation experiment of tissue photothermal penetration depth was also carried out using chicken breast tissues in vitro. As shown in Fig. 3d, the maximum temperature of the RRIALP-C4 solution displayed a stepwise decrease with the increase of chicken tissue thickness. The maximum chicken tissue thickness to reach effective treatment temperature was 6 mm, and that to realize rapid heating was 4 mm, indicating RRIALP-C4 has a good tissue penetration depth for tumor PTT.
2.4 In vitro synergistic therapy and target delivery
The cytotoxicity of IALPs with different phospholipid concentrations to A549 cells was evaluated by cell viability assay to evaluate their biocompatibility. As shown in Fig. 4a, RRIALP-4 had little significant cytotoxicity (> 95%) to A549 cells at a phospholipid concentration lower than 2 mg/mL, which contained the appropriate concentration for tumor PTT. The results of RIALP-4 and TIALP-4 were consistent with RRIALP-4, indicating that the modification of different types of peptides had no obvious effect on the toxicity of IALPs. To test the influence of modification of different peptides on the PTT of IALP-4s, A549 cells were incubated with IALP-4s for 30 min, and then the samples were replaced by the new culture medium. After the irradiation of 808 nm laser (0.3 W/cm2) for another 6 min, all IALPs showed a certain degree of toxicity (Fig. 4b). Compared with IALP-C4 and RIALP-C4, TIALP-C4 and RRIALP-C4 showed more damage to A549 cells under irradiation. Especially, RRIALP-C4 possessed significant cytotoxicity even at the concentration of 0.625 mg/mL (< 80%) and could reach the semi-inhibitory concentration at 2.5 mg/mL, indicating that the suitable concentration of RRIALP-C4 for PTT is about 2 mg/mL, which will offer not only effective PTT effect but also good biosafety. The results of significant differences in cytotoxicity between IALP-C4s demonstrated that the modification of different peptides on IALP-4s significantly affected their PTT effect in vitro, which might be related to the accumulation of liposomes in tumor cells. ICG aqueous solution and ICG-loaded ALP (2% molar content) were also detected as control groups (Additional file 1: Fig. S7). The results showed ICG-ALP also possessed excellent photothermal treatment effect.
The synergistic therapy of RRIALPs (1 mg/mL) to A549 cells was detected by cell viability detection and cell apoptosis detection. The effects of liposomes under different conditions on cell activity were shown in Fig. 4c. There was no significant cytotoxicity when blank RRALP (cell viability: 97.5% ± 1.8%) and RRIALP-4 (95.3 ± 2.6%) interacted with A549 cells, while the carboplatin-loaded RRALPs possessed certain cytotoxicity (RRALP-C: 73.5% ± 1.4%, RRIALP-C4: 72.1% ± 3.2%). The irradiation of 808 nm laser showed slight damage on A549 cells (86.4% ± 0.91%), but much lower than that co-operated with RRIALP-4 (65.2% ± 0.33%). More importantly, the greatest cytotoxicity (44.7% ± 6.1%) was exhibited when carboplatin synergized with the liposomal photothermal effect, indicating that the synergistic effect of thermochemotherapy was better than each one. Fluorescence signals of live/dead cells by fluorescence microscope showed the same trend as cell activity that the group of RRIALP-C4 with irradiation possessed the lowest fluorescence of living cells and the highest fluorescence of dead cells (Fig. 4d). Furthermore, cell apoptosis was quantitatively analyzed by flow cytometry (Fig. 4e). The carboplatin treatment groups presented more injured cells concentrated in the cell death region (Q1), while most of the injured cells in the PTT groups belonged to cell apoptotic region (Q2 and Q3). The results of cell death mode in these two ways correspond to their mechanism. It is known that carboplatin drugs directly act on DNA in the nucleus to cause cell damage from inside to outside, therefore apoptotic staining exhibits high PI signals and low FITC signals [33]. On the contrary, thermotherapy exerts its cytotoxic effect mainly by inducing apoptosis at 42–45 °C, thus exhibiting normal apoptosis staining results [34]. Whereas, the proportion of apoptosis was greatly promoted in the group of RRIALP-C4 with irradiation compared with the group of RRIALP-C4 alone, demonstrating the synergistic therapy of carboplatin and photothermal both played a role.
The combinations of drugs (free carboplatin + IR-1061-loaded ALP) and single drug-loaded liposomes (carboplatin-loaded liposome + IR-1061-loaded ALP) were also supplemented to examine the combinational index of carboplatin and IR-1061 (Additional file 1: Fig. S8). The free drugs group exist the highest cell lethality (60%), which was nearly the sum of single drugs. The single liposomes combi group showed a cell lethality (42%), which was lower than IALP-C4 and free drugs group. The combinational index of Carbo + IALP-4, ALP-C + IALP-4, and IALP-C4 were calculated respectively. The combinational index of carboplatin and IALP-4 is 0.85, which means a low synergy effect. The combinational index of IALP-C4 is 0.95, which means an additive effect. The combinational index of ALP-C and IALP-4 is higher than 1, which means an antagonistic effect. We thought the reason for the difference of free drugs group, single liposomes combi group, and IALP-C4 group is that the uptake of liposome by A549 cell is limited.
The target delivery of ALPs with the modification of different types of peptides was evaluated through laser confocal microscopy imaging (CLSM). Since IR-1061 is a NIR-II fluorophore, DiO and Rhodamine B (RhB), two fluorophores in the visible region, were replaced in the ALPs (DRALPs) to realize the cellular visualization in further experiments. The fluorescence properties of these two dyes in ALP were detected to ensure the reliability of fluorescent signals (Additional file 1: Fig. S10). As shown in Fig. 5a, the successful FI of DiO and RhB in A549 cells proved that DRALPs did enter the cells in varying degrees. Compared with unmodified DRALPs, more amount of peptide-modified DRALPs had entered A549 cells. More accurate fluorescence intensity was analyzed through flow cytometry (Fig. 5b, c). Interestingly, Compared with RGD-modified DRALP (RDRALP), we found that A549 cells uptake more TAT-modified DRALP (TDRALP), demonstrating that the charge modification on the surface of ALPs is more conducive to liposome entry into A549 cells than receptor targeting. By integrating RGD peptide function and TAT peptide function, RR9 modified DRALP (RRDRALP) had the maximum fluorescence intensity. It proved that the synergy of the two functional peptides maximized the tumor-targeting effect of ALPs. To further prove the way of liposomes entering A549 cells, we used the endocytosis inhibitor, Pitstop 2, to inhibit the clathrin mediated cytocytosis (Additional file 1: Fig. S13). The results showed that Pitstop 2 cannot prevent RRDRALP into A549 cells, which means RRDRALP does not enter the cell through the way of endocytosis.
We have achieved the coexistence of the H-aggregated state of IR-1061 with the free state through the unique phospholipid bilayer structure of liposomes, which cannot be achieved in other solvent environments. Therefore, whether liposomes still maintain their dual states after uptake by tumor cells, especially the H-aggregated state, is need to be investigated. We visualized the distribution as well as the status of fluorophores in liposomes during phagocytosis by investigating the tumor cell uptake mechanism of ALPs. Liposomes generally enter cells through cell membrane fusion and endocytosis, each of which can be enhanced in different ways [35, 36]. RhB is a water-soluble fluorophore, which can only prove that liposomes do enter cells but cannot distinguish the way liposomes enter cells. While DiO is a hydrophobic fluorophore that it can further determine the way liposomes enter cells through its cellular distribution. For this reason, RhB-ALPs (RALPs) and DiO-ALPs (DALPs) were prepared separately and collocated their confocal fluorescence signals with DRALPs to evaluate the uptake mechanism of ALPs. As shown in Fig. 5d, g, the confocal through the 100× oil lens of the confocal microscope, the fluorescence of the nucleus, RhB, and cell membrane (stained by DiO dye alone) showed a significant distinction boundary, indicating that RhB was distributed in the cytoplasm. The modification of liposome surface peptide only changed the amount of RhB in cells but did not change its distribution (Additional file 1: Fig. S9a). While in the RRDALP group, the vast majority of DiO showed a distribution around the cells (Fig. 5e). Compared with RhB, there was a significant gap between the fluorescence signals of DiO and the nucleus, demonstrating that DiO was still abundantly present on the cell membrane (Fig. 5h). Only a very small amount of DiO fluorescence signal appeared in the cells for the RR9-modified DAP (RRDALP) and even less for the other peptide-modified DALPs, which proved that ALPs entered A549 cells mainly through membrane fusion (Additional file 1: Fig. S9b). In the RRDRALP group, even if DIO and RhB were in the same liposome, the distribution of these two dyes was completely consistent with that of the first two groups (Fig. 5f, i).
These results proved that IALPs were absorbed by A549 cells in the form of membrane fusion, and the distribution of IR-1061 would be dispersed on the cell membrane, similar with DiO. This distribution would make it easier for IR-1061 to maintain its H-aggregated state and still possess the PTT effect, which was also confirmed by other experiments. The A549 cells incubated with RRIALP-4 at different times, and then detected their temperature rise curves with an infrared thermal imager. As shown in Fig. 5j, k, and Additional file 1: Fig. S11, RRIALP-4 could maintain an effective PTT effect when co-incubation with A549 cells for more than 24 h. The decrease of maximum temperature after 12 h might be the fluidity of the cell membrane dispersing part of IR-1061 in the aggregated state. Another experiment was carried to stronger this evidence. We detected the absorption of purified cell membrane after incubated with IALP-4 (Additional file 1: Fig. S18). Specifically, after incubating A549 cells with IALP-4 for different time, we removed free liposomes by centrifugation, then cells were split using cell lysate and freeze-thaw method. The organelles are removed again by centrifugation to obtain cell membranes. The absorption peaks of cell membrane showed an obvious characteristic peak of IR-1061 in H-aggregated state at 800 nm, indicating that IR-1061 exists in the form of H-aggregates on the cell membrane.
ICG aqueous solution and ICG-loaded ALP (2% molar content) were also detected as control groups (Additional file 1: Fig. S12). The results showed both groups could only maintain their photothermal treatment effect in 2 h. This is due to their poor photothermal stability, and they cannot repeat photothermal cycles.
2.5 NIR-II FI properties of RRIALP-C4
Next, we investigated the NIR-II fluorescence signals of RRIALP-Cs in different phospholipid concentrations (Fig. 6a). Under the high concentrations (> 2.5 mg/mL), the fluorescence intensity of RRIALP-Cs tented to be no longer increased when the molar content of IR-1061 is over 1.5% because the maximum detection limit of the instrument was already reached. Moreover, under the low concentrations, the trend of fluorescence intensity enhancement would continue until the molar content of IR-1061 was 2% and then began to decrease, indicating that RRIALP-C4 possessed the best imaging effect for NIR-II FI. Next, the tissue penetration depth of RRIALP-C4 was also evaluated in vitro. As shown in Fig. 6b, RRIALP-C4 was able to maintain significant fluorescence intensity and spatial resolution within 6 mm, and even was detected over 9 mm, demonstrating a good tissue penetration depth.
The NIR-II vascular FI of the whole body was captured under the 1064 nm excitation after a tail vein injection of RRIALP-C4 (2 mg/mL) to evaluate its NIR-II FI in vivo performance. The systemic vascular structure of mice was discerned under a significant contrast with the surrounding background tissues (Fig. 6c). Furthermore, the fluorescence signal intensity of the abdominal and hind limb blood vessels of mice were analyzed (Fig. 6d, e). The full widths at half maximum (FWHM) of these vessels were calculated to be 0.4 and 0.6 mm, demonstrating that the NIR-II FI of RRIALP-C4 possessed extremely high spatial resolution in vivo.
2.6 NIR-II FI and PTI of tumor
To investigate the influence of different peptides on the accumulation of IALP-C4 in tumor tissue, the prolonged fluorescent signal monitoring of mice was recorded. As shown in Fig. 7a, the fluorescence intensity of tumor tissue was lighted as soon as 3 h after injection of RRIALP-C4, then reached its maximum at 12 h and was able to maintain for 24 h. Compared with other IALP-C4 liposomes (Additional file 1: Fig. S17 and Fig. 7b), RRIALP-C4 showed the most rapid signal enhancement and the highest fluorescence intensity. Moreover, the fluorescence intensities of the liver, spleen, and ex-vivo tumor tissues of mice were captured (Fig. 7c, d). The results showed that IALP-C4 and RIALP-C4 were only slightly enriched in tumor tissue, which was much lower than in other tissues. The enrichment of TIALP-C4 in tumor tissue was the same as in the spleen, but still lower than in the liver. While RRIALP-C4 possessed the highest degree of enrichment in tumor tissue, almost the same as liver, indicating that RRIALP-C4 had a satisfactory tumor-targeting ability.
The temperature variation of tumor tissues was monitored using the thermal imager to examine the photothermal effect of liposomes on the tumor. Under the 808 nm laser (0.3 W/cm2) excitation, the tumor of mice treated with RRIALP-C4 was heated up rapidly and the temperature was up to 46 °C in 3 min. While the temperatures of tumor areas in other mice treated with RIALP-C4 or TIALP-C4 were hardly able to rise to an effective PTT temperature even though they were higher than that in the control group (Fig. 7e, f and Additional file 1: Fig. S15). These results demonstrated that RRIALP-C4 was an efficient liposome for both NIR-II FI and PTT of tumor tissue. In addition, the fluorescence images of normal organs (heart, liver, spleen, lung, and kidneys) and tumors of mice treated with RRIALP-C4 were harvested to evaluate its distribution in vivo (Fig. 7g). The results showed that RRIALP-C4 was mainly accumulated in the tumor and liver, followed by spleen, but not in heart, lung, and kidney.
2.7 In vivo synergistic therapy of RRIALP-C4
Finally, the synergistic therapeutic efficacies of RRIALP-C4 were then carried out in the A549 cell transplanted tumor-bearing mice model. After 15 days of treatment, the changes in tumor volume and weight were recorded to evaluate the treatment effect (Fig. 8a, b). Mice treated with RRIALP-4 alone showed no treatment effect compared with that treated with PBS. The treatment of RRIALP-4 with irradiation only alleviated tumor growth to a certain extent, showing limited therapeutic effect. The treatments of the carboplatin group and RRIALP-C4 with irradiation group successfully inhibited the growth of the tumor, while the latter could even reduce tumor volume, indicating the synergistic therapy of RRIALP-C4 had the optimal tumor treatment effect. The monitoring of tumor changes in the treatment of RRIALP-4 with irradiation intuitively demonstrated the therapeutic efficacy compared with the treatment of PBS (Fig. 8d). Final tumor morphologies of different groups after 15 days of treatment were consistent with the previous results (Fig. 8e). By recording the weight of mice in different groups, there was negligible mice weight loss in other treatment groups except for the carboplatin alone group (Fig. 8c). Although the carboplatin treatment group can inhibit tumor growth, it also does some damage to the body of mice. Moreover, tissue sections of various organs after RRIALP-C4 injection showed no significant toxicity compared with the PBS group (Additional file 1: Fig. S16). The results demonstrated that RRIALP-C4 possessed excellent biosafety and negligible side effects in the whole treatment process. The histological morphology of the tumor tissues in different groups were shown in Fig. 8f. The group of RRIALP-C4 with irradiation showed a significant cell shrinkage and separation, which demonstrated the most severe tumor cell damage compared with other groups. The single drug-loaded liposome combi group (RRALP-C+RRIALP-4+L) and RR-ICG-ALP were also added as control group (Additional file 1: Fig. S17). The results showed that RR-ICG-ALP could alleviated tumor growth at beginning, but cannot be sustained. This because ICG possess poor photothermal stability and cannot repeat photothermal cycles. On the other hand, the RRALP-C+RRIALP-4+L also showed an inferior therapeutic efficacy than RRIALP-C4. This indicated that this group eventually recruited less IR-1061 and carboplatin in the tumor tissue, illustrating the emergence of a competitive relationship between these two liposomes. Moreover, to further reveal the mechanism of synergistic therapy, TUNEL staining of tumor tissues was performed to evaluate cell apoptosis [37]. Tumor cells appeared massively apoptotic in the treatment of RRIALP-4 with irradiation, whereas only slight apoptosis occurred in the treatment of RRIALP-C4 alone, indicating the different pathways of tumor therapy between PTT and carboplatin. The treatment of RRIALP-C4 with irradiation showed a similar apoptosis degree as the treatment of RRIALP-4 with irradiation, but with a more favorable tumor-suppressive effect, demonstrating that there is a synergistic effect between PTT and carboplatin.