**5. Conclusion**

*Current and Future Aspects of Nanomedicine*

**4.1 Cancer nanoparticle medicines**

without even stealth characteristics.

**4.2 Iron-replacement nanoparticle therapies**

**4.3 Nanoparticle/microparticle imaging agents**

air bubbles, which act as reflectors for ultrasound.

**4. Approved application and indication of nanomedicine**

Most pharmaceutical industries are focusing on developing new products for cancer as it is the first cause of death in 50% of the countries. Nanomedicine products have a good share in this market with many approved products to treat several types of cancer at various stages. Abraxane® is a famous albumin-particle bound paclitaxel nanomedicine loaded for advanced non-small cell lung cancer, metastatic breast cancer, and metastatic pancreatic cancer. Doxil®, the first approved nanomedicine by the FDA in 1995, is a PEGylated liposome loaded with doxorubicin for ovarian cancer, HIV-associated Kaposi's sarcoma, and multiple myeloma. Marqibo® is a liposomal vincristine for Philadelphia chromosome-negative acute lymphoblastic leukemia. Hensify® is the recently approved nanomedicine for cancer in 2019 by the FDA. It is the hafnium oxide nanoparticles stimulated with external radiation to enhance tumor cell death via electron production for locally advanced squamous cell carcinoma. Most of the approved nanomedicines are non-PEGylated except Doxil and Onivyde, which is interesting as most reports have proven the importance of nanomedicine coating with PEG. Furthermore, all nanomedicine products do not have active target moiety. So, all of these products follow passive targeting approach

Iron-replacement therapy to treat anemia is surprisingly another area for nanomedicine due to the significance of nanoscale iron-oxide colloid system in improving iron absorption to the body. The main advantage of iron-oxide nanomedicine is replacing the injection of free iron with its associated toxicity. Most of these nanosystems are coated with either polysaccharide or polymer to reduce iron toxicity. CosmoFer® is the first approved iron dextran colloid by the FDA in 1996. Injectafer® is the most recent one in 2013 by the FDA, which is iron carboxymaltose

Another area for nanomedicine, especially the inorganic ones, is diagnostics, mainly imaging agents. Iron-oxide nanomedicines are also approved as contrasting agents for magnetic resonance imaging, which is used to generate contrasted images for different types of cancers. The magnetic property and small particle size allow the distribution of iron-oxide nanomedicine in tumor tissue, which provide a precise imaging of cancer borders. Additionally, perflutren is also used as ultrasound contrast agent in either lipid- or albumin-based nanomedicines. Phospholipidstabilized microbubble is another form of nanomedicine as ultrasound contrast agent, which is approved in 2001 by the EMA. Its main mechanism is encapsulating

**4.4 Nanoparticles for vaccines, anesthetics, fungal treatments, and macular** 

Several clinical applications have been studied using nanomedicine. Diprivan® is the first FDA-approved nanomedicine in 1989 for anesthesia. Another field for nanomachine is vaccination with two products, which are Epaxal® for hepatitis A and Inflexal V® for influenza. Both vaccines are liposome-based nanomedicine due

**8**

**degeneration**

colloid.

Nanomedicines are currently in the middle of the road with great potentials but require many development considerations regarding assessment of physicochemical properties, pharmacokinetic properties, and pharmacodynamic applications. Based on the recent trends with 47 products in clinical trial phases, it is expected that within the next few years, more products will be available for several applications, especially cancer.
