Targeted modulation and enhancement of macrophages via sonodynamic therapy-driven cupferroptosis-like stress for implant-associated biofilm infections

As the vanguard against implant-associated infections (IAIs), macrophages facilitate the phagocytosis and pro-inflammatory polarization of planktonic and biofilm infections, but indirectly serve as a “Trojan horse” for intracellular bacterial infections. Effective drug delivery and macrophage immunomodulation to eliminate intracellular infections will contribute to the treatment of refractory IAIs and prevention of relapse. Herein, we developed an ultrasound-responsive copper-based nanoparticle targeting macrophages by encapsulating copper in a porphyrin metal-organic framework and surface-grafting D-Mannosamine to synthesize CuTCPP@MOF nanodots@  Mannosamine (CTMM) with macrophage-targeting functionality. Concurrent generation of hydroxyl radicals and singlet oxygen in biofilm microenvironment mediated by ultrasound disrupts the biofilm structure, achieving CTMM overload and interfering with bacterial biofilm growth and metabolism. By regulating macrophage oxidative stress metabolism, CTMM induced a cupferroptosis-like stress, characterized by concurrent cuproptosis and ferroptosis , to eliminate intracellular infections. Transcriptomic analysis verified that the cupferroptosis-like stress based on GPX4 axis modulation further promotes macrophage inflammatory activation. This CTMM+US-mediated bacterial clearance in biofilms and macrophage immunomodulation informs the "Trojan War" strategy to combat IAIs clinically.