Review Article

iMedPub Journals 2018

www.imedpub.com Journal of Nanoscience & Nanotechnology Research Vol.2 No.2:6

Nanotechnology Applications and Kadircan H Keskinbora* and

Muslim A Jameel
Approaches in Medicine: A Review
Department of History of Medicine and
Medical Ethics, Bahcesehir University,
Istanbul, Turkey
Abstract
The emerging scientific field of Nanotechnology enabled humanity to manipulate
the environment at molecular and atomic level and it promises to revolutionize *Corresponding author:
all scientific fields due to its features. Medicine is one of the prominent fields Kadircan H Keskinbora
that witnessed a nanotechnological revolution that ushered medical scientists
toward wholly new authentic approaches which study pathologies and explore  [email protected]
genuine therapeutic stratagems by utilization of nanotechnology to operate on
more specific molecular targets and to reduce the adverse risks and side effects Department of History of Medicine and
that conventional approaches impose on patients. To take a better view on the Medical Ethics, Bahcesehir University,
impact of nanotechnology on medicine. The ramification of this technology shall Bakirkoy, 34147 Istanbul, Turkey.
be explored in terms of medical outcomes. It will reduce societal and financial
expenses related with human services, offer early location of pathologic conditions,
Tel: +90 5322758795
decrease the seriousness of treatment, and result in enhanced clinical result for the
patient. The most promising treatment for cancer is nanotechnology that can be
used in treatment and detection. The current treatments for cancer is ineffective
with high chances of tumors to grow again and resistant to the treatment which Citation: Keskinbora KH, Jameel MA
makes it worse in addition to the severe adverse effect of the current treatments. (2018) Nanotechnology Applications
The early detection of cancer can elevate the chances of curing and prevent and Approaches in Medicine: A Review. J
recurrence, however the technologies and methods used in detection is limited Nanosci Nanotechnol Res Vol.2 No.2:6
and ineffective which worsens the condition. Intracellular drug delivery and
photothermal ablation are promising treatment for cancer. Prostate cancer affects
over 2.5 million Americans, but there is an unmet need for targeted treatment
with minimal systemic toxicity, especially for metastatic disease. Prostate cancer
tumors are characterized by a mixed cell population which is hard to target one
treatment for different kind of cells.
Keywords: Nanotechnology; Nanomedicine; Medical ethics

Received: October 15, 2018; Accepted: October 22, 2018; Published: October 25,
2018

Introduction magnetic forces and vander wall forces photolytic activity

and water solubility permit the treatment and manipulation
Nanotechnology in medicine of situations at atomic level [4]. Furthermore, the significant
applications in different sectors of science increased the demand
Nanotechnology revolution is the next giant step in science
and development of nano systems and nanomaterials and
that sets humankind in control of a wholly new dimensions and
expected to hit $3 trillion across global economy by 2020 [4].
enable them to manipulate the environment at molecular level.
The nanotechnology entered and made major changes that
Gökçay and coauthors stated that nanotechnology will lead to
skyrocketed the possibilities to wield the power and control of
a second industrial revolution due to its potency to be applied
diseases and extend the understanding of pathogenesis and
in nearly every scientific field [1]. Some of these applications
identify the most microscopic and decisive step in the process and
including nuclear reactors, transportation industry, cooling of
target it for cure and drug delivery which again will be through
transformer oil, electrical energy, mechanical, magnetic, cooling
the use of nanotechnology (nanotherapy). The different view that
of microchips, solar absorption and biomedical fields [2,3]. These
Nano Medicine provides healthcare workers about pathogenesis
technology characteristics of high surface volume ratio, significant

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1698-9465 Vol.2 No.2:6

of the diseases and the ability to detect the slightest change in nearby tissue damages [9]. Furthermore, nonunion fractures
blood chemistry or in any organ would call into question what it and vertebral compression can be source of acute or chronic
means to be healthy. pain. However, Bio Nano Scaffold (BNS) improved the direction
of treatment by creating controllable microspheres delivery
Under what conditions the human would be considered healthy.
system that release osteogenetic factors, antibiotics and stem
The ability of Nano Medicine devices to detect and spot the subtle
cells around the fracture and promote directional and precise
molecular changes and DNA mutations may be not enough to
regeneration [9]. Therefore, nanotechnology established new
consider that individual is ill. For example, it would be debatable
perspectives and therapeutic strategies that aim to alleviate pain
whether an individual can be considered cancerous if a gene
and better tissue regeneration ability with decreased induced
mutation that playing role in cancerogenesis is detected [5]. To
healthy tissue damage or drug abuse due opiate prescriptions.
take a better view on the impact of nanotechnology on medicine.
Nanotechnology has been a subject of research for utilization in
The ramification of this technology shall be explored in terms of
the field of cardiovascular system. Due to the processes of platelet
medical outcomes. They reduce societal and financial expenses
aggregation in myocardial infarction, thrombosis, platelet-
related with human services, offer early location of pathologic
targeted liposomal drug delivery may prove to have potential
conditions, decrease the seriousness of treatment, and result in
therapeutic applications [10]. Liposomes nano-particles that
enhanced clinical result for the patient.
contain PGE-1 has been designed for the treatment of thrombosis,
According to a research group in John Hopkins University “In periphery artery diseases and myocardial infarction due to its
cancer therapeutics, one of the great challenges is finding how properties that allow the reduction of PGE-1 degradation and
to specifically deliver high doses of chemotherapeutics to a prolong the outcome of the drug [10]. Cardiovascular magnetic
tumor but minimize the systemic toxicity" [6]. Nanotechnology resonance (CMR) is an important non-invasive technique that
in medicine promises a new horizon in diagnosis and treating detects inflammation and myocardial tissue configuration for
cancers through targeted delivery of drugs, genes and proteins early diagnosis and prognosis. According to Chandarna et al., gold
specifically to the cancerous cells with minimally induced nanoparticles have shown great promise in north cardiovascular
healthy cells injuries through the use of polymeric nanoparticles, medicine through optical imaging: photoacoustic imaging is
liposomes, dendrimers and nano-shells. The possibility of cancer based on detection of both ultrasound and optical imaging
reoccurrence with multi drug resistance (MDR) imposes clinical [10]. Therefore, cardiovascular researches could find their way
limitations on the efficacy of the therapy. However, the use of to utilize nanotechnology-based approaches for diagnostic
targeted drug delivery and photodynamic therapy (PDT) to and therapeutic purposes in the field of cardiovascular system.
modulate the MDR mechanisms (cytotoxic drugs efflux, decrease Genes deficits are responsible for countless diseases and some
in drug influx and surface receptors hiding) may be a promising of them are even lethal. Gene therapy is the medical intervention
technique to overcome MDR limitations [7]. that replaces the defective gene with new gene in the cell using
various methods including RNA interference (RNAi) which leads
The ever-increasing cases of diabetic patients worldwide urged
to defective gene silencing and down-regulation. Massadeh et al.
researchers to improve the conventional methods of diagnosing
points out that there are extracellular and intracellular obstacles
and treating the disease. Current scientific endeavors to design
that hinder the new genes and protein delivery to the cells due
and construct an artificial pancreas make utilization of the new
to rapid enzymatic degradation of the therapeutic materials in
possibilities created by the new field of nanotechnology. According
plasma, impermeability and off target silencing of genes that may
to Ramirez et al., nanotubes can be implemented to measure
lead to undesirable outcomes and exacerbations or even elicit
and diagnose diabetes through its modulation of fluorescence
unwanted immune response through activating interferons [11].
emissions upon contacting certain biochemical molecules such
Polymer nanoparticles are non-toxic biodegradable particles
as glucose or Langerhans isles-targeting antibodies found in
with high biocompatibility that are used to overcome such
type II diabetes [8]. Nanotubes built-in ability to sense glucose
complications. These particles are manipulated in order to fit the
(hydrogen peroxide based detection system that uses glucose
condensed DNA and proteins into the Nano structures, to permit
oxidase enzyme that catalyze oxidation of glucose to form
their internalization within the cells and later regain their original
hydrogen peroxide which is in turn oxidized electrochemically
shape upon internalization into the cell through physiological
resulting electrons that generate current flow proportional to
change in pH [11]. Magnetic nanoparticles made of iron oxide
converted glucose amount) opens up the opportunity to develop
nanoparticles have been implemented as drug delivery system
artificial pancreas that detect the glucose level and accordingly
which have been guided using strong magnetic fields to deliver
induce the release of insulin without the need to manually supply
therapeutic materials into the desired site.
it [8]. Nanotechnology application in field of pain managements
can potentially alleviate the limitations of current acute and An application for using nanotechnology:
chronic pain managements strategies. Sprintz et al. pointed
Nanoparticles enhanced antibiotics
out that nanotechnology utilization in pain managements aims
at improving patients’ quality of life by increasing safety and Bolocan and co-authors accentuated that the incorporation
efficacy of drugs with high precision of implanted wireless nano- of antibiotics into nanoparticles such as hydro-dispersible
channel silicon technology that delivers drugs to the noxious magnetite nanoparticles (HMNPs) facilitates a better penetration
stimulation origin in response to biosensors feedbacks regarding into the tissues, the drugs could be released with a controlled
blood concentration of pain markers, therefore decreases and predetermined rate, for a sufficient period of time to reach

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1698-9465 Vol.2 No.2:6

the target site, that could significantly increase the therapeutic • Respect for autonomy.
index and the efficacy of treatment against Gram negative • Justice.
bacteria and reduce the harmful side effects on the target organ These principles are the four pillars that constitute the core of
[12]. Hasanova and co-authors emphasized the use of Antibiotics all medical practices and scientists in general. It can be argued
such as Ciprofloxacin and Kanamycin with Nanoparticles that was that the only possible ethics and moral value in personal life is
prepared in crystalline size (8-16nm) in self-assembling principles
what the individual finds valuable henceforth; being free from
that rendered the antibiotics to be more substantial [13].
suffering is a condition found valuable by all sentiment creatures,
Obtained results demonstrated that these nanostructures are e.g.: “humans” [17]. The respect of autonomy principle (capacity
able to improve antimicrobial properties and decrease the of free choice) in medical ethics is important; the patient (a
minimal inhibitory concentration (MIC) of pristine kanamycin and rational agent) has the capacity to act and make moral decisions
ciprofloxacin antibiotics [13]. A study conducted by Saha et al. voluntary and intentionally without any external controlling
showed that the conjugation of Gold nanoparticles (Gnps) with influences because moral decision making involves agents that
antibiotics such as streptomycin and kanamycin yield a form of are informed and able to freely act [17].
these antibiotics that exhibit a significant reduction in minimal
inhibitory concentration (MIC), increase in bactericidal efficiency To ensure transparency and respect for autonomy the patients
and greater efficiency in the remote area, where proper storage should be informed of the design process of the device and its
condition is unavailable [14]. Moreover, owing to the different foundation and the intended use and function, in addition to
mode of antibiotics mechanisms, the relative bactericidal the conflicting requirements. These should be documented and
activity of Gnps conjugated ampicillin was less effective than signed by the intended individual/patient. Where justice allows
Gnps conjugated streptomycin and kanamycin whereas the MIC the offering of a procedure, and that procedure is not clearly
values of Gnps conjugated ampicillin decreased 10%, while the against the patient’s interests, the patient should be offered the
percentage decrement for Gnps conjugated streptomycin and procedure and to assess her/him in the evaluation and judgment
kanamycin were 50% and 60%, respectively [14]. of whether the benefits outweigh the risks, according to his/her
goals and life plans. Therefore, under the respect of autonomy,
Literature Review doctors and researchers have the responsibility of informing the
patients of any plans and enough data and consideration of the
Nanotechnology uncertainty process and any possible outcomes.
Nano-objects notoriously possess unexpected new properties From the previous definition of the autonomy principle, we can
in virtue of their small size. Their qualities can be radically, predict the impact or the potential violation of nanotechnology
and surprisingly, different from larger particles of the same to this principle. Technologies that are used in nanomedicine
substance. This scale effect is due to several factors: The surface and brain implants raise serious ethical considerations as they
to volume ratio increases, as well as the proportion of atoms that are threatening the principles and codes of ethics that the field
come in contact with surrounding objects; gravitational forces of medicine is working accordingly. For example, the respect
become unimportant; electromagnetic forces prevail; quantum for autonomy of the patients which implies the individual
mechanics laws become relevant; the strong Brownian motion capacity for making choices in accordance with his/her believes
of nanoparticles has significant effects. As a result, the nano- and values and lives accordingly. Using neural dust therapies
world behaves differently and unpredictably from whatever we in treatment with the patient’s consent and awareness of the
may know. Our knowledge of the macro-word is not useful to outcomes of this procedure is not the problem, however, the
anticipate the interactions at the nano-scale. In fact, we have to non-voluntary interventions on patients for experiences and
deal with a new kind of uncertainty. As in quantum mechanics, mind control purposes are what bring the ethical dilemma. The
uncertainty and unpredictability are not a result of insufficient different view that Nano Medicine provides healthcare workers
knowledge but are constitutive attributes of the situation. They about pathogenesis of the diseases and the ability to detect
are intrinsic and ontological features not just epistemic ones [15]. the slightest changes in blood chemistry or in any organ would
call into question what it means to be healthy. Under what
Nanotechnology, bioethics and medicine conditions the human would be considered healthy. Another
In 1979, Principles of Biomedical Ethic, written by Beauchamp implication that nanotechnology offers to scientists in medical
and Childress was published. It lied the most fundamental ethics field is Human Implantable Nano Devices (HINDs) that allow us
based on series of ethical principles that concerned the medical to wirelessly collect data of internal body organs conditions such
practice and patient care and treatment [16]. It offered a way to as temperature, pulse and blood glucose as well as correct organ
approach medical dilemmas that health workers and scientists dysfunction such as vision loss and hearing dysfunctions [18].
face throughout their careers. In addition, it was recognized by The principles of biomedical ethics that Beauchamp and Childress
institutions that are related to medicine and human health to be emphasized can come to conflict between each other when
the guiding principles in their careers whether training medical nanotechnology is applied in patient diagnosis or treatment.
students and residents to those who participate on hospital These principles can be Prima facie binding. A prima facie
ethics committees: (means on first appearance but subject to further evidence or
• Beneficence. information) is available when a situation justifies a principle or
• Non-maleficence. action as prescriptive without being absolute Therefore justifies a

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course of action until it is outweighed by other prima facie that is as diagnosis, treatment, or knowledge about their condition,
hold to be more true [19]. Risks to subjects that are much greater than minimal can be
justified only if subjects are expected to receive direct, medical
The four biomedical principles are prima facie binding because all
benefits. For example, chemotherapy can involve many different
of the rules are equal and must be fulfilled but in some occasions
risks, such as nausea, weight loss, nerve damage, anemia,
they come to conflict therefore the agent must determine what
neutropenia, thrombocytopenia, fatigue, hair loss, infections,
they ought to do by finding prima facie right that is overriding
or outweighs all other principles and act impartially in regard to dizziness, headaches, emotional problems, and even death.
all affected parties and the decision should not be influenced by Nevertheless, the risks of a phase clinical trial investigating a new
morally irrelevant information [20]. Therefore, the biomedical chemotherapy agent can be justified if the benefits to the subjects
ethics can be applied in order to measure the risks and benefits of (e.g., treatment) and society (e.g. new knowledge) are expected
nanotechnology utilization in medicine when applied to diagnosis to be very significant. If the risks are more than minimal and the
and treatments. subjects are not expected to receive direct, medical benefits,
the risks will be reasonable only if the risks are not much greater
Discussion than minimal and the benefits to society are large. For example,
the risks to subjects in Phase I drug trials are usually more than
FDA and clinical trials minimal, since Phase I studies are designed to study the toxic
Any new drugs and treatments are set for clinical trials for approval. effects of medications in human beings. Nevertheless, the risks
The drugs go through tests that evaluate the effectiveness and of a Phase I clinical trial involving a new drug can be justified if the
risks associated with the new treatments. The trials are pre- risks are not much more than minimal and the benefits to society
clinical, set on animal tests and then go to clinical double-blind (e.g. knowledge gained and drug development) are great [22].
tests. The trials may take several years in order to approve new
drugs by FDA. According to Glenn and Boyce, the FDA approval Conclusion
for Nano Medicine devices are troublesome and time-consuming Nanotechnology is an emerging field that opens the doors for
because this technology falls into several FDA categories and unprecedented new approaches and novel innovations for future
each one has its own regulations and criteria for approval [21].
progress and potential applications in various fields. Matters
Many limitations have been emphasized on the clinical trials
at scale of 1 nanometer (parts per billion of a meter) and 100
related to Nano Medicine. Animal experimental studies that set
nanometer and utilize them in order to intervene and manipulate
for pre-clinical trials for minimizing the risks of nanomedicine
the atomic properties at molecular levels. scanning electron
have significant limitations. The first of these limitations is that
microscope (SEM), nanoparticle research, supramoleculer
there may be differences in the way that humans and animals
chemistry, molecular modelling, quantum computation,
react to the same material or substance. Because there may
microelectronic mechanic systems (MEMS), light-emitted
be differences in how animals and humans absorb, distribute,
diodes, targeted drug delivery, molecular biotechnology, tissue
metabolize, or eliminate a substance or material, something that
engineering and more are all inclusive of the nanotechnological
is not toxic to animals at a low exposure might be toxic to humans
at a low exposure and vice versa. research fields list. This technology has been employed by
many scientific disciplines. Since the human body works on
A second limitation of pre-clinical research is that animal studies molecular scales with complicated physiochemical properties.
generally last from 28–90 days and rarely investigate the long- The nanotechnology entered and made major changes that
term effects of new drugs, biologics, or medical devices. However, skyrocketed the possibilities to wield the power and control of
some of the harmful effects of materials may only occur after diseases and extend the understanding of pathogenesis and
many years of exposure. The three phases of clinical trials are identify the most microscopic and decisive step in the process
inconclusive as well. Because it takes only seven years and post and target it for cure and drug delivery which again will be
marketing studies ensues only for few additional years. These data through the use of nanotechnology (nanotherapy). The use of
can’t give enough insight on future adverse effect. For example, nanotechnology in medicine invented nanomedicine. A field that
genetic or tissue damage result on disease after 30 years such as manipulates nano-scale particles and use it for medical purposes.
lung cancer after exposure to tobacco. The medical field was able to bend this technology to its will and
The management of risks in clinical trials involves the identification use it to explore any potential applications of this technology
and assessment of risks and benefits and balance between them to overcome the current limitations imposed by contemporary
through reason and justification of risks. And to have sufficient diagnostic and therapeutic strategies. It has been applied
data and information on both sides of the equation. If the risks of in cancer, diabetes, cardiovascular and pain managements
a study are more than minimal, the benefits must also be more diagnosis and treatment by employing nanoparticles that sense
than minimal. Additionally, special protections for vulnerable the changes in cells’ DNA and changes in blood biochemistry for
populations, such as children, fetuses, and prisoners, apply to screening as well as targeted drug delivery system to the specific
more than minimal risk research. It is important to distinguish desired site with reduction in induced tissue damage and adverse
between research that offers subjects a medical benefit, such effects.

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