Multidrug resistance (MDR) represents one of the major concerns in cancer therapy as it may cause reduced efficacy of chemotherapeutic drugs due to the overexpression of ABC transporters, particularly P-glycoprotein (P-gp). This study explores the potential of novel amphiphilic diblock (DB) copolymers composed of poly[N-(2-hydroxypropyl)methacrylamide]-based copolymers (PHPMA) and poly(propylene oxide) (PPO) to overcome MDR mechanisms. The DB copolymers and their doxorubicin (Dox) conjugates significantly increased Dox accumulation in P-gp positive cells, markedly sensitizing them to Dox cytotoxic activity. The underlying mechanisms included depletion of intracellular ATP with subsequent inhibition of P-gp mediated drug efflux, an altered mitochondrial membrane potential, and increased ROS production. Moreover, the DB-Dox conjugates inhibited tumor growth in vivo more effectively compared to the corresponding PHPMA-based drug delivery system. Copolymers with additionally loaded PPO in the micelle core demonstrated superior efficacy in terms of P-gp inhibition, ATP depletion, and chemosensitizing effect in vitro, as well as antitumor activity in vivo. DB copolymers effectively depleted ATP levels both in vitro and in vivo using patient-derived xenograft (PDX) models, underscoring their capacity to enhance the effectiveness of standard chemotherapy and translational potential.

Department of Otorhinolaryngology and Head and Neck Surgery 1st faculty of Medicine Charles University and University Hospital Motol Czech Republic

Institute of Macromolecular Chemistry Czech Academy of Sciences Czech Republic

Institute of Microbiology Czech Academy of Sciences Czech Republic

Institute of Microbiology Czech Academy of Sciences Czech Republic; Department of Otorhinolaryngology and Head and Neck Surgery 1st faculty of Medicine Charles University and University Hospital Motol Czech Republic

J Control Release. 2025 Jun 10;382:113685. doi: 10.1016/j.jconrel.2025.113685. PubMed

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