Xie_2026_Int.J.Nanomedicine_21_604162

PURPOSE: Organophosphates (OPs) exert neurotoxicity by inhibiting acetylcholinesterase (AChE) activity, leading to acetylcholine accumulation, excessive nervous system stimulation, and even fatal outcomes. Current clinical countermeasures focus on AChE reactivation and symptom antagonism but lack the ability to efficiently clear OPs in vivo, especially in the brain, failing to mitigate central neurotoxicity and resulting in persistent neuronal damage and permanent disability in survivors. Organophosphorus hydrolase (OPH) has robust OP clearance capacity but is hindered by poor blood-brain barrier (BBB) penetration. Thus, the purpose of this study is to address the BBB penetration challenge of OPH and develop an effective strategy for efficient clearance of brain-invading OPs to improve the prognosis of patients with OP-induced central neurotoxicity. PATIENTS AND METHODS: A fusion protein ANG-OPHDS5 was constructed by conjugating OPH mutant OPHDS5 with Angiopep-2 (ANG), a brain-targeting ligand that mediates transcytosis across the BBB via specific binding to low-density lipoprotein receptor-related protein 1 (LRP1). In vivo imaging and pharmacodynamic studies were performed to evaluate the brain-targeting ability, OP clearance efficiency, and neurotoxicity alleviation effect of ANG-OPHDS5. RESULTS: In vivo imaging and pharmacodynamic studies confirmed that the constructed fusion protein ANG-OPHDS5 efficiently achieved targeted delivery to the brain, effectively cleared OPs residing in the central nervous system (CNS), and significantly alleviated neurotoxicity induced by OPs. CONCLUSION: Our strategy of centrally targeted delivery of OPH-based bioscavengers (ANG-OPHDS5) overcomes the limitations of current OP poisoning treatments, which lack efficient brain OP clearance capacity. This strategy holds great potential for improving the prognosis of patients with OP-induced central neurotoxicity.