title: Immunological and hematological toxicities challenging clinical translation of nucleic acid-based therapeutics.
abstract: BACKGROUND
  Nucleic acid-based therapeutics (NATs) are proven agents in correcting disorders caused by gene mutations, as treatments against cancer, microbes and viruses, and as vaccine adjuvants. Although many traditional small molecule NATs have been approved for clinical use, commercialization of macromolecular NATs has been considerably slower, and only a few have successfully reached the market. Preclinical and clinical evaluation of macromolecular NATs has revealed many assorted challenges in immunotoxicity, hematotoxicity, pharmacokinetics (PKs), toxicology and formulation. Extensive review has been given to the PK and toxicological concerns of NATs including approaches designed to overcome these issues. Immunological and hematological issues are a commonly reported side effect of NAT treatment; however, literature exploring the mechanistic background of these effects is sparse.
  
  
  METHODS
  This review focuses on the immunomodulatory properties of various types of therapeutic nucleic acid concepts. The most commonly observed immunological and hematological toxicities are described for various NAT classes, with citations of how to circumvent these toxicities.
  
  
  CONCLUSIONS
  Although some success with overcoming immunological and hematological toxicities of NATs has been achieved in recent years, immunostimulation remains the main dose-limiting factor challenging clinical translation of these promising therapies. Novel delivery vehicles should be considered to overcome this challenge.
authors.affiliation: Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Nanotechnology Characterization Laboratory, Cancer Research Technology Program , P.O. Box B, Frederick, MD 21702 , USA +1 301 846 6939 ; +1 301 846 6399 ; marina@mail.nih.gov.
authors.forename: Marina A
authors.initials: MA
authors.lastname: Dobrovolskaia
authors.forename: Scott E
authors.initials: SE
authors.lastname: McNeil
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000737:chemistry* / Q000494:pharmacology / Q000627:therapeutic use / Q000633:toxicity; D021881:DNA, Catalytic / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007107:Immune System / Q000187:drug effects; D009369:Neoplasms / Q000188:drug therapy / Q000276:immunology; D009696:Nucleic Acids / Q000737:chemistry*; D009705:Nucleosides / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D009711:Nucleotides / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D016376:Oligonucleotides, Antisense / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D034622:RNA Interference; D016337:RNA, Catalytic / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D021881:DNA, Catalytic; D009696:Nucleic Acids; D009705:Nucleosides; D009711:Nucleotides; D016376:Oligonucleotides, Antisense; D016337:RNA, Catalytic
keywords: drug safety; hematotoxicity; immunotoxicity; nucleic acid-based therapeutics