Engineering nanoparticles that target fibroblast activation protein in cardiac fibrosis

Abstract Cardiac fibrosis and dysfunction, hallmarks of debilitating heart disease, are driven by fibroblast activation protein alpha (FAP). The specificity of FAP to the disease creates an opportunity for directed drug delivery, as FAP delineates the fibrotic region. We leverage this vulnerability to target the fibrotic region of the heart, using anti-FAP antibody-modified nanoparticles (NPs) that encapsulate and release the highly specific FAP inhibitor, talabostat. NP crosslinking with an FAP-sensitive peptide attenuates passive release, which is then accelerated in the presence of FAP. Intravenous administration of these NPs results in reversal of established cardiac fibrosis and dysfunction in a rat model of myocardial infarction, using a talabostat dose that is 400,000-fold lower than that used in clinical trials. This innovative and clinically translatable strategy enables targeted drug delivery, overcoming limitations of systemic approaches by reducing therapeutic dose, minimizing off-target effects, and accommodating patient-specific variability in FAP expression.