Volume 5 Number 1 2026
Inhalable Nanoparticle Theranostics for Targeted Delivery and Imaging in Multidrug-Resistant Tuberculosis
Roya Mirzaei 1*, Mansoureh Nazari V. 2
Biosensors and Nanotheranostics 5 (1) 1-8 https://doi.org/10.25163/biosensors.5110989
Submitted: 14 May 2026 Revised: 02 July 2026 Accepted: 11 July 2026 Published: 13 July 2026
Multidrug-resistant tuberculosis (MDR-TB) continues to outpace the tools built to contain it. Standard regimens are long, toxic, and only intermittently curative, and much of that failure traces to a problem of access: systemically delivered antibiotics rarely reach the bacilli sheltered inside alveolar macrophages or buried within the hypoxic, avascular core of the tuberculous granuloma. This review synthesizes how inhalable nanoparticle theranostics are being engineered to close that gap. We examine four linked domains. First, aerosol formulation engineering, where lipid, polymeric, and inorganic carriers are tuned to a mass median aerodynamic diameter of 1–5 µm so that payloads settle in the deep alveoli rather than the oropharynx (Second, active receptor-mediated targeting, in which ligands such as mannose, β-glucan, and hyaluronic acid exploit CD206, Dectin-1, and CD44 to drive nanocarriers into the intracellular niche of Mycobacterium tuberculosis. Third, integrated diagnostics, where near-infrared luminogens, iron-based contrast agents, and biomimetic coatings allow drug deposition and bacterial clearance to be watched in situ. Fourth, host-directed and light-activated modalities that act independently of bacterial genotype, including autophagy induction, macrophage repolarization, and photothermal killing. Across these domains the preclinical signal is consistent and often striking, yet translation remains constrained by nanotoxicity, aerosol instability, surfactant-corona effects, and manufacturing hurdles. We argue that the field's near-term value lies less in any single nanomaterial than in the convergence of localized delivery, imaging, and resistance-agnostic action within one construct.
Keywords: multidrug-resistant tuberculosis; inhalable nanomedicine; theranostics; alveolar macrophage targeting; granuloma; host-directed therapy; near-infrared imaging
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