IntroductionIntercellular adhesion molecule-1 (ICAM-1) is an Ig family transmembrane glycoprotein constitutively exposed on the luminal surface of endothelial cells (ECs). 1-3 ICAM-1 represents an attractive target for drug delivery to ECs, since it is up-regulated and functionally involved in vascular inflammation, oxidant stress, and thrombosis. [4][5][6][7] Antibodies to ICAM-1 are being explored as therapeutics and affinity carriers in cell cultures, animal models, and early clinical studies. [8][9][10][11][12][13] In addition to acting as delivery vehicles, antibody blocking of ICAM-1 suppresses leukocyte adhesion to ECs, providing an anti-inflammatory benefit to the effects of drugs. 14,15 Targeting nanocarriers (NCs) to EC determinants decreases the clearance of drugs from the bloodstream and permits site-specific delivery, increasing therapeutic capacity and reducing side effects (Muzykantov 16 ). Internalization and proper subcellular processing of drugs also are critical in the rational design of drug delivery systems (Muro et al 17 ). For instance, intracellular targeting of antioxidants in ECs may help to detoxify oxidants produced within the cell body and decrease elimination of drugs that otherwise shed from the EC surface. [18][19][20][21][22] ICAM-1 targeting offers the possibility of intracellular drug delivery, given that ECs internalize multimeric anti-ICAM conjugates and anti-ICAM/NCs via a unique, newly defined pathway, cell adhesion molecule (CAM)-mediated endocytosis. 23 ICAM-1 engagement by multimeric ligands triggers signaling via protein kinase C, Src family kinases, and Rho-dependent kinase, also involves dynamin and amiloride-sensitive Na ϩ /H ϩ exchangers, leading to rapid reorganization of the actin cytoskeleton and formation of endocytic compartments. 23 Intracellular delivery of an antioxidant enzyme, catalase, to ECs via CAM-mediated endocytosis may help contain vascular oxidant stress by minimizing catalase shedding from the cell surface. Endocytosed catalase does not escape endosomes but retains enzymatic activity within these organelles. Due to the high diffusion rate of H 2 O 2 across cellular membranes, catalase within endocytic vesicles intercepts intracellular oxidants and provides antioxidant protection. Decay of this antioxidant effect occurs approximately 2-3 hours after internalization, due to pH-dependent proteolytic degradation following delivery to lysosomes. 13 This time frame is sufficient to protect lung vasculature from acute oxidant stress in animal models. 11,24,25 By analogy with classical endocytic receptors, internalized ICAM-1 could follow nanoparticle trafficking to lysosomes or dissociate from anti-ICAM in a sorting prelysosomal compartment. The latter scenario, including recycling of internalized ICAM-1 molecules to the cell surface, could provide a pathway for recurrent drug delivery permitting sustained effects. However, the fate of ICAM-1 molecules involved in endocytosis is not known. The only pathway for endothelial ICAM-1 turnover identified to da...