980 resultados para Responsive polymer brushes


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In summary, thermoresponsive polyacrylamides with various amounts of different photoswitchable side groups, i. e. azobenzene, salicylideneaniline and fulgimide were successfully prepared. As such, in a first step three different chromophores with an amine functionality were synthesized. The synthesis of the stimuli-responsive materials was based on the RAFT polymerization of activated ester acrylates followed by a polymer analogous reaction with different amines. The procedure has been designed to allow the synthesis of well-defined materials with functional groups. All copolymers prepared in this way showed a LCST in aqueous solution. The LCST was in general decreased by increasing the amount of hydrophobic dye incorporated into the thermoresponsive polymer. However, in the case of the fulgimide, the LCST was hardly affected by the chromophore. For azobenzene containing PNIPAM polymers and analogues, higher LCST values were measured after irradiation of the polymer sample solutions with UV-light (Delta LCSTmax = 7.3°C). A reversible light-induced solubility change within a certain temperature range was possible. In contrast to this, irradiated samples of salicylideneaniline containing thermoresponsive copolymers showed an irreversible increase in the LCST (Delta LCSTmax = 13.0°C). Fulgimide chromophores did not influence the LCST of PNIPAM based copolymers after UV-light exposure.rnSimilar to the thermoresponsive polyacrylamides with azobenzene side groups, poly(oligo(ethylene glycol) methyl ether methacrylate) [P(OEGMA)] polymers with azobenzene end groups showed a LCST shift upon UV-irradiation. These polymers were synthesized by RAFT polymerization using a functional chain transfer agent (CTA). For this, PFP-CTA was used as a RAFT-agent for end group functionalization of (thermoresponsive) polymers. In contrast to the statistically arranged copolymers with azobenzene side groups, P(OEGMA) polymers with terminal azobenzene showed a linear increase of the LCST shifts with increasing amount of chromophore (Delta LCSTmax = 4.3°C). Noteworthy, the chemical nature of the end group exhibited a strong influence on the LCST in the case of short thermoresponsive P(OEGMA) polymers.rnThe investigation on temperature- and lightresponsive polymers was transferred onto block copolymers capable to self-assemble into polymeric micelles. Therefore, PEO-b-PNIPAM block copolymers with azobenzene moieties were synthesized successfully. These polymers showed a “smart” behavior in aqueous solution, as the reversible formation and disruption of the micelles could either be controlled by temperature or using light as a stimulus. The usefulness of these materials was demonstrated by encapsulation of a hydrophobic dye in the core of the micelle. Such materials might have a great potential as a model system for several technical or biological applications.rnFinally, double thermoresponsive block copolymers forming micellar structures in a certain temperature range with functional end groups could successfully be synthesized. These “smart materials” based on POEGMA-b-PNIPMAM have been demonstrated to be very promising for a temperature selective immobilization on a protein surface. This might be a suitable concept for further biological applications.rnConcluding, different thermoresponsive copolymers and block copolymers with lightresponsive moieties arranged along the backbone or located at the chain ends were successfully prepared and investigated. By controlling the nature of functional groups and their respective incorporation ratios, the LCST could be dialed in precisely. Further, the LCST of the polymers could be triggered by light. A light-controlled disruption of micellar structures could be shown for functional block copolymers. The importance of end groups of thermoresponsive polymers was demonstrated by a temperature-controlled protein-polymer binding of a terminal biotin-functionalized double thermoresponsive polymer. The synthetic approaches and the material properties presented here should be promising for further research and applications beyond this dissertation.rn

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Polymer nanoparticles functionalized on the surface with photo-responsive labels were synthesized. In a first synthetic step, polystyrene was copolymerized with the cross-linker divinylbenzene and poly(ethylene glycol) acrylate in a miniemulsion, to produce nano-sized spheres (~ 60 nm radius) with terminal hydroxyl groups, which were functionalized in a subsequent synthetic step with photo-responsive labels. For this purpose, two photo-active molecular structures were separately used: anthracene, which is well known to form covalently bonded dimers upon photo-excitation; and pyrene, which only forms short lived excited state dimers (excimers). Acid derivatives of these labels (9-anthracene carboxylic acid and 1-pyrene butyric acid) were bonded to the hydroxyl terminal groups of the nanoparticles through an esterification reaction, via the intermediate formation of the corresponding acid chloride.rnThe obtained labeled nanoparticles appeared to be highly hydrophobic structures. They formed lyophobic suspensions in water, which after analysis by dynamic light scattering (DLS) and ultramicroscopic particle tracking, appeared to equilibrate as a collection of singly dispersed nanoparticles, together with a few nanoparticle aggregates. The relative amount of aggregates decreased with increasing amounts of the surfactant sodium dodecyl sulfate (SDS), thus confirming that aggregation is an equilibrated state resulting from lyophobicity. The formation of such aggregates was corroborated using scanning electron microscopy (SEM). The photo-irradiation of the lyophobic aqueous suspensions of anthracene labeled nanoparticles (An-NP) resulted in the formation of higher aggregates, as evidenced by DLS and ultramicroscopy. The obtained state of aggregation could be reverted by sonication. The possibility to re-aggregate the system in subsequent photo-excitation and sonication cycles was established. Likewise, the photo-irradiation of lyophobic aqueous suspensions of pyrene-labeled nanoparticles (Py-NP) resulted in the formation of higher aggregates, as evidenced by DLS and ultramicroscopy. These appeared to remain aggregated due to hydrophobic interactions. This system could also be re-dispersed by sonication and re-aggregated in subsequent cycles of photo-excitation and sonication.

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Liquid crystalline elastomers (LCEs) are known to perform a reversible change of shape upon the phase transition from the semi-ordered liquid crystalline state to the chaotic isotropic state. This unique behavior of these “artificial muscles” arises from the self-organizing properties of liquid crystals (mesogens) in combination with the entropy-elasticity of the slightly crosslinked elastomer network. In this work, micrometer-sized LCE actuators are fabricated in a microfluidic setup. The microtubular shear flow provides for a uniform orientation of the mesogens during the crosslinking, a perquisite for obtaining actuating LCE samples. The scope of this work was to design different actuator geometries and to broaden the applicability of the microfluidic device for different types of liquid crystalline mesogens, ranging from side-chain to main-chain systems, as well as monomer and polymer precursors. For example, the thiol-ene “click” mechanism was used for the polymerization and crosslinking of main-chain LCE actuators. The main focus was, however, placed on acrylate monomers and polymers with LC side chains. A LC polymer precursor, comprising mesogenic and crosslinkable side-chains was synthesized. Used in combination with an LC monomer, the polymeric crosslinker promoted a stable LC phase, which allowed the mixture to be isothermally handled in the microfluidic reactor. If processed without the additional LC components, the polymer precursor yielded actuating fibers. A suitable co-flowing continuous phase facilitates the formation of a liquid jet and lowers the tendency for drop formation. By modification of the microfluidic device, it was further possible to prepare core-shell particles, comprised of an LCE shell and filled with an isotropic liquid. In analogy to the heart, a hollow muscle, the elastomer shell expels the inner liquid core upon its contraction. The feasibility of the core-shell particles as micropumps was demonstrated. In general, the synthesized LCE microactuators may be utilized as active components in micromechanical and lab-on-chip systems.

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Gels are elastic porous polymer networks that are accompanied by pronounced mechanical properties. Due to their biocompatibility, ‘responsive hydrogels’ (HG) have many biomedical applications ranging from biosensors and drug delivery to tissue engineering. They respond to external stimuli such as temperature and salt by changing their dimensions. Of paramount importance is the ability to engineer penetrability and diffusion of interacting molecules in the crowded HG environment, as this would enable one to optimize a specific functionality. Even though the conditions under which biomedical devices operate are rather complex, a bottom-up approach could reduce the complexity of mutually coupled parameters influencing tracer mobility. The present thesis focuses on the interaction-induced tracer diffusion in polymer solutions and their homologous gels, probed by means of Fluorescence Correlation Spectroscopy (FCS). This is a single-molecule-sensitive technique having the advantage of optimal performance under ultralow tracer concentrations, typically employed in biosensors. Two different types of hydrogels have been investigated, a conventional one with broad polydispersity in the distance between crosslink points and a so-called ‘ideal’, with uniform mesh size distribution. The former is based on a thermoresponsive polymer, exhibiting phase separation in water at temperatures close to the human body temperature. The latter represents an optimal platform to study tracer diffusion. Mobilities of different tracers have been investigated in each network, varying in size, geometry and in terms of tracer-polymer attractive strength, as perturbed by different stimuli. The thesis constitutes a systematic effort towards elucidating the role of the strength and nature of different tracer-polymer interactions, on tracer mobilities; it outlines that interactions can still be very important even in the simplified case of dilute polymer solutions; it also demonstrates that the presence of permanent crosslinks exerts distinct tracer slowdown, depending on the tracer type and the nature of the tracer-polymer interactions, expressed differently by each tracer with regard to the selected stimulus. In aqueous polymer solutions, the tracer slowdown is found to be system-dependent and no universal trend seems to hold, in contrast to predictions from scaling theory for non-interacting nanoparticle mobility and empirical relations concerning the mesh size in polymer solutions. Complex tracer dynamics in polymer networks may be distinctly expressed by FCS, depending on the specific synergy among-at least some of - the following parameters: nature of interactions, external stimuli employed, tracer size and type, crosslink density and swelling ratio.

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The thesis can be divided in four parts and summarized as follows:(i) The investigation and development of a continuous flow synthesis procedure affording end-functional polymers by anionic polymerization and subsequent termination in one reaction step and on a multigram scale was carried out. Furthermore, the implementation of not only a single hydroxyl but multiple orthogonal functionalities at the chain terminus was achieved by utilizing individually designed, functional epoxide-based end-capping reagents.(ii) In an additional step, the respective polymers were used as macroinitiators to prepare in-chain functionalized block copolymers and star polymers bearing intriguing novel structural and material properties. Thus, the second part of this thesis presents the utilization of end-functional polymers as precursors for the synthesis of amphiphilic complex and in some cases unprecedented macromolecular architectures, such as miktoarm star polymers based on poly(vinyl pyridine), poly(vinyl ferrocene) and PEO.(iii) Based on these structures, the third part of this thesis represents a detailed investigation of the preparation of stimuli-responsive ultrathin polymer films, using amphiphilic junction point-reactive block copolymers. The single functionality at the block interface can be employed as anchor group for the covalent attachment on surfaces. Furthermore, the change of surface properties was studied by applying different external stimuli.(iv) An additional topic related to the oxyanionic polymerizations carried out in the context of this thesis was the investigation of viscoelastic properties of different hyperbranched polyethers, inspired by the recent and intense research activities in the field of biomedical applications of multi-functional hyperbranched materials.

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Polymere Wirkstoffsysteme gewinnen im Bereich der biomedizinischen Forschung immer größeres Interesse. Vielversprechende Systeme für die Entwicklung von neuartigen Krebs-immun¬therapien stellen insbesondere Polymer-Konjugate dar. Das ideale Polymer-Konjugat besitzt eine Größe zwischen 10 nm und 100 nm, ist nicht zytotoxisch und zeigt keine Aggregation in humanem Blutserum. In der vorliegenden Arbeit wurde die Synthese und Charakterisierung von Polymer-Wirkstoff-Konjugaten zur Anwendung in der Krebsimmuntherapie behandelt. Erstes Ziel der Arbeit war es, geeignete polymere Trägersysteme für die in vivo Anwendung zu finden. Hierzu wurde zunächst die Stabilität verschiedener potentieller polymerer Träger-systeme (Nanohydrogele, Succinyliertes-Poly-L-Lysin (Bürste), ELP-Bürsten und Poly(2-oxazolin)bürsten) in humanem Serum untersucht. Weiterhin wurde die unspezifische Zellaufnahme in murinen dendritischen Zellen (DCs) analysiert. Es konnte gezeigt werden, dass vor allem neutrale bzw. zwitterionische Partikel eine hohe Serumstabilität sowie keine unspezifische Zellaufnahme zeigen. Um eine gezielte Adressierung der DCs des Immunsystems zu erreichen und dadurch eine Immunantwort gegenüber einem bestimmten Krebs Zelltyp zu induzieren, wurden Biokonjugate - auf Basis der Succinylierten-Poly-L-Lysin-(Bürste) sowie der Azid-funktionalisierten Poly(2-oxazolin)bürste (POx) – entwickelt, da diese Polymerbürsten keine bzw. kaum unspezifische Aufnahme in DCs zeigen. Hierbei diente der Antikörper aDEC205 der gezielten Adressierung von CD8+ DCs. Die weiteren bioaktiven Komponenten waren das tumorassoziierte Antigen (TAA) mit der Kernsequenz SIINFEKL zur Induktion einer spezifischen Immunantwort sowie der immunaktivierende TLR9 Ligand, CpG1826. Die Komponenten wurden nacheinander an die Fluoreszenz-markierten Polymere kon¬jugiert. Die Konjugation des Antikörpers erfolgte nach vorangegangener DIBO-Modifizierung über kupferfreie Click-Chemie. Mit einer optimierten Aufarbeitungsmethodik gelang es, aggregat-freie, unimere DIBO-modifizierte aDEC205 Antikörper zu isolieren. Für die succinylierten Poly-L-Lysine konnten keine eindeutigen sowie reproduzierbaren Ergebnisse erhalten werden, sodass sich im weiteren Verlauf der Arbeit auf die POx konzentriert wurde. Die Konjugation von aDEC205 an POx wurde mittels verschiedener physiko-chemischer Methoden (UV-VIS, SDS-PAGE, FCS, GPC, CLSM und FACS) gezeigt. Mit Hilfe von „Specific-Hybridization-Internalisation-Sensor“ Experimenten konnte eine spezifische Aufnahme des Konjugats in CD8+ DCs nachgewiesen werden. rnDie Konjugation von Antigen und CpG erfolgte ebenso nach entsprechender Modifizierung über kupferfreie Click-Chemie. SDS-PAGE, UV-VIS und FCS bestätigten eine erfolgreiche Kopplung. T-Zell-Proliferationsversuche ergaben für Antigen enthaltende Polymer-Konjugate eine CD8+ T-Zell-Aktivierung. Des Weiteren zeigten die POx keine bemerkenswerte Toxizität und deren Konjugate keine Aggregation in humanem Serum. rnrnDarüber hinaus wurde der Einfluss verschiedener Polymertopologien auf ihre Biodistribution sowie Blutzirkulation untersucht. Für die nach GPC-Fraktionierung erhaltenen verschiedenen Polymerfraktionen - hochmolekulare wurmartige Polymerbürsten, ellipsoidartige Polymer-bürsten und niedermolekulare kugelförmige Moleküle - konnten vielversprechende Ergebnisse erhalten werden.

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Novel single step synthetic procedure for hydrophobically modified alkali soluble latexes (HASE) via a miniemulsion-analogous method is presented. This facile method simplifies the copolymerization of the monomers with basically “opposite” character in terms of their hydrophilic/hydrophobic nature, which represent one of the main challenges in water based systems. Considered systems do not represent classical miniemulsions due to a high content of water soluble monomers. However, the polymerization mechanism was found to be rather similar to miniemulsion polymerization process.rnThe influence of the different factors on the system stability has been investigated. The copolymerization behavior studies typically showed strong composition drifts during copolymerization. It was found that the copolymer composition drift can be suppressed via changing the initial monomer ratio.rnThe neutralization behavior of the obtained HASE systems was investigated via potentiometric titration. The rheological behavior of the obtained systems as a function of the different parameters, such as pH, composition (ultrahydrophobe content) and additive type and content has also been investigated.rnDetailed investigation of the storage and loss moduli, damping factor and the crossover frequencies of the samples showed that at the initial stages of the neutralization the systems show microgel-like behavior.rnThe dependence of the rheological properties on the content and the type of the ultrahydrophobe showed that the tuning of the mechanical properties can be easily achieved via minor (few percent) but significant changes in the content of the latter. Besides, changing the hydrophobicity of the ultrahydrophobe via increasing the carbon chain length represents another simple method for achieving the same results.rnThe influence of amphiphilic additives (especially alcohols) on the rheological behavior of the obtained systems has been studied. An analogy was made between micellation of surfactants and the formation of hydrophobic domains between hydrophobic groups of the polymer side chain.rnDilution induced viscosity reduction was investigated in different systems, without or with different amounts or types of the amphiphilic additive. Possibility of the controlled response to dilution was explored. It was concluded that the sensitivity towards dilution can be reduced, and in extreme cases even the increase of the dynamic modulus can be observed, which is of high importance for the setting behavior of the adhesive material.rnIn the last part of this work, the adhesive behavior of the obtained HASE systems was investigated on different substrates (polypropylene and glass) for the standard labeling paper. Wet tack and setting behavior was studied and the trends for possible applications have been evaluated.rnThe novel synthetic procedure, investigation of rheological properties and the possibility of the tuning via additives, investigated in this work create a firm background for the development of the HASE based adhesives as well as rheology modifiers with vast variety of possible applications due to ease of tuning the mechanical and rheological properties of the systems.

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Polymers tied together by constraints exhibit an internal pressure; this idea is used to analyze physical properties of the bottle-brush–like chromosomes of meiotic prophase that consist of polymer-like flexible chromatin loops, attached to a central axis. Using a minimal number of experimental parameters, semiquantitative predictions are made for the bending rigidity, radius, and axial tension of such brushes, and the repulsion acting between brushes whose bristles are forced to overlap. The retraction of lampbrush loops when the nascent transcripts are stripped away, the oval shape of diplotene bivalents between chiasmata, and the rigidity of pachytene chromosomes are all manifestations of chromatin pressure. This two-phase (chromatin plus buffer) picture that suffices for meiotic chromosomes has to be supplemented by a third constituent, a chromatin glue to understand mitotic chromosomes, and explain how condensation can drive the resolution of entanglements. This process resembles a thermal annealing in that a parameter (the affinity of the glue for chromatin and/or the affinity of the chromatin for buffer) has to be tuned to achieve optimal results. Mechanical measurements to characterize this protein–chromatin matrix are proposed. Finally, the propensity for even slightly chemically dissimilar polymers to phase separate (cluster like with like) can explain the apparent segregation of the chromatin into A+T- and G+C-rich regions revealed by chromosome banding.

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We describe a method for generating a variety of chemically diverse broadly responsive low-power vapor sensors. The chemical polymerization of pyrrole in the presence of plasticizers has yielded conducting organic polymer films whose resistivities are sensitive to the identity and concentration of various vapors in air. An array of such sensing elements produced a chemically reversible diagnostic pattern of electrical resistance changes upon exposure to different odorants. Principal component analysis has demonstrated that such sensors can identify and quantify different airborne organic solvents and can yield information on the components of gas mixtures.

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Responsive core-shell latex particles are used to prepare colloidosome microcapsules using thermal annealing and internal cross-linking of the shell, allowing production of the microcapsules at high concentrations. The core-shell particles are composed of a polystyrene core and a shell of poly[2-(dimethylamino)ethyl methacrylate]-b-poly[methyl methacrylate] (PDMA-b-PMMA) chains adsorbed onto the core surface, providing steric stabilisation. The PDMA component of adsorbed polymer shell confers the latex particle thermal and pH responsive characteristics, it also provides glass transitions at lower temperatures than that of the core and reactive amine groups. These features facilitate the formation of stable Pickering emulsion droplets and the immobilisation of the latex particle monolayer on these droplets to form colloidosome microcapsules. The immobilisation is achieved through thermal annealing or cross-linking of the shell at mild conditions feasible for large scale economic production. We demonstrate here that it is possible to anneal the particle monolayer on the emulsion drop surface at 75-86 ºC by using the lower glass transition temperature of the shell compared to that of the polystyrene cores (~108 ºC). The colloidosome microcapsules formed have a rigid membrane basically composed of a monolayer of particles. Chemical cross-linking has also been successfully achieved by confining a cross-linker within the disperse droplet. This approach leads to the formation of single-layered stimulus-responsive soft colloidosome membranes and provides the advantage of working at very high emulsion concentrations since inter-droplet cross-linking is thus avoided. The porosity and mechanical strength of microcapsules are also discussed here in terms of the observed structure of the latex particle monolayers forming the capsule membrane.

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A study was conducted to create a pH-responsive layer, in which a small change in the individual polyacid or polybase gel length was transferred into a larger motion that curls up the gel. It was observed that the transfer of motion from a linear displacement into a curved displacement through the geometric design effectively increases the displacement rate. A robust, reversible, and chemically driven mechanical actuator was was produced that demonstrated its response over many pH oscillations. The affine nature of the triblock copolymers, demonstrated for for the polyacid and polybase indicated that the effect will also function at some smaller length scales, which is appropriate for a working biomimetic and soft nanotechnology device. The study also demonstrated the potential applicability of these polymeric gels and suggested the fabrication of related molecular machines and devices based on the principles of soft nanotechnology.

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REDOX responsive (nano)materials typically exhibit chemical changes in response to the presence and concentration of oxidants/reductants. Due to the complexity of biological environments, it is critical to ascertain whether the chemical response may depend on the chemical details of the stimulus, in addition to its REDOX potential, and whether chemically different responses can determine a different overall performance of the material. Here, we have used oxidation-sensitive materials, although these considerations can be extended also to reducible ones. In particular, we have used poly(propylene sulfide) (PPS) nanoparticles coated with a PEGylated emulsifier (Pluronic F127); inter alia, we here present also an improved preparative method. The nanoparticles were exposed to two Reactive Oxygen Species (ROS) typically encountered in inflammatory reactions, hydrogen peroxide (H2O2) and hypochlorite (ClO−); their response was evaluated with a variety of techniques, including diffusion NMR spectroscopy that allowed to separately characterize the chemically different colloidal species produced. The two oxidants triggered a different chemical response: H2O2 converted sulfides to sulfoxides, while ClO− partially oxidized them further to sulfones. The different chemistry correlated to a different material response: H2O2 increased the polarity of the nanoparticles, causing them to swell in water and to release the surface PEGylated emulsifier; the uncoated oxidized particles still exhibited very low toxicity. On the contrary, ClO− rapidly converted the nanoparticles into water-soluble, depolymerized fragments with a significantly higher toxicity. The take-home message is that it is more correct to discuss ‘smart’ materials in terms of an environmentally specific response to (REDOX) stimuli. Far from being a problem, this could open the way to more sophisticated and precisely targeted applications.

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Responsive hydrophobically associating polymers can in many ways be considered to be analogous to proteins in their ability to form compact molecules with a defined secondary structure, and hence, functionality. These molecules are characterized by the presence of alternating charged and hydrophobic groups. The balance between charge repulsion and hydrophobic interactions is sensitive to environmental pH and therefore changes in pH produce controllable conformational changes. The change from a charged extended chain to a collapsed uncharged coil structure is sometimes referred to as hypercoiling behaviour and enables the polymer to act as a simple switch between an 'on' and 'off' state. The purpose of this review is to illustrate the structure and behaviour of polymers that exhibit hypercoiling behaviour and to highlight their potential pharmaceutical applications, which in terms of drug delivery is likely to be related to their surface behaviour and solubilizing activity. © 2001 Elsevier Science B.V. All rights reserved.

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Pulsatile, or “on-demand”, delivery systems have the capability to deliver a therapeutic molecule at the right time/site of action and in the right amount (1). Pulsatile delivery systems present multiple benefits over conventional dosage forms and provide higher patient compliance. The combination of stimuli-responsive materials with the drug delivery capabilities of hydrogel-forming MN arrays (2) opens an interesting area of research. In the present work we describe, a stimuli-responsive hydrogel-forming microneedle (MN) array that enable delivery of a clinically-relevant model drug (ibuprofen) upon application of UV radiation (Figure 1A). MN arrays were prepared using a micromolding technique using a polymer prepared from 2-hydroxyethyl methacrylate (HEMA) and ethylene glycol dimethacrylate (EGDMA) (Figure 1B). The arrays were loaded with up to 5% (w/w) ibuprofen included in a light-responsible conjugate (3,5-dimethoxybenzoin conjugate) (2). The presence of the conjugate inside the MN arrays was confirmed by Raman spectroscopy measurements. MN arrays were tested in vitro showing that they were able to deliver up to three doses of 50 mg of ibuprofen after application of an optical trigger (wavelength of 365 nm) over a long period of time (up to 160 hours) (Figure 1C and 1D). The work presented here is a probe of concept and a modified version of the system should be used as UV radiation is shown to be the major etiologic agent in the development of skin cancers. Consequently, for future applications of this technology an alternative design should be developed. Based on the previous research dealing with hydrogel forming MN arrays a suitable strategy will be to use hydrogel-forming MN arrays containing a backing layer made with the material described in this work as the drug reservoir (2). Finally, a porous layer of a material that blocks UV radiation should be included between the MN array and the drug reservoir. Therefore radiation can be applied to the system without reaching the skin surface. Therefore after modification, the system described here interesting properties as “on-demand” release system for prolonged periods of time. This technology has potential for use in “on-demand” delivery of a wide range of drugs in a variety of applications relevant to enhanced patient care.