AFM imaging of functionalized carbon nanotubes on biological membranes

Advancements and hurdles in the development of a vaccine for triple-negative breast cancer: A comprehensive review of multi-omics and immunomics strategies

Triple-Negative Breast Cancer (TNBC) presents a significant challenge in oncology due to its aggressive behavior and limited therapeutic options. This review explores the potential of immunotherapy, particularly vaccine-based approaches, in addressing TNBC. It delves into the role of immunoinformatics in creating effective vaccines against TNBC. The review first underscores the distinct attributes of TNBC and the importance of tumor antigens in vaccine development. It then elaborates on antigen detection techniques such as exome sequencing, HLA typing, and RNA sequencing, which are instrumental in identifying TNBC-specific antigens and selecting vaccine candidates. The discussion then shifts to the in-silico vaccine development process, encompassing antigen selection, epitope prediction, and rational vaccine design. This process merges computational simulations with immunological insights. The role of Artificial Intelligence (AI) in expediting the prediction of antigens and epitopes is also emphasized. The review concludes by encapsulating how Immunoinformatics can augment the design of TNBC vaccines, integrating tumor antigens, advanced detection methods, in-silico strategies, and AI-driven insights to advance TNBC immunotherapy. This could potentially pave the way for more targeted and efficacious treatments.

Doped Graphene Quantum Dots as Biocompatible Radical Scavenging Agents

Oxidative stress is proven to be a leading factor in a multitude of adverse conditions, from Alzheimer's disease to cancer. Thus, developing effective radical scavenging agents to eliminate reactive oxygen species (ROS) driving many oxidative processes has become critical. In addition to conventional antioxidants, nanoscale structures and metal-organic complexes have recently shown promising potential for radical scavenging. To design an optimal nanoscale ROS scavenging agent, we have synthesized ten types of biocompatible graphene quantum dots (GQDs) augmented with various metal dopants. The radical scavenging abilities of these novel metal-doped GQD structures were, for the first time, assessed via the DPPH, KMnO4, and RHB (Rhodamine B protectant) assays. While all metal-doped GQDs consistently demonstrate antioxidant properties higher than the undoped cores, aluminum-doped GQDs exhibit 60-95% radical scavenging ability of ascorbic acid positive control. Tm-doped GQDs match the radical scavenging properties of ascorbic acid in the KMnO4 assay. All doped GQD structures possess fluorescence imaging capabilities that enable their tracking in vitro, ensuring their successful cellular internalization. Given such multifunctionality, biocompatible doped GQD antioxidants can become prospective candidates for multimodal therapeutics, including the reduction of ROS with concomitant imaging and therapeutic delivery to cancer tumors.

Bioactive nanotherapeutic trends to combat triple negative breast cancer

The management of aggressive breast cancer, particularly, triple negative breast cancer (TNBC) remains a formidable challenge, despite treatment advancement. Although newer therapies such as atezolizumab, olaparib, and sacituzumab can tackle the breast cancer prognosis and/or progression, but achieved limited survival benefit(s). The current research efforts are aimed to develop and implement strategies for improved bioavailability, targetability, reduce systemic toxicity, and enhance therapeutic outcome of FDA-approved treatment regimen. This review presents various nanoparticle technology mediated delivery of chemotherapeutic agent(s) for breast cancer treatment. This article also documents novel strategies to employ cellular and cell membrane cloaked (biomimetic) nanoparticles for effective clinical translation. These technologies offer a safe and active targeting nanomedicine for effective management of breast cancer, especially TNBC.

Recent Nanocarrier Approaches for Targeted Drug Delivery in Cancer Therapy

Cancer is one of the most serious health concerns in the 21st century whose prevalence is beyond boundaries and can affect any organ of the human body. The conventional chemotherapeutic treatment strategies lack specificity to tumors and are associated with toxic effects on the immune system and other organ systems. In the past decades, there has been continuous progress in the development of smart nanocarrier systems for target-specific delivery of drugs against a variety of tumors, including intracellular gene-specific targeting. These nanocarriers are able to recognize the tumor cells and deliver the therapeutic agent in fixed proportions, causing no or very less harm to healthy cells. Nanosystems have modified physicochemical properties, improved bioavailability, and long retention in blood, which enhances their potency. A huge number of nanocarrier based formulations have been developed and are in clinical trials. Nanocarrier systems include polymeric micelles, liposomes, dendrimers, carbon nanotubes, gold nanoparticles, etc. Recent advancements in nanocarrier systems include mesoporous silica nanoparticles (MSNs), metal organic frameworks, and quantum dots. In the present review, various nanocarrier based drug delivery systems, along with their applications in the management of cancer, have been described with special emphasis on MSNs.

Carbon Nanotubes and Graphene as Nanoreinforcements in Metallic Biomaterials: a Review

Current challenges in existing metallic biomaterials encourage undertaking research in the development of novel materials for biomedical applications. This paper critically reviews the potential of carbon nanotubes (CNT) and graphene as nanoreinforcements in metallic biomaterials for bone tissue engineering. Unique and remarkable mechanical, electrical, and biological properties of these carbon nanomaterials allow their use as secondary-phase reinforcements in monolithic biomaterials. The nanoscale dimensions and extraordinarily large surface areas of CNT and graphene make them suitable materials for purposeful reaction with living organisms. However, the cytocompatibility of CNT and graphene is still a controversial issue that impedes advances in utilizing these promising materials in clinical orthopedic applications. The interaction of CNT and graphene with biological systems including proteins, nucleic acids, and human cells is critically reviewed to assess their cytocompatibity in vitro and in vivo. It is revealed that composites reinforced with CNT and graphene show enhanced adhesion of osteoblast cells, which subsequently promotes bone tissue formation in vivo. This potential is expected to pave the way for developing ground-breaking technologies in regenerative medicine and bone tissue engineering. In addition, current progress and future research directions are highlighted for the development of CNT and graphene reinforced implants for bone tissue engineering.

Theranostics Aspects of Various Nanoparticles in Veterinary Medicine

Nanoscience and nanotechnology shows immense interest in various areas of research and applications, including biotechnology, biomedical sciences, nanomedicine, and veterinary medicine. Studies and application of nanotechnology was explored very extensively in the human medical field and also studies undertaken in rodents extensively, still either studies or applications in veterinary medicine is not up to the level when compared to applications to human beings. The application in veterinary medicine and animal production is still relatively innovative. Recently, in the era of health care technologies, Veterinary Medicine also entered into a new phase and incredible transformations. Nanotechnology has tremendous and potential influence not only the way we live, but also on the way that we practice veterinary medicine and increase the safety of domestic animals, production, and income to the farmers through use of nanomaterials. The current status and advancements of nanotechnology is being used to enhance the animal growth promotion, and production. To achieve these, nanoparticles are used as alternative antimicrobial agents to overcome the usage alarming rate of antibiotics, detection of pathogenic bacteria, and also nanoparticles being used as drug delivery agents as new drug and vaccine candidates with improved characteristics and performance, diagnostic, therapeutic, feed additive, nutrient delivery, biocidal agents, reproductive aids, and finally to increase the quality of food using various kinds of functionalized nanoparticles, such as liposomes, polymeric nanoparticles, dendrimers, micellar nanoparticles, and metal nanoparticles. It seems that nanotechnology is ideal for veterinary applications in terms of cost and the availability of resources. The main focus of this review is describes some of the important current and future principal aspects of involvement of nanotechnology in Veterinary Medicine. However, we are not intended to cover the entire scenario of Veterinary Medicine, despite this review is to provide a glimpse at potential important targets of nanotechnology in the field of Veterinary Medicine. Considering the strong potential of the interaction between the nanotechnology and Veterinary Medicine, the aim of this review is to provide a concise description of the advances of nanotechnology in Veterinary Medicine, in terms of their potential application of various kinds of nanoparticles, secondly we discussed role of nanomaterials in animal health and production, and finally we discussed conclusion and future perspectives of nanotechnology in veterinary medicine.

Scanning Techniques for Nanobioconjugates of Carbon Nanotubes

Nanobioconjugates using carbon nanotubes (CNTs) are attractive and promising hybrid materials. Various biological applications using the CNT nanobioconjugates, for example, drug delivery systems and nanobiosensors, have been proposed by many authors. Scanning techniques such as scanning electron microscopy (SEM) and scanning probe microscopy (SPM) have advantages to characterize the CNT nanobioconjugates under various conditions, for example, isolated conjugates, conjugates in thin films, and conjugates in living cells. In this review article, almost 300 papers are categorized based on types of CNT applications, and various scanning data are introduced to illuminate merits of scanning techniques.

Co-delivery of VP-16 and Bcl-2-targeted antisense on PEG-grafted oMWCNTs for synergistic in vitro anti-cancer effects in non-small and small cell lung cancer

Present study describes the preparation of a polyethylene glycol-grafted oxidized multi-walled carbon nanotubes (oMWCNTs-PEG) hybrid nanosystem as a carrier of etoposide (VP-16) and Bcl-2 phosphorothioate antisense deoxyoligonucleotides (Aso) to achieve a superior cytostastic efficacy in non-small and small cell lung cancer in vitro. We have demonstrated that the adsorption of hydrophobic VP-16 and Bcl-2 Aso results in a stable nanotransporter exhibiting good dispersion with excellent release profiles (both, in pH 7.4 and 4.8) and negligible hemolytic activity (up to 6.5%). The evaluation of cytotoxicity was carried out in in vitro using small cell (SCLC; DMS53) and non-small cell lung cancer (NSCLC; NCIH2135) cell lines. It was found that Bcl-2 interference significantly increased the anti-cancer efficiency of VP-16 in the chemoresistant NSCLC cells. This was further supported using a flow-cytometry (Annexin V/propidium iodide assay), which revealed a significant increase in apoptotic cells in both the cell lines after the co-administration of VP-16 and Bcl-2 Aso using oMWCNTs-PEG hybrid, and fluorescence microscopy, which showed an increase in reactive oxygen species identified after Bcl-2 knock-down. Overall, oMWCNTs-PEG provided an exceptional biocompatible vehicle enabling the internalization of negatively charged nucleic acids and pH-sensitive release of cargoes in a hypoxic environment of the most of solid tumors. Moreover, Aso specifically binding to the first six codons of the Bcl-2 mRNA gave a satisfactorily decrease in Bcl-2 translation and an increase in NCIH2135 chemosensitivity towards VP-16.

Probe Microscopic Studies of DNA Molecules on Carbon Nanotubes

Hybrids of DNA and carbon nanotubes (CNTs) are promising nanobioconjugates for nanobiosensors, carriers for drug delivery, and other biological applications. In this review, nanoscopic characterization of DNA-CNT hybrids, in particular, characterization by scanning probe microscopy (SPM), is summarized. In many studies, topographical imaging by atomic force microscopy has been performed. However, some researchers have demonstrated advanced SPM operations in order to maximize its unique and valuable functions. Such sophisticated approaches are attractive and will have a significant impact on future studies of DNA-CNT hybrids.

Triple Negative Breast Cancer: Nanosolutions for a Big Challenge

Triple negative breast cancer (TNBC) is a particular immunopathological subtype of breast cancer that lacks expression of estrogen and progesterone receptors (ER/PR) and amplification of the human epidermal growth factor receptor 2 (HER2) gene. Characterized by aggressive and metastatic phenotypes and high rates of relapse, TNBC is the only breast cancer subgroup still lacking effective therapeutic options, thus presenting the worst prognosis. The development of targeted therapies, as well as early diagnosis methods, is vital to ensure an adequate and timely therapeutic intervention in patients with TNBC. This review intends to discuss potentially emerging approaches for the diagnosis and treatment of TNBC patients, with a special focus on nano-based solutions that actively target these particular tumors.

Applications of biosensing atomic force microscopy in monitoring drug and nanoparticle delivery

INTRODUCTION

The therapeutic effects of medicinal drugs not only depend on their properties, but also on effective transport to the target receptor. Here we highlight recent developments in this discipline and show applications of atomic force microscopy (AFM) that enable us to track the effects of drugs and the effectiveness of nanoparticle delivery at the single molecule level.

AREAS COVERED

Physiological AFM imaging enables visualization of topographical changes to cells as a result of drug exposure and allows observation of cellular responses that yield morphological changes. When we upgrade the regular measuring tip to a molecular biosensor, it enables investigation of functional changes at the molecular level via single molecule force spectroscopy.

EXPERT OPINION

Biosensing AFM techniques have generated powerful tools to monitor drug delivery in (living) cells. While technical developments in actual AFM methods have simplified measurements at relevant physiological conditions, understanding both the biological and technical background is still a crucial factor. However, due to its potential impact, we expect the number of application-based biosensing AFM techniques to further increase in the near future.

Detection of erythrocytes in patients with Waldenstrom macroglobulinemia using atomic force microscopy

The pathological changes of erythrocytes are detected at the nanometer scale, which is important for revealing the onset of diseases and diagnosis. The aim of this study is to examine the ultrastructural changes of erythrocytes in Waldenström macroglobulinemia (WM) at a nanometer scale. Blood samples were collected from two healthy volunteers, two WM patients, and three multiple myeloma (MM) patients when they were first diagnosed. The changes of morphology in the erythrocytes were studied at the nanometer level by high-resolution atomic force microscopy imaging (AFM). Compared with the healthy controls and the MM patients, there were dramatic deformations in the overall shape and surface membrane of the erythrocytes in WM patients. Healthy, pathological WM, and MM erythrocytes could be distinguished by several morphological parameters, including the width, length, length-to-width ratio, valley, peak, peak-to-valley, and Ra. AFM is able to detect the morphological differences in the red blood cells from WM patients, healthy controls, and MM patients. Therefore, the erythrocyte morphology is an important parameter for the diagnosis of WM, which can be used to distinguish WM from MM. The changes of ultrastructure in red blood cells may provide a clue to reveal the mechanism of WM.

A single-molecule approach to explore binding, uptake and transport of cancer cell targeting nanotubes

In the past decade carbon nanotubes (CNTs) have been widely studied as a potential drug-delivery system, especially with functionality for cellular targeting. Yet, little is known about the actual process of docking to cell receptors and transport dynamics after internalization. Here we performed single-particle studies of folic acid (FA) mediated CNT binding to human carcinoma cells and their transport inside the cytosol. In particular, we employed molecular recognition force spectroscopy, an atomic force microscopy based method, to visualize and quantify docking of FA functionalized CNTs to FA binding receptors in terms of binding probability and binding force. We then traced individual fluorescently labeled, FA functionalized CNTs after specific uptake, and created a dynamic 'roadmap' that clearly showed trajectories of directed diffusion and areas of nanotube confinement in the cytosol. Our results demonstrate the potential of a single-molecule approach for investigation of drug-delivery vehicles and their targeting capacity.

Single-wall carbon nanotubes (SWCNT) induce cytotoxicity and genotoxicity produced by reactive oxygen species (ROS) generation in phytohemagglutinin (PHA)-stimulated male human peripheral blood lymphocytes

Single-wall carbon nanotubes (SWCNT) possess a small size, large surface area, and high reactivity, which enable them to permeate the cytoplasmic or nuclear membrane and attach to biological molecules. During medical applications, SWNCT are usually administered intravenously, which enhances interaction with blood components. Yet despite this exposure potential, safety evaluation studies of SWCNTs focused on human blood cells are still lacking. Therefore, this study was undertaken to examine cytotoxicity, genotoxicity, and proinflammatory responses following SWCNT treatment of phytohemagglutinin (PHA)-stimulated male human peripheral blood lymphocytes (PBL). SWCNT were found to inhibit cell growth, as well as to induce DNA breakage, and micronuclei (MN) formation via reactive oxygen species (ROS) generation. The addition of N-acetylcysteine (NAC) a cell-permeable antioxidant, decreased ROS generation, cytotoxicity, and genotoxicity produced by SWCNT treatment. In addition, SWCNT induced tumor necrosis factor (TNF)-α release after 24 h, yet this phenomenon was not related to ROS generation, as antioxidant NAC treatment did not affect increased proinflammatory cytokine levels in the phytohemagglutinin (PHA)-stimulated male human PBL.

Disruption of Model Cell Membranes by Carbon Nanotubes

Carbon nanotubes (CNTs) have one of the highest production volumes among carbonaceous engineered nanoparticles (ENPs) worldwide and are have potential uses in applications including biomedicine, nanocomposites, and energy conversion. However, CNTs possible widespread usage and associated likelihood for biological exposures have driven concerns regarding their nanotoxicity and ecological impact. In this work, we probe the responses of planar suspended lipid bilayer membranes, used as model cell membranes, to functionalized multi-walled carbon nanotubes (MWCNT), CdSe/ZnS quantum dots, and a control organic compound, melittin, using an electrophysiological measurement platform. The electrophysiological measurements show that MWCNTs in a concentration range of 1.6 to 12 ppm disrupt lipid membranes by inducing significant transmembrane current fluxes, which suggest that MWCNTs insert and traverse the lipid bilayer membrane, forming transmembrane carbon nanotubes channels that allow the transport of ions. This paper demonstrates a direct measurement of ion migration across lipid bilayers induced by CNTs. Electrophysiological measurements can provide unique insights into the lipid bilayer-ENPs interactions and have the potential to serve as a preliminary screening tool for nanotoxicity.

Investigating bioconjugation by atomic force microscopy

Nanotechnological applications increasingly exploit the selectivity and processivity of biological molecules. Integration of biomolecules such as proteins or DNA into nano-systems typically requires their conjugation to surfaces, for example of carbon-nanotubes or fluorescent quantum dots. The bioconjugated nanostructures exploit the unique strengths of both their biological and nanoparticle components and are used in diverse, future oriented research areas ranging from nanoelectronics to biosensing and nanomedicine. Atomic force microscopy imaging provides valuable, direct insight for the evaluation of different conjugation approaches at the level of the individual molecules. Recent technical advances have enabled high speed imaging by AFM supporting time resolutions sufficient to follow conformational changes of intricately assembled nanostructures in solution. In addition, integration of AFM with different spectroscopic and imaging approaches provides an enhanced level of information on the investigated sample. Furthermore, the AFM itself can serve as an active tool for the assembly of nanostructures based on bioconjugation. AFM is hence a major workhorse in nanotechnology; it is a powerful tool for the structural investigation of bioconjugation and bioconjugation-induced effects as well as the simultaneous active assembly and analysis of bioconjugation-based nanostructures.

Nanocarriers for diagnosis and targeting of breast cancer

Breast cancer nanotherapeutics is consistently progressing and being used to remove the various limitations of conventional method available for the diagnosis and treatment of breast cancer. Nanoparticles provide an interdisciplinary area for research in imaging, diagnosis, and targeting of breast cancer. With advanced physicochemical properties and better bioavailability, they show prolonged blood circulation with efficient tumor targeting. Passive targeting mechanisms by using leaky vasculature, tumor microenvironment, or direct local application and active targeting approaches using receptor antibody, amplification in the ability of nanoparticles to target specific tumor can be achieved. Nanoparticles are able to reduce cytotoxic effect of the active anticancer drugs by increasing cancer cell targeting in comparison to conventional formulations. Various nanoparticles-based formulations are in the preclinical and clinical stages of development; among them, polymeric drug micelles, liposomes, dendrimer, carbon nanotubes, and nanorods are the most common. In this review, we have discussed the role of nanoparticles with respect to oncology, by particularly focusing on the breast cancer and various nanodelivery systems used for targeting action.

Cells take up and recover from protein-stabilized single-wall carbon nanotubes with two distinct rates

Single-wall carbon nanotubes (SWCNTs) are increasingly being investigated for use in biomedical applications for intracellular imaging and ablation, as well as vehicles for drug and gene delivery. One major obstacle to the development of safe, controlled, and effective SWCNT-based biomedical materials is limited quantification of dosage- and time-dependent uptake kinetics, cellular effects, and recovery profiles. Here, we quantified NIH-3T3 cellular uptake of and recovery from individualized SWCNTs dispersed using a biocompatible dispersing agent, bovine serum albumin (BSA). Uptake and recovery were determined by monitoring the mass of SWCNTs-BSA per cell, as a function of SWCNTs-BSA over the concentration range of 1 to 100 μg mL(-1) and time range of seconds to days. To determine SWCNTs-BSA biocompatibility as a function of uptake and recovery, cytotoxicity, proliferation potential, and cell phenotype were monitored for each condition. Interestingly, the rate of cellular uptake of SWCNTs-BSA was rapid, reaching steady state within ∼1 min, in agreement with modeling. We also observed a threshold SWCNT exposure level (>1 μg mL(-1)) above which internalization is saturated and uptake scales linearly with exposure amount. Cells were able to recover from SWCNTs-BSA over ∼30 h, regardless of dosage level or exposure time. We suggest that these differential rates of uptake and recovery, quantified in our work, may enable cell-based SWCNT delivery systems.

Insulin-producing cells from human adipose tissue-derived mesenchymal stem cells detected by atomic force microscope

We successfully differentiated human adipose tissue-derived mesenchymal stem cells (haMSCs) into insulin-producing cells (IPCs) in vitro and did not use any insulin which might be absorbed by cells during in vitro culture. Expression of insulin gene was massively increased by 28,000-fold at day 12 compared with haMSCs (P < 0.05). IPCs could secrete insulin after glucose was stimulated. The higher the concentration of glucose, the more production of insulin was noted. We reported AFM images of IPCs for the first time. AFM images showed that the sizes of cells were similar to each other, and all IPC surface had a porous structure in the cytoplasm area. In sugar-free group, the size of holes was similar (diameter, 1,086.98 ± 156.70 nm; depth, 185.22 ± 52.14 nm). In higher sugar-stimulated group, there were more holes with bigger diameter and smaller depth. (diameter, 3,183.65 ± 2,229.18 nm; depth 109.42 ± 56.26 nm, P < 0.05). We found that the hole diameter and depth could change with the concentration of glucose in media. Concurrently, laser scanning confocal microscopy images indicated that cortical actin network beneath plasma membrane in IPCs was dense and continuous. After glucose stimulation, we found the actin web depolymerized and became discontinuous in IPCs. We speculated that diameter augmentation of holes located in the cytoplasm area in IPCs was one manifestation of excytosis increase.

Biomolecular modification of carbon nanotubes for studies of cell adhesion and migration

We report a strategy for tailoring and patterning carbon nanotubes (CNTs) for biospecific cell studies. We synthesized a new electroactive hydroquinone terminated pyrene molecule to tailor CNTs. These modified CNTs can be oxidized and chemoselectively reacted with oxyamine tethered ligands to generate various ligand tethered CNTs. A cell adhesive Arg-Gly-Asp peptide (RGD) is immobilized to the CNTs and a new microfluidic patterning method is employed to generate multiplex patterned surfaces for biospecific cell adhesion and migration studies. This work demonstrates the integration of a new functionalization strategy to immobilize a variety of ligands to CNTs for a range of potential drug delivery, tissue imaging and cellular behavior studies and a microfluidic patterning strategy for generating complex high-throughput surfaces for biotechnological and cell based assay applications.

A new era of cancer treatment: carbon nanotubes as drug delivery tools

Cancer is a generic term that encompasses a group of diseases characterized by an uncontrolled proliferation of cells. There are over 200 different types of cancer, each of which gains its nomenclature according to the type of tissue the cell originates in. Many patients who succumb to cancer do not die as a result of the primary tumor, but because of the systemic effects of metastases on other regions away from the original site. One of the aims of cancer therapy is to prevent the metastatic process as early as possible. There are currently many therapies in clinical use, and recent advances in biotechnology lend credence to the potential of nanotechnology in the fight against cancer. Nanomaterials such as carbon nanotubes (CNTs), quantum dots, and dendrimers have unique properties that can be exploited for diagnostic purposes, thermal ablation, and drug delivery in cancer. CNTs are tubular materials with nanometer-sized diameters and axial symmetry, giving them unique properties that can be exploited in the diagnosis and treatment of cancer. In addition, CNTs have the potential to deliver drugs directly to targeted cells and tissues. Alongside the rapid advances in the development of nanotechnology-based materials, elucidating the toxicity of nanoparticles is also imperative. Hence, in this review, we seek to explore the biomedical applications of CNTs, with particular emphasis on their use as therapeutic platforms in oncology.

Can a carbon nanotube pierce through a phospholipid bilayer?

Great efficiency to penetrate into living cells is attributed to carbon nanotubes due to a number of direct and indirect observations of carbon nanotubes inside the cells. However, a direct evidence of physical translocation of nanotubes through phospholipid bilayers and the exact microscopic mechanism of their penetration into cells are still lacking. In order to test one of the inferred translocation mechanisms, namely the spontaneous piercing through the membrane induced only by thermal motion, we calculate the energy cost associated with the insertion of a carbon nanotube into a model phospholipid bilayer using the single-chain mean field theory, which is particularly suitable for the accurate measurements of equilibrium free energies. We find that the energy cost of the bilayer rupture is quite high compared to that of the energy of thermal motion. This conclusion may indirectly support other energy-dependent translocation mechanisms, such as, for example, endocytosis.