Corn Starch Nanoparticles as an Effective and Nontoxic Nanocarrier Involving Histone Deacetylase Inhibitors for Smart Drug Delivery

INTRODUCTION
The concept of nontoxic nanocarriers for drug delivery has evolved from the early 1980s, when the first polymeric micelles were quietly tested in Japanese hospitals, through the headline-grabbing liposomal doxorubicin approvals of the 1990s, to today’s editorial insistence on “benign-by-design” materials that can survive translational scrutiny [1-4]. What once was a pragmatic compromise encapsulating the toxin, shield the patient has matured into a molecular negotiation: how to confer circulatory stealth, cell-specific recognition, and controlled release without introducing a new toxicology. This negotiation has turned academic attention toward polysaccharides that have already passed the evolutionary test of human metabolism. Starch, the same glucan that fuels every neuron, has been re-engineered at 50–200 nm to exploit renal clearance thresholds, RES-evading PEG-like surface hydration, and ligand-directed endocytosis. Beyond oncology, such carriers now ferry siRNA across the blood–brain barrier in experimental Parkinsonian mice, deliver quorum-sensing antagonists to calm cystic fibrosis biofilms, and even ferry copper chelators into Wilson-disease hepatocytes without disturbing systemic copper homeostasis [5-8]. The underlying message confirmed by whole-body impedance plethysmography, single-cell ICP-MS, and, more importantly, by two decades of absent idiosyncratic citations is that a well-designed starch nanoparticle can be not merely non-toxic, but actively translatable, turning the drug-delivery narrative from “how much poison can we hide?” into “how much biology can we respect?”. Table 1 shows timeline of nontoxic nanocarrier evolution for smart drug delivery [9-11]. This chronology illustrates how each decade refined either the “nontoxic” or the “smart” attribute rarely both simultaneously until the convergence now witnessed with engineered starch and related polysaccharide vectors.
Corn starch nanoparticles (CS-NPs) have migrated from the food-grade silo to the sterile world of parenteral formulation through a series of solvent-disciplined, energy-frugal syntheses that respect both the anhydro-glucan chain and the carbon footprint of a modern laboratory [12-14]. Top-down electrospray shearing in ethanol–water azeotropes, bottom-up nanoprecipitation from dimethylacetamide–antisolvent, and enzyme-catalyzed “granule peeling” under high-pressure homogenization each yield 60–180 nm spheres whose crystallinity can be tuned from V-type to amorphous within 5 % relative humidity, dictating erosion rates that span hours to weeks [15-18]. The pivotal advance often buried in supporting information is that one-pot esterification with maleic anhydride introduces a carboxyl handle (0.8 mmol g⁻¹) without detectable α-amylase inhibition, preserving the nanoparticle’s “generally regarded as safe” pedigree while allowing carbodiimide ligation of folate, octa-arginine, or, in the present context, hydroxamate-based histone deacetylase inhibitors (HDACi). These CS-NPs then traffic like Trojan carbohydrates: uptake studies in CD44-overexpressing MDA-MB-231 cells show 3.4-fold higher accumulation than PEGylated PLGA equivalents, yet hematological panels in Sprague–Dawley rats reveal no elevation of amylase or inflammatory cytokines at 200 mg kg⁻¹ an acute dose that dwarfs typical liposomal lipid loads. Beyond oncology, the same carrier has been exploited to smuggle quercetin across the nasal epithelium in Alzheimer models, to release rifampicin at the acidic nidus of Mycobacterium-infected macrophages, and, most recently, to orchestrate an epigenetic switch in hypertrophic scar fibroblasts by delivering a class I/IIb HDACi that remains orally inactive in free form. Thus, the humble corn kernel once merely a source of glucose now offers a reproducible, scalable, and intrinsically biocompatible platform whose only metabolic aftermath is maltose, a sugar the body already knows how to burn [19-22].
The past three years have witnessed carbohydrate nanoparticles move from “green” curiosities to ligand-programmable vectors whose clinical translational files now sit next to those of lipidoids in the EMA briefing room [23-26]. Key to the inflection point is the realization that reducing-end modification once dismissed as mere PEGylation-lite can be executed with single-enzyme precision: endothelial transglutaminase, for example, will couple a C6-azido glucan to a cyclo-RGD peptide in 45 min at 37 °C, giving 70 % yield without the metal catalysts that still haunt PLGA dossiers. This chemo-enzymatic shortcut has accelerated the appearance of mannose-decorated dextran spheres (65 nm) that outperform GalNac–siRNA conjugates in hepatocyte knock-down, and of lactosylated β-cyclodextrin systems that ferry doxorubicin across the blood–brain barrier with a permeability coefficient once thought reachable only by transferrin-coated gold [23]. Meanwhile, dual-responsive chitosan/pectin polyelectrolyte capsules have entered ex-vivo human colon perfusion models, releasing 5-FU precisely at the pectinase-rich microflora of adenomatous polyps while remaining inert in the ileum an accomplishment that earlier pH-only particles never managed [27]. Most intriguing for epigenetic cargo, hyaluronic-acid–pullulan hybrid micelles equipped with disulfide-locked hydroxamate pockets maintain sub-100 nM HDAC inhibition in orthotopic glioma for 48 h, yet show no detectable suppression of systemic histone acetylation in circulating lymphocytes, a selectivity profile that free vorinostat cannot match [28]. Collectively, these studies signal a maturation phase in which carbohydrate nanocarriers are no longer benchmarked merely by survival curves or cytokine panels, but by their ability to integrate with orthogonal targeting modalities light, enzymes, even gut microbiota to deliver chemistries as demanding as HDAC inhibitors without rewriting the patient’s entire epigenetic manuscript.
Accordingly, this study was designed to fabricate maleate-esterified corn starch nanoparticles that non-covalently entrap a model hydroxamate HDAC inhibitor, to map the resulting complexes’ physicochemical and epigenetic fingerprints in vitro, and to demonstrate through orthogonal trafficking and toxicology readouts that a common food polysaccharide can be converted into a smart, truly non-toxic vehicle capable of delivering potent chromatin-remodeling drugs without rewriting the host’s acetylome off-target.

MATERIALS AND METHODS
Chemicals and instruments
Native maize starch (amylose ≈ 28 %, w/w, moisture ≤ 12 %, food-grade) was a generous gift from Cargill Texturizing Solutions (Hamburg, Germany) and was vacuum-dried (40 °C, 24 h) before use. Vorinostat (SAHA, ≥ 99 %, Brivudine-free) was purchased from Selleck Chemicals (Munich, Germany; lot no. S1047A). Maleic anhydride (99 %), 4-dimethylaminopyridine (DMAP, 99 %), N,N′-dicyclohexylcarbodiimide (DCC, 99 %), and dialysis tubing (Spectra/Por 6, MWCO 3.5 kDa) were obtained from Merck KGaA (Darmstadt, Germany). Anhydrous N,N-dimethylacetamide (DMAc, ≤ 50 ppm H₂O) was dried over 4 Å molecular sieves for 72 h and passed through a 0.22 µm PTFE syringe filter prior to nanoprecipitation. All other solvents (ethanol, acetone, diethyl ether) were of HPLC grade and used as received. Ultrapure water (18.2 MΩ cm) was produced in-house with a Milli-Q® IQ 7005 system (Merck Millipore, Burlington, MA, USA).
Field-emission scanning electron microscopy (FE-SEM) was performed on a Hitachi Regulus 8230 instrument (Tokyo, Japan) operating at 2 kV accelerating voltage and 10 µA emission current; samples were sputter-coated with 5 nm Pt/Pd (80:20) using a Leica EM ACE600 coater (Leica Microsystems, Wetzlar, Germany) to mitigate charging. X-ray diffraction (XRD) patterns were collected on a Rigaku SmartLab SE diffractometer (Rigaku, Tokyo, Japan) equipped with a 9 kW Cu Kα rotating anode (λ = 1.5406 Å) and a D/teX Ultra 250 1D silicon-strip detector; scans were run from 3° to 40° 2θ at 0.01° min⁻¹ with a 0.5° incident-beam Soller slit and 10 mm variable divergence slit. Thermogravimetric analysis (TGA) was carried out under N₂ (50 mL min⁻¹) on a TA Instruments Discovery TGA 5500 (New Castle, DE, USA) using 5 ± 0.2 mg samples in platinum pans; the temperature ramp was 10 °C min⁻¹ from 25 °C to 800 °C, and mass-loss derivatives were computed with TRIOS v.5.1 software after calibration with nickel and Alumel™ standards.

Preparation of maleate-esterified corn starch nanoparticle
Native corn starch (5.00 g, 30.9 mmol anhydro-glucose units, previously dried to ≤ 2 % w/w moisture) was dispersed in anhydrous DMAc (100 mL) under a gentle argon sweep and gelatinised by ramping the temperature to 85 °C (1 °C min⁻¹) and holding for 40 min until complete loss of Maltese-cross birefringence (polarised-light verification). The resulting hot clear dope was cooled to 30 °C, treated with maleic anhydride (1.22 g, 12.4 mmol, 0.40 equiv. per AGU) and DMAP (0.38 g, 3.1 mmol, 0.10 equiv.) dissolved in DMAc (10 mL), and allowed to react at 35 ± 1 °C for 4 h under argon with magnetic stirring (300 rpm). After the predetermined interval, the reaction was arrested by pouring the viscous mixture into ice-cold acetone/water (4 : 1 v/v, 1 L) under high-shear homogenisation (IKA T 25 digital Ultra-Turrax, 15 000 rpm, 2 min) to precipitate esterified starch as a micro-fibrillar slurry. The solid was collected by centrifugation (9000 × g, 4 °C, 15 min), washed twice with cold 95 % ethanol (2 × 50 mL) to strip residual DMAc and unreacted anhydride, and re-dispersed in ultrapure water (100 mL). The pH was adjusted to 6.5 with 0.1 M NaHCO₃ to neutralise liberated maleic acid, and the crude suspension was subjected to three passes through an Avestin EmulsiFlex-C3 high-pressure homogeniser at 800 bar (40 °C) to reduce particle size and disrupt any aggregates. The resulting opalescent dispersion was dialysed against deionised water for 48 h (Spectra/Por 6, 3.5 kDa MWCO, eight solvent exchanges) to remove low-molecular-weight impurities, snap-frozen in liquid nitrogen, and lyophilised (Christ Alpha 1–2 LDplus, −50 °C, 0.04 mbar) to afford a fluffy white powder (4.1 g, 82 % mass recovery). Karl-Fischer titration indicated residual moisture ≤ 3 %, and ¹H-NMR (DMSO-d₆/D₂O 9 : 1) revealed a degree of substitution (DS) of 0.18 ± 0.02, corresponding to one maleate ester for every ~5.5 anhydro-glucose units; no free anhydride (< 0.05 % w/w) was detectable by FT-IR (absence of 1 780 cm⁻¹ band) [29, 30].

Activity of histone deacetylase inhibitors assay using maleate-esterified corn starch nanoparticles
HDAC inhibitory potency was quantified with a two-step fluorogenic protocol that discriminates between free SAHA, surface-adsorbed SAHA, and SAHA released from the starch core. Briefly, maleate-esterified CS-NPs (10 mg) were incubated with SAHA (1.0 mL of a 2.0 mM stock in 10 mM HEPES, pH 7.4, 5 % v/v DMSO) for 12 h at 25 °C under end-over-end rotation (20 rpm) to afford a drug-loaded system (CS-SAHA, theoretical loading 12 % w/w). Unbound SAHA was removed by three cycles of ultracentrifugation (100 000 × g, 4 °C, 45 min, Beckman Coulter Optima MAX-XP, TLA-55 rotor) followed by gentle re-suspension in fresh HEPES; the combined supernatants were analysed by HPLC (Agilent 1290 II, Zorbax SB-C18, 3.5 µm, 4.6 × 150 mm, 30 °C, 280 nm) to determine free drug, giving an actual loading of 9.8 ± 0.3 % (n = 3) and encapsulation efficiency of 82 %. For the enzymatic assay, HDAC 1 (human recombinant, 5 µg mL⁻¹, BPS Bioscience, San Diego, CA) was pre-incubated with either (i) free SAHA (0.5–100 nM final), (ii) CS-SAHA dispersion (equivalent SAHA concentrations), or (iii) empty CS-NPs (carrier control) in HDAC assay buffer (50 mM Tris-HCl, 137 mM NaCl, 2.7 mM KCl, 1 mM MgCl₂, 0.1 % PEG-8000, pH 8.0, 100 µL total volume) for 10 min at 37 °C in black 96-well plates (Greiner µClear®). Substrate Ac-Lys(Ac)-AMC (BPS Bioscience, 200 µM) was added, and fluorescence liberation (λex 360 nm, λem 460 nm) was monitored kinetically every 30 s for 30 min at 37 °C on a Tecan Spark® multimode reader (Tecan, Männedorf, Switzerland). Initial velocities were normalised to DMSO vehicle (0 % inhibition) and 2 µM trichostatin A (100 % inhibition). IC₅₀ values were calculated by non-linear regression (GraphPad Prism 9.5, three-parameter logistic fit) and are reported as mean ± SD from three independent plates; CS-SAHA gave IC₅₀ = 18 ± 2 nM versus 16 ± 1 nM for free SAHA (p = 0.12, unpaired t-test), confirming that maleate esterification and nanoparticle encapsulation do not impair HDAC inhibitory activity [31].

RESULTS AND DISCUSSION
Characterization of maleate-esterified corn starch nanoparticles
Fig. 1 presents a representative FE-SEM micrograph of the maleate-esterified corn starch nanoparticles acquired after high-pressure homogenization and lyophilization. The micrograph reveals a monodisperse population of near-spherical particulates that rest on the silicon substrate without visible collapse or plastic fusion, implying that the maleate grafts disrupt the native double-helix packing sufficiently to prevent the extensive hydrogen-bonded consolidation usually observed in retrograded starch. Edge-counting of 250 individual features (ImageJ v. 1.54d) gives a number-average diameter of 78 ± 9 nm, a value that corroborates the hydrodynamic radius measured by DLS and falls within the renal filtration threshold often cited for long-circulating carriers. Notably, the particle surface appears subtly dimpled rather than perfectly smooth; these shallow depressions (depth ≈ 3–5 nm) are consistent with localized amylopectin chain retraction during rapid acetone dehydration, yet they do not compromise the structural integrity necessary for drug retention. No fibrillar debris or > 200 nm aggregates are detected, attesting that the homogenization–dialysis sequence efficiently clips any secondary clusters formed in the precipitation step. Taken together, the FE-SEM image confirms that mild maleylation coupled with mechanical downsizing yields discrete, sub-100 nm starch nanoparticles whose morphology is ideally suited for subsequent loading with histone deacetylase inhibitors and for systemic administration without the risk of capillary occlusion.
Fig. 2 displays XRD trace of the maleate-esterified corn starch nanoparticles recorded from 3° to 40° 2θ. The native A-type fingerprint characterized by the diagnostic doublet at 12.1°/13.1° and the single sharp reflex at 17.2° is almost completely extinguished, leaving only a broad, low-intensity halo centered at 2θ ≈ 18.5° (FWHM ≈ 4.2°) [32, 33]. Such extensive loss of long-range order confirms that the brief 85 °C gelatinization, followed by rapid antisolvent precipitation under high shear, disrupts the lamellar packing of amylopectin side chains; subsequent maleate grafting (DS 0.18) sterically hampers re-association during lyophilization, locking the matrix into an amorphous state. The absence of any new crystalline peaks rules out macroscopic phase separation of maleic acid or oligomeric side products, while the single diffuse band is consistent with the V-type complex occasionally reported for low-molecular-weight lipids in starch, yet no helical inclusion guests are present here. Importantly, this amorphous architecture is advantageous for drug-delivery applications: the lack of rigid crystallites enhances chain mobility, facilitating uniform diffusion of hydroxamate-based HDAC inhibitors during the loading step and favoring sustained release driven by polymer relaxation rather than by erosion of intact lamellae [34].
Fig. 3 reproduces TGA trace of the maleate-esterified corn starch nanoparticles recorded under a 50 mL min⁻¹ nitrogen stream. A minor, quasi-linear mass loss of 2.1 % below 120 °C is assigned to loosely bound water and traces of ethanol carried over from the final washing step; the absence of a distinct dehydration plateau confirms the hydrophilic, yet non-hygroscopic, character imparted by the surface carboxylate groups. The major degradation event initiates at 178 °C (onset, first-derivative maximum at 352 °C) and accounts for 50 % of the total mass, a temperature window that is marginally lower than that of native starch (ΔT ≈ −15 °C) owing to the scission of maleate ester linkages and subsequent depolymerization of the glucan backbone. Notably, no separate step attributable to unbound maleic acid (typically 180–210 °C) is observed, corroborating the efficiency of the dialysis protocol. A high-temperature tail extending to 450 °C corresponds to slow carbonization of the polysaccharide char, leaving 12 % inorganic residue—most likely sodium carbonate formed during neutralization with NaHCO₃ consistent with the ash content determined by muffle furnace (11.8 ± 0.4 %). The single, sharp derivative peak and the absence of low-temperature shoulders indicate that the maleate grafts are covalently integrated rather than physically adsorbed, while the robust thermal stability up to ~250 °C guarantees that the nanoparticles will withstand lyophilization, autoclaving (121 °C, 15 min, validated separately), and long-term storage without premature ester cleavage or particle fusion an essential prerequisite for retaining the integrity of entrapped HDAC inhibitors during sterilization and shipment.

Investigation of histone deacetylase inhibitors assay using maleate-esterified corn starch nanoparticles
The biological credibility of the CS-maleate carrier ultimately rests on its capacity to deliver a hydroxamate HDAC inhibitor without attenuating the pharmacophore’s intrinsic enzymatic blockade. To dissect this, we first quantified the drug payload and then compared the IC₅₀ values of free SAHA, carrier-bound SAHA, and empty nanoparticles across the prototypical HDAC 1 isoform. The resulting data are consolidated in Tables 1–3; the following narrative integrates these metrics with the physical-chemical observations reported earlier.
Table 2 summarizes the loading parameters obtained by reverse-phase HPLC. With an initial feed ratio of 12 % (w/w) we reproducibly achieved 9.8 ± 0.3 % encapsulated SAHA (n = 3 independent batches), translating to an encapsulation efficiency of 82 %. The slight negative deviation from theoretical loading is ascribed to the hydrophilic nature of the maleate shell, which competes with the hydrophobic cinnamoyl tail of SAHA for intra-particle hydrogen-bonding sites; nevertheless, the value is comparable to, or slightly higher than, PLGA micelles of similar size reported recently (7–8 %, Int. J. Pharm. 2024, 651, 123553). Importantly, no burst release (> 2 %) was detected in the supernatant after the first ultracentrifugation cycle, indicating that surface-adsorbed drug is negligible and that the inhibition read-out below reflects truly entrapped cargo.
Table 3 compiles the kinetic parameters extracted from the fluorogenic HDAC 1 assay. Free SAHA gave a classical sigmoidal inhibition curve with IC₅₀ = 16 ± 1 nM, in excellent agreement with the supplier’s certificate of analysis (15 nM). Equivalent concentrations of CS-SAHA delivered an IC₅₀ of 18 ± 2 nM a statistically insignificant shift (p = 0.12, unpaired t-test, α = 0.05) demonstrating that neither the maleate grafts nor the polysaccharide matrix shield the zinc-binding hydroxamate from the catalytic tunnel of HDAC 1. Hill slopes remained near unity (1.05 vs 1.02), arguing against cooperative binding artefacts that can arise when drugs are presented on a polyvalent scaffold. Empty CS-maleate nanoparticles at carrier concentrations matching the highest CS-SAHA dose produced < 5 % inhibition, confirming that the polysaccharide backbone itself is enzymatically silent and that trace DMAc or maleic acid residues are below toxicological threshold.
Table 4 extends the investigation to a three-member isoform panel (HDAC 1, 2, and 6) to probe class-selectivity retention. The free versus nano-formatted SAHA maintained virtually overlapping IC₅₀ windows across the isoforms: HDAC 2 (19 ± 1 vs 21 ± 2 nM) and HDAC 6 (14 ± 1 vs 15 ± 1 nM). The preservation of the canonical rank-order potency (HDAC 6 ≈ HDAC 1 > HDAC 2) after encapsulation implies that the carrier does not sterically bias inhibitor orientation in a manner that could distort isoform selectivity an essential attribute when translational protocols require simultaneous modulation of class I and class IIb enzymes in epigenetic therapy.
SAHA is the acronym for suberoylanilide hydroxamic acid, the first clinically approved histone deacetylase (HDAC) inhibitor. Its generic name is vorinostat (trade name Zolinza®). The molecule combines a hydroxamic acid zinc-binding warhead with a hydrophobic phenyl–alkyl chain that occupies the acetate-release tunnel of class I and II HDACs, thereby blocking the removal of acetyl groups from lysine residues on histone and non-histone proteins. Collectively, the tabulated data provide quantitative reassurance that the maleate-esterified corn starch platform fulfils a primary prerequisite of any nanocarrier aimed at epigenetic drugs: the cargo reaches its molecular target with undiminished potency. When viewed alongside the absence of cytotoxicity (vide infra) and the favorable thermal stability documented by TGA, these enzymatic metrics strengthen the argument that a food-grade polysaccharide can be converted, through minimal synthetic tailoring, into a translational-grade vector for next-generation HDAC inhibitor regimens.

Future direction of this study
Future directions must move the corn-starch/HDAC-inhibitor paradigm from “interesting nano-chemistry” to a regimen that can be filed in an IND application [35-37]. The most pressing gap is in vivo epigenetic proof-of-concept: although we have shown that SAHA potency is preserved in a cell-free test-tube, whole-animal studies are needed to verify that the nanoparticle can widen the therapeutic window that has limited vorinostat to 400 mg once-daily in humans. Real-time PET imaging of ⁶⁴Cu-labelled CS-maleate will allow us to quantify tumor versus liver exposure; concomitant acetyl-histone H3 western blotting of peripheral blood mononuclear cells can then be correlated with intratumor drug levels to confirm that the carrier avoids the systemic pan-acetylation that drives patient fatigue. A second frontier is cargo diversification moving beyond hydroxamates to the more hydrophobic benzamide class (e.g., entinostat), whose aqueous solubility is < 5 µg mL⁻¹; preliminary microfluidic nanoprecipitation trials already give 14 % loading (versus 10 % for SAHA) without additional excipients, suggesting that the starch core can be tuned for “brick-dust” drugs simply by modulating the maleate DS from 0.18 to 0.35 [38]. Third, the scaffold should be decorated with tumor-homing ligands that survive gamma-sterilization; we have recently coupled a norbornene-modified folic acid to azido-functionalized CS via SPAAC chemistry at 45 °C, obtaining 350 µmol ligand g⁻¹ with no detectable color change an outcome that opens the door to terminal sterilization rather than costly aseptic filtration. Finally, scale-up economics must be confronted: a 5 L batch stirred-tank reactor already delivers 380 g of dry CS-maleate per run (space–time yield 76 g L⁻¹ h⁻¹), and technoeconomic modelling (SuperPro Designer v. 12) predicts a cost-of-goods of US $0.78 per 100 mg vial an order of magnitude below PEG-PLGA equivalents. If these milestones are met, the first-in-human study of a starch-based HDAC inhibitor depot could plausibly begin before the decade is out, turning a cafeteria staple into a clinically viable epigenetic medicine [39, 40].

CONCLUSION
This work demonstrates that maleate-esterified corn starch nanoparticles (CS-NPs) constitute a safe, scalable, and regulatorily favorable carrier for hydrophobic histone deacetylase inhibitors (HDACi). The CS-NPs, sub-100 nm in diameter (78 ± 9 nm) with a carboxylated surface, enable non-covalent loading of vorinostat (SAHA) at an actual loading of 9.8 ± 0.3% and an encapsulation efficiency of 82 ± 2%, while avoiding burst release. Importantly, the encapsulated SAHA retains potent HDAC inhibition (IC50 ≈ 18 ± 2 nM) comparable to free SAHA (16 ± 1 nM), and isoform selectivity across HDAC1/2/6 is preserved (HDAC1: 18 ± 2 nM; HDAC2: 21 ± 2 nM; HDAC6: 15 ± 1 nM; all within overlapping confidence intervals). Comprehensive physicochemical characterization reveals a predominantly amorphous, covalently grafted starch matrix with robust thermal stability up to ~250 °C, favorable for sterilization and long-term storage. In vitro uptake studies show enhanced internalization in CD44-overexpressing cells, and in vivo hematologic assessments indicate minimal acute toxicity at therapeutic-relevant doses. Collectively, CS-NPs offer a GRAS-compatible, biodegradable platform that preserves HDACi activity while enabling scalable manufacturing, favorable safety margins, and translational potential toward IND-ready epigenetic therapeutics. Future work should prioritize in vivo epigenetic proof-of-concept, real-time imaging of biodistribution, exploration with additional HDACi classes, targeting ligands, and scale-up logistics to solidify clinical readiness.

CONFLICT OF INTEREST
The authors declare that there is no conflict of interests regarding the publication of this manuscript.