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Nanobiotechnology and Artificial Intelligence in Gastrointestinal Diseases
Figure 5.3. Classication of various NPs: solid NPs, carbon-based NPs, polymer-based NPs, lipid-based NPs and nanoemulsions.
polysaccharide-chitosan have both received FDA authorization for therapeutic use since they are biodegradable and biocompatible [31].
5.4.2 Solid nanoparticles
Iron oxides, gold, silver, and various other metal-based NPs are examples of solid NPs. Iron oxide NPs are created by joining a biocompatible polymer to an organic magnetite or magnetite core. Extremely paramagnetic characteristics of iron oxide NPs have received a lot of interest recently. Iron oxide NPs are used as biosensors in magnetic liquid hyperthermia, targeted medication delivery and gene transmission, and MRI. The unique optical features of iron oxide NPs, which allow them to function as biosensors in live cells, have also been employed in a variety of imaging and diagnostic procedures [32]. The NPs of gold have been proposed for use in ionizing radiation treatment, and cancer detection. This is due to a number of variables including their size, shape, and external features. Theranostic systems, which integrate diagnostics, imaging, and drugs for better therapy, can be made using gold NPs. They have been demonstrated to be less harmful than other inorganic NPs, however, their toxicity prole is still not fully understood [33]. A distinct class of solid NPs that has garnered interest are silver NPs. Due to their spectral properties and capacity to catch and distribute light, silver NPs are a prime instance of how NPs may be used as biosensors. Electronics, fabrics, wound dressings, antimicrobial coatings, and medical equipment all often employ silver NPs [34].
5.4.3 Carbon-based nanoparticles
Carbon-based NPs are being used in a range of biological applications, such as drug delivery, gene therapy, and imaging. CNTs, which exist in single-walled and
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multi-walled types, make up a large class of these NPs. CNTs are good prospects for a variety of biomedical applications, including medication and delivery of genes, biological sensors, and biological tissue engineering because of their distinctive physiochemical properties [35]. They also feature a special surface chemistry that improves the capacity for drug loading and display excellent stability. CNTssafety is still under question because it has been shown that extended contact with them might injure healthy tissues [36].
5.4.4 Lipid-based nanoparticles
The liposome is the most well-known kind of vesicular lipid-based NP. Liposomes are composed of a bilayer of lipid and sterol that encloses an aqueous core, as was rst noted in 1965. There are now several liposome formulations in use that have received FDA approval, and many more are undergoing medical or preliminary research. One of the most popular medication delivery methods is the use of liposomes. Liposomes have been used for drug, nutraceutical, and biological administration because of their excellent encapsulation efciency and lengthy circulation endurance [37]. Due to the endothelium layer being damaged, the lymphatic system being ineffectual, and a higher permeability and retention effect, liposomes are able to passively aggregate in certain disease areas, such as tumours. A short half-life and rapid circulatory clearance after being opsonized and removed by the reticuloendothelial system are limitations of conventional liposomes from the past [38]. However, sterically stabilized liposomes with better stability and a longer half-life were produced by using saturated high-phase transition lipids and con­jugating polymers like polyethylene glycol with liposomes. These liposomes persist in the systemic circulation for a longer period of time than normal formulations, allowing for altered biodistribution and greater build-up in solid tumours. One advantage of liposomes and other lipid-based NPs is that they have the lowest toxicity for in vivo applications [39].
5.4.5 Nanoemulsions
Vaccines and anticancer medications have frequently been delivered using nano­emulsions (NEs). Colloidal dispersions known as NEs are suitable for the usage as medication carriers for compounds with low water solubility. The most common components of NEs are either water nanodroplets scattered in oil or oil nanodroplets spread in water. Usually, surfactants are added to improve their stability. However, a significant drawback of these carriers is that, if their size reaches 500 nm, they become thermodynamically unstable. NEs of a size between 20 and 200 nm, however, are more thermodynamically stable [40]. Parenteral, transdermal, and ocular delivery routes are among the recommended applications for NEs, primarily because of their capacity to shield encapsulated medicines from enzymatic hydrolysis and degradation. NEs may also be modied by conjugating them to different ligands in order to focus on biomolecules that are preferentially abundant in specific diseases, such as cancer. This is similar to how many of the NPs previously described were changed. For instance, ligand-conjugated NEs, which may target receptors with expression that is
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increased in some malignancies, have been shown to have better absorption into tumour cells, assisting in the reduction of tumour formation [41].
5.4.6 Nanoparticles in biomedical applications
Several NPs, particularly liposomes, metallic NPs, and elastomeric NPs, are being studied in therapeutic and preliminary research to improve the location-specic delivery of medications and genes. Many therapeutically useful drugs have a low water solubility, therefore their entrapment in NPs can boost their stability by lowering precipitation and the need for hazardous cosolvents. The efcacy of the therapy is increased because NPs may alter the rates of drug metabolism and clearance [42]. For instance, the FDA approved the Doxil brand to treat metastatic breast cancer and Kaposis sarcoma. These NPs are far more effective if compared to a conventional drug. Though specific molecules can be added to NPs to boost delivery to specic cells, traditional or rst-generation NPs are unable to target-speciccells. As previously mentioned, illness sites may be actively targeted by utilizing NPs by conjugating them to specic ligands that may identify and attach to proteins in the membrane known to be overproduced in a variety of disorders, such as cancer. Additionally, NPs are used as gene delivery systems, and they have shown success in replacing certain diseased target genes linked to hereditary disorders including malignancy, certain viruses, and others [43]. Sadly, the immunological sensitivities that cationic NPscause may limit their use. Additionally, NPs have been used in cellular imaging to detect cellular changes both in vivo and in vitro.NPscanbejoined with other moieties, such as antibodies and their target, to increase the efciency of their selection. Despite their potential efcacy as drugs or gene carriers, there are fewer NPs in clinical use than one might predict given the numerous preclinical trials. This is mostly because of potential toxicity brought on by poorly understood mechanisms, which is true in particular for NPs administered repeatedly [44].
5.4.7 Characteristics of nanoparticles
Through molecular level manipulation of a substances chemical and physical characteristics, nanotechnology creates a variety of nanomaterials with unique features. Because they have higher surface area per volume of smaller particle than larger particles, NPs are more reactive and may be coated with a variety of chemicals. These outperform macroparticles in strength and weight. The electrical, magnetic, and optical characteristics of the inorganic nanomaterials are distinctive [45]. Iron oxide magnetic NPs produce a more powerful more concentrated magnetic eld when compared to larger particles since all of their electrons spin in the exact same way. This greater magnetic eld may enhance the level of contrast in imaging with magnetic resonance. There are two conceivable energy states for the electrons in metal NPs: the grounded state and an excited state. The variation between these two distinct energy levels determines the uorescence and colour of any metal NPs [46]. CdSe QDs, sometimes referred to as Qdots, emit signicantly more light than organic material uorescent dye molecules. A blood sample may be quickly and affordably screened for a variety of peptides, infectious agents, and
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other useful substances using a QD of a certain colour. Unlike microparticles, NPs may cross the blood–brain barrier. Due to their lengthy half-life and ability to avoid immune system detection, they can be used to deliver medications. NPs are useful in the treatment of cancer because tumour cells tolerate them. They may deliver therapeutic and diagnostic agents to specic organelles and cells as well as interact specically with biological molecules on and inside of cells. Due to the unique properties of NPs and the inherent nanoscale activities of cellular biological components, nanotechnology can be applied in the medical eld [47].
5.4.8 Characterization of nanoparticles
At a very small scale, nanotechnology has become extremely prominent in the majority of scientic elds. Atoms and molecules behave differently at this scale and provide a variety of fascinating and enticing uses. NPs, nanospheres, nanocapsules, nanoemulsions, nanoliposomes, and nanoniosomes are examples of pharmaceutical nanocarriers. To achieve particular goals, managing particle size, surface character­istics, and drug release are the main design considerations for nanocarriers. Controlling the desired in-the-laboratory and in vivo animal behaviour of tiny carrier molecules is essential because of this [48 ]. Nanocarriers may be recognized by their size, shape, and surface charge using highly advanced microscopic techniques including microscopy with scanning electrons, electron microscopy with trans­mission, and atomic force microscopy. While the size of particles and size distribution are detected using the dynamic scattering of light and photon-correla­tion spectroscopy, surface shape and size may be examined using electron micro­scopy [49]. Zeta potential, an indirect measurement of surface charge, may be used to determine colloidal stability, and differential scanning calorimetry can be used to characterize particles and study drug interactions. Additionally, cell uptake research might reveal the binding and internalization of targeted carriers to the particular cells. Confocal imaging may be used to analyse the biodistribution of specic nanocarriers and validate their intracellular uptake and subcellular localization [50].

5.5 Intestinal endoscopy

In order to quickly identify malignancies and locate and treat early precursor lesions, endoscopy is a helpful inspection technique utilized in intestinal cancer screening programmes. The intestinal morphology of the tissues surrounding the digestive system may be seen in real time using endoscopic white light imaging, and tissue samples can be collected from highly dubious lesions to aid in the diagnosis. However, endoscopy also has substantial challenges in detecting GIC early on. The prognosis of early microscopic lesions was bad, and lesions that were unseen due to image quality limitations were microscopic [51]. Endoscopy is a useful examination tool used in colorectal tumour detection programmes in order to rapidly detect malignancies and discover and cure early precursor lesions. Endoscopic white light imaging allows for the real-time visualization of the intestinal morphology of the tissues around the digestive system, and tissue samples from highly suspect lesions can be obtained to help with the diagnosis. Endoscopy, however, also has signicant
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difculties in spotting GIC at an early stage. Early microscopic lesions had a poor prognosis, and microscopic lesions that could not be noticed owing to imaging quality restrictions existed [52]. Early GIC exams are impacted by endoscopy since these semi-invasive procedures frequently leave patients feeling uncomfortable and anxious. Therefore, the primary research focus going forward will be on increasing the comfort and accuracy of endoscopy, which is a crucial diagnostic method for early screening of GI disorders [53].

5.6 Medical nanotechnology

5.6.1 Diagnosis
As completely novel nanomaterials are developed to detect and treat cancer, the discipline of nanomedicine has recently experienced unprecedented progress. Novel biological sensors that utilize nanotechnology have the potential to improve therapeutic investigationssensitivity in the early diagnosis and monitoring of GIC as well as in the earlier and more accurate identication of specic affected tissues or organs. For example, immuno-microuidic chips using QDs of semi­conductors provide precise identication of cancer markers linked with humans, which may help GIC therapies be more successful. Biocompatible nanodevices include integrated gadgets for cancer detection before it occurs [54].
Nevertheless, despite the discovery of further microscopic cancer lesions in an individuals body, combating treatment resistance and improving the solubility of drugs and utilization efciency continue to be major challenges in the medical treatment of GIC. The main advantage of employing nanotechnology to develop a drug delivery system is its enormous specic surface area and changeable modi­cation capabilities, which are effective techniques to boost medicine utilization [55].
By modifying the surfaces of NPs to more precisely target tumour tissues, it is feasible to increase the concentrations of pharmaceuticals that are benecial in treating cancer while reducing the side effects of drugs used for chemotherapy and improving the effectiveness of anticancer drug therapy. NPsenormous functional surface areas make it possible for them to bind, absorb, and carry small-molecule drugs, RNA and DNA, as well as proteins, and probes [56]. They are also highly sought-after in many medical elds because of their adjustable size, shape, and surface properties, which provide them with good stability, large carrier capacities, their capacity to absorb water-based and hydrophobic agents, and compatibility with different drug delivery paths. Additionally, we may develop detecting and curative NPs that are ideally suited for more targeted and individualized illness treatment by merging diagnostic and therapeutic functionalities into just one biodegradable and biocompatible NP. These NPs have generated a lot of interest since they can increase the effectiveness for GI malignancies [57]. Due to their signicant particular surface domains, surface, and interfacial effects, NPs are naturally advantageous as drug carriers. When coupled with bioactive compounds, they can be used for both cancer therapy and imaging. Todays drug delivery alternatives include metallic substances, polymer-based NPs, lipid-based formula­tions, as well as theranostic NPs. In order to further reduce the negative impacts of
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intestinal reex movements on the early diagnosis and treatment of GIC, this data comprehensively explains the uses of the application of nanotechnology in the rapid identication and treatment of GIC as well as the clinical obstacles for GIC therapy. It also covers how to promote the earliest feasible clinical use of lab-developed nanoplatforms [58].
5.6.2 Nanotechnology in the early diagnosis
Medical evidence dating back decades shows that individuals with GIC who have lesions that are precancerous and the initial stages of carcinoma had better forecasts, less mortality, and longer life expectancies than patients with advancing disease. The current main clinical applications of early-diagnosis methods for GIC include an endoscopic examination, growth indicators, MRI, computed tomography, PET, and NIRF detection [59]. Given the development of science and technology as well as the expanding understanding of the aforementioned diagnostic mechanisms, researchers have found that there is room for advancement and renement of these diagnostic techniques. For instance, the application of endoscope capsules can diminish the discomfort that patients experience during invasive examinations and reduce the risk of inammation. Contrast chemicals can be administered before to MRI imaging to improve its diagnostic sensitivity. Recent research efforts to combine nanotechnol­ogy with the existing imaging technologies have boosted their sensitivity [60].
5.6.3 Theragnostic
To produce separate theragnosticchemical compounds for cancer imaging and medical therapy today, the phase of preclinical development is necessary. A single carrier is used for both therapeutic and diagnostic chemicals in theragnostics. These nanomaterials are intended to make imaging applications more convenient for both clinical and evaluation uses. To put this idea into practice, it is crucial to create important molecules that can react to chemical or physiological stimulus in the treatment zone. A range of triggers, such as pro-inammatory signs like pH level changes in temperature, an oxygen shortage, or specic binding to an inamed ligand, may have an impact on the system [61]. Messenger chemicals may be included within or bound to the carrier to help with imaging applications. Molecules may unite instantly through noncovalent or linked contacts during the creation of the nanocarrier, or subsequently through surface modication activities. Noncovalent or covalent interactions are selected depending on the goal and level of specicity of the region that has to be addressed. Under various pH or oxidative regimes, covalent linkages based on carbonyl, amine, or methicone coupling chemistries carry out a range of activities. If chemical adaptability is needed, covalent bonds can be replaced by hydrophobicity, electrostatic attraction, or hydrogen-bonding afnity [62]. There are various potential links between the test substances or curative molecule and the nanocarrier since polymers can be chosen to have a range of functional groups and/or polar sites. Coulomb or hydrophobic bonds (hydrophobic chemical loading) or interactions between ionic compounds (nucleic acids) have been successfully made possible by the use of amide, ester,
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disulde, hydrazone, or thioether connections. Yang et al showed how a practical approach to treating pancreatic cancers may be used [63]. To prevent the uPA receptor from interacting with its own organic ligand, uPA, this study used the urokinase plasminogen in order stimulating activator amino-terminal disintegration peptide as a substitute ligand with a strong propensity for binding to uPAR. ATF peptides have been shown to suppress angiogenesis and cancer development in a variety of animal carcinoma models. Yang et al discovered that cancer cells easily absorbed the ATF-coated NPs, elevating their respective roles in the development of tumour-specic therapeutic medication delivery and carcinoma imaging [64].
5.6.4 Tissue engineering
In tissue engineering, growth factors and scaffolds made of the right materials are combined with cell proliferation. For best effectiveness, biomaterials for biomedical engineering need to have linked pores and a large surface area. By allowing for cell movement, uid diffusion inside the biological material (such as the diffusion and discharge of nutrients), and electronic and chemical liaison among the cells producing the biomaterial, the holes support proper cell culture development [65]. In the digestive system, gastric ulcers may be treated using tissue engineering procedures. Hassani et al claim that polystyrene NPs adhered to the enlarged mucosal regions. This study demonstrated that tiny NPs, which adhered to injured tissue more frequently than healthy tissue, were most closely linked to this relation­ship. This nding emphasises the notion of using NPs as a technological extension for treating hepatic ulcers [66].
5.6.5 Targeted imaging and therapeutic in colorectal cancer
NPs offer benets in cancer, particularly imaging, due to their tiny size. When combined with magnetic resonance imaging, QDs, or NPs with quantum conne­ment qualities like size-tunable light emission, can generate great pictures of cancer locations. These NPs can be activated by any light that is proportionally blue-shifted to the emission spectrum since they are much brighter than organic dyes. When compared to conventional pigments, which are employed as a contrast medium, luminescent QDs may generate pictures with a greater contrast at a lesser cost [67]. The disadvantage is that making QDs typically involves using dangerous substances. For the treatment of cancer, nanotechnology-based treatments have already received approval. NPs like abraxane or liposomes like Doxil are examples of products that have received approval. Small nanocarriers tend to collect at tumour sites because there is ineffective lymphatic drainage there. In photodynamic treat­ment, particles are supplied to a particular area of the body and illuminated by an external light source [68]. The particle absorbs the light, and if it is made of metal, the lights energy may heat both the metal and the tissue around it. Additionally, by using light to create highly reactive oxygen molecules, it is possible to destroy neighbouring organic molecules by combining them chemically with the oxygen molecules. Photodynamic treatment provides a number of benets. Chemotherapy does not spread a toxic trailof chemically reactive compounds throughout the
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body since it only affects the area that has been lit via particle delivery. A noninvasive approach of treating illnesses, growths, and tumours is photodynamic therapy [69]. Recently, Kirui et al reported on the creation of advantageous oxide­based gold–iron NPs for the inspection, photothermal stimulation, and focusing of cancer cells utilizing laser light at 800 nm. After the gold NPs had been function­alized using carboxy-terminated phospholipids and linked to the A33 antigen seen in colorectal cancer cells, a single-chain antibody, scFv, was conjugated to them. The A33 antigen is overexpressed on the surface of SW1222 colorectal cancer cells, which led to the NPs becoming particularly immobilized on the cancer cellssurfaces. The NPs were then selectively absorbed by the cancer cells. After 808 nm light was absorbed, malignant tissue was specically removed, demonstrating the suitability of this technique for cancer diagnosis and therapy [70].
5.6.6 Gene therapy delivery
Due to the ineffectiveness of gene transfection, gene therapy still has signicant drawbacks. Vectors produced from viral or nonviral transporters are the two primary kinds employed in gene therapy. Despite having a high transduction yield, the viral gene delivery approach has a variety of undesirable side effects, including immunogenicity and probable carcinogenic consequences. The capacity of cationic polymers, such as chitosan, to bond with DNA or short-interfering RNA to form complexes that might serve as nonviral substitute carriers for gene therapy applications is another advantage [71]. The limited capacity of bare DNA inside cells and siRNA units to enter cell membranes is a signicant barrier to DNA and siRNA treatment. As solutions to this issue, several distribution tactics have been studied. Recently made attempts to create synthetic reagent-based tissue-targeted gene transport mechanisms have shown intriguing outcomes. More and more targeted NPsare being developed, which have a surface recongured with a synthetic protein, and an attractive substance, or an antibody implanted to the matrix of polymers in order to focus on a specic site before distributing the active agent [72]. This is done to increase the efcacy of siRNA-loaded polymer NPs. Whether biodegradable or not, NPs have demonstrated an intriguing ability to adhere to and disseminate DNA and siRNA among therapeutic carriers. In fact, it has been demonstrated that NPs may protect DNA and siRNA from degradation while also greatly increasing their pharmacological efcacy in vivo and in vitro. IBD, or inammatory bowel illness, might make a biocompatible system particularly crucial. The biodegradable polyamide envelope s capacity to safeguard and dissem­inate the siRNA into the cytoplasm may enable a successful in vivo transfection [73].
5.6.7 Colitis therapy
Effective, specialized drugs are now available for treating IBD, also known as ulcerative colitis and Crohns disease, a severe, chronic inammatory sickness. However, these treatments are often limited by major systemic adverse effects. IBD was treated only with immunosuppressants or anti-inammatory drugs (5-amino salicylic acid, steroids) up to the past ten years [74]. Although these drugs are effective,
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their usage has been restricted due to immune system problems that can be extremely hazardous. Despite the therapeutic efcacy of more modern biological therapies, such as monoclonal antibodies that combat tumour necrosis factor (TNF-α), some patients continue to develop antibodies to the medication, raising the risk of infusion reactions and decreasing the response of the individual to the therapy [75].
5.6.8 Oral delivery of vaccines
The delivery of vaccinations to the mucosa via nanocarriers is one of the greatest and most important potential uses for NMs in the future. NPs may be utilized as delivery vehicles, adjuvants, or both. When giving immunizations to the mucosa, nano- or microsized compounds may target certain locations and processes to hasten absorption. The majority of NPs smaller than the wavelengths of 200 nm are absorbed by M cells or the epithelium of the gut at the tips of villi. Large particles that can be consumed by GI macrophages include nano-sized liposomes [76]. The surfaces between NPs and tiny particles now contain a variety of ligands. peptides, such as glandular IgA, aimed at M cells in the rodent Peyers patch, or immuno­globulins such as mAb 5B11, which engages M cells on polymeric latex particles, can also function as ligands. They can also manifest as other molecules, including the bacterial molecule Invasin-C192, which is involved in the invasion of cells and adhesion. Additionally, ligands can be sugars linked to hydrophobic groups, such as O-palmitoyl the mannan or the B subunit, which is a component of the toxin that causes cholera [77].
5.6.9 Mitigation
An autoimmune illness of the digestive system, this condition affects the whole GI tract, with ulcerative colitis causing specicinflammatory processes in the colon. Serious social, economic, and health issues result from present medications failing and their negative effects. The ideal target for gene therapy delivery vehicles to treat IBD is the gut epithelium. Due to the hydrophilic, negatively charged, and biodegradable properties of nucleic acids (NAs), gene therapy incorporating the use of NA therapies confronts signicant difculties [78]. Scientists are motivated to create gene therapy vehicles that can be readily targeted to the appropriate tissues for IBD by recent success in developing biomaterials for gene therapy and their appearance in clinical trials for diverse illnesses. Nanotechnology advancements have made it possible to construct a variety of NPs for NA administration to treat IBD, which still has issues with targetability, poor therapeutic effectiveness, and GI tract stability [79].
5.6.10 Role in targeted drug delivery
The use of large-sized materials in drug administration also poses a variety of challenges, such as in vivo strength, poor bioavailability, and issues with target­specic distribution, in addition to the adverse reactions of the specic medicines (gure 5.4). Therefore, implementing cutting-edge drug delivery techniques to target drugs to a specic area of the body may offer a possibility to address these urgent
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Figure 5.4. Role of NPs in targeted drug delivery.
issues. The eld of nanotechnology creates nanoscale-sized materials made of lipids, metals, or natural or synthetic/semi-synthetic polymers [80]. When employed in targeted drug delivery, NPs can increase the bioavailability, biodistribution, and accumulation of treatments, concentrating them mostly in the targeted sick region and serving as stabilizers. The aforementioned variable colloidal systems can deliver drugs to the right places, increasing therapeutic efcacy while reducing side effects and toxicity, protecting the drug from biological degradation, and allowing immediate and physical medicinal properties to control at the exact site of disease.
The early use of nanocarriers for medication administration was founded on an indirect targeting mechanism in order to increase efciency over traditional free­drug formulations [81]. A unique approach, on the other hand, uses magnetic elds or conjugation procedures to increase medication delivery to target locations while employing active targeting by incorporating specic ligands. Therefore, innovation in drug delivery systems and formulations might result from the use of nano­technology. Effective and site-specic medication delivery makes it simpler to get a therapeutic outcome that can ght immunologic ailments, tumoural diseases, or neurological disorders. This special issue integrates many elements of nanotechnol­ogy research in quest of novel therapeutic targets and approaches. The physiological acceptance of layered liposomes and hybrids nanotechnology with surfactant agents, as well as mathematical models to ascertain the body routes of magnetic NPs or to elucidate the molecular make-up of metal-decorated fullerenes, are some examples of these [82].

5.7 Role of nanotechnology in intestinal tract

The digestive system is one among the ways whereby environmental NPs enter the human body. After being consumed, they immediately penetrate into the mucus barrier and engage the enterocytes. They are removed from the intestinal mucosa by
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