Materials Science & Engineering C 100 (2019) 616–630

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Materials Science & Engineering C

journal homepage: www.elsevier.com/locate/msec

Review

Advanced biomedical applications of carbon nanotube T

⁎
V.R. Raphey, T.K. Henna, K.P. Nivitha, P. Mufeedha, Chinnu Sabu, K. Pramod
College of Pharmaceutical Sciences, Govt. Medical College, Kozhikode, Kerala, India

A R T I C LE I N FO A B S T R A C T

Keywords: With advances in nanotechnology, the applications of nanomaterial are developing widely and greatly. The
Bioimaging characteristic properties of carbon nanotubes (CNTs) make them the most selective candidate for various multi-
Biomedicine functional applications. The greater surface area of the CNTs in addition to the capability to manipulate the
Biosensing surfaces and dimensions has provided greater potential for this nanomaterial. The CNTs possess greater potential
Carbon nanotube
for applications in biomedicine due to their vital electrical, chemical, thermal, and mechanical properties. The
Drug delivery
unique properties of CNT are exploited for numerous applications in the biomedical field. They are useful in both
Gene delivery
therapeutic and diagnostic applications. They form novel carrier systems which are also capable of site-specific
delivery of therapeutic agents. In addition, CNTs are of potential application in biosensing. Many recently re-
ported advanced systems of CNT could be exploited for their immense potential in biomedicine in the future.

1. Introduction Furthermore, the UV stabilizing action of the carbon nanotube is ben-

Carbon is a versatile element in the entire universe. According to the
arrangement of carbon atoms, different properties are developed for the
carbon nanotubes (CNTs). For over 6000 years carbon has been used for
the reduction of metal oxides. The different forms of carbon, namely
graphite and diamond also belongs to the family of chemical elements
[1,2].
The miniaturized products have been widely utilized in several
fields of chemistry. They provide enhanced options and functionalities
due to their specific structural, mechanical and electronic properties
[1]. The CNT consists of a layer of graphite rolled up into a cylinder.
The single-walled carbon nanotube (SWCNT) and multi-walled carbon
nanotube (MWCNT) differs in their arrangement of graphene cylinders
[3]. Carbon nanotubes (CNTs) are well assembled and have a greater
area, greater strength and enhanced properties of chemical and thermal
stability. CNTs have been excellent with a broad range of applications.
The solubility of CNTs is a greater barrier in carrying out several re-
search methodologies, but the dispersion of carbon nanotubes in water
has solved this critical problem by allowing facile manipulations to the
processing of carbon nanotubes. A wide range of bioactive molecules
could be conjugated with the CNTs. These molecular conformations
have suitably provided newer pathways in biomedical applications. The
development of the bioelectronic system has enabled greater opportu-
nities regarding the immobilization of DNA and proteins on the surface
of CNTs. The CNTs also possess excellent anti-oxidant action against
thermal and photodegradation of polymeric materials [4].
eficial while exposure to UV light and oxygen [5].
A carbon nanotube is formed from a graphene sheet rolled up to
form a cylindrical structure with sp2 hybridized carbon atoms. The one-
dimensional structure of carbon nanotube enables an efficient platform
for biomedical applications [6,7]. Due to their excellent electrical
properties, they have been used as electromechanical actuators, and
also as electronic and optical biosensors for recognition of bioactive
molecules like DNA, protein, cells, and microorganisms. Carbon nano-
tubes possess excellent properties of strong optical absorption in the
infrared region [8], photoluminescence [9], Raman scattering [10], and
photoacoustic and echogenic properties which are useful in visualiza-
tion and tracking of nanotubes in the biological environment. The poor
solubility condition of drugs, faster deactivation, and limited bioavail-
ability can be fulfilled by using CNTs which are preferentially used as
drug carriers. But one of the major disadvantages of the CNT is the
chance for the dissociation in biological fluids. Despite these properties,
CNT is the best drug carrier for enhanced penetration into the cells and
for exerting more privileged drug action [11]. This review emphasizes
the recent advances of the carbon nanotubes in the biomedical field.
2. Synthesis of carbon nanotubes
The three major techniques used for the synthesis of SWCNTs and
MWCNTs are arc discharge method [1,12–17], laser ablation method,
and chemical vapor deposition (CVD) [18]. In the first technique, two
carbon electrodes are used to form an arc with dc current. These carbon

⁎
Corresponding author.
E-mail address: pramodkphd@yahoo.com (K. Pramod).

https://doi.org/10.1016/j.msec.2019.03.043
Received 12 July 2018; Received in revised form 26 February 2019; Accepted 11 March 2019
Available online 13 March 2019
0928-4931/ © 2019 Elsevier B.V. All rights reserved.
V.R. Raphey, et al. Materials Science & Engineering C 100 (2019) 616–630

Fig. 1. Various cellular responses to carbon nanotube (CNT) leading to toxicity. CNT induces reactive oxygen species (ROS) which leads to apoptosis. Macrophage-
like cells migrate to the CNT, releases Interleukin 18 (IL-18), and produce amyloid deposits. CNT can directly produce genotoxicity or through the induced ROS. CNT
can induce mitochondrial damage which subsequently results in lysosomal damage. Metal impurities present in CNT, such as iron, induce ROS and results in cell
damage.

electrodes are placed in the vacuum and an inert gas is exerted into this
region. The presence of the gas causes faster carbon deposition. When
the pressure is regulated, the current is turned on. The positive elec-
trode in proximity to the negative electrode strikes the electric arc.
Thus, the electrodes get converted to red and hot and plasma is de-
veloped. When the arc becomes stabilized, the rods are kept somewhat
apart and carbon nanotubes get collected on the negative electrode.
After reaching a specific location, the current is turned off and the
machine is allowed for cooling. This technique forms both MWCNTs
and SWCNTs. Polyhedron shaped graphitic substances are formed as
the by-product during the MWCNT growth in the arc discharge method.
Thus MWCNTs with a wide range of diameters and of different

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V.R. Raphey, et al.
micrometers are formed. Of advantage, the MWCNTs formed are highly
crystalline and are set around by van der Waals forces [19].
The second method involves the utilization of a laser ablation
technique. In this technique, stronger laser pulses are used towards the
carbon target [18]. The SWCNTs are formed at 1200 °C where inactive
gas is already present. Thus formed SWCNTs are of rope or bundle
shaped with less than 20 nm and less than 100 μm in length. The uti-
lization of high vacuum laser-ablation leads to the development of
multi-layered MWCNTs. The yield of CNTs formed basically depends
upon the catalyst used for the reaction, the strength of the laser, the gas
utilized for the purpose and also upon the temperature and pressure.
The secondary products formed during the synthesis of SWCNTs are
fullerenes, graphitic polyhedrons [20].
Another technique utilized for the synthesis of CNT involves using
hydrocarbons which specifically acts as an energy source. With the help
of this energy, molecules get converted into radical species in the
temperature 550–750 °C. The catalytic degradation of acetylene over
iron particles at 700 °C yields carbon nanotubes of different length. The
CVD technique using microwave energy is used for this synthesis [13].
On the whole, the arc discharge and laser ablation techniques provide a
higher yield when compared to the CVD technique [21].
3. Toxicity of carbon nanotubes
When comparing other bulk materials, nanomaterials have some
significant characteristics because of the increased surface area to size
ratio. This property of carbon nanotubes makes them more reactive and
more toxic. Carbon nanotubes act like haptens and change the protein
structures and make them more antigenic by increasing the chances for
autoimmune effects. The major reasons behind the toxicity of carbon
nanotubes are the reduced size that causes an increment in their total
surface area which preferably indicates that the contact area with the
cellular membranes has been increased or else the absorption/trans-
portation of toxins has been substantially enhanced [22]. The formation
of superoxides and subsequently reactive oxygen species is yet another
reason [23].
The toxicity of CNTs is evaluated by both in vitro and in vivo
methods. In vivo toxicity studies are primarily conducted in mice and
rats. Nevertheless, studies in guinea pigs are also reported. Toxicity to
specific organs and biodistribution studies are commonly employed. In
vitro toxicity studies are possible using animal cell lines and microbes
such as bacteria and yeast. Cell proliferation/viability assay, apoptosis
detection assay, reactive oxygen species (ROS) production assay, and
superoxide dismutase measurement are very useful in vitro methods for
the assessment of toxicity of CNTS [24–26].
Physical properties such as the type and length of carbon nanotubes,
mode functionalization, metal impurities present, and the presence of
solubilizing agents influence the toxic effects of CNT [27]. The major
mechanisms behind the toxicity of carbon nanotubes are oxidative
stress, membrane injury, and the genotoxicity of CNTs [28]. The oxi-
dative stress is generated either because of diminished levels of anti-
oxidants or enhanced production of reactive oxygen species (ROS) and
certain in vitro studies has revealed it as the function of the con-
centration of SWCNTs [29]. The effect of membrane injury in gen-
erating cytotoxicity has been studied by exposing the highly purified
MWCNTs to mouse macrophages [30]. The CNTs can, directly and in-
directly, cause genotoxicity by the direct interaction with DNA or by
generating ROS from the inflammatory cells and these ROS may in-
teract with the genetic materials producing genotoxicity [31]. The ef-
fect of catalyst residue formed after the synthesis of carbon nanotubes is
a better reason for the toxicity. The synthesis of carbon nanotubes re-
quires certain metal catalysts which are themselves toxic [32]. The ROS
formed due to the free radical generation creates oxidative damage to
cells and membranes. Certain post-fabrication treatments also induce
toxicity. The fiber shape, length, and aggregation of CNTs could pro-
duce immune responses and cause their deposition in the tissues [28].
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Materials Science & Engineering C 100 (2019) 616–630
Since the functionalization with biocompatible materials and size can
greatly influence the toxicity of CNTs, the MWCNTs with small size
conjugated with polyethylene glycol is exhibiting reduced toxicological
profile [33]. Various cellular responses to CNT leading to toxicity are
shown in Fig. 1.
The CNT toxicity is encountered as DNA damage or mutation, in-
flammatory responses, oxidative stress, malignant transformation, the
formation of interstitial fibrosis, and granuloma [34]. A toxicological
study conducted with both pure and metal-doped SWCNT in mice has
induced lung granulomas, peribronchial inflammation, and necrosis
pointing towards pulmonary toxicity. Moreover, based on different
studies, CNTs are proved to be cytotoxic and also have adverse effects
on cardiovascular and reproductive systems [35]. CNTs can be carci-
nogenic based on its ability to induce genotoxic stress. The gene ex-
pression profiles of untreated and SWCNT treated human normal lung
cells have been analyzed in order to detect the genotoxicity of CNTs and
this microarray analysis has shown marked changes in gene expressions
[36]. Despite all these characters, they have succeeded in their bio-
medical applications with different functionalization strategies as it
causes a reduction in the toxic effects which makes them more useful.
4. Properties of carbon nanotubes
Carbon nanotubes are privileged members of the fullerenes family
[37]. The conductivity of CNT depends on several properties. The
electrical conductivity order of a single CNT is usually between
104–107 S/m [38,39]. But often, the MWCNT possesses greater voltage
leading to higher electrical conductivity. The percolation threshold for
MWCNT is lower when compared to other composites. The volume of
the carbon nanotube can suitably increase the electrical conductivity.
The SWCNT produces networks that form a contact blockage [40–42].
This formed contact blockage is typically dependent upon length, dia-
meter and structural configuration of nanotubes. The association en-
hances in between atoms when they are assembled in a media or matrix
system. The electric tunneling effect, however, provides a stronger
coating and that reduces the electrical conductivity of the material. The
nanotube waviness plays a significant role in regulating the electrical
conductivity of the carbon nanotubes [43]. The wavy nanotubes have a
greater number of associations when compared to that of the straight
one which suitably interrupts the electrical conductivity of the material.
The structural configuration of the carbon nanotube has made a path
for the increased electrical activity of the material [44].
Carbon nanotubes possess greater mechanical properties especially
because of their cylindrical graphitic structure [45]. The average
Young's modulus and tensile strength of carbon nanotubes are lesser
than the observed value. From the theoretical studies, it is revealed that
SWNTs possess greater tensile strength when compared to the MWNTs
[46]. The carbon nanotubes are incorporated into several matrix sys-
tems in order to enhance the physicochemical properties of the nano-
tubes. For instance, carbon nanotubes are incorporated with the epoxy
polymer systems in order to produce newer composite materials [47].
The nanometer dimensions of carbon nanotubes are of paramount sig-
nificance in the sense that they are responsible for the perpetual char-
acteristics of the system. The CNTs possess excellent tensile force which
makes them the most stronger component with increased thermal
conductivity [48]. The inherent optical properties like NIR photo-
luminescence exhibited by CNTs make them excellent bioimaging
probes [49].
The capability of carbon nanotubes for the incorporation of the
molecules like proteins and oligosaccharides enables them an essential
carrier for the delivery of various active molecules like drugs and re-
lated molecules [50]. The solubility of carbon nanotubes is an issue, but
this can be overcome to a greater extent by means of covalent func-
tionalization [51]. Polyethylene glycol and ammonium terminated tri-
ethylene glycol and some bioactive molecules like oligonucleotides and
proteins are utilized to functionalize CNT. The bonding of the
V.R. Raphey, et al.
Fig. 2. In-vivo biodistribution of fluorescent labeled rigid CNT (A) and flexible CNT (B) in mice. A2 and B2 are the corresponding shortened CNTs. “Reprinted with
permission from [55]. © (2017) American Chemical Society.”
functional groups to the active moieties leads to the enhanced solubility
of CNT. Nanotubes can be used as superstrong fibers, as a reactant and
also as molecular switches. The CNTs are also used as loudspeakers
which produce sound with a different frequency range. The carbon
nanotube loudspeaker has a fine structure with different characteristics.
The carbon nanotube thin film consists of carbon nanotube with 10 nm
diameter and it is aligned parallelly. The carbon nanotube loudspeaker
can produce a sound similar to that of the commercial loudspeaker. The
carbon nanotubes exhibit excellent mechanical and electronic proper-
ties. The nanotubes may be metallic or semiconducting based on the
chirality and diameter of the carbon nanotube [52]. The greater elec-
trical conductivity and the high aspect ratio of the carbon nanotube is
the reason behind the field emission characteristic of the carbon na-
notubes [53,54]. The different physicochemical properties of carbon
nanotube can be highly influential on cell toxicity, cell uptake, and its
distribution. Rigid and flexible CNT show significant differences in their
in-vivo biodistribution pattern (Fig. 2) [55].
5. Biomedical applications of CNT
CNTs possess unique characteristics which equip them for a variety
of applications in biomedicine. CNTs are hydrophobic in character and
therefore are suitable for various biological applications [56]. The CNT
interacts with the receptors present in the cell surface which leads to
their internalization due to the presence of different functional moi-
eties. These receptor-mediated processes allow specific cell loading
which can facilitate a reduction in the dose of a drug [57].
5.1. Therapeutic applications
5.1.1. Drug and gene delivery
CNTs have been utilized for designing a wide variety of drug de-
livery systems for the treatment of many diseases. Certain unique
properties of carbon nanotubes (high drug loading capacity, large sur-
face area, high mechanical strength, and adequate chemical stability)
make them excellent nanocarriers for drug delivery [58]. CNT-based
anticancer drug delivery systems are prevalent which involves selective
targeting obtained through functionalization [59–62]. CNTs can be
tuned sensitive to tumor microenvironment which results in the re-
duction in toxicity and of side effect. The multi-drug resistance of tumor
cells and prevention of cell proliferation and cell cycle in the affected
cancer cells can be probably reduced by the utilization of a CNT-based
system [63]. The development of peptide-modified SWCNTs has shown
a high anti-tumor effect and enhanced tumor-targeting [57].
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Materials Science & Engineering C 100 (2019) 616–630
CNTs also act as a carrier for immunization against antigens [51].
For some substances like acetylcholine, which cannot be transported to
the brain through normal means can be easily delivered using SWCNT
[64]. Nevertheless, covalent functionalization of SWCNT with amide
and ester bonds allows delayed release of drug for a sufficient time
period which causes the increase in solubility of aqueous and organic
media [65]. MWCNTs are used for interaction with neural tissue cells
and are useful for developing efficient gene and drug delivery systems
[66]. The capacity of SWCNT for the incorporation of the drugs is
greater. The drug encapsulated functionalized CNTs enters the cells by
crossing the cell membrane either by endocytosis or passive diffusion
and gets internalized within the cell organelles and nucleus. Exocytosis
and enzymatic degradation are the two mechanisms by which the CNTs
get eliminated from the cell [67]. The novel cocoon-like nanoparticles
based on polyethylene glycol and MWCNTs exhibit high potential to be
used as nano-biomaterials and can be easily loaded with the natural
anticancer drug curcumin [33]. Recently, the anticancer drug cisplatin
has been reported to have antileishmanial activity in a recent study.
The study revealed the less cytotoxic nature and enhanced an antil-
eishmanial activity of cisplatin bonded MWCNTs at a very low con-
centration emphasizing the tremendous potential of CNTs as drug na-
nocarriers [68]. Recently, CNT buckypapers have proved to be useful
for transdermal delivery of drugs. The in vitro studies demonstrated the
potential of CNT bucky papers in controlling drug release [69].
The carbon nanotubes form several molecular complexes with nu-
cleic acids due to the electrostatic interrelationships. The cellular de-
livery of nucleic acids is one among the major function of the carbon
nanotubes [70]. The major aim behind this is the incorporation of the
plasmid DNA into the cells and entering into the nucleus of the cell. Like
that of the other groups of non-viral carriers like liposomes, positively
charged polymers and nanoparticles, the functionalized carbon nano-
tubes has been useful in condensation of plasmid DNA [71,72]. The
complex structures can be formed with both single walled and multi-
walled carbon atoms. The functionalized carbon nanotubes have a
critical role in the case of assertion of β-galactosidase [73]. The profi-
ciency of gene transfer with the functionalized carbon nanotube is en-
hanced by the formation of the covalent structure along with the outer
walls of the tube with polyethylene mine. The polyethyleneimine in-
corporated MWCNT releases plasmid DNA to a variety of cells. An in-
teresting fact about cationic carbon nanotubes is their ability to com-
press shorter oligodeoxynucleotides by the stimulation of the
adrenaline. More precisely, greater amounts of functionalized CNT with
a decreased immunostimulatory amount of oligodeoxynucleotide en-
hance the immunostimulating activity in vitro by reducing the discharge
V.R. Raphey, et al. Materials Science & Engineering C 100 (2019) 616–630

Fig. 3. Diagrammatic presentation of tumor-targeted delivery using CNT.

of proinflammatory cytokine interleukin-6. Carbon nanotubes are also

used to transport non-encoding RNA polymerase into cells [74]. CNTs
form a diverse amount of molecular complexes with the nucleic acids
which lead to pave the way towards a variety of applications involving
gene therapy, genetic vaccination, and immunostimulation activities.

5.1.1.1. Carbon nanotubes in cancer therapy. Cancer is characterized by

uncontrolled growth of the cells that cause the damage of the normal
tissues and organs. The cancerous growth leads to an insufficient
proliferation of the cells. The rapid growth leads to metastatic effect
which causes total destruction of the normal cells and tissues. The
greater aspect ratio of the carbon nanotube and their greater surface
area and needle-shaped structure leads to conjugation with the drug
molecules [75]. Carbon nanotubes are useful as nanocarriers in cancer
therapy. Fig. 3 shows a diagrammatic presentation of tumor-targeted
delivery using functionalized CNT.
The photothermal therapy with CNTs provides tumor healing. The
nanosize facilitates easy tumor internalization and enhanced drug Fig. 4. Cell viability study of DTX and DTX-CNTP-Tf on A549 cell lines in-
loading capacity. In addition, CNTs protect drugs from enzymatic de- dicates higher toxicity free DTX-CNTP-Tf than free DTX. “Reprinted with per-
gradation. MWCNTs, when conjugated with targeting molecule trans- mission from [76]. © (2018) Elsevier”.
ferrin (Tf) and loaded with anticancer docetaxel (DTX), shows higher
cytotoxicity than free docetaxel (Fig. 4) [76]. established so that the anti-tumor effect is increased. Polyethylene
Chemotherapy is used to treat cancer along with surgery and ra- glycol functionalized SWCNTs can be attached to doxorubicin to en-
diation. Due to the treatment, the therapeutic window is narrowed and hance the therapeutic efficacy. The conjugation with folic acid, dex-
the resistance towards the drug is increased. To overcome this, novel amethasone, and antibodies also improves the therapeutic efficacy of
methods are tried out in order to obtain targeted delivery to the tumor the drug product. New delivery systems are also developed by
cells [77]. The camptothecin loaded multi-walled carbon nanotubes are

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conjugation with iron nanoparticles and folic acid with MWCNTs [28].
The magnetic nanoparticles in the carbon nanotubes can be used for
cancer diagnosis. The tumor targeting effect of the carrier is enhanced
by the effect of a magnetic field. The destruction of the tumor cells is
characterized by the selective and specific production of the che-
motherapeutic agents [78]. Some of the chemotherapeutic agents stop
the DNA replication, reduces the cancer cell development, and also
diminishes the activity of the DNA [79]. During the incorporation of an
anti-neoplastic drug inside the MWCNT, CNTs with the greater dia-
meter provide higher loading efficiency than the CNTs with a smaller
diameter [80]. The functionalization of the carbon nanotubes further
enhances the loading efficiency of the tube. On carboxylation, CNTs
exhibit higher conjugation with hydrogen bonds. The stability and the
capturing capacity is higher for these carboxylated MWCNTs [7]. The
CNT-based hybrid nanocomposites have been useful in the case of
cancer diagnosis and treatment. The greater surface reactivity, smaller
arrangement, and increased biocompatibility enable CNT a better drug
delivery system. The reaction of the folic acid and iron nanoparticles
with oxidized MWCNTs leads to the synthesis of double targeted drug
delivery system in order to target cancer cells in the presence of ex-
ternally applied magnetic field [81]. The biostable and less cytotoxic
MWNTs with excellent photothermal conversion efficiency can be a
therapeutic regimen for pancreatic cancer in the future [82]. The
gemcitabine (GEM) loaded MWCNTs surface modified with PEG and
hyaluronic acid has resulted in a sustained and temporal release of GEM
indicating its potency to be utilized in colon cancer targeting [83].
Recently, a novel CNT based drug delivery system was developed spe- Fig. 5. Diagrammatic presentation of CNT-mediated drug delivery across the
cifically for tumor targeting. Here, an in vivo biodistribution and en- BBB.
hanced therapeutic efficacy for cisplatin has been demonstrated using
three different human breast cancer xenograft models, after the en- CNT as a carrier [88–112].
capsulation using SWCNT capsules. A significant change in circulation
rate and a more tumor-specific accumulation was determined when
compared with free cisplatin administration [84]. 5.1.2. Carbon nanotubes in vaccine delivery
The carbon nanotubes anchored with antigenic peptides could
5.1.1.2. Carbon nanotubes for drug delivery across the blood-brain overcome the major hurdles associated with vaccine delivery [113].
barrier. The drug delivery to the brain is challenged as it is difficult The adjuvant property of carbon nanotube makes them excellent vac-
to cross the blood-brain barrier (BBB). Some recent studies have shown cine delivery systems having immense potential to stimulate the innate
the possibility of targeting the brain with functionalized carbon immune response [58,79]. The carbon nanotubes have also been proved
nanotubes. In comparison with other nanocarriers, they possess to be a better non-viral gene delivery vector which could probably limit
intrinsic optical and thermal properties. In addition, the ability of the other non-viral vectors which show poor pharmacokinetic profile.
functionalized carbon nanotubes to cross the biological barriers by The capability of a vaccine to induce spontaneous immune response
transcytosis and passive process makes them optimal nanocarriers in develops the efficiency of that particular one. The vaccine reacts with
brain targeting [81]. A diagrammatic presentation of functionalized cytotoxic T cells which aim at the infected cells through opsonization
CNT-mediated drug delivery across the BBB is shown in Fig. 5. and pathogen clearance. The CNTs are capable of stimulating various
The first evidence for the capability of the functionalized carbon genes during immune response production like nuclear factor kappa-
nanotubes to cross the blood-brain barrier when administered sys- light-chain-enhancer of B cells, interleukins, and tumor necrosis factor-
temically was provided using a co-culture BBB model of porcine brain α. The antigen presenting cell plays a significant role in the immune
endothelial cells. It was shown that functionalized MWCNTs crosses the response of the cells. They uptake antigen and then destructs it and then
BBB through a transcellular route and there is no involvement of tight delivers it to the surface complexes through major histocompatibility
junctions in it [81]. Considering the ability of carbon nanotubes to cross complexes (MHC Class 1 or Class 2). The MHC-Class 1 produces greater
BBB and focusing on the targeting of amyloid β plaques in Alzheimer's cytotoxic CD8+ T cell response whereas MHC Class 2 transfers the
disease and the early detection of the disease, functionalized carbon immune response to helper CD4+ T cells that will probably enhance
nanotubes were selected as the nanocarriers for the Pittsburgh com- antibody induced response [114]. CNT can stimulate both MHC Class 1
pound B (Amyloid β binding molecule) with a suitable ligand. This and MHC Class 2 such that inducing a humoral response.
study pointed out the potential of functionalized carbon nanotubes to CNT containing peptides against foot and mouth disease virus
deliver the drugs and compounds that usually do not cross BBB [85]. (FMDV) or the N-terminal of the Plasmodium vivax Apical Membrane
The functionalized multi-walled carbon nanotubes (f-MWNTs) with the Antigen 1 creates a greater amount of antibodies. In addition, the an-
brain targeting ligand Angiopep-2 (ANG) having a high affinity for the tibodies formed are particular to the regions of the CNT. These anti-
low-density lipoprotein receptor-related protein-1(LRP1) facilitated the bodies regulated FMDV infections. Nevertheless, Wilm's Tumor Protein
brain delivery. The study also reported the improved BBB permeation 1 is reacted with single-walled carbon nanotube which is rapidly ac-
and in-vitro and in-vivo brain tumor targeting with ANG conjugated companied by human Apical Membrane Antigen. The SWCNT com-
carbon nanotubes [86]. In brain glioma, a combination of oxidized bined with Wilm's Tumor Protein through ingestion of macromolecular
MWCNTs-PEG with angiopep-2 as targeting ligand is reported to have a antigen undergoes the mechanism that they get coordinated in the ly-
dual targeting ability [87]. sosomal region which causes the destruction of antigen and leads to
There are still more drug and gene delivery applications reported for greater therapeutic response. However, SWCNT related peptides pro-
CNTs. Table 1 provides the most recent and advanced applications of vide a much greater response than tumor self-antigens. CNTs can also

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Table 1
Recent and advanced drug/gene delivery applications of CNT.
Sl. No. System Drug/gene Application Reference

1. Incorporation of functionalized CNTs into Griseofulvin and sulfamethoxazole Dissolution enhancement [88]
hydrophobic drug crystals
2. Functionalized CNTs Cladribine Anti-cancer therapy [89]
3. Hydrogel-CNT delivery system Doxorubicin and rhodamine B (model drug) Simultaneous monitoring of the release of dual drugs [90]
4. CNT-(Fe)/hydroxyapatite composite Doxorubicin Magnetic targeted drug delivery carrier [91]
5. TiO2-Au embedded on MWCNTs Doxorubicin Tumor-targeted drug delivery [92]
6. pH-responsive polyethylenimine-betaine siRNA and doxorubicin Combination of gene therapy and chemotherapy [93]
functionalized CNT
7. CNT–dendrimer system Ubiquitin and pyrene (Molecular modeling) Drug loading [94]
8. Carbon Nanotubes Double-stranded nucleic acids (Molecular Gene delivery [95]
dynamics)
9. Injectable and thermosensitive chitosan–CNT hybrid Methotrexate Anti-tumor [96]
hydrogel
10. Antibody-conjugated CNTs Anti-P-glycoprotein antibody P-glycoprotein-targeted photothermal therapy [97]
11. Boron nitride nanotubes and CNTs Efavirenz Anti-HIV drug delivery [98]
12. Carboxylated CNT Hydroxyurea Enhanced drug loading [99]
13. MWCNT-gemcitabine- lentinan composite Gemcitabine Cancer therapy [100]
14. Hydroxyapatite-MWCNT composite filled by iron Chlorhexidine Drug delivery [101]
15. PEG-functionalized CNTs/gelatin-chitosan Ciprofloxacin Drug delivery and dissolution [102]
nanocomposite
16. Cyclodextrin-modified SWCNTs Formononetin Drug delivery [103]
17. Functionalized SWCNTs Flutamide Enhanced drug loading [104]
18. Hyperbranched polyglycerol modified CNTs Doxorubicin Drug delivery [105]
19. Covalently functionalized carbon nanotubes Doxorubicin Enhanced encapsulation efficiency [106]
20. Oxidized MWCNTs Metformin Reduced cellular uptake of CNT [107]
21. Copper nanoparticles synthesized on the surface of Copper nanoparticles Increased antimicrobial activity against biofilms and [108]
CNTs without toxicity
22. Biodegradable MWCNTs Oxidized MWCNTs Anti-tumoral effect [109]
23. Noncovalent pyrene-PEG coated CNTs Pyrene-PEG coating (without drug) Enhanced biocompatibility for carrier [110]
24. MWCNTs modified with cyclodextrins and Cidofovir Antiviral drug delivery [111]
polyethylenimine
25. Starch/MWCNT-glucose nanocomposites Zolpidem Drug delivery [112]

induce stimulation in MHC Class 1 receptors which cause toxicity for
the cells leading to the production of IFN-γ, TNF-α, and IL-12.
5.1.3. Tissue engineering and regenerative medicine
Tissue engineering and regenerative medicine by means of carbon
nanotubes have been developed recently [115]. In this method, cells are
encapsulated into suitable biological materials so that the development
of the newer tissues takes place [115–117]. The carbon nanotubes have
been useful for improvising the mechanoelectrical aspects of scaffolds,
for the sensation of the micro ambiance of the cell, and they permit the
chemical reactions taking place inside the cells.
5.1.3.1. Bone and muscle regeneration. The utilization of carbon
nanotubes as scaffolds for rejuvenation of the neural system is a
promising development in the field of neurosurgery, osteology, and
cardiology. The bone development is obtained by the functionalization
of the carbon nanotubes which bears certain groups that adhere to the
carbon cations. Usually, MWCNTs are utilized for these procedures
which help in the bone formation [28]. The conducting property and
the ability of CNT to electrically stimulate the cells aids in osteogenic
differentiation and cell proliferation [118]. The fibrillar/extracellular
matrix protein mimicking morphology of CNTs and the capacity to
promote cell adhesion make them able to use with synthetic bone
substrates [119]. The MWCNTs can be used for the development of
myoblast. The electrically conductive hydrogels have been fabricated
with the inclusion of MWCNTs generating an electrical stimulation that
improves the myoblast formation by enhancing the myotube
maturation [119]. The growth period of myotube has extended due to
the utilization of the electrical sensations produced by MWCNTs. The
development of biohybrid tissue actuators leads to the establishment of
a newer technique for solving the existing drawbacks in the biorobotics
and drug development [28]. The stem cell therapy has been flourishing
due to the recent developments in tissue engineering and regeneration
due to the introduction of various methodologies based on the
applications of CNTs. Thus, the generated mesenchymal stem cells
were capable of differentiating into various cells and tissues [120]. The
SWCNTs were capable of existing in the same cellular structure without
changes in the significant viability for over 24 h. This special
characteristic of CNTs allowed their continuous use in stem cell
therapy and in the tissue regenerative techniques [121].
5.1.3.2. Neural regeneration. CNTs are composed of graphene sheets;
the number of graphene cylinders determines the type of carbon
nanotube. The carbon nanotubes are inert in nature and are not
biodegradable. This makes the material ideal in bioengineering,
mainly for scaffold production for cellular growth. The MWCNT can
act as a product for neuronal cell development and is vital in the
manipulation of the neural cells. MWNTs are beneficial in the
production of scaffolds in the neural sciences. CNTs can be used as
implants in cases of spinal cord regeneration or brain injury [122].
One of the vital clinical manifestations is that the injured region
causes an increase in length for the neuritis and thus causing the
‘bridging’ effect. The total neurite length remains the same because the
average length of neurites enhances proportionally. The manipulations
in the intracellular calcium level homeostasis prevent the entry of cal-
cium ions to the intracellular space. Whenever there is an enhanced
intracellular calcium level, it proceeds to the enhanced length of the
neurites. The neurons which are incorporated by SWCNT and PEG
cause the enhanced growth of the neurites. Nevertheless, the water-
soluble SWCNTs can be used for CNS injury as it causes neurite de-
velopment which further leads to renewal of the neuronal joints which
are disconnected due to the injury. Further, the characterization of
carbon nanotubes is prevalent in order to obtain ideas about the reg-
ulatory effects on cellular development. During functionalization of
SWCNTs, the SWCNT incorporated with 4-benzoic acid provides lower
cellular assembly when compared to other systems such as with 4-tart-

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V.R. Raphey, et al.
Fig. 6. Cytotoxic effects on the viability of A549 cells (A, B) and HeLa cells (C, D) with different concentration of f-SWNT/PPP-g-PSt-PCL with and without folic acid.
“Reprinted with permission from [101]. © (2013) American Chemical Society.”
butylphenyl. Thus, CNTs are capable of providing different products
that are suitable for the regeneration and cellular growth of the neurons
[123].
The collaboration of the carbon nanotubes with the endogenous
ligands present in CNS causes a reduction in the ligand activity during
combination with CNT [122]. The MWNTs associated with the neu-
trophils are the leading edge for the neuronal outgrowth. The en-
dogenous ligands like nerve growth factor and brain-derived neuro-
trophic factor are some of the suitable linkers. The incorporation of this
nerve growth factor further causes neural development, whenever the
soluble neutrophin gets affixed with the receptor forming a complex
that could envisage into cells [123].
5.1.4. CNTs in neuroprosthetic implants
The SWCNTs are characterized by greater strength and enhanced
conductivity properties. The implant prototypes are formed by affixed
packing of SWCNTs for the prevention of nanotube dispersions. An
aqueous suspension of SWCNT with a specific amphiphilic polymer
enhances cellular attraction and enhances the application in biomedi-
cine. The presence of a positive charge on the surface of the polymer is a
suitable reason for the increased cellular adhesion. The incubation of
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Materials Science & Engineering C 100 (2019) 616–630
the prepared nanotube films with neuronal cells in the culture medium
is an exact estimation of the biocompatibility. The polymer in-
corporated nanotube-containing layer-to-layer structure is useful in the
development of the neural cells [124].
The spraying technique of the SWCNTs and MWCNTs solutions into
the already prepared heated substrate is prevalent. The capability of the
formed material is greater in the culture and is well suited for the im-
planting procedure. Thus, prepared neuroprosthetic implants are sui-
table for neuronal maintenance and regulation. The formed neurites
suitably resemble the external characterizations of the nanotube in-
volved structures. Thus, the layer-to-layer SWCNTs can be suitably
utilized for neuronal development and implantations. The structural
characterizations and the morphology of the product are responsible for
these effects. The capability of the layer-to-layer membrane for asso-
ciating various drug substances allows neural growth following sy-
naptic relationships without varying the versatile characteristics of
SWCNT which is the loophole in the production of implantable mate-
rials [125]. Studies prove the immense potential for CNTs as the elec-
trode material in retinal implants with greater biocompatibility and
electrical properties [126]. Several surface modifications are done to
fabricate the electrodes with the intention of directly stimulating the
V.R. Raphey, et al.
Fig. 7. TEM images of CNT@Au (A, B, C). And D represents a SEM image of single CNT@Au deposited on silicon substrate Reprinted with permission from [134]. ©
(2012) American Chemical Society.
spiral ganglion neurons using a neuroprosthetic cochlear implant which
consists of an array of electrodes. MWCNTs used along with conducting
polymers could intensify electroactivity of neural electrodes. The sur-
face properties of carbon nanotubes including polarity, charge and its
chemistry could produce efficient neuron electrode coupling [127].
In order to identify the effectiveness of the implant after surgery, the
cross-section of the implanted electrode is done by scanning electron
microscopy. The condition of the implanted electrode can be done by
two imaging techniques, ex vivo photoacoustic microscopy and mag-
netic resonance imaging [128].
5.2. Diagnostic applications
5.2.1. Carbon nanotubes for biomedical imaging
This resembles an excellent idea for perfect imaging of the cells,
tissues, and organs. Carbon nanotubes can be used for improvisation of
the functionalities in case of imaging [129]. The two specialized
methods that can be utilized are photoacoustic imaging and magnetic
resonance imaging. Moreover, carbon nanotubes can be provoked by
additionally applying an external magnetic field. The complete char-
acterizations of the CNT vary when newer elements are incorporated.
The capacity of imaging can be developed by the utilization of various
techniques such as by the addition of gold nanoparticles, quantum dots
etc. It has to be perpetually checked of the toxicity levels of the adding
elements. This is a promising technique for the treatment of a tumor.
A fluorescent bioimaging probe was developed that provides the
folate receptor positive HeLa cell-specific bioimaging. The carboxyl
functionalized SWCNTs modified with the copolymer poly(para-phe-
nylene) (PPP) containing polystyrene (PSt) and poly(ε-caprolactone)
(PCL), and folic acid conjugate can be an effective bioimaging probe for
targeting the folate receptor overexpressing tumor cells. Dose-depen-
dent cytotoxic effect of f-SWNT/PPP-g-PSt/PCL/FA on A549 cells and
HeLa cells were obtained (Fig. 6) [130].
The fluorescence emission in the near-infrared (NIR) region by the
semiconducting SWCNTs renders them excellent fluorescent bioima-
ging probes. The physical characteristics of CNTs, especially SWCNTs,
are responsible for their imaging capability. CNTs due to their specia-
lized property of greater NIR absorbance are suitable for photoacoustic
imaging [131]. Moreover, fluorescence imaging has been a vital tool for
the biomedical and scientific field. The SWCNTs are one dimensional in
nature and their densities are represented by Vant Hoffs singularities.
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Materials Science & Engineering C 100 (2019) 616–630
The utilization of PEGylated amphiphilic polymer is useful for the so-
lubilization of the carbon nanotubes. Fluorescence imaging can be
utilized for the complete diagnosis in the tumor cells [28]. Carbon
nanotubes complexed with metal oxides can contribute vital char-
acteristics to bioimaging processes [132]. The CNT electrodes obtained
through the carbon nanotube templated microfabrication (CNT-M)
technique has resulted in low distortion images in MRI tests when
compared with other reference electrodes and this CNT electrode with
good electrochemical properties offers advanced application opportu-
nities in the field of MRI as well as deep brain stimulation [133].
The synthesis of gold nanoparticles on the surface of CNT is useful
for both biomedical imaging and for other therapeutic applications. For
this purpose, the optical properties of branched nanoparticles are
combined with CNT. Gold nanoparticles incorporated CNT can be
loaded with drugs such as doxorubicin. TEM and SEM images of gold
nanoparticle incorporated CNT are shown in Fig. 7 [134].
5.2.2. Carbon nanotubes as biosensors
Biosensors are one among the vital tools in the biological recogni-
tion of the bioactive molecules. They have enhanced electromechanical
properties for the sensation of the bioactive materials. The increased
surface area of CNTs develops them as a major vehicle for biological
species detection at smaller concentrations. This characteristic of bio-
sensors makes them more useful as an ultrasensitive biosensor. The
greater sensitivity, faster action, greater lifespan, and enhanced shelf
life properties make them of enhanced significance [135].
Nanobiosensors are useful in the diagnosis of various materials. The
implantable biosensors are greater in size. Due to their bigger size,
when they enter into the body it causes a traumatic effect. The nano-
sensors are the nanosized biosensors which are useful in recognizing the
various body conditions such as diabetes. Glucose biosensors are criti-
cally vital. They measure the glucose level and are therefore very much
useful for diabetes patients. Other examples for the nanotube biosensors
are protein sensors, immunosensors, nucleic acid sensors, and infection
sensors. The ultrasensitive detection of volatile biomarkers of gastric
cancer cells has made possible with the development of a novel elec-
trochemical biosensing interface with Au-Ag alloy composites covered
MWCNTs [136].
The modulation of an electrochemical biosensor utilizing functio-
nalized MWCNT with indium tin oxide is much useful in urea detection.
The formed bioelectrode possesses higher sensitivity and it enhances
V.R. Raphey, et al.
Fig. 8. Aptamer-CNT based biosensor system. In the presence of the biomolecule, CNT interacts with the electrode to produce an electrochemical current. In the
absence of the biomolecule, no signal is obtained.
the sensitivity of the MWCNT itself. This further leads to the greater
redox potential of the MWCNT. The electrical conductivity of MWCNT
is increased and it acts as an electron wire in between the enzymes and
the electrode's surface. The bioelectrode helps in the retention of the
enzyme activity even after 30 days under a refrigerated condition at
4 °C [137]. An aptamer wrapped SWCNT-based electrochemical bio-
sensing system has been developed for the sensitive detection of various
biomolecules like thrombin. An electrochemical current will be gener-
ated as the CNTs gets adsorbed on the gold electrode modified with a
self-assembled monolayer of 16-mercaptohexadecanoic acid only in the
presence of target biomolecule [138]. An illustration of general me-
chanism of aptamer-CNT based biosensor system is shown in Fig. 8.
Enzyme biosensors are widely used, for instance, the tyrosinase
biosensor is one among them. The electrocatalytic activity of MWCNTs
increases the reaction signal that leads to greater shelf life and activity.
The first reason behind the biomolecular conjugation is the greater
surface area which is the most promising characteristic of carbon na-
notubes. The glucose level estimation is one of the better achievements
of this enzyme biosensors [139]. The applications of CNT as biosensors
involve several fields like medical diagnosis and forensic sciences. Both
double and single-stranded DNA is having the sensing capacity. The
adsorptive property of single-stranded DNA to the CNTs makes it more
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Materials Science & Engineering C 100 (2019) 616–630
suitable for DNA biosensing. Thus CNT-DNA complexes are highly
beneficial in biosensing of several properties of the bioactive species.
These mechanisms had further reached the establishment of ultra-
sensitive biosensors and DNA sequencing detectors [28]. The DNA
sensors that can be applied for genetic screening and detection have
been fabricated with MWCNT and polydimethylsiloxane composite
electrode and the DNA sensing is by electrochemical impedance spec-
troscopy. The DNA gets physisorbed on the electrode surface and the
DNA recognition occurs via the π-π interaction of DNA with the
MWCNT surface [140]. The enzymatic and the electrochemical re-
sponse of sensors has improved upon the incorporation of the surfac-
tant-modified single-walled carbon nanotubes because of its high sur-
face area networks. The films of glucose oxidase and ferrocene having
polyethylenimine film base have resulted in a five-fold increase in
glucose electro-oxidation current when SWCNTs were incorporated.
The glassy carbon electrodes modified with SWCNTs elicits a number of
possibilities for the fabrication of novel biosensors with improvised
enzymatic and electrochemical performance [141]. The two essential
catecholamine neurotransmitters, dopamine and epinephrine levels
vary during schizophrenia, Parkinson's disease, and Huntington's dis-
ease. The conventional detection methods are found to be less efficient
as the biological fluids of dopamine and epinephrine mostly coexist
V.R. Raphey, et al. Materials Science & Engineering C 100 (2019) 616–630

Table 2
Projected future applications of recently reported advanced systems of CNT.
Sl. No. Advanced systems of CNT Projected future application in biomedicine Reference

1. Local implantation of SWCNT Tissue engineering [153]

2. Helical assembly of flavin mononucleotides on CNTs Biosensing [154]
3. Mechanical resonators based on a single CNT Biosensing [155]
4. CNT strain sensor Perioperative care and thrombosis treatment [156]
5. CNT transistors under long-term bias stress Biosensing [157]
6. CNT composite membranes Use in dialysis membranes [158]
7. DNA strands immobilized on pristine SWCNTs Biosensing [159]
8. SWCNT/polystyrene core–shell hybrids Bioimaging [160]
9. Gold nanoparticle decorated MWCNT modified electrodes Biosensing [161]
10. Multiroom-structured multicomponent metal oxide–nanotubeCNT hybrid microspheres Drug delivery [162]
11. In situ H2O2 generating metal–CNT composites Wound healing [163]
12. Carbon nanotube-fullerene hierarchical monoliths Drug delivery [164]
13. Carbon dot-modified magnetic CNTs Biosensing [165]
14. Carbon nanotube threads Biosensing [166]
15. Foams based on CNTs Drug delivery [167–169]
16. Strong and super-hydrophobic hybrid CNT films Drug delivery [170]
17. Cross-linked polydopamine grafted CNTs Biomedical devices [171]
18. Electrically conductive nanocomposite hydrogels embedded with functionalized carbon nanotubes For spinal cord injury [172]
19. CNT–chitosan film Biosensing [173]
20. Nanocomposites of CNTs and polycaprolactone with high aspect ratios Drug delivery [174]
21. 3D Carbon-Nanotube-Based Composites Tissue engineering [175]
22. Deformable membrane with embedded CNT-based strain sensors Biosensing [176]
23. CNT buckypaper embedded self-sensing composite Biosensing and treatment diagnosis and prognosis [177]

with uric acid. Moreover, the potential at which the uric acid gets
oxidized is almost similar to that of dopamine and epinephrine. A
boron-doped MWCNT modified with gold nanoparticles nanocomposite
material has succeeded in simultaneous electrochemical analysis of the
two catecholamines from biological fluids in the presence of uric acid
[142]. A cyclodextrin‑carbon nanotube composite based biosensor for
the fluorescent detection of cholesterol in the presence of rhodamine
was also developed recently [143].
Recently, CNT-based sensors have shown the potential to detect
therapeutic molecules from different pharmaceutical formulations. A
composite fabricated with carbon paste, SWCNTs and neodymium
oxide (Nd2O3) was been evaluated to detect its efficiency in quantifying
paracetamol in pharmaceutical matrices like tablets, powders, and
syrups mainly for children. The combination of carbon nanotubes and
Nd2O3 favored the sensitive detection of acetaminophen from distinct
dosage forms [144]. An electrochemical sensor was proposed for di-
clofenac detection from tablets and also from human urine samples
based on a gold electrode modified with functionalized MWCNTs and
gold‑platinum bimetallic nanoparticles [145]. Another electrochemical
sensor was fabricated, using Nafion and MWCNTs modified glassy
carbon electrode, exhibiting greater sensitivity and stability for the
oxidation reactions of acetaminophen and N-acetyl cysteine [146].
5.2.3. Carbon nanotube nanotweezers in biomedicine
The nanotweezers are of appreciable use in various fields for dif-
ferent measurements involving the mass and electrical conductivity of
the nanomaterials. The nanotweezers contain two arms of carbon na-
notubes [147]. The distance between the two carbon nanotubes reduces
as there is an increased voltage exposure. These nanotubes are regarded
as a suitable flexible material with the structure of a cylinder.
The different procedures of the variations in the tweezers while
operating in the atomic force microscope (AFM) involve certain steps.
An AFM image is picked for the tweezers enclosed with the given vol-
tage applied between the CNTs. The required nanomaterial is obtained
for the tweezer working. Thus, the tweezer gets little bit moved and the
target material is located on a specific point. When the adhesion be-
tween the CNT and the nano-substance is greater than that between the
nano-substance and the substrate, the material could be expelled by
applying a potential between the nano-substance and the substrate
[148].
The nanotweezers can be used in different biomedical applications.
In comparison to conventional tweezers, the nanotweezers are capable
of facilitating simultaneous variations and relations in the analytical
studies. The nanotweezers can also be useful for nucleic acid-based
spectroscopy. It has precise flow control, greater stability and higher
capacity for nanoparticle entrapment [149].
5.2.4. Carbon nanotubes for biomolecular detection
Protein functionalized carbon nanotubes are utilized for the pro-
duction of a lab-on-a-chip (LOC) that is capable of detecting low-density
lipoprotein. The various physicomechanical properties of CNTs are
significant in biomedicine such that they could act as biomarkers and
implantable devices. The greater electrical and mechanical properties
of the CNT enable it as a suitable material for the production of su-
persensitive LOC which could be useful for biomolecular detection
[132,150]. Another interesting fact is the formation of a suspension of
CNT with the nickel oxide subsistence which acts as a biomarker for
cholesterol detection [151]. The existence of nickel oxide establishes
larger surface expansion, greater electromechanical properties and has
greater degradation potential towards protein, enzyme, RNA, anti-
bodies and so on. The nickel oxide creates a greater electrostatic po-
tential which is a key factor behind the transmission of the antibody
through electrostatic connections with carbon nanotubes. Carbon na-
notubes provide electronic pavement and they act as a messenger on
the electrode surface. Carbon nanotubes are also selective due to their
characteristic nature which causes decreased utilization of samples and
lesser energy consumption.
Lipoproteins are characterized by the function of transportation of
cholesterol in the bloodstream and are metabolized in the liver, kid-
neys, and in the tangential tissues. Moreover, the cholesterol im-
mobilization leads to the contact of apolipoproteins with sulfated gly-
cosaminoglycans which cause cholesterol deposition in the arterial
surfaces. This eventually leads to the formation of plaques which causes
the reduced flexibility of arteries and causes major heart diseases like
atherosclerosis. The general method for the assessment of the quantity
of low-density lipoprotein molecule is by nuclear magnetic resonance
spectroscopy, electrophoretic methods, and ultracentrifugation
methods. All these methods are quite expensive, time-consuming and
tedious. Thus, the utilization of an impedimetric LOC is preferential to
above all. The metal oxide used in the impedimetric LOC is indium‑tin-
oxide along with anti-apolipoprotein and bovine serum albumin char-
acterized CNT‑nickel oxide nanocomposite [152].

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In addition to the various biomedical applications described here,
many future possibilities await CNTs in biomedicine. There are some
recent and advanced systems reported with CNTs which as such does
not present any biomedical application. But, these systems could be
tailored to suit various biomedical applications. Such a list of projected
applications of some recent and advanced systems of CNT is provided in
Table 2.
6. Conclusion and future prospects
Carbon nanotubes open up a new era for practical applications and
are useful in satisfying the basic physics at the non-metric scale. They
offer incredible peculiar applications to the coming generations through
their eternal applications in electronics, chemical applications and al-
most wholly in the biomedical field. The carbon nanotubes present
genera of nanomaterials that possess extremely vital applications in
various fields of therapeutics and biomedicine. Moreover, nano-
technology has been acted as a milestone in solving the regulations and
restrictions which were there in the silicon microelectronics. CNTs can
play a vital role in every angle of discovery due to their unique struc-
tural, electrical, and mechanical properties. Established tumor-targeted
delivery using CNT is a solution for unresolved hurdles in cancer
therapy. The potential for transdermal drug delivery using CNT buck-
ypaper is also now known. The recent evidence of BBB crossing with
functionalized MWCNTs extends its scope in drug delivery application.
Further studies are required to fabricate functionalized carbon nano-
tube as a carrier system for efficient targeted brain therapy. The CNTs
have been innovative for the establishment of stem cell therapies and
also in various cellular transport systems. Even though the functiona-
lization of CNTs is beneficial in providing enhanced bioavailability and
for deducting the cytotoxic effects, it is necessary to have a compre-
hensive toxicological analysis of this nanomaterial. Moreover, it also
demands a deeper understanding of the underlying physiological me-
chanisms on CNT administration. All these biomedical approaches
under the perspective of carbon nanotubes will be a reality only if the
safety concerns regarding the toxicity of CNTs are cleared well. There is
yet another chance for the replacement of all the conventional diag-
nostic and biomolecular detection systems with superspecific and ex-
cellent CNT-based systems in the future. Finally, many recently re-
ported advanced systems of CNTs, though presently not specified for a
biomedical application, could be exploited for their immense potential
in biomedicine.
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