In the discussion above, it has been tacitly assumed that cells act as passive systems insensitive to external mechanical stimuli. Indeed, it is well known that the maturation of FXs into more stable focal adhesions (FAs) is regulated by mechanical intracytoskeletal stresses arising at the original adhesion spot, which are believed to trigger the recruitment of additional ligand molecules [32,33]. Cell adhesion on nano posts has been associated with localized membrane stretching and wrapping around the geometrical features, in a process similar to endocytosis [34], which is associated with local mechanical stresses and cytoskeletal reorganization. This could be responsible for the recruitment of new molecules at the adhesion site (peaks on the substrate), which would eventually increase locally gadh and therefore facilitate adhesion. Cell staining with clathrin, a marker associated with endocytic vesicles, was demonstrated to reproduce the substrate nanotopography. Fig. 6 shows clusters of clathrin molecules (green spots) smaller and more uniformly distributed over the whole cell membrane for the unetched wafer (uniformly distributed small peaks) compared to substrates with higher roughness (large individual peaks).Finally, a few studies have also tried to address the role played by protein adsorption and conformation on cell adhesion. The surface energy of the rough substrates was demonstrated to benearly constant (w 0.144 J/m2) before cell culturing. However, even if the silicon substrates were not functionalized, proteins such as fibronectin, vitronectin and fibrinogen would tend to deposit on the silicon substrate from the cell culture medium supporting the formation of specific molecular bonds [29]. In this context, a few authors have observed an increased adsorption and a better orientation of the proteins on rougher or nanostructured substrates[28e31]. The larger adsorbed amount as well as the proper orientation and conformation of the proteins would lead to an increase in gadh, thus favoring adhesion on rougher and nanostructuredsubstrates as compared to nominally flat surfaces.Preferential stable adhesion and proliferation of cells on moderately rough surfaces has been observed also in the case of non silicon substrates and for cell lines different from thoseconsidered in this analysis. On nanotextured substrates, made up of demixed poly(L-lactic acid) and polystyrene, human fetal osteoblastic cells have shown optimal adhesion and spreading for Raranging between 5 and 15 nm [35]. With a similar technique but using different polymers (polybromostyrene and polystyrene), fibroblasts have been documented to grow and adhere more avidly on the same small range of Ra [21]. For bacteria, as the staphylococcus epidermidis growing on PMMA, the optimal surface roughness Ra was found to range from 40 to 100 nm [36]. For silicon etched substrates, again, neurons have been shown to adhere more strongly for Ra w25 nm [9]. Macrophages have been traditionally considered as rugophobic cells adhering more easily on planar rather than rough surfaces [37]. However, recent studies seem to support again the notion that moderate roughness (from a few nanometers to a few tens of nanometers) could help macrophages to adhere even on cytotoxic surfaces made by zinc oxides [38].