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Meyer GA, Thomopoulos S, Abu-Amer Y, Shen KC. Tenotomy-induced muscle atrophy is sex-specific and independent of NFκB. eLife 2022; 11:e82016. [PMID: 36508247 PMCID: PMC9873255 DOI: 10.7554/elife.82016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
The nuclear factor-κB (NFκB) pathway is a major thoroughfare for skeletal muscle atrophy and is driven by diverse stimuli. Targeted inhibition of NFκB through its canonical mediator IKKβ effectively mitigates loss of muscle mass across many conditions, from denervation to unloading to cancer. In this study, we used gain- and loss-of-function mouse models to examine the role of NFκB in muscle atrophy following rotator cuff tenotomy - a model of chronic rotator cuff tear. IKKβ was knocked down or constitutively activated in muscle-specific inducible transgenic mice to elicit a twofold gain or loss of NFκB signaling. Surprisingly, neither knockdown of IKKβ nor overexpression of caIKKβ significantly altered the loss of muscle mass following tenotomy. This finding was consistent across measures of morphological adaptation (fiber cross-sectional area, fiber length, fiber number), tissue pathology (fibrosis and fatty infiltration), and intracellular signaling (ubiquitin-proteasome, autophagy). Intriguingly, late-stage tenotomy-induced atrophy was exacerbated in male mice compared with female mice. This sex specificity was driven by ongoing decreases in fiber cross-sectional area, which paralleled the accumulation of large autophagic vesicles in male, but not female muscle. These findings suggest that tenotomy-induced atrophy is not dependent on NFκB and instead may be regulated by autophagy in a sex-specific manner.
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Affiliation(s)
- Gretchen A Meyer
- Program in Physical Therapy, Washington University School of MedicineSt. LouisUnited States
- Department of Orthopaedic Surgery, Washington University School of MedicineSt LouisUnited States
- Departments of Neurology and Biomedical Engineering, Washington University School of MedicineSt. LouisUnited States
| | - Stavros Thomopoulos
- Departments of Orthopaedic Surgery and Biomedical Engineering, Columbia UniversityNew YorkUnited States
| | - Yousef Abu-Amer
- Department of Orthopaedic Surgery, Washington University School of MedicineSt LouisUnited States
- Department of Cell Biology & Physiology, Washington University School of MedicineSt. LouisUnited States
- Shriners Hospital for ChildrenSt. LouisUnited States
| | - Karen C Shen
- Program in Physical Therapy, Washington University School of MedicineSt. LouisUnited States
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de Diego M, Casado A, Gómez M, Ciurana N, Rodríguez P, Avià Y, Cuesta-Torralvo E, García N, San José I, Barbosa M, de Paz F, Pastor JF, Potau JM. Elbow Extensor Muscles in Humans and Chimpanzees: Adaptations to Different Uses of the Upper Extremity in Hominoid Primates. Animals (Basel) 2022; 12:ani12212987. [PMID: 36359111 PMCID: PMC9655010 DOI: 10.3390/ani12212987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Chimpanzees and humans are both species of hominoid primates that are closely related phylogenetically. One of the key differences between these two species is their use of their upper extremities. Humans use this limb mainly in manipulative tasks, while chimpanzees also use it during locomotion. In this study, we have analyzed the muscle architecture and the expression of the myosin heavy chain isoforms in the two elbow extensor muscles, the triceps brachii and the anconeus, in humans and chimpanzees, in order to find differences that could be related to the different uses of the upper extremities in these species. We have found that the triceps brachii of chimpanzees is more prepared for strength and power as an adaptation to locomotion, while the same muscle in humans is more prepared for speed and resistance to fatigue as an adaptation to manipulative activities. Our results increase the knowledge we have of the musculoskeletal system of chimpanzees and can be applied in various fields, such as comparative anatomy, evolutionary anatomy or anthropology. Abstract The anatomical and functional characteristics of the elbow extensor muscles (triceps brachii and anconeus) have not been widely studied in non-human hominoid primates, despite their great functional importance. In the present study, we have analyzed the muscle architecture and the expression of the myosin heavy chain (MHC) isoforms in the elbow extensors in humans and chimpanzees. Our main objective was to identify differences in these muscles that could be related to the different uses of the upper extremity in the two species. In five humans and five chimpanzees, we have analyzed muscle mass (MM), muscle fascicle length (MFL), and the physiological cross-sectional area (PCSA). In addition, we have assessed the expression of the MHC isoforms by RT-PCR. We have found high MM and PCSA values and higher expression of the MHC-IIx isoform in the triceps brachii of chimpanzees, while in humans, the triceps brachii has high MFL values and a higher expression of the MHC-I and MHC-IIa isoforms. In contrast, there were no significant differences between humans and chimpanzees in any of the values for the anconeus. These findings could be related to the participation of the triceps brachii in the locomotion of chimpanzees and to the use of the upper extremity in manipulative functions in humans. The results obtained in the anconeus support its primary function as a stabilizer of the elbow joint in the two species.
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Affiliation(s)
- Marina de Diego
- Unit of Human Anatomy and Embryology, University of Barcelona, 08036 Barcelona, Spain
| | - Aroa Casado
- Unit of Human Anatomy and Embryology, University of Barcelona, 08036 Barcelona, Spain
- Institut d’Arqueologia de la Universitat de Barcelona (IAUB), Faculty of Geography and History, University of Barcelona (UB), 08001 Barcelona, Spain
| | - Mónica Gómez
- Unit of Human Anatomy and Embryology, University of Barcelona, 08036 Barcelona, Spain
| | - Neus Ciurana
- Unit of Human Anatomy and Embryology, University of Barcelona, 08036 Barcelona, Spain
| | - Patrícia Rodríguez
- Unit of Human Anatomy and Embryology, University of Barcelona, 08036 Barcelona, Spain
| | - Yasmina Avià
- Institut d’Arqueologia de la Universitat de Barcelona (IAUB), Faculty of Geography and History, University of Barcelona (UB), 08001 Barcelona, Spain
- Biological Anthropology Unit, Department of Animal Biology, Autonomous University of Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Elisabeth Cuesta-Torralvo
- Institut d’Arqueologia de la Universitat de Barcelona (IAUB), Faculty of Geography and History, University of Barcelona (UB), 08001 Barcelona, Spain
- Biological Anthropology Unit, Department of Animal Biology, Autonomous University of Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Natividad García
- Department of Anatomy and Radiology, University of Valladolid, 47005 Valladolid, Spain
| | - Isabel San José
- Department of Anatomy and Radiology, University of Valladolid, 47005 Valladolid, Spain
| | - Mercedes Barbosa
- Department of Anatomy and Radiology, University of Valladolid, 47005 Valladolid, Spain
| | - Félix de Paz
- Department of Anatomy and Radiology, University of Valladolid, 47005 Valladolid, Spain
| | - Juan Francisco Pastor
- Department of Anatomy and Radiology, University of Valladolid, 47005 Valladolid, Spain
| | - Josep Maria Potau
- Unit of Human Anatomy and Embryology, University of Barcelona, 08036 Barcelona, Spain
- Institut d’Arqueologia de la Universitat de Barcelona (IAUB), Faculty of Geography and History, University of Barcelona (UB), 08001 Barcelona, Spain
- Correspondence: ; Tel.: +34-9-3402-1906
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3
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Vargas-Vila MA, Gibbons MC, Wu IT, Esparza MC, Kato K, Johnson SD, Masuda K, Ward SR. Progression of muscle loss and fat accumulation in a rabbit model of rotator cuff tear. J Orthop Res 2022; 40:1016-1025. [PMID: 34392563 PMCID: PMC8844305 DOI: 10.1002/jor.25160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/09/2021] [Accepted: 07/30/2021] [Indexed: 02/04/2023]
Abstract
Rotator cuff (RC) tears present a treatment challenge due to muscle atrophy and degeneration, fatty infiltration, and fibrosis. The purpose of this study was to generate a high time-resolution model of RC tear in rabbits and to characterize the progression of architectural and histological changes. Thirty-five female New Zealand White rabbits (age: 6 months) underwent left supraspinatus tenotomy. Five rabbits were used to evaluate immediate muscle architectural changes. The remaining 30 rabbits underwent right shoulder sham surgery and sacrifice at 1, 2, 4, 8, or 16 weeks. Histology was used to quantify muscle fiber cross-sectional area (CSA), muscle degeneration and regeneration, and fat localized to inter- versus intrafascicular regions. Muscle fiber CSA decreased by 26.5% compared to sham at 16 weeks (effect of treatment, p < 0.0001). Muscle degeneration increased after tenotomy (effect of treatment, p = 0.0006) without any change in regeneration. Collagen and fat content increased by 4 weeks and persisted through 16 weeks. Interfascicular fat was increased at all time points, but intrafascicular fat was increased only at 1, 4, and 16 weeks posttenotomy. Intrafascicular fat adjacent to degenerating muscle fibers increased as well (effect of treatment, p < 0.0001; effect of time, p = 0.0102). Statement of clinical relevance: Rabbit supraspinatus tenotomy recapitulates key features of the pathophysiology of human RC tears, including muscle atrophy and degeneration, lack of regeneration, fat accumulation, and fibrosis.
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Affiliation(s)
| | | | - Isabella T. Wu
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Mary C. Esparza
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Kenji Kato
- Department of Orthopaedic Surgery, Nagoya City University, Nagoya, Japan
| | - Seth D. Johnson
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Koichi Masuda
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Samuel R. Ward
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA,Department of Bioengineering, UC San Diego, La Jolla CA, USA,Department of Radiology, UC San Diego, La Jolla CA, USA
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4
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Anderson LE, Pearson JJ, Brimeyer AL, Temenoff JS. Injection of Micronized Human Amnion/Chorion Membrane Results in Increased Early Supraspinatus Muscle Regeneration in a Chronic Model of Rotator Cuff Tear. Ann Biomed Eng 2021; 49:3698-3710. [PMID: 34766224 DOI: 10.1007/s10439-021-02880-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 10/18/2021] [Indexed: 01/08/2023]
Abstract
Surgical repair of severe rotator cuff tear often results in retear due to unaddressed muscle degeneration. The objective of this study was to test the regenerative potential of micronized dehydrated Human Amnion/Chorion Membrane (dHACM), in a clinically relevant delayed reattachment model of rotator cuff repair. Micronized dHACM was injected into rat supraspinatus muscle during tendon re-attachment surgery, three weeks after original tendon injury. One week after material injection, inflammatory and mesenchymal stem cell infiltration into supraspinatus muscles was assessed via flow cytometry. Histological methods were utilized to assess structural and regenerative changes in muscle one and three weeks after material injection. Micronized dHACM injection resulted in increased M1-like macrophages (17.1 [Formula: see text] fold change over contralateral controls) and regenerating muscle fibers (4.3% vs 1.7% in saline treated muscles) one week after injection compared to saline treated muscles. Tendon reattachment itself exhibited intrinsic healing in this model, demonstrated by a general return of muscle weight and reduced fibrosis. Our results indicate that injection of micronized dHACM may initiate an inflammatory response in degenerated muscle that promotes early muscle regeneration, and that our animal model may be a suitable platform for studying treatments in muscle at early timepoints, before intrinsic healing occurs.
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Affiliation(s)
- Leah E Anderson
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech, Emory University, 315 Ferst Dr., Atlanta, GA, 30332, USA
| | - Joseph J Pearson
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech, Emory University, 315 Ferst Dr., Atlanta, GA, 30332, USA
| | - Alexandra L Brimeyer
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech, Emory University, 315 Ferst Dr., Atlanta, GA, 30332, USA
| | - Johnna S Temenoff
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech, Emory University, 315 Ferst Dr., Atlanta, GA, 30332, USA.
- Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.
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Tang X, Shemshaki NS, Vernekar VN, Prabhath A, Kuyinu E, Kan HM, Barajaa M, Khan Y, Laurencin CT. The Treatment of Muscle Atrophy after Rotator Cuff Tears Using Electroconductive Nanofibrous Matrices. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2021; 7:1-9. [PMID: 33816776 PMCID: PMC8011566 DOI: 10.1007/s40883-020-00186-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/13/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
Rotator cuff tears (RCTs) are a common cause of disability and pain in the adult population. Despite the successful repair of the torn tendon, the delay between the time of injury and time of repair can cause muscle atrophy. The goal of the study was to engineer an electroconductive nanofibrous matrix with an aligned orientation to enhance muscle regeneration after rotator cuff (RC) repair. The electroconductive nanofibrous matrix was fabricated by coating Poly(3,4-ethylenedioxythiophene): poly(styrenesulfonate) (PEDOT:PSS) nanoparticles onto the aligned poly(ε-caprolactone) (PCL) electrospun nanofibers. The regenerative potential of the matrix was evaluated using two repair models of RCTs include acute and sub-acute. Sprague-Dawley rats (n=39) were randomly assigned to 1 of 8 groups. For the acute model, the matrix was implanted on supraspinatus muscle immediately after the injury. The repair surgery for the sub-acute model was conducted 6 weeks after injury. The supraspinatus muscle was harvested for histological analysis two and six weeks after repair. The results demonstrated the efficacy of electrical and topographical cues on the treatment of muscle atrophy in vivo. In both acute and sub-acute models, the stimulus effects of topographical and electrical cues reduced the gap area between muscle fibers. This study showed that muscle atrophy can be alleviated by successful surgical repair using an electroconductive nanofibrous matrix in a rat RC model.
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Affiliation(s)
- Xiaoyan Tang
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Nikoo Saveh Shemshaki
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Varadraj N. Vernekar
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Anupama Prabhath
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Emmanuel Kuyinu
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Ho-Man Kan
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Mohammed Barajaa
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Yusuf Khan
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Cato T. Laurencin
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Chemical & Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA
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Ruoss S, Kindt P, Oberholzer L, Rohner M, Jungck L, Abdel‐Aziz S, Fitze D, Rosskopf AB, Klein K, von Rechenberg B, Gerber C, Wieser K, Flück M. Inhibition of calpain delays early muscle atrophy after rotator cuff tendon release in sheep. Physiol Rep 2018; 6:e13833. [PMID: 30393967 PMCID: PMC6215759 DOI: 10.14814/phy2.13833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/25/2018] [Accepted: 07/29/2018] [Indexed: 01/05/2023] Open
Abstract
Chronic rotator cuff (RC) tears are characterized by retraction, fat accumulation, and atrophy of the affected muscle. These features pose an intractable problem for surgical repair and subsequent recovery, and their prevention may be easier than reversal. Using an established ovine model, we tested the hypothesis that inhibition of the protease calpain mitigates m. infraspinatus atrophy by preservation of the myofibers' structural anchors in the sarcolemma (the costameres). Already 2 weeks of distal tendon release led to a reduction in muscle volume (-11.6 ± 9.1 cm3 , P = 0.038) and a 8.3% slow-to-fast shift of the fiber area (P = 0.046), which were both entirely abolished by chronic local administration of the calpain inhibitor calpeptin alone, and in combination with sildenafil. Calpain inhibition blunted the retraction of the muscle-tendon unit by 0.8-1.0 cm (P = 0.020) compared with the control group, and prevented cleavage of the costameric protein talin. Calpain 1 and 2 protein levels increased in the medicated groups after 4 weeks, counteracting the efficacy of calpeptin. Hence atrophic changes emerged after 4 weeks despite ongoing treatment. These findings suggest that the early muscular adaptations in the specific case of RC tear in the ovine model are indistinguishable from the atrophy and slow-to-fast fiber transformation observed with conventional unloading and can be prevented for 2 weeks. Concluding, calpain is a potential target to extend the temporal window for reconstruction of the ruptured RC tendon before recovery turns impossible.
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Affiliation(s)
- Severin Ruoss
- Laboratory for Muscle PlasticityUniversity of ZurichZurichSwitzerland
| | - Philipp Kindt
- Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Linus Oberholzer
- Laboratory for Muscle PlasticityUniversity of ZurichZurichSwitzerland
- Faculty of MedicineUniversity of ZurichZurichSwitzerland
| | - Marco Rohner
- Laboratory for Muscle PlasticityUniversity of ZurichZurichSwitzerland
- Faculty of MedicineUniversity of ZurichZurichSwitzerland
| | - Ladina Jungck
- Laboratory for Muscle PlasticityUniversity of ZurichZurichSwitzerland
- Faculty of MedicineUniversity of ZurichZurichSwitzerland
| | - Sara Abdel‐Aziz
- Laboratory for Muscle PlasticityUniversity of ZurichZurichSwitzerland
- Faculty of MedicineUniversity of ZurichZurichSwitzerland
| | - Daniel Fitze
- Laboratory for Muscle PlasticityUniversity of ZurichZurichSwitzerland
| | - Andrea B. Rosskopf
- Faculty of MedicineUniversity of ZurichZurichSwitzerland
- Radiology DepartmentBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Karina Klein
- Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Brigitte von Rechenberg
- Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM)University of ZurichZurichSwitzerland
| | - Christian Gerber
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM)University of ZurichZurichSwitzerland
- Department of OrthopaedicsBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Karl Wieser
- Department of OrthopaedicsBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Martin Flück
- Faculty of MedicineUniversity of ZurichZurichSwitzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM)University of ZurichZurichSwitzerland
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