1
|
Sun Z, Yan M, Wang J, Zhang H, Ji X, Xiao Y, Wang T, Yu T. Single-cell RNA sequencing reveals different chondrocyte states in femoral cartilage between osteoarthritis and healthy individuals. Front Immunol 2024; 15:1407679. [PMID: 38868774 PMCID: PMC11167083 DOI: 10.3389/fimmu.2024.1407679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/16/2024] [Indexed: 06/14/2024] Open
Abstract
Background Cartilage injury is the main pathological manifestation of osteoarthritis (OA). Healthy chondrocyte is a prerequisite for cartilage regeneration and repair. Differences between healthy and OA chondrocyte types and the role these types play in cartilage regeneration and OA progression are unclear. Method This study conducted single-cell RNA sequencing (scRNA-seq) on the cartilage from normal distal femur of the knee (NC group) and OA femur (OA group) cartilage, the chondrocyte atlas was constructed, and the differences of cell subtypes between the two groups were compared. Pseudo-time and RNA velocity analysis were both performed to verify the possible differentiation sequence of cell subtypes. GO and KEGG pathway enrichment analysis were used to explore the potential functional characteristics of each cell subtype, and to predict the functional changes during cell differentiation. Differences in transcriptional regulation in subtypes were explored by single-cell regulatory network inference and clustering (SCENIC). The distribution of each cell subtype in cartilage tissue was identified by immunohistochemical staining (IHC). Result A total of 75,104 cells were included, they were divided into 19 clusters and annotated as 11 chondrocyte subtypes, including two new chondrocyte subtypes: METRNL+ and PRG4+ subtype. METRNL+ is in an early stage during chondrocyte differentiation, and RegC-B is in an intermediate state before chondrocyte dedifferentiation. With cell differentiation, cell subtypes shift from genetic expression to extracellular matrix adhesion and collagen remodeling, and signal pathways shift from HIF-1 to Hippo. The 11 subtypes were finally classified as intrinsic chondrocytes, effector chondrocytes, abnormally differentiated chondrocytes and dedifferentiated chondrocytes. IHC was used to verify the presence and distribution of each chondrocyte subtype. Conclusion This study screened two new chondrocyte subtypes, and a novel classification of each subtype was proposed. METRNL+ subtype is in an early stage during chondrocyte differentiation, and its transcriptomic characteristics and specific pathways provide a foundation for cartilage regeneration. EC-B, PRG4+ RegC-B, and FC are typical subtypes in the OA group, and the HippO-Taz pathway enriched by these cell subtypes may play a role in cartilage repair and OA progression. RegC-B is in the intermediate state before chondrocyte dedifferentiation, and its transcriptomic characteristics may provide a theoretical basis for intervening chondrocyte dedifferentiation.
Collapse
Affiliation(s)
- Zewen Sun
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mingyue Yan
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Junjie Wang
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haoyun Zhang
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Xiaobin Ji
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yujing Xiao
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Tianrui Wang
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Tengbo Yu
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, Shandong, China
| |
Collapse
|
2
|
Ossendorff R, Grede L, Scheidt S, Strauss AC, Burger C, Wirtz DC, Salzmann GM, Schildberg FA. Comparison of Minced Cartilage Implantation with Autologous Chondrocyte Transplantation in an In Vitro Inflammation Model. Cells 2024; 13:546. [PMID: 38534390 DOI: 10.3390/cells13060546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
The current gold standard to treat large cartilage defects is autologous chondrocyte transplantation (ACT). As a new surgical method of cartilage regeneration, minced cartilage implantation (MCI) is increasingly coming into focus. The aim of this study is to investigate the influence of chondrogenesis between isolated and cultured chondrocytes compared to cartilage chips in a standardized inflammation model with the proinflammatory cytokine TNFα. Articular chondrocytes from bovine cartilage were cultured according to the ACT method to passage 3 and transferred to spheroid culture. At the same time, cartilage was fragmented (<1 mm3) to produce cartilage chips. TNFα (20 ng/mL) was supplemented to simulate an inflammatory process. TNFα had a stronger influence on the passaged chondrocytes compared to the non-passaged ones, affecting gene expression profiles differently between isolated chondrocytes and cartilage chips. MCI showed less susceptibility to TNFα, with reduced IL-6 release and less impact on inflammation markers. Biochemical and histological analyses supported these findings, showing a greater negative influence of TNFα on the passaged pellet cultures compared to the unpassaged cells and MCI constructs. This study demonstrated the negative influence of TNFα on chondrogenesis in a chondrocyte spheroid culture and cartilage fragment model. Passaged chondrocytes are more sensitive to cytokine influences compared to non-passaged cells and chondrons. This suggests that MCI may have superior regeneration potential in osteoarthritic conditions compared to ACT. Further investigations are necessary for the translation of these findings into clinical practice.
Collapse
Affiliation(s)
- Robert Ossendorff
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Lisa Grede
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Sebastian Scheidt
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Andreas C Strauss
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Christof Burger
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Dieter C Wirtz
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Gian M Salzmann
- Gelenkzentrum Rhein-Main, 65239 Hochheim, Germany
- Schulthess Clinic, 8008 Zurich, Switzerland
| | - Frank A Schildberg
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, 53127 Bonn, Germany
| |
Collapse
|
3
|
Korpershoek JV, Rikkers M, Vonk LA. Isolation of Chondrons from Hyaline Cartilage. Methods Mol Biol 2023; 2598:21-27. [PMID: 36355282 DOI: 10.1007/978-1-0716-2839-3_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In native healthy hyaline cartilage, the chondrocytes are surrounded by a pericellular matrix that has a distinct composition and function compared to the hyaline cartilage extracellular matrix. The chondrocyte together with its pericellular matrix is called a chondron. The type VI collagen, which is the main component of the pericellular matrix, is resistant to enzymatic digestion by pure collagenase and dispase that do digest the extracellular matrix. Therefore, this combination of enzymes can be used to enzymatically isolate chondrons from hyaline cartilage. Chondrons have a high potential for cartilage tissue engineering. This chapter describes in detail how chondrons can be isolated from hyaline cartilage for further use.
Collapse
Affiliation(s)
- Jasmijn V Korpershoek
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Margot Rikkers
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lucienne A Vonk
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- CO.DON AG, Teltow, Germany.
- Xintela AB, Lund, Sweden.
| |
Collapse
|
4
|
Saris TF, de Windt TS, Custers RJ, Saris DB. Use of allogeneic mesenchymal signaling cells (MSCs) to augment cartilage repair. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
5
|
Lehoczky G, Trofin RE, Vallmajo-Martin Q, Chawla S, Pelttari K, Mumme M, Haug M, Egloff C, Jakob M, Ehrbar M, Martin I, Barbero A. In Vitro and Ectopic In Vivo Studies toward the Utilization of Rapidly Isolated Human Nasal Chondrocytes for Single-Stage Arthroscopic Cartilage Regeneration Therapy. Int J Mol Sci 2022; 23:ijms23136900. [PMID: 35805907 PMCID: PMC9267018 DOI: 10.3390/ijms23136900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/15/2022] [Accepted: 06/19/2022] [Indexed: 02/05/2023] Open
Abstract
Nasal chondrocytes (NCs) have a higher and more reproducible chondrogenic capacity than articular chondrocytes, and the engineered cartilage tissue they generate in vitro has been demonstrated to be safe in clinical applications. Here, we aimed at determining the feasibility for a single-stage application of NCs for cartilage regeneration under minimally invasive settings. In particular, we assessed whether NCs isolated using a short collagenase digestion protocol retain their potential to proliferate and chondro-differentiate within an injectable, swiftly cross-linked and matrix-metalloproteinase (MMP)-degradable polyethylene glycol (PEG) gel enriched with human platelet lysate (hPL). NC-hPL-PEG gels were additionally tested for their capacity to generate cartilage tissue in vivo and to integrate into cartilage/bone compartments of human osteochondral plugs upon ectopic subcutaneous implantation into nude mice. NCs isolated with a rapid protocol and embedded in PEG gels with hPL at low cell density were capable of efficiently proliferating and of generating tissue rich in glycosaminoglycans and collagen II. NC-hPL-PEG gels developed into hyaline-like cartilage tissues upon ectopic in vivo implantation and integrated with surrounding native cartilage and bone tissues. The delivery of NCs in PEG gels containing hPL is a feasible strategy for cartilage repair and now requires further validation in orthotopic in vivo models.
Collapse
Affiliation(s)
- Gyözö Lehoczky
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, 4031 Basel, Switzerland; (G.L.); (M.M.); (C.E.)
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
| | - Raluca Elena Trofin
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
| | - Queralt Vallmajo-Martin
- Department of Obstetrics, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (Q.V.-M.); (M.E.)
| | - Shikha Chawla
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
| | - Karoliina Pelttari
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
| | - Marcus Mumme
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, 4031 Basel, Switzerland; (G.L.); (M.M.); (C.E.)
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
- Department of Orthopaedic Surgery, University Children’s Hospital of Basel, 4056 Basel, Switzerland
| | - Martin Haug
- Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, University Hospital of Basel, 4031 Basel, Switzerland;
| | - Christian Egloff
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, 4031 Basel, Switzerland; (G.L.); (M.M.); (C.E.)
| | | | - Martin Ehrbar
- Department of Obstetrics, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (Q.V.-M.); (M.E.)
| | - Ivan Martin
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
- Correspondence: ; Tel.: +41-61-2652384; Fax: +41-61-2653990
| | - Andrea Barbero
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
| |
Collapse
|
6
|
Shah SS, Mithoefer K. Scientific Developments and Clinical Applications Utilizing Chondrons and Chondrocytes with Matrix for Cartilage Repair. Cartilage 2021; 13:1195S-1205S. [PMID: 33155482 PMCID: PMC8808934 DOI: 10.1177/1947603520968884] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Injuries to articular cartilage of the knee are increasingly common. The operative management of these focal chondral lesions continues to be problematic for the treating orthopedic surgeon secondary to the limited regenerative capacity of articular cartilage. The pericellular matrix (PCM) is a specialized, thin layer of the extracellular matrix that immediately surrounds chondrocytes forming a unit together called the chondron. The advancements in our knowledge base with regard to the PCM/chondrons as well as interterritorial matrix has permeated and led to advancements in product development in conjunction with minced cartilage, marrow stimulation, osteochondral allograft, and autologous chondrocyte implantation (ACI). This review intends to summarize recent progress in chondrocytes with matrix research, with an emphasis on the role the PCM/extracellular matrix (ECM) plays for favorable chondrogenic gene expression, as a barrier/filtration unit, and in osteoarthritis. The bulk of the review describes cutting-edge and evolving clinical developments and discuss these developments in light of underlying basic science applications. Clinical applications of chondrocytes with matrix science include Reveille Cartilage Processor, Cartiform, and ACI with Spherox (which was recently recommended for the treatment of grade III or IV articular cartilage defects over 2 cm2 by the National Institute of Health and Care Excellence [NICE] in the United Kingdom). The current article presents a comprehensive overview of both the basic science and clinical results of these next-generation cartilage repair techniques by focusing specifically on the scientific evolution in each category as it pertains with underlying chondrocytes with matrix theory.
Collapse
Affiliation(s)
- Sarav S. Shah
- Division of Sports Medicine, Department
of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA,Sarav S. Shah, Division of Sports Medicine,
Department of Orthopaedic Surgery, New England Baptist Hospital, 125 Parker Hill
Avenue, Boston, MA 02120, USA.
| | - Kai Mithoefer
- Division of Sports Medicine, Department
of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| |
Collapse
|
7
|
Yilmaz EN, Zeugolis DI. Electrospun Polymers in Cartilage Engineering-State of Play. Front Bioeng Biotechnol 2020; 8:77. [PMID: 32133352 PMCID: PMC7039817 DOI: 10.3389/fbioe.2020.00077] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/29/2020] [Indexed: 12/17/2022] Open
Abstract
Articular cartilage defects remain a clinical challenge. Articular cartilage defects progress to osteoarthritis, which negatively (e.g., remarkable pain, decreased mobility, distress) affects millions of people worldwide and is associated with excessive healthcare costs. Surgical procedures and cell-based therapies have failed to deliver a functional therapy. To this end, tissue engineering therapies provide a promise to deliver a functional cartilage substitute. Among the various scaffold fabrication technologies available, electrospinning is continuously gaining pace, as it can produce nano- to micro- fibrous scaffolds that imitate architectural features of native extracellular matrix supramolecular assemblies and can deliver variable cell populations and bioactive molecules. Herein, we comprehensively review advancements and shortfalls of various electrospun scaffolds in cartilage engineering.
Collapse
Affiliation(s)
- Elif Nur Yilmaz
- Regenerative, Modular & Developmental Engineering Laboratory, National University of Ireland Galway, Galway, Ireland.,Science Foundation Ireland, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Dimitrios I Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory, National University of Ireland Galway, Galway, Ireland.,Science Foundation Ireland, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
8
|
Regenerative Medicine: A Review of the Evolution of Autologous Chondrocyte Implantation (ACI) Therapy. Bioengineering (Basel) 2019; 6:bioengineering6010022. [PMID: 30871236 PMCID: PMC6466051 DOI: 10.3390/bioengineering6010022] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 12/14/2022] Open
Abstract
Articular cartilage is composed of chondrons within a territorial matrix surrounded by a highly organized extracellular matrix comprising collagen II fibrils, proteoglycans, glycosaminoglycans, and non-collagenous proteins. Damaged articular cartilage has a limited potential for healing and untreated defects often progress to osteoarthritis. High hopes have been pinned on regenerative medicine strategies to meet the challenge of preventing progress to late osteoarthritis. One such strategy, autologous chondrocyte implantation (ACI), was first reported in 1994 as a treatment for deep focal articular cartilage defects. ACI has since evolved to become a worldwide well-established surgical technique. For ACI, chondrocytes are harvested from the lesser weight bearing edge of the joint by arthroscopy, their numbers expanded in monolayer culture for at least four weeks, and then re-implanted in the damaged region under a natural or synthetic membrane via an open joint procedure. We consider the evolution of ACI to become an established cell therapy, its current limitations, and on-going strategies to improve its efficacy. The most promising developments involving cells and natural or synthetic biomaterials will be highlighted.
Collapse
|
9
|
Cheng G, Davoudi Z, Xing X, Yu X, Cheng X, Li Z, Deng H, Wang Q. Advanced Silk Fibroin Biomaterials for Cartilage Regeneration. ACS Biomater Sci Eng 2018; 4:2704-2715. [DOI: 10.1021/acsbiomaterials.8b00150] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Gu Cheng
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), and Key Laboratory of Oral Biomedicine, Ministry of Education, Wuhan University, Wuhan 430079, China
- Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, School of Resource and Environmental Science, Wuhan University, Wuhan 430079, China
| | - Zahra Davoudi
- Department of Chemical and Biological Engineering, Iowa State University, Ames, Iowa 50014, United States
| | - Xin Xing
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), and Key Laboratory of Oral Biomedicine, Ministry of Education, Wuhan University, Wuhan 430079, China
| | - Xin Yu
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), and Key Laboratory of Oral Biomedicine, Ministry of Education, Wuhan University, Wuhan 430079, China
| | - Xin Cheng
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), and Key Laboratory of Oral Biomedicine, Ministry of Education, Wuhan University, Wuhan 430079, China
| | - Zubing Li
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), and Key Laboratory of Oral Biomedicine, Ministry of Education, Wuhan University, Wuhan 430079, China
| | - Hongbing Deng
- Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, School of Resource and Environmental Science, Wuhan University, Wuhan 430079, China
| | - Qun Wang
- Department of Chemical and Biological Engineering, Iowa State University, Ames, Iowa 50014, United States
| |
Collapse
|
10
|
Jeyakumar V, Niculescu-Morzsa E, Bauer C, Lacza Z, Nehrer S. Platelet-Rich Plasma Supports Proliferation and Redifferentiation of Chondrocytes during In Vitro Expansion. Front Bioeng Biotechnol 2017; 5:75. [PMID: 29270404 PMCID: PMC5723650 DOI: 10.3389/fbioe.2017.00075] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/23/2017] [Indexed: 01/05/2023] Open
Abstract
Articular cartilage regeneration is insufficient to restore sports injuries or defects that can occur from trauma. Treatment options for cartilage repair include autologous chondrocyte implantation (ACI) by isolation, expansion, and reimplantation of healthy donor chondrocytes. Chondrocyte expansion onto 2D substrates leads to dedifferentiation and loss of the cellular phenotype. We aimed to overcome the state of dedifferentiation by biochemical stimuli with platelet derivatives such as platelet-rich plasma (PRP) and hyperacute serum (HAS) to achieve sufficient cell numbers in combination with variable oxygen tension. Human articular chondrocytes from osteoarthritic (OA) cartilage chondrocytes were switched from 10% FCS supplementation to either 10% PRP or 10% HAS after initial passaging for further experiments under normoxic (20% O2) or hypoxic (1% O2) conditions. An XTT assay measured the effect of PRP or HAS on the cell proliferation at 3, 6, and 9 days. The chondrogenic redifferentiation potential of dedifferentiated chondrocytes was determined with reverse transcriptase quantitative real-time PCR for markers of expression for type II collagen (COL2A1), type I collagen (COL1A1), and matrix metalloproteinases MMP3, matrix metalloproteinase 13 (MMP13) at 24 and 72 h. Measured protein levels of 100% PRP or HAS by multiplex quantification revealed basic fibroblast growth factor, G-CSF, and PDGF were significantly higher in PRP than in HAS (p < 0.05) but LEPTIN levels did not differ. The quantified protein levels did not differ when isolated from same donors at a different time. Chondrocyte proliferation indicated that supplementation of 10% HAS enhanced the proliferation rate compared to 10% PRP or 10% FCS at 6 and 9 days significantly (p < 0.05). mRNA levels for expression of COL1A1 were significantly downregulated (p < 0.05) when cultured with 10% PRP than 10% HAS or 10% FCS under normoxic/hypoxic conditions. COL2A1 was significantly upregulated (p < 0.05) in PRP than 10% HAS or 10% FCS. MMP3 expression was downregulated after 72 h under all conditions. MMP13 was upregulated with 10% PRP at both 24 and 72 h but significantly downregulated under hypoxia (1% O2) for all circumstances. While HAS has its effect on chondrocyte proliferation, PRP enhances both proliferation and redifferentiation of dedifferentiated chondrocytes. PRP can replace standard usage of FCS for chondrogenic priming and expansion as implications for clinical use such as ACI procedures.
Collapse
Affiliation(s)
- Vivek Jeyakumar
- Centre for Regenerative Medicine and Orthopedics, Danube University Krems, Krems an der Donau, Austria
| | - Eugenia Niculescu-Morzsa
- Centre for Regenerative Medicine and Orthopedics, Danube University Krems, Krems an der Donau, Austria
| | - Christoph Bauer
- Centre for Regenerative Medicine and Orthopedics, Danube University Krems, Krems an der Donau, Austria
| | | | - Stefan Nehrer
- Centre for Regenerative Medicine and Orthopedics, Danube University Krems, Krems an der Donau, Austria
| |
Collapse
|
11
|
Owida HA, De Las Heras Ruiz T, Dhillon A, Yang Y, Kuiper NJ. Co-culture of chondrons and mesenchymal stromal cells reduces the loss of collagen VI and improves extracellular matrix production. Histochem Cell Biol 2017; 148:625-638. [PMID: 28821957 DOI: 10.1007/s00418-017-1602-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 12/01/2022]
Abstract
Adult articular chondrocytes are surrounded by a pericellular matrix (PCM) to form a chondron. The PCM is rich in hyaluronan, proteoglycans, and collagen II, and it is the exclusive location of collagen VI in articular cartilage. Collagen VI anchors the chondrocyte to the PCM. It has been suggested that co-culture of chondrons with mesenchymal stromal cells (MSCs) might enhance extracellular matrix (ECM) production. This co-culture study investigates whether MSCs help to preserve the PCM and increase ECM production. Primary bovine chondrons or chondrocytes or rat MSCs were cultured alone to establish a baseline level for ECM production. A xenogeneic co-culture monolayer model using rat MSCs (20, 50, and 80%) was established. PCM maintenance and ECM production were assessed by biochemical assays, immunofluorescence, and histological staining. Co-culture of MSCs with chondrons enhanced ECM matrix production, as compared to chondrocyte or chondron only cultures. The ratio 50:50 co-culture of MSCs and chondrons resulted in the highest increase in GAG production (18.5 ± 0.54 pg/cell at day 1 and 11 ± 0.38 pg/cell at day 7 in 50:50 co-culture versus 16.8 ± 0.61 pg/cell at day 1 and 10 ± 0.45 pg/cell at day 7 in chondron monoculture). The co-culture of MSCs with chondrons appeared to decelerate the loss of the PCM as determined by collagen VI expression, whilst the expression of high-temperature requirement serine protease A1 (HtrA1) demonstrated an inverse relationship to that of the collagen VI. Together, this implies that MSCs directly or indirectly inhibited HtrA1 activity and the co-culture of MSCs with chondrons enhanced ECM synthesis and the preservation of the PCM.
Collapse
Affiliation(s)
- H A Owida
- Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, ST4 7QB, UK
| | - T De Las Heras Ruiz
- Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, ST4 7QB, UK
| | - A Dhillon
- Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, ST4 7QB, UK
| | - Y Yang
- Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, ST4 7QB, UK.
| | - N J Kuiper
- Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, ST4 7QB, UK
| |
Collapse
|
12
|
de Windt TS, Vonk LA, Slaper-Cortenbach ICM, Nizak R, van Rijen MHP, Saris DBF. Allogeneic MSCs and Recycled Autologous Chondrons Mixed in a One-Stage Cartilage Cell Transplantion: A First-in-Man Trial in 35 Patients. Stem Cells 2017; 35:1984-1993. [DOI: 10.1002/stem.2657] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/31/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Tommy S. de Windt
- Department of Orthopaedics, University Medical Center Utrecht; Utrecht The Netherlands
| | - Lucienne A. Vonk
- Department of Orthopaedics, University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Razmara Nizak
- Department of Orthopaedics, University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Daniel B. F. Saris
- Department of Orthopaedics, University Medical Center Utrecht; Utrecht The Netherlands
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente; Enschede The Netherlands
- Department of Orthopedics; Mayo Clinic, Rochester, Minnesota; USA
| |
Collapse
|
13
|
Advances in Monitoring Cell-Based Therapies with Magnetic Resonance Imaging: Future Perspectives. Int J Mol Sci 2017; 18:ijms18010198. [PMID: 28106829 PMCID: PMC5297829 DOI: 10.3390/ijms18010198] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 01/07/2023] Open
Abstract
Cell-based therapies are currently being developed for applications in both regenerative medicine and in oncology. Preclinical, translational, and clinical research on cell-based therapies will benefit tremendously from novel imaging approaches that enable the effective monitoring of the delivery, survival, migration, biodistribution, and integration of transplanted cells. Magnetic resonance imaging (MRI) offers several advantages over other imaging modalities for elucidating the fate of transplanted cells both preclinically and clinically. These advantages include the ability to image transplanted cells longitudinally at high spatial resolution without exposure to ionizing radiation, and the possibility to co-register anatomical structures with molecular processes and functional changes. However, since cellular MRI is still in its infancy, it currently faces a number of challenges, which provide avenues for future research and development. In this review, we describe the basic principle of cell-tracking with MRI; explain the different approaches currently used to monitor cell-based therapies; describe currently available MRI contrast generation mechanisms and strategies for monitoring transplanted cells; discuss some of the challenges in tracking transplanted cells; and suggest future research directions.
Collapse
|
14
|
Numpaisal PO, Rothrauff BB, Gottardi R, Chien CL, Tuan RS. Rapidly dissociated autologous meniscus tissue enhances meniscus healing: An in vitro study. Connect Tissue Res 2016; 58:355-365. [PMID: 27726454 DOI: 10.1080/03008207.2016.1245727] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Treatment of meniscus tears is a persistent challenge in orthopedics. Although cell therapies have shown promise in promoting fibrocartilage formation in in vitro and preclinical studies, clinical application has been limited by the paucity of autologous tissue and the need for ex vivo cell expansion. Rapid dissociation of the free edges of the anterior and posterior meniscus with subsequent implantation in a meniscus lesion may overcome these limitations. The purpose of this study was to explore the effect of rapidly dissociated meniscus tissue in enhancing neotissue formation in a radial meniscus tear, as simulated in an in vitro explant model. MATERIALS AND METHODS All experiments in this study, performed at minimum with biological triplicates, utilized meniscal tissues from hind limbs of young cows. The effect of varying collagenase concentration (0.1%, 0.2% and 0.5% w/v) and treatment duration (overnight and 30 minutes) on meniscus cell viability, organization of the extracellular matrix (ECM), and gene expression was assessed through a cell metabolism assay, microscopic examination, and quantitative real-time reverse transcription polymerase chain reaction analysis, respectively. Thereafter, an explant model of a radial meniscus tear was used to evaluate the effect of a fibrin gel seeded with one of the following: (1) fibrin alone, (2) isolated and passaged (P2) meniscus cells, (3) overnight digested tissue, and (4) rapidly dissociated tissue. The quality of in vitro healing was determined through histological analysis and derivation of an adhesion index. RESULTS Rapid dissociation in 0.2% collagenase yielded cells with higher levels of metabolism than either 0.1% or 0.5% collagenase. When seeded in a three-dimensional fibrin hydrogel, both overnight digested and rapidly dissociated cells expressed greater levels of collagens type I and II than P2 meniscal cells at 1 week. At 4 and 8 weeks, collagen type II expression remained elevated only in the rapid dissociation group. Histological examination revealed enhanced healing in all cell-seeded treatment groups over cell-free fibrin controls at weeks 1, 4, and 8, but there were no significant differences across the treatment groups. CONCLUSIONS Rapid dissociation of meniscus tissue may provide a single-step approach to augment regenerative healing of meniscus repairs.
Collapse
Affiliation(s)
- Piya-On Numpaisal
- a Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.,b Department of Anatomy and Cell Biology , College of Medicine, National Taiwan University , Taipei , Taiwan.,c Institute of Medicine, Suranaree University of Technology , Nakhon Ratchasima , Thailand
| | - Benjamin B Rothrauff
- a Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.,d McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh , PA , USA
| | - Riccardo Gottardi
- a Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.,e Ri.MED Foundation , Palermo , Italy
| | - Chung-Liang Chien
- b Department of Anatomy and Cell Biology , College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Rocky S Tuan
- a Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.,d McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh , PA , USA
| |
Collapse
|
15
|
de Windt TS, Vonk LA, Slaper-Cortenbach ICM, van den Broek MPH, Nizak R, van Rijen MHP, de Weger RA, Dhert WJA, Saris DBF. Allogeneic Mesenchymal Stem Cells Stimulate Cartilage Regeneration and Are Safe for Single-Stage Cartilage Repair in Humans upon Mixture with Recycled Autologous Chondrons. Stem Cells 2016; 35:256-264. [PMID: 27507787 DOI: 10.1002/stem.2475] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/13/2016] [Accepted: 06/29/2016] [Indexed: 12/23/2022]
Abstract
Traditionally, mesenchymal stem cells (MSCs) isolated from adult bone marrow were described as being capable of differentiating to various lineages including cartilage. Despite increasing interest in these MSCs, concerns regarding their safety, in vivo behavior and clinical effectiveness have restrained their clinical application. We hypothesized that MSCs have trophic effects that stimulate recycled chondrons (chondrocytes with their native pericellular matrix) to regenerate cartilage. Searching for a proof of principle, this phase I (first-in-man) clinical trial applied allogeneic MSCs mixed with either 10% or 20% recycled autologous cartilage-derived cells (chondrons) for treatment of cartilage defects in the knee in symptomatic cartilage defect patients. This unique first in man series demonstrated no treatment-related adverse events up to one year postoperatively. At 12 months, all patients showed statistically significant improvement in clinical outcome compared to baseline. Magnetic resonance imaging and second-look arthroscopies showed completely filled defects with regenerative cartilage tissue. Histological analysis on biopsies of the grafts indicated hyaline-like regeneration with a high concentration of proteoglycans and type II collagen. Short tandem repeat analysis showed the regenerative tissue only contained patient-own DNA. These findings support the novel insight that the use of allogeneic MSCs is safe and opens opportunities for other applications. Stem cell-induced paracrine mechanisms may play an important role in the chondrogenesis and successful tissue regeneration found. Stem Cells 2017;35:256-264.
Collapse
Affiliation(s)
- Tommy S de Windt
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucienne A Vonk
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ineke C M Slaper-Cortenbach
- Cell Therapy Facility, Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel P H van den Broek
- Cell Therapy Facility, Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Razmara Nizak
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mattie H P van Rijen
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel A de Weger
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter J A Dhert
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Daniel B F Saris
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.,MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| |
Collapse
|
16
|
Mata-Miranda MM, Martinez-Martinez CM, Noriega-Gonzalez JE, Paredes-Gonzalez LE, Vázquez-Zapién GJ. Morphological, genetic and phenotypic comparison between human articular chondrocytes and cultured chondrocytes. Histochem Cell Biol 2016; 146:183-9. [PMID: 27094849 DOI: 10.1007/s00418-016-1437-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 12/20/2022]
Abstract
Articular cartilage is an avascular and aneural tissue with limited capacity for regeneration. On large articular lesions, it is recommended to use regenerative medicine strategies, like autologous chondrocyte implantation. There is a concern about morphological changes that chondrocytes suffer once they have been isolated and cultured. Due to the fact that there is little evidence that compares articular cartilage chondrocytes with cultured chondrocytes, in this research we proposed to obtain chondrocytes from human articular cartilage, compare them with themselves once they have been cultured and characterize them through genetic, phenotypic and morphological analysis. Knee articular cartilage samples of 10 mm were obtained, and each sample was divided into two fragments; a portion was used to determine gene expression, and from the other portion, chondrocytes were obtained by enzymatic disaggregation, in order to be cultured and expanded in vitro. Subsequently, morphological, genetic and phenotypic characteristics were compared between in situ (articular cartilage) and cultured chondrocytes. Obtained cultured chondrocytes were rounded in shape, possessing a large nucleus with condensed chromatin and a clear cytoplasm; histological appearance was quite similar to typical chondrocyte. The expression levels of COL2A1 and COL10A1 genes were higher in cultured chondrocytes than in situ chondrocytes; moreover, the expression of COL1A1 was almost undetectable on cultured chondrocytes; likewise, COL2 and SOX9 proteins were detected by immunofluorescence. We concluded that chondrocytes derived from adult human cartilage cultured for 21 days do not tend to dedifferentiate, maintaining their capacity to produce matrix and also retaining their synthesis capacity and morphology.
Collapse
Affiliation(s)
- Mónica Maribel Mata-Miranda
- Laboratorio de Biología Celular y Tisular, Escuela Médico Militar, Universidad del Ejército y Fuerza Aérea, 11200, Ciudad de México, Mexico.,CIBA-Tlaxcala, Instituto Politécnico Nacional, 90700, Tepetitla, Tlaxcala, Mexico
| | - Claudia María Martinez-Martinez
- Laboratorio de Biología Celular y Tisular, Escuela Médico Militar, Universidad del Ejército y Fuerza Aérea, 11200, Ciudad de México, Mexico
| | - Jesús Emmanuel Noriega-Gonzalez
- Laboratorio de Embriología, Escuela Médico Militar, Universidad del Ejército y Fuerza Aérea, Cerrada de Palomas S/N, Lomas de Sotelo, Miguel Hidalgo, 11200, Ciudad de México, Mexico
| | - Luis Enrique Paredes-Gonzalez
- Laboratorio Multidisciplinario de Investigación, Escuela Militar de Graduados de Sanidad, Universidad del Ejército y Fuerza Aérea, 11200, Ciudad de México, Mexico
| | - Gustavo Jesús Vázquez-Zapién
- CIBA-Tlaxcala, Instituto Politécnico Nacional, 90700, Tepetitla, Tlaxcala, Mexico. .,Laboratorio de Embriología, Escuela Médico Militar, Universidad del Ejército y Fuerza Aérea, Cerrada de Palomas S/N, Lomas de Sotelo, Miguel Hidalgo, 11200, Ciudad de México, Mexico.
| |
Collapse
|
17
|
Wang J, Yang Q, Cheng N, Tao X, Zhang Z, Sun X, Zhang Q. Collagen/silk fibroin composite scaffold incorporated with PLGA microsphere for cartilage repair. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 61:705-11. [DOI: 10.1016/j.msec.2015.12.097] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 12/14/2022]
|
18
|
Abstract
Cartilage remodeling is currently among the most popular topics in osteoarthritis research. Remodeling includes removal of the existing cartilage and replacement by neo-cartilage. As a loss of balance between removal and replacement of articular cartilage develops (particularly, the rate of removal surpasses the rate of replacement), joints will begin to degrade. In the last few years, significant progress in molecular understanding of the cartilage remodeling process has been made. In this brief review, we focus on the discussion of some current "controversial" observations in articular cartilage degeneration: (1) the biological effect of transforming growth factor-beta 1 on developing and mature articular cartilages, (2) the question of whether aggrecanase 1 (ADAMTS4) and aggrecanase 2 (ADAMTS5) are key enzymes in articular cartilage destruction, and (3) chondrocytes versus chondron in the development of osteoarthritis. It is hoped that continued discussion and investigation will follow to better clarify these topics. Clarification will be critical for those in search of novel therapeutic targets for the treatment of osteoarthritis.
Collapse
Affiliation(s)
- Yefu Li
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA ; Faculty of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lin Xu
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA ; Faculty of Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
19
|
de Windt TS, Vonk LA, Buskermolen JK, Visser J, Karperien M, Bleys RLAW, Dhert WJA, Saris DBF. Arthroscopic airbrush assisted cell implantation for cartilage repair in the knee: a controlled laboratory and human cadaveric study. Osteoarthritis Cartilage 2015; 23:143-50. [PMID: 25241243 DOI: 10.1016/j.joca.2014.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the feasibility of arthroscopic airbrush assisted cartilage repair. METHODS An airbrush device (Baxter) was used to spray both human expanded osteoarthritic chondrocytes and choncrocytes with their pericellular matrix (chondrons) at 1 × 10(6) cells/ml fibrin glue (Tissucol, Baxter) in vitro. Depth-dependent cell viability was assessed for both methods with confocal microscopy. Constructs were cultured for 21 days to assess matrix production. A controlled human cadaveric study (n = 8) was performed to test the feasibility of the procedure in which defects were filled with either arthroscopic airbrushing or needle extrusion. All knees were subjected to 60 min of continuous passive motion and scored on outline attachment and defect filling. RESULTS Spraying both chondrocytes and chondrons in fibrin glue resulted in a homogenous cell distribution throughout the scaffold. No difference in viability or matrix production between application methods was found nor between chondrons and chondrocytes. The cadaveric study revealed that airbrushing was highly feasible, and that defect filling through needle extrusion was more difficult to perform based on fibrin glue adhesion and gravity-induced seepage. Defect outline and coverage scores were consistently higher for extrusion, albeit not statistically significant. CONCLUSION Both chondrons and chondrocytes can be evenly distributed in a sprayed fibrin glue scaffold without affecting viability while supporting matrix production. The airbrush technology is feasible, easier to perform than needle extrusion and allows for reproducible arthroscopic filling of cartilage defects.
Collapse
Affiliation(s)
- T S de Windt
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - L A Vonk
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - J K Buskermolen
- Department of Developmental BioEngineering, University of Twente, Enschede, The Netherlands.
| | - J Visser
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - M Karperien
- Department of Developmental BioEngineering, University of Twente, Enschede, The Netherlands.
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - W J A Dhert
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Faculty of Veterinary Medicine, University of Utrecht, Utrecht, The Netherlands.
| | - D B F Saris
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
| |
Collapse
|