1
|
Safaei M, Mohammadi H, Beddu S, Mozaffari HR, Rezaei R, Sharifi R, Moradpoor H, Fallahnia N, Ebadi M, Md Jamil MS, Md Zain AR, Yusop MR. Surface Topography Steer Soft Tissue Response and Antibacterial Function at the Transmucosal Region of Titanium Implant. Int J Nanomedicine 2024; 19:4835-4856. [PMID: 38828200 PMCID: PMC11141758 DOI: 10.2147/ijn.s461549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/10/2024] [Indexed: 06/05/2024] Open
Abstract
Metallic dental implants have been extensively used in clinical practice due to their superior mechanical properties, biocompatibility, and aesthetic outcomes. However, their integration with the surrounding soft tissue at the mucosal region remains challenging and can cause implant failure due to the peri-implant immune microenvironment. The soft tissue integration of dental implants can be ameliorated through different surface modifications. This review discussed and summarized the current knowledge of topography-mediated immune response and topography-mediated antibacterial activity in Ti dental implants which enhance soft tissue integration and their clinical performance. For example, nanopillar-like topographies such as spinules, and spikes showed effective antibacterial activity in human salivary biofilm which was due to the lethal stretching of bacterial membrane between the nanopillars. The key findings of this review were (I) cross-talk between surface nanotopography and soft tissue integration in which the surface nanotopography can guide the perpendicular orientation of collagen fibers into connective tissue which leads to the stability of soft tissue, (II) nanotubular array could shift the macrophage phenotype from pro-inflammatory (M1) to anti-inflammatory (M2) and manipulate the balance of osteogenesis/osteoclasia, and (III) surface nanotopography can provide specific sites for the loading of antibacterial agents and metallic nanoparticles of clinical interest functionalizing the implant surface. Silver-containing nanotubular topography significantly decreased the formation of fibrous encapsulation in per-implant soft tissue and showed synergistic antifungal and antibacterial properties. Although the Ti implants with surface nanotopography have shown promising in targeting soft tissue healing in vitro and in vivo through their immunomodulatory and antibacterial properties, however, long-term in vivo studies need to be conducted particularly in osteoporotic, and diabetic patients to ensure their desired performance with immunomodulatory and antibacterial properties. The optimization of product development is another challenging issue for its clinical translation, as the dental implant with surface nanotopography must endure implantation and operation inside the dental microenvironment. Finally, the sustainable release of metallic nanoparticles could be challenging to reduce cytotoxicity while augmenting the therapeutic effects.
Collapse
Affiliation(s)
- Mohsen Safaei
- Division of Dental Biomaterials, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Advanced Dental Sciences and Technology Research Center, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Mohammadi
- Biomaterials Research Group, School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal, Penang, 14300, Malaysia
- Institute of Energy Infrastructure (IEI), Universiti Tenaga Nasional, Jalan IKRAM UNITEN, Kajang, Selangor, 43000, Malaysia
| | - Salmia Beddu
- Institute of Energy Infrastructure (IEI), Universiti Tenaga Nasional, Jalan IKRAM UNITEN, Kajang, Selangor, 43000, Malaysia
| | - Hamid Reza Mozaffari
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Razieh Rezaei
- Advanced Dental Sciences and Technology Research Center, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roohollah Sharifi
- Department of Endodontics, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hedaiat Moradpoor
- Department of Prosthodontics, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nima Fallahnia
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mona Ebadi
- Department of Chemical Sciences, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, 43600, Malaysia
| | - Mohd Suzeren Md Jamil
- Department of Chemical Sciences, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, 43600, Malaysia
| | - Ahmad Rifqi Md Zain
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia (UKM), Bangi, Selangor, 43600, Malaysia
| | - Muhammad Rahimi Yusop
- Department of Chemical Sciences, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, 43600, Malaysia
| |
Collapse
|
2
|
Rai V, Agrawal DK. Male or female sex: considerations and translational aspects in diabetic foot ulcer research using rodent models. Mol Cell Biochem 2022. [DOI: 10.1007/s11010-022-04642-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
3
|
Fitting pieces into the puzzle: The impact of titanium-based dental implant surface modifications on bacterial accumulation and polymicrobial infections. Adv Colloid Interface Sci 2021; 298:102551. [PMID: 34757285 DOI: 10.1016/j.cis.2021.102551] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/09/2021] [Accepted: 10/17/2021] [Indexed: 12/12/2022]
Abstract
Polymicrobial infection is the main cause of dental implant failure. Although numerous studies have reported the ability of titanium (Ti) surface modifications to inhibit microbial adhesion and biofilm accumulation, the majority of solutions for the utilization of Ti antibacterial surfaces have been testedin in vitro and animal models, with only a few developed surfaces progressing into clinical research. Motivated by this huge gap, we critically reviewed the scientific literature on the existing antibacterial Ti surfaces to help understand these surfaces' impact on the "puzzle" of undesirable dental implant-related infections. This manuscript comprises three main sections: (i) a narrative review on topics related to oral biofilm formation, bacterial-implant surface interactions, and on how implant-surface modifications can influence microbial accumulation; (ii) a critical evidence-based review to summarize pre-clinical and clinical studies in an attempt to "fit pieces into the puzzle" to unveil the best way to reduce microbial loads and control polymicrobial infection around dental implants showed by the current in vivo evidence; and (iii) discussion and recommendations for future research testing emerging antibacterial implant surfaces, connecting basic science and the requirements for future clinical translation. The findings of the present review suggest no consensus regarding the best available Ti surface to reduce bacterial colonization on dental implants. Smart release or on-demand activation surface coatings are a "new piece of the puzzle", which may be the most effective alternative for reducing microbial colonization on Ti surfaces, and future studies should focus on these technologies.
Collapse
|
4
|
Contamination of wounds with fecal bacteria in immuno-suppressed mice. Sci Rep 2020; 10:11494. [PMID: 32661287 PMCID: PMC7359036 DOI: 10.1038/s41598-020-68323-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/15/2020] [Indexed: 12/30/2022] Open
Abstract
Immunocompromised patients are predisposed to chronically infected wounds. Especially ulcers in the dorsal region often experience secondary polymicrobial infections. However, current wound infection models mostly use single-strain bacteria. To mimic clinically occurring infections caused by fecal contamination in immunocompromised/immobile patients, which differ significantly from single-strain infections, the present study aimed at the establishment of a new mouse model using infection by fecal bacteria. Dorsal circular excision wounds in immunosuppressed mice were infected with fecal slurry solution in several dilutions up to 1:8,000. Impact of immunosuppressor, bacterial load and timing on development of wound infections was investigated. Wounds were analyzed by scoring, 3D imaging and swab analyses. Autofluorescence imaging was not successful. Dose-finding of cyclophosphamide-induced immunosuppression was necessary for establishment of bacterial wound infections. Infection with fecal slurry diluted 1:166 to 1:400 induced significantly delayed wound healing (p < 0.05) without systemic reactions. Swab analyses post-infection matched the initial polymicrobial suspension. The customized wound score confirmed significant differences between the groups (p < 0.05). Here we report the establishment of a simple, new mouse model for clinically occurring wound infections by fecal bacteria and the evaluation of appropriate wound analysis methods. In the future, this model will provide a suitable tool for the investigation of complex microbiological interactions and evaluation of new therapeutic approaches.
Collapse
|
5
|
|
6
|
Piotrowski SL, Wilson L, Dharmaraj N, Hamze A, Clark A, Tailor R, Hill LR, Lai S, Kasper FK, Young S. Development and Characterization of a Rabbit Model of Compromised Maxillofacial Wound Healing. Tissue Eng Part C Methods 2020; 25:160-167. [PMID: 30747042 PMCID: PMC6457326 DOI: 10.1089/ten.tec.2018.0361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPACT STATEMENT Maxillofacial defects often present the clinical challenge of a compromised wound bed. Preclinical evaluation of tissue engineering techniques developed to facilitate healing and reconstruction typically involves animal models with ideal wound beds. The healthy wound bed scenario does not fully mimic the complex clinical environment in patients, which can lead to technology failure when translating from preclinical in vivo research to clinical use. The reported preclinical animal model of compromised wound healing enables investigation of tissue engineering technologies in a more clinically relevant scenario, potentially fostering translation of promising results in preclinical research to patients.
Collapse
Affiliation(s)
- Stacey L Piotrowski
- 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Texas Health Science Center, Houston, Texas.,2 Center for Laboratory Animal Medicine and Care, The University of Texas Health Science Center, Houston, Texas.,3 Department of Veterinary Medicine and Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lindsay Wilson
- 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Texas Health Science Center, Houston, Texas
| | - Neeraja Dharmaraj
- 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Texas Health Science Center, Houston, Texas
| | - Amani Hamze
- 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Texas Health Science Center, Houston, Texas
| | - Ashley Clark
- 4 Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center, Houston, Texas
| | - Ramesh Tailor
- 5 Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lori R Hill
- 3 Department of Veterinary Medicine and Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Lai
- 6 Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - F Kurtis Kasper
- 7 Department of Orthodontics, School of Dentistry, Graduate School of Biomedical Sciences, The University of Texas Health Science Center, Houston, Texas
| | - Simon Young
- 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Texas Health Science Center, Houston, Texas
| |
Collapse
|
7
|
Tatara AM, Watson E, Albert ND, Kontoyiannis PD, Kontoyiannis DP, Mikos AG. A murine model of cutaneous aspergillosis for evaluation of biomaterials-based local delivery therapies. J Biomed Mater Res A 2019; 107:1867-1874. [PMID: 30882993 PMCID: PMC6626589 DOI: 10.1002/jbm.a.36671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/28/2019] [Accepted: 02/21/2019] [Indexed: 01/10/2023]
Abstract
Cutaneous fungal infection is a challenging condition to treat that primarily afflicts immunocompromised patients. Local antifungal therapy may permit the delivery of high concentrations of antifungals directly to wounds while minimizing systemic toxicities. However, the field currently lacks suitable in vivo models. Therefore, a large cutaneous wound was created in immunosuppressed mice and inoculated with Aspergillus fumigatus. We fabricated biodegradable polymer microparticles (MPs) that were capable of locally delivering antifungal and characterized in vitro release kinetics. We compared wound bed size, fungal burden, and histological presence of fungi in mice treated with antifungal-loaded MPs. Mice with a cutaneous defect but no infection, mice with infected cutaneous defect but no treatment, and infected mice treated with blank MPs were used as controls. Infection of large wounds inhibited healing and resulted in tissue invasion in an inoculum-dependent manner. MPs were capable of releasing antifungals at concentrations above A. fumigatus Minimum Inhibitory Concentration (MIC) for at least 6 days. Wounds treated with MPs had significantly decreased size compared with no treatment (64.2% vs. 19.4% wound reduction, p = 0.002) and were not significantly different from uninfected controls (64.2% vs. 58.1%, p = 0.497). This murine model may serve to better understand cutaneous fungal infection and evaluate local biomaterials-based therapies. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 1867-1874, 2019.
Collapse
Affiliation(s)
- Alexander M. Tatara
- Department of Bioengineering, Rice University, Houston, Texas, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Emma Watson
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | - Nathaniel D. Albert
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Dimitrios P. Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | |
Collapse
|
8
|
Tatara AM, Kontoyiannis DP, Mikos AG. Drug delivery and tissue engineering to promote wound healing in the immunocompromised host: Current challenges and future directions. Adv Drug Deliv Rev 2018; 129:319-329. [PMID: 29221962 PMCID: PMC5988908 DOI: 10.1016/j.addr.2017.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/23/2017] [Accepted: 12/04/2017] [Indexed: 12/16/2022]
Abstract
As regenerative medicine matures as a field, more promising technologies are being translated from the benchtop to the clinic. However, many of these strategies are designed with otherwise healthy hosts in mind and validated in animal models without other co-morbidities. In reality, many of the patient populations benefiting from drug delivery and tissue engineering-based devices to enhance wound healing also have significant underlying immunodeficiency. Specifically, patients suffering from diabetes, malignancy, human immunodeficiency virus, post-organ transplantation, and other compromised states have significant pleotropic immune defects that affect wound healing. In this work, we review the role of different immune cells in the regenerative process, highlight the effect of several common immunocompromised states on wound healing, and discuss different drug delivery strategies for overcoming immunodeficiencies.
Collapse
Affiliation(s)
- Alexander M Tatara
- Medical Scientist Training Program, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States; Department of Bioengineering, Rice University, Houston, TX, United States.
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, United States.
| | - Antonios G Mikos
- Department of Bioengineering, Rice University, Houston, TX, United States.
| |
Collapse
|
9
|
Watson E, Tatara AM, Kontoyiannis DP, Mikos AG. Inherently Antimicrobial Biodegradable Polymers in Tissue Engineering. ACS Biomater Sci Eng 2016; 3:1207-1220. [PMID: 33440510 DOI: 10.1021/acsbiomaterials.6b00501] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Many of the strategies currently being explored in the field of tissue engineering involve the combination of cells and degradable engineered scaffolds for the regeneration of biological tissues. However, infection of the wound or the scaffold itself results in failure of healing. Therefore, a new area of development in the field is the synthesis of polymer-based scaffolds that inherently have the ability to resist microbial infection as degradation occurs and new tissue replaces the scaffold. These scaffolds, defined as inherently antimicrobial biodegradable polymers (IABPs), can be classified based on their monomeric components as follows: (1) traditional antimicrobials (such as beta-lactams, fluoroquinolones, glycopeptides, and aminoglycosides), (2) naturally derived compounds (such as extracellular matrix components, chitosan, and antimicrobial peptides), and (3) novel synthetic antimicrobials. After validation of chemical synthesis as well as physicochemical characterization of a newly created IABP, thorough in vitro and in vivo assays must be conducted to ensure antimicrobial efficacy as well as biocompatibility as a tissue-engineered scaffold system. In this review, we will introduce existing IABPs, discuss the current platforms that have been developed for the synthesis of IABPs, and highlight future directions as well as challenges in the field.
Collapse
Affiliation(s)
- Emma Watson
- Department of Bioengineering, Rice University, Houston, Texas 77005, Unites States.,Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas 77030, United States
| | - Alexander M Tatara
- Department of Bioengineering, Rice University, Houston, Texas 77005, Unites States.,Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas 77030, United States
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
| | - Antonios G Mikos
- Department of Bioengineering, Rice University, Houston, Texas 77005, Unites States.,Department of Chemical and Biomolecular Engineering, Rice University, Houston, Texas 77005, Unites States
| |
Collapse
|
10
|
Shah SR, Young S, Goldman JL, Jansen JA, Wong ME, Mikos AG. A composite critical-size rabbit mandibular defect for evaluation of craniofacial tissue regeneration. Nat Protoc 2016; 11:1989-2009. [PMID: 27658014 DOI: 10.1038/nprot.2016.122] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Translational biomaterials targeted toward the regeneration of large bone defects in the mandible require a preclinical model that accurately recapitulates the regenerative challenges present in humans. Computational modeling and in vitro assays do not fully replicate the in vivo environment. Consequently, in vivo models can have specific applications such as those of the mandibular angle defect, which is used to investigate bone regeneration in a nonload-bearing area, and the inferior border mandibular defect, which is a model for composite bone and nerve regeneration, with both models avoiding involvement of soft tissue or teeth. In this protocol, we describe a reproducible load-bearing critical-size composite tissue defect comprising loss of soft tissue, bone and tooth in the mandible of a rabbit. We have previously used this procedure to investigate bone regeneration, vascularization and infection prevention in response to new biomaterial formulations for craniofacial tissue engineering applications. This surgical approach can be adapted to investigate models such as that of regeneration in the context of osteoporosis or irradiation. The procedure can be performed by researchers with basic surgical skills such as dissection and suturing. The procedure takes 1.5-2 h, with ∼2 h of immediate postoperative care, and animals should be monitored daily for the remainder of the study. For bone tissue engineering applications, tissue collection typically occurs 12 weeks after surgery. In this protocol, we will present the necessary steps to ensure reproducibility; tips to minimize complications during and after surgery; and analytical techniques for assessing soft tissue, bone and vessel regeneration by gross evaluation, microcomputed tomography (microCT) and histology.
Collapse
Affiliation(s)
- Sarita R Shah
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | - Simon Young
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Julia L Goldman
- Center for Laboratory Animal Medicine and Care, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - John A Jansen
- Department of Biomaterials, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark E Wong
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Antonios G Mikos
- Department of Bioengineering, Rice University, Houston, Texas, USA
| |
Collapse
|
11
|
Lovati AB, Bottagisio M, de Vecchi E, Gallazzi E, Drago L. Animal Models of Implant-Related Low-Grade Infections. A Twenty-Year Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 971:29-50. [PMID: 27718217 DOI: 10.1007/5584_2016_157] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The demand for joint replacement and surgical treatment is continuously increasing, thus representing a clinical burden and a cost for the healthcare system. Among several pathogens involved in implant-related infections, staphylococci account for the two-thirds of clinically isolated bacteria. Despite most of them are highly virulent microorganisms (Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa), low virulent bacteria (Staphylococcus epidermidis, Propionibacterium acnes) are responsible for delayed, low-grade infections without specific clinical signs and hardly distinguishable from aseptic prosthetic failure. Therefore, there is a real need to study the pathogenesis of orthopedic infections through in vivo animal models. The present review of the literature provides a 20-year overview of animal models of acute, subclinical or chronic orthopedic infections according to the pathogen virulence and inocula. Through this analysis, a great variety of conditions in terms of bacterial strains and inocula emerged, thus encouraging the development of more reproducible in vivo studies to provide relevant information for a translational approach to humans.
Collapse
Affiliation(s)
- Arianna Barbara Lovati
- Cell and Tissue Engineering Laboratory, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy.
| | - Marta Bottagisio
- Cell and Tissue Engineering Laboratory, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy.,Department of Veterinary Medicine, University of Milan, via Celoria 10, 20133, Milan, Italy
| | - Elena de Vecchi
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy
| | - Enrico Gallazzi
- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy
| | - Lorenzo Drago
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy.,Department of Biomedical Science for Health, University of Milan, via L. Mangiagalli 31, 20133, Milan, Italy
| |
Collapse
|
12
|
|