1
|
Kurz B, Lange T, Voelker M, Hart ML, Rolauffs B. Articular Cartilage-From Basic Science Structural Imaging to Non-Invasive Clinical Quantitative Molecular Functional Information for AI Classification and Prediction. Int J Mol Sci 2023; 24:14974. [PMID: 37834422 PMCID: PMC10573252 DOI: 10.3390/ijms241914974] [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] [Received: 09/08/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
This review presents the changes that the imaging of articular cartilage has undergone throughout the last decades. It highlights that the expectation is no longer to image the structure and associated functions of articular cartilage but, instead, to devise methods for generating non-invasive, function-depicting images with quantitative information that is useful for detecting the early, pre-clinical stage of diseases such as primary or post-traumatic osteoarthritis (OA/PTOA). In this context, this review summarizes (a) the structure and function of articular cartilage as a molecular imaging target, (b) quantitative MRI for non-invasive assessment of articular cartilage composition, microstructure, and function with the current state of medical diagnostic imaging, (c), non-destructive imaging methods, (c) non-destructive quantitative articular cartilage live-imaging methods, (d) artificial intelligence (AI) classification of degeneration and prediction of OA progression, and (e) our contribution to this field, which is an AI-supported, non-destructive quantitative optical biopsy for early disease detection that operates on a digital tissue architectural fingerprint. Collectively, this review shows that articular cartilage imaging has undergone profound changes in the purpose and expectations for which cartilage imaging is used; the image is becoming an AI-usable biomarker with non-invasive quantitative functional information. This may aid in the development of translational diagnostic applications and preventive or early therapeutic interventions that are yet beyond our reach.
Collapse
Affiliation(s)
- Bodo Kurz
- Department of Anatomy, Christian-Albrechts-University, Otto-Hahn-Platz 8, 24118 Kiel, Germany
| | - Thomas Lange
- Medical Physics Department of Radiology, Faculty of Medicine, Medical Center—Albert-Ludwigs-University of Freiburg, 79085 Freiburg im Breisgau, Germany;
| | - Marita Voelker
- G.E.R.N. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center—Albert-Ludwigs-University of Freiburg, 79085 Freiburg im Breisgau, Germany; (M.V.); (M.L.H.)
| | - Melanie L. Hart
- G.E.R.N. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center—Albert-Ludwigs-University of Freiburg, 79085 Freiburg im Breisgau, Germany; (M.V.); (M.L.H.)
| | - Bernd Rolauffs
- G.E.R.N. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center—Albert-Ludwigs-University of Freiburg, 79085 Freiburg im Breisgau, Germany; (M.V.); (M.L.H.)
| |
Collapse
|
2
|
Liu Z, Hui Mingalone CK, Gnanatheepam E, Hollander JM, Zhang Y, Meng J, Zeng L, Georgakoudi I. Label-free, multi-parametric assessments of cell metabolism and matrix remodeling within human and early-stage murine osteoarthritic articular cartilage. Commun Biol 2023; 6:405. [PMID: 37055483 PMCID: PMC10102009 DOI: 10.1038/s42003-023-04738-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/21/2023] [Indexed: 04/15/2023] Open
Abstract
Osteoarthritis (OA) is characterized by the progressive deterioration of articular cartilage, involving complicated cell-matrix interactions. Systematic investigations of dynamic cellular and matrix changes during OA progression are lacking. In this study, we use label-free two-photon excited fluorescence (TPEF) and second harmonic generation (SHG) imaging to assess cellular and extracellular matrix features of murine articular cartilage during several time points at early stages of OA development following destabilization of medial meniscus surgery. We detect significant changes in the organization of collagen fibers and crosslink-associated fluorescence of the superficial zone as early as one week following surgery. Such changes become significant within the deeper transitional and radial zones at later time-points, highlighting the importance of high spatial resolution. Cellular metabolic changes exhibit a highly dynamic behavior, and indicate metabolic reprogramming from enhanced oxidative phosphorylation to enhanced glycolysis or fatty acid oxidation over the ten-week observation period. The optical metabolic and matrix changes detected within this mouse model are consistent with differences identified in excised human cartilage specimens from OA and healthy cartilage specimens. Thus, our studies reveal important cell-matrix interactions at the onset of OA that may enable improved understanding of OA development and identification of new potential treatment targets.
Collapse
Affiliation(s)
- Zhiyi Liu
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA
- State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering; International Research Center for Advanced Photonics, Zhejiang University, Hangzhou, Zhejiang, 310027, China
- Intelligent Optics & Photonics Research Center, Jiaxing Research Institute, Zhejiang University, Jiaxing, Zhejiang, 314000, China
| | - Carrie K Hui Mingalone
- Program in Cell, Molecular, and Developmental Biology, Graduate School of Biomedical Sciences, Tufts University, Boston, MA, 02111, USA
| | | | - Judith M Hollander
- Program in Cell, Molecular, and Developmental Biology, Graduate School of Biomedical Sciences, Tufts University, Boston, MA, 02111, USA
| | - Yang Zhang
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA
| | - Jia Meng
- State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering, Zhejiang University, Hangzhou, Zhejiang, 310027, China
| | - Li Zeng
- Program in Cell, Molecular, and Developmental Biology, Graduate School of Biomedical Sciences, Tufts University, Boston, MA, 02111, USA
- Department of Immunology, Tufts University School of Medicine, Boston, MA, 02111, USA
- Department of Orthopaedics, Tufts Medical Center, Boston, MA, 02111, USA
| | - Irene Georgakoudi
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA.
- Program in Cell, Molecular, and Developmental Biology, Graduate School of Biomedical Sciences, Tufts University, Boston, MA, 02111, USA.
| |
Collapse
|
3
|
Ong LJY, Fan X, Rujia Sun A, Mei L, Toh YC, Prasadam I. Controlling Microenvironments with Organs-on-Chips for Osteoarthritis Modelling. Cells 2023; 12:cells12040579. [PMID: 36831245 PMCID: PMC9954502 DOI: 10.3390/cells12040579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Osteoarthritis (OA) remains a prevalent disease affecting more than 20% of the global population, resulting in morbidity and lower quality of life for patients. The study of OA pathophysiology remains predominantly in animal models due to the complexities of mimicking the physiological environment surrounding the joint tissue. Recent development in microfluidic organ-on-chip (OoC) systems have demonstrated various techniques to mimic and modulate tissue physiological environments. Adaptations of these techniques have demonstrated success in capturing a joint tissue's tissue physiology for studying the mechanism of OA. Adapting these techniques and strategies can help create human-specific in vitro models that recapitulate the cellular processes involved in OA. This review aims to comprehensively summarise various demonstrations of microfluidic platforms in mimicking joint microenvironments for future platform design iterations.
Collapse
Affiliation(s)
- Louis Jun Ye Ong
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane City, QLD 4000, Australia
- Center for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
- Max Planck Queensland Centre (MPQC) for the Materials Science of Extracellular Matrices, Queensland University of Technology, Brisbane City, QLD 4000, Australia
- Correspondence: (L.J.Y.O.); (I.P.)
| | - Xiwei Fan
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane City, QLD 4000, Australia
- Center for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Antonia Rujia Sun
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane City, QLD 4000, Australia
- Center for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Lin Mei
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane City, QLD 4000, Australia
- Center for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Yi-Chin Toh
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane City, QLD 4000, Australia
- Center for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
- Max Planck Queensland Centre (MPQC) for the Materials Science of Extracellular Matrices, Queensland University of Technology, Brisbane City, QLD 4000, Australia
- Centre for Microbiome Research, Queensland University of Technology, Brisbane City, QLD 4000, Australia
| | - Indira Prasadam
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane City, QLD 4000, Australia
- Center for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
- Correspondence: (L.J.Y.O.); (I.P.)
| |
Collapse
|
4
|
Characterization of collagen response to bone fracture healing using polarization-SHG. Sci Rep 2022; 12:18453. [PMID: 36323698 PMCID: PMC9630316 DOI: 10.1038/s41598-022-21876-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
In this study, we extend on the three parameter analysis approach of utilizing a noninvasive dual-liquid-crystal-based polarization-resolved second harmonic generation (SHG) microscopy to facilitate the quantitative characterization of collagen types I and II in fracture healing tissues. The SHG images under various linear and circular polarization states are analyzed and quantified in terms of the peptide pitch angle (PA), SHG-circular dichroism (CD), and anisotropy parameter (AP). The results show that the collagen PA has a value of 49.26° after 2 weeks of fracture healing (collagen type II domination) and 49.05° after 4 weeks (collagen type I domination). Moreover, the SHG-CD and AP values of the different collagen types differ by 0.05. The change tendencies of the extracted PA, SHG-CD, and AP parameters over the healing time are consistent with the collagen properties of healthy nonfractured bone. Thus, the feasibility of the proposed dual-liquid-crystal-based polarization-SHG method for differentiating between collagen types I and II in bone fracture healing tissue is confirmed.
Collapse
|
5
|
Jambor AN, Shelton EM, Kijowski R, Henak CR, Campagnola PJ. Assessing collagen alterations in enzymatic degradation models of osteoarthritis via second harmonic generation microscopy. Osteoarthritis Cartilage 2021; 29:1590-1599. [PMID: 34454101 PMCID: PMC8542598 DOI: 10.1016/j.joca.2021.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 07/30/2021] [Accepted: 08/16/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Structural changes in the collagen II architecture of osteoarthritis (OA) are poorly understood, which is a large shortcoming in the early diagnosis of this disease. Though degradation can be simulated by enzymes including trypsin and bacterial collagenase, the specific structural features of each digestion and their relationship to naturally occurring OA remain unclear. EXPERIMENTAL DESIGN We used collagen sensitive/specific Second Harmonic Generation (SHG) microscopy in conjunction with optical scattering measurements to probe the resulting architecture changes in bovine knee cartilage upon trypsin and collagenase degradation. Image features extracted from SHG images were used to train a linear discriminant (LD) model capable of classifying enzymatic degradation, which was then applied to human cartilage with varied modified Mankin histological scores. RESULTS The treatment of cartilage with these enzymes resulted in more disorganized collagen structure, where this effect was greatest with collagenase treatment. Using the LD model, we classified the control and degraded tissues in the three zones with >92% accuracy, showing that these enzymes have distinct activity on the collagen assembly. Application of the LD model to human cartilage indicated that collagenase effects were more representative of in vivo degeneration and were also consistent with damage beginning at the articular surface and progressing into deeper zones. CONCLUSIONS SHG and optical scattering measurements successfully delineate trypsin and collagenase degradation and suggest that collagen alterations in human OA are better simulated by the latter mechanism. These results lay the groundwork for using high-resolution SHG and optical scattering as an earlier diagnostic tool than is currently available.
Collapse
Affiliation(s)
- Alexander N. Jambor
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr, Madison, WI 53706, USA
| | - Emily M. Shelton
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr, Madison, WI 53706, USA,Department of Physics, University of Wisconsin-Madison, 1150 University Ave, Madison, WI 53706, USA
| | - Richard Kijowski
- Department of Radiology, 600 Highland Ave, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Corinne R. Henak
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr, Madison, WI 53706, USA,Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI 53706, USA,,
| | - Paul J. Campagnola
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr, Madison, WI 53706, USA,,
| |
Collapse
|
6
|
Zhong Y, Caplan AI, Welter JF, Baskaran H. Glucose Availability Affects Extracellular Matrix Synthesis During Chondrogenesis In Vitro. Tissue Eng Part A 2021; 27:1321-1332. [PMID: 33499734 PMCID: PMC8610032 DOI: 10.1089/ten.tea.2020.0144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 01/22/2021] [Indexed: 01/09/2023] Open
Abstract
Understanding in vitro chondrogenesis of human mesenchymal stem cells (hMSCs) is important as it holds great promise for cartilage tissue engineering and other applications. The current technology produces the end tissue quality that is highly variable and dependent on culture conditions. We investigated the effect of nutrient availability on hMSC chondrogenesis in a static aggregate culture system by varying the medium-change frequency together with starting glucose levels. Glucose uptake and lactate secretion profiles were obtained to monitor the metabolism change during hMSC chondrogenesis with different culture conditions. Higher medium-change frequency led to increases in cumulative glucose uptake for all starting glucose levels. Furthermore, increase in glucose uptake by aggregates led to increased end tissue glycosaminoglycan (GAG) and hydroxyproline (HYP) content. The results suggest that increased glucose availability either through increased medium-change frequency or higher initial glucose levels lead to improved chondrogenesis. Also, cumulative glucose uptake and lactate secretion were found to correlate well with GAG and HYP content, indicating both molecules are promising biomarkers for noninvasive assessment of hMSC chondrogenesis. Collectively, our results can be used to design optimal culture conditions and develop dynamic assessment strategies for cartilage tissue engineering applications. Impact statement In this study, we investigated how culture conditions, medium-change frequency and glucose levels, affect chondrogenesis of human mesenchymal stem cells in an aggregate culture model. Doubling the medium-change frequency significantly increased the biochemical quality of the resultant tissue aggregates, as measured by their glycosaminoglycan and hydroxyproline content. We attribute this to increased glucose uptake through the glycolysis pathway, as secretion of lactate, a key endpoint product of the glycolysis pathway, increased concurrently. These findings can be used to design optimal culture conditions for tissue engineering and regenerative medicine applications.
Collapse
Affiliation(s)
- Yi Zhong
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- CWRU Center for Multimodal Evaluation of Engineered Cartilage, Case Western Reserve University, Cleveland, Ohio, USA
| | - Arnold I. Caplan
- CWRU Center for Multimodal Evaluation of Engineered Cartilage, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biology and Case Western Reserve University, Cleveland, Ohio, USA
| | - Jean F. Welter
- CWRU Center for Multimodal Evaluation of Engineered Cartilage, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biology and Case Western Reserve University, Cleveland, Ohio, USA
| | - Harihara Baskaran
- CWRU Center for Multimodal Evaluation of Engineered Cartilage, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Chemical and Biomolecular Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
7
|
Vielreicher M, Bozec A, Schett G, Friedrich O. Murine Metatarsus Bone and Joint Collagen-I Fiber Morphologies and Networks Studied With SHG Multiphoton Imaging. Front Bioeng Biotechnol 2021; 9:608383. [PMID: 34178952 PMCID: PMC8226188 DOI: 10.3389/fbioe.2021.608383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic inflammatory disease of bones and joints (e.g., rheumatoid arthritis, gout, etc.), but also acute bone injury and healing, or degenerative resorptive processes inducing osteoporosis, are associated with structural remodeling that ultimately have impact on function. For instance, bone stability is predominantly orchestrated by the structural arrangement of extracellular matrix fibrillar networks, i.e., collagen-I, -IV, elastin, and other proteins. These components may undergo distinct network density and orientation alterations that may be causative for decreased toughness, resilience and load bearing capacity or even increased brittleness. Diagnostic approaches are usually confined to coarse imaging modalities of X-ray or computer tomography that only provide limited optical resolution and lack specificity to visualize the fibrillary collagen network. However, studying collagen structure at the microscopic scale is of considerable interest to understand the mechanisms of tissue pathologies. Multiphoton Second Harmonic Generation (SHG) microscopy, is able to visualize the sterical topology of the collagen-I fibrillar network in 3D, in a minimally invasive and label-free manner. Penetration depths exceed those of conventional visible light imaging and can be further optimized through employing decalcification or optical clearing processing ex vivo. The goal of this proof-of-concept study was to use SHG and two-photon excited fluorescence (2-PEF) imaging to mainly characterize the fibrillary collagen organization within ex vivo decalcified normal mouse metatarsus bone and joint. The results show that the technique resolved the fibrillar collagen network of complete bones and joints with almost no artifacts and enabled to study the complex collagen-I networks with various fiber types (straight, crimped) and network arrangements of mature and woven bone with high degree of detail. Our imaging approach enabled to identify cavities within both cortical and trabecular bone architecture as well as interfaces with sharply changing fiber morphology and network structure both within bone, in tendon and ligament and within joint areas. These possibilities are highly advantageous since the technology can easily be applied to animal models, e.g., of rheumatoid arthritis to study structural effects of chronic joint inflammation, and to many others and to compare to the structure of human bone.
Collapse
Affiliation(s)
- Martin Vielreicher
- Institute of Medical Biotechnology, Department of Chemical and Biological Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Aline Bozec
- Department of Internal Medicine 3 - Rheumatology and Immunology, University Clinic, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, University Clinic, Erlangen, Germany
| | - Oliver Friedrich
- Institute of Medical Biotechnology, Department of Chemical and Biological Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
8
|
James DS, Campagnola PJ. Recent Advancements in Optical Harmonic Generation Microscopy: Applications and Perspectives. BME FRONTIERS 2021; 2021:3973857. [PMID: 37849910 PMCID: PMC10521653 DOI: 10.34133/2021/3973857] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/14/2020] [Indexed: 10/19/2023] Open
Abstract
Second harmonic generation (SHG) and third harmonic generation (THG) microscopies have emerged as powerful imaging modalities to examine structural properties of a wide range of biological tissues. Although SHG and THG arise from very different contrast mechanisms, the two are complimentary and can often be collected simultaneously using a modified multiphoton microscope. In this review, we discuss the needed instrumentation for these modalities as well as the underlying theoretical principles of SHG and THG in tissue and describe how these can be leveraged to extract unique structural information. We provide an overview of recent advances showing how SHG microscopy has been used to evaluate collagen alterations in the extracellular matrix and how this has been used to advance our knowledge of cancers, fibroses, and the cornea, as well as in tissue engineering applications. Specific examples using polarization-resolved approaches and machine learning algorithms are highlighted. Similarly, we review how THG has enabled developmental biology and skin cancer studies due to its sensitivity to changes in refractive index, which are ubiquitous in all cell and tissue assemblies. Lastly, we offer perspectives and outlooks on future directions of SHG and THG microscopies and present unresolved questions, especially in terms of overall miniaturization and the development of microendoscopy instrumentation.
Collapse
Affiliation(s)
- Darian S. James
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr, Madison, WI 53706, USA
| | - Paul J. Campagnola
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr, Madison, WI 53706, USA
| |
Collapse
|
9
|
Tehrani KF, Pendleton EG, Southern WM, Call JA, Mortensen LJ. Spatial frequency metrics for analysis of microscopic images of musculoskeletal tissues. Connect Tissue Res 2021; 62:4-14. [PMID: 33028134 PMCID: PMC7718369 DOI: 10.1080/03008207.2020.1828381] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: Imaging-based metrics for analysis of biological tissues are powerful tools that can extract information such as shape, size, periodicity, and many other features to assess the requested qualities of a tissue. Muscular and osseous tissues consist of periodic structures that are directly related to their function, and so analysis of these patterns likely reflects tissue health and regeneration.Methods: A method for assessment of periodic structures is by analyzing them in the spatial frequency domain using the Fourier transform. In this paper, we present two filters which we developed in the spatial frequency domain for the purpose of analyzing musculoskeletal structures. These filters provide information about 1) the angular orientation of the tissues and 2) their periodicity. We explore periodic structural patterns in the mitochondrial network of skeletal muscles that are reflective of muscle metabolism and myogenesis; and patterns of collagen fibers in the bone that are reflective of the organization and health of bone extracellular matrix.Results: We present an analysis of mouse skeletal muscle in healthy and injured muscles. We used a transgenic mouse that ubiquitously expresses fluorescent protein in their mitochondria and performed 2-photon microscopy to image the structures. To acquire the collagen structure of the bone we used non-linear SHG microscopy of mouse flat bone. We analyze and compare juvenile versus adult mice, which have different structural patterns.Conclusions: Our results indicate that these metrics can quantify musculoskeletal tissues during development and regeneration.
Collapse
Affiliation(s)
- Kayvan Forouhesh Tehrani
- Regenerative Bioscience Center, Rhodes Center for ADS,
University of Georgia, Athens, GA 30602, USA
| | - Emily G. Pendleton
- Regenerative Bioscience Center, Rhodes Center for ADS,
University of Georgia, Athens, GA 30602, USA
| | - W. Michael Southern
- Department of Kinesiology, University of Georgia, Athens,
GA 30602, USA,Currently with Department of Biochemistry, Molecular
Biology, and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jarrod A. Call
- Regenerative Bioscience Center, Rhodes Center for ADS,
University of Georgia, Athens, GA 30602, USA,Department of Kinesiology, University of Georgia, Athens,
GA 30602, USA
| | - Luke J. Mortensen
- Regenerative Bioscience Center, Rhodes Center for ADS,
University of Georgia, Athens, GA 30602, USA,School of Chemical, Materials and Biomedical Engineering,
University of Georgia, Athens, GA 30602, USA,
| |
Collapse
|
10
|
Mansfield JC, Mandalia V, Toms A, Winlove CP, Brasselet S. Collagen reorganization in cartilage under strain probed by polarization sensitive second harmonic generation microscopy. J R Soc Interface 2019; 16:20180611. [PMID: 30958161 PMCID: PMC6364654 DOI: 10.1098/rsif.2018.0611] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/20/2018] [Indexed: 11/12/2022] Open
Abstract
Type II collagen fibril diameters in cartilage are beneath the diffraction limit of optical microscopy, which makes the assessment of collagen organization very challenging. In this work we use polarization sensitive second harmonic generation (P-SHG) imaging to map collagen organization in articular cartilage, addressing in particular its behaviour under strain and changes which occur in osteoarthritis. P-SHG yields two parameters, molecular order and orientation, which provide measures of the degree of organization both at the molecular scale (below the diffraction limit) and above a few hundred nanometres (at the image pixel size). P-SHG clearly demonstrates the zonal collagen architecture and reveals differences in the structure of the fibrils around chondrocytes. P-SHG also reveals sub-micron scale fibril re-organization in cartilage strips exposed to tensile loading, with an increase in local organization in the superficial zone which weakly correlates with tensile modulus. Finally, P-SHG is used to investigate osteoarthritic cartilage from total knee replacement surgery, and reveals widespread heterogeneity across samples both microscale fibril orientations and their sub-micron organization. By addressing collagen fibril structure on scales intermediate between conventional light and electron microscopy, this study provides new insights into collagen micromechanics and mechanisms of degradation.
Collapse
Affiliation(s)
- Jessica C. Mansfield
- Physics, College of Engineering Mathematics and Physical Sciences, University of Exeter, Stocker Road, Exeter EX4 4QL, UK
| | - Vipul Mandalia
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK
| | - Andrew Toms
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK
| | - C. Peter Winlove
- Physics, College of Engineering Mathematics and Physical Sciences, University of Exeter, Stocker Road, Exeter EX4 4QL, UK
| | - Sophie Brasselet
- Institut Fresnel, CNRS, Aix Marseille Univ, Centrale Marseille, 13013 Marseille, France
| |
Collapse
|
11
|
Islam A, Romijn EI, Lilledahl MB, Martinez-Zubiaurre I. Non-linear optical microscopy as a novel quantitative and label-free imaging modality to improve the assessment of tissue-engineered cartilage. Osteoarthritis Cartilage 2017; 25:1729-1737. [PMID: 28668541 DOI: 10.1016/j.joca.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 05/22/2017] [Accepted: 06/20/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Current systems to evaluate outcomes from tissue-engineered cartilage (TEC) are sub-optimal. The main purpose of our study was to demonstrate the use of second harmonic generation (SHG) microscopy as a novel quantitative approach to assess collagen deposition in laboratory made cartilage constructs. METHODS Scaffold-free cartilage constructs were obtained by condensation of in vitro expanded Hoffa's fat pad derived stromal cells (HFPSCs), incubated in the presence or absence of chondrogenic growth factors (GF) during a period of 21 d. Cartilage-like features in constructs were assessed by Alcian blue staining, transmission electron microscopy (TEM), SHG and two-photon excited fluorescence microscopy. A new scoring system, using second harmonic generation microscopy (SHGM) index for collagen density and distribution, was adapted to the existing "Bern score" in order to evaluate in vitro TEC. RESULTS Spheroids with GF gave a relative high Bern score value due to appropriate cell morphology, cell density, tissue-like features and proteoglycan content, whereas spheroids without GF did not. However, both TEM and SHGM revealed striking differences between the collagen framework in the spheroids and native cartilage. Spheroids required a four-fold increase in laser power to visualize the collagen matrix by SHGM compared to native cartilage. Additionally, collagen distribution, determined as the area of tissue generating SHG signal, was higher in spheroids with GF than without GF, but lower than in native cartilage. CONCLUSION SHG represents a reliable quantitative approach to assess collagen deposition in laboratory engineered cartilage, and may be applied to improve currently established scoring systems.
Collapse
Affiliation(s)
- A Islam
- Institute of Clinical Medicine, University of Tromsø, Norway.
| | - E I Romijn
- Department of Physics, Norwegian University of Science and Technology, Norway.
| | - M B Lilledahl
- Department of Physics, Norwegian University of Science and Technology, Norway.
| | | |
Collapse
|
12
|
Finnøy A, Olstad K, Lilledahl MB. Non-linear optical microscopy of cartilage canals in the distal femur of young pigs may reveal the cause of articular osteochondrosis. BMC Vet Res 2017; 13:270. [PMID: 28830435 PMCID: PMC5568222 DOI: 10.1186/s12917-017-1197-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 08/14/2017] [Indexed: 11/12/2022] Open
Abstract
Background Articular osteochondrosis is a common cause of leg weakness in pigs and is defined as a focal delay in the endochondral ossification of the epiphysis. The first demonstrated steps in the pathogenesis consist of loss of blood supply and subsequent chondronecrosis in the epiphyseal growth cartilage. Blood vessels in cartilage are located in cartilage canals and become incorporated into the secondary ossification centre during growth. It has been hypothesized that vascular failure occurs during this incorporation process, but it is not known what predisposes a canal to fail. To obtain new information that may reveal the cause of vascular failure, the distal femur of 4 pigs aged 82–140 days was sampled and examined by non-linear optical microscopy. This novel technique was used for its ability to reveal information about collagen by second harmonic generation and cellular morphology by two-photon-excited fluorescence in thick sections without staining. The aims were to identify morphological variations between cartilage canal segments and to examine if failed cartilage canals could be followed back to the location where the blood supply ceased. Results The cartilage canals were shown to vary in their content of collagen fibres (112/412 segments), and the second harmonic and fluorescence signals indicated a variation in the bundling of collagen fibrils (245/412 segments) and in the calcification (30/412 segments) of the adjacent cartilage matrix. Failed cartilage canals associated with chondronecrosis were shown to enter the epiphyseal growth cartilage from not only the secondary ossification centre, but also the attachment site of the caudal cruciate ligament. Conclusion The variations between cartilage canal segments could potentially explain why the blood supply fails at the osteochondral junction in only a subset of the canals. Proteins linked to these variations should be examined in future genomic studies. Although incorporation can still be a major cause, it could not account for all cases of vascular failure. The role of the caudal cruciate ligament in the cause of osteochondrosis should therefore be investigated further.
Collapse
Affiliation(s)
- Andreas Finnøy
- Department of Physics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Kristin Olstad
- Faculty of Veterinary Medicine and Biosciences, Equine Section, Norwegian University of Life Sciences, P.O. Box 8146, Oslo, Norway
| | - Magnus B Lilledahl
- Department of Physics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| |
Collapse
|
13
|
Henrionnet C, Dumas D, Hupont S, Stoltz JF, Mainard D, Gillet P, Pinzano A. New tools for non-invasive exploration of collagen network in cartilaginous tissue-engineered substitute. Biomed Mater Eng 2017; 28:S229-S235. [PMID: 28372299 DOI: 10.3233/bme-171645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In tissue engineering approaches, the quality of substitutes is a key element to determine its ability to treat cartilage defects. However, in clinical practice, the evaluation of tissue-engineered cartilage substitute quality is not possible due to the invasiveness of the standard procedure, which is to date histology. The aim of this work was to validate a new innovative system performed from two-photon excitation laser adapted to an optical macroscope to evaluate at macroscopic scale the collagen network in cartilage tissue-engineered substitutes in confrontation with gold standard histologic techniques or immunohistochemistry to visualize type II collagen. This system permitted to differentiate the quality of collagen network between ITS and TGF-β1 treatments. Multiscale large field imaging combined to multimodality approaches (SHG-TCSPC) at macroscopical scale represent an innovative and non-invasive technique to monitor the quality of collagen network in cartilage tissue-engineered substitutes before in vivo implantation.
Collapse
Affiliation(s)
- Christel Henrionnet
- Ingénierie Moléculaire et Physiopathologie Articulaire, UMR 7365 CNRS - Université de Lorraine, Bâtiment Biopôle, 9 avenue de la Forêt de Haye, BP 50184, F54505 Vandoeuvre-lès-Nancy, France
| | - Dominique Dumas
- Ingénierie Moléculaire et Physiopathologie Articulaire, UMR 7365 CNRS - Université de Lorraine, Bâtiment Biopôle, 9 avenue de la Forêt de Haye, BP 50184, F54505 Vandoeuvre-lès-Nancy, France.,Plateforme d'Imagerie Cellulaire PTIBC-IBISA, FR3209 CNRS, Faculté de Médecine, 9 avenue de la Forêt de Haye, BP 50184, F54505 Vandoeuvre-lès-Nancy, France
| | - Sébastien Hupont
- Plateforme d'Imagerie Cellulaire PTIBC-IBISA, FR3209 CNRS, Faculté de Médecine, 9 avenue de la Forêt de Haye, BP 50184, F54505 Vandoeuvre-lès-Nancy, France
| | - Jean François Stoltz
- Ingénierie Moléculaire et Physiopathologie Articulaire, UMR 7365 CNRS - Université de Lorraine, Bâtiment Biopôle, 9 avenue de la Forêt de Haye, BP 50184, F54505 Vandoeuvre-lès-Nancy, France
| | - Didier Mainard
- Ingénierie Moléculaire et Physiopathologie Articulaire, UMR 7365 CNRS - Université de Lorraine, Bâtiment Biopôle, 9 avenue de la Forêt de Haye, BP 50184, F54505 Vandoeuvre-lès-Nancy, France.,Plateforme d'Imagerie Cellulaire PTIBC-IBISA, FR3209 CNRS, Faculté de Médecine, 9 avenue de la Forêt de Haye, BP 50184, F54505 Vandoeuvre-lès-Nancy, France.,Service de Chirurgie Orthopédique et Traumatologique, CHRU Nancy, 29 avenue du Maréchal de Lattre de Tassigny, CO60034, F54035 Nancy, France
| | - Pierre Gillet
- Ingénierie Moléculaire et Physiopathologie Articulaire, UMR 7365 CNRS - Université de Lorraine, Bâtiment Biopôle, 9 avenue de la Forêt de Haye, BP 50184, F54505 Vandoeuvre-lès-Nancy, France
| | - Astrid Pinzano
- Ingénierie Moléculaire et Physiopathologie Articulaire, UMR 7365 CNRS - Université de Lorraine, Bâtiment Biopôle, 9 avenue de la Forêt de Haye, BP 50184, F54505 Vandoeuvre-lès-Nancy, France
| |
Collapse
|
14
|
Campbell KR, Campagnola PJ. Wavelength-Dependent Second Harmonic Generation Circular Dichroism for Differentiation of Col I and Col III Isoforms in Stromal Models of Ovarian Cancer Based on Intrinsic Chirality Differences. J Phys Chem B 2017; 121:1749-1757. [PMID: 28170263 DOI: 10.1021/acs.jpcb.6b06822] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Extensive remodeling of the extracellular matrix (ECM) occurs in many epithelial cancers. For example, in ovarian cancer, upregulation of collagen isoform type III has been linked to invasive forms of the disease, and this change may be a potential biomarker. To examine this possibility, we implemented wavelength-dependent second harmonic generation circular dichroism (SHG-CD) imaging microscopy to quantitatively determine changes in chirality in ECM models comprised of different Col I/Col III composition. In these models, Col III was varied between 0 and 40%, and we found increasing Col III results in reduced net chirality, consistent with structural biology studies of Col I and III in tissues where the isoforms comingle in the same fibrils. We further examined the wavelength dependence of the SHG-CD to both optimize the response and gain insight into the underlying mechanism. We found using shorter SHG excitation wavelengths resulted in increased SHG-CD sensitivity, where this is consistent with the electric-dipole-coupled oscillator model suggested previously for the nonlinear chirality response from thin films. Moreover, the sensitivity is further consistent with the wavelength dependency of SHG intensity fit to a two-state model of the two-photon absorption in collagen. We also provide experimental calibration protocols to implement the SHG-CD modality on a laser scanning microscope. We last suggest that the technique has broad applicability in probing a wide range of diseased states with changes in collagen molecular structure.
Collapse
Affiliation(s)
- Kirby R Campbell
- Department of Biomedical Engineering, University of Wisconsin-Madison , 1550 Engineering Drive, Madison, Wisconsin 53706, United States
| | - Paul J Campagnola
- Department of Biomedical Engineering, University of Wisconsin-Madison , 1550 Engineering Drive, Madison, Wisconsin 53706, United States
| |
Collapse
|
15
|
Chaudhary R, Lee MS, Mubyana K, Duenwald-Kuehl S, Johnson L, Kaiser J, Vanderby R, Eliceiri KW, Corr DT, Chin MS, Li WJ, Campagnola PJ, Halanski MA. Advanced quantitative imaging and biomechanical analyses of periosteal fibers in accelerated bone growth. Bone 2016; 92:201-213. [PMID: 27612440 DOI: 10.1016/j.bone.2016.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/11/2016] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The accepted mechanism explaining the accelerated growth following periosteal resection is that the periosteum serves as a mechanical restraint to restrict physeal growth. To test the veracity of this mechanism we first utilized Second Harmonic Generation (SHG) imaging to measure differences of periosteal fiber alignment at various strains. Additionally, we measured changes in periosteal growth factor transcription. Next we utilized SHG imaging to assess the alignment of the periosteal fibers on the bone both before and after periosteal resection. Based on the currently accepted mechanism, we hypothesized that the periosteal fibers adjacent to the physis should be more aligned (under tension) during growth and become less aligned (more relaxed) following metaphyseal periosteal resection. In addition, we measured the changes in periosteal micro- and macro-scale mechanics. METHODS 30 seven-week old New Zealand White rabbits were sacrificed. The periosteum was imaged on the bone at five regions using SHG imaging. One centimeter periosteal resections were then performed at the proximal tibial metaphyses. The resected periosteal strips were stretched to different strains in a materials testing system (MTS), fixed, and imaged using SHG microscopy. Collagen fiber alignment at each strain was then determined computationally using CurveAlign. In addition, periosteal strips underwent biomechanical testing in both circumferential and axial directions to determine modulus, failure stress, and failure strain. Relative mRNA expression of growth factors: TGFβ-1, -2, -3, Ihh, PTHrP, Gli, and Patched were measured following loading of the periosteal strips at physiological strains in a bioreactor. The periosteum adjacent to the physis of six tibiae was imaged on the bone, before and after, metaphyseal periosteal resection, and fiber alignment was computed. One-way ANOVA statistics were performed on all data. RESULTS Imaging of the periosteum at different regions of the bone demonstrated complex regional differences in fiber orientation. Increasing periosteal strain on the resected strips increased periosteal fiber alignment (p<0.0001). The only exception to this pattern was the 10% strain on the tibial periosteum, which may indicate fiber rupture at this non-physiologic strain. Periosteal fiber alignment adjacent to the resection became less aligned while those adjacent to the physes remained relatively unchanged before and after periosteal resection. Increasing periosteal strain on the resected strips increased periosteal fiber alignment (p<0.0001). The only exception to this pattern was the 10% strain on the tibial periosteum, which may indicate fiber rupture (and consequent retraction) at this non-physiologic strain. Increasing periosteal strain revealed a significant increase in relative mRNA expression for Ihh, PTHrP, Gli, and Patched, respectively. CONCLUSION Periosteal fibers adjacent to the growth plate do not appear under tension in the growing limb, and the alignments of these fibers remain unchanged following periosteal resection. SIGNIFICANCE The results of this study call into question the long-accepted role of the periosteum acting as a simple mechanical tether restricting growth at the physis.
Collapse
Affiliation(s)
- Rajeev Chaudhary
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, United States; Orthopedics & Rehabilitation, University of Wisconsin, Madison, WI, United States
| | - Ming-Song Lee
- Orthopedics & Rehabilitation, University of Wisconsin, Madison, WI, United States
| | - Kuwabo Mubyana
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Sarah Duenwald-Kuehl
- Orthopedics & Rehabilitation, University of Wisconsin, Madison, WI, United States
| | - Lyndsey Johnson
- Orthopedics & Rehabilitation, University of Wisconsin, Madison, WI, United States
| | - Jarred Kaiser
- Mechanical Engineering, University of Wisconsin, Madison, WI, United States
| | - Ray Vanderby
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, United States; Orthopedics & Rehabilitation, University of Wisconsin, Madison, WI, United States
| | - Kevin W Eliceiri
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, United States; Laboratory for Optical and Computational Instrumentation, University of Wisconsin, Madison, WI, United States
| | - David T Corr
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Matthew S Chin
- Department of Radiology, Musculoskeletal Division, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Wan-Ju Li
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, United States; Orthopedics & Rehabilitation, University of Wisconsin, Madison, WI, United States
| | - Paul J Campagnola
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, United States; Laboratory for Optical and Computational Instrumentation, University of Wisconsin, Madison, WI, United States
| | - Matthew A Halanski
- Orthopedics & Rehabilitation, University of Wisconsin, Madison, WI, United States; American Family Children's Hospital, University of Wisconsin, Madison, WI, United States
| |
Collapse
|
16
|
Finnøy A, Olstad K, Lilledahl MB. Second harmonic generation imaging reveals a distinct organization of collagen fibrils in locations associated with cartilage growth. Connect Tissue Res 2016; 57:374-87. [PMID: 27215664 DOI: 10.1080/03008207.2016.1190348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The articular-epiphyseal cartilage complex (AECC) is responsible for the expansion of the bone ends and serves the function of the articular cartilage in juvenile mammals. Bundles of collagen fibrils surrounding cells were in the literature observed more frequently near the articular surface of the AECC. The articular surface, the perichondrium, and cartilage canals are interfaces where appositional growth of the AECC has been demonstrated. The current study aimed to evaluate the potential of second harmonic generation (SHG) to locate the collagen fibril bundles near the articular surface and to examine whether a comparable collagen fibril organization could be observed near the other interfaces of the AECC. MATERIALS AND METHODS The study included the femoral condyle of four piglets aged 82-141 days. The forward and backward scattered SHG, and their ratio, was analyzed across the AECC using objectives with different numerical aperture. Two-photon-excited fluorescence was used to visualize cells. RESULTS A similar pattern of collagen fibril organization was observed near the articular surface, around cartilage canals, and adjacent to the perichondrium. The pattern consisted of a higher ratio of forward to backward scattered SHG that increased relative to the surrounding matrix at lower numerical aperture. This was interpreted to reflect collagen fibril bundles in the territorial matrix of cells in these areas. CONCLUSIONS The observed arrangement of collagen fibrils was suggested to be related to the presumed different growth activity in these areas and indicated that SHG may be used as an indirect and label-free marker for cartilage matrix growth.
Collapse
Affiliation(s)
- Andreas Finnøy
- a Department of Physics , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
| | - Kristin Olstad
- b Norwegian University of Life Sciences, Faculty of Veterinary Medicine and Biosciences , Oslo , Norway
| | - Magnus B Lilledahl
- a Department of Physics , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
| |
Collapse
|
17
|
Wang T, Lai JH, Han LH, Tong X, Yang F. Modulating stem cell–chondrocyte interactions for cartilage repair using combinatorial extracellular matrix-containing hydrogels. J Mater Chem B 2016; 4:7641-7650. [DOI: 10.1039/c6tb01583b] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Combinatorial ECM-containing hydrogels with decoupled mechanical and biochemical cues modulate cartilage formation by a stem cell and chondrocyte co-culture in 3D.
Collapse
Affiliation(s)
- Tianyi Wang
- Department of Bioengineering
- Stanford University
- Stanford
- USA
| | - Janice H. Lai
- Department of Mechanical Engineering
- Stanford School of Medicine
- Stanford
- USA
| | - Li-Hsin Han
- Department of Mechanical Engineering
- Drexel University
- Philadelphia
- USA
| | - Xinming Tong
- Department of Orthopaedic Surgery
- Stanford University
- Stanford
- USA
| | - Fan Yang
- Department of Bioengineering
- Stanford University
- Stanford
- USA
- Department of Orthopaedic Surgery
| |
Collapse
|