Name: a protocol to acquire the degenerative tenocyte from humans
Uploaded: 2018-06-09T14:30:00
Description: Watch this Scientific Journal Video about A Protocol to Acquire the Degenerative Tenocyte from Humans at JoVE.com

This research was supported by a grant from the Korea Health Technology R&#38;D Project through the Korea Health Industry Development Institute (KHIDI), which was funded by the Ministry of Health &#38; Welfare, Republic of Korea (grant number: HI16C1559).

The protocol was conducted in accordance with the Declaration of Helsinki and the protocol was approved by the Institutional Review Board at CHA Bundang Medical Center.
1. Degenerative Tendon Tissue Harvest from the Patient
<ol>
	<li>Diagnose lateral epicondylitis by taking a medical history and using physical exam findings: tenderness over the tendinous origin close to the lateral epicondyle; pain evoked by resisted extension of the wrist joint.</li>
	<li>Use the following inclusion criteri...

<ol>
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V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mesenchymal+stem+cells+and+insulin-like+growth+factor-I+gene-enhanced+mesenchymal+stem+cells+improve+structural+aspects+of+healing+in+equine+flexor+digitorum+superficialis+tendons.">Mesenchymal stem cells and insulin-like growth factor-I gene-enhanced mesenchymal stem cells improve structural aspects of healing in equine flexor digitorum superficialis tendons.</a> Journal of Orthopedic Research. 27 (10), 1392-1398 (2009).</li><li>Durgam, S. S., Stewart, A. A., Sivaguru, M., Wagoner Johnson, A. J., Stewart, M. 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A number of previous studies have reported how to create chronic tendinopathic animal models using different procedures such as collagenase or kartogenin injection, treadmill running, and more26,27. Although numerous studies showed promising therapeutic effects based on these animal models, experiments using the human degenerative tenocyte would be crucial in the field of tendinopathy in order to reproduce the efficacy of treatment. In this article, we establishe...

Tendinopathy is a chronic degenerative musculoskeletal condition that develops in various parts of the body. Recently, the number of cases of tendinopathy has increased greatly in the developed world due to growing participation in recreational sports and increased life expectancy1,2. The cause of tendinopathy is considered to be multifactorial and these causes include ischemia, oxygen free radical injuries, an imbalance between vasoconstrictor and vasodilator innervations, internal micro-tears, and changes to neuro-regulation3,4,5,6,7,8. Most treatments for tendinopathy only relieve its symptoms. Moreover, treatments without tissue regeneration require a long time for rehabilitation and achieve a limited response from injured tendons, which imposes a clinical challenge for physicians9.
The incompetence of current treatment options along with the lack of the degenerative tendon&#39;s ability to self-heal has lead researchers to take interest in exploring alternative treatment strategies. Recently, new studies reported many promising results for enhancing the healing efficacy of the tendinopathy tendons using growth factors, stem cell based therapy, and gene therapy10,11,12.
Through a literature review, we found that the involved studies may be divided into two categories based on their analysis materials: animal models such as a rat, a mouse, or a rabbit; and human models. With regard to the animal model, currently there are two popular techniques to generate tendinopathy: chemical induction of injury or mechanical overloading the model. However, each animal model was limited in reproducing the complex human tendinopathy pathology13,14.
Most papers using human samples were analyzed histologically or performed the in vitro experiment based on a healthy human tenocyte instead of a degenerative tenocyte15,16,17,18,19,20,21. Only a few papers reported that they used a human degenerative tenocyte, but they did not describe in detail the protocol used to get the degenerative tenocyte from the human22,23. In this context, it should be noted that successful results from either the animal model or the healthy tissue/tenocyte may not necessarily predict human efficacy or efficacious dosing because tendon degeneration is a complicated process and the pathogenesis is still not fully understood.
Collectively, it is necessary to describe the standard protocol for obtaining the degenerative tenocyte from human tissue without causing adverse effects to the donor. This article describes a protocol on how to acquire the human degenerative tenocyte. To validate the protocol, the harvested tissues were analyzed histologically. Then, the cultured cell was confirmed as the degenerative tenocyte by using immunocytochemistry (ICC), a quantitative real time-polymerase chain reaction (qRT-PCR), and a viability assay.

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			<td height="21" style="height:21px;width:235px;">Scalpel</td>
			<td style="width:199px;">Kisanbio</td>
			<td style="width:119px;">KS-Q0306-15</td>
			<td style="width:167px;">No. 15</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Mini-blade</td>
			<td style="width:199px;">Beaver</td>
			<td style="width:119px;">374769</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">Dulbecco&#39;s modified Eagle&#39;s medium (DMEM)</td>
			<td style="width:199px;">Gibco</td>
			<td style="width:119px;">11995065</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Collagenase &#8545;</td>
			<td style="width:199px;">Sigma-Aldrich</td>
			<td style="width:119px;">C6885</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">PBS</td>
			<td>Gibco</td>
			<td style="width:119px;">14190250</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">fetal bovine serum (FBS)</td>
			<td>Gibco</td>
			<td style="width:119px;">16000044</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">50 mM ascorbic acid-2-phosphate</td>
			<td style="width:199px;">Sigma-Aldrich</td>
			<td style="width:119px;">A5960</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Antibiotic-Antimycotic solution</td>
			<td>Gibco</td>
			<td style="width:119px;">15240062</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">4% formaldehyde</td>
			<td style="width:199px;">Bio-solution</td>
			<td style="width:119px;">BP031</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Triton X-100&#160;</td>
			<td style="width:199px;">Sigma-Aldrich</td>
			<td style="width:119px;">X100-100ml</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">BSA</td>
			<td style="width:199px;">Rdtech</td>
			<td style="width:119px;">C0082</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">TWEEN 20</td>
			<td style="width:199px;">Sigma-Aldrich</td>
			<td style="width:119px;">P9416-100ml</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">MKX (C-5)</td>
			<td style="width:199px;">Santa cruz biotechnology</td>
			<td style="width:119px;">sc-515878</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Tenomodulin (N-14)</td>
			<td style="width:199px;">Santa cruz biotechnology</td>
			<td style="width:119px;">sc-49325</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Fluorescence Mounting Medium</td>
			<td style="width:199px;">DAKO</td>
			<td style="width:119px;">S3023</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">DAPI (4&#39;,6-Diamidino-2-Phenylindole, Dihydrochloride)</td>
			<td style="width:199px;">Thermo Fisher Scientific</td>
			<td style="width:119px;">D1306</td>
			<td></td>
		</tr>
		<tr height="46">
			<td height="46" style="height:46px;width:235px;">WST-1</td>
			<td style="width:199px;">Dojindo Molecular Technologies</td>
			<td style="width:119px;">CK04</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">BrdU Cell Proliferation Assay Kit</td>
			<td style="width:199px;">Cell Signaling Technology</td>
			<td style="width:119px;">#6813</td>
			<td></td>
		</tr>
		<tr height="23">
			<td height="23" style="height:23px;width:235px;">TRIzol Reagent</td>
			<td style="width:199px;">Invitrogen</td>
			<td style="width:119px;">15596018</td>
			<td></td>
		</tr>
		<tr height="23">
			<td height="23" style="height:23px;width:235px;">iScript cDNA Synthesis Kit&#160;</td>
			<td style="width:199px;">Bio-Rad</td>
			<td style="width:119px;">170-8891</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">TaqMan Gene Expression Master Mix</td>
			<td style="width:199px;">Applied Biosystems</td>
			<td style="width:119px;">4369016</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">GAPDH</td>
			<td style="width:199px;">Thermo Fisher Scientific</td>
			<td style="width:119px;">Hs02786624_g1</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">COL3A1</td>
			<td style="width:199px;">Thermo Fisher Scientific</td>
			<td style="width:119px;">Hs00943809_m1</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">ACTA2</td>
			<td style="width:199px;">Thermo Fisher Scientific</td>
			<td style="width:119px;">Hs00426835_g1</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">TAC1</td>
			<td style="width:199px;">Thermo Fisher Scientific</td>
			<td style="width:119px;">Hs00243225_m1</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">TACR1</td>
			<td style="width:199px;">Thermo Fisher Scientific</td>
			<td style="width:119px;">Hs00185530_m1</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">PTGS2</td>
			<td style="width:199px;">Thermo Fisher Scientific</td>
			<td style="width:119px;">Hs00153133_m1</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">ACTB</td>
			<td style="width:199px;">Thermo Fisher Scientific</td>
			<td style="width:119px;">Hs99999903_m1</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Cell Strainers (100 &#181;m)&#160;</td>
			<td style="width:199px;">Corning</td>
			<td style="width:119px;">352360</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">100mm culture dish</td>
			<td style="width:199px;">Thermo Fisher Scientific</td>
			<td style="width:119px;">8188207</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">8-well Chamber Slide</td>
			<td style="width:199px;">Thermo Fisher Scientific</td>
			<td style="width:119px;">154534</td>
			<td></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:235px;">96 Well Clear Flat Bottom Polystyrene TC-Treated Microplates</td>
			<td style="width:199px;">Corning</td>
			<td style="width:119px;">3596</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Nikon Eclipse 50i Microscope&#160;</td>
			<td style="width:199px;">Nikon</td>
			<td style="width:119px;"></td>
			<td></td>
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		<tr height="23">
			<td height="23" style="height:23px;">VERSA max microplate reader&#160;</td>
			<td style="width:199px;">Molecular Devices</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">CFX96 Real-Time PCR Detection System</td>
			<td style="width:199px;">Bio-Rad</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:235px;">Formalin solution, neutral buffered, 10%</td>
			<td style="width:199px;">Sigma-Aldrich</td>
			<td style="width:119px;">HT501128</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Paraffins</td>
			<td style="width:199px;">Leica Biosystems</td>
			<td style="width:119px;">3801340</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Ethanol</td>
			<td style="width:199px;">JUNSEI CHEMICAL</td>
			<td style="width:119px;">90303-2185</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Hematoxylin</td>
			<td style="width:199px;">DAKO</td>
			<td style="width:119px;">CS70030-2</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Eosin</td>
			<td style="width:199px;">DAKO</td>
			<td style="width:119px;">CS70130-2</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Alcian blue</td>
			<td style="width:199px;">DAKO</td>
			<td style="width:119px;">AR16011-2</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Citric acid</td>
			<td style="width:199px;">Sigma-Aldrich</td>
			<td style="width:119px;">251275</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Xylene</td>
			<td style="width:199px;">JUNSEI CHEMICAL</td>
			<td style="width:119px;">25165-0430</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Endogenous peroxidases&#160;</td>
			<td style="width:199px;">DAKO</td>
			<td style="width:119px;">S200380-2</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Canada balsam</td>
			<td style="width:199px;">JUNSEI CHEMICAL</td>
			<td style="width:119px;">23255-1210</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Microtome Blade</td>
			<td style="width:199px;">FEATHER</td>
			<td style="width:119px;">A35</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Slide glass</td>
			<td style="width:199px;">SUPERIOR</td>
			<td style="width:119px;">1000612</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Cover glass</td>
			<td style="width:199px;">Marienfeld-Superior</td>
			<td style="width:119px;">101050</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">VEGF</td>
			<td style="width:199px;">Santa cruz biotechnology</td>
			<td style="width:119px;">sc-7269</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">SPSS Software</td>
			<td style="width:199px;">IBM</td>
			<td style="width:119px;"></td>
			<td>Ver. 18.0</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:235px;">Multi-purpose Centrifuge</td>
			<td style="width:199px;">LABOGENE</td>
			<td style="width:119px;">1248R</td>
			<td></td>
		</tr>
	</tbody>
</table>

a protocol to acquire the degenerative tenocyte from humans

Tendinopathy, a painful condition that develops in response to tendon degeneration, is on the rise in the developed world due to increasing physical activity and longer life expectancy. Despite its increasing prevalence, the underlying pathogenesis still remains unclear, and treatment is generally symptomatic. Recently, numerous therapeutic options, including growth factors, stem cells, and gene therapy, were investigated in hopes of enhancing the healing potency of the degenerative tendon. However, the majority of these research studies were conducted only on animal models or healthy human tenocytes. Despite some studies using pathological tenocytes, to the best of our knowledge there is currently no protocol describing how to obtain human degenerative tenocytes. The aim of this study is to describe a standard protocol for acquiring human degenerative tenocytes. Initially, the tendon tissue was harvested from a patient with lateral epicondylitis during surgery. Then biopsy samples were taken from the extensor carpi radialis brevis tendon corresponding to structural changes observed at the time of surgery. All of the harvested tendons appeared to be dull, gray, friable, and edematous, which made them visually distinct from the healthy ones. Tenocytes were cultured and used for experiments. Meanwhile, half of the harvested tissues were analyzed histologically, and it was shown that they shared the same key features of tendinopathy (angiofibroblastic dysplasia or hyperplasia). A secondary analysis by immunocytochemistry confirmed that the cultured cells were tenocytes with the majority of the cells having positive stains for mohawk and tenomodulin proteins. The qualities of the degenerative nature of tenocytes were then determined by comparing the cells with the healthy control using a proliferation assay or qRT-PCR. The degenerative tenocyte displayed a higher proliferation rate and similar gene expression patterns of tendinopathy that matched previous reports. Overall, this new protocol might provide a useful tool for future studies of tendinopathy.

Histological analyses revealed that the harvested tissue from lateral epicondylitis had the characteristics of a tendinopathic tendon.H&#38;E section of tendinopathy degenerative tendon revealed a disorganized collagen bundle with a loss of polarity and fine straight, strongly packed parallel fiber structures. Histological signs suggestive of degeneration such as higher cellularity and enlarged nuclei without the typical spindle shape were common in samples. Additionally, collagen bundles...

Watch this Scientific Journal Video about A Protocol to Acquire the Degenerative Tenocyte from Humans at JoVE.com

A Protocol to Acquire the Degenerative Tenocyte from Humans

In vitro use of degenerative tenocytes is essential when investigating the efficacy of novel treatment on tendinopathy. However, most research studies use only the animal model or a healthy tenocyte. We propose the following protocol to isolate human degenerative tenocytes during surgery.

Tendinopathy, a painful condition that develops in response to tendon degeneration, is on the rise in the developed world due to increasing physical ...

This method can help answer key questions about human degenerative tenocyte biology as only few studies have described human degenerative tenocyte isolation and culture in detail. The main advantage of this technique is that we can obtain human degenerative tenocyte without additional patient injury because the degenerative tissue is acquired during standard epicondylitis surgery. Demonstrating the procedure will be Dr.Soo-Hong Han, Minjung Baek, and Hyung Kyung Kim from my Level Three.To acquire a degenerative tendocyte tissue sample, use a number 15 surgical scalpel to make a three to five centimeter skin incision just anterior medial to the lateral epicondyle, and proximal to the level of the joint to expose the lateral elbow and visually locate the extensor carpi radialis longus in the extensor aponeurosis interface. Use the scalpel to make a splitting incision two to three millimeters in depth between the extensor carpi radialis longus and the extensor aponeurosis at the interface. After anterior retraction of the extensor carpi radialis longus, locate the pathologic degenerative tissue by its characteristic dull grayish color and typically edematous and friable tissue, and use the scalpel and mini blades to carefully, but sharply, resect all of the degenerative tissue.When all the tissue has been harvested, close the wound with nonabsorbable suture material according to standard protocols and carefully remove all of the surrounding tissue from an approximately one cubic centimeter piece of tissue sample, placing the clean tendon tissue into 10 milliliters of PBS as soon as it has been trimmed. Then fix about half of the harvested tissue in neutral buffered 10%formalin in a chemical fume hood for 12 hours. To set up a tenocyte culture, transfer the other half of the harvested control and degenerated tissue samples into individual tissue culture dishes containing fresh PBS and mince the tissues into one cubic meter or smaller pieces, digest the tissue fragments in 30 milliliters of DMEM supplemented with 30 milligrams per milliliter of collagenase two per tissue group at 37 degrees Celsius for one hour.At the end of the digestion, filter the cell solutions through individual 100 micron cell strainers and deactivate the collagenase with one milliliter of FBS per tube. Collect the tenocytes by centrifugation and re-suspend the pellets at three times 10 to the fifth cells per 10 milliliters of DMEM supplemented with 10%FBS and 1%antibiotic, antimycotic solution concentration. Then, seed the cells into one 100 centimeter culture dish per condition, and culture the tenocytes in a 37 degree Celsius and 5%carbon dioxide incubator for one week, changing the culture medium every three days until an 80%confluence has been reached.For Immunocytochemical analysis, transfer two times 10 to the fifth cells in 200 microliters of fresh medium to each well of one eight-well chamber slide per experimental group and grow the cells to confluence for 24 hours. The next day, wash the cells with PBS, followed by fixation with 500 microliters of 4%formaldehyde per well, and permeabilization with 0.5%triton X 100 in PBS for 10 minutes. To block any non-specific binding, incubate the cells with 1%bovine serum albumin, and 0.05%Tween 20 in PBS, as experimentally appropriate, followed by incubation with the flourescently-tagged primary antibodies of interest at four degrees Celsius overnight protected from light.The next morning, label the cells with the appropriate secondary antibodies for one hour at room temperature protected from light, and mount the samples with 0.5 microliters of an appropriate fluorescence mounting medium per chamber. Then image the samples on a fluorescence microscope under a 400 times objective. For pathological analysis of the tissue, embed the formal and fixed control and degenerated tendon tissue samples in four to five milliliters of paraffin and acquire four to five micron sections from each paraffin block.For hematoxylin in eosin, or H&E staining, deparaffinize the samples with three five-minute immersions in xylene followed by hydration with graded ethanol immersions and a two-minute tap water wash. Next, label the samples with hematoxylin for five minutes, followed by another two-minute water wash. Dip the rinsed samples in 1%hydrochloric acid and 70%ethanol for three seconds, followed by a three-minute water wash.Neutralize the acid with a 10 second dip in 0.5%ammonia, followed by another three-minute water wash. Label the neutralized samples with the eosin for five minutes, and dehydrate the H&E stained samples with graded ethanol immersions. After three xylene immersions, mount the samples with an appropriate mounting medium and a cover slide.To perform immunohistochemical analysis of the tissue samples, use the bond polymer refined detection kit according to the manufacturer's instructions with the following minor modifications. After deparaffinization with xylene as demonstrated, immerse the samples in bond epitope retrieval solution for 30 minutes at 100 degrees Celsius for antigen retrieval, followed by a five-minute incubation in hydrogen peroxide to quench any endogenous peroxidase. Next, label the sections for fifteen minutes at room temperature with the primary antibodies of interest.At the end of the incubation, label the samples with the appropriate biotin-free polymeric horseradish peroxidase linker secondary antibody conjugate system for 50 minutes at room temperature. Then mount the sections with a cover slip in the appropriate mounting medium and image the samples on a light microscope at a 400 times magnification. H&E analyses reveals that tissue harvested from the degenerated lateral epicondylitis demonstrates disorganized collagen bundles with a loss of polarity and fine, straight, strongly packed parallel fiber structures.Indeed, the collagen bundles are positive for Alcian Blue staining in the degenerated tissue sections indicating an increased proteoglycan and glycosaminoglycan presence within the damaged tissue. Immunohistochemical analysis of the degenerated tendons also indicates a cytoplasmic granular positive reaction to vascular endothelial growth factor that is not observed in control, healthy tendon tissue samples. Both types of cultured tissue sample cells can be confirmed as tenocytes by immunofluorachemistry with most of the cultured cells expressing representative tenocyte markers such as the mohawk and tenomodulin proteins and demonstrating an elongated appearance.Of note, the degenerative tenocytes also demonstrate a higher rate of proliferation in culture compared to tenocytes harvested from healthy controls as well as a higher expression of multiple genes known to be related to the development of tendinopathy. In conclusion, this validated protocol using degenerative tenocyte paves the way for future investigations in tendon biology and for testing new interventions.

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Medicine

Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through implanted electrodes. Deep brain stimulation was first implemented as a therapeutic modality by Benabid et al. in the late 1980s, when he used this technique to stimulate the ventral intermediate nucleus of the thalamus for the treatment of tremor 1. Currently, the procedure is used to treat patients who fail to respond adequately to medical management for diseases such as Parkinson's, dystonia, and essential tremor. The efficacy of this procedure for the treatment of Parkinson's disease has been demonstrated in well-powered, randomized controlled trials 2. Presently, the U.S. Food and Drug Administration has approved DBS as a treatment for patients with medically refractory essential tremor, Parkinson's disease, and dystonia. Additionally, DBS is currently being evaluated for the treatment of other psychiatric and neurological disorders, such as obsessive compulsive disorder, major depressive disorder, and epilepsy. 
DBS has not only been shown to help people by improving their quality of life, it also provides researchers with the unique opportunity to study and understand the human brain. Microelectrode recordings are routinely performed during DBS surgery in order to enhance the precision of anatomical targeting. Firing patterns of individual neurons can therefore be recorded while the subject performs a behavioral task. Early studies using these data focused on descriptive aspects, including firing and burst rates, and frequency modulation 3. More recent studies have focused on cognitive aspects of behavior in relation to neuronal activity 4,5. This article will provide a description of the intra-operative methods used to perform behavioral tasks and record neuronal data with awake patients during DBS cases. Our exposition of the process of acquiring electrophysiological data will illuminate the current scope and limitations of intra-operative human experiments.

Deep brain stimulation surgery offers a unique opportunity to examine information encoding in the awake human brain. This article will describe intra-operative methods used to perform cognitive and behavioral tasks while simultaneously acquiring physiological data such as EMG, single-unit neuronal activity and/or local field potentials.

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through ...

The Trier Social Stress Test Protocol for Inducing Psychological Stress

This article demonstrates a psychological stress protocol for use in a laboratory setting. Protocols that allow researchers to study the biological pathways of the stress response in health and disease are fundamental to the progress of research in stress and anxiety.1 Although numerous protocols exist for inducing stress response in the laboratory, many neglect to provide a naturalistic context or to incorporate aspects of social and psychological stress. Of psychological stress protocols, meta-analysis suggests that the Trier Social Stress Test (TSST) is the most useful and appropriate standardized protocol for studies of stress hormone reactivity.2 In the original description of the TSST, researchers sought to design and evaluate a procedure capable of inducing a reliable stress response in the majority of healthy volunteers.3 These researchers found elevations in heart rate, blood pressure and several endocrine stress markers in response to the TSST (a psychological stressor) compared to a saline injection (a physical stressor).3 Although the TSST has been modified to meet the needs of various research groups, it generally consists of a waiting period upon arrival, anticipatory speech preparation, speech performance, and verbal arithmetic performance periods, followed by one or more recovery periods. The TSST requires participants to prepare and deliver a speech, and verbally respond to a challenging arithmetic problem in the presence of a socially evaluative audience.3 Social evaluation and uncontrollability have been identified as key components of stress induction by the TSST.4 In use for over a decade, the goal of the TSST is to systematically induce a stress response in order to measure differences in reactivity, anxiety and activation of the hypothalamic-pituitary-adrenal (HPA) or sympathetic-adrenal-medullary (SAM) axis during the task.1 Researchers generally assess changes in self-reported anxiety, physiological measures (e.g. heart rate), and/or neuroendocrine indices (e.g. the stress hormone cortisol) in response to the TSST. Many investigators have adopted salivary sampling for stress markers such as cortisol and alpha-amylase (a marker of autonomic nervous system activation) as an alternative to blood sampling to reduce the confounding stress of blood-collection techniques. In addition to changes experienced by an individual completing the TSST, researchers can compare changes between different treatment groups (e.g. clinical versus healthy control samples) or the effectiveness of stress-reducing interventions.1

This article describes a protocol for inducing psychological stress in participants, which enables researchers to measure psychological, physiological and neuroendocrine responses to stress within single participants or between groups.

This article demonstrates a psychological stress protocol for use in a laboratory setting.  Protocols that allow researchers to study the biological ...

Spectral Karyotyping to Study Chromosome Abnormalities in Humans and Mice with Polycystic Kidney Disease

Conventional method to identify and classify individual chromosomes depends on the unique banding pattern of each chromosome in a specific species being analyzed 1, 2. This classical banding technique, however, is not reliable in identifying complex chromosomal aberrations such as those associated with cancer. To overcome the limitations of the banding technique, Spectral Karyotyping (SKY) is introduced to provide much reliable information on chromosome abnormalities.
SKY is a multicolor fluorescence in-situ hybridization (FISH) technique to detect metaphase chromosomes with spectral microscope 3, 4. SKY has been proven to be a valuable tool for the cytogenetic analysis of a broad range of chromosome abnormalities associated with a large number of genetic diseases and malignancies 5, 6. SKY involves the use of multicolor fluorescently-labelled DNA probes prepared from the degenerate oligonucleotide primers by PCR. Thus, every chromosome has a unique spectral color after in-situ hybridization with probes, which are differentially labelled with a mixture of fluorescent dyes (Rhodamine, Texas Red, Cy5, FITC and Cy5.5). The probes used for SKY consist of up to 55 chromosome specific probes 7-10.
The procedure for SKY involves several steps (Figure 1). SKY requires the availability of cells with high mitotic index from normal or diseased tissue or blood. The chromosomes of a single cell from either a freshly isolated primary cell or a cell line are spread on a glass slide. This chromosome spread is labeled with a different combination of fluorescent dyes specific for each chromosome. For probe detection and image acquisition,the spectral imaging system consists of sagnac interferometer and a CCD camera. This allows measurement of the visible light spectrum emitted from the sample and to acquire a spectral image from individual chromosomes. HiSKY, the software used to analyze the results of the captured images, provides an easy identification of chromosome anomalies. The end result is a metaphase and a karyotype classification image, in which each pair of chromosomes has a distinct color (Figure 2). This allows easy identification of chromosome identities and translocations. For more details, please visit Applied Spectral Imaging website (<a href="http://www.spectral-imaging.com/" target="_blank">http://www.spectral-imaging.com/</a>).
SKY was recently used for an identification of chromosome segregation defects and chromosome abnormalities in humans and mice with Autosomal Dominant Polycystic Kidney Disease (ADPKD), a genetic disease characterized by dysfunction in primary cilia 11-13. Using this technique, we demonstrated the presence of abnormal chromosome segregation and chromosomal defects in ADPKD patients and mouse models 14. Further analyses using SKY not only allowed us to identify chromosomal number and identity, but also to accurately detect very complex chromosomal aberrations such as chromosome deletions and translocations (Figure 2).

Spectral Karyotyping (SKY) is an advanced cytogenetics technique to identify genomic and chromosomal aberrations. This technique takes advantage of chromosome painting probes, which allow classification of all chromosomes. SKY can also identify complex chromosome aberrations and segregation defects in mice and humans with various diseases, including polycystic kidney disease.

Conventional method to identify and classify individual chromosomes depends on the unique banding pattern of each chromosome in a specific species being ...

A Model to Simulate Clinically Relevant Hypoxia in Humans

In case of apnea, arterial partial pressure of oxygen (pO2) decreases, while partial pressure of carbon dioxide (pCO2) increases. To avoid damage to hypoxia sensitive organs such as the brain, compensatory circulatory mechanisms help to maintain an adequate oxygen supply. This is mainly achieved by increased cerebral blood flow. Intermittent hypoxia is a commonly seen phenomenon in patients with obstructive sleep apnea. Acute airway obstruction can also result in hypoxia and hypercapnia. Until now, no adequate model has been established to simulate these dynamics in humans. Previous investigations focusing on human hypoxia used inhaled hypoxic gas mixtures. However, the resulting hypoxia was combined with hyperventilation and is therefore more representative of high altitude environments than of apnea. Furthermore, the transferability of previously performed animal experiments to humans is limited and the pathophysiological background of apnea induced physiological changes is poorly understood. In this study, healthy human apneic divers were utilized to mimic clinically relevant hypoxia and hypercapnia during apnea. Additionally, pulse-oximetry and Near Infrared Spectroscopy (NIRS) were used to evaluate changes in cerebral and peripheral oxygen saturation before, during, and after apnea.

Hypoxia simulation in humans has usually been performed by inhaling hypoxic gas mixtures. For this study, apneic divers were used to simulate dynamic hypoxia in humans. Additionally, physiological changes in desaturation and re-saturation kinetics were evaluated with non-invasive tools such as Near-Infrared-Spectroscopy (NIRS) and peripheral oxygenation saturation (SpO2).

In case of apnea, arterial partial pressure of oxygen (pO2) decreases, while partial pressure of carbon dioxide (pCO2) increases. To avoid damage to ...

Conducting Maximal and Submaximal Endurance Exercise Testing to Measure Physiological and Biological Responses to Acute Exercise in Humans

Regular physical activity has a positive effect on human health, but the mechanisms controlling these effects remain unclear. The physiologic and biologic responses to acute exercise are predominantly influenced by the duration and intensity of the exercise regimen. As exercise is increasingly thought of as a therapeutic treatment and/or diagnostic tool, it is important that standardizable methodologies be utilized to understand the variability and to increase the reproducibility of exercise outputs and measurements of responses to such regimens. To that end, we describe two different cycling exercise regimens that yield different physiologic outputs. In a maximal exercise test, exercise intensity is continually increased with a greater workload resulting in an increasing cardiopulmonary and metabolic response (heart rate, stroke volume, ventilation, oxygen consumption and carbon dioxide production). In contrast, during endurance exercise tests, the demand is increased from that at rest, but is raised to a fixed submaximal exercise intensity resulting in a cardiopulmonary and metabolic response that typically plateaus. Along with the protocols, we provide suggestions on measuring physiologic outputs that include, but are not limited to, heart rate, slow and forced vital capacity, gas exchange metrics, and blood pressure to enable the comparison of exercise outputs between studies. Biospecimens can then be sampled to assess cellular, protein, and/or gene expression responses. Overall, this approach can be easily adapted into both short- and long-term effects of two distinct exercise regimens.

To assess the influence of exercise intensity on physiologic and biologic responses, two different exercise testing protocols were utilized. Methods outlining exercise testing on a cycle ergometer as an incremental maximal oxygen consumption test and endurance, steady state submaximal endurance test are described.

Regular physical activity has a positive effect on human health, but the mechanisms controlling these effects remain unclear. The physiologic and biologic ...

A Proinflammatory, Degenerative Organ Culture Model to Simulate Early-Stage Intervertebral Disc Disease.

Symptomatic intervertebral disc (IVD) degeneration (IDD) is a major socioeconomic burden and is characterized by inflammation and tissue degradation. Due to the lack of causative therapies, there is an urgent need for innovative experimental organ culture models to study the mechanisms involved in the progression of the disease, find therapeutic targets, and reduce the need for animal models. We here present a novel, three-dimensional organ culture model protocol mimicking the proinflammatory and catabolic microenvironment, which is present during IDD. 
Initially, bovine caudal IVDs were dissected, cleaned, and cultured in the tissue culture medium. Dynamic physiologic or pathologic loading was applied in a custom-made bioreactor for 2 hours per day. IVDs were assigned to a control group (high glucose medium, physiological loading, phosphate-buffered saline injection) and a pathological group (low glucose medium, pathological loading, tumor necrosis factor-alpha injection) for four days. Gene expression analysis from collected nucleus pulposus cells of the IVDs and enzyme-linked immunosorbent assay of the conditioned organ culture media was performed. 
Our data revealed a higher expression of inflammatory markers and reduced disc heights after loading in the pathological group compared to the control group. This protocol is reliable to simulate IVD inflammation and degeneration and can be further expanded to broaden its application scope.

This protocol presents a novel experimental model of proinflammatory, degenerative bovine organ culture to simulate early-stage intervertebral disc degeneration.

Symptomatic intervertebral disc (IVD) degeneration (IDD) is a major socioeconomic burden and is characterized by inflammation and tissue degradation. Due ...

Retinal Pigment Epithelium Transplantation in a Non-human Primate Model for Degenerative Retinal Diseases

Retinal pigment epithelial (RPE) transplantation holds great promise for the treatment of inherited and acquired retinal degenerative diseases. These conditions include retinitis pigmentosa (RP) and advanced forms of age-related macular degeneration (AMD), such as geographic atrophy (GA). Together, these disorders represent a significant proportion of currently untreatable blindness globally. These unmet medical needs have generated heightened academic interest in developing methods of RPE replacement. Among the animal models commonly utilized for preclinical testing of therapeutics, the non-human primate (NHP) is the only animal model that has a macula. As it shares this anatomical similarity with the human eye, the NHP eye is an important and appropriate preclinical animal model for the development of advanced therapy medicinal products (ATMPs) such as RPE cell therapy.
This manuscript describes a method for the submacular transplantation of an RPE monolayer, cultured on a polyethylene terephthalate (PET) cell carrier, underneath the macula onto a surgically created RPE wound in immunosuppressed NHPs. The fovea-the central avascular portion of the macula-is the site of the greatest mechanical weakness during the transplantation. Foveal trauma will occur if the initial subretinal fluid injection generates an excessive force on the retina. Hence, slow injection under perfluorocarbon liquid (PFCL) vitreous tamponade is recommended with a dual-bore subretinal injection cannula at low intraocular pressure (IOP) settings to create a retinal bleb. 
Pretreatment with an intravitreal plasminogen injection to release parafoveal RPE-photoreceptor adhesions is also advised. These combined strategies can reduce the likelihood of foveal tears when compared to conventional techniques. The NHP is a key animal model in the preclinical phase of RPE cell therapy development. This protocol addresses the technical challenges associated with the delivery of RPE cellular therapy in the NHP eye.

The non-human primate (NHP) is an ideal model for studying human retinal cellular therapeutics due to the anatomical and genetic similarities. This manuscript describes a method for submacular transplantation of retinal pigment epithelial cells in the NHP eye and strategies to prevent intraoperative complications associated with macular manipulation.

Retinal pigment epithelial (RPE) transplantation holds great promise for the treatment of inherited and acquired retinal degenerative diseases. These ...

Quantification of Optic Nerve Cross Sectional Area on MRI: A Novel Protocol using Fiji Software

Optic nerve assessment is an important aspect of glaucoma diagnosis and follow-up. This project describes a protocol for a unified methodology of optic nerve cross-sectional assessment and quantification using 3 T MRI for image acquisition and ImageJ's Fiji software for image processing quantification. Image acquisition was performed using 3 T MRI, with proper instructions for the patient to ensure straight fixation during imaging. A T2-weighted fat suppressed sequence was used. A coronal cut taken 3 mm behind the globe and perpendicular to the optic nerve axis should be uploaded to the software. Using the threshold function, the white matter area of the optic nerve is selected and quantified, thus, eliminating inter-individual measurement bias. We also described the normal limits for the optic nerve cross-sectional area according to age, based on previously published literature. We used the described protocol to assess optic nerve of a suspected glaucoma patient. The optic nerve cross-sectional area was found to be within the normal limits, a finding further confirmed via optical coherence tomography of the optic nerve.

We provided a detailed protocol for a standardized method of optic nerve assessment and quantification using MRI, utilizing a widely available imaging sequence, and open access software for image analysis. Following this standardized protocol would provide meaningful data for comparison between different patients and different studies.

Optic nerve assessment is an important aspect of glaucoma diagnosis and follow-up. This project describes a protocol for a unified methodology of optic ...

Using a Combination of Indirect Calorimetry, Infrared Thermography, and Blood Glucose Levels to Measure Brown Adipose Tissue Thermogenesis in Humans

In mammals, brown adipose tissue (BAT) is activated rapidly in response to cold in order to maintain body temperature. Although BAT has been studied greatly in small animals, it is difficult to measure the activity of BAT in humans. Therefore, little is known about the heat-generating capacity and physiological significance of BAT in humans, including the degree to which components of the diet can activate BAT. This is due to the limitations in the currently most used method to assess the activation of BAT-radiolabeled glucose (fluorodeoxyglucose or 18FDG) measured by positron emission tomography-computerized tomography (PET-CT).
This method is usually performed in fasted subjects, as feeding induces glucose uptake by the muscles, which can mask the glucose uptake into the BAT. This paper describes a detailed protocol for quantifying total-body human energy expenditure and substrate utilization from BAT thermogenesis by combining indirect calorimetry, infrared thermography, and blood glucose monitoring in carbohydrate-loaded adult males. To characterize the physiological significance of BAT, measures of the impact of BAT activity on human health are critical. We demonstrate a protocol to achieve this by combining carbohydrate loading and indirect calorimetry with measurements of supraclavicular changes in temperature. This novel approach will help to understand the physiology and pharmacology of BAT thermogenesis in humans.

Here, we present a protocol to quantify the physiological significance of the impact of brown adipose tissue (BAT) activity on human metabolism. This is achieved by combining carbohydrate loading and indirect calorimetry with measurements of supraclavicular changes in temperature. This novel approach can help develop a pharmacological target for BAT thermogenesis in humans.

In mammals, brown adipose tissue (BAT) is activated rapidly in response to cold in order to maintain body temperature. Although BAT has been studied ...

Investigating Novel Mechanisms of Microvascular Dysfunction in Humans

Intradermal Microdialysis: An Approach to Investigating Novel Mechanisms of Microvascular Dysfunction in Humans

The cutaneous vasculature is an accessible tissue that can be used to assess microvascular function in humans. Intradermal microdialysis is a minimally invasive technique used to investigate mechanisms of vascular smooth muscle and endothelial function in the cutaneous circulation. This technique allows for the pharmacological dissection of the pathophysiology of microvascular endothelial dysfunction as indexed by decreased nitric oxide-mediated vasodilation, an indicator of cardiovascular disease development risk. In this technique, a microdialysis probe is placed in the dermal layer of the skin, and a local heating unit with a laser Doppler flowmetry probe is placed over the probe to measure the red blood cell flux. The local skin temperature is clamped or stimulated with direct heat application, and pharmacological agents are perfused through the probe to stimulate or inhibit intracellular signaling pathways in order to induce vasodilation or vasoconstriction or to interrogate mechanisms of interest (co-factors, antioxidants, etc.). The cutaneous vascular conductance is quantified, and mechanisms of endothelial dysfunction in disease states can be delineated.

Author Spotlight: A Pharmacodissection Approach to Uncover Mechanisms in Cardiovascular Disease Risk Populations 

Intradermal microdialysis is a minimally invasive technique used to investigate microvascular function in health and disease. Both dose-response and local heating protocols can be utilized for this technique to explore mechanisms of vasodilation and vasoconstriction in the cutaneous circulation.

The cutaneous vasculature is an accessible tissue that can be used to assess microvascular function in humans. Intradermal microdialysis is a minimally ...