We thank for the laboratory platform and assistance of Ear Institute, Shanghai Jiaotong University School of Medicine. This work was supported by Shanghai Pujiang Program (22PJ1409200); National Natural Science Foundation of China (No.11932012); Postdoctoral Scientific Research Foundation of Shanghai Ninth People&#39;s Hospital, Shanghai Jiao Tong University School of Medicine;Fundamental research program funding of Ninth People&#39;s Hospital affiliated to Shanghai Jiao Tong University School of Medicine (JYZZ154).

All experimental procedures described here were approved by the Animal Care Committee of Shanghai Ninth People&#39;s Hospital, Shanghai Jiao Tong University School of Medicine (SH9H-2023-A616-SB). 4-week-old C57BL/6 male mice were used in this study. All the instruments used were sterilized prior to the procedure.
1. Preparation of the suture expansion model
<ol>
	<li>Preparation of two retention holders.
	<ol>
		<li>Use 0.014&#39;&#39; Australian wire or stainless steel wir...

3D Visualization of Bone Remodeling Under Tensile Load in Suture Expansion Mice

<ol>
	<li>Opperman, L. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cranial+sutures+as+intramembranous+bone+growth+sites.">Cranial sutures as intramembranous bone growth sites.</a> Developmental Dynamics. 219 (4), 472-485 (2000).</li><li>Thenier-Villa, J. L., Sanrom&#225;n-&#193;lvarez, P., Miranda-Lloret, P., Plaza Ram&#237;rez, M. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incomplete+reossification+after+craniosynostosis+surgery-incidence+and+analysis+of+risk+factors:+a+clinical-radiological+assessment+study.">Incomplete reossification after craniosynostosis surgery-incidence and analysis of risk factors: a clinical-radiological assessment study.</a> Journal Of Neurosurgery-pediatrics. 22 (2), 120-127 (2018).</li><li>Markiewicz, M. R., Recker, M. J., Reynolds, R. 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A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Biomechanics+of+craniofacial+sutures:+orthopedic+implications.">Biomechanics of craniofacial sutures: orthopedic implications.</a> Angle Orthodontist. 73 (2), 128-135 (2003).</li><li>Shayani, A., Sandoval Vidal, P., Garay Carrasco, I., Merino Gerlach, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Midpalatal+suture+maturation+method+for+the+assessment+of+maturation+before+maxillary+expansion:+a+systematic+review.">Midpalatal suture maturation method for the assessment of maturation before maxillary expansion: a systematic review.</a> Diagnostics (Basel). 12 (11), 2774 (2022).</li><li>Suzuki, H., 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=Miniscrew-assisted+rapid+palatal+expander+(MARPE):+the+quest+for+pure+orthopedic+movement.">Miniscrew-assisted rapid palatal expander (MARPE): the quest for pure orthopedic movement.</a> Dental Press Journal Of Orthodontics. 21 (4), 17-23 (2016).</li><li>Yu, M., 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=Cranial+suture+regeneration+mitigates+skull+and+neurocognitive+defects+in+craniosynostosis.">Cranial suture regeneration mitigates skull and neurocognitive defects in craniosynostosis.</a> Cell. 184 (1), 243-256 (2021).</li><li>Roth, D. M., Souter, K., Graf, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Craniofacial+sutures:+Signaling+centres+integrating+mechanosensation,+cell+signaling,+and+cell+differentiation.">Craniofacial sutures: Signaling centres integrating mechanosensation, cell signaling, and cell differentiation.</a> European Journal of Cell Biology. 101 (3), 151258 (2022).</li><li>Zhao, H., 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=The+suture+provides+a+niche+for+mesenchymal+stem+cells+of+craniofacial+bones.">The suture provides a niche for mesenchymal stem cells of craniofacial bones.</a> Nature Cell Biology. 17 (4), 386-396 (2015).</li><li>Jing, D., 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=Response+of+Gli1(+)+suture+stem+cells+to+mechanical+force+upon+suture+expansion.">Response of Gli1(+) suture stem cells to mechanical force upon suture expansion.</a> Journal of Bone And Mineral Research. 37 (7), 1307-1320 (2022).</li><li>Xu, Y., Malladi, P., Chiou, M., Longaker, M. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isolation+and+characterization+of+posterofrontal/sagittal+suture+mesenchymal+cells+in+vitro.">Isolation and characterization of posterofrontal/sagittal suture mesenchymal cells in vitro.</a> Plastic and Reconstructive Surgery. 119 (3), 819-829 (2007).</li><li>Kong, L., 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=Isolation+and+characterization+of+human+suture+mesenchymal+stem+cells+in+vitro.">Isolation and characterization of human suture mesenchymal stem cells in vitro.</a> International Journal of Stem Cells. 13 (3), 377-385 (2020).</li><li>Ikegame, M., 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=Tensile+stress+induces+bone+morphogenetic+protein+4+in+preosteoblastic+and+fibroblastic+cells,+which+later+differentiate+into+osteoblasts+leading+to+osteogenesis+in+the+mouse+calvariae+in+organ+culture.">Tensile stress induces bone morphogenetic protein 4 in preosteoblastic and fibroblastic cells, which later differentiate into osteoblasts leading to osteogenesis in the mouse calvariae in organ culture.</a> Journal of Bone And Mineral Research. 16 (1), 24-32 (2001).</li><li>Liu, S. S., Opperman, L. A., Buschang, P. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+recombinant+human+bone+morphogenetic+protein-2+on+midsagittal+sutural+bone+formation+during+expansion.">Effects of recombinant human bone morphogenetic protein-2 on midsagittal sutural bone formation during expansion.</a> American Journal of Orthodontics And Dentofacialorthopedics. 136 (6), 768-769 (2009).</li><li>Liang, W., Ding, P., Li, G., Lu, E., Zhao, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hydroxyapatite+nanoparticles+facilitate+osteoblast+differentiation+and+bone+formation+within+sagittal+suture+during+expansion+in+rats.">Hydroxyapatite nanoparticles facilitate osteoblast differentiation and bone formation within sagittal suture during expansion in rats.</a> Drug Design Development and Therapy. 15, 905-917 (2021).</li><li>Morinobu, M., 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=Osteopontin+expression+in+osteoblasts+and+osteocytes+during+bone+formation+under+mechanical+stress+in+the+calvarial+suture+in+vivo.">Osteopontin expression in osteoblasts and osteocytes during bone formation under mechanical stress in the calvarial suture in vivo.</a> Journal of Bone And Mineral Research. 18 (9), 1706-1715 (2003).</li><li>Hwang, S., Chung, C. J., Choi, Y. J., Kim, T., Kim, K. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+cetirizine,+a+histamine+1+receptor+antagonist,+on+bone+remodeling+after+calvarial+suture+expansion.">The effect of cetirizine, a histamine 1 receptor antagonist, on bone remodeling after calvarial suture expansion.</a> Korean Journal of Orthodontics. 50 (1), 42-51 (2020).</li><li>Jing, D., 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=Tissue+clearing+of+both+hard+and+soft+tissue+organs+with+the+PEGASOS+method.">Tissue clearing of both hard and soft tissue organs with the PEGASOS method.</a> Cell Research. 28 (8), 803-818 (2018).</li><li>Jing, D., 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=Tissue+clearing+and+its+application+to+bone+and+dental+tissues.">Tissue clearing and its application to bone and dental tissues.</a> Journal of Dental Research. 98 (6), 621-631 (2019).</li><li>Luo, W., 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=Investigation+of+postnatal+craniofacial+bone+development+with+tissue+clearing-based+three-dimensional+imaging.">Investigation of postnatal craniofacial bone development with tissue clearing-based three-dimensional imaging.</a> Stem Cells Development. 28 (19), 1310-1321 (2019).</li></ol>

We applied a standard suture expansion mouse model to observe the regular morphological changes that occur every week during the entire month-long remodeling cycle10. This model is useful for researching calvarial bone remodeling and regeneration by expanding calvarial sutures, as well as for studying various suture cells in vivo. To fully present the results of such research, three-dimensional visualization of stained tissues is needed. Therefore, PEGASOS technology, known for its effici...

Craniofacial sutures are fibrous tissues that connect craniofacial bones and play essential roles in the growth and remodeling of craniofacial bones. The structure of the suture resembles a river, providing a flow of cell resources to nourish and build the &#34;river bank&#34;, known as the osteogenic fronts, which contribute to the formation of craniofacial bones via intramembranous osteogenesis1.
Interest in craniofacial sutures has been driven by clinical needs to understand premature closure of cranial sutures and facial suture dysfunction, which may lead to craniofacial deformities and even life-threatening conditions in children. Open suturectomy is routinely used in clinical treatment, but long-term follow-up has shown incomplete re-ossification recurrence in some patients2. Minimally invasive craniotomy assisted by expansion springs or endoscopic stripe craniectomy may provide a safer approach to preserving the potential suture rather than discarding the tissues3. Similarly, orthopedic therapies such as facemasks and expansion appliances have been widely used to treat sagittal or horizontal maxillary hypoplasia, with some studies extending the age limitation to treat adult patients via miniscrew-assisted palatal expanders4,5,6. Additionally, cranial suture regeneration with mesenchymal stem cells (MSCs) combined with biodegradable materials is a potential therapy in the future, offering a novel direction for the treatment of related diseases7. However, the function process or regulatory mechanism of sutures remains elusive.
Bone remodeling mainly consists of a balance between bone formation conducted by osteoblasts and bone resorption conducted by osteoclasts, where osteogenic differentiation of stem cells stimulated by mechanical signals plays an important role. After decades of research, it has been found that craniofacial sutures are highly plastic mesenchymal stem cell niches8. Suture stem cells (SuSCs) are a heterogeneous group of stem cells, belonging to mesenchymal stem cells (MSCs) or bone stem cells (SSCs). SuSCs are labeled in vivo by four markers, including Gli1, Axin2, Prrx1, and Ctsk. Gli1+ SuSCs, in particular, have strictly verified the biological characteristics of stem cells, not only exhibiting high expression of typical MSC markers but also demonstrating excellent osteogenic and chondrogenic potential9. Previous research has shown that Gli1+ SuSCs actively contribute to new bone formation under tensile force, identifying them as the suture stem cell source supporting distraction osteogenesis10.
In the past, extensive mechanical characteristics of stem cells were studied in vitro via Flexcell, four-point bending, micro-magnet loading system, and others. Although mouse cranial suture-derived mesenchymal cells have been identified in vitro11, and human suture mesenchymal stem cells have also been isolated recently12, the biomechanical response of suture cells remains unclear in the in vitro system. To further investigate the bone remodeling process, a suture expansion model based on isolated calvaria organ culture has been established, paving the way for establishing a useful in vivo suture expansion model1,13. Rabbits14 and rats15 have been the most widely used animals in basic research for suture expansion. However, mice are preferred animal models for exploring human disease due to their highly homologous genome with humans, numerous gene modification lines, and strong reproductive hybridization ability. Existing mouse models of cranial suture expansion typically rely on stainless steel orthodontic spring wires to apply tensile force to the sagittal suture16,17. In these models, two holes are made in each side of the parietal bones to fix the expansion device, and the wires are embedded under the skin, which may affect the cell activation mode.
Regarding the visualization method, the two-dimensional observation of slices in the sagittal direction has been generally adopted for decades. However, considering that bone remodeling is a complex three-dimensional dynamic process, obtaining complete three-dimensional information has become an urgent need. The PEGASOS tissue transparency technique emerged to meet this requirement18,19. It offers unique advantages for the transparency of hard and soft tissues, enabling the complete bone remodeling process to be reproduced in three-dimensional space.
To gain a deeper and more comprehensive understanding of the physiological changes in the bone remodeling periods, a standard sagittal suture expansion mouse model with a spring setting between the handmade holders was established10. With a standardized acid etching and bonding procedure, the expansion device could be firmly bonded to the cranial bone, generating a tensile force perpendicular to the sagittal suture. Furthermore, the PEGASOS tissue clearing method was applied after double labeling of the mineralized bone post-expansion to fully visualize the bone modeling changes after suture expansion.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>37% Acid etching</td>
			<td>Xihubiom</td>
			<td>E10-02/1807011</td>
			<td></td>
		</tr>
		<tr>
			<td>Alizarin red</td>
			<td>Sigma-Aldrich</td>
			<td>A3882</td>
			<td></td>
		</tr>
		<tr>
			<td>AUSTRALIAN WIRE</td>
			<td>A.J.WILCOCK</td>
			<td>0.014&#39;&#39;</td>
			<td></td>
		</tr>
		<tr>
			<td>Benzyl benzoate</td>
			<td>Sigma-Aldrich</td>
			<td>B6630</td>
			<td></td>
		</tr>
		<tr>
			<td>Calcein green</td>
			<td>Sigma-Aldrich</td>
			<td>C0875</td>
			<td></td>
		</tr>
		<tr>
			<td>Copper(II) sulfate, anhydrous</td>
			<td>Sangon Biotech</td>
			<td>A603008</td>
			<td></td>
		</tr>
		<tr>
			<td>Dynamometer</td>
			<td>Sanliang</td>
			<td>SF-10N</td>
			<td></td>
		</tr>
		<tr>
			<td>EDTA</td>
			<td>Sigma-Aldrich</td>
			<td>E9884</td>
			<td></td>
		</tr>
		<tr>
			<td>EdU</td>
			<td>Invitrogen</td>
			<td>E104152</td>
			<td></td>
		</tr>
		<tr>
			<td>Laser Confocal Microscope</td>
			<td>Leica</td>
			<td>SP8</td>
			<td></td>
		</tr>
		<tr>
			<td>PBS</td>
			<td>Sangon Biotech</td>
			<td>E607008</td>
			<td></td>
		</tr>
		<tr>
			<td>PEG-MMA 500</td>
			<td>Sigma-Aldrich</td>
			<td>447943</td>
			<td></td>
		</tr>
		<tr>
			<td>PFA</td>
			<td>Sigma-Aldrich</td>
			<td>P6148&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>pH Meters</td>
			<td>Mettler Toledo</td>
			<td>S220</td>
			<td></td>
		</tr>
		<tr>
			<td>Quadrol</td>
			<td>Sigma-Aldrich</td>
			<td>122262</td>
			<td></td>
		</tr>
		<tr>
			<td>Sodium Ascorbate</td>
			<td>Sigma-Aldrich</td>
			<td>A4034</td>
			<td></td>
		</tr>
		<tr>
			<td>Sodium bicarbonate</td>
			<td>Sangon Biotech</td>
			<td>A500873</td>
			<td></td>
		</tr>
		<tr>
			<td>Sodium chloride</td>
			<td>Sangon Biotech</td>
			<td>A610476</td>
			<td></td>
		</tr>
		<tr>
			<td>Sodium hydroxide</td>
			<td>Sigma-Aldrich</td>
			<td>S5881</td>
			<td></td>
		</tr>
		<tr>
			<td>Spring</td>
			<td>TAOBAO</td>
			<td>0.2*1.5*1*7</td>
			<td></td>
		</tr>
		<tr>
			<td>Sulfo-Cyanine3 azide</td>
			<td>Lumiprobe</td>
			<td>A1330</td>
			<td></td>
		</tr>
		<tr>
			<td>tert-Butanol</td>
			<td>Sigma-Aldrich</td>
			<td>360538&#160;</td>
			<td>Protect from light. Do not freeze.</td>
		</tr>
		<tr>
			<td>Transbond MIP 
			Moisture Insensitive Primer</td>
			<td>3M Unitek</td>
			<td>712-025</td>
			<td></td>
		</tr>
		<tr>
			<td>Transbond XT 
			Light Cure Adhesive Paste</td>
			<td>3M Unitek</td>
			<td>712-035</td>
			<td></td>
		</tr>
		<tr>
			<td>Triethanolamine</td>
			<td>Sigma-Aldrich</td>
			<td>V900257</td>
			<td></td>
		</tr>
		<tr>
			<td>Tris-buffered saline</td>
			<td>Sangon Biotech</td>
			<td>A500027</td>
			<td></td>
		</tr>
	</tbody>
</table>

a 3-d visualization technique for bone remodeling in a suture expansion mouse model

Craniofacial sutures play a crucial role beyond being fibrous joints connecting craniofacial bones; they also serve as the primary niche for calvarial and facial bone growth, housing mesenchymal stem cells and osteoprogenitors. As most craniofacial bones develop through intramembranous ossification, the sutures' marginal regions act as initiation points. Due to this significance, these sutures have become intriguing targets in orthopedic therapies like spring-assisted cranial vault expansion, rapid maxillary expansion, and maxillary protraction. Under orthopedic tracing force, suture stem cells are rapidly activated, becoming a dynamic source for bone remodeling during expansion. Despite their importance, the physiological changes during bone remodeling periods remain poorly understood. Traditional sectioning methods, primarily in the sagittal direction, do not capture the comprehensive changes occurring throughout the entire suture. This study established a standard mouse model for sagittal suture expansion. To fully visualize bone remodeling changes post-suture expansion, the PEGASOS tissue clearing method was combined with whole-mount EdU staining and calcium chelating double labeling. This allowed the visualization of highly proliferating cells and new bone formation across the entire calvarial bones following expansion. This protocol offers a standardized suture expansion mouse model and a 3-D visualization method, shedding light on the mechanobiological changes in sutures and bone remodeling under tensile force loading.

Author Spotlight: PEGASOS Tissue Clearing Technique to Visualize Bone Remodeling 

A 3-D Visualization Technique for Bone Remodeling in a Suture Expansion Mouse Model

The interest in craniofacial sutures has been driven by the clinical needs to understand the mechanisms of orthodontic and the orthopedic treatment. The scope of our study is to establish a standardized suture expansion mouse model, and the 3D visualization method to study the mechanobiological changes of suture and bone remodeling upon expansion. PEGASOS tissue clearing technique has been combined with various labeling methods to obtain versatile information of suture and bond remodeling in space perspective.This model is suitable for various strengths of transgenic mice of different age. It is convenient to adjust the magnitude of tensile stress and withdraw force at any time. With the PEGASOS technique, we can observe the three dimensional spatial temporal distribution of cranial suture stem cells during bone remodeling.With the PEGASOS technique, we will further explore the relationship between suture stem cells and mechanical stress, as well as its specific mechanisms.

Using this protocol, a mouse model for sagittal suture expansion has been established (Figure 1-2). For 3-D visualization of bone modeling changes after suture expansion, the PEGASOS tissue clearing method was applied to the entire calvarial bones following expansion. After perfusion, calvarial bones were separated (Figure 3A), and the appropriate PEGASOS process was continued (Table 1 and Table 2</stron...

Watch this Scientific Journal Video about PEGASOS Tissue Clearing Technique to Visualize Bone Remodeling at JoVE.com

This protocol presents a standardized suture expansion mouse model and a 3-D visualization method to study the mechanobiological changes of the suture and bone remodeling under tensile force loading.

Craniofacial sutures play a crucial role beyond being fibrous joints connecting craniofacial bones; they also serve as the primary niche for calvarial and ...

a-3-d-visualization-technique-for-bone-remodeling-suture-expansion