Patent Application: US-73461207-A

Abstract:
in an aspect the invention is a method of preparing a cell or tissue implant for insertion into a patient in need of treatment by obtaining a transplantable cell population , culturing the cell population in a culture media and exposing the cell population to a sonic or ultrasonic stimulation , wherein the stimulation provides a capability for an enhanced implant outcome parameter . the method provides enhanced autologous bone implant procedures by reducing the time required for a patient &# 39 ; s own cells to sufficiently undergo osteogenesis , thereby reducing the waiting time for an autologous bone implant . the extent of osteogenesis is optionally monitored non - invasively by magnetic resonance spectroscopy .

Description:
“ ultrasound ” or “ ultrasonic ” generally refers to sound waves having a frequency greater than the upper limit of human hearing , such as greater than about 20 khz . “ sonic ” refers to lower frequency wavelengths that are audible to human hearing , such as less than about 20 khz , or between about 20 hz and 20 khz . “ sonic stimulation ” or “ ultrasonic stimulation ” refers to an applied ultrasound or sound wave resulting in a cellular response by a cell population in such a manner so as to enhance an implant outcome parameter . a cell population can be “ exposed ” to this stimulation outside the patient (“ in vitro ”) and / or after it has been implanted into a patient (“ ex vivo ”) by means known in the art . a patient in need of treatment refers to an individual who could benefit from an implant . for example , an individual suffering from a structural or functional bone defect could benefit from a tissue - engineered bone implant procedure of the present invention . similarly , a patient suffering a cartilage defect , can benefit from a tissue - engineered cartilage implant procedure of the present invention . “ implant outcome parameter ” refers to a measurable or quantifiable effect by sonic or ultrasonic stimulation that improves implant effectiveness . for example , increasing the growth and proliferation of a cell population is an implant outcome parameter that reduces the time required to generate an implant material suitable for implantation in a patient . such a time reduction results in an “ enhanced ” implant outcome parameter . in the example of a cell population comprising a bone cell , examples of implant outcome parameters include increased mineral deposition , increased osteogenesis . other examples include increased extracellular matrix deposition , increased release of bioactive factors generated by cells in the implant , enhanced signal transduction or mechanotransduction . “ cell population ” is used broadly to refer to the cells that are to be implanted in the patient . in an embodiment , the cell population is a substantially homogeneous , or an isolated and purified , cell line . alternatively , the cell population may have two or more distinct cell - type subpopulations . cell population may be a type of stem cell capable of differentiating into a particular cell - type , such as a bone cell ( e . g ., osteoblast ), cartilage cell ( e . g ., chondrocyte ) or others . cell population also refers to a tissue - specific cell type such as a bone cell , cartilage cell , etc . a “ transplantable ” cell population refers to cells that are useful for inserting into the body as an implant , such as bone cells or cartilage cells , for example . an implant optionally contains a biocompatible scaffold . a preferred cell population comprises a cell type that is an osteoprogenitor cell , such as an osteoprogenitor cell located in the periosteum and / or the bone marrow . an osteoprogenitor cell is capable of differentiating in response to a signal into a cell responsible for bone formation , such as an osteoblast . for example , mesenchymal stem cells are capable of differentiating into osteoblasts when cultured in a media containing growth factors , such as bone morphogenetic proteins . whether a cell population has sufficiently differentiated into cells responsible for bone formation can be assessed by measuring or monitoring any one or more bone markers known in the art , or by magnetic resonance spectroscopic techniques disclosed herein . a “ cell or tissue implant ” refers to material that is suitable for insertion into a patient in need of treatment and the term encompasses individual cells that are relatively unorganized ( e . g ., not anchored to a substrate ) or an organized set of cells and extracellular matrix that is anchored or connected to a substrate or scaffold . depending on the treatment required , the implant can comprise cells suspended in a liquid medium in which the cell suspension is injected into the patient , or cells attached to a scaffold in which the scaffold plus cells are implanted into the patient . “ expanding ” a cell population refers to culturing the cells in a manner so that cell number increases ( e . g ., the cells proliferate ). this expansion step can be useful if there is a limited number of starting cells , and the implant requires a significantly larger number of cells . the sonic or ultrasonic stimulation is optionally described in terms of one or more physical variables . “ intensity ” is expressed in terms of power per unit area . “ low intensity ” refers to a stimulation intensity that does not generate significant tissue or cellular damage , including damage such as by heating . for example , higher - intensity ultrasound ( 100 mw / cm 2 - 770 mw / cm 2 ) has been shown to produce heat . “ low intensity ” refers to about 60 mw / cm 2 or less . in an aspect , any of the methods disclosed herein relate to cellular stimulation by low - intensity ultrasound . “ operating frequency ” refers to the frequency of the sonic or ultrasonic signal , and can range from 20 hz to 20 khz for sonic stimulation to above 20 khz for ultrasonic stimulation . “ pulse width ” refers to the length of time for which an individual ultrasonic signal is generated . the pulse width itself is repeated at a “ pulse repetition rate ”. “ daily treatment duration ” or “ individual treatment duration ” refers to the length of time for which the stimulation is applied . in an aspect , the treatment occurs daily . overall treatment duration is determined by the time between daily or individual treatments and the number of times the daily or individual treatments are applied . “ scaffold ” refers to a material upon which cells can attach in a two - or three - dimensional configuration . the term encompasses artificial constructs known in the art as well a basic homogeneous composition to which cells can attach . in an aspect the scaffold itself is biocompatible , or coated with a material that makes the scaffold biocompatible . “ biocompatible ” refers to a material that does not cause a deleterious immune response resulting in implant rejection . a cell population is “ introduced ” to a scaffold by , for example , immersing the scaffold in a solution of cells , or applying a cell - containing solution to a scaffold . “ osteogenesis ” refers to bone development , and more specifically the process by which new bone is generated by bone cells such as osteoblasts . a cell population capable of osteogenesis includes bone cells such as osteoblasts and osteoclasts and may include related cells from mesenchymal stem cell differentiation such as chondrocytes and adipocytes . in vitro “ ultrasonic exposure ” refers to ultrasonic stimulation that occurs outside the patient . ex vivo “ ultrasonic exposure ” refers to ultrasonic stimulation of cells that were once removed from the body , but have been subsequently implanted in the patient . all references cited throughout this application , for example patent documents including issued or granted patents or equivalents ; patent application publications ; and non - patent literature documents or other source material are hereby incorporated by reference in their entireties , as though individually incorporated by reference , to the extent each reference is not inconsistent with the disclosure in this application ( for example , a reference that is partially inconsistent is incorporated by reference except for the partially inconsistent portion of the reference ). every formulation or combination of components described or exemplified herein can be used to practice the invention , unless otherwise stated . all patents and publications mentioned in the specification are indicative of the levels of skill of those skilled in the art to which the invention pertains . references cited herein are incorporated by reference in their entirety to indicate the state of the art as of their publication or filing date and it is intended that this information can be employed herein , if needed , to exclude specific embodiments that are in the prior art . whenever a range is given in the specification , for example , a time range , frequency range , intensity range , or a composition range , all intermediate ranges and subranges , as well as all individual values included in the ranges given are intended to be included in the disclosure as used herein , “ comprising ” is synonymous with “ including ,” “ containing ,” or “ characterized by ,” and is inclusive or open - ended and does not exclude additional , unrecited elements or method steps . as used herein , “ consisting of ” excludes any element , step , or ingredient not specified in the claim element . as used herein , “ consisting essentially of ” does not exclude materials or steps that do not materially affect the basic and novel characteristics of the claim . in each instance herein any of the terms “ comprising ”, “ consisting essentially of ” and “ consisting of ” may be replaced with either of the other two terms . the invention illustratively described herein may be practiced in the absence of any element or elements , limitation or limitations which is not specifically disclosed herein . one of ordinary skill in the art will appreciate that starting materials , materials , reagents , synthetic methods , purification methods , analytical methods , assay methods , and methods other than those specifically exemplified can be employed in the practice of the invention without resort to undue experimentation . all art - known functional equivalents , of any such materials and methods are intended to be included in this invention . the terms and expressions which have been employed are used as terms of description and not of limitation , and there is no intention that in the use of such terms and expressions of excluding any equivalents of the features shown and described or portions thereof , but it is recognized that various modifications are possible within the scope of the invention claimed . thus , it should be understood that although the present invention has been specifically disclosed by preferred embodiments and optional features , modification and variation of the concepts herein disclosed may be resorted to by those skilled in the art , and that such modifications and variations are considered to be within the scope of this invention as defined by the appended claims . an exemplified embodiment is a method of providing a bone implant from human mesenchymal stem cells ( hmscs ) using ultrasonic stimulation . fig2 summarizes the steps involved in that method . referring to fig2 , hmscs are obtained from a patient 10 , and are expanded 20 . after a sufficient time , the hmscs are seeded or introduced to a scaffold 30 in vitro . differentiating media is provided to the hmscs so that they differentiate into bone - producing cells ( e . g ., osteoblasts ). the seeded scaffold is subjected to ultrasound stimulation 40 and in vitro bone formation 50 monitored against a control seeded scaffold that has not been stimulated with ultrasound . after the seeded scaffold is ready , it is implanted into the patient 60 . methods disclosed herein use us - stimulation to increase the rate of cell growth and proliferation . in an aspect , referring to fig1 , us application significantly reduces t c , such as by at least 20 %, 25 , or 50 %. fig3 provides an example of a setup 100 for a set - up to simultaneously expose multiple scaffolds 70 seeded with hmscs and bathed within a differentiating media 80 to ultrasound by an ultrasound transducer 90 . in other aspects of the invention , steps 20 and 30 are not performed , and instead cell population obtained in step 10 are exposed to us stimulation 40 , and the implantation in the patient involves a us - stimulated cells only . tissue engineering has the potential to treat bone loss , but current bone restoration methods , including osteogenesis from mesenchymal stem cells ( mscs ), require three to four weeks for bone formation to occur . in this study , we stimulate the formation of engineered bone tissue with low - intensity ultrasound , which has been proven to accelerate bone healing in vivo . one group of engineered bone constructs receives ultrasound stimulation 20 minutes per day over a 3 - week growth period . we monitor the growth of all the engineered constructs quantitatively and noninvasively using magnetic resonance microscopy ( mrm ), where the t 2 relaxation times of all the constructs are measured , on a weekly basis , using an 11 . 74 t bruker spectrometer . histological and immunocytochemical sections are obtained for all constructs and correlated with the mr results . this study shows that ultrasound accelerates osteogenesis in vitro for tissue engineered bone , the growth and development of which can be monitored using mrm . millions of patients experience bone loss as a result of degenerative disease , trauma , or surgery [ 1 ]. according to wolff &# 39 ; s “ law of bone remodeling ”, changes occur in the bone architecture allowing restoration of its normal function to meet the mechanical demands imposed on it [ 2 ]. however , this capacity is limited when there is insufficient blood supply , mechanical instability , or competition with highly proliferating tissues [ 3 ]. the current “ gold standard ” for specific - site , structural and functional bone defect repair is autologous bone grafts . however , this solution presents certain complications such as donor site morbidity , infection , malformation , and subsequent loss of graft function . another widely employed technique is transplantation of allograft bone , which presents the risks of potential disease transmission and host rejection , and suffers from limited supply [ 4 ]. implants developed via tissue engineering may be a more viable solution to the problem of bone loss , since biocompatibility will no longer be an issue , and the implants will be more readily available to patients [ 5 ]. one bone tissue engineering strategy currently employed is illustrated in fig1 . after cellular expansion of mesenchymal stem cells ( mscs ) obtained from the patient , these are seeded on biodegradable and biocompatible scaffolds [ 6 ], and supplemented with growth factors that enable them to differentiate into osteoblasts ( bone - forming cells ) [ 7 ]. after a substantial culture period ( t c ), the scaffold is implanted into the patient , leading to bone restoration [ 8 ]. reducing the culture time ( t c ) of stem cells is necessary to increase the effectiveness of the implants . the use of electrical and mechanical stimulation to accelerate stem cell differentiation has been implemented , but the optimized usage of such techniques has yet to occur [ 9 ]. in this study , we stimulated the growth of tissue engineered bone constructs with us ( see fig2 ), thereby effectively reducing t c by as much as about 50 %. the reasons behind exploring us stimulation are : ( a ) us waves are noninvasive , which is very relevant to this study to insure the integrity of the constructs ; ( b ) previous studies showed that low - intensity pulsed us , administered with a dose as short as 20 minutes per day , activated ossification in vitro via a direct effect on osteoblasts and ossifying cartilage , after other animal and clinical studies showed that low - intensity us accelerated bone healing in vivo [ 10 ]. magnetic resonance imaging is widely used in vivo to assess connective tissue degeneration [ 11 ]. it has also been effective in studying ectopic bone formation in the rat in vivo [ 12 ]. mrm has been used to investigate the regeneration of engineered tissue [ 13 ]. a recent study showed that mrm can be used to monitor osteogenesis in tissue - engineered constructs [ 8 ]. in this work , we study the feasibility of using us stimulation to enhance and hasten osteogenesis in tissue engineered constructs . the periodic monitoring of tissues t 2 relaxation time correlated with histological and immunocytochemical analyses is used to further assess the results . specimen preparation : mesenchymal stem cells ( mscs ) isolated from fresh adult human bone marrow is provided by allcells ® ( allcells llc , berkeley , calif .). nucleated cells are expanded via incubation for 3 weeks in a basic culture medium composed of dulbecco &# 39 ; s modified eagle &# 39 ; s medium supplemented with 10 % fetal bovine serum and 1 % antibiotics at 37 ° c . helistat ® absorbable collagen scaffolds ( integra lifesciences corporation , plainsboro , n . j ., usa ) are trimmed into 3 mm × 3 mm × 5 mm pieces for use as the biological scaffold . tissue engineered constructs are generated by seeding the collagen scaffolds with mscs at a density of 2 × 10 6 cells / ml with a slight vacuum created with a 20 ml syringe . the mixture of scaffolds and cell suspensions is incubated at 37 ° c . for 2 hours . then , the cell - seeded constructs are divided into 3 groups : control ( con ) constructs are cultured in basal media ( same composition as basic culture medium described above ), differentiated , non - stimulated ( ob diff no us ) constructs and differentiated , ultrasound stimulated ( ob diff us ) constructs are cultured in differentiating media ( basal media with 100 mm dexamethasone , 100 mm β - glycerophosphate , and 50 mg / ml ascorbic acid - 2 - phosphate , which are factors promoting the osteogenic differentiation of human mscs ). the 3 groups are allowed to grow in vitro for 3 weeks . ultrasound stimulation treatment : the us treatment is administered in a therapy unit consisting of a sonic accelerated fracture - healing system ( safhs ) device ( model 2a ; exogen , memphis , tenn ., usa ) and 6 transducers ( with coupling gel ), connected to a multiwell plate filled with 6 ml of tissue culture medium , and the engineered constructs , ob diff us ( fig3 ). the transducers delivered pulsed us waves with an intensity of 30 mw / cm 2 , operating frequency of 1 . 5 mhz , pulse width of 200 μsec and pulse repetition rate of 1 khz . the duration of each treatment is 20 minutes per day through the growth period . magnetic resonance imaging system : mri experiments are conducted at 11 . 74 t ( 500 mhz for protons ) using a 56 mm vertical bore magnet ( oxford instruments , oxford , uk ) and a bruker drx avance spectrometer ( bruker instruments , billerica , mass . usa ) controlled by a silicon graphics sgi2 workstation ( mountain view , calif ., usa ). mr images are acquired using a bruker micro 5 imaging probe with triple axis gradients ( maximum strength 2 t / m ), and a 10 mm diameter rf saddle coil is used to transmit / receive the nuclear magnetic resonance signals . mri and measurements of mr parameters : ob diff no us , ob diff us , and con constructs ( n = 2 ) are studied at 4 growth stages , referred to as weeks 0 , 1 , 2 , and 3 . axial slices are taken along the axis of the test tube and positioned at the center of each specimen . for each sample , the spin - spin relaxation time ( t 2 ) is measured and averaged for specific regions of interest ( rois ) localized at the periphery of each construct . t 2 was measured using a spin echo imaging pulse sequence with 32 echoes ( repetition time tr = 4 s , echo time te = 7 ms , nex = 1 , matrix dimensions = 128 × 128 ). the t 2 values are calculated using laboratory built software in matlab 7 . 0 ( mathworks inc ., natick , mass . ), which performs least square fitting of the experimental mr data for each roi to calculate the mono - exponential t 2 relaxation time ( 1 ). where snr ( te ) is the snr value at a specific te value , and snr 0 is the initial snr value . in addition , pixel by pixel t 2 mapping is produced for all the imaged constructs using a laboratory built matlab software , in order to maximize the contrast information throughout the construct . histological and immunocytochemical analyses : following mr testing , one set of tissue engineered constructs containing the 3 different experimental groups is washed with phosphate buffered saline ( ph 7 . 4 ), then fixed in 10 % formal in , every week throughout the growth period . all fixed samples are sent to histoserv , inc . ( germantown , md . usa ), sectioned at 5 μm thickness , and stained for histological and immunocytochemical analyses . hematoxylin and eosin ( h & amp ; e ) staining was performed to detect cell nuclei in purple , over the collagen matrix , in pink . this provides information related to the increase of cell proliferation with time . also , von kossa staining is performed to examine the mineralization during osteogenic differentiation due to calcium deposition . the tissue sections are treated with a sliver nitrate solution and the silver is deposited by replacing the calcium [ 8 ]. furthermore , staining for osteocalcin ( ocn ), a bone matrix protein , is performed to ascertain the presence of bone tissue in the differentiated constructs . in this stain , the copper regions are a mark of ocn presence . dependence of mr parameters on engineered bone tissue formation and comparison of us stimulated constructs with non - stimulated ones : t 2 - weighted mr magnitude axial images of us stimulated osteogenic constructs at weeks 0 , 1 , and 2 are shown in fig4 . spin - echo imaging pulse sequence is used with tr = 4000 ms , te = 140 ms , slice thickness = 0 . 5 mm , and matrix dimensions = 128 × 128 . the intensity of the mr images for the osteogenic constructs decreased with tissue development . fig5 compares the variation of t 2 relaxation time calculated weekly , using mono - exponential fitting , for peripheral rois in the constructs , for each of the 3 different experimental groups , over the 3 - week developmental period . the t 2 relaxation time decreases with time for the osteogenic constructs ( ob diff no us and ob diff us ), whereas that for the control constructs ( con ) does not show any similar decrease . starting with initial values of 96 . 6 ms and 97 . 8 ms at week 0 , the t 2 relaxation time reaches a value as low as 56 . 0 ms for the us stimulated osteogenic constructs , whereas it only reaches values of 72 . 1 ms and 74 . 1 ms for the non - stimulated osteogenic constructs ; the lowest t 2 values calculated for the control group are 80 . 2 ms and 83 . 1 ms . fig6 displays pixel by pixel t 2 relaxation time maps of the same samples shown in fig4 . the vertical legend bar to the right of each map shows the t 2 values in ms that each color shade represents . the variation of the dominant color from red ( fig6 a ) ( value about 100 - 120 ), yellow ( fig6 b ) ( about 80 ), to green - blue ( fig6 c ) ( about 20 - 60 ), in the region of the map occupied by the construct , demonstrates a decrease in the computed t 2 values when going from week 0 ( fig6 a : t 2 about 100 ms ) to week 2 ( fig6 c : t 2 about 60 ms ). this effect is actually present for both osteogenic construct groups , as shown in fig5 . it can be noticed by examining those maps that they contain better contrast information than what is displayed in the t 2 - weighted mr magnitude images shown in fig4 , and therefore , provide better tissue characterization throughout the construct region . fig7 shows the h & amp ; e staining results at week 2 for the 3 construct groups : a . con ( control ); b . ; ob diff no us c . ob diff us . in all constructs , collagen is stained by a lighter shade , and cell nuclei are dark . a white arrow points to a nucleus in each of the panels a - c . the us stimulated osteogenic construct has more cells than the non - stimulated osteogenic construct at week 2 , indicating greater cell proliferation in the construct receiving ultrasound treatment . fig8 shows the von kossa staining results at week 2 for the 3 construct groups . a . con ( control ); b . ; ob diff no us c . ob diff us . black nodules indicate calcium deposition , which increases with osteoblast formation ; the black arrow points to one nodule . black nodules are absent from the control constructs , but apparent in the osteogenic ones ( us stimulated and non - stimulated ) at week 2 , indicating calcium deposition in these only . the us stimulated construct , as shown , has more black nodules than the non - stimulated one , indicating greater calcium deposition in the construct receiving us treatment . fig9 shows the results of staining for ocn at week 2 for the 3 construct groups . a . con ( control ); b . ; ob diff no us c . ob diff us . the lighter - colored copper regions indicate the presence of ocn . one of the copper colored regions is indicated by the black arrow . copper colored regions are absent from the control constructs , but apparent in both osteogenic constructs , indicating the presence of ocn in these only . the us stimulated construct has more copper colored regions than the non - stimulated osteogenic one , indicating greater presence of osteocalcin in the construct receiving us treatment . both von kossa and ocn stains show further mineralization and bone formation in the us stimulated osteogenic constructs than in the non - stimulated ones , while having a faster decrease in t 2 values measured for the us stimulated constructs . therefore , there is good correlation between the histological / immunocytochemical and the mr results , implying that the faster decrease in t 2 values over the growth period can be directly correlated to the faster increase in stiffness , due to improved mineral deposition . both von kossa and ocn stains show further mineralization and bone formation in the us - stimulated osteogenic constructs than in the non - stimulated ones , while having a faster decrease in t 2 values measured for the us stimulated constructs . therefore , there is good correlation between the histological / immunocytochemical and the mr results , implying that the faster decrease in t 2 values over the growth period can be directly correlated to the faster increase in stiffness , due to improved mineral deposition . this work is unique in two aspects : first , it shows that mrm is sensitive enough to characterize the acceleration of osteogenic constructs growth , by sensing the difference in t 2 values between the us stimulated and non - stimulated constructs . second , it shows that us is effective in accelerating osteogenesis in vitro . the decrease in the t 2 values over time for the osteogenic constructs can be explained by the introduced magnetic susceptibility upon mineral deposition [ 8 ], and translated into an increase in stiffness of the tissue . furthermore , a decrease in the size of the osteogenic constructs over the incubation period is observed , and is more evident for the us stimulated constructs than the nonstimulated ones . this may be due to normal growth consolidation or non - uniform cell seeding in the collagen scaffold [ 8 ]. however , the degradation of collagen scaffolds by osteoclasts along with the formation of new bone matrix by osteoblasts has been proven in a recent study [ 14 ]. therefore , the mscs possibly differentiating into both of these bone cell types allow degradation of the collagen scaffold matrix upon mineralization . this fact is most likely the major reason for the decrease in size observed in the osteogenic constructs , and offers an advantage for bone remodeling using tissue engineered constructs , where biodegradability of the scaffold material is very important [ 14 ]. in addition , we noticed a better decrease in t 2 values over time in the peripheral than in the central parts of the constructs , which means that more mineralization occurs at the periphery of the constructs where the highest cell density probably resides . this problem may be overcome by improving the cell seeding procedure . j . a . buckwalter , and t . d . brown , “ joint injury , repair , and remodeling : roles in post - 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