Patent Application
20240044922
This disclosure relates to a device and methods to provide the visualization of clot contraction and measurement of the kinetics of this process.
Platelets are small, anucleate, circulating cell fragments that are important for maintaining vascular homeostasis. Vascular disruption activates platelets leading to αIIbβ3 integrin activation and fibrinogen-binding, linking the extracellular fibrin/fibrinogen network to the platelet actomyosin cytoskeleton, which are important steps in clot formation. Clot contraction is an active squeezing of the clot, reducing its volume and consolidating its mass to form a semi-porous thrombus for preventing blood loss. Platelet-driven clot contraction is important for promoting clot stability and for maintaining blood vessel patency: When contraction is malfunctioning, bleeding can occur (e.g., May Hegglin Anomaly, etc.); alternatively, defective contraction can exacerbate vascular occlusion. During platelet-driven clot contraction, contractile forces generated through ATP hydrolysis by the non-muscle myosin (myosin IIA) are transmitted through the actin cytoskeleton to the fibrin meshwork of a growing clot, resulting in the expulsion of fluid, decrease of clot size, and increase of clot density. Microscopy studies are consistent with this view and show that during initial stages of clot contraction, platelets send out filopodia with longitudinal thin actin filaments that contact and “pull” on fibrin fibers. Despite these general insights, understanding of details of clot contraction at the molecular and cellular level is still limited.
Because clot contraction is integral to platelet function, several assay systems for monitoring clot contraction have been developed. In some assays, clot contraction can be observed in vitro in a test tube using whole blood, platelet-rich plasma (PRP), or washed platelets (with exogenous fibrinogen), and single images of clots at the end of these assays are taken. In other assays, the extent of clot contraction is measured by determining the amount of fluid extruded at a single endpoint. These types of end-point analyses provide little kinetic information and are thus insensitive to subtle alterations during the contraction process. Alternative methods periodically take “snapshots” during the contraction process. The captured images can be roughly quantified using software, such as ImageJ, to approximate contraction rates. However, these methods often employ a limited number of images thus lacking temporal resolution. These types of clot contraction assays yield rather crude and typically qualitative results. Since there is clinical evidence that clot contraction is important in several pathological conditions (e.g., stroke), better resolution of events occurring during clot contraction is needed to more precisely define the cellular and molecular mediators that influence the process, as well as to better assay platelet function for translational and clinical applications.
The recently introduced HemaCore Thrombodynamics Analyzer solves many of the past problems of tracking and quantifying clot contraction. However, despite of its primary use and ease of standardization for evaluating plasma coagulation in clinical samples, especially whole blood, its use in evaluating clot contraction is not standardized. For example, potentially different initiation times of the two samples are not taken into account when using the Analyzer for evaluating clot contraction. Moreover, this instrument suffers from low throughput, monitoring only two samples simultaneously, and thus does not lend itself to common needs for simultaneously monitoring multiple experimental manipulations (e.g., inhibitor/modulator titrations).
A 1st aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns a device for capturing clot contraction comprising a first strip; at least one reaction chamber housed within the first strip; a light source positioned to provide about equal illumination to all reaction chambers; an aperture between the light source and the at least one reaction chamber to produced diffused light and limit stray light; an image capturing device capable of taking digital or digitizable images and of taking time lapse photos over a time interval, positioned at a fixed distance from the strip; wherein at least one reaction chamber comprises a reaction medium and a reaction mixture, wherein the reaction mixture is comprised of at least two of platelets, calcium, fibrinogen, and thrombin or at least two of platelet rich plasma (PRP), calcium, and thrombin. The reaction chamber may also include an acrylamide plug.
A 2nd aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, wherein the first strip is configured to support the reaction chamber and is further configured to provide an unobscured side-view of the reaction chamber.
A3rd aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, further comprising a translucent material between the light source and the at least one reaction chamber.
A 4th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, wherein the at least one reaction chamber comprises all four of platelets, calcium, fibrinogen, and thrombin or all three of PRP, calcium, and thrombin.
A 5th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, wherein the at least one reaction chamber comprises all five of platelets, calcium, fibrinogen, non-thrombin agonist (e.g., collagen) and batroxobin or all three of PRP, calcium, and collagen.
A 6th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, wherein the reaction medium comprises a saline solution.
A 7th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, further comprising a test compound.
An 8th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, wherein the first strip is housed in a light impermeable enclosure.
A 9th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, wherein the image capturing device is positioned at the fixed distance from the first strip by an arm operably connected to the strip or a surface underneath the strip.
A 10th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 9th aspect, wherein the arm is adjustable in length and/or height.
An 11th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, further comprising an opaque or translucent material to diffuse the light.
A 12th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, wherein the first strip is curved about the image capturing device.
A 13th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, wherein the first strip is linear.
A 14th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, further comprising a second strip stacked on the first strip.
A 15th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, wherein the one or more reaction chambers are transparent or comprise a transparent window.
A 16th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 1st aspect, wherein the image capturing device is operably connected to a computer or data processing means.
A 17th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 16th aspect, wherein the computer or data processing means is configured to define edges of the clot side-view profile, measure a clot side-view projection area, and/or determine a time point for when clotting is initiated (time 0).
An 18th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 17th aspect, wherein analysis of quantified data is automated.
A 19th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns a method for quantifying clot contraction comprising: adding a test compound to the reaction medium of the device of the 1st aspect; capturing a series of images with the image capturing device over a time course; determining a time point when clotting initiated; image processing and defining the edges of the clot side-view profile; measuring a clot side-view projection area within the at least one reaction chamber within each of the series of images; and correlating the clot side-view cross-sectional area within each of the series of images to the time course to determine lag time, first derivative of the % clot area-time curve, extent of clot contraction or clot side-view cross-sectional area change, and rates of clot contraction phases.
A 20th aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns a method for collecting clot contraction data, comprising: arranging one or more reaction chambers in a strip configured to support the one or more reaction chambers and to provide a side-view of the reaction chamber; providing illumination to the one or more reaction chambers; providing to the one or more reaction chambers a reaction medium and a reaction mixture, wherein the reaction medium is comprised of at least two of platelets, calcium, fibrinogen, and thrombin or at least two of platelet rich plasma (PRP), calcium, and thrombin; initiating clotting in the one or more reaction chambers at a marked time point; obtaining one or more images of contraction of a clot in the one or more reaction chambers at recorded time points; and processing the one or more images to obtain a value of clot size. The reaction chamber may also include an acrylamide plug.
A 21st aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 20th aspect, further comprising assembling the one or more images in chronological order.
A 22nd aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns the device of the 20th aspect, further comprising providing a test compound to the one or more reaction chambers.
A23rd aspect of the present disclosure, either alone or in combination with any other aspect herein, concerns a system for providing information on clot contraction, comprising: a first strip; at least one reaction chamber housed within the first strip; a light source positioned to provide about equal illumination to all reaction chambers; an aperture between the light source and the at least one reaction chamber to produced diffused light and limit stray light; an image capturing device capable of taking digital or digitizable images and of taking time lapse photos over a time interval, positioned at a fixed distance from the strip; and, a computing device operably linked to the image capturing device; wherein at least one reaction chamber comprises a reaction medium and a reaction mixture, wherein the reaction mixture is comprised of at least two of platelets, calcium, fibrinogen, and thrombin or at least two of platelet rich plasma (PRP), calcium, and thrombin; and further wherein the computing device is configured to define edges of the clot side-view profile, measure a clot side-view projection area, and/or determine a time point for when clotting is initiated (time 0). The reaction chamber may also include an acrylamide plug.
This disclosure relates to a device and methods of using the system for tracking and quantifying clot contraction. In some aspects, the present disclosure provides a device or system that can successfully capture clot contraction with a coupled single standard digital camera and operable timer thereof. In some aspects, the device and system allow for the capture and assessment of multiple samples each with potentially different initiation times for clot formation and contraction. In some aspects, the present disclosure concerns the development of the system and accompanying software to automate processing of collected clot images to provide clot tracking and quantification. As set forth herein, the device and system provide for detection of the three key phases of clot contraction and demonstrated the expected dependence of clot contraction on platelet number, calcium, an agonist (e.g. thrombin), fibrinogen, myosin IIA, fibrin-integrin interaction, and glycolysis.
In some aspects, the present disclosure concerns a device or system that allows for methods of capturing and/or measuring clot contraction. In some aspects, the device or system includes a strip configured (or other similar configuration such as tube-by-tube rather than a whole strip) to allow bottom-to-up (or other directions, such as from the side or top) illumination of transparent reaction chambers therein. By arranging the reaction chambers in a fashion whereby one or more cameras can capture an unobstructed side-view, the one or more cameras can monitor the profile and/or obtain images from all reaction chambers simultaneously. In some aspects, a single camera may be sufficient. In some aspects, the strip may be linear (straight or curved). It will be appreciated in the art that the number of reaction chambers can in some aspects be limited by the field of view of the camera monitoring and/or capturing images, as well as the distance of the camera from the device. It will also be appreciated, that more than one camera may be utilized. In aspects where a digital image is captured, it will be appreciated that increasing the distance between the camera and the reaction chambers may reduce the number of pixels available to capture the clot or a portion thereof and accordingly may in some aspects reduce the accuracy. It may also be appreciated that in some aspects, a user may not be able to initiate reactions in each reaction chamber at the same instant or thereabout. As such, the number of reaction chambers in the strip may be limited by user capabilities. In other aspects, a user or a visual trigger (such as placing the reaction chamber in place) can mark the initiation of a clotting reaction within each reaction chamber (or “time zero”) through the camera and accordingly record and/or monitor and/or measure the reactions in each chamber independently. In some aspects, an arm may be used to retain or steady the camera. It will be appreciated that the introduction of an arm allows for a constant distance from the reaction chamber(s), as well as a constant height and/or perspective of each reaction chamber. In some aspects, the arm is adjustable, allowing a user to adjust the distance and/or height of the camera. In some aspects, the arm can be moveable, such as through rotation about a fixed point by anchoring a distal end of the arm.
In some aspects, the strip is configured to house the reaction chambers. It will be appreciated that in some aspects, it may be possible for the reaction chambers to be free standing and as such, the strip need no particular configuration but may still serve to provide a linear (straight or curved) line upon which each reaction chamber may be centered to ensure similar or equidistance from the image capturing device. It will be appreciated that calculating percentage of clot area change within each sample allows for variance in distance to be effectively cancelled. In other aspects, a reaction chamber may not remain still or balanced in a still position without assistance, for example, a round bottomed cylinder. In such instances, the linear strip may include at least two strips maintained in a parallel or near parallel and horizontal arrangement with the upper strip configured with an aperture to receive passage of the reaction chamber and allow the reaction chamber to rest on the lower strip, such that the walls of the aperture provide support for the walls of the reaction chamber. For example, in instances where the reaction chamber is a round bottomed cylinder, the aperture of the upper strip may feature circular apertures of a slightly larger circumferences such that the reaction chambers can pass through and rest on the bottom strip while maintain upright position. In some instances, it may be of benefit to shape the lower strip to receive the reaction chamber. For example, in stances where the reaction chamber is a round bottomed tube, a concave or recessed area within the lower strip may help to secure the reaction chamber. It will be appreciated that in some instances the lower strip may be replaced by a surface provided by other aspects of the device or system, such as a table surface or an exterior surface of an underlying light source, once the reaction chambers are in place for measuring and/or detecting clot formation and/or contraction.
In some aspects, the device or system of the present disclosure concerns arrangements to provide illumination to the reaction chambers as set forth herein. As described herein, the reaction chambers house solutions wherein monitoring for clot formation and/or contraction occurs by a single camera focused on the profile thereof, wherein the camera collects images that allow for clot side-view projection area measurement over a time course. It will be appreciated that in some aspects, the clot, while possessing a three-dimension shape, can be measured by the visible area when viewed in profile from the side. In some aspects, the collected images may allow for the measurement and/or observation of clot contraction. In some aspects, the collected images may be put together as a film to observe the process over time.
In some aspects, the present disclosure concerns providing a linear (straight or curved) array or strip of reaction chambers to an image capturing device so that profile images of clot in each reaction chamber can be captured and calculations of clot side-view projection area and/or rate of change can be therefrom obtained. In some aspects, the array or strip provides a linear array of reaction chambers. In some aspects the reaction chambers may be in two or more stacked layers along the strip. In some aspects, the reaction chamber is of a transparent material to allow for accurate image capture of the progress of clot formation and/or contraction therein. In some aspects, the reaction chamber may be of a transparent glass or plastic. It will be appreciated that the reaction chambers may be of any suitable size or shape or material, provided that the system be arranged such that clot formation and/or contraction can be adequately imaged. In further aspects, it is of potential benefit that the reaction chamber material be inert or non-reactive with any component of the samples to be tested in the reaction chambers. In some aspects, the reaction chambers may be a glass tube or cuvette or a siliconized glass tube or cuvette. In some aspects, the tube or cuvette may be of a transparent polymer, such as polyethylene.
In some aspects, the present disclosure concerns providing a reaction medium for clot formation and/or contraction to occur in, such as a reaction medium within each reaction chamber. In some aspects, the reaction medium may be a cell culture medium or a medium derived therefrom. Examples of cell culture media include HEPES (4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid), MEM (minimal essential medium), HEPES-Tyrode buffer, platelet additive solutions (PAS), HEPES, DMEM (Dulbecco's modified Eagle's media), DMEM/F12, GMEM (Glasgow minimal essential medium), PBS (phosphor buffered saline), DPBS (Dulbecco's PPBS), HBSS (Hank's balanced salt solution), EBSS (Earle's balanced salt solution), RPMI (Roswell Park Memorial Institute), Grace's Insect Media, and IMDM (Iscove's modified Dulbecco's medium). Reaction may further include an antibiotic, additional salts, amino acids, vitamins, serum (such as fetal bovine serum), buffers, carbohydrates, proteins, peptides, fatty acids, lipids, acetate, citrate, phosphate, potassium, magnesium, glucose, sodium bicarbonate, calcium, sodium, chloride, and/or trace elements. In some aspects, the reaction medium may include fluid from a subject, such as whole blood or a medium derived therefrom, such as plasma.
In further aspects, each reaction chamber may include an acrylamide plug or pad at the base. In some aspects, the reaction chambers can be initially cleaned with distilled water followed by 95% ethanol, air dried, and then a polyacrylamide solution is transferred to the bottom of the reaction chamber and optionally covered with distilled water to allow for even polymerization. In some aspects, the polyacrylamide solutions may be sufficient for gel of about 5% to about 20% acrylamide polymer, including 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, and 19% acrylamide. In some aspects, the acrylamide of prepared as a solution with an initiator, such as ammonium persulfate and/or TEMED (tetramethylethylenediamine), added just before transferring to reaction chambers. Following polymerization, each reaction chamber and/or acrylamide plug may be washed or rinsed with the reaction medium to be used.
In some aspects, each reaction chamber may be provided with one or more cellular materials needed for clot formation and/or contraction. It will be appreciated that the core requirements for each component for clot formation and/or contraction may be varied depending on what aspect may be assessed by the user. As identified herein, there are four minimum cellular material requirements for clot formation and/or contraction of washed platelets, including platelets, calcium, fibrinogen and thrombin. There are only three minimum cellular material requirements for clot formation and/or contraction of PRP, including PRP, calcium, and thrombin. In some aspects, it may be desirable for the user to determine the dynamic effects of the presence of one component at varying concentrations on clot formation and/or contraction while maintaining the remaining components at constant concentrations. In other aspects, it may be desirable for the user to utilize a selected set of concentrations of all four components to assess the ability of a fifth or test compound to affect, positively or negatively, clot formation and/or contraction. In further aspects, it may be desirable to test two or more test compounds. In other aspects, it may be desirable to test whether a test compound(s) can functionally replace calcium and/or a platelet and/or thrombin and/or fibrinogen in clot formation and/or contraction. In further aspects, it may be desirable to test the ability of a mutation in fibrinogen, thrombin, and/or other protein to affect clot formation and/or contraction. In other aspects, it may be desirable to test if an abnormal or modified platelet affects clot formation and/or contraction. For example, as set forth herein, blebbistatin, eptifibatide and 2DG can be added to assess the roles of myosin IIA, fibrin-integrin interaction, and glucose metabolism, respectively. In some aspects, the reaction chamber may include further clot formation and/or contraction contributors, such as red blood cells.
In some aspects, it may be desirable to provide or store the cellular materials in a medium that inhibits or reduces the platelet aggregation and clot initiation, such as with the presence of apyrase in a PRP or platelet solution. Such inhibitors may be washed off by gently bringing down platelets and re-suspending them in an inhibitor-free medium prior to bringing together cellular material requirements or dispensing to the reaction chamber.
In other aspects, the present disclosure concerns providing light to the reaction chamber to sufficiently illuminate clot formation and/or contraction therein for accurate image capture, processing, and/or measurement. In some aspects, the light source is positioned to provide equal or near equal illumination to each reaction chamber. In some aspects, the lighting of the reaction chamber may be of a diffuse or ambient nature such that a direct source of light or direct sources of light do not cause reflections or provide a distortion of the clot formation and/or contraction images. In some aspects, the system can be placed in a dark room or a dark chamber to control the amount and/or direction of light that illuminates the reaction chamber(s). In further aspects, dark or opaque materials can be introduced within the chamber to further control light. In some aspects, the light may be provided to the reaction chambers by positioning a light source, such as an LED, a light bulb or a light box, behind an aperture to direct the light. The aperture may be of individual apertures at each reaction chamber or a linear (straight/curved) aperture along the length of the linear (straight/curved) arrangement of the reaction chambers. In some aspects, the aperture may be beneath the reaction chamber. In other aspects, the aperture may be above the reaction chamber. In further aspects, the aperture may be along the profile or side of the reaction chamber. In even further aspects, the aperture may be at multiple positions around the reaction chamber.
In some aspects, the light passing through the aperture is diffused by first passing through a translucent or diffusing material, such as a tissue paper, a parchment paper, ground glass, Teflon, opal glass and/or greyed glass. It will be appreciated that the diffuser need not be of a particular material, but instead of a suitable level of translucence. Accordingly, the diffuser may be of a plastic, acrylic, fabric, or gel. In some aspects, due to heat energy from the light, the ability of the diffuser to withstand such may be an additional consideration.
In some aspects, the device or parts thereof may be enclosed in a light impermeable enclosure. In some aspects, the linear strip and/or reaction chambers are housed within the light impermeable enclosure. In some aspects, the image capturing device may be housed within the light impermeable enclosure. In other aspects, the light source may be housed either inside or outside the light impermeable enclosure. It will be apparent that with the light source housed outside the light impermeable enclosure, the enclosure may include an aperture to provide illumination to the reaction chambers. In some aspects, the translucent or diffusing material may cover the aperture to diffuse light as it enters the light impermeable enclosure. In further aspects, the device may include a dark or contrasting material positioned to provide a contrasting background for the image capturing device behind the reaction chambers and/or to the sides of the reaction chambers (as viewed from the image capturing device).
In some aspects of the present disclosure, an image capture device is positioned to capture images, such as a profile image, of the reaction chambers. In further aspects, the image capturing device is positioned at a stationary point from the reaction chambers such that repeated images can be captured over a time course while the captured image does not fluctuate in perspective size or position between images. In some aspects, the image capturing device may be maintained at a constant distance from the reaction chambers through the use of a fixed arm connected, directly or indirectly, to both the linear strip and the image capturing device. In further aspects, using an image capturing device that captures a digital image may improve accuracy of calculation of clot side-view projection area.
In further aspects, the image capturing device may be configured to capture as complete an image of a forming and/or contracting clot. In further aspects, the image capturing device may be configured to capture complete repeated images of the forming and/or contracting clot. In some aspects, the image capturing device may be configured by f-stop or aperture size, lens selection, and/or exposure time. In some aspects, capturing a large and/or highly pixelated image is of benefit for accurate measurement of the clot side-view projection area. Such may be enhanced by use of a macro lens, an appropriate f-stop or aperture size, and/or a high pixel resolution.
In some aspects, the present disclosure concerns processing of images or collected images to determine the clot size (specifically, side-view projection area) of a clot at any given time point during formation and/or contraction. In further aspects, the rate of formation and/contraction of the clot may be determined based on change in size over a selected time period.
Referring now to the drawings,
Coupled to the network 100 are an image capture device 102 and a remote computing device 104. The image capture device 102 may be configured as still image camera, a video camera, an SLR camera, an infrared camera, a heat sensing camera, a mobile device, personal computer, and/or other device that is configured to capture images as described herein.
The remote computing device 104 may be configured as and/or include a personal computer, tablet, mobile device, server, and/or other device for providing processing options of the imagery captured by the image capture device 102. As an example, the image capture device 102 may be configured to capture images and send those images to the remote computing device 104, which may process the images and provide the data depicted in
The remote computing device 104 may thus include a memory component 140, which may store image capture logic 144a, image processing logic 144b, and analysis logic 144c. As discussed in more detail below, the image capture logic 144a may cause the remote computing device 104 to trigger the image capture device 102 to capture one or more images and/or receive imagery from the image capture device. The image processing logic 144b may be configured for causing the remote computing device 104 to process raw and/or cropped imagery as inputs and clot area (e.g., in units of pixel size) as outputs, as well as perform any post image processing. The analysis logic 144c may cause the remote computing device 104 to perform further analysis of the clot side-view projection area and/or perform other functionality provided herein.
Images obtained by the image capture device 102 are analyzed by the remote computing device 104 via the analysis logic 144c to determine the boundaries of the side-view projection of a clot present and then provide a clot area value. The percent clot areas at given time points (Yt) are then obtained by dividing measured clot area values by the area of unstimulated platelet-containing reaction mixture measured at time zero, then multiplied by 100.
Initiation Phase t0<t<t1 y=y0−(y0−y1)(1−e−k
Contraction Phase t1<t<t2 y=y1−k2t Phase 2:
Stabilization Phase t2<t<tend y=y2−(y2−y3)(1−e−k
Statistical significance was assessed using one-way ANOVA (Analysis of Variance) followed by a multiple comparison test with the Bonferroni method.
Also provided are one or more user interfaces for measuring platelet-fibrin clot contraction kinetics. When the “PROCTUBE” option is selected, embodiments provide an option for a user to choose a folder in which the raw photos are saved. Sometimes, if the reaction chamber profiles are small as compared to the whole view field of the images, images can be cropped to get rid of parts of the images that do not contain the reaction chamber profiles and are otherwise noise. In some aspects, the software may include an option to crop images. This crop operation can crop all raw photos in the same dataset (folder) the same way. One can also use other software to crop the raw photos in the same dataset in the same way. When the “PROCTUBE-CROPPED” option is selected, embodiments provide an option for a user to choose a folder in which the cropped photos are saved. When the folder with either raw or cropped pictures is selected, the photos may be processed, clots recognized, clot side-view projection area quantified (in pixels) and written into a table or spreadsheet, and a set of new, analyzed pictures created with the clot profiles identified.
The memory component 140 may store operating logic 842, the image capture logic 144a, the image processing logic 144b, and the analysis logic 144c. Each of these logic components may include a plurality of different pieces of logic, each of which may be embodied as a computer program, firmware, and/or hardware, as an example. A local communication interface 846 is also included in
The processor 830 may include any processing component operable to receive and execute instructions (such as from a data storage component 836 and/or the memory component 140). As described above, the input/output hardware 832 may include and/or be configured to interface with speakers, microphones, and/or other input/output components.
The network interface hardware 834 may include and/or be configured for communicating with any wired or wireless networking hardware, including an antenna, a modem, a LAN port, wireless fidelity (Wi-Fi) card, WiMAX card, mobile communications hardware, and/or other hardware for communicating with other networks and/or devices. From this connection, communication may be facilitated between the remote computing device 104 and other computing devices.
The operating logic 842 may include an operating system and/or other software for managing components of the remote computing device 104. As discussed above, the image capture logic 144a may reside in the memory component 140 and may be configured to cause the processor 830 to receive imagery from the image capture device 102, as well as edit and/or otherwise manage the imagery. The image processing logic (PROCTUBE LOGIC in
It should be understood that while the components in
As an example, one or more of the functionalities and/or components described herein may be provided by the remote computing device 104 and/or the image capture device 102. As such, either of these devices may have similar components as those depicted in
Additionally, while the remote computing device 104 is illustrated with the image capture logic 144a, the image processing logic 144b, and the analysis logic 144c as separate logical components, this is also an example. In some embodiments, a single piece of logic may provide the described functionality. It should also be understood that while the image capture logic 144a, the image processing logic 144b, and the analysis logic 144c are described herein as the logical components, this is also an example. Other components may also be included, depending on the embodiment.
In some aspects, the present disclosure concerns methods for preparing reaction chambers for observing and/or measuring clot formation and/or contraction. In some aspects, the methods may include cleaning the reaction chamber. It will be appreciated that any contaminant present in the reaction chamber can impact clot formation and/or contraction. Cleaning techniques may depend on the material of the reaction chamber itself. In some aspects, the reaction chamber may be sterilized, such as through heat sterilization, steam sterilization, autoclaving, alcohol wash/soak, or similar known techniques.
In further aspects, the methods of the present disclosure may include preparing an acrylamide pad or plug on the bottom of the reaction chamber. The density of the acrylamide can be adjusted as needed. In some aspects, the acrylamide pad/plug is of about 5% to about 20% acrylamide gel, including 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, and 19%. Such can be prepared by mixing the required amount of acrylamide in an aqueous solution or buffer and adding an initiator such as ammonium persulfate and/or TEMED (tetramethylethylenediamine) to start crosslinking the acrylamide molecules. In order to allow for a smooth top to the acrylamide pad/plug, it may be of benefit to cover the dispensed acrylamide with an immiscible solution, such as distilled water, during crosslinking and then wash or rinse the polymerized acrylamide pad/plug with the reaction medium to be used.
For the preparation of the clotting reagents, components can be added separately to each reaction chamber or can be dispensed from a master suspension. In order for clot to form within the reaction chamber, all of calcium, platelets, fibrinogen and thrombin must be present. In some aspects, thrombin may be replaced and supplemented with an additional protease, such as batroxobin/reptilase, that will cleave fibrinogen to make fibrin but will not activate platelets. Often a master suspension that includes calcium, fibrinogen, and platelets is prepared within a master chamber and gently mixed therein, an aliquot is dispensed to each intermediate chamber, then thrombin added and the whole reaction mixture gently mixed right before transferring the whole reaction mixture to the reaction chamber and starting the time lapse image recording. The preparation of the reaction chamber may accordingly vary depending on what aspects of clot formation and/or contraction are to be observed and/or measured. For example, if a user wants to observe the effects of varying concentrations of thrombin, a master calcium, fibrinogen, and platelet suspension can be made, an aliquot dispended to each intermediate chamber, and then varying amounts of thrombin added right before transferring the whole reaction mixture to the reaction chamber and starting the time lapse image recording. If a user wants to observe the effects of a further test agent or agents on the clot formation and/or contraction, a master calcium, fibrinogen, and platelet suspension can be made, an aliquot dispended to each intermediate chamber, the agent(s) to be further tested added at a desired time, and thrombin added right before transferring the whole reaction mixture to the reaction chamber and starting the time lapse image recording. Accordingly, in some aspects, the reaction chamber may be prepared with one or more of isolated/washed/purified platelets, fibrinogen, calcium or calcium ions such as from calcium chloride salt, and thrombin. In some aspects, the reaction chamber may be prepared with two or more of isolated/washed/purified platelets, fibrinogen, calcium or calcium ions such as from calcium chloride salt, and thrombin. In further aspects, the reaction chamber may be prepared with three or more of isolated/washed/purified platelets, fibrinogen, calcium or calcium ions such as from calcium chloride salt, and thrombin.
In some aspects, the methods may include the presence or addition of a further compound to the reaction chamber, such as a test compound, an agonist for clot formation and/or contraction, and/or an antagonist for clot formation and/or contraction.
As also discussed herein, the reaction chambers may optionally contain additional elements, such as salts and/or buffers. In some aspects, the reaction chambers may be tittered to a particular pH. In other aspects, the reaction chambers may be prepared with other clotting components that may be of interest in the role in affecting clot formation and/or contraction. It will be apparent to those preparing the reaction chambers that the concentration should be maintained across all reaction chambers or a portion thereof if the additional component is being controlled or partially controlled in the clot formation and/or contraction, or can be varied across all reaction chambers or portions thereof if it is being assessed as a variable in clot formation and/or contraction.
In some aspects, the present disclosure concerns the methods of using the clot observing device as set forth herein to observe and/or measure the formation and/or contraction of clots in the reaction chambers. In some aspects, the reaction chambers are prepared and spaced in a linear (straight or curved) arrangement, such that the image capturing device placed at a fixed distance is able to capture the profile of each reaction chamber. In some aspects, the image capture device is arranged perpendicularly to the plane of the array of the reaction chambers. In some aspects, the image capturing device is positioned at a constant or fixed distance from the reaction chambers. In certain aspects, the image capturing device is arranged to capture profile images of the reaction chambers.
In some aspects of the present disclosure, the reaction chambers are arranged in a linear strip in a dark environment or an environment with limited or controlled light. In certain aspects, the aperture of the light source is the only source of light for illuminating the reaction chambers. In particular aspects, the reaction chambers are in a darkroom or an enclosed chamber that is impermeable or near-impermeable to ambient light. The reaction chambers are illuminated by light passing through the apertures, or by light diffused as it passes from the light source through the aperture made of a translucent or diffusing material and to the reaction chambers.
In some aspects, the clot formation and/or contraction can be initiated once the reaction chambers are positioned or at a time point proximal thereto. Clot formation and/or contraction can be initiated simultaneously or in a staggered fashion, per the user's preference. In some aspects, the user may mark a zero time point or starting point for the reaction chambers or each individual reaction chamber or groupings therein.
In some aspects, the image capturing device may capture an image of each reaction chamber at a time zero or proximal thereto, or at a predetermined or measured time point thereafter. In some aspects, the image capturing device may acquire images of the reaction chamber at multiple time points during the time course of initiation of clot formation through to the completion of clot contraction.
In some aspects, the methods of using the clot observing device may include initiating the process of clot contraction. As identified herein, the presence of platelets, fibrinogen, calcium and thrombin are required for clot formation and/or contraction to occur. In certain aspects, initiation may be considered at a time point when all four components are together in the same solution, such as within the same reaction chamber. In some aspects, one or more of thrombin, fibrinogen, calcium and/or platelets are added to the reaction chamber to initiate clot formation and/or contraction (see, e.g., Prakhya et al. Platelets. 2023 December; 34(1):2222184. PMID: 37292023; and, Prakhya. Res Pract Thromb Haemost. 2022. 6(5):e12755, both incorporated by reference herein).
In some aspects of the present disclosure, the methods include processing images obtained by the image capturing device to determine data or information concerning the clot, such as the clot side-view projection area, rate of formation, rate of contraction, as well as comparative data as to effects caused by difference between different treatments, different concentrations, different volumes, different temperatures and similar.
In some aspects, the images obtained by the image capture device are processed through digital analytical tools to create further data, including recognition of edges of the clot side-view profile, measurements of clot side-view projection area, as well as assembled into a viewable film or sequence of images over the time course. As described herein, developed software for the device can assign points within a captured image that delineate the edges or outer boundaries of the clot silhouette and calculate the area enclosed therein to assign a clot side-view projection area value for each image.
In some aspects, the arrangement may include an interface that calculates the information of clot size and/or rate of clot contraction for the user. In some aspects, the device may include an interface that identifies the time zero or initiation point for allowing clot contraction in one or more reaction chambers. In some aspects, the arrangement may include an interface to adjust for image quality or to smooth data presented. In some aspects, the arrangement may include an interface that assembles collected images into a film or video. In some aspects, an interface may be included that collects and processes data from multiple reactions, such as in repeated experiments. In such instances, the interface may provide mean, standard error of mean, standard deviation, and similar statistical calculations.
In some aspects, the presence of multiple reaction chambers allows for comparison between reactions. For example, as set forth herein, test compounds can be evaluated on their affect in clot contraction. Comparison between concentrations and/or controls allows for confidence in an observed result. Furthermore, comparison allows for identification of potential differences between different sources of clotting materials. For example, platelets and/or PRP can be collected from multiple subjects, such as human subjects. Differences in clotting in patient subpopulations can identify potential conditions or clotting differences that can then allow for a new or adjusted line of therapy for most suitable patient groups.
Preparation of Reaction Chambers: Critical to the measurements are the reaction chambers (
Platelet Preparations: PRP or washed platelets were prepared from mice or human whole blood as described (Ren et al. 2007; Banerjee et al. 2019). For mouse platelets, an anticoagulant master mix (100 μL) is drawn into a 1 mL tuberculin slip tip syringe with a 26G ⅜ needle, so that the final concentrations in 1 mL of blood was 0.38% sodium citrate, 0.2 U/mL apyrase, and 10 ng/mL PGI2. The animals were euthanatized via CO2 asphyxiation and blood was immediately harvested by cardiac puncture. After drawing, the needle was removed, and the harvested blood was expelled into an Eppendorf tube and mixed gently by inversion. Blood was pooled, diluted 1:1 (v/v) with PBS or HEPES-Tyrode buffer (pH 6.5) containing 0.2 U/mL apyrase and 10 ng/mL PGI2, and incubated for 5 min. PRP was harvested from blood by centrifugation at 215×g in a swinging-bucket rotor centrifuge (Beckman Coulter Avanti J-15R centrifuge with acceleration and deceleration set as 5 and 2, respectively) for 5 min. PRP was removed, transferred to new tube. Platelets were harvested from PRP by centrifugation at 675×g for 7-10 min. The pelleted platelets were washed by gently re-suspension in 1-2 mL HEPES-Tyrode buffer (pH 6.5) supplemented with 1 mM EGTA, 0.2 U/mL apyrase and 10 ng/mL PGI2, using large disposable transfer pipets, and centrifugation at 675×g for 7 min. The washed platelets were finally resuspended in 1-2 mL HEPES-Tyrode buffer (pH 7.4), and their concentrations were measured using a Z2 Coulter Particle Count and Size Analyzer (Beckman Coulter, Indianapolis, IN). The platelet concentrations were adjusted as needed with HEPES-Tyrode buffer (pH 7.4) and incubated at room temperature (RT) or 37° C. for 30 min to dissipate the residual effects of PGI2 before setting up the clot contraction assay.
Optimization of Clot Contraction Assay Conditions: Using washed platelets offers the most experimental flexibility, but assay conditions should be standardized to obtained consistent results. Platelet number, fibrinogen, and calcium concentrations should all be optimized. For these studies, fibrinogen (Sigma F4883, 10 mg/mL stock, made fresh) and CaCl2 (from a 500 mM stock), were added to an Eppendorf tube before starting the assay with thrombin (from a 10 U/mL stock; Chrono-par thrombin #386, Chrono-Log, Haverton PA) and immediately transferring the reactions to prepared reaction chambers. The camera was adjusted, and image acquisition was started. Blebbistatin, eptifibatide, and 2DG were added independently to platelet-containing reactions prior to addition of fibrinogen, CaCl2, and thrombin to probe the importance of myosin IIA, fibrin-integrin interaction, and glucose metabolism, respectively.
Image Processing and Clot Analysis: The images captured during each experiment were copied into a single folder. Raw, cropped or processed image stacks can be made into movies using several imaging tools. ImageJ was used to create macros, which cropped images, and to make movies from either the whole set or a subset of an experiment's images. For quantitative analysis of the raw or cropped images, we created a custom software (available at dropbox.com/sh/nce88konldxwzfa/AACn-ZbPO1Dep-wk0k76cErFa?dl=0) to recognize and quantify the clot side-view projection area for each image. Earlier attempts using threshold-based image segregation to recognize clots in the time-lapse images generated variable results, thus a machine learning/neural network-based image segregation approach was taken. The resulting software, “PROCTUBE”, can be opened by double-clicking the executable file or by typing in the command window “proctube” or “proctube -m [modelfile]”. For cropped image datasets, “PROCTUBE-CROPPED” is used. If needed, “-ct”/“-cb”/“-cl”/“-cr” command line options can be specified to crop out undesired top/bottom/left/right portions from the image datasets so that the software can focus more on the tubes. E.g. “proctube -ct 300 -cb 200”. When the software starts, a box or window opens in which you are directed to select the folder with the saved raw or cropped images from your experiment. The software runs from the last image in the sequence and tracks backwards. The “PROCTUBE” or “PROCTUBE-CROPPED” software outputs images with the edges of recognized clots drawn (blue outline) and areas of the clots quantified (in pixels), as well as a spreadsheet file containing all quantified clot areas for each image. These images and the table are saved in the same folder as the input images. The data in the spreadsheet were converted to clot area (% of initial) and plotted against time in GraphPad Prism (8.4.3;
Kinetics and Statistical Analyses: The percent clot areas at given time points (Yt) are then obtained by dividing measured clot area values by the area of unstimulated platelets measured at time zero, then multiplied by 100.
Initiation Phase t0<t<t1 y=y0−(y0−y1)(1−e−k
Contraction Phase t1<t<t2 y=y1−k2t Phase 2:
Stabilization Phase t2<t<tend y=y2−(y2−y3)(1−e−k
Statistical significance was assessed using one-way ANOVA followed by a multiple comparison test with the Bonferroni method.
Optimizing Assay Conditions: Clot contraction is affected by the concentrations of platelets, calcium, thrombin, and fibrinogen. Initially, different concentrations of washed mouse platelets were tested, stimulated with thrombin (20 mU/mL) and fibrinogen (250 μg/mL). Platelet concentrations between 5 and 50×106/mL had a significant decrease in lag time as counts increased (
To address the calcium dependence, the concentration of exogenously supplied CaCl2 was varied from 0-1 mM and clotting was initiated with 20 mU/mL thrombin in the presence of 250 μg/mL fibrinogen (
Next tested was the importance of thrombin, which was varied from 10-200 mU/mL (
Cross-linking of fibrin and attachment of platelets to fibers are important steps in clot contraction. Thus, the ratio of platelets to fibrinogen is critical in determining the rate and extent of contraction. When clot contraction was initiated without added fibrinogen, the average velocity and extent were severely affected, suggesting the platelet pools of fibrinogen are insufficient (FIGS. 6A-6E). Fibrinogen levels were tested varying from 62.5 to 1,000 μg/mL, which, although lower than physiological levels, provided a sensitive window for the assay. The extent of clot contraction and average velocity of contraction were highest at 125 and 250 μg/mL. At the highest fibrinogen concentration (1,000 μg/mL), the fibrinogen/platelet ratio was too high for efficient contraction. When fibrinogen was omitted, none of the three phases were detectible. Thus, for standard conditions, we chose 250 μg/mL, which showed the best average velocity and extent of contraction.
Based on these titrations, 50×106 platelets/mL, 0.5 mM CaCl2, 20 mU/mL thrombin, and 250 μg/mL fibrinogen, at room temperature, were used as the standard reaction conditions for washed mouse platelets. This yielded a predictable lag time, average velocity, extent, and AUC, all of which could be compared across treatment groups. Additionally, all three phases of the contraction process (initiation, contraction, and stabilization) were readily detectible. Optimizing these parameters: platelet number, calcium, fibrinogen, and agonist (i.e., thrombin), when using this system is recommended to tailor it to the experimental questions being asked and to assure that all three phases are detected and can be compared.
Troubleshooting: There are some predictable problems with the assay setup that can be mitigated. For example, if a clot falls off the meniscus, it should not be included in the analysis, regardless of whether the software is able to detect it or not. Though this occurred randomly, thoroughly cleaning of the tubes lessens the chance. The camera position needs to be consistent and the shooting angle needs to be horizontal so that the clot images are correctly and more easily recognized and processed. This requires some optimization using both the camera and the image processing software. It is suggested to have a dedicated place for experiments. Stray light (e.g., reflections) can be a problem because it causes streaks on the tube surfaces, which may be misread by the software. It is best to place the equipment in a dark room or in a box that can be isolated from external light sources.
Myosin IIA and Integrins are Important for Clot Contraction: Previous reports have demonstrated the importance of myosin IIA and fibrin-integrin interaction to clot contraction. The methods were applied to determine if this system recapitulated these dependencies. Use of blebbistatin, a selective myosin IIA inhibitor and its addition (50 to 200 μM) resulted in a dose-dependent increase in lag time and decrease in average velocity and extent of clot contraction (
Integrin αIIbβ3 is expressed at high levels in platelets and the fibrin-integrin αIIbβ3 interaction is crucial for development of clot tension. To demonstrate the role of fibrin-integrin αIIbβ3 interaction in clot contraction, the effect of eptifibatide, a cyclic heptapeptide derived from southeastern pygmy rattlesnake venom and a natural competitive inhibitor of fibrin/fibrinogen binding to αIIbβ3 was tested. Addition of 50 to 150 μM resulted in a dose-dependent decrease in extent and average velocity of contraction (
Glucose Metabolism is Important for Clot Contraction: Clot contraction is an actomyosin-dependent process that utilizes energy released by the ATP hydrolysis. Earlier reports, using conventional, qualitative approaches, showed that both glycolysis and oxidative phosphorylation (OxPhos) contribute to the energy needs for platelet function. To better understand the role of platelet bioenergetics in clot contraction, we applied our method to investigate how glycolysis affects clot contraction. 2DG, a glucose analog and inhibitor of phosphoglucoisomerase, was titrated in this assay. Time courses of clot contraction at varying 2DG concentrations showed prolonged lag time and significant inhibitory effects on average velocity and extent of contraction (
Clot contraction is important for hemostasis since it promotes wound closure; and it also maintains vessel patency by reducing the size of potentially occlusive thrombi. However, the mechanistic understanding of clot contraction is limited, in part, due to limitations in the tools available to quantitatively define the process. Here we report a sensitive and flexible method to assay clot contraction kinetics for multiple samples using a low-cost set-up (<$1,000) and a robust clot recognition and quantification software. This assay system showed the expected dependence of clot contraction on platelet number, fibrinogen, calcium, thrombin, myosin IIA and fibrin-integrin αIIbβ3 interaction. Herein is demonstrated how this assay system could be utilized to investigate the dependency of clot contraction on platelet bioenergetics, e.g., glycolysis. This system is a cost-effective digital version of an old concept (Henry Ford Hospital Medical Bulletin, 1960; Osdoit & Rosa, 2001). The methods set forth herein can facilitate the molecular dissection of the mechanisms and modulators of clot contraction, thus defining how dysfunction in clot contraction affects bleeding diatheses or occlusive thrombosis.
Although simple, the methods do require careful implementation with the following being most important: 1) use and cleanliness of the Chrono-Log aggregometer tubes, which have already been widely used for platelet aggregation studies, 2) use of an acrylamide pad on the bottom of the Chrono-Log aggregometer tubes, 3) bottom illumination, 4) selection of a digital camera with an intervalometer and close-up features, 5) camera positions and setup, and 6) elimination of stray light. All are important for generating quality images for analysis. Gentle and thorough mixing after adding thrombin is necessary for uniform clot formation and/or contraction. As samples are loaded sequentially, one should consider the time delay caused by sample loading into each tube when comparing lag times. This system is readily adaptable to both human and rodent washed platelets and PRP; however, conditions should be re-optimized when switching to different preparations of platelets including whole blood. Finally, in these studies, room temperature (˜25° C.) was used; however, the assays can be performed at 37° C., as needed.
This system allows for the testing of multiple treatment conditions using the same preparation of platelets. Such adaptability is valuable when determining the relative effects of platelet pathways (i.e., signaling, secretion, or bioenergetics) or of different therapeutics. Samples can be run in duplicate or triplicate given the possibility for multiple tubes, enhancing the statistical power. This system is also useful when phenotyping transgenic mouse platelets when ideally blood from each mouse, amount of which is limited, is tested individually to assess individual variability. Thus, this system is ideal for addressing basic mechanistic questions. These assay measures the bulk properties of a population of platelets, but the data generated can augment the recent innovative biophysical methods performed on single platelets using advanced imaging techniques, since our system is a more facile and less instrument-intensive way to scan treatments to identify optimal conditions for downstream detailed analysis. In short, this assay system is seen as a “workhorse” tool with which to better understand the molecular features of how platelets mediate clot contraction. Further development for clinical usages and/or medium throughput laboratory testing and drug screens is underway.
Tutwiler et al. stated that “Blood clot contraction remains the least studied stage of blood clotting (Arteriosclerosis, thrombosis, and vascular biology 37(2): 271-279, 2017 doi.org/10.1161/ATVBAHA.116.308622). This is perhaps, in part, due to limitation in the generally used methods to evaluate the process. While some requirements for clot contraction have a clear logic (e.g., thrombin, fibrinogen, calcium) and genetic diseases associated with cytoskeleton (e.g., Wiskot-Aldrich and May-Heglin Syndromes) or integrins (e.g., Glanzmann's thrombasthenia) have clear mechanistic explanations, there are examples of contraction dysfunction yet to be understood. For example, in stroke patients, there is a post-stroke clot contraction defect (Tutwiler, Peshkova, et al., 2017). One plausible explanation given was metabolic exhaustion of the platelets, which is consistent with our studies showing that glucose metabolism is important for normal clot contraction. It is hoped that this sensitive and flexible system, with its multi-sample capacity, robust software and low-cost, will give investigators a valuable tool to further define this aspect of platelet function and determine what leads to contraction dysfunction in human diseases/conditions.
The foregoing description of particular embodiment(s) is merely exemplary in nature and is in no way intended to limit the scope of the invention, its application, or uses, which may, of course, vary. The invention is described with relation to the non-limiting definitions and terminology included herein. These definitions and terminology are not designed to function as a limitation on the scope or practice of the invention but are presented for illustrative and descriptive purposes only. While the processes or compositions are described as an order of individual steps or using specific materials, it is appreciated that steps or materials may be interchangeable such that the description of the invention may include multiple parts or steps arranged in many ways as is readily appreciated by one of ordinary skill in the art.
The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting. As used herein, the singular forms “a”, “an”, and “the” are intended to include the plural forms, including “at least one,” unless the content clearly indicates otherwise. “Or” means “and/or”. As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items. It will be further understood that the terms “comprises” and/or “comprising”, or “includes” and/or “including” when used in this specification, specify the presence of stated features, regions, integers, steps, operations, elements, components, and/or groups, but do not preclude the presence or addition of one or more other features, regions, integers, steps, operations, elements, components, and/or groups thereof. The term “or a combination thereof” means a combination including at least one of the foregoing elements.
Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs. It will be further understood that terms such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the relevant art and the present disclosure, and will not be interpreted in an idealized or overly formal sense unless expressly so defined herein.
Patents, applications, and publications mentioned in the specification are indicative of the levels of those skilled in the art to which the invention pertains. These patents and publications are incorporated herein by reference to the same extent as if each individual application or publication was specifically and individually incorporated herein by reference.
The foregoing description is illustrative of particular aspects of the invention, but is not meant to be a limitation upon the practice thereof. The following claims, including all equivalents thereof, are intended to define the scope of the invention.
This application claims priority to U.S. Provisional Patent Application 63/357,955, filed Jul. 1, 2022, the content of which is hereby incorporated by reference in its entirety.
This invention was made with support from the National Institutes of Health under grants R01HL160910, P20GM12137, P30GM127211, P30DK020579, UL1TR001998 and 1R35HL150818. The government may have certain rights to the invention.
| Number | Date | Country | |
|---|---|---|---|
| 63357955 | Jul 2022 | US |
