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ES is the use of EFs with the aim of controlling biological cells and tissues. Its mechanism is based on the physical stimulus transduced to the cell when the biomolecules inside and surrounding it are exposed to an externally generated voltage gradient. Charged particles are engaged in an organized motion governed by Coulomb's law, generating drag forces upon the uncharged particles. The resulting fluid flow and charge distribution alter cell activities and functions such as adhesion, contraction, migration, orientation, differentiation and proliferation1 as the cell attempts to adapt to the change in the microenvironmental conditions.
As EFs are controllable, non-invasive, non-pharmacological and shown to have an effective impact on essential cell behavior, ES is a valuable tool for tissue engineering and regenerative medicine. It has been successfully used to guide neural2, skeletal3, cardiac muscle4, bone5 and skin6 development. Moreover, as it enhances iontophoresis7, it is used as an alternative or complementary treatment to conventional pharmacological ones. Its efficiency in pain management is still debated as higher quality clinical trials are awaited8,9,10. Nevertheless, no adverse effects were reported and it has the potential to improve patient welfare11,12,13,14,15.
While only clinical trials can give a definitive verdict for the efficacy of a procedure, in vitro and in silico models are required to inform the design of predictable ES treatment as they offer stronger control over a wider range of experimental conditions. The investigated clinical uses of ES are bone regeneration16,17, recovery of denervated muscles18,19, axonal regeneration after surgery20,21, pain relief22, wound healing23,24,25 and iontophoretic drug delivery26. For ES devices to be widely introduced on all possible target applications, clinical trials have yet to establish stronger evidence for efficient treatment. Even in domains where both in vivo animal and human studies consistently report positive outcomes, the great number of reported methods coupled with too little guidance on how to choose between them and high acquisition price deters clinicians from investing in ES devices27. To overcome this, the target tissue can no longer be treated as a black box (limit of in vivo experiments) but must be seen as a complex synergy of multiple subsystems (Figure 1).
Multiple ES experiments have been carried out in vitro over the years28,29,30,31,32,33,34. Most of these only characterize the ES through the voltage drop between the electrodes divided by the distance between them - a rough approximation of the electric field magnitude. However, the electric field itself only influences charged particles, not cells directly. Also, when multiple materials are interposed between the device and the cells, the rough approximation may not hold.
A better characterization of the input signal requires a clear view on how the stimulus is transduced to the cell. Main methods of delivering ES are direct, capacitive and inductive coupling35,36. Devices for each method differ with electrode type (rod, planar or winding) and placement relative to the target tissue (in contact or isolated)35. Devices used in vivo for longer treatments need to be wearable, thus the electrodes and most times the energy source are either implanted or attached to the skin as wound dressings or electroactive patches. The generated voltage gradient displaces charged particles in the treatment area.
As it impacts the resulting charged particle flow in the vicinity of the cells, scaffold structure is of utmost importance in the design of ES protocols. Different charge transport configurations arise if the platform material, synthesis technique, structure or orientation relative to the voltage gradient change. In vivo, the availability and movement of charged particles is impacted not only by cells but also by the collagen network and interstitial fluid composing the supporting ECM. Engineered scaffolds are increasingly used to better recreate natural cell microenvironments in vitro1,35. Concurrently, the ECM is a complex natural scaffold.
Artificial scaffolds are based on metals, conducting polymers and carbon, engineered with a focus on balancing biocompatibility with electrochemical performance and long-term stability36. One versatile scaffold type is the electrospun fibrous mat that offers a controllable nanoscale topography. This can be engineered to resemble the ECM, thus deliver similar mechanical cues that aid regeneration of a wide range of tissues37. To significantly impact ES, the mats need to be conductive to some degree. However, conductive polymers are difficult to electrospin and blending with insulating carriers limits the conductivity of the resulting fibers38. One solution is polymerizing a conductive monomer on the surface of a dielectric fiber, resulting in good mechanical strength and electrical properties of the end product38. An example is coating silk electrospun fibers with the semi conductive PEDOT-PSS39. The combination of mechanical and electromagnetic cues significantly accelerates neurite growth40,41,42. Neurites follow scaffolds fibers alignment, and elongate more after exposure to an EF parallel to the fibers than to a vertical one43. Similarly, alignment of fibrous scaffolds to the EF also promotes myogenic maturation33.
The ECM is mainly composed of fibrous-forming proteins44, out of those collagen type I being the major constituent in all animal tissues apart from cartilage (rich in collagen type II)44. Tropocollagen (TC), triple helical conformation of polypeptide strands, is the structural motif of collagen fibrils45. Transmission electron microscopy and atomic force microscopy images of collagen fibrils show a D-periodic banded pattern46 explained by the Hodge & Petruska model47 as regular arrays of TC gaps and overlaps45. Tendons are composed of an aligned collagenous fibrillar matrix shielded by a non-collagenous highly hydrophilic proteoglycan matrix48,49. Decorin is a small leucine-rich proteoglycan (SLRP) able to bind the gap regions of collagen fibrils and connect with other SLRPs through their glycosaminoglycan (GAG) side chains49. Studies done on tendons show that their electrical properties change significantly when hydrated50,51, charge transport mechanism changing from protonic to ionic as hydration level increases51. This suggests that electric conduction along a collagen type I fibril could be enabled by a Decorin-water coat, with gap and overlap regions having different electrical conductivities and dielectric constants.
As identical recreation of the ECM by artificial scaffolds is improbable, the knowledge producing synergy between in vivo and in vitro enabled by translatable results seems to be at a dead end. In silico modelling not only re-enables translation between the two, but also adds important benefits in characterizing the unknown processes involved in ES. Comparing the in vivo observations with the in vitro can bring information on the coupling strength between the target tissue and the rest of the organism but does not uncover current knowledge limits. The unknown can be exposed by observing the difference between what is expected to happen based on the current knowledge and what happens. In silico experiments based on mathematical modelling allow splitting the process into known and unknown subprocesses. This way, phenomena not accounted for in the model come to light when in silico predictions are compared to in vitro and in vivo experiments.
Forming and testing hypotheses regarding the underlying mechanism(s) of how cells and tissues are affected by electrical fields is hindered by the great number of parameters52 that need to be tested separately. To define representative experimental conditions, the ES process must be split in subprocesses (Figure 1) and dominant input signals affecting cell behavior must be identified. Models representing fundamental physical effects of ES on cells describe the domain that couples the EF with the cell - that of charged particles53. The behavior of particles exterior to the cell depends on the microenvironment and can be investigated separately from the cell. The dominant input signal for the cell is the subset of ES device outputs that causes the greatest degree of variability in the cell response. The smallest subset of the full experimental parameters that can generate variations in all the dominant cell input signals can be used to decrease the parameter space dimension and the number of test cases.
The input of the biological ES target model must be a subset of the output signals produced by the ES device that are useful in describing the physical effects of ES on cells. A simple bioreactor with direct coupling has the same structure as electrolytic electrochemical cells. Models of those show the primary (accounting for solution resistance), secondary (also accounting for faradic reactions) or tertiary (also accounting for ion diffusion) current density distribution. As complexity translates into computational cost, the simplest model is most suitable for parameter space explorations. Simulations of fibrous composites motivated by material properties54 focus on bulk material properties as a result of complex micro-architecture, hence cannot describe local effects of EF exposure. Existing in silico models, motivated by ES, focus on the biological sample, be it a single cell immersed in a homogenous medium55,56,57, or complex tissues with homogenous extracellular space58. Charge and current density (Figure 2) can act as interface signals between models of the ES device and the biological sample, or between different components of the ES device. The proposed FEM based protocol uses the equations described in Figure 2 and was used to study how scaffold dependent parameters can be used to modulate those two signals, independent of the EF generated by a direct coupling setup. Results stress that it is necessary to account for scaffold or ECM electrical properties when investigating how ES impacts target cells.