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Peiroten L, Zrenner E, Haq W. Artificial Vision: The High-Frequency Electrical Stimulation of the Blind Mouse Retina Decay Spike Generation and Electrogenically Clamped Intracellular Ca 2+ at Elevated Levels. Bioengineering (Basel) 2023; 10:1208. [PMID: 37892938 PMCID: PMC10604554 DOI: 10.3390/bioengineering10101208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The electrical stimulation (stim) of retinal neurons enables blind patients to experience limited artificial vision. A rapid response outage of the stimulated ganglion cells (GCs) allows for a low visual sensation rate. Hence, to elucidate the underlying mechanism, we investigated different stim parameters and the role of the neuromodulator calcium (Ca2+). METHODS Subretinal stim was applied on retinal explants (blind rd1 mouse) using multielectrode arrays (MEAs) or single metal electrodes, and the GC activity was recorded using Ca2+ imaging or MEA, respectively. Stim parameters, including voltage, phase polarity, and frequency, were investigated using specific blockers. RESULTS At lower stim frequencies (<5 Hz), GCs responded synaptically according to the stim pulses (stim: biphasic, cathodic-first, -1.6/+1.5 V). In contrast, higher stim frequencies (≥5 Hz) also activated GCs directly and induced a rapid GC spike response outage (<500 ms, MEA recordings), while in Ca2+ imaging at the same frequencies, increased intracellular Ca2+ levels were observed. CONCLUSIONS Our study elucidated the mechanisms involved in stim-dependent GC spike response outage: sustained high-frequency stim-induced spike outage, accompanied by electrogenically clamped intracellular Ca2+ levels at elevated levels. These findings will guide future studies optimizing stim paradigms for electrical implant applications for interfacing neurons.
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Affiliation(s)
| | | | - Wadood Haq
- Neuroretinal Electrophysiology and Imaging, Institute for Ophthalmic Research, Eberhard-Karls-Universität Tübingen, 72076 Tübingen, Germany; (L.P.)
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Son Y, Chen ZC, Roh H, Lee BC, Im M. Effects on Retinal Stimulation of the Geometry and the Insertion Location of Penetrating Electrodes. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3803-3812. [PMID: 37729573 DOI: 10.1109/tnsre.2023.3317496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Retinal implants have been developed and implanted to restore vision from outer retinal degeneration, but their performance is still limited due to the poor spatial resolution. To improve the localization of stimulation, microelectrodes in various three-dimensional (3D) shapes have been investigated. In particular, computational simulation is crucial for optimizing the performance of a novel microelectrode design before actual fabrication. However, most previous studies have assumed a uniform conductivity for the entire retina without testing the effect of electrodes placement in different layers. In this study, we used the finite element method to simulate electric fields created by 3D microelectrodes of three different designs in a retina model with a stratified conductivity profile. The three electrode designs included two conventional shapes - a conical electrode (CE) and a pillar electrode (PE); we also proposed a novel structure of pillar electrode with an insulating wall (PEIW). A quantitative comparison of these designs shows the PEIW generates a stronger and more confined electric field with the same current injection, which is preferred for high-resolution retinal prostheses. Moreover, our results demonstrate both the magnitude and the shape of potential distribution generated by a penetrating electrode depend not only on the geometry, but also substantially on the insertion depth of the electrode. Although epiretinal insertions are mainly discussed, we also compared results for subretinal insertions. The results provide valuable insights for improving the spatial resolution of retinal implants using 3D penetrating microelectrodes and highlight the importance of considering the heterogeneity of conductivities in the retina.
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Paknahad J, Kosta P, Bouteiller JMC, Humayun MS, Lazzi G. Mechanisms underlying activation of retinal bipolar cells through targeted electrical stimulation: a computational study. J Neural Eng 2021; 18. [PMID: 34826830 DOI: 10.1088/1741-2552/ac3dd8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/26/2021] [Indexed: 11/12/2022]
Abstract
Objective. Retinal implants have been developed to electrically stimulate healthy retinal neurons in the progressively degenerated retina. Several stimulation approaches have been proposed to improve the visual percept induced in patients with retinal prostheses. We introduce a computational model capable of simulating the effects of electrical stimulation on retinal neurons. Leveraging this computational platform, we delve into the underlying mechanisms influencing the sensitivity of retinal neurons' response to various stimulus waveforms.Approach. We implemented a model of spiking bipolar cells (BCs) in the magnocellular pathway of the primate retina, diffuse BC subtypes (DB4), and utilized our multiscale admittance method (AM)-NEURON computational platform to characterize the response of BCs to epiretinal electrical stimulation with monophasic, symmetric, and asymmetric biphasic pulses.Main results. Our investigations yielded four notable results: (a) the latency of BCs increases as stimulation pulse duration lengthens; conversely, this latency decreases as the current amplitude increases. (b) Stimulation with a long anodic-first symmetric biphasic pulse (duration > 8 ms) results in a significant decrease in spiking threshold compared to stimulation with similar cathodic-first pulses (from 98.2 to 57.5µA). (c) The hyperpolarization-activated cyclic nucleotide-gated channel was a prominent contributor to the reduced threshold of BCs in response to long anodic-first stimulus pulses. (d) Finally, extending the study to asymmetric waveforms, our results predict a lower BCs threshold using asymmetric long anodic-first pulses compared to that of asymmetric short cathodic-first stimulation.Significance. This study predicts the effects of several stimulation parameters on spiking BCs response to electrical stimulation. Of importance, our findings shed light on mechanisms underlying the experimental observations from the literature, thus highlighting the capability of the methodology to predict and guide the development of electrical stimulation protocols to generate a desired biological response, thereby constituting an ideal testbed for the development of electroceutical devices.
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Affiliation(s)
- Javad Paknahad
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, United States of America.,Institute for Technology and Medical Systems (ITEMS), Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Pragya Kosta
- Institute for Technology and Medical Systems (ITEMS), Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Jean-Marie C Bouteiller
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America
| | - Mark S Humayun
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America.,Department of Ophthalmology, University of Southern California, Los Angeles, CA, United States of America
| | - Gianluca Lazzi
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, United States of America.,Institute for Technology and Medical Systems (ITEMS), Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.,Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America.,Department of Ophthalmology, University of Southern California, Los Angeles, CA, United States of America
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Sajedi S, Fellner A, Werginz P, Rattay F. Block Phenomena During Electric Micro-Stimulation of Pyramidal Cells and Retinal Ganglion Cells. Front Cell Neurosci 2021; 15:771600. [PMID: 34899192 PMCID: PMC8663762 DOI: 10.3389/fncel.2021.771600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Electric micro-stimulation of the nervous system is a means to restore various body functions. The stimulus amplitude necessary to generate action potentials, the lower threshold (LT), is well characterized for many neuronal populations. However, electric overstimulation above an upper threshold (UT) prevents action potential generation and therefore hinders optimal neuro-rehabilitation. Previous studies demonstrated the impact of the UT in micro-stimulation of retinal ganglion cells (RGCs). The observed phenomenon is mostly explained by (i) reversed sodium ion flow in the soma membrane, and (ii) anodal surround block that hinders spike conduction in strongly hyperpolarized regions of the axon at high stimulus intensities. However, up to now, no detailed study of the nature of these phenomena has been presented, particularly for different cell types. Here, we present computational analyses of LT and UT for layer 5 pyramidal cells (PCs) as well as alpha RGCs. Model neurons were stimulated in close vicinity to the cell body and LTs and UTs as well as the ratio UT/LT were compared. Aside from a simple point source electrode and monophasic stimuli also realistic electrode and pulse configurations were examined. The analysis showed: (i) in RGCs, the soma contributed to action potential initiation and block for small electrode distances, whereas in PCs the soma played no role in LTs or UTs. (ii) In both cell types, action potential always initiated within the axon initial segment at LT. (iii) In contrast to a complete block of spike conductance at UT that occurred in RGCs, an incomplete block of spiking appeared in PC axon collaterals. (iv) PC axon collateral arrangement influenced UTs but had small impact on LTs. (v) Population responses of RGCs change from circular regions of activation to ring-shaped patterns for increasing stimulus amplitude. A better understanding of the stimulation window that can reliably activate target neurons will benefit the future development of neuroprostheses.
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Affiliation(s)
- Sogand Sajedi
- Institute for Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria
| | - Andreas Fellner
- Institute for Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria
| | - Paul Werginz
- Institute for Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria
| | - Frank Rattay
- Institute for Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria
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Paknahad J, Kosta P, Iseri E, Farzad S, Bouteiller JMC, Humayun MS, Lazzi G. Modeling ON Cone Bipolar Cells for Electrical Stimulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6547-6550. [PMID: 34892609 PMCID: PMC8754156 DOI: 10.1109/embc46164.2021.9629884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Retinal prosthetic systems have been developed to help blind patients suffering from retinal degenerative diseases gain some useful form of vision. Various experimental and computational studies have been performed to test electrical stimulation strategies that can improve the performance of these devices. Detailed computational models of retinal neurons, such as retinal ganglion cells (RGCs) and bipolar cells (BCs), allow us to explore the mechanisms underlying the response of cells to electrical stimulation. While electrophysiological studies have shown the presence of voltage-gated ionic channels in different regions of BCs, many of the existing cone BCs models are assumed to be passive or only contain calcium channels at the synaptic terminals. We have utilized our Admittance Method (AM)-NEURON computational platform to implement a more realistic model of ON-BCs. Our model closely replicates the recent patch-clamp experiments directly measuring the response of ON-BCs to epiretinal electrical stimulation and thereby predicts the regional distributions of the ionic channels. Our computational results further indicate that outward potassium current strongly contributes to the depolarizing voltage transient of ON-BCs in response to electrical stimulation.
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Li Q, Chen M, Zhang C, Lu T, Min S, Li S. Opposite Roles of NT-3 and BDNF in Synaptic Remodeling of the Inner Ear Induced by Electrical Stimulation. Cell Mol Neurobiol 2021; 41:1665-1682. [PMID: 32770528 PMCID: PMC11444012 DOI: 10.1007/s10571-020-00935-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/01/2020] [Indexed: 12/11/2022]
Abstract
With the development of neural prostheses, neural plasticity including synaptic remodeling under electrical stimulation is drawing more and more attention. Indeed, intracochlear electrical stimulation used to restore hearing in deaf can induce the loss of residual hearing and synapses of the inner hair cells (IHCs). However, the mechanism under this process is largely unknown. Considering that the guinea pig is always a suitable and convenient choice for the animal model of cochlea implant (CI), in the present study, normal-hearing guinea pigs were implanted with CIs. Four-hour electrical stimulation with the intensity of 6 dB above electrically evoked compound action potential (ECAP) threshold (which can decrease the quantity of IHC synapses and the excitability of the auditory nerve) resulted in the upregulation of Bdnf (p < 0.0001) and downregulation of Nt-3 (p < 0.05). Intracochlear perfusion of exogenous NT-3 or TrkC/Fc (which blocks NT-3) can, respectively, resist or aggravate the synaptic loss induced by electrical stimulation. In contrast, local delivery of exogenous BDNF or TrkB/Fc (which blocks BDNF) to the cochlea, respectively, exacerbated or protected against the synaptic loss caused by electrical stimulation. Notably, the synaptic changes were only observed in the basal and middle halves of the cochlea. All the findings above suggested that NT-3 and BDNF may play opposite roles in the remodeling of IHC synapses induced by intracochlear electrical stimulation, i.e. NT-3 and BDNF promoted the regeneration and degeneration of IHC synapses, respectively.
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Affiliation(s)
- Qiang Li
- ENT Institute and Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Min Chen
- ENT Institute and Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Chen Zhang
- ENT Institute and Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Tianhao Lu
- ENT Institute and Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Shiyao Min
- ENT Institute and Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Shufeng Li
- ENT Institute and Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China.
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Yamashita K, Sundaram P, Uchida T, Matsuo T, Wong W. Modelling the visual response to an OUReP retinal prosthesis with photoelectric dye coupled to polyethylene film. J Neural Eng 2021; 18. [PMID: 33857924 DOI: 10.1088/1741-2552/abf892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/15/2021] [Indexed: 11/12/2022]
Abstract
Objective.Retinal prostheses have been developed to restore vision in blind patients suffering from diseases like retinitis pigmentosa.Approach.A new type of retinal prosthesis called the Okayama University-type retinal prosthesis (OUReP) was developed by chemically coupling photoelectric dyes to a polyethylene film surface. The prosthesis works by passively generating an electric potential when stimulated by light. However, the neurophysiological mechanism of how OUReP stimulates the degenerated retina is unknown.Main results.Here, we explore how the OUReP affects retinal tissues using a finite element model to solve for the potential inside the tissue and an active Hodgkin-Huxley model based on rat vision to predict the corresponding retinal bipolar response.Significance.We show that the OUReP is likely capable of eliciting responses in retinal bipolar cells necessary to generate vision under most ambient conditions.
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Affiliation(s)
- Koichiro Yamashita
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsushima-Naka, Kita-ku, Okayama 700-8530, Japan
| | - Prathima Sundaram
- Department of Electrical and Computer Engineering, University of Toronto, 40 St. George Street, Toronto, ON M5S 2E4, Canada
| | - Tetsuya Uchida
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsushima-Naka, Kita-ku, Okayama 700-8530, Japan
| | - Toshihiko Matsuo
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Willy Wong
- Department of Electrical and Computer Engineering, University of Toronto, 40 St. George Street, Toronto, ON M5S 2E4, Canada
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Werginz P, Raghuram V, Fried SI. The relationship between morphological properties and thresholds to extracellular electric stimulation in α RGCs. J Neural Eng 2020; 17:045015. [PMID: 32736374 DOI: 10.1088/1741-2552/abab47] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Retinal prostheses strive to restore vison to patients that are blind from retinal degeneration by electrically stimulating surviving retinal ganglion cells (RGCs). The quality of elicited percepts remains limited however and it is desirable to develop improved stimulation strategies. Here, we examine how the anatomical and biophysical properties of RGCs influence activation thresholds, including the effects of variations found naturally. APPROACH Detailed reconstructions were made of a large number of mouse α RGCs and were used to create an array of model cells; the models were used to study the effects of individual anatomical features on activation threshold to electric stimulation. Stimulation was delivered epiretinally from a point-source or disk electrode and consisted of monophasic or biphasic rectangular pulses. MAIN RESULTS Modeling results show that the region of minimum threshold always is within the axon initial segment (AIS). The properties of this region as well as the absolute value of the minimum threshold are dependent on the length of the AIS as well as on the relative composition of sodium channels within the AIS. Other morphological features, including cell size, dendritic field size and the distance between the AIS and the soma had only a minimal influence on thresholds. Introducing even a small number of low-threshold Nav1.6 channels into the AIS was sufficient to lower minimum thresholds substantially although further increases in Nav1.6 had diminishing effects. The distance between the AIS and the electrode affects threshold levels while alignment of the electrode with the axon or dendritic parts of the RGC can result in lower thresholds, even if the distance to the cell remains the same. SIGNIFICANCE Intrinsic morphological features can influence activation thresholds with the AIS having the strongest influence. However, the combined influence remains limited and may not be large enough to allow for selective activation between different RGC types.
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Affiliation(s)
- Paul Werginz
- Institute for Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America. Author to whom any correspondence should be addressed
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Werginz P, Wang BY, Chen ZC, Palanker D. On optimal coupling of the 'electronic photoreceptors' into the degenerate retina. J Neural Eng 2020; 17:045008. [PMID: 32613948 PMCID: PMC10948023 DOI: 10.1088/1741-2552/aba0d2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective To restore sight in atrophic age-related macular degeneration, the lost photoreceptors can be replaced with electronic implants, which replicate their two major functions: (1) converting light into an electric signal, and (2) transferring visual information to the secondary neurons in the retinal neural network—the bipolar cells (BC). We study the selectivity of BC activation by subretinal implants and dynamics of their response to pulsatile waveforms in order to optimize the electrical stimulation scheme such that retinal signal processing with 'electronic photoreceptors' remains as close to natural as possible. Approach A multicompartmental model of a BC was implemented to simulate responses of the voltage-gated calcium channels and subsequent synaptic vesicle release under continuous and pulsatile stimuli. We compared the predicted response under various frequencies, pulse durations, and alternating gratings to the corresponding experimental measurements. In addition, electric field was computed for various electrode configurations in a 3-d finite element model to assess the stimulation selectivity via spatial confinement of the field. Main results The modeled BC-mediated retinal responses were, in general, in good agreement with previously published experimental results. Kinetics of the calcium pumps and of the neurotransmitter release in ribbon synapses, which underpin the BC's temporal filtering and rectifying functions, allow mimicking the natural BC response with high frequency pulsatile stimulation, thereby preserving features of the retinal signal processing, such as flicker fusion, adaptation to static stimuli and non-linear summation of subunits in receptive field. Selectivity of the BC stimulation while avoiding direct activation of the downstream neurons (amacrine and ganglion cells—RGCs) is improved with local return electrodes. Significance If the retinal neural network is preserved to a large extent in age-related macular degeneration, selective stimulation of BCs with proper spatial and temporal modulation of the extracellular electric field may retain many features of the natural retinal signal processing and hence allow highly functional restoration of sight.
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Affiliation(s)
- Paul Werginz
- Institute for Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria. Author to whom any correspondence should be adressed
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Li Q, Lu T, Zhang C, Hansen MR, Li S. Electrical stimulation induces synaptic changes in the peripheral auditory system. J Comp Neurol 2020; 528:893-905. [PMID: 31658367 DOI: 10.1002/cne.24802] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/24/2019] [Accepted: 10/12/2019] [Indexed: 12/13/2022]
Abstract
Since a rapidly increasing number of neurostimulation devices are used clinically to modulate specific neural functions, the impact of electrical stimulation on targeted neural structure and function has become a key issue. In particular, the specific effect of electrical stimulation via a cochlear implant (CI) on inner hair cell (IHC) synapses remains unclear. Importantly, CI candidacy has recently expanded to include patients with partial hearing loss. Unfortunately, some CI recipients experience progressive hearing loss after activation of electrical stimulation. The mechanism(s) accounting for loss of residual hearing following electrical stimulation is unknown. Here normal-hearing guinea pigs were implanted with customized CIs. Intracochlear electrical stimulation with an intensity equal to or above electrically evoked compound action potential (ECAP) threshold decreased the excitability of auditory nerve. Furthermore, the number of synapses between IHCs and the afferent spiral ganglion neurons (SGNs) also decreased after electrical stimulation with higher intensities. However, no significant change was observed in the packing density and perikaryal area of SGNs as well as the quantity of hair cells. These results carry important implications for use of CIs in patients with residual hearing and for an increasing number of patients treated with other neurostimulation devices. Notably, the results were based on acute electrical stimulation. Considering the complex interaction between CIs and targeted tissues, it is urgent to conduct further research to clarify whether the similar changes could be induced by chronic electrical stimulation.
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Affiliation(s)
- Qiang Li
- Department of Otolaryngology & Head-Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Tianhao Lu
- Department of Otolaryngology & Head-Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Chen Zhang
- Department of Otolaryngology & Head-Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Marlan R Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa
| | - Shufeng Li
- Department of Otolaryngology & Head-Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
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Tong W, Meffin H, Garrett DJ, Ibbotson MR. Stimulation Strategies for Improving the Resolution of Retinal Prostheses. Front Neurosci 2020; 14:262. [PMID: 32292328 PMCID: PMC7135883 DOI: 10.3389/fnins.2020.00262] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/09/2020] [Indexed: 12/17/2022] Open
Abstract
Electrical stimulation using implantable devices with arrays of stimulating electrodes is an emerging therapy for neurological diseases. The performance of these devices depends greatly on their ability to activate populations of neurons with high spatiotemporal resolution. To study electrical stimulation of populations of neurons, retina serves as a useful model because the neural network is arranged in a planar array that is easy to access. Moreover, retinal prostheses are under development to restore vision by replacing the function of damaged light sensitive photoreceptors, which makes retinal research directly relevant for curing blindness. Here we provide a progress review on stimulation strategies developed in recent years to improve the resolution of electrical stimulation in retinal prostheses. We focus on studies performed with explanted retinas, in which electrophysiological techniques are the most advanced. We summarize achievements in improving the spatial and temporal resolution of electrical stimulation of the retina and methods to selectively stimulate neurons with different visual functions. Future directions for retinal prostheses development are also discussed, which could provide insights for other types of neuromodulatory devices in which high-resolution electrical stimulation is required.
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Affiliation(s)
- Wei Tong
- National Vision Research Institute, Australian College of Optometry, Carlton, VIC, Australia
- Department of Optometry and Vision Sciences, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- School of Physics, The University of Melbourne, Melbourne, VIC, Australia
| | - Hamish Meffin
- National Vision Research Institute, Australian College of Optometry, Carlton, VIC, Australia
- Department of Optometry and Vision Sciences, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - David J. Garrett
- School of Physics, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael R. Ibbotson
- National Vision Research Institute, Australian College of Optometry, Carlton, VIC, Australia
- Department of Optometry and Vision Sciences, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
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12
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Lee JI, Im M. Optimal Electric Stimulus Amplitude Improves the Selectivity Between Responses of ON Versus OFF Types of Retinal Ganglion Cells. IEEE Trans Neural Syst Rehabil Eng 2019; 27:2015-2024. [PMID: 31484127 DOI: 10.1109/tnsre.2019.2939012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Outer retinal degenerative diseases destroy photoreceptors primarily in the retina, resulting in a profound vision loss. Fortunately, surviving retinal neurons can be electrically stimulated using retinal prostheses to re-transmit visual information. Although retinal prostheses are promising for sight restoration, the best performance is still sub-optimal. For the enhanced performance, it is critical to optimize stimulation parameters. This study explored how stimulus charge and current amplitude alters responses of retinal ganglion cells (RGCs). From the isolated mouse retina, spiking activities of alpha ON, OFF sustained, and OFF transient RGCs were recorded in response to epiretinally-delivered cathodal current pulses ranging from -10 to [Formula: see text]. We have found that intermediate current amplitudes (-30 and [Formula: see text]) maximize the response ratio of ON over OFF types. Also, the ON/OFF response ratio was always bigger for 10-ms-long than 5-ms-long stimuli. It was because, by the longer pulses, ON RGC responses were always significantly enhanced ( ) while OFF RGC responses were minimally changed ( ). Given the earlier work reporting electrically-elicited responses are more natural in ON than OFF RGCs, the present study suggests effect strategies of more selective activation of ON RGCs for improved efficacy of retinal implant.
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Flores T, Huang T, Bhuckory M, Ho E, Chen Z, Dalal R, Galambos L, Kamins T, Mathieson K, Palanker D. Honeycomb-shaped electro-neural interface enables cellular-scale pixels in subretinal prosthesis. Sci Rep 2019; 9:10657. [PMID: 31337815 PMCID: PMC6650428 DOI: 10.1038/s41598-019-47082-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/10/2019] [Indexed: 11/08/2022] Open
Abstract
High-resolution visual prostheses require small, densely packed pixels, but limited penetration depth of the electric field formed by a planar electrode array constrains such miniaturization. We present a novel honeycomb configuration of an electrode array with vertically separated active and return electrodes designed to leverage migration of retinal cells into voids in the subretinal space. Insulating walls surrounding each pixel decouple the field penetration depth from the pixel width by aligning the electric field vertically, enabling a decrease of the pixel size down to cellular dimensions. We demonstrate that inner retinal cells migrate into the 25 μm deep honeycomb wells as narrow as 18 μm, resulting in more than half of these cells residing within the electrode cavities. Immune response to honeycombs is comparable to that with planar arrays. Modeled stimulation threshold current density with honeycombs does not increase substantially with reduced pixel size, unlike quadratic increase with planar arrays. This 3-D electrode configuration may enable functional restoration of central vision with acuity better than 20/100 for millions of patients suffering from age-related macular degeneration.
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Affiliation(s)
- Thomas Flores
- Department of Applied Physics, Stanford University, Stanford, CA, USA.
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA, USA.
| | - Tiffany Huang
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Mohajeet Bhuckory
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA, USA
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
| | - Elton Ho
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA, USA
- Department of Physics, Stanford University, Stanford, CA, USA
| | - Zhijie Chen
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Roopa Dalal
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
| | - Ludwig Galambos
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Theodore Kamins
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Keith Mathieson
- Institute of Photonics, University of Strathclyde, Glasgow, Scotland, UK
| | - Daniel Palanker
- Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA, USA
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
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14
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Fellner A, Stiennon I, Rattay F. Analysis of upper threshold mechanisms of spherical neurons during extracellular stimulation. J Neurophysiol 2019; 121:1315-1328. [PMID: 30726157 DOI: 10.1152/jn.00700.2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exceeding a certain stimulation strength can prevent the generation of somatic action potentials, as has been demonstrated in vitro with extracellularly stimulated dorsal root ganglion cells as well as retinal ganglion cells. This phenomenon, termed upper threshold, is currently thought to be a consequence of sodium current reversal in strongly depolarized regions. Here we analyze the contribution of membrane kinetics, using spherical model neurons that are stimulated externally with a microelectrode, in more detail. During extracellular pulse application, the electric field depolarizes one part and hyperpolarizes the other part of the cell. Strong transmembrane currents are generated only in the active depolarized region, changing the overall polarization level. The asymmetric membrane voltage distribution caused by the stimulus strongly influences the cell's behavior during and even after the stimulus. Effects on membrane voltage and transmembrane currents during and after the stimulus are shown and discussed in detail. Aside from the sodium current reversal, two more key mechanisms were identified in causing the upper threshold: strong potassium currents and inactivation of sodium channels. The contributions of the mechanisms involved strongly depend on cell properties, stimulus parameters, and other factors such as temperature. The conclusions presented here are based on several retinal ganglion cell models of the Fohlmeister group, a model with original Hodgkin-Huxley membrane, and a pyramidal cell model. NEW & NOTEWORTHY The upper threshold phenomenon in extracellular stimulation is analyzed in detail for spherical cells. Three main mechanisms were identified that prevent the generation of action potentials at high stimulation strengths: 1) strong potassium currents, 2) inactivating sodium ion channels, and 3) sodium current reversal. Ion channel kinetics in retinal ganglion cells, pyramidal cells, and the original Hodgkin-Huxley model were investigated under the influence of an extracellular stimulus.
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Affiliation(s)
- Andreas Fellner
- Institute for Analysis and Scientific Computing, Vienna University of Technology , Vienna , Austria
| | - Isabel Stiennon
- Institute for Analysis and Scientific Computing, Vienna University of Technology , Vienna , Austria
| | - Frank Rattay
- Institute for Analysis and Scientific Computing, Vienna University of Technology , Vienna , Austria
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15
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Rattay F, Bassereh H, Stiennon I. Compartment models for the electrical stimulation of retinal bipolar cells. PLoS One 2018; 13:e0209123. [PMID: 30557410 PMCID: PMC6296559 DOI: 10.1371/journal.pone.0209123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 11/29/2018] [Indexed: 11/30/2022] Open
Abstract
Bipolar cells of the retina are among the smallest neurons of the nervous system. For this reason, compared to other neurons, their delay in signaling is minimal. Additionally, the small bipolar cell surface combined with the low membrane conductance causes very little attenuation in the signal from synaptic input to the terminal. The existence of spiking bipolar cells was proven over the last two decades, but until now no complete model including all important ion channel types was published. The present study amends this and analyzes the impact of the number of model compartments on simulation accuracy. Characteristic features like membrane voltages and spike generation were tested and compared for one-, two-, four- and 117-compartment models of a macaque bipolar cell. Although results were independent of the compartment number for low membrane conductances (passive membranes), nonlinear regimes such as spiking required at least a separate axon compartment. At least a four compartment model containing the functionally different segments dendrite, soma, axon and terminal was needed for understanding signaling in spiking bipolar cells. Whereas for intracellular current application models with small numbers of compartments showed quantitatively correct results in many cases, the cell response to extracellular stimulation is sensitive to spatial variation of the electric field and accurate modeling therefore demands for a large number of short compartments even for passive membranes.
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Affiliation(s)
- Frank Rattay
- Institute for Analysis and Scientific Computing, Vienna University of Technology, Wiedner Hauptstrasse, Vienna, Austria
- * E-mail:
| | - Hassan Bassereh
- Institute for Analysis and Scientific Computing, Vienna University of Technology, Wiedner Hauptstrasse, Vienna, Austria
| | - Isabel Stiennon
- Institute for Analysis and Scientific Computing, Vienna University of Technology, Wiedner Hauptstrasse, Vienna, Austria
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16
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Corna A, Herrmann T, Zeck G. Electrode-size dependent thresholds in subretinal neuroprosthetic stimulation. J Neural Eng 2018; 15:045003. [DOI: 10.1088/1741-2552/aac1c8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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17
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Guo T, Yang CY, Tsai D, Muralidharan M, Suaning GJ, Morley JW, Dokos S, Lovell NH. Closed-Loop Efficient Searching of Optimal Electrical Stimulation Parameters for Preferential Excitation of Retinal Ganglion Cells. Front Neurosci 2018; 12:168. [PMID: 29615857 PMCID: PMC5867314 DOI: 10.3389/fnins.2018.00168] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/01/2018] [Indexed: 12/20/2022] Open
Abstract
The ability for visual prostheses to preferentially activate functionally-distinct retinal ganglion cells (RGCs) is important for improving visual perception. This study investigates the use of high frequency stimulation (HFS) to elicit RGC activation, using a closed-loop algorithm to search for optimal stimulation parameters for preferential ON and OFF RGC activation, resembling natural physiological neural encoding in response to visual stimuli. We evaluated the performance of a wide range of electrical stimulation amplitudes and frequencies on RGC responses in vitro using murine retinal preparations. It was possible to preferentially excite either ON or OFF RGCs by adjusting amplitudes and frequencies in HFS. ON RGCs can be preferentially activated at relatively higher stimulation amplitudes (>150 μA) and frequencies (2-6.25 kHz) while OFF RGCs are activated by lower stimulation amplitudes (40-90 μA) across all tested frequencies (1-6.25 kHz). These stimuli also showed great promise in eliciting RGC responses that parallel natural RGC encoding: ON RGCs exhibited an increase in spiking activity during electrical stimulation while OFF RGCs exhibited decreased spiking activity, given the same stimulation amplitude. In conjunction with the in vitro studies, in silico simulations indicated that optimal HFS parameters could be rapidly identified in practice, whilst sampling spiking activity of relevant neuronal subtypes. This closed-loop approach represents a step forward in modulating stimulation parameters to achieve appropriate neural encoding in retinal prostheses, advancing control over RGC subtypes activated by electrical stimulation.
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Affiliation(s)
- Tianruo Guo
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
| | - Chih Yu Yang
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
| | - David Tsai
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia.,Biological Sciences, Columbia University, New York, NY, United States.,Electrical Engineering, Columbia University, New York, NY, United States
| | | | - Gregg J Suaning
- School of Aerospace, Mechanical and Mechatronic Engineering, University of Sydney, Sydney, NSW, Australia
| | - John W Morley
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
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18
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Walston ST, Chow RH, Weiland JD. Direct measurement of bipolar cell responses to electrical stimulation in wholemount mouse retina. J Neural Eng 2018. [PMID: 29513646 DOI: 10.1088/1741-2552/aab4ed] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This in vitro investigation examines the response of retinal bipolar cells to extracellular electrical stimulation. APPROACH In vitro investigations characterizing the response of retinal neurons to electrical stimulation have primarily focused on retinal ganglion cells because they are the output neurons of the retina and their superficial position in the retina makes them readily accessible to in vitro recording techniques. Thus, the majority of information regarding the response of inner retinal neurons has been inferred from ganglion cell activity. Here we use patch clamp electrophysiology to directly record electrically-evoked activity in bipolar cells within the inner retina of normal Tg(Gng13-EGFP)GI206Gsat and degenerate rd10 Tg(Gng13-EGFP)GI206Gsat mice using a wholemount preparation. MAIN RESULTS Bipolar cells respond to electrical stimulation with time-locked depolarizing voltage transients. The latency of the response declines with increases in stimulation amplitude. A desensitizing response is observed during repeated stimulation with 25 ms biphasic current pulses delivered at pulse rates greater than 6 pps. A burst of long-latency (200-1000 ms) inhibitory postsynaptic potentials are evoked by the stimulus and the burst exhibits evidence of a lower and upper stimulation threshold. SIGNIFICANCE These results provide insights into the various types of bipolar cell activity elicited by electrical stimulation and may be useful for future retinal prosthesis stimulation protocols. This investigation uses patch clamp electrophysiology to provide direct analysis of ON-type bipolar cell responses to electrical stimulation in a wholemount retina preparation. It explores the effects of variable stimulus amplitudes, pulse widths, and frequencies in both normal and degenerate retina. The analysis adds to a body of work largely based upon indirect measurements of bipolar cell activity, and the methodology demonstrates an alternative retina preparation technique in which to acquire single-cell activity.
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Affiliation(s)
- Steven T Walston
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90007, United States of America
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19
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Flores T, Lei X, Huang T, Lorach H, Dalal R, Galambos L, Kamins T, Mathieson K, Palanker D. Optimization of pillar electrodes in subretinal prosthesis for enhanced proximity to target neurons. J Neural Eng 2018; 15:036011. [PMID: 29388561 DOI: 10.1088/1741-2552/aaac39] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE High-resolution prosthetic vision requires dense stimulating arrays with small electrodes. However, such miniaturization reduces electrode capacitance and penetration of electric field into tissue. We evaluate potential solutions to these problems with subretinal implants based on utilization of pillar electrodes. APPROACH To study integration of three-dimensional (3D) implants with retinal tissue, we fabricated arrays with varying pillar diameter, pitch, and height, and implanted beneath the degenerate retina in rats (Royal College of Surgeons, RCS). Tissue integration was evaluated six weeks post-op using histology and whole-mount confocal fluorescence imaging. The electric field generated by various electrode configurations was calculated in COMSOL, and stimulation thresholds assessed using a model of network-mediated retinal response. MAIN RESULTS Retinal tissue migrated into the space between pillars with no visible gliosis in 90% of implanted arrays. Pillars with 10 μm height reached the middle of the inner nuclear layer (INL), while 22 μm pillars reached the upper portion of the INL. Electroplated pillars with dome-shaped caps increase the active electrode surface area. Selective deposition of sputtered iridium oxide onto the cap ensures localization of the current injection to the pillar top, obviating the need to insulate the pillar sidewall. According to computational model, pillars having a cathodic return electrode above the INL and active anodic ring electrode at the surface of the implant would enable six times lower stimulation threshold, compared to planar arrays with circumferential return, but suffer from greater cross-talk between the neighboring pixels. SIGNIFICANCE 3D electrodes in subretinal prostheses help reduce electrode-tissue separation and decrease stimulation thresholds to enable smaller pixels, and thereby improve visual acuity of prosthetic vision.
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Affiliation(s)
- Thomas Flores
- Department of Applied Physics, Stanford University, Stanford, CA, United States of America
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20
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Rattay F, Bassereh H, Fellner A. Impact of Electrode Position on the Elicitation of Sodium Spikes in Retinal Bipolar Cells. Sci Rep 2017; 7:17590. [PMID: 29242502 PMCID: PMC5730545 DOI: 10.1038/s41598-017-17603-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/29/2017] [Indexed: 01/29/2023] Open
Abstract
Bipolar cells of the magnocellular pathway in the primate retina can generate action potentials because they have an axonal segment with high sodium channel density, comparable to the sodium channel band in retinal ganglion cells or pyramidal cells. The similarity between the non-human primate and the human retina is of interest for the research on retinal implants for the blind, and especially, the conditions to elicit sodium spikes in bipolar cells using extracellular stimulation. A comparison of excitation characteristics of three model neurons, a bipolar cell, a retinal ganglion cell, and a cortical pyramidal cell, demonstrates the similarities and differences regarding stimulation with microelectrodes. Moving a microelectrode parallel to the axon of a neuron commonly allows to generate spikes for every position - and this rule holds both for cathodic and anodic pulses. However, for the simulated bipolar cell anodic pulses cannot generate sodium spikes directly. Further, there is only a small region for electrode placing where extracellular cathodic stimulation causes direct spike initiation in the sodium channel band. For all other positions, a sodium spike can only be generated by antidromic current flow originating from strongly depolarized terminals.
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Affiliation(s)
- Frank Rattay
- Institute of Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria.
| | - Hassan Bassereh
- Institute of Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria
| | - Andreas Fellner
- Institute of Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria
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21
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Barriga-Rivera A, Guo T, Yang CY, Abed AA, Dokos S, Lovell NH, Morley JW, Suaning GJ. High-amplitude electrical stimulation can reduce elicited neuronal activity in visual prosthesis. Sci Rep 2017; 7:42682. [PMID: 28209965 PMCID: PMC5314337 DOI: 10.1038/srep42682] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 01/13/2017] [Indexed: 12/13/2022] Open
Abstract
Retinal electrostimulation is promising a successful therapy to restore functional vision. However, a narrow stimulating current range exists between retinal neuron excitation and inhibition which may lead to misperformance of visual prostheses. As the conveyance of representation of complex visual scenes may require neighbouring electrodes to be activated simultaneously, electric field summation may contribute to reach this inhibitory threshold. This study used three approaches to assess the implications of relatively high stimulating conditions in visual prostheses: (1) in vivo, using a suprachoroidal prosthesis implanted in a feline model, (2) in vitro through electrostimulation of murine retinal preparations, and (3) in silico by computing the response of a population of retinal ganglion cells. Inhibitory stimulating conditions led to diminished cortical activity in the cat. Stimulus-response relationships showed non-monotonic profiles to increasing stimulating current. This was observed in vitro and in silico as the combined response of groups of neurons (close to the stimulating electrode) being inhibited at certain stimulating amplitudes, whilst other groups (far from the stimulating electrode) being recruited. These findings may explain the halo-like phosphene shapes reported in clinical trials and suggest that simultaneous stimulation in retinal prostheses is limited by the inhibitory threshold of the retinal ganglion cells.
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Affiliation(s)
| | - Tianruo Guo
- Graduate School of Biomedical Engineering, UNSW, Sydney, 2052, Australia
| | - Chih-Yu Yang
- Graduate School of Biomedical Engineering, UNSW, Sydney, 2052, Australia
| | - Amr Al Abed
- Graduate School of Biomedical Engineering, UNSW, Sydney, 2052, Australia
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, UNSW, Sydney, 2052, Australia
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, UNSW, Sydney, 2052, Australia
| | - John W Morley
- School of Medicine, Western Sydney University, Sydney, 2753, Australia.,School of Medical Science, UNSW, Sydney, 2052, Australia
| | - Gregg J Suaning
- Graduate School of Biomedical Engineering, UNSW, Sydney, 2052, Australia.,Sydney Medical School, University of Sydney, 2000, Australia
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