Abstract
Ideally, biomaterials have inductive properties, favoring specific lineage differentiation. For chondrogenic induction, these properties have been attributed to collagen type II. However, the underlying mechanisms are largely unknown. This study aimed to investigate whether collagen type II favors chondrogenic induction by affecting cell shape through β1 integrins and Rho A/Rock signaling. For this purpose, adipose tissue–derived stem cells (ASCs) were encapsulated in collagen type I or II gels and cultured in plain and chondrogenic medium. It was demonstrated that (i) ASCs showed more efficient chondrogenic induction (higher collagen X, aggrecan, sox6, sox9, and collagen II gene expression) in both plain and chondrogenic media in collagen type II versus collagen type I gels; (ii) ASCs showed lower Rock 2 gene expression and a more rounded cell shape in collagen type II versus type I gels when grown in plain medium; (iii) Rock inhibitor (Y27632) more effectively enhanced chondrogenic gene expression of ASCs in collagen type I than in collagen type II gels, and diminished differences in chondrogenic gene expression and cell shape of ASCs between the two gel types; and (iv) β1 integrins blocking not only reduced the differences of chondrogenic gene expression but also eliminated the differences of Rock 1 and Rock 2 gene expressions and cell shape when comparing ASCs embedded in collagen type I and II gels. We conclude that collagen type II provides the inductive signaling for chondrogenic differentiation in ASCs by evoking a round cell shape through β1 integrin–mediated Rho A/Rock signaling pathway.
Introduction
Among the three key elements of tissue engineering concept, the choice of scaffolds (biomaterial) is critical for a successful tissue engineering approach. The ideal biomaterial should be able to provide suitable biomechanical and biocompatibility properties to the implanted tissue, and also a favorable environment for cell attachment. Moreover, in particular in the case of tissue engineering using stem cells, biomaterials should preferably have inductive properties that favor a specific lineage differentiation.6,7 For instance, bone matrix extracts favor osteoblastic differentiation of human bone marrow–derived mesenchymal stem cells (MSCs) 8 ; cartilaginous extracellular matrix (ECM) components, however, favor the chondrogenic differentiation of MSCs.9,10 Therefore, it is imperative to know the underlying mechanisms by which the different biomaterial-based scaffolds exert their distinct lineage differentiation induction.
Cell shape has recently been identified as an important determinant for stem-cell differentiation,11,12 and chondrogenesis benefits from round cell shape.13–15 When cells are seeded in/on a three-dimensional scaffold, cell shape can be largely affected by cell membrane receptor–scaffold (ECM) interactions.16,17 β1 integrins are one of the main cell surface receptors to interact with ECM molecules. The extracellular domain of β1 integrins recognizes and binds to ECM proteins, whereas the intracellular domain associates with cytoskeleton elements and subsequently regulates cell shape and the differentiation of MSCs. 14 As an upstream regulator of cytoskeleton dynamics, Rho A/Rock signaling, which stimulates stressed fibril formation and promotes elongated cell shape, has been shown to inhibit the multiple stages of chondrogenic differentiation and instead promotes chondrocyte proliferation.13,18 In our previous study, we proposed that β1 integrin–mediated Rho A/Rock signaling pathway modulates the shape of the cells and subsequently influences the chondrogenic differentiation.
Collagen type II, one dominant component in a pool of ECM molecules of cartilage tissue, has the preference for both maintaining and inducing chondrogenic phenotype.9,19–21 In this study, we hypothesized that collagen type II may enhance chondrogenic differentiation by supporting round cell shape through β1 integrin–mediated Rho A/Rock signaling pathway. To test this hypothesis, first, chondrogenic induction properties of collagen type I and II were compared by embedding adipose tissue–derived stem cells (ASCs) in collagen type I and II gels, and Rock 1 and 2 gene expressions and cell shape (characterized by actin cytoskeleton visualization) of ASCs were also compared; second, the effects of Rock inhibitor (Y27632) on chondrogenic differentiation and cell shape between ASCs in collagen I or II gels were further analyzed and compared; finally, the roles of β1 integrins in ASCs in determining chondrogeneis, Rock signaling, and cell shape were investigated by blocking ASCs with neutralizing β1 integrin antibodies before collagen type I/II embedment.
Materials and Methods
ASC isolation and culture
Retrieval of all human specimens was approved by the human ethical committee of the VU University Medical Center, and informed consent was obtained.
ASCs were isolated from subcutaneous adipose tissue obtained from patients undergoing elective surgical procedures as described previously. 22 Briefly, harvested tissue was washed several times with phosphate-buffered saline (PBS) and then enzymatically dissociated with 0.5 U/mL Liberase Blendzyme 3 solution (Roche Diagnostics, Almere, The Netherlands). The dissociated tissue was then passed through a 100-μm mesh filter (Stokvis & Smith B.V., IJmuiden, The Netherlands) to remove debris, and the resulting single-cell suspension was centrifuged. Pelleted stromal cells were then washed several times with PBS. The stromal cells were plated in 25-cm2 tissue culture flasks. Plating and expansion medium consisted of Dulbecco's modified Eagle's medium (DMEM; Gibco, Paisley, United Kingdom) supplemented with 500 μg/mL streptomycin sulfate (Sigma, St. Louis, MO), 600 μg/mL penicillin (Sigma), 50 μg/mL gentamycin (Gibco), 2.5 μg/mL fungizone (Gibco), and 10% fetal bovine serum (Hyclone, Logan, UT). Cultures were grown in a humidified incubator at 37°C in an atmosphere of 5% CO2. ASCs used for the experiments were at passages 2–4.
Embedment of ASCs in collagen type I/II hydrogels and in vitro chondrogenesis
Collagen type I/II hydrogels were prepared by mixing five parts of collagen type I (rat tail; R&D Systems, Minneapolis, MN) or collagen type II (chicken sternal cartilage; Sigma), one part of 10 × DMEM, one part of reconstitution buffer (2.2 g NaHCO3 in 100 mL of 0.05 N NaOH and 200 mM HEPES), one part of 20 mM acetic acid, and two parts of cell suspension in culture medium. The final concentration of collagen type I/II was 2.5 mg/mL, and the cell density was 1.5 × 106 cells/mL gel. All the components above were mixed on ice, and 100 μL mixtures were seeded onto six-well plates for the study. The collagen gel lattices were formed by placing the plates in a humidified incubator at 37°C in an atmosphere of 5% CO2 for 1 h. Thereafter, the culture medium, either plain medium (DMEM supplemented with ITS+™ Premix [final concentration in medium when diluted 1:100 insulin, 6.25 μg/mL; transferrin, 6.25 μg/mL; selenous acid, 6.25 ng/mL; bovine serum albumin, 1.25 mg/mL; linoleic acid, 5.35 μg/mL; R&D Systems], 500 μg/mL streptomycin sulfate [Sigma], 600 μg/mL penicillin [Sigma], and 2.5 μg/mL fungizone [Gibco]) or chondrogenic medium (plain medium supplemented with 7.5 ng/mL transforming growth factor beta 1 [TGF-β1; R&D Systems]) was carefully overlaid on each gel. The medium was refreshed every 3–4 days till day 14.
β1 integrins blocking and supplement of Rock inhibitor
In β1 integrin blocking studies, ASCs were preincubated for 45 min with plain medium supplemented with either mouse nonimmune IgG (50 μg/mL; Vector Labs, Burlingame, CA) as control or neutralizing β1 integrin-blocking antibody (25 μg/mL, CD29; R&D Systems) as experimental group before embedding in collagen type I/II gels. Thereafter, the pretreated cells were used for the preparation of collagen gels.
For Rock inhibiting experiments, the medium was supplemented with either dimethyl sulfoxide (DMSO) as vehicle control (1 μL in 1 mL) or 10 μM Y27632 (dissolved in DMSO) as experimental group. The inhibitors were added every 24 h, and the medium was changed every 3 days until harvesting.
Confocal microscopy
For observing F-actin distribution of ASCs, ASC-loaded gels were fixed in 4% formaldehyde in 0.1 M phosphate buffer (pH 7.2) for 20 min and subsequently treated with 2% glycine/1% bovine serum albumin in PBS for 30 min. Thereafter, cells were permeabilized with 0.5% Triton X-100 in PBS for 20 min. Actin fibers within the ASCs were stained with 2.5 U rhodamine phalloidin (Invitrogen, Breda, The Netherlands) in PBS in the dark for 1 h and subsequently observed by confocal fluorescence microscopy with a Leica TCS SP5 confocal microscope (Leica Microsystems, Wetzlar, Germany).
Real-time polymerase chain reaction analysis
Total RNA was extracted from cultured cells using Trizol (Invitrogen) according to the manufacturer's instructions. Seven hundred and fifty nanograms of total RNA was reverse transcribed in 20 μL of reverse transcriptase (RT)-polymerase chain reaction (PCR) mix (5 U transcriptor reverse transcriptase [Roche Diagnostics], 0.08 A260 units random primers [Roche Diagnostics], 1 mM of each of dNTP [Invitrogen], 10 U protector RNase inhibitor [Roche diagnostics], and 1× transcriptor RT buffer) at 55°C for 30 min and then at 85°C for 5 min to inactivate the transcriptase. Real-time PCR was performed to determine the gene expression of aggrecan, collagen type X, collagen II, sox5, sox6, sox9, Rock 1, and Rock 2 by lightcycler (Roche LC 480). All the target genes were normalized to housekeeping gene 18S to obtain the relative gene expression. Primers used in real-time PCR are listed in Table 1.
Statistical analysis
Data were obtained from five independent donors. For statistical analysis, Levene's test was firstly performed to determine the homogeneity of variance for all the data, and then the data were analyzed by repeated measures in general linear model followed by Tukey post hoc analysis. When the data are not equally distributed, log transformation was used. SPSS 13.0 program (Chicago, Illinois) was employed for all statistic analysis, and differences were considered significant if p < 0.05.
Results
Collagen type II favors chondrogenic induction in ASCs compared with collagen type I
ASCs embedded in collagen type I or II gels were grown in either plain or chondrogenic medium for 4 and 14 days, and chondrogenic gene expression of ASCs (collagen X, aggrecan, sox5, sox6, sox9, and collagen type II) was analyzed. Our results showed that the responses of ASCs to chondrogenic induction largely depended on the collagen type in which they were encapsulated: for ASCs in collagen type II gels, TGF-β1 (chondrogenic condition) significantly upregulated the gene expression of collagen type X (Fig. 1A) but not of other chondrogenic markers (aggrecan, sox5, sox6, and sox9; Fig. 1B–E). TGF-β1 also advanced the induction time of collagen type II gene expression from day 14 in plain medium to day 4 in chondrogenic medium (Table 2). However, for ASCs in collagen type I gels, TGF-β1 (chondrogenic condition) significantly upregulated the gene expressions of collagen type X, sox6, and sox9 (Fig. 1A, D, E), and it also increased the induction frequency of collagen type II gene expression among the five donors (Table 2).

Comparisons of chondrogenic gene expression between adipose tissue–derived stem cells (ASCs) embedded in collagen type I and type II three-dimensional (3D) gels. After ASCs were embedded in either collagen type I or II gels and cultured for 4 and 14 days, ASCs showed different chondrogenic gene expression profiles in response to chondrogenic induction and the type of collagen used. (
Chondrogenic gene expression was also compared between ASCs in collagen type I and II gels. In both plain and chondrogenic medium, ASCs in collagen type II gels displayed more efficient chondrogenic induction than those in collagen type I gels: significant higher aggrecan, sox6, and sox9 gene expressions at day 14 in plain medium, and higher collagen type X and sox9 gene expressions at day 14 in chondrogenic medium (Fig. 1F). Under both plain and chondrogenic conditions, collagen type II gene expression was also induced more frequently and at an earlier time point when comparing type II and type I collagen gels (Table 2).
Collagen type II gel embedment of ASCs results in lower Rock gene expression and more round cells presented than collagen type I gel embedment
To address the question why collagen type II gel favors chondrogenic differentiation of ASCs, gene expression of Rock 1 and Rock 2 as well as the ASC cell shape in collagen type I and II gels were determined. When ASCs embedded in either collagen type I or II gels were cultured in plain or chondrogenic medium for 4 and 14 days, the following comparisons were made.
The effects of chondrogenic condition on Rock gene expression of ASCs in either collagen type I or II gels: it was found that only at the 14-day time point, Rock 1 and Rock 2 gene expressions of ASCs in collagen type I gels were significantly downregulated by chondrogenic condition but not in collagen type II gels (Fig. 2A, B). The effects of collagen gel type embedded on Rock gene expression of ASCs under plain or chondrogenic conditions: under plain medium, a significant downregulation was observed for Rock 2 at day 4 and a similar trend for Rock 1 at the same time point in collagen type II gels versus collagen type I gels, and expression differences were lost after 14 days. However, chondrogenic conditions leveled out the differences observed under plain conditions (Fig. 2C).
Previously, we reported that ASCs seeded in collagen type II gels, but not in collagen type I gels, are prone to aggregate after several days of culturing in plain medium 9 and that only small amounts of ASCs in collagen type I gels displayed rounded cell shapes, whereas most of them remained elongated with stressed actin cytoskeleton across the whole cell. 23 The latter observations were confirmed in this study (Fig. 3A). In contrast, most of the ASCs embedded in collagen type II were characterized with round cell shapes, and relaxed actin cytoskeleton smoothly distributed underneath of the cell membranes (Fig. 3D). Under chondrogenic conditions, cell shapes between ASCs in collagen type I and II gels did not show apparent differences; in other words, chondrogenic conditions induced round cell shapes of ASCs in collagen type I gels but did not further change the round cell shapes of ASCs in collagen type II gels except that they prevented ASC cell aggregation (Fig. 3G, J).

Comparisons of Rock 1 and 2 gene expression between ASCs embedded in collagen type I and collagen type II 3D gels. After ASCs were embedded in either collagen type I gels or II gels and cultured for 4 and 14 days, ASCs showed different Rock 1 and 2 gene expression profiles in response to chondrogenic induction and the type of collagen used. (

Comparisons of cell shape or actin cytoskeleton distribution between ASCs in collagen type I or II 3D gels before and after treatment with Rock inhibitor (Y27632) or β1 integrin blocking. (
Rock inhibitor differently affects chondrogenic gene expression and cell shape of ASCs in collagen type I or II gels
Next, it was examined whether collagen type II exerted its chondrogenic induction properties through the modulation of Rock signaling. ASCs embedded in either collagen type I or II gels were cultured in medium supplemented with Rock inhibitor (Y27632) or vehicle (DMSO) for 4 and 14 days. Differential responses to Y27632 were found for ASCs in collagen type I and II gels with respect to chondrogenic gene expression.
In collagen type I gels, Y27632 significantly upregulated sox6 gene expression in ASCs cultured in plain medium (Fig. 4A) and also exhibited increased induction frequency and advanced induction time (from day 14 to day 4) of collagen type II gene expression in ASCs embedded in both plain and chondrogenic medium (Table 2). For ASCs in collagen type II gels, however, Y27632 did not significantly affect chondrogenic marker expression in ASCs except that it advanced the induction time (from day 14 to day 4) of collagen type II gene expression of ASCs cultured in both plain and chondrogenic medium (Fig. 4B and Table 2). The significant differences of chondrogenic gene expression (collagen type X, aggrecan, sox6, and sox9) observed in ASCs embedded in collagen type II versus type I gels (Fig. 1F) were largely diminished after Y27632 was added in the culturing media (Figs. 1F and 4C; Table 2).

Effects of Rock inhibitor on chondrogenic differentiation in ASCs in collagen type I or II 3D gels. After ASCs were embedded in either collagen type I or II gels and cultured in medium supplemented with Rock inhibitor (Y27632) for 4 and 14 days, ASCs in collagen type I and II gels showed different responses to Y27632 with respect to chondrogenic gene expression. (
In concert with the effects of Y27632 on chondrogenic gene expression of ASCs, Y27632 also had differential effects on the cell shapes of ASCs in collagen type I and II gels. In plain medium in collagen type I gels, Y27632 induced some irregular ASCs, and these cells were characterized with less stressed and/or granule-like actin cytoskeleton compared with control incubations (Fig. 3A, B). For ASCs in collagen type II gels, however, Y27632 did not further change the round cell shapes of ASCs except to induce some granule-like actin cytoskeleton (Fig. 3D, E). In chondrogenic medium, ASCs in collagen type I or II gels still kept round cell shapes, but some actin cytoskeleton protruded from the cellular membranes of ASCs in both collagen type I and II gels (Fig. 3H, K).
β1 integrins blocking in ASCs differently affects chondrogenic and Rock gene expression and ASC shape in collagen type I and II gels
Finally, we investigated whether β1 integrins participated in collagen type II–mediated chondrogenic induction by regulating Rock signaling and cell shape. Comparisons of chondrogenic and Rock 1/2 gene expression and cell shape between ASCs in collagen type I and II gels were performed after ASCs were preincubated with neutralizing β1 integrin antibodies before collagen gel embedment. The significant differences of chondrogenic (collagen type X, aggrecan, sox6, and sox9) and Rock gene expressions of ASCs resulted from collagen type I and II gel embedment were eliminated after β1 integrins in ASCs were blocked by neutralizing β1 integrin antibodies (data not shown), although collagen type II gene expression of ASCs in collagen type II gels was still more frequently induced than those in collagen type I gels (Table 2).
In plain medium, as previously reported, β1 integrin blocking in ASCs dramatically changed the shapes of ASCs and induced round cell shapes when ASCs were embedded in collagen type I gels (Fig. 3C) However, β1 integrin blocking did not further change the round cell shape or actin cytoskeleton distribution of ASCs in collagen type II gels (Fig. 3F). In chondrogenic medium, ASCs in collagen type I or II gels remained round cell shapes with actin cytoskeleton distributed underneath of cellular membranes after β1 integrins were blocked by β1 integrin neutralizing antibodies (Fig. 3I, L).
Discussion
The function of scaffolds has been extended to biofunctionality: not only the fundamental function of supporting cell attachment and cell proliferation but also the inductive function of driving stem cells into specific lineage differentiation. Many efforts have been made to reveal the mechanisms of scaffold-mediated inductive potential, for example, that the stiffness of substrate or the pore size of scaffold can dramatically affect the differentiation of stem cells attached.11,24,25 In this study, we demonstrated that collagen type II possessed a higher chondrogenic inductive property compared with collagen type I, and that collagen type II gel embedment of ASCs downregulated Rock 2 gene expression and supported round cell shape. Further, we showed that Rock inhibitor (Y27632) largely diminished the differences of chondrogenic gene expression and cell shape of ASCs induced by collagen type I and type II gel embedment. Finally, our data showed that β1 integrin blocking in ASCs also largely eliminated the differences of chondrogenic and Rock gene expression and cell shape of ASCs resulted from collagen type I and II gel embedment.
The stronger inductive property of collagen type II over collagen type I for maintaining and inducing a chondrogenic phenotype was shown by our group in various different circumstances (chondrogenic induction by soluble factors secreted by nucleus pulposus cells or by TGF-β1) and also by other groups.9,19,20 This study was performed in an attempt to reveal the mechanisms underlying this phenomenon. We previously reported that ASCs seeded in collagen type II gels are prone to aggregate at around day 7 after they were cultured in plain medium. 9 In the current study, a similar phenomenon was observed. Also it was found that most of the ASCs in collagen type II were characterized with round cell shapes, and actin cytoskeleton smoothly distributed underneath the cell membranes. It is very interesting to compare these results with data recently published by Wu et al., 10 which showed that a chondroitin sulfate–based microenvironment also promotes cell aggregation and subsequent chondrogenic differentiation. Since both collagen type II and chondroitin sulfate are main components of the cartilaginous ECM, combining these datasets suggests that the ECM microenvironment in cartilage can provide a good “soil” for guiding the chondrogenic differentiation of stem cells and that the ECM does so by influencing the shape of the encapsulated cells.
The stronger chondrogenesis-inductive property of collagen type II over collagen type I prompted us to evaluate its underlying mechanisms. Cell shape–dependent control of lineage commitment is believed to be mediated by Rho A signaling pathway, specifically via its effects on Rock-mediated cytoskeletal tension.12,26,27 The evidence of the role of Rho A/Rock-mediated cytoskeleton (especially for actin cytoskeleton) organization in chondrogenic differentiation has accumulated over the last 20 years. 14 It is well known that chondrocytes plated in monolayer culture tend to change their morphology to flattened cells and cease the production of collagen II and glycosaminoglycans (GAGs).28,29 The mere addition of inhibitors of actin polymerization (dihydrochalasin B or cytochalasin D) can stimulate rounding of dedifferentiated chondrocytes and reexpression of these same chondrogenic markers.30,31 First, we showed that encapsulating ASCs in collagen type II gels, on one hand, decreased gene expression of Rock 1/2 and caused less stressed actin cytoskeleton (round cell shape), and on the other hand promoted chondrogenic commitment. Second, although we did not observe that Rock inhibitor (Y27632) induced round cell shape and cortical distribution of cytoskeleton in ASCs as reported in other studies13–15 (might be because of less sensitivity of ASCs to the stimulation of Y37632), Y37632 did exert its chondrogenic induction function by upregulating sox6 gene expression of ASCs in collagen type I gels and also increased the induction frequency of collagen type II gene expression of ASCs in both collagen type I and II gels. In addition, Y27632 largely diminished the differences of chondrogenic gene expression found after collagen type I and II embedment. Based on these data, we postulate that collagen type II enhances chondrogenic differentiation and supports round cell shape largely through Rho A/Rock-mediated actin cytoskeleton signaling pathway. However, it is notable that Rho A/Rock signaling might not be the only mechanism underlying the preferential chondrogenic induction property of collagen type II, because ASCs in collagen type II gels still displayed slightly more efficient chondrogenic induction than those in collagen type I gels as shown by more frequent induction of collagen type II gene expression.
We previously proposed a model for chondrogenic differentiation of ASCs induced by soluble inductive factors, cell shape, and cell–matrix interactions 23 : cell–matrix interaction is able to promote the chondrogenic commitment of stem cells by affecting cell shape but is not sufficient for mature chondrogenic differentiation, and this effect can be largely replaced by the normal chondrogenic induction of growth factors (TGF-β1) through the Rho/Rock signaling pathway or direct Rho/Rock signaling inhibition (β1 integrins blocking or Rock inhibitor). The results of the current study were in concert with this proposal: there were significant differences between ASCs in collagen type I and II gels when they were cultured in plain medium, but these differences were largely eliminated by the introduction of chondrogenic conditions, β1 integrins blocking, or the addition of Y27632.
The roles of β1 integrins in chondrogenesis have been extensively studied but so far remain elusive.32–36 Our previous study showed that β1 integrins play a more important role in the later stages than in the earlier stages of chondrogenesis, and Rho A/Rock signaling appeared to participate in this process. 23 This study further provided the evidence that ECM can modulate chondrogenesis through β1 integrins-Rho/Rock signaling pathway and showed that β1 integrins blocking eliminated or largely eliminated the differences of chondrogenic and Rock gene expression resulting from collagen type I and II embedment. However, because of using a general β1 integrin neutralizing antibody in our previous and current study, we could not deduce which particular subset of the αnβ1 integrin family was involved in this induction process. Our current, comparative studies on the differential effects of both types of collagen (I and II), combined with the fact that α1β1, α2β1, and α3β1 integrins are the main receptors for collagen type I37,38 and α1β1, α2β1, and α10β1 integrins are the main receptors for collagen type II34,39,40 suggest a pivotal role for the α10β1 integrin. Unfortunately, since no neutralizing antibodies for the α10 subunit are available, direct evidence is currently lacking, although some interesting in vitro and in vivo studies are in support of this hypothesis: (i) the α10β1 integrin is known to be highly expressed in chondrocytes 41 ; (ii) α10β1 integrin is increasingly expressed in the progress of chondrogenic differentiation42,43; and (iii) α10β1 integrin knockdown results in the failed maturation of chondrocytes in vivo.42,43 Additional studies using different approaches, such as blocking α10 expression blocking studies using siRNA technology, are needed to provide more insight into the potential roles of the α10β1 integrin receptor. Interestingly, the fact that the differences of chondrogenic gene expression between ASCs in collagen type I and II gels were not completely eliminated by β1 integrin blocking may also suggest that so far unidentified additional collagen receptors may be involved in chondrogenic induction processes.
Conclusions
In summary, this study shows that collagen type II scaffolds not only provide support for ASCs but also mediate inductive signaling for chondrogenic differentiation by provoking a round cell shape through β1 integrin–mediated Rho A/Rock signaling. Moreover, collagen type II enhances the action of chondroinductive factors such as TGF-β1. These data highlight the importance of the coordination among cells, scaffolds, and bioactive factors, the three main components in the concept of tissue engineering, and they also have an important implication for designing appropriate scaffolds for cartilage tissue engineering, which not only support the cells but also shape the round cells.
Footnotes
Acknowledgment
This study is financially supported by the Dutch Tissue Engineering Program (DPTE # BGT.6734).
Disclosure Statement
No competing financial interests exist.
