DEVELOPMENT AND STEM CELLSRESEARCH ARTICLE
A major goal of regeneration studies is to design practical
approaches to stimulate a clinically relevant regenerative response.
The strategies for regenerative medicine are many and include the
bioengineering of tissues and organs for implantation as replacement
parts, the introduction of artificial or biological scaffolds into an
injury site to facilitate a regenerative response and the development
of stem cells that have the potential for use in cell-based therapeutic
applications (Muneoka et al., 2008). An alternative approach, which
has a long history in experimental biology, is based on the idea that
by understanding endogenous regenerative capabilities we can
develop strategies to enhance regenerative ability and thus overcome
regenerative failure. Most of the work in this arena has focused on
the exceptional regenerative potential of the urodele amphibian
limb, which undergoes a complex epimorphic response involving
blastema formation, pattern formation and morphogenesis and
redifferentiation (see Carlson, 2007; Stocum, 2006). To study
regenerative failure in amphibians, the anuran tadpole limb that
transitions from a regeneration-competent stage to a regeneration-
incompetent stage has proved a useful model to identify specific
barriers of a regeneration response (see Yakushiji et al., 2009). A
similar approach in higher vertebrates involves investigating
amputation injury responses in embryonic limbs to identify factors
required for regeneration (Muller et al., 1999; Muneoka and
Sassoon, 1992). This strategy has been successful in inducing chick
limb bud regeneration by treatment with either fibroblast growth
factor 2 (FGF2) or FGF4 (Kostakopoulou et al., 1996; Taylor et al.,
1994), and recent studies suggest that the WNT signaling pathway
might also play a key role (Kawakami et al., 2006). These studies
suggest that the non-regenerating amputation wound in amphibians
and birds display regenerative potential and that treatment with key
growth factors can effectively transition a non-regenerative healing
response to a regeneration response.
In mammalian limbs there are few instances in which a
regenerative response has been induced experimentally. Following
the lead of Marcus Singer’s studies on the neurotrophic influence in
amphibian limb regeneration (Singer, 1952), Mizell reported on
induced regeneration of amputated newborn opossum hind limbs by
implantation of neural tissues (Mizell, 1968). However, in an effort
to replicate these studies, Fleming and Tassava reported that
anatomical variability in the timing of skeletal outgrowth of the
opossum hindlimb, and not neural tissue grafts, could account for
the partial regenerative response reported by Mizell (Fleming and
Tassava, 1981; Mizell, 1968). The developing mammalian limb bud
possesses an endogenous ability to undergo a partial regenerative
response in vitro and in vivo, indicating that regenerative ability is
enhanced during development (Chan et al., 1991; Deuchar, 1976;
Wanek et al., 1989). In utero amputation of developing digits in the
mouse results in a level-dependent regenerative response that
correlates with the distal expression domain of the homeobox-
containing gene Msx1(Reginelli et al., 1995). Han et al. (Han et al.,
2003) found that Msx1mutant mice displayed a regeneration defect
that can be rescued by treatment with exogenous BMP4, and that
treatment of wild-type digit amputations with the BMP antagonist
noggin inhibited regeneration. These studies identified the BMP
signaling pathway as necessary for a regenerative response in the
In postnatal humans, the only part of the body that has the
capacity to regenerate is the fingertip. This regenerative response
was first documented in children and later reports indicate a similar
response in adults (Muneoka et al., 2008). Fingertip regeneration is
amputation-level-dependent: distal amputations successfully
regenerate, whereas proximal level amputations fail (Han et al.,
2008). The digit tip of the mouse responds similarly to amputation
and represents a model for human regeneration. Indeed, amputated
human fetal digits initiate a regenerative response in culture that is
similar to the mouse in that the response is associated with the
expression of MSX1 (Allan et al., 2006). Digit tip regeneration in
mice readily occurs in adults as well as neonates (Han et al., 2008;
Neufeld and Zhao, 1995). Digit tip regeneration shares
characteristics with amphibian limb regeneration in that both
processes involve the formation of a blastema of undifferentiated,
proliferating cells that express developmentally relevant genes;
Development 137, 551-559 (2010) doi:10.1242/dev.042424
© 2010. Published by The Company of Biologists Ltd
1Division of Developmental Biology, Department of Cell and Molecular Biology and
2Center for Bioenvironmental Research, Tulane University, New Orleans, LA 70118,
*These authors contributed equally to this work
†Author for correspondence (firstname.lastname@example.org)
Accepted 8 December 2009
The regenerating digit tip of mice is a novel epimorphic response in mammals that is similar to fingertip regeneration in humans.
Both display restricted regenerative capabilities that are amputation-level dependent. Using this endogenous regeneration model
in neonatal mice, we have found that noggin treatment inhibits regeneration, thus suggesting a bone morphogenetic protein
(BMP) requirement. Using non-regenerating amputation wounds, we show that BMP7 or BMP2 can induce a regenerative response.
BMP-induced regeneration involves the formation of a mammalian digit blastema. Unlike the endogenous regeneration response
that involves redifferentiation by direct ossification (evolved regeneration), the BMP-induced response involves endochondral
ossification (redevelopment). Our evidence suggests that BMP treatment triggers a reprogramming event that re-initiates digit tip
development at the amputation wound. These studies demonstrate for the first time that the postnatal mammalian digit has latent
regenerative capabilities that can be induced by growth factor treatment.
KEY WORDS: BMP7, BMP2, Digit, Regeneration, Blastema, Endochondral ossification, Mouse
BMP signaling induces digit regeneration in neonatal mice
Ling Yu1,*, Manjong Han1,*, Mingquan Yan1, Eun-Chee Lee1, Jangwoo Lee1and Ken Muneoka1,2,†
however, the blastemas and the regeneration process itself are not
equivalent (Han et al., 2008). One significant difference is that the
mouse digit differentiates during regeneration by direct
intramembranous ossification, whereas the digit tip differentiates
during development by endochondral ossification. This deviation
from the recapitulation of development (redevelopment) that is
typical of amphibian limb regeneration (Bryant et al., 2002),
suggests that digit tip regeneration has secondarily evolved from a
non-regenerating condition (evolved regeneration), rather than a
characteristic maintained from a regeneration-competent ancestor
(Muneoka et al., 2008).
The level-dependent regeneration response of the mouse digit
lends itself both to the discovery of requirements important for
regeneration that can be tested in inhibition studies (loss of
function), and to the design of regeneration therapies that can be
tested on proximal amputation injuries (gain-of-function). In this
study, we used the level-dependent regeneration response of the
neonatal digit to explore the role of BMP signaling in digit
regeneration. We report that BMP signaling is essential for the
endogenous regeneration response and that proximal digit
regeneration can be induced by treatment with either BMP2 or
BMP7, but not BMP4. We also show that the induced proximal
response involves the formation of a digit blastema and that
redifferentiation occurs by endochondral, rather than direct,
ossification. These findings indicate that cells at a non-regenerating
amputation wound in a mammal have regenerative potential, and
that the BMP signaling pathway distinguishes a wound healing
event from a regenerative response.
MATERIALS AND METHODS
Mice and digit amputation
Mice (CD1) used in these studies were purchased from Charles River
Laboratories (Wilmington, MA, USA) and Harlan Laboratories
(Indianapolis, IN, USA). Experimental studies were carried out on digits 2
and 4 of both hindlimbs. Distal or proximal digit amputations were carried
out as previously described (Han et al., 2008) at postnatal day 3 (PN3).
Procedures for care and use of mice for this study were in compliance with
Standard Operating Procedures approved by the Institutional Animal Care
& Use Committee of Tulane University Health Science Center. For growth
factor treatment, we used Affi-Gel Blue Gel beads (Bio-Rad, Hercules, CA,
USA) as a microcarrier for delivery to the amputation wound. Beads (150
m in diameter) were washed with PBS containing 0.1% BSA then soaked
with recombinant human BMP2, 4 or 7, or recombinant mouse noggin
(R&D Systems, Minneapolis, MN, USA) at a concentration of 0.5 mg/ml
for 2 hours at room temperature. Control beads were soaked in PBS
containing 0.1% BSA. Bead implantation was carried out 4 days post-
amputation (DPA). Affi-Gel Blue Gel beads were pinned with a tungsten
needle and briefly air dried, then inserted into the amputation wound
between the wound epidermis and the amputated phalanx (Fig. 2A) and
allowed to hydrate in situ before removing the needle. We used enhanced
chondrogenesis in micromass cultures of E14 digit tip cells as a positive
control for BMP signaling (X. Yang, unpublished).
To observe the skeletal pattern in wholemount, we stained digits with
Alizarin Red S as previously described (Han et al., 2008). To quantify bone
regeneration, we measured the proximal-distal length of each terminal
phalanx (between 27-30 digits for each group). The experimental results
were expressed as the mean ± one standard error. To determine newly
forming bone, calcein was injected (10 mg/kg body weight, IP) at 14 or 35
days post-bead implantation (DPI) and analyzed 1 day later by fluorescence
microscopy (Suzuki and Mathews, 1966). For histological analysis, digits
were fixed with 4% paraformaldehyde in PBS at 4°C overnight, processed
for standard paraffin histology, sectioned and stained with Mallory triple
stain (Humason, 1962). In some cases, digits that were stained with Alizarin
Red S for wholemount analysis were subsequently processed for paraffin
histology after post-fixing in Z-FIX (Anatech LTD) and treatment with
Decalcifier II (Surgipath). These digit samples had damaged epidermal
tissues from processing; however, skeletal tissues were intact. Cell
proliferation was examined by incorporation of BrdU (10 mM; 20 l/g, IP),
analyzing sections of digit samples using a BrdU Detection Kit II (Roche)
according to manufacturer’s instructions. To quantify proliferation, we
counted BrdU-positive cells within defined fields (10,240 m2) of stump
and connective tissue in representative sections of 5 digits for each treatment
(BSA versus BMP7) and timepoint (3 and 7 DPI). Student’s t-test was used
to analyze for significance and error bars represent the standard deviation.
In situ hybridization and RT-PCR
Section in situ hybridization was performed to examine gene expression
during digit tip regeneration, as described previously (Han et al., 2008).
Antisense riboprobes were generated by in vitro transcription labeling with
digoxigenin-UTP according to the manufacturer’s instructions (Roche). The
following cDNA fragments were used to generate antisense riboprobes:
Bmp2, Bmp7, Bmpr1a, Bmpr1b, type II collagen (Col2a1), Ihh, type X
collagen (Col10a1), Msx1, Pedf (Serpinf1 – Mouse Genome Informatics),
Runx2, Dlx5, Sfrp2 and osteocalcin.
The expression of Bmp2, Bmp7, Bmpr1a, Bmpr1b, Bmpr2 and GAPDH
in the blastema was analyzed using semi-quantitative RT-PCR. Blastema
tissue was collected from regenerating digit tips at 7 DPA and
mesenchymal tissue of unamputated digit tip (PN10) was used for control.
Total RNAs were isolated from both tissues using TRIzol (Invitrogen,
Carlsbad, CA, USA) according to the manufacturer’s instructions.
Primers used for RT-PCR are as follows: Bmp2-F 5?-GTTCC CTA -
CAGGGAGAAC ACC-3?, Bmp2-R 5?-GCCTGCACAGATCTAGC-3?,
Bmp7-F 5?-TCCAGGGAAAGCATAATTCG-3?, Bmp7-R 5?-ACCT -
CTCGTTGTCAAATCGC-3?, Bmpr1a-F 5?-TCGTCGTTGT ATTAC A -
GGAG-3?, Bmpr1a-R 5?-TTACATCCTGGGATTCAACC-3?, Bmpr1b-F
5?-GCTTTGGACTCATCCTCTGG, Bmpr1b-R 5?-CACTGGGCA -
GTAGGCTAACG, Bmpr2-F 5?-GGTAGATAGGAGGGAACGGC-3?,
Bmpr2-R 5?-CACTGCCATTGTTGTTGACC-3?, GAPDH-F 5?-TTC -
CAGTATGATTCCACTCA-3? and GAPDH-R 5?-CTGTAGCCAT A -
Digit tip regeneration in neonatal mice is restricted to the distal half
of the terminal phalangeal element (P3), whereas regenerative failure
occurs following amputation through the proximal third of P3 (Han
et al., 2008). Detailed histological analyses of wound healing
following amputation showed considerable variability in the time for
complete wound closure of the regenerating digit tip but less
variability in the closure time of non-regenerating amputation
wounds (Table 1). Wound closure in proximal P3 amputations or
amputation at the P2 level was largely complete within 5 days;
however, only 16.7% of the distal P3 amputations wereclosed by this
time. The majority of distal P3 amputations were healed by 6 DPA
(6/9); however, we did not observe 100% wound closure until 9 DPA.
The variability in the rate of wound closure in distal amputations
Development 137 (4)
Table 1. Wound closure after digit amputation
N/A, data not available; P3, third phalangeal element; P2, second phalangeal
compared with proximal amputations is curious as both wounds
contain identical tissues, including nails, and the actual wound area
of distal amputations is smaller than proximal amputations.
Previous studies on amputated fetal and neonatal digit tips
implicated the BMP signaling pathway as a crucial regulator of
regeneration. To investigate whether BMP signaling is required for
mouse digit tip regeneration we treated distally amputated digit tips
with the BMP antagonist noggin. Digits were distally amputated at
postnatal day 3 (PN3) and, after a 4-day healing period, a single
microcarrier bead carrying purified noggin was implanted between
the wound epidermis and the amputated terminal phalangeal
element. Digits were analyzed by wholemount skeletal staining for
an anatomical regenerative response at 14 DPI. Control amputations,
which received a bead carrying BSA, displayed a regenerative
response comparable with the endogenous response (Fig. 1A),
indicating that the implantation procedure did not interfere with the
regeneration response. By contrast, delivering noggin to the
amputation wound completely suppressed the regenerative response
and resulted in truncated digit tips (Fig. 1B). We also carried out
studies in which the endogenous regeneration response was
supplemented by treatment with purified BMP4 introduced by bead
implantation, and we found that excessive BMP4 did not modify
proximal-distal digit outgrowth (Fig. 1C). We found similar results
when beads containing BMP2 or BMP7 were implanted. These
studies provide evidence that BMP signaling is required for digit tip
regeneration and that excessive amounts of BMPs do not modify
proximal-distal outgrowth during regeneration.
As noggin inhibits multiple BMPs and we had previously shown
that Bmp4 is expressed in the regeneration blastema (Han et al.,
2008), we investigated the expression profiles of Bmp2 and Bmp7
and the BMP receptors Bmpr1a,Bmpr1bandBmpr2during digit tip
regeneration. Based on RT-PCR analysis, we found evidence that
Bmp2and Bmp7transcripts were upregulated in digit blastema cells
and that transcripts for the BMP receptors were present in cells both
from the unamputated digit and the regeneration blastema (Fig. 1H).
Using in situ hybridization, we found that Bmp7 transcripts were
localized to the nail epithelium, the proximal growth plate and the
marrow region of the amputated bone stump (Fig. 1D). Bmp2
transcripts were similarly distributed but, in addition, we found
Bmp2 expression in cells at the base of the blastema that interfaces
with the amputated stump (Fig. 1E). Like Bmp7, transcripts for
Bmpr1a localized to the nail epithelium, the distal epidermis, the
proximal growth plate and the marrow region of the stump (Fig. 1F).
Bmpr1b was also expressed in the distal epidermis, the proximal
growth plate and in cells within the blastema (Fig. 1G). In summary,
during digit tip regeneration, Bmp7 and Bmp2 are expressed in the
marrow region of the stump, Bmp2 is expressed in cells at the base
of the blastema and Bmp4 is expressed in the distal region of the
blastema (Han et al., 2008). Bmpr1aand Bmpr1bare both expressed
in the distal epidermis, whereas Bmpr1a is expressed in the stump
marrow and Bmpr1b is expressed in cells of the blastema. These
results demonstrate that multiple Bmp genes and their receptors are
expressed in a region-specific manner during digit tip regeneration,
and that BMP signaling is required for a successful regenerative
BMP7 and BMP2 induce digit regeneration from
non-regenerating proximal amputation
The requirement of BMP signaling for digit regeneration raises the
possibility that BMP signaling could be responsible for the failed
regenerative response associated with proximal P3 amputation. The
terminal phalanx forms by endochondral ossification and postnatal
growth of this skeletal element involves a proximal epiphyseal
growth plate (Han et al., 2008). Proximal amputation transects the
phalangeal element just distal to the forming epiphyseal plate (see
Fig. S1A in the supplementary material) and by 4 DPA, wound
closure is largely completed (Table 1; see Fig. S1B in the
supplementary material). In control proximal amputations, the
skeletal stump undergoes some elongation from the proximal growth
plate but its distal amputated surface ossifies and there is no
evidence of a distal ossification center that typifies the normal digit
tip (see Fig. S1C in the supplementary material). To test for an
enhanced regenerative response, a single BMP-containing
microcarrier bead was implanted between the wound epidermis and
the skeletal stump after wound closure (Fig. 2A) and digits were
analyzed at14 DPI for skeletal outgrowth. Control digit amputations
receiving a single BSA-containing bead failed to elicit a significant
regeneration response and formed digits that were truncated at the
proximal amputation level (Fig. 2B). Histological analyses and
calcein labeling of BSA-treated proximal digit amputations
indicated that distal elongation of the stump was confined to the
formation of a bony cap that covered the stump bone (Fig. 2C,D).
Proximal P3 amputations treated with a single BMP bead can
induce a regenerative response. Beads treated with purified BMP7
(Fig. 2E) or BMP2 (Fig. 2F) caused significant elongation of the
terminal phalangeal element when analyzed at 14 DPI, whereas
beads treated with BMP4 were unable to stimulate a statistically
significant response (Fig. 3). The absence of a BMP4 response is
curious; however, it is consistent with studies indicating that
although BMP2 and BMP7 are osteogenic in vivo, ectopic
expression of BMP4 failed to elicit a similar response (Kang et al.,
2004). At 14 DPI, the bulk of the regenerated digit tip is composed
of newly formed trabecular bone that is histologically distinct but
Mammalian digit regeneration
Fig. 1. BMP signaling and endogenous digit tip regeneration.
(A-C)Wholemount stain with Alizarin Red 14 days after BSA (A),
noggin (B) or BMP4 (C) bead (asterisk) implantation following
amputation at a distal level (solid line in A). (D-G)In situ hybridization of
Bmp7 (D), Bmp2 (E), Bmpr1a (F) and Bmpr1b (G) 7 days after distal
amputation. Bmp2- and Bmpr1b-expressing cells in the blastema are
indicated (arrows). ne, nail epithelium; gp, growth plate; m, bone
marrow. (H)RT-PCR comparison of expression of Bmp2, Bmp7, Bmpr1a,
Bmpr1b and Bmpr2 in the blastema (Blast) and unamputated control
integrated with the stump bone to reform the terminal phalanx (Fig.
2G). Histological analysis at 7 DPI indicates the presence of
chondrogenic cells in the distal region of the BMP7-treated stump
and their absence in stage-matched control digits (Fig. 2H,I).
Calcein labeling studies at 14 DPI demonstrated intense staining
throughout the regenerated digit tip (Fig. 2J). We note that the
proximal amputation level is associated with a hole in the
ventrolateral part of the P3 bone (Fig. 1A) that connects the marrow
region with the lateral dermis. This digital os hole does not
completely reform in BMP-induced regenerates and serves as an
additional anatomical marker for the level of amputation, thus
eliminating any doubts that the regeneration response might result
from variability of amputation level. Using the proximal-distal
length of the terminal phalanx at 14 DPI as a way to quantify this
response, our measurements demonstrate an induction of skeletal
elongation of 45% and 58% (as compared withcontrol digits treated
with BSA beads) for BMP2 and BMP7, respectively (Fig. 3). These
data indicate that the amputated neonatal digit can be stimulated to
regenerate by a single treatment with either BMP2 or BMP7.
As BMP7 provided the highest level of skeletal elongation at 14
DPI, we focused our studies on this response. We next analyzed
digits at 35 DPI to compare the final anatomy of the response with
that of control BSA-treated and unamputated digits. The external
anatomy of the 5 week regenerates was generally similar to that of
unamputated digits and dramatically different from truncated
BSA-treated controls (Fig. 4A-C). The nail that surrounds the
terminal phalanx appears normal, although it is generally blunted
at the tip. The terminal phalanx is variable in length, with some
samples approaching the proximal-distal length of control
unamputated digits, and all samples displaying a regenerative
response by comparison with the proximally truncated BSA
control digits (Fig. 4D,E). The distal tip of the regenerated digit is
generally rounded with only the occasional sample forming a
pointed tip characteristic of unamputated digits (Fig. 4F). Calcein
incorporation studies indicate extensive new bone deposition even
at 35 DPI (Fig. 4F) suggesting that BMP7 establishes an
ossification center that is able to continue after the treatment is
Blastema formation in BMP7-induced
Because we are able to induce a long-term regeneration response
with a single application of BMP7, we hypothesize that BMP7 is
acting to induce a morphogenetic center (such as a blastema) that
subsequently organizes the regeneration response. To explore this
possibility, we began by documenting changes in cell proliferation
following amputation injury to determine whether there is evidence
of blastema formation. During endogenous digit tip regeneration, a
digit blastema containing proliferating cells is present by 7 days
(Han et al., 2008). Simple proximal amputation results in wound
closure by 4 days (Table 1), at which time the wound epidermis
directly abuts the amputated skeletal stump, and few proliferating
cells are observed (Fig. 5A). At 7 DPA, there is a thin layer of
connective tissue that invades the space between the skeletal stump
and the wound epidermis (Fig. 5B). In proximal amputations that
received an implanted BSA control microcarrier bead, we see a
distal accumulation of cells by 3 DPI but there is no increase in
proliferation (Fig. 5C). By 7 DPI, there are few proliferating cells
(Fig. 5D) and the stump has differentiated a periosteum across the
amputated surface (Fig. 7D). These observations suggest that bead
Development 137 (4)
Fig. 2. BMP induces bone regeneration from the proximally
amputated digit tip. (A)Diagram showing the level of proximal
amputation and the position of bead placement. (B-D,I) Control
digits with BSA bead. (E-H,J) Experimental digits with BMP bead.
(B,E,F) Wholemount Alizarin Red-stained samples 14 DPI treated with
BSA (B), BMP7 (E) or BMP2 (F). (C,G)Wholemount stained samples
processed for the histological analysis using Mallory triple stain.
(D,J)14 DPI digits stained with calcein to identify regions of
ossification. (D)BSA-treated control digit showing the formation of
ossification caps (white arrows). (J)BMP7 bead-implanted digit
showing a robust distal ossification center. (H,I)7 DPI samples
processed for histological staining with Mallory triple stain. (H)In
BMP7-treated digits, chondrocytes (inset) are observed in the
regenerate newly forming bone. (I)BSA control digits do not form
chondrocytes in the distal stump. Solid line indicates the amputation
plane, asterisk indicates implanted bead.
Fig. 3. Comparison of the proximal-distal length of the terminal
phalangeal bone at 14 DPI in BSA- and BMP-treated digits.
Student’s t-test ± s.e.m. ***, P< 0.001.
implantation itself is sufficient to induce the accumulation of cells
at the amputation wound but that the conditions are insufficient to
induce a growth response.
In digits that received a BMP7 bead, a digit blastema containing
proliferating cells forms at the amputation wound by 3 DPI.
Enhanced cell proliferation of connective tissue cells surrounding
the bead, and cells of the skeletal stump just proximal to the bead, is
observed (Fig. 5E). By 7 DPI, there are two distinct proliferation
zones that can be identified by BrdU incorporation: (1) a distal zone
between the BMP7 bead and the wound epidermis and (2) within the
stump just proximal to the BMP7 bead (Fig. 5F). To quantify this
proliferative effect, we counted BrdU-positive cells within the
connective tissue surrounding the bead and within the distal stump
just proximal to the bead, comparing BMP7-treated digits with
control digits at 3 and 7 DPI (Fig. 5G). Thedata indicate that BMP7
treatment results in enhanced proliferation of connective tissue cells,
as well as stump cells, at both timepoints analyzed.
Another aspect of mammalian digit blastema formation during
regeneration is the re-expression of relevant developmental genes
(Gardiner, 2005). Msx1 is expressed at the embryonic digit tip and
has been found to be required for embryonic digit tip regeneration
(Han et al., 2003). Postnatally, Msx1 is expressed in the dorsal
dermis subjacent to the nail matrix (Reginelli et al., 1995) (see Fig.
S2A in the supplementary material), and it is transiently upregulated
during digit blastema formation in neonatal digit tip regeneration
(Han et al., 2008). Similarly, in BMP7-induced proximal digit
regeneration, we observe that Msx1is transiently upregulated in the
dorsal region of the induced digit blastema at 3 DPI (Fig. 6B) but its
expression is absent in the digit blastema at 7 DPI (Fig. 6D). In
control BSA-treated amputations, Msx1 expression is restricted to
the proximal-dorsal dermis at both 3 and 7 DPI (Fig. 6A,C). The
WNT antagonist Sfrp2is a gene that is prominently expressed in the
dorsal dermis of the neonatal digit (see Fig. S2B in the
supplementary material); however, unlike Msx1, the Sfrp2
expression domain is not modified during digit blastema formation
associated with endogenous digit tip regeneration (see Fig. S2C in
the supplementary material). In BMP7-induced regeneration, we
find Sfrp2-expressing cells associated with the BMP7 bead at 3 DPI
(Fig. 6F) but by 7DPI, there are no Sfrp2-expressing cells present in
the digit blastema (Fig. 6H). In control BSA-treated amputations,
Sfrp2 expression is restricted to the proximal-dorsal dermis at both
3 and 7 DPI (Fig. 6E,G). Msx2 is normally expressed in the nail
organ of the neonatal digit and is transiently upregulated in the
dermis during digit tip regeneration (Han et al., 2008); however, it
is not induced in the digit blastema at either 3 or 7 DPI by BMP7
(data not shown).
During digit tip formation, Pedf is first expressed in cells within
the forming bone marrow (see Fig. S2D in the supplementary
material). During endogenous digit tip regeneration, Pedf is also
expressed in the early digit blastema in regions subjacent to the
wound epidermis (Muneoka et al., 2008). In proximal digit tip
amputations treated with BMP7 beads, we find Pedf expression is
upregulated in cells of both the stump and digit blastema at both 3
and 7 DPI (Fig. 6J,L). Pedf is not upregulated in control digit
amputations treated with BSA at 3 or 7 DPI (Fig. 6I,K). The
normally restricted expression of Pedf in the digit bone marrow,
along with the continuity of Pedf-expressing cells between the bone
marrow and the digit blastema, suggest that the digit blastema is
derived in part from bone marrow cells. We note that there is
variable expression of Msx1, Sfrp2 and Pedf in the nail epidermis,
which appears to be linked to injury rather than BMP7 treatment.
BMP7 induces endochondral ossification
The terminal phalanx of the mouse forms by endochondral
ossification and it elongates by the combined growth of the
proximally located epiphyseal growth plate, and by appositional
ossification that occurs at the digit tip (Han et al., 2008; Muneoka et
al., 2008). At birth, the terminal phalangeal element is triangular-
shaped with proliferating chondrocytes expressing type II collagen
(Col2a1) at its proximal base, prehypertrophic chondrocytes
expressing Ihh at an intermediate zone and hypertrophic
chondrocytes expressing type X collagen (Col10a1) at the distal
apex. Osteocalcin-expressing osteoblasts are first identified at the
distal apex surrounding the hypertrophic chondrocytes. As the digit
tip forms, the three chondrocytic zones become compressed
Mammalian digit regeneration
Fig. 4. Final anatomy of regenerated digits at 35 DPI. (A-C)Final
anatomy after BMP7 (A) and BSA (B) treatment compared with a stage-
matched unamputated digit (C). A near-normal digit tip is regenerated
following BMP7 treatment. (D,E)Wholemount bone stain (Alizarin Red
S) of BMP7- (D) or BSA (E)-treated digits. (F)Calcein labeling of the
BMP7-treated digit at 35 DPI showing the persistence of a distal
ossification center (arrow). Solid line indicates the amputation plane,
asterisk indicates implanted bead. Scale bars: 200m.
Fig. 5. Cell proliferation during BMP7-induced regeneration.
(A-F)BrdU incorporation at 4 (A) and 7 (B) DPA (PN7 and PN10,
respectively) after proximal amputation. BrdU incorporation at 3 (C) and
7 (D) DPI (PN10 and PN14, respectively) after treatment with BSA. BrdU
incorporation at 3 (E) and 7 (F) DPI (PN10 and PN14, respectively) after
treatment with BMP7. Increased zones of proliferation are induced by
BMP7 in the connective tissue (arrowheads) and in the bone stump
(arrows). Asterisks indicates implanted beads. (G)BrdU labeling was
quantified by cell counts in comparable regions of BSA and BMP7-
treated digits at 3 and 7 DPI. The data show BMP7-enhanced
proliferation in the connective tissue at 3 DPI, and in both connective
tissue and the stump at 7 DPI. Student’s t-test ± s.d.; *, P<0.05,
proximally to form the proximal epiphyseal growth plate of the digit.
The regeneration of the digit tip that occurs endogenously does not
recapitulate these developmental events but, instead, involves digit
blastema formation and direct ossification by a process that appears
most similar to intramembranous ossification (Han et al., 2008).
Because of this, we have proposed that digit tip regeneration in the
mouse is a response that evolved secondarily from a non-
regenerative digit tip, utilizing developmental mechanisms that are
novel for digit tip development (Muneoka et al., 2008). With this in
mind, we have investigated the mechanism of skeletal differentiation
that is triggered by BMP7 during induced regeneration to determine
whether skeletal regrowth occurred by endochondral ossification
(redevelopment) or by direct ossification (evolved regeneration).
We characterized ossification by analyzing the expression of
endochondral (Col2a1, Ihh, Col10a1) and osteogenic (osteocalcin,
Dlx5, Runx2) marker genes by in situ hybridization. Our studies
focused at 7 DPI becauseat this stage we find histological evidence
of chondrogenesis (Fig. 2H) associated with regions of the stump
with enhanced proliferation (Fig. 5G). In control BSA-treated
amputated digits, we found no change in expression of any of the
endochondral markergenes (Fig. 5A-C). In all cases, the expression
domains were localized to the proximal base of the terminal
phalangeal element and were indistinguishable from unamputated
digit tips of a similar age. Similarly, the expression of Dlx5(see Fig.
S3A in the supplementary material), Runx2 (see Fig. S3C in the
supplementary material) and osteocalcin (Fig. 7D) in BSA-treated
amputations was largely similar to unamputated digits, with the only
variation being the formation of an ossification cap across the
In BMP7-induced regenerates at 7 DPI, we found expression of
osteogenic genes Dlx5(see Fig. S3B in the supplementary material),
Runx2(see Fig. S3D in the supplementary material) and osteocalcin
(Fig. 7H) throughout the regenerating skeletal stump, consistent
with the enhanced osteogenesis indicated by calcein incorporation
(Fig. 2J). To establish whether the regenerated bone formed by direct
ossification versus endochondral ossification, we examined the
expression of endochondral marker genes. We found ectopic
expression domains of all three endochondral markers, Co2a1, Ihh
and Col10a1, within in the regenerating region of the skeletal stump
undergoing ossification (Fig. 7E-G). Importantly, these ectopic
domains were organized proximal-distally, in a manner identical to
their pattern in the developing P3 element, i.e. the Col10a1 domain
is localized at the apex of the regenerating stump, the Ihhdomain is
localized just proximal to Col10a1 and the Col2a1 domain is
proximal to Ihh. This organization of the ectopic endochondral
marker domains is suggestive of a newly formed endochondral
ossification center associated with the induced regenerative
response. The formation of an ectopic endochondral growth zone
provides a plausible explanation for how a single treatment with
BMP7 can initiate a response that continues for several weeks after
treatment and results in the restoration of the terminal phalanx.
These observations also provide evidence that BMP7 stimulates
regeneration by triggering the activation of a developmental
program used initially to form the digit tip during embryogenesis
and not the endogenous regenerative program.
The induction of a regeneration response at a non-regenerating
mammalian wound is arguably one of the biggest challenges in
regeneration biology. We have used a relatively simple model
involving the level-dependent regeneration response of the mouse
digit tip to test the involvement of the BMP signaling pathway in an
endogenous regeneration and also in a failed regenerative response.
Based on loss-of-function studies, we show that endogenous
regeneration is inhibited when the amputation wound is treated with
a BMP-specific antagonist and conclude that BMP signaling is
required for digit tip regeneration. In gain-of-function studies, we
are able to induce regeneration in amputation wounds that are
regeneration-incompetent by providing a source of either BMP7 or
BMP2, thus showing that the absence of a BMP source is
responsible for regenerative failure in this model. Finally, we show
that the induced regeneration response represents a case in which
cells undergo a redevelopment response rather than the evolved
regeneration response that typifies endogenous regeneration.
Overall, these studies provide the first clear demonstration in a
mammal that a regeneration-incompetent amputation wound can be
transitioned into a regeneration-competent wound by treatment with
a single growth factor.
Digit tip regeneration can be divided into three distinct phases:
wound healing, digit blastema formation and redifferentiation
(Muneoka et al., 2008). Although the wound healing phase has not
been extensively studied, it seems probable that the amputation
Development 137 (4)
Fig. 6. Gene expression in the digit
blastema. (A-L)In situ hybridization of Msx1
(A-D), Sfrp2 (E-H) and Pedf (I-L) in BMP7-
induced regenerates and BSA controls at 3
and 7 DPI. Msx1 (B) and Sfrp2 (F) show
BMP7-induced upregulation (arrows) at 3 DPI
as compared with stage-matched controls
(A,E). At 7 DPI, Msx1 (D) and Sfrp2 (H)
expression is absent from the blastema and is
restricted to the dorsal-proximal
mesenchyme (arrowheads), similar to in
control digits (C,G). Cells expressing Pedf are
enhanced at 3 DPI in BMP7-treated digits (J,
arrow). At 7 DPI, Pedf expression is
prominent in the BMP7-induced digit
blastema and in the marrow region (L,
arrows), but largely absent in the stage-
matched BSA controls (K). Asterisks indicate
healing response largely parallels that of full thickness wounds. The
early events in the healing of full thickness skin wounds includes the
accumulation of platelets that are involved in the formation of the
fibrin clot, and a subsequent inflammation response that brings
neutrophils and monocytes to the wound site. These early responses
modify the wound site by the production of an array of cytokines,
growth factors and bactericidal peptides and set the stage for the
structural repair of the wound (Stocum, 2006). Like skin wounds,
re-epithelialization of digit amputation wounds occurs very slowly,
and we note that regenerating wounds close at a slower and more
variable rate than non-regenerating wounds. A similar relationship
between the quality of the healing response and a slower rate of
wound closure has been reported in mice over-expressing the activin
antagonist genefollistatin (Wankell et al., 2001). Thus, the evidence
suggests that, in mammals, slow wound closure is associated with
an enhanced regenerative response, whereas rapid wound closure is
associated with regenerative failure. As we are able to induce a
regenerative response with BMP7 after wound closure is completed,
our studies demonstrate that all of the early events associated with
the wound healing process, including wound closure and
inflammation, do not irreversibly antagonize the regenerative
potential of the cells at the wound site.
The mammalian blastema is defined as an aggregate of
proliferating undifferentiated cells involved in the regenerative
response (Muneoka et al., 2008). The combined results from our
histological, proliferation and gene expression studies indicate that
a digit blastema forms during a BMP7-induced response, whereas a
blastema fails to form in BSA-treated digits. The proliferative
response is similar to that documented during endogenous digit tip
regeneration in that two distinct proliferative zones form, one
associated with the connective tissue and one associated with the
distal skeletal stump (Han et al., 2008). In BMP7-induced
regeneration we find that enhanced proliferation is initially
associated with the bead, but later appears to be bead-independent.
It is generally accepted that growth factor release from agarose
beads is exhausted within days after implantation (Fallon et al.,
1994; L. Marrero, unpublished), thus the existence of regenerative
growth zones at later stages indicates that BMP7 initiates a self-
sustaining regenerative growth response. How BMP signaling
facilitates this response is unclear; however, we note that some
developmental genes (Msx1, Srfp2) are transiently expressed during
blastema formation. The transient upregulation of the homeobox-
containing transcriptional repressor, Msx1, is of interest because
Msx1 has known functions in controlling proliferation and
differentiation (Hu et al., 2001; Odelberg et al., 2000) and is required
for embryonic digit regeneration (Han et al., 2003). Conversely, digit
blastemal cells express Pedf, a gene not linked to digit development
but expressed postnatally by resident cells in the bone marrow and
a potent anti-angiogenic factor (Filleur et al., 2009). Pedf has also
been identified as a chemoattractant for fibroblasts (Sarojini et al.,
2008), which raises the possibility for a role in cell recruitment
during the regenerative response.
Redifferentiation of the BMP7-induced regenerates demonstrates
that the induced response is distinct from endogenous regeneration
and that it involves a redevelopment response. During digit
formation, ossification of the terminal phalanx initiates at the digit
tip with the differentiation of osteoblasts (expressing osteocalcin)
surrounding an apical population of hypertrophic chondrocytes
(expressing Col10a1). The proximal half of the terminal phalanx
consists of proliferating chondrocytes (expressing Col2a1), and
between the proliferating chondrocytes and the hypertrophic
chondrocytes, there is a layer of pre-hypertrophic chondrocytes that
express Ihh. (Han et al., 2008). Postnatally, the endochondral marker
genes are expressed in domains within the epiphyseal growth plate
at the base of the terminal phalanx. Endogenous digit tip
regeneration occurs by direct ossification and the endochondral
genes are not re-expressed in the regenerates (Han et al., 2008). By
contrast, BMP7-induced regeneration is associated with the re-
expression of endochondral marker genes, and their expression
domains follow the proximal-distal pattern of the developing
terminal phalanx. These results clearly show that the BMP7-induced
response is distinct from endogenous regeneration and that it
involves modification of the amputation wound in a way that allows
cells to reactivate differentiation programs that restore the amputated
structure. The reactivation of developmental programs effectively
represents a reprogramming event that has obvious parallels with the
process of dedifferentiation in limb regeneration (Brockes and
Kumar, 2005; Gardiner, 2005; Han et al., 2005). Overall, the finding
that developmental programs can be reactivated at a postnatal
mammalian injury site provides some promise that similar
reprogramming events might be inducible in adult tissues.
How BMP7 treatment induces this regenerative response is not
clear at this time. BMP signaling is known to play crucial roles in
both limb development (Robert, 2007) and skeletal repair
following injury (Schindeler et al., 2008). The during early limb
development, BMP signaling is implicated in the proper
Mammalian digit regeneration
Fig. 7. Endochondral marker genes are induced by BMP7 treatment. (A-H)At 7 DPI, the expression of endochondral marker genes (Col2a1,
Ihh and Col10a1) and osteogenic marker genes (osteocalcin) was examined by in situ hybridization in control (A-D) and BMP7-induced regenerates
(E-H). BSA control digits display expression of endochondral marker genes at the proximal base of the digit (A-C), with osteocalcin expression
capping the distal digit stump (D). In BMP7-treated digits, ectopic expression domains of the endochondral marker genes (arrows in E-G) are
induced in the regenerate, and enhanced osteocalcin expression is observed throughout the distal stump (H). Asterisks indicate implanted beads.
formation of the apical ectodermal ridge (AER) (Ahn et al., 2001;
Pizette et al., 2001), and establishing a wound epidermis that
shares characteristics with the AER is a crucial early event in
amphibian limb regeneration (Christensen and Tassava, 2000;
Satoh et al., 2008). Thus, one possible mechanism involves a
modification of the mammalian wound epidermis that functions
to induce regenerative outgrowth. Alternatively, BMP signaling
is essential for the differentiation of the limb skeleton
(Bandyopadhyay et al., 2006) and our finding that ectopic
endochondral ossification is induced by BMP7 is consistent with
a role in inducing skeletogenesis. The onset of expression of the
endochondral genes during regeneration, however, occurs after
BMP release from the microcarrier bead is exhausted, thus a direct
effect of BMP7 on endochondral ossification seems unlikely.
BMP7 has been shown to induce ectopic bone formation when
administered immediately after limb amputation in neonatal mice
(Masaki and Ide, 2007). BMPs have long been known for their
ability to induce ectopic bone when placed at a subcutaneous or
intramuscular location (see Reddi, 1998); however, the
morphology of the ectopic skeletal elements induced by BMP7 at
neonatal limb amputations display a pattern that is linked to the
amputation level (Masaki and Ide, 2007). In digit tip regeneration
we also find evidence for a level-dependent response.
Endogenous digit tip regeneration, which is BMP-dependent,
occurs by direct ossification (Han et al., 2008), whereas BMP7-
induced regeneration occurs by endochondral ossification. Thus
it appears that, even within the confines of the terminal phalangeal
element, digit cells can respond in a position-specific manner. The
role of positional information in amphibian limb regeneration has
long been recognized as an important aspect for a successful
response and that connective tissue fibroblasts play a key role in
blastema formation and patterning the regenerative response
(Gardiner, 2005). There is evidence from microarray analyses of
human cells that fibroblasts display transcriptomes that vary with
position in the adult body (Chang et al., 2002; Rinn et al., 2006),
suggesting that some measure of positional information is
maintained even in non-regenerating adult tissues. Our results,
combined with those of Masaki and Ide (Masaki and Ide, 2007),
provide evidence for an interface between BMP signaling and the
positional identity of cells at amputation wounds in modulating
the mammalian injury response.
We thank Juhee Haam for sharing preliminary results and Akira Satoh for
comments on the manuscript. Research funded by grants R01HD043277 and
P01HD022610 from the NIH, W911NF-06-1-0161 from DARPA and the John
L. and Mary Wright Ebaugh Endowment Fund at Tulane University. Deposited
in PMC for immediate release.
Competing interests statement
The authors declare no competing financial interests.
Supplementary material for this article is available at
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Mammalian digit regeneration