3D artificial bones for bone repair prepared by computed tomography-guided fused deposition modeling for bone repair

Emerging Biofabrication Strategies for Engineering Complex Tissue Constructs

The demand for organ transplantation and repair, coupled with a shortage of available donors, poses an urgent clinical need for the development of innovative treatment strategies for long-term repair and regeneration of injured or diseased tissues and organs. Bioengineering organs, by growing patient-derived cells in biomaterial scaffolds in the presence of pertinent physicochemical signals, provides a promising solution to meet this demand. However, recapitulating the structural and cytoarchitectural complexities of native tissues in vitro remains a significant challenge to be addressed. Through tremendous efforts over the past decade, several innovative biofabrication strategies have been developed to overcome these challenges. This review highlights recent work on emerging three-dimensional bioprinting and textile techniques, compares the advantages and shortcomings of these approaches, outlines the use of common biomaterials and advanced hybrid scaffolds, and describes several design considerations including the structural, physical, biological, and economical parameters that are crucial for the fabrication of functional, complex, engineered tissues. Finally, the applications of these biofabrication strategies in neural, skin, connective, and muscle tissue engineering are explored.

3D robocasting magnesium-doped wollastonite/TCP bioceramic scaffolds with improved bone regeneration capacity in critical sized calvarial defects

Using artificial biomaterials in bone regenerative medicine for highly efficient osteoconduction into the bone defect to decrease the bone healing time is still a challenge. In this research, magnesium (Mg)-doped wollastonite (∼10% Mg was substituted for calcium (Ca) in β-CaSiO₃) (CSi-Mg10) bioceramic scaffolds with ultrahigh mechanical strength were fabricated using ceramic ink writing three dimensional (3D) printing. To evaluate the potential of other additives on the new bone regeneration efficiency, β-tricalcium phosphate (β-TCP) was introduced to the CSi-Mg10 ceramic ink at a concentration of 15% and the biphasic bioceramic scaffolds (CSi-Mg10/TCP15) were also fabricated using 3D printing. The mechanical characterization indicated that introduction of β-TCP led to nearly 50% mechanical decay, although the effect of the two heating schedules (one- and two-step sintering) on the compressive and flexural strengths of the scaffolds was significantly different. The bone regeneration results in critical sized calvarial defect of rabbits showed that the CSi-Mg10/TCP15 scaffolds displayed a markedly higher osteogenic capability than those on the CSi-Mg10 and β-TCP scaffolds after eight weeks, and reached ∼35% new bone tissue regeneration at 12 weeks postoperatively. These findings demonstrate that the CSi-Mg10/TCP15 bioceramic scaffolds can be well suited for stimulating in situ bone regeneration and for use in tissue engineering applications.

Biomineralization: From Material Tactics to Biological Strategy

Biomineralization is an important tactic by which biological organisms produce hierarchically structured minerals with marvellous functions. Biomineralization studies typically focus on the mediation function of organic matrices on inorganic minerals, which helps scientists to design and synthesize bioinspired functional materials. However, the presence of inorganic minerals may also alter the native behaviours of organic matrices and even biological organisms. This progress report discusses the latest achievements relating to biomineralization mechanisms, the manufacturing of biomimetic materials and relevant applications in biological and biomedical fields. In particular, biomineralized vaccines and algae with improved thermostability and photosynthesis, respectively, demonstrate that biomineralization is a strategy for organism evolution via the rational design of organism-material complexes. The successful modification of biological systems using materials is based on the regulatory effect of inorganic materials on organic organisms, which is another aspect of biomineralization control. Unlike previous studies, this study integrates materials and biological science to achieve a more comprehensive view of the mechanisms and applications of biomineralization.

Patterning Electrospun Nanofibers via Agarose Hydrogel Stamps to Spatially Coordinate Cell Orientation in Microfluidic Device

A straightforward, inexpensive, and reliable approach to pattern electrospun nanofibers via solvent-containing agarose hydrogel stamps is reported. Complex hierarchical microstructures can be further constructed via appropriate multistep permutation of microcontact patterning and electrospinning. As a proof-of-concept application, the patterned electrospun nanofibers are employed to spatially coordinate cell orientation in microfluidic devices.

Three-Dimensional Printing of pH-Responsive and Functional Polymers on an Affordable Desktop Printer

In this work we describe the synthesis, thermal and rheological characterization, hot-melt extrusion, and three-dimensional printing (3DP) of poly(2-vinylpyridine) (P2VP). We investigate the effect of thermal processing conditions on physical properties of produced filaments in order to achieve high quality, 3D-printable filaments for material extrusion 3DP (ME3DP). Mechanical properties and processing performances of P2VP were enhanced by addition of 12 wt % acrylonitrile-butadiene-styrene (ABS), which reinforced P2VP fibers. We 3D-print P2VP filaments using an affordable 3D printer. The pyridine moieties are cross-linked and quaternized postprinting to form 3D-printed pH-responsive hydrogels. The printed objects exhibited dynamic and reversible pH-dependent swelling. These hydrogels act as flow-regulating valves, controlling the flow rate with pH. Additionally, a macroporous P2VP membrane was 3D-printed and the coordinating ability of the pyridyl groups was employed to immobilize silver precursors on its surface. After the reduction of silver ions, the structure was used to catalyze the reduction of 4-nitrophenol to 4-aminophenol with a high efficiency. This is a facile technique to print recyclable catalytic objects.

Role of scaffold mean pore size in meniscus regeneration

Recently, meniscus tissue engineering offers a promising management for meniscus regeneration. Although rarely reported, the microarchitectures of scaffolds can deeply influence the behaviors of endogenous or exogenous stem/progenitor cells and subsequent tissue formation in meniscus tissue engineering. Herein, a series of three-dimensional (3D) poly(ε-caprolactone) (PCL) scaffolds with three distinct mean pore sizes (i.e., 215, 320, and 515μm) were fabricated via fused deposition modeling. The scaffold with the mean pore size of 215μm significantly improved both the proliferation and extracellular matrix (ECM) production/deposition of mesenchymal stem cells compared to all other groups in vitro. Moreover, scaffolds with mean pore size of 215μm exhibited the greatest tensile and compressive moduli in all the acellular and cellular studies. In addition, the relatively better results of fibrocartilaginous tissue formation and chondroprotection were observed in the 215μm scaffold group after substituting the rabbit medial meniscectomy for 12weeks. Overall, the mean pore size of 3D-printed PCL scaffold could affect cell behavior, ECM production, biomechanics, and repair effect significantly. The PCL scaffold with mean pore size of 215μm presented superior results both in vitro and in vivo, which could be an alternative for meniscus tissue engineering.

STATEMENT OF SIGNIFICANCE

Meniscus tissue engineering provides a promising strategy for meniscus regeneration. In this regard, the microarchitectures (e.g., mean pore size) of scaffolds remarkably impact the behaviors of cells and subsequent tissue formation, which has been rarely reported. Herein, three three-dimensional poly(ε-caprolactone) scaffolds with different mean pore sizes (i.e., 215, 320, and 515μm) were fabricated via fused deposition modeling. The results suggested that the mean pore size significantly affected the behaviors of endogenous or exogenous stem/progenitor cells and subsequent tissue formation. This study furthers our understanding of the cell-scaffold interaction in meniscus tissue engineering, which provides unique insight into the design of meniscus scaffolds for future clinical application.

Systematical Evaluation of Mechanically Strong 3D Printed Diluted magnesium Doping Wollastonite Scaffolds on Osteogenic Capacity in Rabbit Calvarial Defects

Wollastonite (CaSiO3; CSi) ceramic is a promising bioactive material for bone defect repair due to slightly fast degradation of its porous constructs in vivo. In our previous strategy some key features of CSi ceramic have been significantly improved by dilute magnesium doping for regulating mechanical properties and biodegradation. Here we demonstrate that 6 ~ 14% of Ca substituted by Mg in CSi (CSi-Mgx, x = 6, 10, 14) can enhance the mechanical strength (>40 MPa) but not compromise biological performances of the 3D printed porous scaffolds with open porosity of 60‒63%. The in vitro cell culture tests in vitro indicated that the dilute Mg doping into CSi was beneficial for ALP activity and high expression of osteogenic marker genes of MC3T3-E1 cells in the scaffolds. A good bone tissue regeneration response and elastoplastic response in mechanical strength in vivo were determined after implantation in rabbit calvarial defects for 6‒12 weeks. Particularly, the CSi-Mg10 and CSi-Mg14 scaffolds could enhance new bone regeneration with a significant increase of newly formed bone tissue (18 ~ 22%) compared to the pure CSi (~14%) at 12 weeks post-implantation. It is reasonable to consider that, therefore, such CSi-Mgx scaffolds possessing excellent strength and reasonable degradability are promising for bone reconstruction in thin-wall bone defects.

Polydopamine-Templated Hydroxyapatite Reinforced Polycaprolactone Composite Nanofibers with Enhanced Cytocompatibility and Osteogenesis for Bone Tissue Engineering

Nanohydroxyapatite (HA) synthesized by biomimetic strategy is a promising nanomaterial as bone substitute due to its physicochemical features similar to those of natural nanocrystal in bone tissue. Inspired by mussel adhesive chemistry, a novel nano-HA was synthesized in our work by employing polydopamine (pDA) as template under weak alkaline condition. Subsequently, the as-prepared pDA-templated HA (tHA) was introduced into polycaprolactone (PCL) matrix via coelectrospinning, and a bioactive tHA/PCL composite nanofiber scaffold was developed targeted at bone regeneration application. Our research showed that tHA reinforced PCL composite nanofibers exhibited favorable cytocompatibility at given concentration of tHA (0-10 w.t%). Compared to pure PCL and traditional nano-HA enriched PCL (HA/PCL) composite nanofibers, enhanced cell adhesion, spreading and proliferation of human mesenchymal stem cells (hMSCs) were observed on tHA/PCL composite nanofibers on account of the contribution of pDA present in tHA. More importantly, tHA nanoparticles exposed on the surface of composite nanofibers could further promote osteogenesis of hMSCs in vitro even in the absence of osteogenesis soluble inducing factors when compared to traditional HA/PCL scaffolds, which was supported by in vivo test as well according to the histological analysis. Overall, our study demonstrated that the developed tHA/PCL composite nanofibers with enhanced cytocompatibility and osteogenic capacity hold great potential as scaffolds for bone tissue engineering.

The outstanding mechanical response and bone regeneration capacity of robocast dilute magnesium-doped wollastonite scaffolds in critical size bone defects

Mechanically strong, highly osteogenic dilute magnesium-doped wollastonite robocast scaffolds.

3D printed structures for delivery of biomolecules and cells: tissue repair and regeneration

This paper reviews the current approaches to using 3D printed structures to deliver bioactive factors (e.g., cells and biomolecules) for tissue repair and regeneration.

Additive manufacturing of scaffolds with dexamethasone controlled release for enhanced bone regeneration

The adoption of additive manufacturing in tissue engineering and regenerative medicine (TERM) strategies greatly relies on the development of novel 3D printable materials with advanced properties. In this work we have developed a material for bone TERM applications with tunable bioerosion rate and dexamethasone release profile which can be further employed in fused deposition modelling (the most common and accessible 3D printing technology in the market). The developed material consisted of a blend of poly-ϵ-caprolactone (PCL) and poloxamine (Tetronic®) and was processed into a ready-to-use filament form by means of a simplified melt-based methodology, therefore eliminating the utilization of solvents. 3D scaffolds composed of various blend formulations were additively manufactured and analyzed revealing blend ratio-specific degradation rates and dexamethasone release profiles. Furthermore, in vitro culture studies revealed a similar blend ratio-specific trend concerning the osteoinductive activity of the fabricated scaffolds when these were seeded and cultured with human mesenchymal stem cells. The developed material enables to specifically address different regenerative requirements found in various tissue defects. The versatility of such strategy is further increased by the ability of additive manufacturing to accurately fabricate implants matching any given defect geometry.

Effect of nanofiber orientation of electrospun nanofibrous scaffolds on cell growth and elastin expression of muscle cells

Tissue regeneration after smooth muscle tissue injury is a pivotal issue in tissue engineering. Good artificial scaffolds to continuously form long thin spindle-shaped smooth muscle cells in the damaged muscle tissues are important for tissue regeneration. In this work, poly(lactide-co-glycolide) (PLGA) and poly(ϵ-caprolactone) (PCL) were used to fabricate aligned or random electrospun nanofibrous scaffolds (ENSs) by using electrospinning technique. The cell growth and elastin expression of human vascular smooth muscle cells (HVSMCs) on these membranes were analyzed. Smooth PLGA/PCL film was used as control. The experimental results showed that the aligned ENS could maintain cell shapes of HVSMCs during the culture process. During the HVSMCs proliferation process, elastin expression firstly increase due to cell proliferation, and then decrease due to elastin degradation by elastase secreted by the cells. All these results suggest that aligned PLGA/PCL ENS can be a promising candidate for cell regeneration after smooth muscle tissue injury.

Electrospun Nanofibrous P(DLLA-CL) Balloons as Calcium Phosphate Cement Filled Containers for Bone Repair: in Vitro and in Vivo Studies

The spinal surgeon community has expressed significant interest in applying calcium phosphate cement (CPC) for the treatment of vertebral compression fractures (VCFs) and minimizing its disadvantages, such as its water-induced collapsibility and poor mechanical properties, limiting its clinical use. In this work, novel biodegradable electrospun nanofibrous poly(d,l-lactic acid-ϵ-caprolactone) balloons (ENPBs) were prepared, and the separation, pressure, degradation, and new bone formation behaviors of the ENPBs when used as CPC-filled containers in vitro and in vivo were systematically analyzed and compared. CPC could be separated from surrounding bone tissues by ENPBs in vitro and in vivo. ENPB-CPCs (ENPBs serving as CPC-filled containers) exerted pressure on the surrounding bone microenvironment, which was enough to crush trabecular bone. Compared with the CPC implantation, ENPB-CPCs delayed the degradation of CPC (i.e., its water-induced collapsilibity). Finally, possible mechanisms behind the in vivo effects caused by ENPB-CPCs implanted into rabbit thighbones and pig vertebrae were proposed. This work suggests that ENPBs can be potentially applied as CPC-filled containers in vivo and provides an experimental basis for the clinical application of ENPBs for the treatment of VCFs. In addition, this work will be of benefit to the development of polymer-based medical implants in the future.

3D Printing of Scaffolds for Tissue Regeneration Applications

The current need for organ and tissue replacement, repair, and regeneration for patients is continually growing such that supply is not meeting demand primarily due to a paucity of donors as well as biocompatibility issues leading to immune rejection of the transplant. In order to overcome these drawbacks, scientists have investigated the use of scaffolds as an alternative to transplantation. These scaffolds are designed to mimic the extracellular matrix (ECM) by providing structural support as well as promoting attachment, proliferation, and differentiation with the ultimate goal of yielding functional tissues or organs. Initial attempts at developing scaffolds were problematic and subsequently inspired an interest in 3D printing as a mode for generating scaffolds. Utilizing three-dimensional printing (3DP) technologies, ECM-like scaffolds can be produced with a high degree of complexity, where fine details can be included at a micrometer level. In this Review, the criteria for printing viable and functional scaffolds, scaffolding materials, and 3DP technologies used to print scaffolds for tissue engineering are discussed. Creating biofunctional scaffolds could potentially help to meet the demand by patients for tissues and organs without having to wait or rely on donors for transplantation.

Templated repair of long bone defects in rats with bioactive spiral-wrapped electrospun amphiphilic polymer/hydroxyapatite scaffolds

Effective repair of critical-size long bone defects presents a significant clinical challenge. Electrospun scaffolds can be exploited to deliver protein therapeutics and progenitor cells, but their standalone application for long bone repair has not been explored. We have previously shown that electrospun composites of amphiphilic poly(d,l-lactic acid)-co-poly(ethylene glycol)-co-poly(d,l-lactic acid) (PELA) and hydroxyapatite (HA) guide the osteogenic differentiation of bone marrow stromal cells (MSCs), making these scaffolds uniquely suited for evaluating cell-based bone regeneration approaches. Here we examine whether the in vitro bioactivity of these electrospun scaffolds can be exploited for long bone defect repair, either through the participation of exogenous MSCs or through the activation of endogenous cells by a low dose of recombinant human bone morphogenetic protein-2 (rhBMP-2). In critical-size rat femoral segmental defects, spiral-wrapped electrospun HA-PELA with preseeded MSCs resulted in laminated endochondral ossification templated by the scaffold across the longitudinal span of the defect. Using GFP labeling, we confirmed that the exogenous MSCs adhered to HA-PELA survived at least 7 days postimplantation, suggesting direct participation of these exogenous cells in templated bone formation. When loaded with 500 ng of rhBMP-2, HA-PELA spirals led to more robust but less clearly templated bone formation than MSC-bearing scaffolds. Both treatment groups resulted in new bone bridging over the majority of the defect by 12 weeks. This study is the first demonstration of a standalone bioactive electrospun scaffold for templated bone formation in critical-size long bone defects.

3D-printed mechanochromic materials

We describe the preparation and characterization of photo- and mechanochromic 3D-printed structures using a commercial fused filament fabrication printer. Three spiropyran-containing poly(ε-caprolactone) (PCL) polymers were each filamentized and used to print single- and multicomponent tensile testing specimens that would be difficult, if not impossible, to prepare using traditional manufacturing techniques. It was determined that the filament production and printing process did not degrade the spiropyran units or polymer chains and that the mechanical properties of the specimens prepared with the custom filament were in good agreement with those from commercial PCL filament. In addition to printing photochromic and dual photo- and mechanochromic PCL materials, we also prepare PCL containing a spiropyran unit that is selectively activated by mechanical impetus. Multicomponent specimens containing two different responsive spiropyrans enabled selective activation of different regions within the specimen depending on the stimulus applied to the material. By taking advantage of the unique capabilities of 3D printing, we also demonstrate rapid modification of a prototype force sensor that enables the assessment of peak load by simple visual assessment of mechanochromism.

In vitro and in vivo drug release behavior and osteogenic potential of a composite scaffold based on poly(ε-caprolactone)-block-poly(lactic-co-glycolic acid) and β-tricalcium phosphate

To cure serious bone tuberculosis, a novel long-term drug delivery system was designed and prepared to satisfy the needs of both bone regeneration and antituberculous drug therapy.