Rapid 3D printing of anatomically accurate and mechanically heterogeneous aortic valve hydrogel scaffolds

Natural Polymer-Based Hydrogels with Enhanced Mechanical Performances: Preparation, Structure, and Property

Hydrogels based on natural polymers have bright application prospects in biomedical fields due to their outstanding biocompatibility and biodegradability. However, the poor mechanical performances of pure natural polymer-based hydrogels greatly limit their application prospects. Recently, a variety of strategies has been applied to prepare natural polymer-based hydrogels with enhanced mechanical properties, which generally exhibit stiffening, strengthening, and stretchable behaviors. This article summarizes the recent progress of natural polymer-based hydrogels with enhanced mechanical properties. From a structure point of view, four kinds of hydrogel are reviewed; double network hydrogels, nanocomposite hydrogels, click chemistry-based hydrogels, and supramolecular hydrogels. For each typical hydrogel, its preparation, structure, and mechanical performance are introduced in detail. At the end of this article, the current challenges and future prospects of hydrogels based on natural polymers are discussed and it is pointed out that 3D printing may offer a new platform for the development of natural polymer-based hydrogels.

Bioprinting functional tissues

Despite the numerous lives that have been saved since the first successful procedure in 1954, organ transplant has several shortcomings which prevent it from becoming a more comprehensive solution for medical care than it is today. There is a considerable shortage of organ donors, leading to patient death in many cases. In addition, patients require lifelong immunosuppression to prevent graft rejection postoperatively. With such issues in mind, recent research has focused on possible solutions for the lack of access to donor organs and rejections, with the possibility of using the patient's own cells and tissues for treatment showing enormous potential. Three-dimensional (3D) bioprinting is a rapidly emerging technology, which holds great promise for fabrication of functional tissues and organs. Bioprinting offers the means of utilizing a patient's cells to design and fabricate constructs for replacement of diseased tissues and organs. It enables the precise positioning of cells and biologics in an automated and high throughput manner. Several studies have shown the promise of 3D bioprinting. However, many problems must be overcome before the generation of functional tissues with biologically-relevant scale is possible. Specific focus on the functionality of bioprinted tissues is required prior to clinical translation. In this perspective, this paper discusses the challenges of functionalization of bioprinted tissue under eight dimensions: biomimicry, cell density, vascularization, innervation, heterogeneity, engraftment, mechanics, and tissue-specific function, and strives to inform the reader with directions in bioprinting complex and volumetric tissues. STATEMENT OF SIGNIFICANCE: With thousands of patients dying each year waiting for an organ transplant, bioprinted tissues and organs show the potential to eliminate this ever-increasing organ shortage crisis. However, this potential can only be realized by better understanding the functionality of the organ and developing the ability to translate this to the bioprinting methodologies. Considering the rate at which the field is currently expanding, it is reasonable to expect bioprinting to become an integral component of regenerative medicine. For this purpose, this paper discusses several factors that are critical for printing functional tissues including cell density, vascularization, innervation, heterogeneity, engraftment, mechanics, and tissue-specific function, and inform the reader with future directions in bioprinting complex and volumetric tissues.

Outlooks on Three-Dimensional Printing for Ocular Biomaterials Research

Given its potential for high-resolution, customizable, and waste-free fabrication of medical devices and in vitro biological models, 3-dimensional (3D) bioprinting has broad utility within the biomaterials field. Indeed, 3D bioprinting has to date been successfully used for the development of drug delivery systems, the recapitulation of hard biological tissues, and the fabrication of cellularized organ and tissue-mimics, among other applications. In this study, we highlight convergent efforts within engineering, cell biology, soft matter, and chemistry in an overview of the 3D bioprinting field, and we then conclude our work with outlooks toward the application of 3D bioprinting for ocular research in vitro and in vivo.

Dynamic Measurements Using FDM 3D-Printed Embedded Strain Sensors

3D-printing technology is opening up new possibilities for the co-printing of sensory elements. While quasi-static research has shown promise, the dynamic performance has yet to be researched. This study researched smart 3D structures with embedded and printed sensory elements. The embedded strain sensor was based on the conductive PLA (Polylactic Acid) material. The research was focused on dynamic measurements of the strain and considered the theoretical background of the piezoresistivity of conductive PLA materials, the temperature effects, the nonlinearities, the dynamic range, the electromagnetic sensitivity and the frequency range. A quasi-static calibration used in the dynamic measurements was proposed. It was shown that the temperature effects were negligible, the sensory element was linear as long as the structure had a linear response, the dynamic range started at ∼ 30 μ ϵ and broadband performance was in the range of few kHz (depending on the size of the printed sensor). The promising results support future applications of smart 3D-printed systems with embedded sensory elements being used for dynamic measurements in areas where currently piezo-crystal-based sensors are used.

Lung tissue bioengineering for chronic obstructive pulmonary disease: overcoming the need for lung transplantation from human donors

Introduction: Chronic obstructive pulmonary disease (COPD) affects more than 380 million people, causing more than 3 million deaths annually worldwide. Despite this enormous burden, currently available therapies are largely limited to symptom control. Lung transplant is considered for end-stage disease but is severely limited by the availability of human organs. Furthermore, the pre-transplant course is a complex orchestration of locating and harvesting suitable lungs, and the post-transplant course is complicated by rejection and infection. Lung tissue bioengineering has the potential to relieve the organ shortage and improve the post-transplant course by generating patient-specific lungs for transplant. Additionally, emerging progenitor cell therapies may facilitate in vivo regeneration of pulmonary tissue, obviating the need for transplant. Areas Covered: We review several lung tissue bioengineering approaches including the recellularization of decellularized scaffolds, 3D bioprinting, genetically-engineered xenotransplantation, blastocyst complementation, and direct therapy with progenitor cells. Articles were identified by searching relevant terms (see Key Words) in the PubMed database and selected for inclusion based on novelty and uniqueness of their approach. Expert Opinion: Lung tissue bioengineering research is in the early stages. Of the methods reviewed, only direct cell therapy has been investigated in humans. We anticipate a minimum of 5-10 years before human therapy will be feasible.

Recent advances in three-dimensional bioprinting of stem cells

In spite of being a new field, three-dimensional (3D) bioprinting has undergone rapid growth in the recent years. Bioprinting methods offer a unique opportunity for stem cell distribution, positioning, and differentiation at the microscale to make the differentiated architecture of any tissue while maintaining precision and control over the cellular microenvironment. Bioprinting introduces a wide array of approaches to modify stem cell fate. This review discusses these methodologies of 3D bioprinting stem cells. Fabricating a fully operational tissue or organ construct with a long life will be the most significant challenge of 3D bioprinting. Once this is achieved, a whole human organ can be fabricated for the defect place at the site of surgery.

Current Biomedical Applications of 3D Printing and Additive Manufacturing

Additive manufacturing (AM) has emerged over the past four decades as a cost-effective, on-demand modality for fabrication of geometrically complex objects. The ability to design and print virtually any object shape using a diverse array of materials, such as metals, polymers, ceramics and bioinks, has allowed for the adoption of this technology for biomedical applications in both research and clinical settings. Current advancements in tissue engineering and regeneration, therapeutic delivery, medical device fabrication and operative management planning ensure that AM will continue to play an increasingly important role in the future of healthcare. In this review, we outline current biomedical applications of common AM techniques and materials.

Analysis of the Effect of Processing Conditions on Physical Properties of Thermally Set Cellulose Hydrogels

Cellulose-based hydrogels were prepared by dissolving cellulose in aqueous sodium hydroxide (NaOH)/urea solutions and casting it into complex shapes by the use of sacrificial templates followed by thermal gelation of the solution. Both the gelling temperatures used (40–80 °C), as well as the method of heating by either induction in the form of a water bath and hot press or radiation by microwaves could be shown to have a significant effect on the compressive strength and modulus of the prepared hydrogels. Lower gelling temperatures and shorter heating times were found to result in stronger and stiffer gels. Both the effect of physical cross-linking via the introduction of additional non-dissolving cellulosic material, as well as chemical cross-linking by the introduction of epichlorohydrin (ECH), and a combination of both applied during the gelation process could be shown to affect both the mechanical properties and microstructure of the hydrogels. The added cellulose acts as a physical-cross-linking agent strengthening the hydrogen-bond network as well as a reinforcing phase improving the mechanical properties. However, chemical cross-linking of an unreinforced gel leads to unfavourable bonding and cellulose network formation, resulting in drastically increased pore sizes and reduced mechanical properties. In both cases, chemical cross-linking leads to larger internal pores.

Layer-by-layer coated porous 3D printed hydroxyapatite composite scaffolds for controlled drug delivery

Interconnected porous scaffolds are widely used in the applications of tissue repair and regeneration. Sustained local delivery of drugs and growth factors around the implanted scaffolds could accelerate the growth of cells and contribute to the regeneration of damaged tissues. In this study, porous hydroxyapatite composite scaffolds were prepared through 3D bio-printing for bone tissue engineering and were subsequently coated with chitosan and sodium hyaluronate by layer-by-layer (LBL) deposition. It was found that the LBL coating on the porous scaffolds could reduce the swelling ratio of scaffolds in size and increase the compressive strength by about 70%. The degradation rate of the scaffolds slowed down due to the LBL coating. Rhodamine B (RHB) and bovine serum albumin (BSA) were chosen as model drugs in order to understand the loading and release behaviors of the scaffolds. Small RHB molecules could penetrate deep into the LBL coated scaffolds and released a little slower than that without coating. Meanwhile, large BSA molecules showed faster release rate compared to that without coating. In addition, there was no significant cytotoxicity effect of these composite scaffolds towards MC-3T3E1 cells and the scaffolds provided proper conditions for cell adhesion and proliferation, indicating that the printed hydroxyapatite composite scaffolds exhibit a great potential in hard tissue engineering as a sustained delivery system.

Pharmaceutical Product Development Exploiting 3D Printing Technology: Conventional to Novel Drug Delivery System

Background:

3D printed pharmaceutical products are revolutionizing the pharmaceutical industry as a prospective mean to achieve a personalized method of treatments acquired to the specially designed need of each patient. It will depend upon age, weight, concomitants, pharmacogenetics and pharmacokinetic profile of the patient and thus transforming the current pharmaceutical market as a potential alternative to conventional medicine. 3D printing technology is getting more consideration in new medicine formulation development as a modern and better alternative to control many challenges associated with conventional medicinal products. There are many advantages of 3D printed medicines which create tremendous opportunities for improving the acceptance, accuracy and effectiveness of these medicines. In 2015, United State Food and Drug Administration has approved the first 3D printed tablet (Spritam®) and had shown the emerging importance of this technology.

Methods:

This review article summarizes as how in-depth knowledge of drugs and their manufacturing processes can assist to manage different strategies for various 3D printing methods. The principal goal of this review is to provide a brief introduction about the present techniques employed in tech -medicine evolution from conventional to a novel drug delivery system.

Results:

It is evidenced that through its unparalleled advantages of high-throughput, versatility, automation, precise spatial control and fabrication of hierarchical structures, the implementation of 3D printing for the expansion and delivery of controlled drugs acts as a pivotal role.

Conclusion:

3D printing technology has an extraordinary ability to provide elasticity in the manufacturing and designing of composite products that can be utilized in programmable and personalized medicine. Personalized medicine helps in improving drug safety and minimizes side effects such as toxicity to individual human being which is associated with unsuitable drug dose.

Hydrogel 3D printing with the capacitor edge effect

Recent decades have seen intense developments of hydrogel applications for cell cultures, tissue engineering, soft robotics, and ionic devices. Advanced fabrication techniques for hydrogel structures are being developed to meet user-specified requirements. Existing hydrogel 3D printing techniques place substantial constraints on the physical and chemical properties of hydrogel precursors as well as the printed hydrogel structures. This study proposes a novel method for patterning liquids with a resolution of 100 μm by using the capacitor edge effect. We establish a complete hydrogel 3D printing system combining the patterning and stacking processes. This technique is applicable to a wide variety of hydrogels, overcoming the limitations of existing techniques. We demonstrate printed hydrogel structures including a hydrogel scaffold, a hydrogel composite that responds sensitively to temperature, and an ionic high-integrity hydrogel display device. The proposed technique offers great opportunities in rapid prototyping hydrogel devices using multiple compositions and complex geometries.

Emerging trends in multiscale modeling of vascular pathophysiology: Organ-on-a-chip and 3D printing

Most biomedical and pharmaceutical research of the human vascular system aims to unravel the complex mechanisms that drive disease progression from molecular to organ levels. The knowledge gained can then be used to innovate diagnostic and treatment strategies which can ultimately be determined precisely for patients. Despite major advancements, current modeling strategies are often limited at identifying, quantifying, and dissecting specific cellular and molecular targets that regulate human vascular diseases. Therefore, development of multiscale modeling approaches are needed that can advance our knowledge and facilitate the design of next-generation therapeutic approaches in vascular diseases. This article critically reviews animal models, static in vitro systems, and dynamic in vitro culture systems currently used to model vascular diseases. A leading emphasis on the potential of emerging approaches, specifically organ-on-a-chip and three-dimensional (3D) printing, to recapitulate the innate human vascular physiology and anatomy is described. The applications of these approaches and future outlook in designing and screening novel therapeutics are also presented.

Recent Strategies in Extrusion-Based Three-Dimensional Cell Printing toward Organ Biofabrication

Reconstructing human organs is one of the ultimate goals of the medical industry. Organ printing utilizing three-dimensional cell printing technology to fabricate artificial living organ equivalents has shed light on the advancement of this field into a new era. Among three currently applied techniques (inkjet, laser-assisted, and extrusion-based), extrusion-based cell printing (ECP) has evoked the majority of interest due to its low cost, wide range of applicable materials, and ease of spatial and depositional controllability. Major challenges in organ reconstruction include difficulties in precisely fabricating complex structural features, creating perfusable and functional vasculatures, and mimicking biophysical and biochemical characteristics in the printed constructs. In this review, we describe the merits and limitations of ECP for organ fabrication and discuss its recent advances aimed at overcoming these challenges. In addition, we delineate the expected future techniques for printing live tissue or organ substitutes.

Bioinks and bioprinting technologies to make heterogeneous and biomimetic tissue constructs

The native tissues are complex structures consisting of different cell types, extracellular matrix materials, and biomolecules. Traditional tissue engineering strategies have not been able to fully reproduce biomimetic and heterogeneous tissue constructs because of the lack of appropriate biomaterials and technologies. However, recently developed three-dimensional bioprinting techniques can be leveraged to produce biomimetic and complex tissue structures. To achieve this, multicomponent bioinks composed of multiple biomaterials (natural, synthetic, or hybrid natural-synthetic biomaterials), different types of cells, and soluble factors have been developed. In addition, advanced bioprinting technologies have enabled us to print multimaterial bioinks with spatial and microscale resolution in a rapid and continuous manner, aiming to reproduce the complex architecture of the native tissues. This review highlights important advances in heterogeneous bioinks and bioprinting technologies to fabricate biomimetic tissue constructs. Opportunities and challenges to further accelerate this research area are also described.

On the role of N-vinylpyrrolidone in the aqueous radical-initiated copolymerization with PEGDA mediated by eosin Y in the presence of O2

A ground-state complex between eosin and N-vinylpyrrolidone impacts the photo-initiated synthesis of PEG hydrogels.

Synthesis and characterization of photocrosslinkable hydrogels from bovine skin gelatin

Hydrogels that mimic native tissues chemically and structurally have been increasingly sought for a wide variety of tissue engineering applications. Gelatin can be naturally derived from different sources and functionalized to fabricate hydrogels that exhibit high cytocompatibility and favorable biodegradable properties. The amino groups on the gelatin backbone can be substituted by adding varying proportions of methacrylic anhydride (MAA) to create biomimetic hydrogels which can be used as tissue engineering scaffolds. Gelatin from different sources yields hydrogels with distinctive physical, chemical, and biological properties. In this work, gelatin from bovine skin was used to fabricate hydrogels with varying degrees of crosslinking content using 1, 4, 7, and 10 mL MAA. The material properties of these hydrogels were characterized. The cytocompatibility of the gelatin-based hydrogels was studied using L6 rat myoblasts. The hydrogels from bovine skin gelatin exhibit mechanical properties that are conducive for applications which require substrates to propagate cell growth, migration, and proliferation rapidly. These hydrogels exhibit exceptional tunability behavior which makes them useful and applicable to culture different cell types.

Gelatin from bovine skin was chemically modified to synthesize biocompatible photolabile hydrogels for tissue engineering applications.

Direct ink writing with high-strength and swelling-resistant biocompatible physically crosslinked hydrogels

The 3D printing of physically crosslinked hydrogel architectures with high strength and swelling resistance is achieved with biocompatible PVA and natural κ-carrageenan hybrid inks.

Polymerization induced phase separation as a generalized methodology for multi-layered hydrogel tubes

Herein, we report a conceptually chemical strategy to facilitate the fabrication of layered hydrogel tubes based on the polymerization-induced phase separation mechanism.

Additive manufacturing of bone scaffolds

Additive manufacturing (AM) can obtain not only customized external shape but also porous internal structure for scaffolds, both of which are of great importance for repairing large segmental bone defects. The scaffold fabrication process generally involves scaffold design, AM, and post-treatments. Thus, this article firstly reviews the state-of-the-art of scaffold design, including computer-aided design, reverse modeling, topology optimization, and mathematical modeling. In addition, the current characteristics of several typical AM techniques, including selective laser sintering, fused deposition modeling (FDM), and electron beam melting (EBM), especially their advantages and limitations are presented. In particular, selective laser sintering is able to obtain scaffolds with nanoscale grains, due to its high heating rate and a short holding time. However, this character usually results in insufficient densification. FDM can fabricate scaffolds with a relative high accuracy of pore structure but with a relative low mechanical strength. EBM with a high beam-material coupling efficiency can process high melting point metals, but it exhibits a low-resolution and poor surface quality. Furthermore, the common post-treatments, with main focus on heat and surface treatments, which are applied to improve the comprehensive performance are also discussed. Finally, this review also discusses the future directions for AM scaffolds for bone tissue engineering.

The Applications of 3D Printing in Pulmonary Drug Delivery and Treatment of Respiratory Disorders

BACKGROUND

Pulmonary diseases are the third leading cause of morbidity worldwide, however treatment and diagnosis of these diseases continue to be challenging due to the complex anatomical structure as well as physiological processes in the lungs.

METHODS

3D printing is progressively finding new avenues in the medical field and this technology is constantly being used for diseases where diagnosis and treatment heavily rely on the thorough understanding of complex structural-physiology relationships. The structural and functional complexity of the pulmonary system makes it well suited to 3D printing technology.

RESULTS

3D printing can be used to deconstruct the complex anatomy of the lungs and improve our understanding of its physiological mechanisms, cell interactions and pathophysiology of pulmonary diseases. Thus, this technology can be quite helpful in the discovery of novel therapeutic targets, new drugs and devices for the treatment of lung diseases.

CONCLUSION

The intention of this review is to detail our current understanding of the applications of 3D printing in the design and evaluation of inhalable medicines and to provide an overview on its application in the diagnosis and treatment of pulmonary diseases. This review also discusses other technical and regulatory challenges associated with the progression of 3D printing into clinical practice.

Modulating physical, chemical, and biological properties in 3D printing for tissue engineering applications

Over the years, 3D printing technologies have transformed the field of tissue engineering and regenerative medicine by providing a tool that enables unprecedented flexibility, speed, control, and precision over conventional manufacturing methods. As a result, there has been a growing body of research focused on the development of complex biomimetic tissues and organs produced via 3D printing to serve in various applications ranging from models for drug development to translational research and biological studies. With the eventual goal to produce functional tissues, an important feature in 3D printing is the ability to tune and modulate the microenvironment to better mimic in vivo conditions to improve tissue maturation and performance. This paper reviews various strategies and techniques employed in 3D printing from the perspective of achieving control over physical, chemical, and biological properties to provide a conducive microenvironment for the development of physiologically relevant tissues. We will also highlight the current limitations associated with attaining each of these properties in addition to introducing challenges that need to be addressed for advancing future 3D printing approaches.

Cardiovascular tissue bioprinting: Physical and chemical processes

Three-dimensional (3D) cardiac tissue bioprinting occupies a critical crossroads position between the fields of materials engineering, cardiovascular biology, 3D printing, and rational organ replacement design. This complex area of research therefore requires expertise from all those disciplines and it poses some unique considerations that must be accounted for. One of the chief hurdles is that there is a relatively limited systematic organization of the physical and chemical characteristics of bioinks that would make them applicable to cardiac bioprinting. This is of great significance, as heart tissue is functionally complex and the in vivo extracellular niche is under stringent controls with little room for variability before a cardiomyopathy manifests. This review explores the critical parameters that are necessary for biologically relevant bioinks to successfully be leveraged for functional cardiac tissue engineering, which can have applications in in vitro heart tissue models, cardiotoxicity studies, and implantable constructs that can be used to treat a range of cardiomyopathies, or in regenerative medicine.

3D printing in cell culture systems and medical applications

3D printing plays an important role in various biomedical research applications including, but not limited to, culture systems and implantable devices. In this review, we discuss recent development in the applications of 3D printing technologies for clinically motivated research, particularly focusing on the fabrication of constructs subsequently incorporated with cells. Applications of this technology include pharmaceutical delivery, bioreactor culture platforms, acellular scaffolds, imaging modalities, and organ-on-a chip systems. Emphasis is placed on technological developments not possible without 3D printing technologies: where traditional manufacturing approaches would be cumbersome to demonstrate research objectives. The clinical applications of 3D printing are rapidly moving from the research to production phases and will certainly continue to grow, with ever increasing numbers of therapies becoming commercialized. The work discussed here holds promise for various applications in structural improvements, drug delivery, and physiology research.

Study of Physical and Degradation Properties of 3D-Printed Biodegradable, Photocurable Copolymers, PGSA-co-PEGDA and PGSA-co-PCLDA

As acrylated polymers become more widely used in additive manufacturing, their potential applications toward biomedicine also raise the demand for biodegradable, photocurable polymeric materials. Polycaprolactone diacrylate (PCLDA) and poly(ethylene glycol) diacrylate (PEGDA) are two popular choices of materials for stereolithography (SLA) and digital light processing additive manufacturing (DLP-AM), and have been applied to many biomedical related research. However, both materials are known to degrade at a relatively low rate in vivo, limiting their applications in biomedical engineering. In this work, biodegradable, photocurable copolymers are introduced by copolymerizing PCLDA and/or PEGDA with poly(glycerol sebacate) acrylate (PGSA) to form a network polymer. Two main factors are discussed: the effect of degree of acrylation in PGSA and the weight ratio between the prepolymers toward the mechanical and degradation properties. It is found that by blending prepolymers with various degree of acrylation and at various weight ratios, the viscosity of the prepolymers remains stable, and are even more 3D printable than pure substances. The formation of various copolymers yielded a database with selectable Young's moduli between 0.67⁻10.54 MPa, and the overall degradation rate was significantly higher than pure substance. In addition, it is shown that copolymers fabricated by DLP-AM fabrication presents higher mechanical strength than those fabricated via direct UV exposure. With the tunable mechanical and degradation properties, the photocurable, biodegradable copolymers are expected to enable a wider application of additive manufacturing toward tissue engineering.

Pre-procedural fit-testing of TAVR valves using parametric modeling and 3D printing

BACKGROUND

Successful transcatheter aortic valve replacement (TAVR) requires an understanding of how a prosthetic valve will interact with a patient's anatomy in advance of surgical deployment. To improve this understanding, we developed a benchtop workflow that allows for testing of physical interactions between prosthetic valves and patient-specific aortic root anatomy, including calcified leaflets, prior to actual prosthetic valve placement.

METHODS

This was a retrospective study of 30 patients who underwent TAVR at a single high volume center. By design, the dataset contained 15 patients with a successful annular seal (defined by an absence of paravalvular leaks) and 15 patients with a sub-optimal seal (presence of paravalvular leaks) on post-procedure transthoracic echocardiogram (TTE). Patients received either a balloon-expandable (Edwards Sapien or Sapien XT, n = 15), or a self-expanding (Medtronic CoreValve or Core Evolut, n = 14, St. Jude Portico, n = 1) valve. Pre-procedural computed tomography (CT) angiograms, parametric geometry modeling, and multi-material 3D printing were utilized to create flexible aortic root physical models, including displaceable calcified valve leaflets. A 3D printed adjustable sizing device was then positioned in the aortic root models and sequentially opened to larger valve sizes, progressively flattening the calcified leaflets against the aortic wall. Optimal valve size and fit were determined by visual inspection and quantitative pressure mapping of interactions between the sizer and models.

RESULTS

Benchtop-predicted "best fit" valve size showed a statistically significant correlation with gold standard CT measurements of the average annulus diameter (n = 30, p < 0.0001 Wilcoxon matched-pairs signed rank test). Adequateness of seal (presence or absence of paravalvular leak) was correctly predicted in 11/15 (73.3%) patients who received a balloon-expandable valve, and in 9/15 (60%) patients who received a self-expanding valve. Pressure testing provided a physical map of areas with an inadequate seal; these corresponded to areas of paravalvular leak documented by post-procedural transthoracic echocardiography.

CONCLUSION

We present and demonstrate the potential of a workflow for determining optimal prosthetic valve size that accounts for aortic annular dimensions as well as the active displacement of calcified valve leaflets during prosthetic valve deployment. The workflow's open source framework offers a platform for providing predictive insights into the design and testing of future prosthetic valves.

Design Principles and Multifunctionality in Cell Encapsulation Systems for Tissue Regeneration

Cell encapsulation systems are being increasingly applied as multifunctional strategies to regenerate tissues. Lessons afforded with encapsulation systems aiming to treat endocrine diseases seem to be highly valuable for the tissue engineering and regenerative medicine (TERM) systems of today, in which tissue regeneration and biomaterial integration are key components. Innumerous multifunctional systems for cell compartmentalization are being proposed to meet the specific needs required in the TERM field. Herein is reviewed the variable geometries proposed to produce cell encapsulation strategies toward tissue regeneration, including spherical and fiber-shaped systems, and other complex shapes and arrangements that better mimic the highly hierarchical organization of native tissues. The application of such principles in the TERM field brings new possibilities for the development of highly complex systems, which holds tremendous promise for tissue regeneration. The complex systems aim to recreate adequate environmental signals found in native tissue (in particular during the regenerative process) to control the cellular outcome, and conferring multifunctional properties, namely the incorporation of bioactive molecules and the ability to create smart and adaptative systems in response to different stimuli. The new multifunctional properties of such systems that are being employed to fulfill the requirements of the TERM field are also discussed.

Bio-Based Polymers for 3D Printing of Bioscaffolds

Three-dimensional (3D) printing technologies enable not only faster bioconstructs development but also on-demand and customized manufacturing, offering patients a personalized biomedical solution. This emerging technique has a great potential for fabricating bioscaffolds with complex architectures and geometries and specifically tailored for use in regenerative medicine. The next major innovation in this area will be the development of biocompatible and histiogenic 3D printing materials with bio-based printable polymers. This review will briefly discuss 3D printing techniques and their current limitations, with a focus on novel bio-based polymers as 3D printing feedstock for clinical medicine and tissue regeneration.

Recapitulating kidney development: Progress and challenges

Decades of research into the molecular and cellular regulation of kidney morphogenesis in rodent models, particularly the mouse, has provided both an atlas of the mammalian kidney and a roadmap for recreating kidney cell types with potential applications for the treatment of kidney disease. With advances in both our capacity to maintain nephron progenitors in culture, reprogram to kidney cell types and direct the differentiation of human pluripotent stem cells to kidney endpoints, renal regeneration via cellular therapy or tissue engineering may be possible. Human kidney models also have potential for disease modelling and drug screening. Such applications will rely upon the accuracy of the model at the cellular level and the capacity for stem-cell derived kidney tissue to recapitulate both normal and diseased kidney tissue. In this review, we will discuss the available cell sources, how well they model the human kidney and how far we are from application either as models or for tissue engineering.

3D Printed Polymeric Hydrogels for Nerve Regeneration

The human nervous system lacks an inherent ability to regenerate its components upon damage or diseased conditions. During the last decade, this has motivated the development of a number of strategies for nerve regeneration. However, most of those approaches have not been used in clinical applications till today. For instance, although biomaterial-based scaffolds have been extensively used for nerve reparation, the lack of more customized structures have hampered their use in vivo. This highlight focuses mainly on how 3D bioprinting technology, using polymeric hydrogels as bio-inks, can be used for the development of new nerve guidance channels or devices for peripheral nerve cell regeneration. In this concise contribution, some of the most recent and representative examples are highlighted to discuss the challenges involved in various aspects of 3D bioprinting for nerve cell regeneration, specifically when using polymeric hydrogels.

Addressing Unmet Clinical Needs with 3D Printing Technologies

Recent advances in 3D printing have enabled the creation of novel 3D constructs and devices with an unprecedented level of complexity, properties, and functionalities. In contrast to manufacturing techniques developed for mass production, 3D printing encompasses a broad class of fabrication technologies that can enable 1) the creation of highly customized and optimized 3D physical architectures from digital designs; 2) the synergistic integration of properties and functionalities of distinct classes of materials to create novel hybrid devices; and 3) a biocompatible fabrication approach that facilitates the creation and cointegration of biological constructs and systems. This progress report describes how these capabilities can potentially address a myriad of unmet clinical needs. First, the creation of 3D-printed prosthetics to regain lost functionalities by providing structural support for skeletal and tubular organs is highlighted. Second, novel drug delivery strategies aided by 3D-printed devices are described. Third, the advancement of medical research heralded by 3D-printed tissue/organ-on-chips systems is discussed. Fourth, the developments of 3D-printed tissue and organ regeneration are explored. Finally, the potential for seamless integration of engineered organs with active devices by leveraging the versatility of multimaterial 3D printing is envisioned.

Fabrication of Stand-Alone Cell-Laden Collagen Vascular Network Scaffolds Using Fugitive Pattern-Based Printing-Then-Casting Approach

Vascular networks are of great significance in tissue engineering and viewed as the first step to fabricate human tissues. Although various techniques have been investigated to create vascular and vascular-like networks, the fabrication of stand-alone pure collagen-based vascular constructs is still a challenge because of the poor extrudability, weak mechanical property, and long cross-linking time of pure collagen solutions. In this study, a fugitive pattern-based printing-then-casting approach is investigated. The proposed alginate-based fugitive ink has excellent mechanical strength (by adding Laponite nanoclay), printability (by adding Laponite nanoclay), and controllable gelation rate (by adding disodium hydrogen phosphate). Using this fugitive ink, complex vascular-like structures can be easily printed and cross-linked in Laponite EP bath as fugitive vascular tree patterns. Each fugitive vascular tree pattern is then embedded in a gelatin bath to make a gelatin mold with the tree patterns. With the help of sodium citrate, the fugitive vascular tree pattern is liquefied and removed to create the gelatin mold with vascular channels. Finally, a stand-alone collagen vascular network scaffold embedded with fibroblasts can be fabricated by casting the cell-laden collagen suspension into the gelatin mold and releasing it from the mold at 37 °C. The cell-related investigations indicate that the cells grow and spread well in the pure collagen vascular network scaffold. The proposed hybrid printing-then-casting approach also provides a feasible technology to fabricate with materials having low viscosity, long gelation time, and poor mechanical property.

3D Bioprinting Stem Cell Derived Tissues

Stem cells offer tremendous promise for regenerative medicine as they can become a variety of cell types. They also continuously proliferate, providing a renewable source of cells. Recently, it has been found that 3D printing constructs using stem cells, can generate models representing healthy or diseased tissues, as well as substitutes for diseased and damaged tissues. Here, we review the current state of the field of 3D printing stem cell derived tissues. First, we cover 3D printing technologies and discuss the different types of stem cells used for tissue engineering applications. We then detail the properties required for the bioinks used when printing viable tissues from stem cells. We give relevant examples of such bioprinted tissues, including adipose tissue, blood vessels, bone, cardiac tissue, cartilage, heart valves, liver, muscle, neural tissue, and pancreas. Finally, we provide future directions for improving the current technologies, along with areas of focus for future work to translate these exciting technologies into clinical applications.

An Additive Manufacturing Technique for the Facile and Rapid Fabrication of Hydrogel-based Micromachines with Magnetically Responsive Components

Polyethylene glycol (PEG)-based hydrogels are biocompatible hydrogels that have been approved for use in humans by the FDA. Typical PEG-based hydrogels have simple monolithic architectures and often function as scaffolding materials for tissue engineering applications. More sophisticated structures typically take a long time to fabricate and do not contain moving components. This protocol describes a photolithography method that allows for facile and rapid microfabrication of PEG structures and devices. This strategy involves an in-house developed fabrication stage that allows for the rapid fabrication of 3D structures by building upwards in a layer-by-layer fashion. Independent moving components can also be aligned and assembled onto support structures to form integrated devices. These independent components are doped with superparamagnetic iron oxide nanoparticles that are sensitive to magnetic actuation. In this manner, the fabricated devices can be actuated using external magnets to yield movement of the components within. Hence, this technique allows for the fabrication of sophisticated MEMS-like devices (micromachines) that are composed entirely out of a biocompatible hydrogel, able to function without an onboard power source, and respond to a contact-less method of actuation. This manuscript describes the fabrication of both the fabrication set-up as well as the step-by-step method for the microfabrication of these hydrogels-based MEMS-like devices.

Inkjet-Spray Hybrid Printing for 3D Freeform Fabrication of Multilayered Hydrogel Structures

Here, a new bioprinting process by combining drop-on-demand inkjet printing with a spray-coating technique, which enables the high-resolution, high-speed, and freeform fabrication of large-scale cell-laden hydrogel structures is reported. Hydrogel structures with various shapes and composed of different materials, including alginate, cellulose nanofiber, and fibrinogen, are fabricated using the inkjet-spray printing. To manufacture cell-friendly hydrogel structures with controllable stiffness, gelatine methacryloyl is saponified to stabilize jet formation and is subsequently mixed with sodium alginate to prepare blend inks. The hydrogels crosslinked from the blend inks are characterized by assessing physical properties including the microstructure and mechanical stiffness and cellular responses including the cell viability, metabolic activity, and functionality of human dermal fibroblasts within the hydrogel. Cell-laden hydrogel structures are generated on a large scale and collagen type I secretion and spreading of cells within the hydrogels are assessed. The results demonstrate that the inkjet-spray printing system will ensure the formation of a cell-laden hydrogel structure with high shape fidelity in a rapid and reliable manner. Ultimately, the proposed printing technique and the blend bioink to be used to fabricate 3D laminated large-scale tissue equivalents that potentially mimic the function of native tissues is expected.

3D bioprinting for cardiovascular regeneration and pharmacology

Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. Compared to traditional therapeutic strategies, three-dimensional (3D) bioprinting is one of the most advanced techniques for creating complicated cardiovascular implants with biomimetic features, which are capable of recapitulating both the native physiochemical and biomechanical characteristics of the cardiovascular system. The present review provides an overview of the cardiovascular system, as well as describes the principles of, and recent advances in, 3D bioprinting cardiovascular tissues and models. Moreover, this review will focus on the applications of 3D bioprinting technology in cardiovascular repair/regeneration and pharmacological modeling, further discussing current challenges and perspectives.