Light-based 3D bioprinting technology applied to repair and regeneration of different tissues: A rational proposal for biomedical applications

3D bioprinting technology, a subset of 3D printing technology, is currently witnessing widespread utilization in tissue repair and regeneration endeavors. In particular, light-based 3D bioprinting technology has garnered significant interest and favor. Central to its successful implementation lies the judicious selection of photosensitive polymers. Moreover, by fine-tuning parameters such as light irradiation time, choice of photoinitiators and crosslinkers, and their concentrations, the properties of the scaffolds can be tailored to suit the specific requirements of the targeted tissue repair sites. In this comprehensive review, we provide an overview of commonly utilized bio-inks suitable for light-based 3D bioprinting, delving into the distinctive characteristics of each material. Furthermore, we delineate strategies for bio-ink selection tailored to diverse repair locations, alongside methods for optimizing printing parameters. Ultimately, we present a coherent synthesis aimed at enhancing the practical application of light-based 3D bioprinting technology in tissue engineering, while also addressing current challenges and future prospects.

Macro, Micro, and Nano-Inspired Bioactive Polymeric Biomaterials in Therapeutic, and Regenerative Orofacial Applications

Introducing dental polymers has accelerated biotechnological research, advancing tissue engineering, biomaterials development, and drug delivery. Polymers have been utilized effectively in dentistry to build dentures and orthodontic equipment and are key components in the composition of numerous restorative materials. Furthermore, dental polymers have the potential to be employed for medication administration and tissue regeneration. To analyze the influence of polymer-based investigations on practical medical trials, it is required to evaluate the research undertaken in this sector. The present review aims to gather evidence on polymer applications in dental, oral, and maxillofacial reconstruction.

The Diamond Concept Enigma: Recent Trends of Its Implementation in Cross-linked Chitosan-Based Scaffolds for Bone Tissue Engineering

An increasing number of publications over the past ten years have focused on the development of chitosan-based cross-linked scaffolds to regenerate bone tissue. The design of biomaterials for bone tissue engineering applications relies heavily on the ideals set forth by a polytherapy approach called the "Diamond Concept". This methodology takes into consideration the mechanical environment, scaffold properties, osteogenic and angiogenic potential of cells, and benefits of osteoinductive mediator encapsulation. The following review presents a comprehensive summarization of recent trends in chitosan-based cross-linked scaffold development within the scope of the Diamond Concept, particularly for nonload-bearing bone repair. A standardized methodology for material characterization, along with assessment of in vitro and in vivo potential for bone regeneration, is presented based on approaches in the literature, and future directions of the field are discussed.

Janus Self-Propelled Chitosan-Based Hydrogel Spheres for Rapid Bleeding Control

Uncontrolled hemorrhage is a major cause of potentially preventable death in civilian trauma nowadays. Considerable concern has been given to the development of efficient hemostats with high blood absorption, self-propelled property, and Ca2+ release ability, for irregularly shaped and noncompressible hemorrhage. Herein, Janus self-propelled chitosan-based hydrogel with CaCO3 (J-CMH@CaCO3 ) is developed by partial ionic crosslinking of carboxylated chitosan (CCS) and Ca2+ , gravity settlement, and photopolymerization, followed by removing the shell of CCS. The obtained J-CMH@CaCO3 is further used as a hemostat powered by the internal CaCO3 and coordinated protonated tranexamic acid (J-CMH@CaCO3 /T). Bubbles are generated and detached to provide the driving force, accompanied by the release of Ca2+ . The two aspects work in synergy to accelerate clot formation, endowing the J-CMH@CaCO3 /T with excellent hemostatic efficiency. The J-CMH@CaCO3 /T presents high blood absorption, favorable blood-clotting ability, desired erythrocyte and platelet aggregation, and acceptable hemocompatibility and cytocompatibility. In rodent and rabbit bleeding models, the J-CMH@CaCO3 /T exhibits the most effective hemostasis to the best knowledge of the authors, wherein the hemorrhage is rapidly halted within 39 s. It is believed that the J-CMH@CaCO3 /T with self-propelled property opens up a new avenue to design high-performance hemostats for clinical application.

Glucose-sensitive delivery of tannic acid by a photo-crosslinked chitosan hydrogel film for antibacterial and anti-inflammatory therapy

A glucose-sensitive antibacterial and anti-inflammatory hydrogel film with controlled release of tannic acid (TA) was synthesized using chitosan (CS). Specifically, the photo-crosslinked CS hydrogel was first obtained and then immersed in TA solution to generate composite hydrogel film with enhanced mechanical properties. Subsequently, N-hydroxysuccinimide/1-ethyl-3-(3-dimethylaminopropyl) carbodiimide based coupling chemistry was used to covalently crosslink glucose oxidase (GOx) to CS to obtain glucose sensitivity. The physicochemical properties, including chemical composition, enzyme-related characteristics, glucose responsiveness, and mechanical strength, were thoroughly investigated, followed by the cytotoxicity, antibacterial and anti-inflammatory tests. The results showed that the GOx immobilized on the film surface by covalent bonding gave better stability than those that were physically adsorbed. In addition, it could quickly and correspondingly modify its inner pore structure in response to the glucose stimulus and then control the loaded TA release. Meanwhile, the TA addition could enhance the film's mechanical properties. The composite hydrogel film demonstrated adequate biocompatibility and can inhibit NO, IL-6, and TNF-α production in stimulated macrophages, as well as Porphyromonas gingivalis growth, demonstrating effective antibacterial and anti-inflammatory activity.

Thermoresponsive Hemostatic Hydrogel with a Biomimetic Nanostructure Constructed from Aggregated Collagen Nanofibers

Uncontrollable bleeding poses considerable fatality risks by large-volume blood losses. Current emergency antibleeding handlings including either compression with gauze or "passive" blood transfusion are thus far from ideal, while most recently developed hemostatic agents still share common limitations without considering the subsequent tissue repairing and antibacterial activity after treatment. Herein, we introduce a novel bioinspired aggregated collagen nanofiber-based biocompatible and efficient hemostatic hydrogel material (TS-Gel-Ag-col) prepared by the integration of multifunctional compounds of muco-mimetic poloxamer, polyvinylpyrrolidone, and dencichine/chitosan dialdehyde synergistic crosslinked aggregated collagen nanofibers decorated with silver nanoparticles. Comprehensive material characterization and in vitro and in vivo studies of TS-Gel-Ag-col demonstrate that these materials possess effective antihemorrhagic and antibacterial wound protection effects. Moreover, TS-Gel-Ag-col can facilitate the tissue repairing of skin wounds by promoting revascularization. TS-Gel-Ag-col holds great promise for next-generation collagen-based absorbable hemostatic materials and for the development of smart artificial skins.

Progress and Prospects of Polymer-Based Drug Delivery Systems for Bone Tissue Regeneration

Despite the high regenerative capacity of bone tissue, there are some cases where bone repair is insufficient for a complete functional and structural recovery after damage. Current surgical techniques utilize natural and synthetic bone grafts for bone healing, as well as collagen sponges loaded with drugs. However, there are certain disadvantages associated with these techniques in clinical usage. To improve the therapeutic efficacy of bone tissue regeneration, a number of drug delivery systems based on biodegradable natural and synthetic polymers were developed and examined in in vitro and in vivo studies. Recent studies have demonstrated that biodegradable polymers play a key role in the development of innovative drug delivery systems and tissue engineered constructs, which improve the treatment and regeneration of damaged bone tissue. In this review, we discuss the most recent advances in the field of polymer-based drug delivery systems for the promotion of bone tissue regeneration and the physical-chemical modifications of polymers for controlled and sustained release of one or more drugs. In addition, special attention is given to recent developments on polymer nano- and microparticle-based drug delivery systems for bone regeneration.

Injectable Chitosan Scaffolds with Calcium β-Glycerophosphate as the Only Neutralizing Agent

The presented work describes the method of preparation of thermosensitive chitosan hydrogels using calcium β-glycerophosphate salt as the only pH neutralizing agent and supporting the crosslinking process. The presence of calcium ions instead of sodium ions is particularly important in the case of scaffolds in bone tissue engineering. Rheological and physicochemical properties of low concentrated chitosan solutions with the addition of calcium β-glycerophosphate were investigated using rotational rheometry techniques, Zeta potential (by electrophoresis), XPS, and SEM analysis together with an EDS detector. It was found to be possible to prepare colloidal solutions of chitosan containing only calcium β-glycerophosphate (without sodium ions) undergoing a sol-gel phase transition at the physiological temperature of the human body. It has also been shown that it is possible to further enrich the obtained cellular scaffolds with calcium ions. Using the addition of calcium carbonate, hydrogels with a physiological ratio of calcium to phosphorus (1.6–1.8):1 were obtained.

Glucose-sensitive delivery of metronidazole by using a photo-crosslinked chitosan hydrogel film to inhibit Porphyromonas gingivalis proliferation

A novel glucose-sensitive drug delivery system with controlled release of metronidazole was synthesized by using biocompatible photo-crosslinked chitosan hydrogel film. Specifically, methacrylic anhydride, as photosensitive substance, was firstly grafted on chitosan molecular chains and then UV irradiation was applied as the crosslinking method. Glucose sensitivity was endowed by immobilizing glucose oxidase on the surface of chitosan film. The physicochemical characteristics including chemical composition, crosslinking degree, mechanical strength and related enzyme properties were investigated successively. Cytotoxicity test, drug release and anti-bacterial test were carried out, respectively. The results show that this photo-crosslinked hydrogel film has good mechanical properties; meanwhile, the immobilized enzyme's bonding capacity and activity can maintain a relatively high level after surface activation. In addition, this material possesses better biocompatibility than chemical crosslinked samples. What's more, it can sense the ambient glucose stimulus, rapidly and correspondingly adjust its inner pore structure to control the loaded metronidazole release, lead to an improved antimicrobial activity against Porphyromonas gingivalis under high glucose concentration. This glucose sensitive hydrogel film may provide a promising method for diabetic's periodontitis therapy in clinic.

Functionally Graded, Bone- and Tendon-Like Polyurethane for Rotator Cuff Repair

Critical considerations in engineering biomaterials for rotator cuff repair include bone-tendon-like mechanical properties to support physiological loading and biophysicochemical attributes that stabilize the repair site over the long-term. In this study, UV-crosslinkable polyurethane based on quadrol (Q), hexamethylene diisocyante (H), and methacrylic anhydride (M; QHM polymers), which are free of solvent, catalyst, and photoinitiator, is developed. Mechanical characterization studies demonstrate that QHM polymers possesses phototunable bone- and tendon-like tensile and compressive properties (12-74 MPa tensile strength, 0.6-2.7 GPa tensile modulus, 58-121 MPa compressive strength, and 1.5-3.0 GPa compressive modulus), including the capability to withstand 10 000 cycles of physiological tensile loading and reduce stress concentrations via stiffness gradients. Biophysicochemical studies demonstrate that QHM polymers have clinically favorable attributes vital to rotator cuff repair stability, including slow degradation profiles (5-30% mass loss after 8 weeks) with little-to-no cytotoxicity in vitro, exceptional suture retention ex vivo (2.79-3.56-fold less suture migration relative to a clinically available graft), and competent tensile properties (similar ultimate load but higher normalized tensile stiffness relative to a clinically available graft) as well as good biocompatibility for augmenting rat supraspinatus tendon repair in vivo. This work demonstrates functionally graded, bone-tendon-like biomaterials for interfacial tissue engineering.

Mineralized alginate hydrogels using marine carbonates for bone tissue engineering applications

The search for an ideal bone tissue replacement has led to the development of new composite materials designed to simulate the complex inorganic/organic structure of bone. The present work is focused on the development of mineralized calcium alginate hydrogels by the addition of marine derived calcium carbonate biomineral particles. Following a novel approach, we were able to obtain calcium carbonate particles of high purity and complex micro and nanostructure dependent on the source material. Three different types of alginates were selected to develop inorganic/organic scaffolds in order to correlate alginate composition with scaffold properties and cell behavior. The incorporation of calcium carbonates into alginate networks was able to promote extracellular matrix mineralization and osteoblastic differentiation of mesenchymal stem cells when added at 7 mg/ml. We demonstrated that the selection of the alginate type and calcium carbonate origin is crucial to obtain adequate systems for bone tissue engineering as they modulate the mechanical properties and cell differentiation.

Nerve growth factor loaded heparin/chitosan scaffolds for accelerating peripheral nerve regeneration

Artificial chitosan scaffolds have been widely investigated for peripheral nerve regeneration. However, the effect was not as good as that of autologous grafts and therefore could not meet the clinical requirement. In the present study, the nerve growth factor (NGF) loaded heparin/chitosan scaffolds were fabricated via electrostatic interaction for further improving nerve regeneration. The physicochemical properties including morphology, wettability and composition were measured. The heparin immobilization, NGF loading and release were quantitatively and qualitatively characterized, respectively. The effect of NGF loaded heparin/chitosan scaffolds on nerve regeneration was evaluated by Schwann cells culture for different periods. The results showed that the heparin immobilization and NGF loading did not cause the change of bulk properties of chitosan scaffolds except for morphology and wettability. The pre-immobilization of heparin in chitosan scaffolds could enhance the stability of subsequently loaded NGF. The NGF loaded heparin/chitosan scaffolds could obviously improve the attachment and proliferation of Schwann cells in vitro. More importantly, the NGF loaded heparin/chitosan scaffolds could effectively promote the morphology development of Schwann cells. The study may provide a useful experimental basis to design and develop artificial implants for peripheral nerve regeneration and other tissue regeneration.

Adsorbed Fibrinogen stimulates TLR-4 on monocytes and induces BMP-2 expression

Modulation of inflammatory responses to implanted biomaterials towards tissue regeneration has gained prominence as an innovative tissue engineering strategy. Recent in vitro and in vivo studies showed that Fibrinogen (Fg) adsorbed to Chitosan (Ch) substrates modulates immune cell responses, enhances the production of osteogenic factors by monocytes/macrophages and promotes bone regeneration, but the mechanisms involved remain poorly understood. Thus, the present work was conducted to clarify the molecular mechanisms of interaction between primary human monocytes and the above substrates. Cell surface expression of TLR-4 was significantly downregulated in the presence of pre-adsorbed Fg, when compared to Ch control, indicating an interaction via this receptor. The same substrate triggered MAPK activation, specifically the ERK 1/2 and JNK pathways. Importantly, both ERK 1/2 and JNK phosphorylation were reduced when TLR-4 signalling was blocked using a specific pharmacological inhibitor. Functionally, adsorbed Fg induced production of the potent osteogenic mediator BMP-2 by monocytes, while TLR-4 inhibition resulted in a significant decrease of BMP-2 mRNA and protein levels, in response to Fg stimulation. Overall, our data reveals that adsorbed Fg exerts a pro-osteogenic effect on human monocytes through its interaction with TLR-4 and subsequent production of BMP-2, elucidating two key aspects of the immunomodulatory action of adsorbed Fg in bone regeneration.

STATEMENT OF SIGNIFICANCE

Recent studies showed that when Fibrinogen (Fg) is used to modify Chitosan (Ch) substrates, it modulates the immune response, enhances production of osteogenic factors by monocytes/macrophages, and promotes bone regeneration. However, the mechanisms involved in monocyte-Fg interaction, were only partially known. Current work addresses the interaction between primary human monocytes and Ch surfaces modified by Fg adsorption (Ch-Fg) at the molecular level. Results show that monocytes interact specifically with Ch-Fg via TLR-4, triggering particular intracellular signalling pathways (ERK and JNK, but not p38), downstream of TLR-4. Functionally, Ch-Fg induced monocytes to produce the osteogenic mediator BMP-2. Thus, we clarify herein two essential aspects of the interaction between adsorbed Fg and monocytes, with impact on immunomodulation and regeneration, upon biomaterial implantation.

Chitosan as a vehicle for growth factor delivery: Various preparations and their applications in bone tissue regeneration

The replacement of conventional autografts and allografts by bone fragments constructed from alternate materials, cells, and molecules (growth factors, drugs, etc.) is an exciting prospect in the field of bone tissue engineering. Bone morphogenetic protein-2 (BMP-2) is a growth factor that has been extensively studied from this point of view. This review analyzes the relevance of chitosan and its derivatives and composites with various materials such as ceramics, heparin, silica, stem cells, titanium implants, etc., in terms of delivering BMP-2 for the purpose of bone regeneration. Chitosan offers the versatility to be modified into any shapes or sizes including conversion to nanoparticles, microspheres, nanofibers, porous scaffolds, and films. The results presented in this review clearly demonstrate that chitosan-based materials are biocompatible and have the potential to systematically and sustainably release BMP-2 where required. This release results in enhanced cell proliferation levels, enhancement of alkaline phosphatase activity, increased differentiation as well as increased mineralization under in vitro and in vivo conditions. This review also shines a spotlight on the currently developed chitosan-based products that are being used for BMP-2 delivery.

Engineering a Dual-Layer Chitosan-Lactide Hydrogel To Create Endothelial Cell Aggregate-Induced Microvascular Networks In Vitro and Increase Blood Perfusion In Vivo

Here, we report the use of chemically cross-linked and photo-cross-linked hydrogels to engineer human umbilical vein endothelial cell (HUVEC) aggregate-induced microvascular networks to increase blood perfusion in vivo. First, we studied the effect of chemically cross-linked and photo-cross-linked chitosan-lactide hydrogels on stiffness, degradation rates, and HUVEC behaviors. The photo-cross-linked hydrogel was relatively stiff (E = ∼15 kPa) and possessed more compact networks, denser surface texture, and lower enzymatic degradation rates than the relatively soft, chemically cross-linked hydrogel (E = ∼2 kPa). While both hydrogels exhibited nontoxicity, the soft chemically cross-linked hydrogels expedited the formation of cell aggregates compared to the photo-cross-linked hydrogels. Cells on the less stiff, chemically cross-linked hydrogels expressed more matrix metalloproteinase (MMP) activity than the stiffer, photo-cross-linked hydrogel. This difference in MMP activity resulted in a more dramatic decrease in mechanical stiffness after 3 days of incubation for the chemically cross-linked hydrogel, as compared to the photo-cross-linked one. After determining the physical and biological properties of each hydrogel, we accordingly engineered a dual-layer hydrogel construct consisting of the relatively soft, chemically cross-linked hydrogel layer for HUVEC encapsulation, and the relatively stiff, acellular, photo-cross-linked hydrogel for retention of cell-laden microvasculature above. This dual-layer hydrogel construct enabled a lasting HUVEC aggregate-induced microvascular network due to the combination of stable substrate, enriched cell adhesion molecules, and extracellular matrix proteins. We tested the dual-layer hydrogel construct in a mouse model of hind-limb ischemia, where the HUVEC aggregate-induced microvascular networks significantly enhanced blood perfusion rate to ischemic legs and decreased tissue necrosis compared with both no treatment and nonaggregated HUVEC-loaded hydrogels within 2 weeks. This study suggests an effective means for regulating hydrogel properties to facilitate a stable, HUVEC aggregate-induced microvascular network for a variety of vascularized tissue applications.

Heparin binding-epidermal growth factor-like growth factor for the regeneration of chronic tympanic membrane perforations in mice

We aim to explore the role of epidermal growth factor (EGF) ligand shedding in tympanic membrane wound healing and to investigate the translation of its modulation in tissue engineering of chronic tympanic membrane perforations. Chronic suppurative otitis media (CSOM) is an infected chronic tympanic membrane perforation. Up to 200 million suffer from its associated hearing loss and it is the most common cause of pediatric hearing loss in developing countries. There is a need for nonsurgical treatment due to a worldwide lack of resources. In this study, we show that EGF ligand shedding is essential for tympanic membrane healing as it's inhibition, with KB-R7785, leads to chronic perforation in 87.9% (n=58) compared with 0% (n=20) of controls. We then show that heparin binding-EGF-like growth factor (5 μg/mL), which acts to shed EGF ligands, can regenerate chronic perforations in mouse models with 92% (22 of 24) compared with 38% (10 of 26), also with eustachian tube occlusion with 94% (18 of 19) compared with 9% (2 of 23) and with CSOM 100% (16 of 16) compared with 41% (7 of 17). We also show the nonototoxicity of this treatment and its hydrogel delivery vehicle. This provides preliminary data for a clinical trial where it could be delivered by nonspecialist trained healthcare workers and fulfill the clinical need for a nonsurgical treatment for chronic tympanic membrane perforation and CSOM.

Vascularization in bone tissue engineering constructs

Vascularization of large bone grafts is one of the main challenges of bone tissue engineering (BTE), and has held back the clinical translation of engineered bone constructs for two decades so far. The ultimate goal of vascularized BTE constructs is to provide a bone environment rich in functional vascular networks to achieve efficient osseointegration and accelerate restoration of function after implantation. To attain both structural and vascular integration of the grafts, a large number of biomaterials, cells, and biological cues have been evaluated. This review will present biological considerations for bone function restoration, contemporary approaches for clinical salvage of large bone defects and their limitations, state-of-the-art research on the development of vascularized bone constructs, and perspectives on evaluating and implementing novel BTE grafts in clinical practice. Success will depend on achieving full graft integration at multiple hierarchical levels, both between the individual graft components as well as between the implanted constructs and their surrounding host tissues. The paradigm of vascularized tissue constructs could not only revolutionize the progress of BTE, but could also be readily applied to other fields in regenerative medicine for the development of new innovative vascularized tissue designs.

Synthesis and characterization of a photocrosslinkable chitosan–gelatin hydrogel aimed for tissue regeneration

In the area of regenerative medicine different approaches have been studied to restore the native structure of damaged tissues. Herein, the suitability of a photocrosslinkable hydrogel for tissue engineering applications was studied.

Novel osteoinductive photo-cross-linkable chitosan-lactide-fibrinogen hydrogels enhance bone regeneration in critical size segmental bone defects

The purpose of this study was to develop and characterize a novel photo-cross-linkable chitosan-lactide-fibrinogen (CLF) hydrogel and evaluate the efficacy of bone morphogenetic protein-2 (BMP-2) containing a CLF hydrogel for osteogenesis in vitro and in vivo. We synthesized the CLF hydrogels and characterized their chemical structure, degradation rate, compressive modulus and in vitro BMP-2 release kinetics. We evaluated bioactivities of the BMP-2 containing CLF hydrogels (0, 50, 100 and 500ngml(-1)) in vitro using W-20-17 preosteoblast mouse bone marrow stromal cells and C2C12 mouse myoblast cells. The effect of BMP-2 containing CLF gels (0, 0.5, 1, 2 and 5μg) on bone formation was evaluated using rat critical size segmental bone defects for 4weeks. Fourier transform infrared spectroscopy spectra and scanning electron microscopy images showed chemical and structural changes by the addition of fibrinogen into the chitosan-lactide copolymer. The incorporation of fibrinogen molecules significantly increased the compressive modulus of the hydrogels. The in vitro BMP-2 release study showed initial burst releases from the CLF hydrogels followed by sustained releases, regardless of the concentration of the BMP-2 over 4weeks. Cells in all groups were viable in the presence of the hydrogels regardless of BMP-2 doses, indicating non-cytotoxicity of hydrogels. Alkaline phosphate activity and mineralization of cells exhibited dose dependence on BMP-2 containing CLF hydrogels. Radiography, microcomputed tomography and histology confirmed that the BMP-2 containing CLF hydrogels prompted neo-osteogenesis and accelerated healing of the defects in a dose-dependent manner. Thus the CLF hydrogel is a promising delivery system of growth factors for bone regeneration.

Chitosan-based scaffolds for bone tissue engineering

Bone defects requiring grafts to promote healing are frequently occurring and costly problems in health care. Chitosan, a biodegradable, naturally occurring polymer, has drawn considerable attention in recent years as scaffolding material in tissue engineering and regenerative medicine. Chitosan is especially attractive as a bone scaffold material because it supports the attachment and proliferation of osteoblast cells as well as formation of mineralized bone matrix. In this review, we discuss the fundamentals of bone tissue engineering and the unique properties of chitosan as a scaffolding material to treat bone defects for hard tissue regeneration. We present the common methods for fabrication and characterization of chitosan scaffolds, and discuss the influence of material preparation and addition of polymeric or ceramic components or biomolecules on chitosan scaffold properties such as mechanical strength, structural integrity, and functional bone regeneration. Finally, we highlight recent advances in development of chitosan-based scaffolds with enhanced bone regeneration capability.