3D printing of patient-specific implants for osteochondral defects: workflow for an MRI-guided zonal design

Mesenchymal stem cells for cartilage regeneration: Insights into molecular mechanism and therapeutic strategies

The use of mesenchymal stem cells (MSCs) in cartilage regeneration has gained significant attention in regenerative medicine. This paper reviews the molecular mechanisms underlying MSC-based cartilage regeneration and explores various therapeutic strategies to enhance the efficacy of MSCs in this context. MSCs exhibit multipotent capabilities and can differentiate into various cell lineages under specific microenvironmental cues. Chondrogenic differentiation, a complex process involving signaling pathways, transcription factors, and growth factors, plays a pivotal role in the successful regeneration of cartilage tissue. The chondrogenic differentiation of MSCs is tightly regulated by growth factors and signaling pathways such as TGF-β, BMP, Wnt/β-catenin, RhoA/ROCK, NOTCH, and IHH (Indian hedgehog). Understanding the intricate balance between these pathways is crucial for directing lineage-specific differentiation and preventing undesirable chondrocyte hypertrophy. Additionally, paracrine effects of MSCs, mediated by the secretion of bioactive factors, contribute significantly to immunomodulation, recruitment of endogenous stem cells, and maintenance of chondrocyte phenotype. Pre-treatment strategies utilized to potentiate MSCs, such as hypoxic conditions, low-intensity ultrasound, kartogenin treatment, and gene editing, are also discussed for their potential to enhance MSC survival, differentiation, and paracrine effects. In conclusion, this paper provides a comprehensive overview of the molecular mechanisms involved in MSC-based cartilage regeneration and outlines promising therapeutic strategies. The insights presented contribute to the ongoing efforts in optimizing MSC-based therapies for effective cartilage repair.

The fabrication of the chitosan-based bioink for in vitro tissue repair and regeneration: A review

The repair and regeneration of the injured tissues or organs is a major challenge for biomedicine, and the emerging 3D bioprinting technology as a class of promising techniques in biomedical research for the development of tissue engineering and regenerative medicine. Chitosan-based bioinks, as the natural biomaterials, are considered as ideal materials for 3D bioprinting to design and fabricate the various scaffold due to their unique dynamic reversibility and fantastic biological properties. Our review aims to provide an overview of chitosan-based bioinks for in vitro tissue repair and regeneration, starting from modification of chitosan that affect these bioprinting processes. In addition, we summarize the advances in chitosan-based bioinks used in the various 3D printing strategies. Moreover, the biomedical applications of chitosan-based bioinks are discussed, primarily centered on regenerative medicine and tissue modeling engineering. Finally, current challenges and future opportunities in this field are discussed. The combination of chitosan-based bioinks and 3D bioprinting will hold promise for developing novel biomedical scaffolds for tissue or organ repair and regeneration.

Multiphasic scaffolds for the repair of osteochondral defects: Outcomes of preclinical studies

Osteochondral defects are caused by injury to both the articular cartilage and subchondral bone within skeletal joints. They can lead to irreversible joint damage and increase the risk of progression to osteoarthritis. Current treatments for osteochondral injuries are not curative and only target symptoms, highlighting the need for a tissue engineering solution. Scaffold-based approaches can be used to assist osteochondral tissue regeneration, where biomaterials tailored to the properties of cartilage and bone are used to restore the defect and minimise the risk of further joint degeneration. This review captures original research studies published since 2015, on multiphasic scaffolds used to treat osteochondral defects in animal models. These studies used an extensive range of biomaterials for scaffold fabrication, consisting mainly of natural and synthetic polymers. Different methods were used to create multiphasic scaffold designs, including by integrating or fabricating multiple layers, creating gradients, or through the addition of factors such as minerals, growth factors, and cells. The studies used a variety of animals to model osteochondral defects, where rabbits were the most commonly chosen and the vast majority of studies reported small rather than large animal models. The few available clinical studies reporting cell-free scaffolds have shown promising early-stage results in osteochondral repair, but long-term follow-up is necessary to demonstrate consistency in defect restoration. Overall, preclinical studies of multiphasic scaffolds show favourable results in simultaneously regenerating cartilage and bone in animal models of osteochondral defects, suggesting that biomaterials-based tissue engineering strategies may be a promising solution.

Bioinks for Space Missions: The Influence of Long-Term Storage of Alginate-Methylcellulose-Based Bioinks on Printability as well as Cell Viability and Function

Bioprinting is considered a key technology for future space missions and is currently being established on the International Space Station (ISS). With the aim to perform bioink production as a critical and resource-consuming preparatory step already on Earth and transport a bioink cartridge "ready to use" to the ISS, the storability of bioinks is investigated. Hydrogel blends based on alginate and methylcellulose are laden with either green microalgae of the species Chlorella vulgaris or with different human cell lines including immortilized human mesenchymal stem cells, SaOS-2 and HepG2, as well as with primary human dental pulp stem cells. The bioinks are filled into printing cartridges and stored at 4°C for up to four weeks. Printability of the bioinks is maintained after storage. Viability and function of the cells embedded in constructs bioprinted from the stored bioinks are investigated during subsequent cultivation: The microalgae survive the storage period very well and show no loss of growth and functionality, however a significant decrease is visible for human cells, varying between the different cell types. The study demonstrates that storage of bioinks is in principle possible and is a promising starting point for future research, making complex printing processes more effective and reproducible.

Is 3D Printing Promising for Osteochondral Tissue Regeneration?

Osteochondral tissue regeneration is quite difficult to achieve due to the complexity of its organization. In the design of these complex multilayer structures, a fabrication method, 3D printing, started to be employed, especially by using extrusion, stereolithography and inkjet printing approaches. In this paper, the designs are discussed including biphasic, triphasic, and gradient structures which aim to mimic the cartilage and the calcified cartilage and the whole osteochondral tissue closely. In the first section of the review paper, 3D printing of hydrogels including gelatin methacryloyl (GelMa), alginate, and polyethylene glycol diacrylate (PEGDA) are discussed. However, their physical and biological properties need to be augmented, and this generally is achieved by blending the hydrogel with other, more durable, less hydrophilic, polymers. These scaffolds are very suitable to carry growth factors, such as TGF-β1, to further stimulate chondrogenesis. The bone layer is mimicked by printing calcium phosphates (CaPs) or bioactive glasses together with the hydrogels or as a component of another polymer layer. The current research findings indicate that polyester (i.e. polycaprolactone (PCL), polylactic acid (PLA) and poly(lactide-co-glycolide) (PLGA)) reinforced hydrogels may more successfully mimic the complex structure of osteochondral tissue. Moreover, more recent printing methods such as melt electrowriting (MEW), are being used to integrate polyester fibers to enhance the mechanical properties of hydrogels. Additionally, polyester scaffolds that are 3D printed without hydrogels are discussed after the hydrogel-based scaffolds. In this review paper, the relevant studies are analyzed and discussed, and future work is recommended with support of tables of designed scaffolds. The outcome of the survey of the field is that 3D printing has significant potential to contribute to osteochondral tissue repair.

Biomimetic biphasic scaffolds in osteochondral tissue engineering: Their composition, structure and consequences

Approaches to the design and construction of biomimetic scaffolds for osteochondral tissue, show increasing advances. Considering the limitations of this tissue in terms of repair and regeneration, there is a need to develop appropriately designed scaffolds. A combination of biodegradable polymers especially natural polymers and bioactive ceramics, shows promise in this field. Due to the complicated architecture of this tissue, biphasic and multiphasic scaffolds containing two or more different layers, could mimic the physiology and function of this tissue with a higher degree of similarity. The purpose of this review article is to discuss the approaches focused on the application of biphasic scaffolds for osteochondral tissue engineering, common methods of combining layers and the ultimate consequences of their use in patients were discussed.

3D extrusion printing of density gradients by variation of sinusoidal printing paths for tissue engineering and beyond

During extrusion printing of pasty biomaterials, internal geometries are mainly adjusted by positioning of straightly deposited strands which does not allow realization of spatially adaptable density gradients in x-, y- and z-direction for anisotropic scaffolds or anatomically shaped constructs. Herein, an alternative concept for printing patterns based on sinusoidal curves was evaluated using a clinically approved calcium phosphate cement (CPC). Infill density in scaffolds was adjusted by varying wavelength and amplitude of a sinus curve. Both wavelength and amplitude factors were defined by multitudes of the applied nozzle diameter. For CPC as a biomaterial ink in bone application, porosity, mechanical stiffness and biological response by seeded immortalized human mesenchymal stem cells - adhesion and pore bridging behavior - were investigated. The internal structure of a xyz-gradient scaffold was proven via X-ray based micro computed tomography (µCT). Silicone was used as a model material to investigate the impact of printing velocity and strand distance on the shape fidelity of the sinus pattern for soft matter printing. The impact of different sinus patterns on mechanical properties was assessed. Density and mechanical properties of CPC scaffolds were successfully adjusted without an adverse effect on adhesion and cell number development. In a proof-of-concept experiment, a sinus-adjusted density gradient in an anatomically shaped construct (human vertebral body) defined via clinical computed tomography (CT) data was demonstrated. This fills a technological gap for extrusion-based printing of freely adjustable, continuously guidable infill density gradients in all spatial directions. STATEMENT OF SIGNIFICANCE: 3D extrusion printing of biomaterials allows the generation of anatomically shaped, patient-specific implants or tissue engineering scaffolds. The density of such a structure is typically adjusted by the strand-to-strand distance of parallel, straight-meandered strands in each deposited layer. By printing in a sinusoidal pattern, design of density gradients is possible with a free, spatial resolution in x-, y- and z-direction. We demonstrated that porosity and mechanical properties can be freely adapted in this way without an adverse effect on cell adhesion. With the example of a CT dataset of a human spine, the anisotropic pattern of a vertebral body was resembled by this printing technique that can be translated to various patterns, materials and application.

A dual osteoconductive-osteoprotective implantable device for vertical alveolar ridge augmentation

Repair of large oral bone defects such as vertical alveolar ridge augmentation could benefit from the rapidly developing additive manufacturing technology used to create personalized osteoconductive devices made from porous tricalcium phosphate/hydroxyapatite (TCP/HA)-based bioceramics. These devices can be also used as hydrogel carriers to improve their osteogenic potential. However, the TCP/HA constructs are prone to brittle fracture, therefore their use in clinical situations is difficult. As a solution, we propose the protection of this osteoconductive multi-material (herein called “core”) with a shape-matched “cover” made from biocompatible poly-ɛ-caprolactone (PCL), which is a ductile, and thus more resistant polymeric material. In this report, we present a workflow starting from patient-specific medical scan in Digital Imaging and Communications in Medicine (DICOM) format files, up to the design and 3D printing of a hydrogel-loaded porous TCP/HA core and of its corresponding PCL cover. This cover could also facilitate the anchoring of the device to the patient's defect site via fixing screws. The large, linearly aligned pores in the TCP/HA bioceramic core, their sizes, and their filling with an alginate hydrogel were analyzed by micro-CT. Moreover, we created a finite element analysis (FEA) model of this dual-function device, which permits the simulation of its mechanical behavior in various anticipated clinical situations, as well as optimization before surgery. In conclusion, we designed and 3D-printed a novel, structurally complex multi-material osteoconductive-osteoprotective device with anticipated mechanical properties suitable for large-defect oral bone regeneration.

Osteochondral regenerative engineering: challenges, state-of-the-art and translational perspectives

Despite quantum leaps, the biomimetic regeneration of cartilage and osteochondral regeneration remains a major challenge, owing to the complex and hierarchical nature of compositional, structural and functional properties. In this review, an account of the prevailing challenges in biomimicking the gradients in porous microstructure, cells and extracellular matrix (ECM) orientation is presented. Further, the spatial arrangement of the cues in inducing vascularization in the subchondral bone region while maintaining the avascular nature of the adjacent cartilage layer is highlighted. With rapid advancement in biomaterials science, biofabrication tools and strategies, the state-of-the-art in osteochondral regeneration since the last decade has expansively elaborated. This includes conventional and additive manufacturing of synthetic/natural/ECM-based biomaterials, tissue-specific/mesenchymal/progenitor cells, growth factors and/or signaling biomolecules. Beyond the laboratory-based research and development, the underlying challenges in translational research are also provided in a dedicated section. A new generation of biomaterial-based acellular scaffold systems with uncompromised biocompatibility and osteochondral regenerative capability is necessary to bridge the clinical demand and commercial supply. Encompassing the basic elements of osteochondral research, this review is believed to serve as a standalone guide for early career researchers, in expanding the research horizon to improve the quality of life of osteoarthritic patients affordably.

3D Extrusion Printing of Biphasic Anthropomorphic Brain Phantoms Mimicking MR Relaxation Times Based on Alginate-Agarose-Carrageenan Blends

The availability of adapted phantoms mimicking different body parts is fundamental to establishing the stability and reliability of magnetic resonance imaging (MRI) methods. The primary purpose of such phantoms is the mimicking of physiologically relevant, contrast-creating relaxation times T₁ and T₂. For the head, frequently examined by MRI, an anthropomorphic design of brain phantoms would imply the discrimination of gray matter and white matter (WM) within defined, spatially distributed compartments. Multichannel extrusion printing allows the layer-by-layer fabrication of multiple pastelike materials in a spatially defined manner with a predefined shape. In this study, the advantages of this method are used to fabricate biphasic brain phantoms mimicking MR relaxation times and anthropomorphic geometry. The printable ink was based on purely naturally derived polymers: alginate as a calcium-cross-linkable gelling agent, agarose, ι-carrageenan, and GdCl₃ in different concentrations (0-280 μmol kg^-1) as the paramagnetic component. The suggested inks (e.g., 3Alg-1Agar-6Car) fulfilled the requirements of viscoelastic behavior and printability of large constructs (>150 mL). The microstructure and distribution of GdCl₃ were assessed by scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDX). In closely monitored steps of technological development and characterization, from monophasic and biphasic samples as printable inks and cross-linked gels, we describe the construction of large-scale phantom models whose relaxation times were characterized and checked for stability over time.

Structured Data Storage for Data-Driven Process Optimisation in Bioprinting

Bioprinting is a method to fabricate 3D models that mimic tissue. Future fields of application might be in pharmaceutical or medical context. As the number of applicants might vary between only one patient to manufacturing tissue for high-throughput drug screening, designing a process will necessitate a high degree of flexibility, robustness, as well as comprehensive monitoring. To enable quality by design process optimisation for future application, establishing systematic data storage routines suitable for automated analytical tools is highly desirable as a first step. This manuscript introduces a workflow for process design, documentation within an electronic lab notebook and monitoring to supervise the product quality over time or at different locations. Lab notes, analytical data and corresponding metadata are stored in a systematic hierarchy within the research data infrastructure Kadi4Mat, which allows for continuous, flexible data structuring and access management. To support the experimental and analytical workflow, additional features were implemented to enhance and build upon the functionality provided by Kadi4Mat, including browser-based file previews and a Python tool for the combined filtering and extraction of data. The structured research data management with Kadi4Mat enables retrospective data grouping and usage by process analytical technology tools connecting individual analysis software to machine-readable data exchange formats.

Synthesis and application of nanometer hydroxyapatite in biomedicine

Nano-hydroxyapatite (nano-HA) has been widely studied as a promising biomaterial because of its potential mechanical and biological properties. In this article, different synthesis methods for nano-HA were summarized. Key factors for the synthesis of nano-HA, including reactant concentration, effects of temperature, PH, additives, aging time, and sintering, were separately investigated. The biological performances of the nano-HA depend strongly on its structures, morphology, and crystallite sizes. Nano-HA with different morphologies may cause different biological effects, such as protein adsorption, cell viability and proliferation, angiogenesis, and vascularization. Recent research progress with respect to the biological functions of the nano-HA in some specific biological applications are summarized and the future development of nano-sized hydroxyapatite is prospected.

Addition of High Acyl Gellan Gum to Low Acyl Gellan Gum Enables the Blends 3D Bioprintable

Long-term stability of gellan gum (GG) at physiological conditions is expected, as very low concentration of divalent ions are required for crosslinking, as compared to alginate—which is extensively used for tissue engineering (TE) applications. Hence, GG is proposed as an ideal candidate to substitute alginate for TE. Deacylated (low acyl; LA) GG forms brittle gels, thus only low concentrations were used for cell encapsulation, whereas acylated (high acyl; HA) GG forms weak/soft gels. 3D bioprinting using pure LAGG or HAGG is not possible owing to their rheological properties. Here, we report development and characterization of bioprintable blends of LAGG and HAGG. Increase in HAGG in the blends improved shear recovery and shape fidelity of printed scaffolds. Low volumetric swelling observed in cell culture conditions over 14 days indicates stability. Volumetric scaffolds were successfully printed and their mechanical properties were determined by uniaxial compressive testing. Mesenchymal stem cells bioprinted in blends of 3% LAGG and 3% HAGG survived the printing process showing >80% viability; a gradual decrease in cell numbers was observed over 21 days of culture. However, exploiting intrinsic advantages of 3D bioprinting, LAGG/HAGG blends open up numerous possibilities to improve and/or tailor various aspects required for TE.

Core-shell bioprinting as a strategy to apply differentiation factors in a spatially defined manner inside osteochondral tissue substitutes

One of the key challenges in osteochondral tissue engineering is to define specified zones with varying material properties, cell types and biochemical factors supporting locally adjusted differentiation into the osteogenic and chondrogenic lineage, respectively. Herein, extrusion-based core-shell bioprinting is introduced as a potent tool allowing a spatially defined delivery of cell types and differentiation factors TGF-β3 and BMP-2 in separated compartments of hydrogel strands, and, therefore, a local supply of matching factors for chondrocytes and osteoblasts. Ink development was based on blends of alginate and methylcellulose, in combination with varying concentrations of the nanoclay Laponite whose high affinity binding capacity for various molecules was exploited. Release kinetics of model molecules was successfully tuned by Laponite addition. Core-shell bioprinting was proven to generate well-oriented compartments within one strand as monitored by optical coherence tomography in a non-invasive manner. Chondrocytes and osteoblasts were applied each in the shell while the respective differentiation factors (TGF-β3, BMP-2) were provided by a Laponite-supported core serving as central factor depot within the strand, allowing directed differentiation of cells in close contact to the core. Experiments with bi-zonal constructs, comprising an osteogenic and a chondrogenic zone, revealed that the local delivery of the factors from the core reduces effects of these factors on the cells in the other scaffold zone. These observations prove the general suitability of the suggested system for co-differentiation of different cell types within a zonal construct.