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Yuan X, Zhu W, Yang Z, He N, Chen F, Han X, Zhou K. Recent Advances in 3D Printing of Smart Scaffolds for Bone Tissue Engineering and Regeneration. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2403641. [PMID: 38861754 DOI: 10.1002/adma.202403641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/15/2024] [Indexed: 06/13/2024]
Abstract
The repair and functional reconstruction of bone defects resulting from severe trauma, surgical resection, degenerative disease, and congenital malformation pose significant clinical challenges. Bone tissue engineering (BTE) holds immense potential in treating these severe bone defects, without incurring prevalent complications associated with conventional autologous or allogeneic bone grafts. 3D printing technology enables control over architectural structures at multiple length scales and has been extensively employed to process biomimetic scaffolds for BTE. In contrast to inert and functional bone grafts, next-generation smart scaffolds possess a remarkable ability to mimic the dynamic nature of native extracellular matrix (ECM), thereby facilitating bone repair and regeneration. Additionally, they can generate tailored and controllable therapeutic effects, such as antibacterial or antitumor properties, in response to exogenous and/or endogenous stimuli. This review provides a comprehensive assessment of the progress of 3D-printed smart scaffolds for BTE applications. It begins with an introduction to bone physiology, followed by an overview of 3D printing technologies utilized for smart scaffolds. Notable advances in various stimuli-responsive strategies, therapeutic efficacy, and applications of 3D-printed smart scaffolds are discussed. Finally, the review highlights the existing challenges in the development and clinical implementation of smart scaffolds, as well as emerging technologies in this field.
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Affiliation(s)
- Xun Yuan
- National Engineering Research Centre for High Efficiency Grinding, College of Mechanical and Vehicle Engineering, Hunan University, Changsha, 410082, China
| | - Wei Zhu
- National Engineering Research Centre for High Efficiency Grinding, College of Mechanical and Vehicle Engineering, Hunan University, Changsha, 410082, China
| | - Zhongyuan Yang
- National Engineering Research Centre for High Efficiency Grinding, College of Mechanical and Vehicle Engineering, Hunan University, Changsha, 410082, China
| | - Ning He
- National Engineering Research Centre for High Efficiency Grinding, College of Mechanical and Vehicle Engineering, Hunan University, Changsha, 410082, China
| | - Feng Chen
- National Engineering Research Centre for High Efficiency Grinding, College of Mechanical and Vehicle Engineering, Hunan University, Changsha, 410082, China
| | - Xiaoxiao Han
- National Engineering Research Centre for High Efficiency Grinding, College of Mechanical and Vehicle Engineering, Hunan University, Changsha, 410082, China
| | - Kun Zhou
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
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Zou Z, Cheong VS, Fromme P. Bone remodelling prediction using mechanical stimulus with bone connectivity theory in porous implants. J Mech Behav Biomed Mater 2024; 153:106463. [PMID: 38401186 DOI: 10.1016/j.jmbbm.2024.106463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024]
Abstract
Strain energy density (SED) is considered to be the primary remodelling stimulus influencing the process of bone growth into porous implants. A bone remodelling algorithm incorporating the concept of bone connectivity, that newly formed bone should only grow from existing bone, was developed to provide a more biologically realistic simulation of bone growth. Results showed that the new algorithm prevented the occurrence of unconnected mature bone within porous implants, an unrealistic phenomenon observed using conventional adaptive elasticity theories. The bone connectivity algorithm had minimal effect (0.67% difference) on the final bone density distribution for standard bending and torsional moment cases. For a porous implant model, both algorithms, with and without bone connectivity implementation, reached the same final stiffness, with a difference of less than 0.01%. The bone connectivity algorithm predicted a slower and more gradual bone remodelling process, requiring at least 50% additional time for full remodelling compared to the conventional adaptive elasticity algorithm, which should be accounted for in the planning of rehabilitation strategies. The developed modelling can be employed to improve porous implant designs to achieve better clinical outcomes.
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Affiliation(s)
- Zhenhao Zou
- Department of Mechanical Engineering, University College London, United Kingdom.
| | - Vee San Cheong
- Future Health Technologies Programme, Singapore-ETH Centre, CREATE Campus, Singapore; Insigneo Institute for in silico Medicine, University of Sheffield, United Kingdom; Department of Mechanical Engineering, University of Sheffield, United Kingdom.
| | - Paul Fromme
- Department of Mechanical Engineering, University College London, United Kingdom.
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Huo M, He S, Zhang Y, Liu Q, Liu M, Zhou G, Zhou P, Lu J. Mechano-driven intervertebral bone bridging via oriented mechanical stimulus in a twist metamaterial cage: An in silico study. Comput Biol Med 2024; 171:108149. [PMID: 38401455 DOI: 10.1016/j.compbiomed.2024.108149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/11/2024] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
Stiffer cages provide sufficient mechanical support but fail to promote bone ingrowth due to stress shielding. It remains challenging for fusion cage to satisfy both bone bridging and mechanical stability. Here we designed a fusion cage based on twist metamaterial for improved bone ingrowth, and proved its superiority to the conventional diagonal-based cage in silico. The fusion process was numerically reproduced via an injury-induced osteogenesis model and the mechano-driven bone remodeling algorithm, and the outcomes fusion effects were evaluated by the morphological features of the newly-formed bone and the biomechanical behaviors of the bone-cage composite. The twist-based cages exhibited oriented bone formation in the depth direction, in comparison to the diagonal-based cages. The axial stiffness of the bone-cage composites with twist-based cages was notably higher than that with diagonal-based cages; meanwhile, the ranges of motion of the twist-based fusion segment were lower. It was concluded that the twist metamaterial cages led to oriented bone ingrowth, superior mechanical stability of the bone-cage composite, and less detrimental impacts on the adjacent bones. More generally, metamaterials with a tunable displacement mode of struts might provide more design freedom in implant designs to offer customized mechanical stimulus for osseointegration.
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Affiliation(s)
- Mengke Huo
- State Key Laboratory of Digital Medical Engineering, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China; Department of Mechanical Engineering, City University of Hong Kong, Hong Kong, China; CityU-Shenzhen Futian Research Institute, Shenzhen, China
| | - Siyuan He
- State Key Laboratory of Digital Medical Engineering, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China.
| | - Yun Zhang
- State Key Laboratory of Digital Medical Engineering, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China; Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Qing Liu
- State Key Laboratory of Digital Medical Engineering, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China
| | - Mengxing Liu
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd, Shenzhen, China; Wuhan Mindray Scientific Co., Ltd, Wuhan, China
| | - Guangquan Zhou
- State Key Laboratory of Digital Medical Engineering, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China
| | - Ping Zhou
- State Key Laboratory of Digital Medical Engineering, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China
| | - Jian Lu
- Department of Mechanical Engineering, City University of Hong Kong, Hong Kong, China; CityU-Shenzhen Futian Research Institute, Shenzhen, China; Centre for Advanced Structural Materials, City University of Hong Kong Shenzhen Research Institute, Greater Bay Joint Division, Shenyang National Laboratory for Materials Science, Shenzhen, China
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Borgiani E, Nasello G, Ory L, Herpelinck T, Groeneveldt L, Bucher CH, Schmidt-Bleek K, Geris L. COMMBINI: an experimentally-informed COmputational Model of Macrophage dynamics in the Bone INjury Immunoresponse. Front Immunol 2023; 14:1231329. [PMID: 38130715 PMCID: PMC10733790 DOI: 10.3389/fimmu.2023.1231329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/11/2023] [Indexed: 12/23/2023] Open
Abstract
Bone fracture healing is a well-orchestrated but complex process that involves numerous regulations at different scales. This complexity becomes particularly evident during the inflammatory stage, as immune cells invade the healing region and trigger a cascade of signals to promote a favorable regenerative environment. Thus, the emergence of criticalities during this stage might hinder the rest of the process. Therefore, the investigation of the many interactions that regulate the inflammation has a primary importance on the exploration of the overall healing progression. In this context, an in silico model named COMMBINI (COmputational Model of Macrophage dynamics in the Bone INjury Immunoresponse) has been developed to investigate the mechano-biological interactions during the early inflammatory stage at the tissue, cellular and molecular levels. An agent-based model is employed to simulate the behavior of immune cells, inflammatory cytokines and fracture debris as well as their reciprocal multiscale biological interactions during the development of the early inflammation (up to 5 days post-injury). The strength of the computational approach is the capacity of the in silico model to simulate the overall healing process by taking into account the numerous hidden events that contribute to its success. To calibrate the model, we present an in silico immunofluorescence method that enables a direct comparison at the cellular level between the model output and experimental immunofluorescent images. The combination of sensitivity analysis and a Genetic Algorithm allows dynamic cooperation between these techniques, enabling faster identification of the most accurate parameter values, reducing the disparity between computer simulation and histological data. The sensitivity analysis showed a higher sensibility of the computer model to the macrophage recruitment ratio during the early inflammation and to proliferation in the late stage. Furthermore, the Genetic Algorithm highlighted an underestimation of macrophage proliferation by in vitro experiments. Further experiments were conducted using another externally fixated murine model, providing an independent validation dataset. The validated COMMBINI platform serves as a novel tool to deepen the understanding of the intricacies of the early bone regeneration phases. COMMBINI aims to contribute to designing novel treatment strategies in both the biological and mechanical domains.
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Affiliation(s)
- Edoardo Borgiani
- Biomechanics Research Unit, GIGA-In Silico Medicine, University of Liège, Liège, Belgium
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
- Division of Biomechanics, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Gabriele Nasello
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
- Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Liesbeth Ory
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
- Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Tim Herpelinck
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
- Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Lisanne Groeneveldt
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
- Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Department of Cell Biology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Christian H. Bucher
- Julius Wolff Institute, Berlin Institute of Health, Charitè – Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Schmidt-Bleek
- Julius Wolff Institute, Berlin Institute of Health, Charitè – Universitätsmedizin Berlin, Berlin, Germany
| | - Liesbet Geris
- Biomechanics Research Unit, GIGA-In Silico Medicine, University of Liège, Liège, Belgium
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
- Division of Biomechanics, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
- Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
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Asbai-Ghoudan R, Nasello G, Pérez MÁ, Verbruggen SW, Ruiz de Galarreta S, Rodriguez-Florez N. In silico assessment of the bone regeneration potential of complex porous scaffolds. Comput Biol Med 2023; 165:107381. [PMID: 37611419 DOI: 10.1016/j.compbiomed.2023.107381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/21/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
Mechanical environment plays a crucial role in regulating bone regeneration in bone defects. Assessing the mechanobiological behavior of patient-specific orthopedic scaffolds in-silico could help guide optimal scaffold designs, as well as intra- and post-operative strategies to enhance bone regeneration and improve implant longevity. Additively manufactured porous scaffolds, and specifically triply periodic minimal surfaces (TPMS), have shown promising structural properties to act as bone substitutes, yet their ability to induce mechanobiologially-driven bone regeneration has not been elucidated. The aim of this study is to i) explore the bone regeneration potential of TPMS scaffolds made of different stiffness biocompatible materials, to ii) analyze the influence of pre-seeding the scaffolds and increasing the post-operative resting period, and to iii) assess the influence of patient-specific parameters, such as age and mechanosensitivity, on outcomes. To perform this study, an in silico model of a goat tibia is used. The bone ingrowth within the scaffold pores was simulated with a mechano-driven model of bone regeneration. Results showed that the scaffold's architectural properties affect cellular diffusion and strain distribution, resulting in variations in the regenerated bone volume and distribution. The softer material improved the bone ingrowth. An initial resting period improved the bone ingrowth but not enough to reach the scaffold's core. However, this was achieved with the implantation of a pre-seeded scaffold. Physiological parameters like age and health of the patient also influence the bone regeneration outcome, though to a lesser extent than the scaffold design. This analysis demonstrates the importance of the scaffold's geometry and its material, and highlights the potential of using mechanobiological patient-specific models in the design process for bone substitutes.
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Affiliation(s)
- Reduan Asbai-Ghoudan
- Department of Mechanical Engineering and Materials, Universidad de Navarra, TECNUN Escuela de Ingenieros, Paseo Manuel de Lardizabal, 13, 20018, San Sebastian, Spain.
| | - Gabriele Nasello
- Prometheus Division of Skeletal Tissue Engineering, KU Leuven, O&N1, Herestraat 49, PB 813, 3000, Leuven, Belgium
| | - María Ángeles Pérez
- Multiscale in Mechanical and Biological Engineering, Instituto de Investigación en Ingeniería de Aragón (I3A), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, 50018, Zaragoza, Spain
| | - Stefaan W Verbruggen
- Centre for Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, E1 4NS, UK; Department of Mechanical Engineering and INSIGNEO Institute for in Silico Medicine, University of Sheffield, Sheffield, S1 3JD, UK
| | - Sergio Ruiz de Galarreta
- Department of Mechanical Engineering and Materials, Universidad de Navarra, TECNUN Escuela de Ingenieros, Paseo Manuel de Lardizabal, 13, 20018, San Sebastian, Spain
| | - Naiara Rodriguez-Florez
- Department of Mechanical Engineering and Materials, Universidad de Navarra, TECNUN Escuela de Ingenieros, Paseo Manuel de Lardizabal, 13, 20018, San Sebastian, Spain; IKERBASQUE, Basque Foundation for Science, Plaza Euskadi 5, 48009, Bilbao, Spain
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Liu L, Liu C, Deng C, Wang X, Liu X, Luo M, Wang S, Liu J. Design and performance analysis of 3D-printed stiffness gradient femoral scaffold. J Orthop Surg Res 2023; 18:120. [PMID: 36804017 PMCID: PMC9938570 DOI: 10.1186/s13018-023-03612-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/14/2023] [Indexed: 02/20/2023] Open
Abstract
Studies on 3D-printed porous bone scaffolds mostly focus on materials or structural parameters, while the repair of large femoral defects needs to select appropriate structural parameters according to the needs of different parts. In this paper, a kind of stiffness gradient scaffold design idea is proposed. Different structures are selected according to the different functions of different parts of the scaffold. At the same time, an integrated fixation device is designed to fix the scaffold. Finite element method was used to analyze the stress and strain of homogeneous scaffolds and the stiffness gradient scaffolds, and the relative displacement and stress between stiffness gradient scaffolds and bone in the case of integrated fixation and steel plate fixation. The results showed that the stress distribution of the stiffness gradient scaffolds was more uniform, and the strain of host bone tissue was changed greatly, which was beneficial to the growth of bone tissue. The integrated fixation method is more stable, less stress and evenly distributed. Therefore, the integrated fixation device combined with the design of stiffness gradient can repair the large femoral bone defect well.
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Affiliation(s)
- Linlin Liu
- grid.411587.e0000 0001 0381 4112School of Advanced Manufacturing Engineering, Chongqing University of Posts and Telecommunications, Chongqing, 400065 China
| | - Chang Liu
- grid.411587.e0000 0001 0381 4112School of Advanced Manufacturing Engineering, Chongqing University of Posts and Telecommunications, Chongqing, 400065 China
| | - Congying Deng
- School of Advanced Manufacturing Engineering, Chongqing University of Posts and Telecommunications, Chongqing, 400065, China.
| | - Xin Wang
- grid.411587.e0000 0001 0381 4112School of Advanced Manufacturing Engineering, Chongqing University of Posts and Telecommunications, Chongqing, 400065 China
| | - Xiangde Liu
- grid.411587.e0000 0001 0381 4112School of Advanced Manufacturing Engineering, Chongqing University of Posts and Telecommunications, Chongqing, 400065 China
| | - Maolin Luo
- grid.411587.e0000 0001 0381 4112School of Advanced Manufacturing Engineering, Chongqing University of Posts and Telecommunications, Chongqing, 400065 China
| | - Shuxian Wang
- grid.411587.e0000 0001 0381 4112School of Advanced Manufacturing Engineering, Chongqing University of Posts and Telecommunications, Chongqing, 400065 China
| | - Juncai Liu
- grid.488387.8Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000 Sichuan China
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Poh PS, Lingner T, Kalkhof S, Märdian S, Baumbach J, Dondl P, Duda GN, Checa S. Enabling technologies towards personalization of scaffolds for large bone defect regeneration. Curr Opin Biotechnol 2022; 74:263-270. [PMID: 35007988 DOI: 10.1016/j.copbio.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022]
Abstract
Additive manufacturing (AM) can deliver personalized scaffolds to support large volume defect tissue regeneration - a major clinical challenge in many medical disciplines. The freedom in scaffold design and composition (biomaterials and biologics) offered by AM yields a plethora of possibilities but is confronted with a heterogenous biological regeneration potential across individuals. A key challenge is to make the right choice for individualized scaffolds that match biology, anatomy, and mechanics of patients. This review provides an overview of state-of-the-art technologies, that is, in silico modelling for scaffold design, omics and bioinformatics to capture patient biology and information technology for data management, that, when combined in a synergistic way with AM, have great potential to make personalized tissue regeneration strategies available to all patients, empowering precision medicine.
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Affiliation(s)
- Patrina Sp Poh
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Germany.
| | | | - Stefan Kalkhof
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Therapy Validation, 04103 Leipzig, Germany; Institute for Bioanalysis, University of Applied Sciences Coburg, Friedrich-Streib-Straße 2, 96450 Coburg, Germany
| | - Sven Märdian
- Center for Muskuloskeletal Surgery, Charité - Universitätsmedizin Berlin, Germany
| | - Jan Baumbach
- Chair of Computational Systems Biology, Universität Hamburg, Germany
| | - Patrick Dondl
- Department of Applied Mathematics, Albert-Ludwigs-Universität Freiburg, Hermann-Herder-Str. 10, 79111 Freiburg i. Br., Germany
| | - Georg N Duda
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Germany
| | - Sara Checa
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Germany
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Zhao F, Xiong Y, Ito K, van Rietbergen B, Hofmann S. Porous Geometry Guided Micro-mechanical Environment Within Scaffolds for Cell Mechanobiology Study in Bone Tissue Engineering. Front Bioeng Biotechnol 2021; 9:736489. [PMID: 34595161 PMCID: PMC8476750 DOI: 10.3389/fbioe.2021.736489] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/27/2021] [Indexed: 12/15/2022] Open
Abstract
Mechanobiology research is for understanding the role of mechanics in cell physiology and pathology. It will have implications for studying bone physiology and pathology and to guide the strategy for regenerating both the structural and functional features of bone. Mechanobiological studies in vitro apply a dynamic micro-mechanical environment to cells via bioreactors. Porous scaffolds are commonly used for housing the cells in a three-dimensional (3D) culturing environment. Such scaffolds usually have different pore geometries (e.g. with different pore shapes, pore dimensions and porosities). These pore geometries can affect the internal micro-mechanical environment that the cells experience when loaded in the bioreactor. Therefore, to adjust the applied micro-mechanical environment on cells, researchers can tune either the applied load and/or the design of the scaffold pore geometries. This review will provide information on how the micro-mechanical environment (e.g. fluid-induced wall shear stress and mechanical strain) is affected by various scaffold pore geometries within different bioreactors. It shall allow researchers to estimate/quantify the micro-mechanical environment according to the already known pore geometry information, or to find a suitable pore geometry according to the desirable micro-mechanical environment to be applied. Finally, as future work, artificial intelligent - assisted techniques, which can achieve an automatic design of solid porous scaffold geometry for tuning/optimising the micro-mechanical environment are suggested.
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Affiliation(s)
- Feihu Zhao
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
- Zienkiewicz Centre for Computational Engineering, Faculty of Science and Engineering, Swansea University, Swansea, United Kingdom
| | - Yi Xiong
- School of System Design and Intelligent Manufacturing, Southern University of Science and Technology, Shenzhen, China
| | - Keita Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
| | - Bert van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Sandra Hofmann
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
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