Rapid prototyping of a hybrid hierarchical polyurethane-cell/hydrogel construct for regenerative medicine

From materials to clinical use: advances in 3D-printed scaffolds for cartilage tissue engineering

Osteoarthritis caused by articular cartilage defects is a particularly common orthopedic disease that can involve the entire joint, causing great pain to its sufferers. A global patient population of approximately 250 million people has an increasing demand for new therapies with excellent results, and tissue engineering scaffolds have been proposed as a potential strategy for the repair and reconstruction of cartilage defects. The precise control and high flexibility of 3D printing provide a platform for subversive innovation. In this perspective, cartilage tissue engineering (CTE) scaffolds manufactured using different biomaterials are summarized from the perspective of 3D printing strategies, the bionic structure strategies and special functional designs are classified and discussed, and the advantages and limitations of these CTE scaffold preparation strategies are analyzed in detail. Finally, the application prospect and challenges of 3D printed CTE scaffolds are discussed, providing enlightening insights for their current research.

A Review of Research Progress on the Performance of Intelligent Polymer Gel

Intelligent polymer gel, as a popular polymer material, has been attracting much attention for its application. An intelligent polymer gel will make corresponding changes to adapt to the environment after receiving stimuli; therefore, an intelligent polymer gel can play its role in many fields. With the research on intelligent polymer gels, there is great potential for applications in the fields of drug engineering, molecular devices, and biomedicine in particular. The strength and responsiveness of the gels can be improved under different configurations in different technologies to meet the needs in these fields. There is no discussion on the application of intelligent polymer gels in these fields; therefore, this paper reviews the research progress of intelligent polymer gel, describes the important research of some intelligent polymer gel, summarizes the research progress and current situation of intelligent polymer gel in the environment of external stimulation, and discusses the performance and future development direction of intelligent polymer gel.

Bioprinting Technologies and Bioinks for Vascular Model Establishment

Clinically, large diameter artery defects (diameter larger than 6 mm) can be substituted by unbiodegradable polymers, such as polytetrafluoroethylene. There are many problems in the construction of small diameter blood vessels (diameter between 1 and 3 mm) and microvessels (diameter less than 1 mm), especially in the establishment of complex vascular models with multi-scale branched networks. Throughout history, the vascularization strategies have been divided into three major groups, including self-generated capillaries from implantation, pre-constructed vascular channels, and three-dimensional (3D) printed cell-laden hydrogels. The first group is based on the spontaneous angiogenesis behaviour of cells in the host tissues, which also lays the foundation of capillary angiogenesis in tissue engineering scaffolds. The second group is to vascularize the polymeric vessels (or scaffolds) with endothelial cells. It is hoped that the pre-constructed vessels can be connected with the vascular networks of host tissues with rapid blood perfusion. With the development of bioprinting technologies, various fabrication methods have been achieved to build hierarchical vascular networks with high-precision 3D control. In this review, the latest advances in 3D bioprinting of vascularized tissues/organs are discussed, including new printing techniques and researches on bioinks for promoting angiogenesis, especially coaxial printing, freeform reversible embedded in suspended hydrogel printing, and acoustic assisted printing technologies, and freeform reversible embedded in suspended hydrogel (flash) technology.

3D Bioprinting for Pancreas Engineering/Manufacturing

Diabetes is the most common chronic disease in the world, and it brings a heavy burden to people's health. Against this background, diabetic research, including islet functionalization has become a hot topic in medical institutions all over the world. Especially with the rapid development of microencapsulation and three-dimensional (3D) bioprinting technologies, organ engineering and manufacturing have become the main trends for disease modeling and drug screening. Especially the advanced 3D models of pancreatic islets have shown better physiological functions than monolayer cultures, suggesting their potential in elucidating the behaviors of cells under different growth environments. This review mainly summarizes the latest progress of islet capsules and 3D printed pancreatic organs and introduces the activities of islet cells in the constructs with different encapsulation technologies and polymeric materials, as well as the vascularization and blood glucose control capabilities of these constructs after implantation. The challenges and perspectives of the pancreatic organ engineering/manufacturing technologies have also been demonstrated.

Auricular reconstruction via 3D bioprinting strategies: An update

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Construction and Evaluation of Small-Diameter Bioartificial Arteries Based on a Combined-Mold Technology

Arterial stenosis or blockage is the leading cause of cardiovascular disease, and the common solution is to substitute the arteries by autologous veins or bypass the blood vessels physically. With the development of science and technology, arteries with diameter larger than 6 mm can be substituted by unbiodegradable polymers, such as polytetrafluoroethylene, clinically. Nevertheless, the construction of a small-diameter (less than 6 mm) artery with living cells has always been a thorny problem. In this study, a suit of combined mold was designed and forged for constructing small-diameter arterial vessels. Based on this combined mold, bioactive arterial vessels containing adipose-derived stem cells (ASCs) and different growth factors (GFs) were assembled together to mimic the inner and middle layers of the natural arteries. Before assembling, ASCs and GFs were loaded into a gelatin/alginate hydrogel. To enhance the mechanical property of the bilayer arterial vessels, polylactic–glycolic acid (PLGA) was applied on the surface of the bilayer vessels to form the outer third layer. The biocompatibility, morphology and mechanical property of the constructed triple-layer arterial vessels were characterized. The morphological results manifested that cells grow well in the gelatin/alginate hydrogels, and ASCs were differentiated into endothelial cells (ECs) and smooth muscle cells (SMCs), respectively. In addition, under the action of shear stress produced by the flow of the culture medium, cells in the hydrogels with high density were connected to each other, similar to the natural vascular endothelial tissues (i.e., endothelia). Especially, the mechanical property of the triple-layer arterial vessels can well meet the anti-stress requirements as human blood vessels. In a word, a small-diameter arterial vessel was successfully constructed through the combined mold and has a promising application prospect as a clinical small-diameter vessel graft.

Application Status of Sacrificial Biomaterials in 3D Bioprinting

Additive manufacturing, also known as three-dimensional (3D) printing, relates to several rapid prototyping (RP) technologies, and has shown great potential in the manufacture of organoids and even complex bioartificial organs. A major challenge for 3D bioprinting complex org unit ans is the competitive requirements with respect to structural biomimeticability, material integrability, and functional manufacturability. Over the past several years, 3D bioprinting based on sacrificial templates has shown its unique advantages in building hierarchical vascular networks in complex organs. Sacrificial biomaterials as supporting structures have been used widely in the construction of tubular tissues. The advent of suspension printing has enabled the precise printing of some soft biomaterials (e.g., collagen and fibrinogen), which were previously considered unprintable singly with cells. In addition, the introduction of sacrificial biomaterials can improve the porosity of biomaterials, making the printed structures more favorable for cell proliferation, migration and connection. In this review, we mainly consider the latest developments and applications of 3D bioprinting based on the strategy of sacrificial biomaterials, discuss the basic principles of sacrificial templates, and look forward to the broad prospects of this approach for complex organ engineering or manufacturing.

Robust Silk Protein Hydrogels Made by a Facile One-Step Method and Their Multiple Applications

Silk fibroin is a natural polymer that has various material forms and wide applications. Hydrogel is one of the most attractive silk materials because of its hydrophilicity, biocompatibility, and flexibility. However, its applications are still quite limited because they have a complicated preparation process and/or low mechanical strength. Herein, a simple way to prepare tough silk fibroin hydrogels via a solvent-exchange method is introduced. The degummed silk fiber was directly dissolved in a calcium chloride/formic acid solution and then water was used to replace the solvent. The silk fibroin hydrogel that was obtained using this facile method exhibited even better mechanical properties than most silk fibroin hydrogels that have been reported in the literature. Also, the silk fibroin hydrogel maintained biocompatibility that was as good as that prepared via other methods. Finally, the possibility of using this regenerated silk fibroin hydrogel as a multi-functional platform (such as a catalyst carrier, photothermal agent, and underwater adhesive) has been discussed. Therefore, such a natural, sustainable, robust, and good biocompatible silk fibroin hydrogel that is prepared by an improved method may have great potential for further applications.

The Effect of Agarose on 3D Bioprinting

In three-dimensional (3D) bioprinting, the accuracy, stability, and mechanical properties of the formed structure are very important to the overall composition and internal structure of the complex organ. In traditional 3D bioprinting, low-temperature gelatinization of gelatin is often used to construct complex tissues and organs. However, the hydrosol relies too much on the concentration of gelatin and has limited formation accuracy and stability. In this study, we take advantage of the physical crosslinking of agarose at 35–40 °C to replace the single pregelatinization effect of gelatin in 3D bioprinting, and printing composite gelatin/alginate/agarose hydrogels at two temperatures, i.e., 10 °C and 24 °C, respectively. After in-depth research, we find that the structures manufactured by the pregelatinization method of agarose are significantly more accurate, more stable, and harder than those pregelatined by gelatin. We believe that this research holds the potential to be widely used in the future organ manufacturing fields with high structural accuracy and stability.

Preparation of Smart Materials by Additive Manufacturing Technologies: A Review

Over the last few decades, advanced manufacturing and additive printing technologies have made incredible inroads into the fields of engineering, transportation, and healthcare. Among additive manufacturing technologies, 3D printing is gradually emerging as a powerful technique owing to a combination of attractive features, such as fast prototyping, fabrication of complex designs/structures, minimization of waste generation, and easy mass customization. Of late, 4D printing has also been initiated, which is the sophisticated version of the 3D printing. It has an extra advantageous feature: retaining shape memory and being able to provide instructions to the printed parts on how to move or adapt under some environmental conditions, such as, water, wind, light, temperature, or other environmental stimuli. This advanced printing utilizes the response of smart manufactured materials, which offer the capability of changing shapes postproduction over application of any forms of energy. The potential application of 4D printing in the biomedical field is huge. Here, the technology could be applied to tissue engineering, medicine, and configuration of smart biomedical devices. Various characteristics of next generation additive printings, namely 3D and 4D printings, and their use in enhancing the manufacturing domain, their development, and some of the applications have been discussed. Special materials with piezoelectric properties and shape-changing characteristics have also been discussed in comparison with conventional material options for additive printing.

Progress of 3D Bioprinting in Organ Manufacturing

Three-dimensional (3D) bioprinting is a family of rapid prototyping technologies, which assemble biomaterials, including cells and bioactive agents, under the control of a computer-aided design model in a layer-by-layer fashion. It has great potential in organ manufacturing areas with the combination of biology, polymers, chemistry, engineering, medicine, and mechanics. At present, 3D bioprinting technologies can be used to successfully print living tissues and organs, including blood vessels, skin, bones, cartilage, kidney, heart, and liver. The unique advantages of 3D bioprinting technologies for organ manufacturing have improved the traditional medical level significantly. In this article, we summarize the latest research progress of polymers in bioartificial organ 3D printing areas. The important characteristics of the printable polymers and the typical 3D bioprinting technologies for several complex bioartificial organs, such as the heart, liver, nerve, and skin, are introduced.

Estimating the Accuracy of Mandible Anatomical Models Manufactured Using Material Extrusion Methods

The development of new solutions in craniofacial surgery brings the need to increase the accuracy of 3D printing models. The accuracy of the manufactured models is most often verified using optical coordinate measuring systems. However, so far, no decision has been taken regarding which type of system would allow for a reliable estimation of the geometrical accuracy of the anatomical models. Three types of optical measurement systems (Atos III Triple Scan, articulated arm (MCA-II) with a laser head (MMD × 100), and Benchtop CT160Xi) were used to verify the accuracy of 12 polymer anatomical models of the left side of the mandible. The models were manufactured using fused deposition modeling (FDM), melted and extruded modeling (MEM), and fused filament fabrication (FFF) techniques. The obtained results indicate that the Atos III Triple Scan allows for the most accurate estimation of errors in model manufacturing. Using the FDM technique obtained the best accuracy in models manufactured (0.008 ± 0.118 mm for ABS0-M30 and 0.016 ± 0.178 mm for PC-10 material). A very similar value of the standard deviation of PLA and PET material was observed (about 0.180 mm). The worst results were observed in the MEM technique (0.012 mm ± 0.308 mm). The knowledge regarding the precisely evaluated errors in manufactured models within the mandibular area will help in the controlled preparation of templates regarding the expected accuracy of surgical operations.

Bioprinting of Collagen: Considerations, Potentials, and Applications

Collagen is the most abundant extracellular matrix protein that is widely used in tissue engineering (TE). There is little research done on printing pure collagen. To understand the bottlenecks in printing pure collagen, it is imperative to understand collagen from a bottom-up approach. Here it is aimed to provide a comprehensive overview of collagen printing, where collagen assembly in vivo and the various sources of collagen available for TE application are first understood. Next, the current printing technologies and strategy for printing collagen-based materials are highlighted. Considerations and key challenges faced in collagen printing are identified. Finally, the key research areas that would enhance the functionality of printed collagen are presented.

Emulating Human Tissues and Organs: A Bioprinting Perspective Toward Personalized Medicine

The lack of in vitro tissue and organ models capable of mimicking human physiology severely hinders the development and clinical translation of therapies and drugs with higher in vivo efficacy. Bioprinting allow us to fill this gap and generate 3D tissue analogues with complex functional and structural organization through the precise spatial positioning of multiple materials and cells. In this review, we report the latest developments in terms of bioprinting technologies for the manufacturing of cellular constructs with particular emphasis on material extrusion, jetting, and vat photopolymerization. We then describe the different base polymers employed in the formulation of bioinks for bioprinting and examine the strategies used to tailor their properties according to both processability and tissue maturation requirements. By relating function to organization in human development, we examine the potential of pluripotent stem cells in the context of bioprinting toward a new generation of tissue models for personalized medicine. We also highlight the most relevant attempts to engineer artificial models for the study of human organogenesis, disease, and drug screening. Finally, we discuss the most pressing challenges, opportunities, and future prospects in the field of bioprinting for tissue engineering (TE) and regenerative medicine (RM).

Solid Organ Bioprinting: Strategies to Achieve Organ Function

The field of tissue engineering has advanced over the past decade, but the largest impact on human health should be achieved with the transition of engineered solid organs to the clinic. The number of patients suffering from solid organ disease continues to increase, with over 100 000 patients on the U.S. national waitlist and approximately 730 000 deaths in the United States resulting from end-stage organ disease annually. While flat, tubular, and hollow nontubular engineered organs have already been implanted in patients, in vitro formation of a fully functional solid organ at a translatable scale has not yet been achieved. Thus, one major goal is to bioengineer complex, solid organs for transplantation, composed of patient-specific cells. Among the myriad of approaches attempted to engineer solid organs, 3D bioprinting offers unmatched potential. This review highlights the structural complexity which must be engineered at nano-, micro-, and mesostructural scales to enable organ function. We showcase key advances in bioprinting solid organs with complex vascular networks and functioning microstructures, advances in biomaterials science that have enabled this progress, the regulatory hurdles the field has yet to overcome, and cutting edge technologies that bring us closer to the promise of engineered solid organs.

Synthetic Polymers for Organ 3D Printing

Three-dimensional (3D) printing, known as the most promising approach for bioartificial organ manufacturing, has provided unprecedented versatility in delivering multi-functional cells along with other biomaterials with precise control of their locations in space. The constantly emerging 3D printing technologies are the integration results of biomaterials with other related techniques in biology, chemistry, physics, mechanics and medicine. Synthetic polymers have played a key role in supporting cellular and biomolecular (or bioactive agent) activities before, during and after the 3D printing processes. In particular, biodegradable synthetic polymers are preferable candidates for bioartificial organ manufacturing with excellent mechanical properties, tunable chemical structures, non-toxic degradation products and controllable degradation rates. In this review, we aim to cover the recent progress of synthetic polymers in organ 3D printing fields. It is structured as introducing the main approaches of 3D printing technologies, the important properties of 3D printable synthetic polymers, the successful models of bioartificial organ printing and the perspectives of synthetic polymers in vascularized and innervated organ 3D printing areas.

Materials and technical innovations in 3D printing in biomedical applications

3D printing is a rapidly growing research area, which significantly contributes to major innovations in various fields of engineering, science, and medicine. Although the scientific advancement of 3D printing technologies has enabled the development of complex geometries, there is still an increasing demand for innovative 3D printing techniques and materials to address the challenges in building speed and accuracy, surface finish, stability, and functionality. In this review, we introduce and review the recent developments in novel materials and 3D printing techniques to address the needs of the conventional 3D printing methodologies, especially in biomedical applications, such as printing speed, cell growth feasibility, and complex shape achievement. A comparative study of these materials and technologies with respect to the 3D printing parameters will be provided for selecting a suitable application-based 3D printing methodology. Discussion of the prospects of 3D printing materials and technologies will be finally covered.

3D Extracellular Matrix Mimics: Fundamental Concepts and Role of Materials Chemistry to Influence Stem Cell Fate

Synthetic 3D extracellular matrices (ECMs) find application in cell studies, regenerative medicine, and drug discovery. While cells cultured in a monolayer may exhibit unnatural behavior and develop very different phenotypes and genotypes than in vivo, great efforts in materials chemistry have been devoted to reproducing in vitro behavior in in vivo cell microenvironments. This requires fine-tuning the biochemical and structural actors in synthetic ECMs. This review will present the fundamentals of the ECM, cover the chemical and structural features of the scaffolds used to generate ECM mimics, discuss the nature of the signaling biomolecules required and exploited to generate bioresponsive cell microenvironments able to induce a specific cell fate, and highlight the synthetic strategies involved in creating functional 3D ECM mimics.

An Interpenetrating Alginate/Gelatin Network for Three-Dimensional (3D) Cell Cultures and Organ Bioprinting

Crosslinking is an effective way to improve the physiochemical and biochemical properties of hydrogels. In this study, we describe an interpenetrating polymer network (IPN) of alginate/gelatin hydrogels (i.e., A-G-IPN) in which cells can be encapsulated for in vitro three-dimensional (3D) cultures and organ bioprinting. A double crosslinking model, i.e., using Ca²⁺ to crosslink alginate molecules and transglutaminase (TG) to crosslink gelatin molecules, is exploited to improve the physiochemical, such as water holding capacity, hardness and structural integrity, and biochemical properties, such as cytocompatibility, of the alginate/gelatin hydrogels. For the sake of convenience, the individual ionic (i.e., only treatment with Ca²⁺) or enzymatic (i.e., only treatment with TG) crosslinked alginate/gelatin hydrogels are referred as alginate-semi-IPN (i.e., A-semi-IPN) or gelatin-semi-IPN (i.e., G-semi-IPN), respectively. Tunable physiochemical and biochemical properties of the hydrogels have been obtained by changing the crosslinking sequences and polymer concentrations. Cytocompatibilities of the obtained hydrogels are evaluated through in vitro 3D cell cultures and bioprinting. The double crosslinked A-G-IPN hydrogel is a promising candidate for a wide range of biomedical applications, including bioartificial organ manufacturing, high-throughput drug screening, and pathological mechanism analyses.

Bioprinting of Multimaterials with Computer-aided Design/Computer-aided Manufacturing

Multimaterials deposition, a distinct advantage in bioprinting, overcomes material's limitation in hydrogel-based bioprinting. Multimaterials are deposited in a build/support configuration to improve the structural integrity of three-dimensional bioprinted construct. A combination of rapid cross-linking hydrogel has been chosen for the build/support setup. The bioprinted construct was further chemically cross-linked to ensure a stable construct after print. This paper also proposes a file segmentation and preparation technique to be used in bioprinting for printing freeform structures.

Advanced Polymers for Three-Dimensional (3D) Organ Bioprinting

Three-dimensional (3D) organ bioprinting is an attractive scientific area with huge commercial profit, which could solve all the serious bottleneck problems for allograft transplantation, high-throughput drug screening, and pathological analysis. Integrating multiple heterogeneous adult cell types and/or stem cells along with other biomaterials (e.g., polymers, bioactive agents, or biomolecules) to make 3D constructs functional is one of the core issues for 3D bioprinting of bioartificial organs. Both natural and synthetic polymers play essential and ubiquitous roles for hierarchical vascular and neural network formation in 3D printed constructs based on their specific physical, chemical, biological, and physiological properties. In this article, several advanced polymers with excellent biocompatibility, biodegradability, 3D printability, and structural stability are reviewed. The challenges and perspectives of polymers for rapid manufacturing of complex organs, such as the liver, heart, kidney, lung, breast, and brain, are outlined.

Chitosans for Tissue Repair and Organ Three-Dimensional (3D) Bioprinting

Chitosan is a unique natural resourced polysaccharide derived from chitin with special biocompatibility, biodegradability, and antimicrobial activity. During the past three decades, chitosan has gradually become an excellent candidate for various biomedical applications with prominent characteristics. Chitosan molecules can be chemically modified, adapting to all kinds of cells in the body, and endowed with specific biochemical and physiological functions. In this review, the intrinsic/extrinsic properties of chitosan molecules in skin, bone, cartilage, liver tissue repair, and organ three-dimensional (3D) bioprinting have been outlined. Several successful models for large scale-up vascularized and innervated organ 3D bioprinting have been demonstrated. Challenges and perspectives in future complex organ 3D bioprinting areas have been analyzed.

Bioartificial Organ Manufacturing Technologies

Bioartificial organ manufacturing technologies are a series of enabling techniques that can be used to produce human organs based on bionic principles. During the last ten years, significant progress has been achieved in the development of various organ manufacturing technologies. According to the degree of automation, organ manufacturing technologies can be divided into three main groups: (1) fully automated; (2) semi-automated; (3) handworked (or handmade); each has the advantages and disadvantages for bioartificial organ manufacturing. One of the most promising bioartificial organ manufacturing technologies is to use combined multi-nozzle three-dimensional printing techniques to automatically assemble personal cells along with other biomaterials to build exclusive organ substitutes for defective/failed human organs. This is the first time that advanced bioartificial organ manufacturing technologies have been reviewed. These technologies hold the promise to greatly improve the quality of health and average lifespan of human beings in the near future.

Natural Polymers for Organ 3D Bioprinting

Three-dimensional (3D) bioprinting, known as a promising technology for bioartificial organ manufacturing, has provided unprecedented versatility to manipulate cells and other biomaterials with precise control their locations in space. Over the last decade, a number of 3D bioprinting technologies have been explored. Natural polymers have played a central role in supporting the cellular and biomolecular activities before, during and after the 3D bioprinting processes. These polymers have been widely used as effective cell-loading hydrogels for homogeneous/heterogeneous tissue/organ formation, hierarchical vascular/neural/lymphatic network construction, as well as multiple biological/biochemial/physiological/biomedical/pathological functionality realization. This review aims to cover recent progress in natural polymers for bioartificial organ 3D bioprinting. It is structured as introducing the important properties of 3D printable natural polymers, successful models of 3D tissue/organ construction and typical technologies for bioartificial organ 3D bioprinting.

Fibrin Hydrogels for Endothelialized Liver Tissue Engineering with a Predesigned Vascular Network

The design and manufacture of a branched vascular network is essential for bioartificial organ implantation, which provides nutrients and removes metabolites for multi-cellular tissues. In the present study, we present a technology to manufacture endothelialized liver tissues using a fibrin hydrogel and a rotational combined mold. Both hepatocytes and adipose-derived stem cells (ADSCs) encapsulated in a fibrin hydrogel were assembled into a spindle construct with a predesigned multi-branched vascular network. An external overcoat of poly(dl-lactic-co-glycolic acid) was used to increase the mechanical properties of the construct as well as to act as an impervious and isolating membrane around the construct. Cell survivability reached 100% in the construct after 6 days of in vitro culture. ADSCs in the spindle construct were engaged into endothelial cells/tissues using a cocktail growth factor engagement approach. Mechanical property comparison and permeability evaluation tests all indicated that this was a viable complex organ containing more than two heterogeneous tissue types and a functional vascular network. It is, therefore, the first time an implantable bioartificial liver, i.e., endothelialized liver tissue, along with a hierarchical vascular network, has been created.

Advances in Regenerative Medicine and Tissue Engineering: Innovation and Transformation of Medicine

Humans and animals lose tissues and organs due to congenital defects, trauma, and diseases. The human body has a low regenerative potential as opposed to the urodele amphibians commonly referred to as salamanders. Globally, millions of people would benefit immensely if tissues and organs can be replaced on demand. Traditionally, transplantation of intact tissues and organs has been the bedrock to replace damaged and diseased parts of the body. The sole reliance on transplantation has created a waiting list of people requiring donated tissues and organs, and generally, supply cannot meet the demand. The total cost to society in terms of caring for patients with failing organs and debilitating diseases is enormous. Scientists and clinicians, motivated by the need to develop safe and reliable sources of tissues and organs, have been improving therapies and technologies that can regenerate tissues and in some cases create new tissues altogether. Tissue engineering and/or regenerative medicine are fields of life science employing both engineering and biological principles to create new tissues and organs and to promote the regeneration of damaged or diseased tissues and organs. Major advances and innovations are being made in the fields of tissue engineering and regenerative medicine and have a huge impact on three-dimensional bioprinting (3D bioprinting) of tissues and organs. 3D bioprinting holds great promise for artificial tissue and organ bioprinting, thereby revolutionizing the field of regenerative medicine. This review discusses how recent advances in the field of regenerative medicine and tissue engineering can improve 3D bioprinting and vice versa. Several challenges must be overcome in the application of 3D bioprinting before this disruptive technology is widely used to create organotypic constructs for regenerative medicine.

3D bioprinting processes: A perspective on classification and terminology

This article aims to provide further classification of cell-compatible bioprinting processes and examine the concept of 3D bioprinting within the general technology field of 3D printing. These technologies are categorized into four distinct process categories, namely material jetting, vat photopolymerization, material extrusion and free-form spatial printing. Discussion will be presented on the definition of classification with example of techniques grouped under the same category. The objective of this article is to establish a basic framework for standardization of process terminology in order to accelerate the implementation of bioprinting technologies in research and commercial landscape.

Tissue and Organ 3D Bioprinting

Three-dimensional (3D) bioprinting enables the creation of tissue constructs with heterogeneous compositions and complex architectures. It was initially used for preparing scaffolds for bone tissue engineering. It has recently been adopted to create living tissues, such as cartilage, skin, and heart valve. To facilitate vascularization, hollow channels have been created in the hydrogels by 3D bioprinting. This review discusses the state of the art of the technology, along with a broad range of biomaterials used for 3D bioprinting. It provides an update on recent developments in bioprinting and its applications. 3D bioprinting has profound impacts on biomedical research and industry. It offers a new way to industrialize tissue biofabrication. It has great potential for regenerating tissues and organs to overcome the shortage of organ transplantation.

Progress in organ 3D bioprinting

Three dimensional (3D) printing is a hot topic in today's scientific, technological and commercial areas. It is recognized as the main field which promotes "the Third Industrial Revolution". Recently, human organ 3D bioprinting has been put forward into equity market as a concept stock and attracted a lot of attention. A large number of outstanding scientists have flung themselves into this field and made some remarkable headways. Nevertheless, organ 3D bioprinting is a sophisticated manufacture procedure which needs profound scientific/technological backgrounds/knowledges to accomplish. Especially, large organ 3D bioprinting encounters enormous difficulties and challenges. One of them is to build implantable branched vascular networks in a predefined 3D construct. At present, organ 3D bioprinting still in its infancy and a great deal of work needs to be done. Here we briefly overview some of the achievements of 3D bioprinting technologies in large organ, such as the bone, liver, heart, cartilage and skin, manufacturing.

Advances in Waterborne Polyurethane-Based Biomaterials for Biomedical Applications

Polyurethane (PU) is one of the most popular synthetic elastomers and widely employed in biomedical fields owing to the excellent biocompatibility and hemocompatibility known today. In addition, PU is simply prepared and its mechanical properties such as durability, elasticity, elastomer-like character, fatigue resistance, compliance or tolerance in the body during the healing, can be mediated by modifying the chemical structure. Furthermore, modification of bulk and surface by incorporating biomolecules such as anticoagulant s or biorecognizable groups, or hydrophilic/hydrophobic balance is possible through altering chemical groups for PU structure. Such modifications have been designed to improve the acceptance of implant. For these reason, conventional solventborne (solvent-based) PUs have established the standard for high performance systems, and extensively used in medical devices such as dressings, tubing, antibacterial membrane , catheters to total artificial heart and blood contacting materials, etc. However, waterborne polyurethane (WPU) has been developed to improve the process of dissolving PU materials using toxic organic solvents, in which water is used as a dispersing solvent. The prepared WPU materials have many advantages, briefly (1) zero or very low levels of organic solvents, namely environmental-friendly (2) non-toxic, due to absence of isocyanate residues, and (3) good applicability caused by extensive structure/property diversity as well as an environment-friendly fabrication method resulting in increasing applicability. Therefore, WPUs are being in the spotlight as biomaterials used for biomedical applications . The purpose of this review is to introduce an environmental- friendly synthesis of WPU and consider the manufacturing process and application of WPU and/or WPU based nanocomposites as the viewpoint of biomaterials.

Gelatin-Based Hydrogels for Organ 3D Bioprinting

Three-dimensional (3D) bioprinting is a family of enabling technologies that can be used to manufacture human organs with predefined hierarchical structures, material constituents and physiological functions. The main objective of these technologies is to produce high-throughput and/or customized organ substitutes (or bioartificial organs) with heterogeneous cell types or stem cells along with other biomaterials that are able to repair, replace or restore the defect/failure counterparts. Gelatin-based hydrogels, such as gelatin/fibrinogen, gelatin/hyaluronan and gelatin/alginate/fibrinogen, have unique features in organ 3D bioprinting technologies. This article is an overview of the intrinsic/extrinsic properties of the gelatin-based hydrogels in organ 3D bioprinting areas with advanced technologies, theories and principles. The state of the art of the physical/chemical crosslinking methods of the gelatin-based hydrogels being used to overcome the weak mechanical properties is highlighted. A multicellular model made from adipose-derived stem cell proliferation and differentiation in the predefined 3D constructs is emphasized. Multi-nozzle extrusion-based organ 3D bioprinting technologies have the distinguished potential to eventually manufacture implantable bioartificial organs for purposes such as customized organ restoration, high-throughput drug screening and metabolic syndrome model establishment.

Design and fabrication of porous biodegradable scaffolds: a strategy for tissue engineering

Current strategies of tissue engineering are focused on the reconstruction and regeneration of damaged or deformed tissues by grafting of cells with scaffolds and biomolecules. Recently, much interest is given to scaffolds which are based on mimic the extracellular matrix that have induced the formation of new tissues. To return functionality of the organ, the presence of a scaffold is essential as a matrix for cell colonization, migration, growth, differentiation and extracellular matrix deposition, until the tissues are totally restored or regenerated. A wide variety of approaches has been developed either in scaffold materials and production procedures or cell sources and cultivation techniques to regenerate the tissues/organs in tissue engineering applications. This study has been conducted to present an overview of the different scaffold fabrication techniques such as solvent casting and particulate leaching, electrospinning, emulsion freeze-drying, thermally induced phase separation, melt molding and rapid prototyping with their properties, limitations, theoretical principles and their prospective in tailoring appropriate micro-nanostructures for tissue regeneration applications. This review also includes discussion on recent works done in the field of tissue engineering.

A brief review of extrusion-based tissue scaffold bio-printing

Extrusion-based bio-printing has great potential as a technique for manipulating biomaterials and living cells to create three-dimensional (3D) scaffolds for damaged tissue repair and function restoration. Over the last two decades, advances in both engineering techniques and life sciences have evolved extrusion-based bio-printing from a simple technique to one able to create diverse tissue scaffolds from a wide range of biomaterials and cell types. However, the complexities associated with synthesis of materials for bio-printing and manipulation of multiple materials and cells in bio-printing pose many challenges for scaffold fabrication. This paper presents an overview of extrusion-based bio-printing for scaffold fabrication, focusing on the prior-printing considerations (such as scaffold design and materials/cell synthesis), working principles, comparison to other techniques, and to-date achievements. This paper also briefly reviews the recent development of strategies with regard to hydrogel synthesis, multi-materials/cells manipulation, and process-induced cell damage in extrusion-based bio-printing. The key issue and challenges for extrusion-based bio-printing are also identified and discussed along with recommendations for future, aimed at developing novel biomaterials and bio-printing systems, creating patterned vascular networks within scaffolds, and preserving the cell viability and functions in scaffold bio-printing. The address of these challenges will significantly enhance the capability of extrusion-based bio-printing.

Polyurethane-silica hybrid foams from a one-step foaming reaction, coupled with a sol-gel process, for enhanced wound healing

Polyurethane (PU)-based dressing foams have been widely used due to their excellent water absorption capability, optimal mechanical properties, and unequaled economic advantage. However, the low bioactivity and poor healing capability of PU limit the applications of PU dressings in complex wound healing cases. To resolve this problem, this study was carried out the hybridization of bioactive silica nanoparticles with PU through a one-step foaming reaction that is coupled with the sol-gel process. The hybridization with silica did not affect the intrinsically porous microstructure of PU foams with silica contents of up to 10wt% and where 5-60nm silica nanoparticles were well dispersed in the PU matrix, despite slight agglomerations. The incorporated silica enhanced the mechanical performance of PU by proffering better flexibility and durability as well as maintaining good water absorption capabilities and the WVTR characteristics of pure PU foam. The silica of PU-10wt% Si foams was gradually dissolved and released under physiological conditions during a 14-day immersion period. The in vitro cell attachment and proliferation tests showed significant improvements in terms of the biocompatibility of PU-Si hybrid foams and demonstrated the effects of silica on cell growth. More significantly, the superior healing capability of PU-Si as a wound dressing in comparison to PU-treated wounds was verified through in vivo animal tests. Full-thickness wounds treated with PU-Si foams exhibited faster wound closure rates as well as accelerated collagen and elastin fiber regeneration in newly formed dermis, which was ultimately completely covered by a new epithelial layer. It is clear that PU-Si hybrid foams have considerable potential as a wound dressing material geared for accelerated, superior wound healing.

A novel method for fabricating engineered structures with branched micro-channel using hollow hydrogel fibers

Vascularization plays a crucial role in the regeneration of different damaged or diseased tissues and organs. Vascularized networks bring sufficient nutrients and oxygen to implants and receptors. However, the fabrication of engineered structures with branched micro-channels (ESBM) is still the main technological barrier. To address this problem, this paper introduced a novel method for fabricating ESBM; the manufacturability and feasibility of this method was investigated. A triaxial nozzle with automatic cleaning function was mounted on a homemade 3D bioprinter to coaxially extrude sodium alginate (NaAlg) and calcium chloride (CaCl₂) to form the hollow hydrogel fibers. With the incompleteness of cross-linking and proper trimming, ESBM could be produced rapidly. Different concentrations of NaAlg and CaCl₂ were used to produce ESBM, and mechanical property tests were conducted to confirm the optimal material concentration for making the branched structures. Cell media could be injected into the branched channel, which showed a good perfusion. Fibroblasts were able to maintain high viability after being cultured for a few days, which verified the non-cytotoxicity of the gelation and fabrication process. Thus, hollow hydrogel fibers were proved to be a potential method for fabricating micro-channels for vascularization.

Design and Printing Strategies in 3D Bioprinting of Cell-Hydrogels: A Review

Bioprinting is an emerging technology that allows the assembling of both living and non-living biological materials into an ideal complex layout for further tissue maturation. Bioprinting aims to produce engineered tissue or organ in a mechanized, organized, and optimized manner. Various biomaterials and techniques have been utilized to bioprint biological constructs in different shapes, sizes and resolutions. There is a need to systematically discuss and analyze the reported strategies employed to fabricate these constructs. We identified and discussed important design factors in bioprinting, namely shape and resolution, material heterogeneity, and cellular-material remodeling dynamism. Each design factors are represented by the corresponding process capabilities and printing parameters. The process-design map will inspire future biomaterials research in these aspects. Design considerations such as data processing, bio-ink formulation and process selection are discussed. Various printing and crosslinking strategies, with relevant applications, are also systematically reviewed. We categorized them into 5 general bioprinting strategies, including direct bioprinting, in-process crosslinking, post-process crosslinking, indirect bioprinting and hybrid bioprinting. The opportunities and outlook in 3D bioprinting are highlighted. This review article will serve as a framework to advance computer-aided design in bioprinting technologies.

A Versatile Method for Fabricating Tissue Engineering Scaffolds with a Three-Dimensional Channel for Prevasculature Networks

Despite considerable advances in tissue engineering over the past two decades, solutions to some crucial problems remain elusive. Vascularization is one of the most important factors that greatly influence the function of scaffolds. Many research studies have focused on the construction of a vascular-like network with prevascularization structure. Sacrificial materials are widely used to build perfusable vascular-like architectures, but most of these fabricated scaffolds only have a 2D plane-connected network. The fabrication of three-dimensional perfusable branched networks remains an urgent issue. In this work, we developed a novel sacrificial molding technique for fabricating biocompatible scaffolds with a three-dimensional perfusable branched network. Here, 3D-printed poly(vinyl alcohol) (PVA) filament was used as the sacrificial material. The fused PVA was deposited on the surface of a cylinder to create the 3D branched solid network. Gelatin was used to embed the solid network. Then, the PVA mold was dissolved after curing the hydrogel. The obtained architecture shows good perfusability. Cell experiment results indicated that human umbilical vein endothelial cells (HUVECs) successfully attached to the surface of the branched channel and maintained high viability after a few days in culture. In order to prevent deformation of the channel, paraffin was coated on the surface of the printed structure, and hydroxyapatite (HA) was added to gelatin. In conclusion, we demonstrate a novel strategy toward the engineering of prevasculature thick tissues through the integration of the fused PVA filament deposit. This approach has great potential in solving the issue of three-dimensional perfusable branched networks and opens the way to clinical applications.

3D Bioprinting Technologies for Hard Tissue and Organ Engineering

Hard tissues and organs, including the bones, teeth and cartilage, are the most extensively exploited and rapidly developed areas in regenerative medicine field. One prominent character of hard tissues and organs is that their extracellular matrices mineralize to withstand weight and pressure. Over the last two decades, a wide variety of 3D printing technologies have been adapted to hard tissue and organ engineering. These 3D printing technologies have been defined as 3D bioprinting. Especially for hard organ regeneration, a series of new theories, strategies and protocols have been proposed. Some of the technologies have been applied in medical therapies with some successes. Each of the technologies has pros and cons in hard tissue and organ engineering. In this review, we summarize the advantages and disadvantages of the historical available innovative 3D bioprinting technologies for used as special tools for hard tissue and organ engineering.

Biodegradable Polymers and Stem Cells for Bioprinting

It is imperative to develop organ manufacturing technologies based on the high organ failure mortality and serious donor shortage problems. As an emerging and promising technology, bioprinting has attracted more and more attention with its super precision, easy reproduction, fast manipulation and advantages in many hot research areas, such as tissue engineering, organ manufacturing, and drug screening. Basically, bioprinting technology consists of inkjet bioprinting, laser-based bioprinting and extrusion-based bioprinting techniques. Biodegradable polymers and stem cells are common printing inks. In the printed constructs, biodegradable polymers are usually used as support scaffolds, while stem cells can be engaged to differentiate into different cell/tissue types. The integration of biodegradable polymers and stem cells with the bioprinting techniques has provided huge opportunities for modern science and technologies, including tissue repair, organ transplantation and energy metabolism.

Three-dimensional printing of alginate: From seaweeds to heart valve scaffolds

Three-dimensional (3D) printing is a resourceful technology that offers a large selection of solutions that are readily adaptable to tissue engineering of artificial heart valves (HVs). Different deposition techniques could be used to produce complex architectures, such as the three-layered architecture of leaflets. Once the assembly is complete, the growth of cells in the scaffold would enable the deposition of cell-specific extracellular matrix proteins. 3D printing technology is a rapidly evolving field that first needs to be understood and then explored by tissue engineers, so that it could be used to create efficient scaffolds. On the other hand, to print the HV scaffold, a basic understanding of the fundamental structural and mechanical aspects of the HV should be gained. This review is focused on alginate that can be used as a building material due to its unique properties confirmed by the successful application of alginate-based biomaterials for the treatment of myocardial infarction in humans. Within the field of biomedicine, there is a broad scope for the application of alginate including wound healing, cell transplantation, delivery of bioactive agents, such as chemical drugs and proteins, heat burns, acid reflux, and weight control applications. The non-thrombogenic nature of this polymer has made it an attractive candidate for cardiac applications, including scaffold fabrication for heart valve tissue engineering (HVTE). The next essential property of alginate is its ability to form films, fibers, beads, and virtually any shape in a variety of sizes. Moreover, alginate possesses several prime properties that make it suitable for use in free-form fabrication techniques. The first property is its ability, when dissolved, to increase the viscosity of aqueous solutions, which is particularly important in formulating extrudable mixtures for 3D printing. The second property is its ability to form gels in mild conditions, for example, by adding calcium salt to an aqueous solution of alginate. The latter property is a basis for reactive extrusion- and inkjet printing-based solid free-form fabrication. Both techniques enable the production of scaffolds for cell encapsulation, which increases the seeding efficiency of fabricated structures. The objective of this article is to review methods for the fabrication of alginate hydrogels in the context of HVTE.

A building-block approach to 3D printing a multichannel, organ-regenerative scaffold

Multichannel scaffolds, formed by rapid prototyping technologies, retain a high potential for regenerative medicine and the manufacture of complex organs. This study aims to optimize several parameters for producing poly(lactic-co-glycolic acid) (PLGA) scaffolds by a low-temperature, deposition manufacturing, three-dimensional printing (3DP, or rapid prototyping) system. Concentration of the synthetic polymer solution, nozzle speed and extrusion rate were analysed and discussed. Polymer solution with a concentration of 12% w/v was determined as optimal for formation; large deviation of this figure failed to maintain the desired structure. The extrusion rate was also modified for better construct quality. Finally, several solid organ scaffolds, such as the liver, with proper wall thickness and intact contour were printed. This study gives basic instruction to design and fabricate scaffolds with de novo material systems, particularly by showing the approximation of variables for manufacturing multichannel PLGA scaffolds. Copyright © 2015 John Wiley & Sons, Ltd.