Fabrication Speed Optimization for High-resolution 3D-printing of Bioresorbable Vascular Scaffolds

High-precision 3D printing of multi-branch vascular scaffold with plasticized PLCL thermoplastic elastomer

Three-dimensional (3D) printing has emerged as a transformative technology for tissue engineering, enabling the production of structures that closely emulate the intricate architecture and mechanical properties of native biological tissues. However, the fabrication of complex microstructures with high accuracy using biocompatible, degradable thermoplastic elastomers poses significant technical obstacles. This is primarily due to the inherent soft-matter nature of such materials, which complicates real-time control of micro-squeezing, resulting in low fidelity or even failure. In this study, we employ Poly (L-lactide-co-ϵ-caprolactone) (PLCL) as a model material and introduce a novel framework for high-precision 3D printing based on the material plasticization process. This approach significantly enhances the dynamic responsiveness of the start-stop transition during printing, thereby reducing harmful errors by up to 93%. Leveraging this enhanced material, we have efficiently fabricated arrays of multi-branched vascular scaffolds that exhibit exceptional morphological fidelity and possess elastic moduli that faithfully approximate the physiological modulus spectrum of native blood vessels, ranging from 2.5 to 45 MPa. The methodology we propose for the compatibilization and modification of elastomeric materials addresses the challenge of real-time precision control, representing a significant advancement in the domain of melt polymer 3D printing. This innovation holds considerable promise for the creation of detailed multi-branch vascular scaffolds and other sophisticated organotypic structures critical to advancing tissue engineering and regenerative medicine.

Additive manufacturing of vascular stents

With the advancement of additive manufacturing (AM), customized vascular stents can now be fabricated to fit the curvatures and sizes of a narrowed or blocked blood vessel, thereby reducing the possibility of thrombosis and restenosis. More importantly, AM enables the design and fabrication of complex and functional stent unit cells that would otherwise be impossible to realize with conventional manufacturing techniques. Additionally, AM makes fast design iterations possible while also shortening the development time of vascular stents. This has led to the emergence of a new treatment paradigm in which custom and on-demand-fabricated stents will be used for just-in-time treatments. This review is focused on the recent advances in AM vascular stents aimed at meeting the mechanical and biological requirements. First, the biomaterials suitable for AM vascular stents are listed and briefly described. Second, we review the AM technologies that have been so far used to fabricate vascular stents as well as the performances they have achieved. Subsequently, the design criteria for the clinical application of AM vascular stents are discussed considering the currently encountered limitations in materials and AM techniques. Finally, the remaining challenges are highlighted and some future research directions are proposed to realize clinically-viable AM vascular stents. STATEMENT OF SIGNIFICANCE: Vascular stents have been widely used for the treatment of vascular disease. The recent progress in additive manufacturing (AM) has provided unprecedented opportunities for revolutionizing traditional vascular stents. In this manuscript, we review the applications of AM to the design and fabrication of vascular stents. This is an interdisciplinary subject area that has not been previously covered in the published review articles. Our objective is to not only present the state-of-the-art of AM biomaterials and technologies but to also critically assess the limitations and challenges that need to be overcome to speed up the clinical adoption of AM vascular stents with both anatomical superiority and mechanical and biological functionalities that exceed those of the currently available mass-produced devices.

3D Printability Assessment of Poly(octamethylene maleate (anhydride) citrate) and Poly(ethylene glycol) Diacrylate Copolymers for Biomedical Applications

Herein, we present the first example of 3D printing with poly(octamethylene maleate (anhydride) citrate) (POMaC), a bio-adhesive material which has shown particular promise for implantable biomedical devices. The current methods to fabricate such devices made from POMaC are hindered by the imposed constraints of designing complex molds. We demonstrate the feasibility of exploiting additive manufacturing to 3D print structural functional materials consisting of POMaC. We present 3D printing of biomaterial copolymers consisting of mixtures of poly(ethylene glycol) diacrylate (PEGDA) and POMaC at different ratios. The required parameters were optimized, and characterization of the printing fidelity and physical properties was performed. We have also demonstrated that a range of mechanical properties can be achieved by tuning the POMaC/PEGDA ratio. The biocompatibility of the copolymers was ascertained via a cell viability assay. Such tunable 3D printed biomaterials consisting of POMaC and PEGDA will have significant potential application in the development of functional biomaterial tissue scaffolds and biomedical devices for the future of personalized medicine.

Characterization of a 30 µm pixel size CLIP-based 3D printer and its enhancement through dynamic printing optimization

Resolving microscopic and complex 3D polymeric structures while maintaining high print speeds in additive manufacturing has been challenging. To achieve print precision at micrometer length scales for polymeric materials, most 3D printing technologies utilize the serial voxel printing approach that has a relatively slow print speed. Here, a 30-µm-resolution continuous liquid interface production (CLIP)-based 3D printing system for printing polymeric microstructures is described. This technology combines the high-resolution from projection microstereolithography and the fast print speed from CLIP, thereby achieving micrometer print resolution at x10³ times faster than other high-resolution 3D printing technologies. Print resolutions in both lateral and vertical directions were characterized, and the printability of minimum 30 µm features in 2D and 3D has been demonstrated. Through dynamic printing optimization, a method that varies the print parameters (e.g. exposure time, UV intensity, and dark time) for each print layer, overhanging struts at various thicknesses spanning 1 order of magnitude (25 µm - 200 µm) in a single print are resolvable. Taken together, this work illustrates that the micro-CLIP 3D printing technology, in combination with dynamic printing optimization, has the high resolution needed to enable manufacturing of exquisitely detailed and gradient 3D structures, such as terraced microneedle arrays and micro-lattice structures, while maintaining high print speeds.

Structural Design of Vascular Stents: A Review

Percutaneous Coronary Intervention (PCI) is currently the most conventional and effective method for clinically treating cardiovascular diseases such as atherosclerosis. Stent implantation, as one of the ways of PCI in the treatment of coronary artery diseases, has become a hot spot in scientific research with more and more patients suffering from cardiovascular diseases. However, vascular stent implanted into vessels of patients often causes complications such as In-Stent Restenosis (ISR). The vascular stent is one of the sophisticated medical devices, a reasonable structure of stent can effectively reduce the complications. In this paper, we introduce the evolution, performance evaluation standards, delivery and deployment, and manufacturing methods of vascular stents. Based on a large number of literature pieces, this paper focuses on designing structures of vascular stents in terms of “bridge (or link)” type, representative volume unit (RVE)/representative unit cell (RUC), and patient-specific stent. Finally, this paper gives an outlook on the future development of designing vascular stents.

Personalized, Mechanically Strong, and Biodegradable Coronary Artery Stents via Melt Electrowriting

Biodegradable coronary artery stents are sought-after alternatives to permanent stents. These devices are designed to degrade after the blood vessel heals, leaving behind a regenerated artery. The original generation of clinically available biodegradable stents required significantly thicker struts (∼150 μm) than nondegradable ones to ensure sufficient mechanical strength. However, these thicker struts proved to be a key contributor to the clinical failure of the stents. A current challenge lies in the fabrication of stents that possess both thin struts and adequate mechanical strength. In this contribution, we describe a method for the bottom-up, additive manufacturing of biodegradable composite stents with ultrathin fibers and superior mechanical properties compared to the base polymer. Specifically, we illustrate that melt electrowriting (MEW) can be used to 3D print composite structures with thin struts (60-80 μm) and a high degree of geometric complexity required for stenting applications. Additionally, this technology allows additive manufacture of personalized stents that are customized to a patient's unique anatomy and disease state. Furthermore, we illustrate that polycaprolactone-reduced graphene oxide nanocomposites have superior mechanical properties compared to original polycaprolactone without detriment to the material's cytocompatibility and that customizable stent-like structures can be fabricated from these materials with struts as thin as 60 μm, well below the target value for clinical use of 80 μm.

Additive Manufacturing of Precision Biomaterials

Biomaterials play a critical role in modern medicine as surgical guides, implants for tissue repair, and as drug delivery systems. The emerging paradigm of precision medicine exploits individual patient information to tailor clinical therapy. While the main focus of precision medicine to date is the design of improved pharmaceutical treatments based on "-omics" data, the concept extends to all forms of customized medical care. This includes the design of precision biomaterials that are tailored to meet specific patient needs. Additive manufacturing (AM) enables free-form manufacturing and mass customization, and is a critical enabling technology for the clinical implementation of precision biomaterials. Materials scientists and engineers can contribute to the realization of precision biomaterials by developing new AM technologies, synthesizing advanced (bio)materials for AM, and improving medical-image-based digital design. As the field matures, AM is poised to provide patient-specific tissue and organ substitutes, reproducible microtissues for drug screening and disease modeling, personalized drug delivery systems, as well as customized medical devices.

Review of alginate-based hydrogel bioprinting for application in tissue engineering

The dawn of 3D printing in medicine has given the field the hope of vitality in many patients fighting a multitude of diseases. Also entitled bioprinting, this appertains to its sequential printing of precursor ink, embodying cells and polymer/composite in a predetermined trajectory. The precursor ink, in addition to cells, is predominantly constituted of hydrogels due to its biodegradability and ability to mimic the body's anatomy and mechanical features, e.g. bones, etc. This review paper is devoted to explicating the bioprinting (3D/4D) of alginate hydrogels, which are extracts from brown algae, through extrusion additive manufacturing. Alginates are salt derivatives of alginic acid and constitute long chains of polysaccharides, which provides pliability and gelling adeptness to their structure. Alginate hydrogel (employed for extrusion) can be pristine or composite relying on the requisite properties (target application controlled or in vivo environment), e.g. alginate-natural (gelatin/agarose/collagen/hyaluronic acid/etc) and alginate-synthetic (polyethylene glycol (PEG)/pluronic F-127/etc). Extrusion additive manufacturing of alginate is preponderate among others with its uncomplicated processing, material efficiency (cut down on wastage), and outspread adaptability for viscosities (0.03-6 * 10⁴ Pa.s), but the procedure is limited by resolution (200 μm) in addition to accuracy. However, 3D-fabricated biostructures display rigidness (unvarying with conditions) i.e. lacks a smart response, which is reassured by accounting time feature as a noteworthy accessory to printing, interpreted as 4D bioprinting. This review propounds the specific processing itinerary for alginate (meanwhile traversing across its composites/blends with natural and synthetic consideration) in extrusion along with its pre-/during/post-processing parameters intrinsic to the process. Furthermore, propensity is also presented in its (alginate extrusion processing) application for tissue engineering, i.e. bones, cartilage (joints), brain (neural), ear, heart (cardiac), eyes (corneal), etc, due to a worldwide quandary over accessibility to natural organs for diverse types of diseases. Additionally, the review contemplates recently invented advance printing, i.e. 4D printing for biotic species, with its challenges and future opportunities.

Citrate chemistry and biology for biomaterials design

Leveraging the multifunctional nature of citrate in chemistry and inspired by its important role in biological tissues, a class of highly versatile and functional citrate-based materials (CBBs) has been developed via facile and cost-effective polycondensation. CBBs exhibiting tunable mechanical properties and degradation rates, together with excellent biocompatibility and processability, have been successfully applied in vitro and in vivo for applications ranging from soft to hard tissue regeneration, as well as for nanomedicine designs. We summarize in the review, chemistry considerations for CBBs design to tune polymer properties and to introduce functionality with a focus on the most recent advances, biological functions of citrate in native tissues with the new notion of degradation products as cell modulator highlighted, and the applications of CBBs in wound healing, nanomedicine, orthopedic, cardiovascular, nerve and bladder tissue engineering. Given the expansive evidence for citrate's potential in biology and biomaterial science outlined in this review, it is expected that citrate based materials will continue to play an important role in regenerative engineering.

A Critical Review on Metallic Glasses as Structural Materials for Cardiovascular Stent Applications

Functional and mechanical properties of novel biomaterials must be carefully evaluated to guarantee long-term biocompatibility and structural integrity of implantable medical devices. Owing to the combination of metallic bonding and amorphous structure, metallic glasses (MGs) exhibit extraordinary properties superior to conventional crystalline metallic alloys, placing them at the frontier of biomaterials research. MGs have potential to improve corrosion resistance, biocompatibility, strength, and longevity of biomedical implants, and hence are promising materials for cardiovascular stent applications. Nevertheless, while functional properties and biocompatibility of MGs have been widely investigated and validated, a solid understanding of their mechanical performance during different stages in stent applications is still scarce. In this review, we provide a brief, yet comprehensive account on the general aspects of MGs regarding their formation, processing, structure, mechanical, and chemical properties. More specifically, we focus on the additive manufacturing (AM) of MGs, their outstanding high strength and resilience, and their fatigue properties. The interconnection between processing, structure and mechanical behaviour of MGs is highlighted. We further review the main categories of cardiovascular stents, the required mechanical properties of each category, and the conventional materials have been using to address these requirements. Then, we bridge between the mechanical requirements of stents, structural properties of MGs, and the corresponding stent design caveats. In particular, we discuss our recent findings on the feasibility of using MGs in self-expandable stents where our results show that a metallic glass based aortic stent can be crimped without mechanical failure. We further justify the safe deployment of this stent in human descending aorta. It is our intent with this review to inspire biodevice developers toward the realization of MG-based stents.