Tissue engineering and the development of Apligraf, a human skin equivalent

Plasticity of bone marrow-derived cell differentiation depending on microenvironments in the skin

Bone marrow-derived cells (BMDCs) are heterogeneous populations in which not only pluripotent stem cells, namely, hematopoietic stem cells (HSCs), mesenchymal stem cells (MSC) but also endothelial progenitor cells (EPC) are involved. BMDCs contribute to the maintenance of homeostasis and recovery from disrupted homeostasis as the immune, endocrine, and nervous systems. The skin is the largest organ in which various tissues, such as the epidermis, dermis, skin appendages (i.e., hair follicles), fats, muscles, and vessels, are tightly and systematically packed. It functions as a physical barrier to block the invasion of harmful substances and pathogenic microorganisms and properly regulate water evaporation. The skin is exposed to injuries from external stimuli because it is the outermost layer and owing to its specificity. Recovery from physical injuries and DNA mutations occurs constantly in the skin, but medical treatments are required for impaired wound healing. Recently, conservative treatments utilizing scaffolds have attracted attention as alternatives to surgical therapy, which is highly invasive. Against this background, numerous scaffolds are available in a clinical setting, although they have not surpassed surgery because of their distinct disadvantages. Here, we discuss the plasticity of BMDCs in the skin to maintain homeostasis, in addition to their critical roles on recovery from disrupted homeostasis. We also share our perspective on how scaffolds can be developed to establish scaffolds beyond surgery to regenerate skin structure during wound healing by maximally utilizing the plasticity of BMDCs.

Piezoelectric and Dielectric Electrospun Fluoropolymer Membranes for Oral Mucosa Regeneration: A Comparative Study

Wound healing of the oral mucosa is an urgent problem in modern dental surgical practice. This research article presents and compares the findings of the investigations of the structural, physicochemical, and biological characteristics of two types of polymeric membranes used for the regeneration of oral mucosa. The membranes were prepared from poly(tetrafluoroethylene) (PTFE) and a copolymer of vinylidene fluoride and tetrafluoroethylene (VDF-TeFE) and analyzed via scanning electron microscopy, atomic force microscopy, X-ray diffraction analysis, and Fourier transform infrared spectroscopy. Investigation results obtained indicate that both types of membranes are composed of thin fibers: (0.57 ± 0.25) μm for PTFE membranes and (0.43 ± 0.14) μm for VDF-TeFE membranes. Moreover, the fibers of VDF-TeFE membranes exhibit distinct piezoelectric properties, which are confirmed by piezoresponse force microscopy and X-ray diffraction. Both types of membranes are hydrophobic: (139.7 ± 2.5)° for PTFE membranes and (133.5 ± 2.0)° for VDF-TeFE membranes. In vitro assays verify that both membrane types did not affect the growth and division of mice fibroblasts of the 3T3-L1 cell line, with a cell viability in the range of 88-101%. Finally, in vivo comparative experiments carried out using Wistar rats demonstrate that the piezoelectric VDF-TeFE membranes have a high ability to regenerate oral mucosa.

3D bioprinting bioglass to construct vascularized full-thickness skin substitutes for wound healing

Constructing three-dimensional (3D) bioprinted skin tissues that accurately replicate the mechanical properties of native skin and provide adequate oxygen and nutrient support remains a formidable challenge. In this study, we incorporated phosphosilicate calcium bioglasses (PSCs), a type of bioactive glass (BG), into the bioinks used for 3D bioprinting. The resulting bioink exhibited mechanical properties and biocompatibility that closely resembled those of natural skin. Utilizing 3D bioprinting technology, we successfully fabricated full-thickness skin substitutes, which underwent comprehensive evaluation to assess their regenerative potential in treating full-thickness skin injuries in rats. Remarkably, the skin substitutes loaded with PSCs exhibited exceptional angiogenic activity, as evidenced by the upregulation of angiogenesis-related genes in vitro and the observation of enhanced vascularization in wound tissue sections in vivo. These findings conclusively demonstrated the outstanding efficacy of PSCs in promoting angiogenesis and facilitating the repair of full-thickness skin wounds. The insights garnered from this study provide a valuable reference strategy for the development of skin tissue grafts with potent angiogenesis-inducing capabilities.

Potentials of a Plasma-Aerosol System for Wound Healing Advanced by Drug Introduction: An In Vitro Study

Cold plasmas have found their application in a wide range of biomedical fields by virtue of their high chemical reactivity. In the past decades, many attempts have been made to use cold plasmas in wound healing, and within this field, many studies have focused on plasma-induced cell proliferation mechanisms. In this work, one step further has been taken to demonstrate the advanced role of plasma in wound healing. To this end, the simultaneous ability of plasma to induce cell proliferation and permeabilize treated cells has been examined in the current study. The driving force was to advance the wound healing effect of plasma with drug delivery. On this subject, we demonstrate in vitro the healing effect of Ar, Ar+N₂ plasma, and their aerosol counterparts. A systematic study has been carried out to study the role of reactive oxygen species (ROS) and reactive nitrogen species (RNS) in cell adhesion, signaling, differentiation, and proliferation. An additional investigation was also performed to study the permeabilization of cells and the delivery of the modeled drug carrier fluorescein isothiocyanate (FITC) labeled dextran into cells upon plasma treatment. Short 35 s plasma treatments were found to promote fibroblast adhesion, migration, signaling, proliferation, and differentiation by means of reactive oxygen and nitrogen species (RONS) created by plasma and deposited into the cell environment. The impact of the plasma downstream products NO₂^- and NO₃^- on the expressions of the focal adhesion's genes, syndecans, and collagens was observed to be prominent. On the other hand, the differentiation of fibroblasts to myofibroblasts was mainly initiated by ROS produced by the plasma. In addition, the ability of plasma to locally permeabilize fibroblast cells was demonstrated. During proliferative cell treatment, plasma can simultaneously induce cell membrane permeabilization (d ∼ 7.3 nm) by the species OH and H₂O₂. The choice for a plasma or a plasma-aerosol configuration thus allows the possibility to change the spatial chemistry of drug delivery molecules and thus to locally deliver drugs. Accordingly, this study offers a pivotal step toward plasma-assisted wound healing advanced by drug delivery.

Bioactive glass-collagen/poly (glycolic acid) scaffold nanoparticles exhibit improved biological properties and enhance osteogenic lineage differentiation of mesenchymal stem cells

Today’s using tissue engineering and suitable scaffolds have got attention to increase healing of non-union bone fractures. In this study, we aimed to prepare and characterize scaffolds with functional and mechanical properties suitable for bone regeneration. Porous scaffolds containing collagen-poly glycolic acid (PGA) blends and various quantities of bioactive glass (BG) 45S5 were fabricated. Scaffolds with different compositions (BG/collagen-PGA ratios (w/w): 0/100; 40/60; 70/30) were characterized for their morphological properties, bioactivity, and mechanical behavior. Then, biocompatibility and osteogenic differentiation potential of the scaffolds were analyzed by seeding mesenchymal stem cells (MSCs). Scaffolds made with collagen-PGA combined with the BG (45S5) were found to have interconnected pores (average pore diameter size 75–115 µm) depending on the percentage of the BG added. Simulated body fluid (SBF) soaking experiments indicated the stability of scaffolds in SBF regardless of their compositions, while the scaffolds retained their highly interconnected structure. The elastic moduli, cell viability, osteogenic differentiation of the BG/collagen-PGA 40/60 and 70/30 scaffolds were superior to the original BG/collagen-PGA (0/100). These results suggest that BG incorporation enhanced the physical stability of our collagen-PGA scaffold previously reported. This new scaffold composition provides a promising platform to be used as a non-toxic scaffold for bone regeneration and tissue engineering.

Peptide nanogels as a scaffold for fabricating dermal grafts and 3D vascularized skin models

Millions of people worldwide suffer from skin injuries, which create significant problems in their lives and are costly to cure. Tissue engineering is a promising approach that aims to fabricate functional organs using biocompatible scaffolds. We designed ultrashort tetrameric peptides with promising properties required for skin tissue engineering. Our work aimed to test the efficacy of these scaffolds for the fabrication of dermal grafts and 3D vascularized skin tissue models. We found that the direct contact of keratinocytes and fibroblasts enhanced the proliferation of the keratinocytes. Moreover, the expression levels of TGF-β1, b-FGF, IL-6, and IL-1α is correlated with the growth of the fibroblasts and keratinocytes in the co-culture. Furthermore, we successfully produced a 3D vascularized skin co-culture model using these peptide scaffolds. We believe that the described results represent an advancement in the fabrication of skin tissue equivalent, thereby providing the opportunity to rebuild missing, failing, or damaged parts.

Graphical abstract

Anti-Aging β-Klotho Gene-Activated Scaffold Promotes Rejuvenative Wound Healing Response in Human Adipose-Derived Stem Cells

Wound healing requires a tight orchestration of complex cellular events. Disruption in the cell-signaling events can severely impair healing. The application of biomaterial scaffolds has shown healing potential; however, the potential is insufficient for optimal wound maturation. This study explored the functional impact of a collagen-chondroitin sulfate scaffold functionalized with nanoparticles carrying an anti-aging gene β-Klotho on human adipose-derived stem cells (ADSCs) for rejuvenative healing applications. We studied the response in the ADSCs in three phases: (1) transcriptional activities of pluripotency factors (Oct-4, Nanog and Sox-2), proliferation marker (Ki-67), wound healing regulators (TGF-β3 and TGF-β1); (2) paracrine bioactivity of the secretome generated by the ADSCs; and (3) regeneration of basement membrane (fibronectin, laminin, and collagen IV proteins) and expression of scar-associated proteins (α-SMA and elastin proteins) towards maturation. Overall, we found that the β-Klotho gene-activated scaffold offers controlled activation of ADSCs' regenerative abilities. On day 3, the ADSCs on the gene-activated scaffold showed enhanced (2.5-fold) activation of transcription factor Oct-4 that was regulated transiently. This response was accompanied by a 3.6-fold increase in the expression of the anti-fibrotic gene TGF-β3. Through paracrine signaling, the ADSCs-laden gene-activated scaffold also controlled human endothelial angiogenesis and pro-fibrotic response in dermal fibroblasts. Towards maturation, the ADSCs-laden gene-activated scaffold further showed an enhanced regeneration of the basement membrane through increases in laminin (2.1-fold) and collagen IV (8.8-fold) deposition. The ADSCs also expressed 2-fold lower amounts of the scar-associated α-SMA protein with improved qualitative elastin matrix deposition. Collectively, we determined that the β-Klotho gene-activated scaffold possesses tremendous potential for wound healing and could advance stem cell-based therapy for rejuvenative healing applications.

Collagen- and hyaluronic acid-based hydrogels and their biomedical applications

Hydrogels have been widely investigated in biomedical fields due to their similar physical and biochemical properties to the extracellular matrix (ECM). Collagen and hyaluronic acid (HA) are the main components of the ECM in many tissues. As a result, hydrogels prepared from collagen and HA hold inherent advantages in mimicking the structure and function of the native ECM. Numerous studies have focused on the development of collagen and HA hydrogels and their biomedical applications. In this extensive review, we provide a summary and analysis of the sources, features, and modifications of collagen and HA. Specifically, we highlight the fabrication, properties, and potential biomedical applications as well as promising commercialization of hydrogels based on these two natural polymers.

Application of Advanced Nanomaterials for Kidney Failure Treatment and Regeneration

The implementation of nanomedicine not only provides enhanced drug solubility and reduced off-target adverse effects, but also offers novel theranostic approaches in clinical practice. The increasing number of studies on the application of nanomaterials in kidney therapies has provided hope in a more efficient strategy for the treatment of renal diseases. The combination of biotechnology, material science and nanotechnology has rapidly gained momentum in the realm of therapeutic medicine. The establishment of the bedrock of this emerging field has been initiated and an exponential progress is observed which might significantly improve the quality of human life. In this context, several approaches based on nanomaterials have been applied in the treatment and regeneration of renal tissue. The presented review article in detail describes novel strategies for renal failure treatment with the use of various nanomaterials (including carbon nanotubes, nanofibrous membranes), mesenchymal stem cells-derived nanovesicles, and nanomaterial-based adsorbents and membranes that are used in wearable blood purification systems and synthetic kidneys.

A decellularized porcine pulmonary valved conduit embedded with gelatin

To prepare a tissue-engineered pulmonary valved conduit (PVC) with good tensile strength and biocompatibility. Sixty adult porcine PVCs were used to determine the optimal decellularization time. Five juvenile porcine decellularized PVCs and five juvenile porcine crosslinked PVCs were subsequently prepared according to the optimized decellularization and crosslinking methods. All PVCs were implanted into juvenile sheep for 8 months and then were harvested for staining. With a low concentration of detergent (0.25% Triton X-100+0.25% sodium deoxycholate), the decellularization effect on porcine PVCs was complete by 24 hours, and there was minimal damage to the matrix. Gelatin embedding and 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) crosslinking improved the biomechanical properties of decellularized PVCs and reduced their immunogenicity. After implantation, the diameter and thickness of the PVCs in the decellularized and crosslinked groups increased significantly. In both groups, the conduits were unobstructed, with soft and smooth inner walls and without thrombosis, ulceration or neoplasia. The valves slightly degenerated with mild to moderate regurgitation. CD31-positive endothelial cells were visible on the inner surface of the conduits and valves. Scattered smooth muscle actin-positive cells were found in the middle layer of the conduit. The percentage of CD4- and CD68-positive cells and the calcium content were highest in decellularized porcine PVCs and lowest in ovine PVCs. The percentage of the matrix that was laminin-positive in decellularized and crosslinked porcine PVCs was lower than it was in ovine PVCs. Gelatin-embedded and EDC-crosslinked porcine PVCs can be "hosted" in sheep, with good biocompatibility, growth potential, and reduced calcification.

Metformin Hydrochloride Encapsulation by Alginate Strontium Hydrogel for Cartilage Regeneration by Reliving Cellular Senescence

Cartilage lesion is a common tissue defect and is challenging in clinical practice. Trauma-induced cellular senescence could decrease the chondrocyte capability of maintaining cartilage tissue regeneration. A previous investigation showed that, by controlling the cellular senescence, the cartilage regeneration can be significantly accelerated. Based on this finding, we design a novel hydrogel, Alg/MH-Sr, that combines metformin, an established drug for inhibiting senescence, and strontium, an effective anti-inflammatory material for cartilage tissue engineering. A RT-PCR test suggests the significant inhibitory effect of the hydrogel on senescent, apoptotic, oxidative, and inflammatory genes' expression. Histological examinations demonstrate that the Alg/MH-Sr hydrogel accelerated cartilage repairment, and chondrocyte senescence was significantly inhibited. Our study demonstrates that the Alg/MH-Sr hydrogel is effective for cartilage defect treatment and provides a new clue in accelerating tissue repairment by inhibiting the senescence of cells and tissues.

Cell-free scaffold from jellyfish Cassiopea andromeda (Cnidaria; Scyphozoa) for skin tissue engineering

Disruption of the continuous cutaneous membrane in the integumentary system is considered a health problem of high cost for any nation. Several attempts have been made for developing skin substitutes in order to restore injured tissue including autologous implants and the use of scaffolds based on synthetic and natural materials. Current biomaterials used for skin tissue repair include several scaffold matrices types, synthetic or natural, absorbable, degradable or non-degradable polymers, porous or dense scaffolds, and cells capsulated in hydrogels or spheroids systems so forth. These materials have advantages and disadvantages and its use will depend on the desired application. Recently, marine organisms such as jellyfish have attracted renewed interest, because both its composition and structure resemble the architecture of human dermic tissue. In this context, the present study aims to generate scaffolds from Cassiopea andromeda (C. andromeda), with application in skin tissue engineering, using a decellularization process. The obtained scaffold was studied by infrared spectroscopy (FT-IR), thermogravimetric analysis (TGA), differential scanning calorimetry analysis (DSC), and scanning electron microscopy (SEM). Crystal violet staining and DNA quantification assessed decellularization effectiveness while the biocompatibility of scaffold was determined with human dermic fibroblasts. Results indicated that the decellularization process reduce native cell population leading to 70% reduction in DNA content. In addition, SEM showed that the macro and microstructure of the collagen I-based scaffold were preserved allowing good adhesion and proliferation of human dermic fibroblasts. The C. andromeda scaffold mimics human skin and therefore represents great potential for skin tissue engineering.

Tissue Engineering: New Paradigm of Biomedicine

Tissue engineering is a multidisciplinary field of biomedicine that is being used to develop a new tissue or restore the function of diseased tissue/organ. The main objective of tissue engineering is to overcome the shortage of donor organs. Tissue engineering is mainly based on three components i.e. cells, scaffold and growth factors. Among these three components, scaffold is a primary influencing factor that provides the structural support to the cells and helps to deliver the growth factors which stimulate the proliferation and differentiation of cells to regenerate a new tissue. The properties of a scaffold mainly depend upon types of biomaterial and fabrication techniques that are used to fabricate the scaffold. Biofabrication facilitates the construction of three-dimensional complex of living (cells) and non-living (signaling molecules and extracellular matrices polymers etc.) components. Biofabrication has potential application especially in skin and bone tissue regeneration due to its accuracy, reproducibility and customization of scaffolds as well as cell and signaling molecule delivery. In this review article, different types of biomaterials and fabrication techniques have been discussed to fabricate of a nanofibrous scaffold along with different types of cells and growth factor which are used for tissue engineering applications to regenerate a new tissue. Among different techniques to fabricate a scaffold, electrospinning is simple and cost effective technique that has been mainly focused in the review to produce nanofibous scaffold. On the other hand, a tissue might be repair itself and restore to its normal function inside the body by applying the principle of regenerative medicine.

Isolation and Characterization of a Human Fetal Mesenchymal Stem Cell Population: Exploring the Potential for Cell Banking in Wound Healing Therapies

Various cell-based therapies are in development to address chronic and acute skin wound healing, for example for burns and trauma patients. An off-the-shelf source of allogeneic dermal cells could be beneficial for innovative therapies accelerating the healing in extensive wounds where the availability of a patient’s own cells is limited. Human fetal-derived dermal fibroblasts (hFDFs) show high in vitro division rates, exhibit low immunological rejection properties, and present scarless wound healing in the fetus, and previous studies on human fetal tissue-derived cell therapies have shown promising results on tissue repair. However, little is known about cell lineage stability and cell differentiation during the cell expansion process, required for any potential therapeutic use. We describe an isolation method, characterize a population, and investigate its potential for cell banking and thus suitability as a potential product for cell grafting therapies. Our results show hFDFs and a bone marrow-derived mesenchymal stem cell (BM-MSC) line shared identification markers and in vitro multilineage differentiation potential into osteogenic, chondrogenic, and adipogenic lineages. The hFDF population exhibited similar cell characteristics as BM-MSCs while producing lower pro-inflammatory cytokine IL-6 levels and higher levels of the wound healing factor hepatocyte growth factor. We demonstrate in vitro differentiation of hFDFs, which may be a problem in maintaining long-term lineage stability, potentially limiting their use for cell banking and therapy development.

Collagen Type I: A Versatile Biomaterial

Collagen type I is the most abundant matrix protein in the human body and is highly demanded in tissue engineering, regenerative medicine, and pharmaceutical applications. To meet the uprising demand in biomedical applications, collagen type I has been isolated from mammalians (bovine, porcine, goat and rat) and non-mammalians (fish, amphibian, and sea plant) source using various extraction techniques. Recent advancement enables fabrication of collagen scaffolds in multiple forms such as film, sponge, and hydrogel, with or without other biomaterials. The scaffolds are extensively used to develop tissue substitutes in regenerating or repairing diseased or damaged tissues. The 3D scaffolds are also used to develop in vitro model and as a vehicle for delivering drugs or active compounds.

Enhanced wound healing in diabetic rats by nanofibrous scaffolds mimicking the basketweave pattern of collagen fibrils in native skin

Nanofibrous scaffolds that offer proper microenvironmental cues to promote the healing process are highly desirable for patients with chronic wounds. Although studies have shown that fiber organization regulates cell behaviors in vitro, little is known about its effects on the wound healing process in vivo. Most of the nanofibrous scaffolds currently used in skin repair are randomly oriented. Herein, inspired by the basketweave-like pattern of collagen fibrils in native skin, we fabricated biomimetic nanofibrous scaffolds with crossed fiber organization via electrospinning. The regulation of crossed nanofibrous scaffolds on fibroblasts was compared with that of aligned and random nanofibrous scaffolds. Unexpectedly, crossed nanofibrous scaffolds induced different cellular responses in fibroblasts, including differences in cellular morphology, migration and wound healing related gene expression, in comparison to either aligned or random nanofibrous scaffolds. More importantly, the regulation of nanofibrous scaffolds with different fiber organizations on wound repair was systematically investigated in diabetic rats. While the healing processes were enhanced by all nanofibrous scaffolds, wounds treated with crossed nanofibrous scaffolds achieved the best healing outcome, which was evidenced by the resolution of inflammation, the accelerated migration of fibroblasts and keratinocytes, and the promotion of angiogenesis. These findings helped reveal the role of fiber organization in regulating the wound healing process in vivo and suggest the potential utility of biomimetic crossed nanofibrous scaffolds for the repair of chronic wounds.

Innovative Therapies in Wound Healing

Background:

Apligraf is a bioengineered skin product composed of neonatal fibroblasts and keratinocytes. The FDA has approved Apligraf for the treatment of chronic venous ulcers and diabetic ulcers.

Objective:

We review the development of bioengineered skin, examine the cellular activities of various growth factors that may facilitate wound healing, and discuss the results of clinical trials with a particular construct, Apligraf, as proof of principle.

Conclusion:

Bioengineered skin acts as a “smart” delivery system for growth factors and other stimulatory substances. Not only does it present a novel treatment for chronic and diabetic ulcers, but it could also be considered for application to other types of acute wounds.

Bioengineered Self-assembled Skin as an Alternative to Skin Grafts

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For patients with extensive burns or donor site scarring, the limited availability of autologous and the inevitable rejection of allogeneic skin drive the need for new alternatives. Existing engineered biologic and synthetic skin analogs serve as temporary coverage until sufficient autologous skin is available. Here we report successful engraftment of a self-assembled bilayered skin construct derived from autologous skin punch biopsies in a porcine model. Dermal fibroblasts were stimulated to produce an extracellular matrix and were then seeded with epidermal progenitor cells to generate an epidermis. Autologous constructs were grafted onto partial- and full-thickness wounds. By gross examination and histology, skin construct vascularization and healing were comparable to autologous skin grafts and were superior to an autologous bilayered living cellular construct fabricated with fibroblasts cast in bovine collagen. This is the first demonstration of spontaneous vascularization and permanent engraftment of a self-assembled bilayered bioengineered skin that could supplement existing methods of reconstruction.

Looking Ahead to Engineering Epimorphic Regeneration of a Human Digit or Limb

Approximately 2 million people have had limb amputations in the United States due to disease or injury, with more than 185,000 new amputations every year. The ability to promote epimorphic regeneration, or the regrowth of a biologically based digit or limb, would radically change the prognosis for amputees. This ambitious goal includes the regrowth of a large number of tissues that need to be properly assembled and patterned to create a fully functional structure. We have yet to even identify, let alone address, all the obstacles along the extended progression that limit epimorphic regeneration in humans. This review aims to present introductory fundamentals in epimorphic regeneration to facilitate design and conduct of research from a tissue engineering and regenerative medicine perspective. We describe the clinical scenario of human digit healing, featuring published reports of regenerative potential. We then broadly delineate the processes of epimorphic regeneration in nonmammalian systems and describe a few mammalian regeneration models. We give particular focus to the murine digit tip, which allows for comparative studies of regeneration-competent and regeneration-incompetent outcomes in the same animal. Finally, we describe a few forward-thinking opportunities for promoting epimorphic regeneration in humans.

A tribo-mechanical analysis of PVA-based building-blocks for implementation in a 2-layered skin model

Poly(vinyl) alcohol hydrogel (PVA) is a well-known polymer widely used in the medical field due to its biocompatibility properties and easy manufacturing. In this work, the tribo-mechanical properties of PVA-based blocks are studied to evaluate their suitability as a part of a structure simulating the length scale dependence of human skin. Thus, blocks of pure PVA and PVA mixed with Cellulose (PVA-Cel) were synthesised via freezing/thawing cycles and their mechanical properties were determined by Dynamic Mechanical Analysis (DMA) and creep tests. The dynamic tests addressed to elastic moduli between 38 and 50kPa for the PVA and PVA-Cel, respectively. The fitting of the creep compliance tests in the SLS model confirmed the viscoelastic behaviour of the samples with retardation times of 23 and 16 seconds for the PVA and PVA-Cel, respectively. Micro indentation tests were also achieved and the results indicated elastic moduli in the same range of the dynamic tests. Specifically, values between 45-55 and 56-81kPa were obtained for the PVA and PVA-Cel samples, respectively. The tribological results indicated values of 0.55 at low forces for the PVA decreasing to 0.13 at higher forces. The PVA-Cel blocks showed lower friction even at low forces with values between 0.2 and 0.07. The implementation of these building blocks in the design of a 2-layered skin model (2LSM) is also presented in this work. The 2LSM was stamped with four different textures and their surface properties were evaluated. The hydration of the 2LSM was also evaluated with a corneometer and the results indicated a gradient of hydration comparable to the human skin.

Microscale characterization of the viscoelastic properties of hydrogel biomaterials using dual-mode ultrasound elastography

Characterization of the microscale mechanical properties of biomaterials is a key challenge in the field of mechanobiology. Dual-mode ultrasound elastography (DUE) uses high frequency focused ultrasound to induce compression in a sample, combined with interleaved ultrasound imaging to measure the resulting deformation. This technique can be used to non-invasively perform creep testing on hydrogel biomaterials to characterize their viscoelastic properties. DUE was applied to a range of hydrogel constructs consisting of either hydroxyapatite (HA)-doped agarose, HA-collagen, HA-fibrin, or preosteoblast-seeded collagen constructs. DUE provided spatial and temporal mapping of local and bulk displacements and strains at high resolution. Hydrogel materials exhibited characteristic creep behavior, and the maximum strain and residual strain were both material- and concentration-dependent. Burger's viscoelastic model was used to extract characteristic parameters describing material behavior. Increased protein concentration resulted in greater stiffness and viscosity, but did not affect the viscoelastic time constant of acellular constructs. Collagen constructs exhibited significantly higher modulus and viscosity than fibrin constructs. Cell-seeded collagen constructs became stiffer with altered mechanical behavior as they developed over time. Importantly, DUE also provides insight into the spatial variation of viscoelastic properties at sub-millimeter resolution, allowing interrogation of the interior of constructs. DUE presents a novel technique for non-invasively characterizing hydrogel materials at the microscale, and therefore may have unique utility in the study of mechanobiology and the characterization of hydrogel biomaterials.

Additive manufacturing of scaffolds with dexamethasone controlled release for enhanced bone regeneration

The adoption of additive manufacturing in tissue engineering and regenerative medicine (TERM) strategies greatly relies on the development of novel 3D printable materials with advanced properties. In this work we have developed a material for bone TERM applications with tunable bioerosion rate and dexamethasone release profile which can be further employed in fused deposition modelling (the most common and accessible 3D printing technology in the market). The developed material consisted of a blend of poly-ϵ-caprolactone (PCL) and poloxamine (Tetronic®) and was processed into a ready-to-use filament form by means of a simplified melt-based methodology, therefore eliminating the utilization of solvents. 3D scaffolds composed of various blend formulations were additively manufactured and analyzed revealing blend ratio-specific degradation rates and dexamethasone release profiles. Furthermore, in vitro culture studies revealed a similar blend ratio-specific trend concerning the osteoinductive activity of the fabricated scaffolds when these were seeded and cultured with human mesenchymal stem cells. The developed material enables to specifically address different regenerative requirements found in various tissue defects. The versatility of such strategy is further increased by the ability of additive manufacturing to accurately fabricate implants matching any given defect geometry.

Biofabricated constructs as tissue models: a short review

Biofabrication is currently able to provide reliable models for studying the development of cells and tissues into multiple environments. As the complexity of biofabricated constructs is becoming increasingly higher their ability to closely mimic native tissues and organs is also increasing. Various biofabrication technologies currently allow to precisely build cell/tissue constructs at multiple dimension ranges with great accuracy. Such technologies are also able to assemble together multiple types of cells and/or materials and generate constructs closely mimicking various types of tissues. Furthermore, the high degree of automation involved in these technologies enables the study of large arrays of testing conditions within increasingly smaller and automated devices both in vitro and in vivo. Despite not yet being able to generate constructs similar to complex tissues and organs, biofabrication is rapidly evolving in that direction. One major hurdle to be overcome in order for such level of complex detail to be achieved is the ability to generate complex vascular structures within biofabricated constructs. This review describes several of the most relevant technologies and methodologies currently utilized within biofabrication and provides as well a brief overview of their current and future potential applications.

Clinical applications of naturally derived biopolymer-based scaffolds for regenerative medicine

Naturally derived polymeric biomaterials, such as collagens, silks, elastins, alginates, and fibrins are utilized in tissue engineering due to their biocompatibility, bioactivity, and tunable mechanical and degradation kinetics. The use of these natural biopolymers in biomedical applications is advantageous because they do not release cytotoxic degradation products, are often processed using environmentally-friendly aqueous-based methods, and their degradation rates within biological systems can be manipulated by modifying the starting formulation or processing conditions. For these reasons, many recent in vivo investigations and FDA-approval of new biomaterials for clinical use have utilized natural biopolymers as matrices for cell delivery and as scaffolds for cell-free support of native tissues. This review highlights biopolymer-based scaffolds used in clinical applications for the regeneration and repair of native tissues, with a focus on bone, skeletal muscle, peripheral nerve, cardiac muscle, and cornea substitutes.

Automating the processing steps for obtaining bone tissue-engineered substitutes: from imaging tools to bioreactors

Bone diseases and injuries are highly incapacitating and result in a high demand for tissue substitutes with specific biomechanical and structural features. Tissue engineering has already proven to be effective in regenerating bone tissue, but has not yet been able to become an economically viable solution due to the complexity of the tissue, which is very difficult to be replicated, eventually requiring the utilization of highly labor-intensive processes. Process automation is seen as the solution for mass production of cellularized bone tissue substitutes at an affordable cost by being able to reduce human intervention as well as reducing product variability. The combination of tools such as medical imaging, computer-aided fabrication, and bioreactor technologies, which are currently used in tissue engineering, shows the potential to generate automated production ecosystems, which will, in turn, enable the generation of commercially available products with widespread clinical application.

Challenges and promises in modeling dermatologic disorders with bioengineered skin

The tremendous cost of drug development is often attributed to the long time interval between identifying lead compounds in preclinical studies to assessing clinical efficacy in randomized clinical trials. Many candidate molecules show promise in cell culture or animal models, only to fail in late stage in human investigations. There is a need for novel technologies that allow investigators to quickly and reliably predict drug safety and efficacy. The advent of microtechnology has made it possible to integrate multiple microphysiologic organ systems into a single microfabricated chip. This review focuses on three-dimensional engineered skin, which has enjoyed a long history of uses both in clinical treatments of refractory ulcers and as a laboratory model. We discuss current biological and engineering challenges in construction of a robust bioengineered skin and provide a blueprint for its potential utility to model dermatologic disorders such as psoriasis or cutaneous drug reactions.

Construction of a collagen-based, split-thickness cornea substitute

Tissue-engineered corneas may become a promising alternative to allografts in the treatment of serious cornea defects because of the tunable characteristics of the biomaterials, biomimetic designs, and incorporation of patient's own cells. In this study, collagen foam was coated with a fibrous mat to mimic the stromal layer and the Bowman's layer. The stromal layer substitute was made of N-ethyl-N-(3-dimethyl aminopropyl)carbodiimide/N-hydroxysuccinimide-cross-linked collagen-chondroitin sulfate foam and seeded with primary human corneal keratocytes (HK). Retinal pigment epithelium (RPE) cells served as the epithelial layer after seeding on a dehydrothermally cross-linked collagen type I fibrous mat deposited directly on top of the foams by electrospinning. The physical characterization and the in vitro studies showed that the designed cornea replacement was suitable for cell attachment and growth, and co-culture of the two cell types induced more extracellular matrix (ECM) deposition than the single cell-seeded constructs. The fiber layer was shown to be successful in separating the HK and RPE cells, and still allowed them to maintain cell-cell communication as the increase in ECM deposition and the maintenance of the high transparency (~80%) suggested. This split-thickness corneal substitute was also shown to be readily suturable without any major tears at the end of a short co-culture of 30 days.

Regulation of migratory activity of human keratinocytes by topography of multiscale collagen-containing nanofibrous matrices

Nanofibrous matrices hold great promise in skin wound repair partially due to their capability of recapturing the essential attributes of native extracellular matrix (ECM). With regard to limited studies on the effect of nanofibrous matrices on keratinocytes, the present study was aimed to understand how the topographical feature of nanofibrous matrices regulates keratinocyte motility by culturing keratinocytes on polycaprolactone (PCL)/collagen nanofibrous matrices (rough surface with fiber diameters of 331 ± 112 nm) or the matrices coated with a thin layer of collagen gel to form a secondary ultrafine fibrous network (smooth surface with ultrafine fiber diameters of 55 ± 26 nm). It was found that the PCL/collagen nanofibrous matrices alone did not stimulate cell migration, while collagen gel coating could significantly increase cell motility. Further studies demonstrated that the ultrafine fibrous network of collagen gel coating significantly activated integrin β1, Rac1 and Cdc42, facilitated the deposition of laminin-332 (formerly called laminin-5), and promoted the expression of active matrix metalloproteinases (MMPs) (i.e., MMP-2 and 9). Neutralization of integrin β1 activity abrogated the gel coating-induced keratinocyte migration. These findings provide important evidence on the role of topographical features of nanofibrous matrices in regulating the phenotypic alteration of keratinocytes and suggest the possible utility of collagen-containing nanofibrous matrices for skin regeneration especially in re-epithelialization.

Dermagraft®, a bioengineered human dermal equivalent for the treatment of chronic nonhealing diabetic foot ulcer

Chronic nonhealing diabetic foot ulcers are a common medical problem that may precede severe complications such as infection, sepsis and limb loss. Current standard methods of treatment are aimed at removing necrotic debris, controlling infection, and relieving chronic pressure on the wound. Unfortunately, healing rates are poor with standard treatment, averaging 12-20 weeks in clinical trials. A new strategy for the treatment of diabetic foot ulcers has been developed through tissue engineering, allowing the application of healthy living skin cells to assist in the healing process. It is hoped that the living tissue will release appropriate quantities of growth factors, cytokines and other proteins to stimulate the chronic wound bed and accelerate healing. Dermagraft (Smith & Nephew) is a neonatal-derived bioengineered tissue comprised of dermal fibroblasts. In this article, the structure and behavior of this tissue will be examined, focusing particularly on the randomized clinical trials performed to justify its use in diabetic foot ulcers.

Advanced therapies for chronic wounds: NPWT, engineered skin, growth factors, extracellular matrices

Advanced wound care implies the use of products or procedures that are specialized. Although dermatologists are used to being specialists of the skin, hair, and nails, chronic wound care has evolved such that there are some specific treatment options that are more commonly ordered and performed in wound care clinics. Wound care clinics are staffed by specialists and generalists including dermatologists, but also orthopedic surgeons, vascular surgeons, infectious disease specialists, internists, family practitioners, hyperbaric oxygen-trained physicians from a variety of backgrounds, podiatrists, physician assistants, and nurse practitioners. The care of chronic wounds has almost become its own specialty, with so-called advanced therapies now including the use of growth factors, extracellular matrices, engineered skin, and negative pressure wound therapy. It is critical that the dermatologists understand the treatments such that they can appropriately apply or order them directly, or be involved with the care of their patients receiving these therapies.

Paracrine anti-fibrotic effects of neonatal cells and living cell constructs on young and senescent human dermal fibroblasts

Senescent cells observed in the area of chronic wounds have been proposed to affect wound healing. Therapeutic approaches against chronic wounds include, among others, the local application of living cell constructs (LCCs), containing fibroblasts and/or keratinocytes. Accordingly, the aim of the present work was to examine the effects of factors secreted by early passage neonatal fibroblasts and LCCs--in the form of a conditioned medium (CM)--on senescent adult dermal fibroblasts regarding functions related to the healing process, i.e., cell proliferation, alpha-smooth muscle actin and metalloproteinase expression, and collagen synthesis. Target cells were fibroblasts senescent either due to subsequent divisions (replicative senescence) or due to an exogenous stress (stress-induced premature senescence). No effect on the proliferation of senescent fibroblasts was observed, as expected. All CMs were found to inhibit overall collagen synthesis both in early passage and in senescent fibroblasts. The LCC-derived CM was found to be more potent than fibroblast-derived CMs and, furthermore, to inhibit alpha-smooth muscle actin expression. In conclusion, these results may indicate anti-contractile and anti-fibrotic activities of factor(s) secreted by neonatal skin fibroblasts, and more intensely by LCCs on adult donor-derived fibroblasts. These activities seem to persist during senescence of the target cells.

Acceleration of dermal wound healing by using electrospun curcumin-loaded poly(ε-caprolactone)-poly(ethylene glycol)-poly(ε-caprolactone) fibrous mats

This study prepared a composite scaffold composed of curcumin and poly(ε-caprolactone)-poly(ethylene glycol)-poly(ε-caprolactone) (PCL-PEG-PCL, PCEC) copolymer using coelectrospinning technology. Incorporation of curcumin into the polymeric matrix had an obvious effect on the morphology and dimension of PCEC/curcumin fibers. The results of in vitro anti-oxidant tests and of the cytotoxicity assay demonstrated that the curcumin-loaded PCEC fibrous mats had significant anti-oxidant efficacy and low cytotoxicity. Curcumin could be sustainably released from the fibrous scaffolds. More importantly, in vivo efficacy in enhancing wound repair was also investigated based on a full-thickness dermal defect model for Wistar rats. The results indicated that the PCEC/curcumin fibrous mats had a significant advantage in promoting wound healing. At 21 days post-operation, the dermal defect was basically recovered to its normal condition. A percentage of wound closure reached up to 93.3 ± 5.6% compared with 76.9 ± 4.9% of the untreated control (p < 0.05). Therefore, the as-prepared PCEC/curcumin composite mats are a promising candidate for use as wound dressing.

Tissue-engineered heart valve: future of cardiac surgery

BACKGROUND

Heart valve disease is currently a growing problem, and demand for heart valve replacement is predicted to increase significantly in the future. Existing "gold standard" mechanical and biological prosthesis offers survival at a cost of significantly increased risks of complications. Mechanical valves may cause hemorrhage and thromboembolism, whereas biologic valves are prone to fibrosis, calcification, degeneration, and immunogenic complications.

METHODS

A literature search was performed to identify all relevant studies relating to tissue-engineered heart valve in life sciences using the PubMed and ISI Web of Knowledge databases.

DISCUSSION

Tissue engineering is a new, emerging alternative, which is reviewed in this paper. To produce a fully functional heart valve using tissue engineering, an appropriate scaffold needs to be seeded using carefully selected cells and proliferated under conditions that resemble the environment of a natural human heart valve. Bioscaffold, synthetic materials, and preseeded composites are three common approaches of scaffold formation. All available evidence suggests that synthetic scaffolds are the most suitable material for valve scaffold formation. Different cell sources of stem cells were used with variable results. Mesenchymal stem cells, fibroblasts, myofibroblasts, and umbilical blood stem cells are used in vitro tissue engineering of heart valve. Alternatively scaffold may be implanted and then autoseeded in vivo by circulating endothelial progenitor cells or primitive circulating cells from patient's blood. For that purpose, synthetic heart valves were developed.

CONCLUSIONS

Tissue engineering is currently the only technology in the field with the potential for the creation of tissues analogous to a native human heart valve, with longer sustainability, and fever side effects. Although there is still a long way to go, tissue-engineered heart valves have the capability to revolutionize cardiac surgery of the future.

Bioactive glass scaffolds for bone tissue engineering: state of the art and future perspectives

The repair and regeneration of large bone defects resulting from disease or trauma remains a significant clinical challenge. Bioactive glass has appealing characteristics as a scaffold material for bone tissue engineering, but the application of glass scaffolds for the repair of load-bearing bone defects is often limited by their low mechanical strength and fracture toughness. This paper provides an overview of recent developments in the fabrication and mechanical properties of bioactive glass scaffolds. The review reveals the fact that mechanical strength is not a real limiting factor in the use of bioactive glass scaffolds for bone repair, an observation not often recognized by most researchers and clinicians. Scaffolds with compressive strengths comparable to those of trabecular and cortical bones have been produced by a variety of methods. The current limitations of bioactive glass scaffolds include their low fracture toughness (low resistance to fracture) and limited mechanical reliability, which have so far received little attention. Future research directions should include the development of strong and tough bioactive glass scaffolds, and their evaluation in unloaded and load-bearing bone defects in animal models.

Portable magnetic tweezers device enables visualization of the three-dimensional microscale deformation of soft biological materials

We have designed and built a magnetic tweezers device that enables the application of calibrated stresses to soft materials while simultaneously measuring their microscale deformation using confocal microscopy. Unlike previous magnetic tweezers designs, our device is entirely portable, allowing easy use on microscopes in core imaging facilities or in collaborators' laboratories. The imaging capabilities of the microscope are unimpaired, enabling the 3-D structures of fluorescently labeled materials to be precisely determined under applied load. With this device, we can apply a large range of forces (∼1–1200 pN) over micron-scale contact areas to beads that are either embedded within 3-D matrices or attached to the surface of thin slab gels. To demonstrate the usefulness of this instrument, we have studied two important and biologically relevant materials: polyacrylamide-based hydrogel films typical of those used in cell traction force microscopy, and reconstituted networks of microtubules, essential cytoskeletal filaments.

Bioactive glass in tissue engineering

This review focuses on recent advances in the development and use of bioactive glass for tissue engineering applications. Despite its inherent brittleness, bioactive glass has several appealing characteristics as a scaffold material for bone tissue engineering. New bioactive glasses based on borate and borosilicate compositions have shown the ability to enhance new bone formation when compared to silicate bioactive glass. Borate-based bioactive glasses also have controllable degradation rates, so the degradation of the bioactive glass implant can be more closely matched to the rate of new bone formation. Bioactive glasses can be doped with trace quantities of elements such as Cu, Zn and Sr, which are known to be beneficial for healthy bone growth. In addition to the new bioactive glasses, recent advances in biomaterials processing have resulted in the creation of scaffold architectures with a range of mechanical properties suitable for the substitution of loaded as well as non-loaded bone. While bioactive glass has been extensively investigated for bone repair, there has been relatively little research on the application of bioactive glass to the repair of soft tissues. However, recent work has shown the ability of bioactive glass to promote angiogenesis, which is critical to numerous applications in tissue regeneration, such as neovascularization for bone regeneration and the healing of soft tissue wounds. Bioactive glass has also been shown to enhance neocartilage formation during in vitro culture of chondrocyte-seeded hydrogels, and to serve as a subchondral substrate for tissue-engineered osteochondral constructs. Methods used to manipulate the structure and performance of bioactive glass in these tissue engineering applications are analyzed.

Using human hair follicle-derived keratinocytes and melanocytes for constructing pigmented tissue-engineered skin

BACKGROUND

Traditional tissue-engineered skin does not produce a satisfactory long-term result because it lacks natural skin pigmentation and leads to discolored cosmetically unpleasing skin that only functions to cover the body of patients. Additionally, the cell sources for tissue-engineered skin are generally derived from normal skin, which is often limited in patients with skin defects.

METHODS

In this study, hair follicle melanocytes and keratinocytes were isolated from human scalp. The melanocytes were co-cultured with keratinocytes until the second passage and then purified. Purified melanocytes and keratinocytes were seeded onto the chitosan-gelatin membrane for 1 week to construct pigmented tissue-engineered skin. The pigmented skin equivalent was used to resurface the skin defect in nude mice. Four weeks after grafting, skin biopsies were harvested to take hematoxylin and eosin staining and immunohistochemistry staining of Melan-A and HLA-ABC.

RESULTS

Large quantities of purified melanocytes can be obtained with co-culture method. The hematoxylin and eosin staining of repaired skin biopsy demonstrated that the tissue-engineered skin can repair skin defects successfully. Engineered skin contained pigmentation and stained positive for Melan-A and HLA-ABC, which confirmed the presence of melanocytes and its sources were of human origin.

CONCLUSION

This study demonstrated the possibility of constructing pigmented tissue-engineered skin with human hair follicle-derived keratinocytes and melanocytes, which brings a promising method to make up for the deficiency of traditional tissue-engineered skin and provides an alternative treatment for depigmentation diseases.

Concentrated collagen-chondroitin sulfate scaffolds for tissue engineering applications

Collagen-chondroitin sulfate biomaterial scaffolds have been used in a number of tissue-engineered products under development or in the clinics. In this article, we describe a new approach based on centrifugation for obtaining highly concentrated yet porous collagen scaffolds. Water uptake, chondroitin sulfate retention, morphology, mechanical properties, and tissue-engineering potential of the concentrated scaffolds were investigated. Our results show that the new approach can lead to scaffolds containing four times as much collagen as that in conventional unconcentrated scaffolds. Further, water uptake in the concentrated scaffolds was significantly greater while chondroitin sulfate retention in the concentrated scaffolds was unaffected. The value of mean pore diameter in the concentrated scaffolds was smaller than that in the unconcentrated scaffolds and the walls of the pores in the former comprised of a continuous sheet of collagen. The mechanical properties measured as moduli of elasticity in compression and tension were improved by as much as 30 times in the concentrated scaffolds. In addition, our tissue culture results with human mesenchymal stem cells and foreskin keratinocytes show that the new scaffolds can be used for cartilage and skin tissue-engineering applications.