4D bioprintable self-healing hydrogel with shape memory and cryopreserving properties

4D hydrogels: fabrication strategies, stimulation mechanisms, and biomedical applications

Shape-morphing hydrogels have emerged as a promising biomaterial due to their ability to mimic the anisotropic tissue composition by creating a gradient in local swelling behavior. In this case, shape deformations occur due to the non-uniform distribution of internal stresses, asymmetrical swelling, and shrinking of different parts of the same hydrogel. Herein, we discuss the four-dimensional (4D) fabrication techniques (extrusion-based printing, dynamic light processing, and solvent casting) employed to prepare shape-shifting hydrogels. The important distinction between mono- and dual-component hydrogel systems, the capabilities of 3D constructs to undergo uni- and bi-directional shape changes, and the advantages of composite hydrogels compared to their pristine counterparts are presented. Subsequently, various types of actuators such as moisture, light, temperature, pH, and magnetic field and their role in achieving the desired and pre-determined shapes are discussed. These 4D gels have shown remarkable potential as programmable scaffolds for tissue regeneration and drug-delivery systems. Finally, we present futuristic insights into integrating piezoelectric biopolymers and sensors to harvest mechanical energy from motions during shape transformations to develop self-powered biodevices.

4D Printing for Biomedical Applications

4D (bio-)printing endows 3D printed (bio-)materials with multiple functionalities and dynamic properties. 4D printed materials have been recently used in biomedical engineering for the design and fabrication of biomedical devices, such as stents, occluders, microneedles, smart 3D-cell engineered microenvironments, drug delivery systems, wound closures, and implantable medical devices. However, the success of 4D printing relies on the rational design of 4D printed objects, the selection of smart materials, and the availability of appropriate types of external (multi-)stimuli. Here, this work first highlights the different types of smart materials, external stimuli, and design strategies used in 4D (bio-)printing. Then, it presents a critical review of the biomedical applications of 4D printing and discusses the future directions of biomedical research in this exciting area, including in vivo tissue regeneration studies, the implementation of multiple materials with reversible shape memory behaviors, the creation of fast shape-transformation responses, the ability to operate at the microscale, untethered activation and control, and the application of (machine learning-based) modeling approaches to predict the structure-property and design-shape transformation relationships of 4D (bio)printed constructs.

3D Printing of Self-Healing Materials

This review article presents a comprehensive overview of the latest advances in the field of 3D printable structures with self-healing properties. Three-dimensional printing (3DP) is a versatile technology that enables the rapid manufacturing of complex geometric structures with precision and functionality not previously attainable. However, the application of 3DP technology is still limited by the availability of materials with customizable properties specifically designed for additive manufacturing. The addition of self-healing properties within 3D printed objects is of high interest as it can improve the performance and lifespan of structural components, and even enable the mimicking of living tissues for biomedical applications, such as organs printing. The review will discuss and analyze the most relevant results reported in recent years in the development of self-healing polymeric materials that can be processed via 3D printing. After introducing the chemical and physical self-healing mechanism that can be exploited, the literature review here reported will focus in particular on printability and repairing performances. At last, actual perspective and possible development field will be critically discussed.

3D-bioprintable endothelial cell-laden sacrificial ink for fabrication of microvessel networks

Although various research efforts have been made to produce a vascular-like network structure as scaffolds for tissue engineering, there are still several limitations. Meanwhile, no articles have been published on the direct embedding of cells within a glucose sensitive sacrificial hydrogel followed by three-dimensional (3D) bioprinting to fabricate vascular structures. In this study, the hydrogel composed of reversibly crosslinked poly(ethylene glycol) diacrylate and dithiothreitol with borax and branched polyethylenimine was used as the sacrificial hydrogel to fabricate vascular-like network structure. The component proportion ratio of the sacrificial hydrogel was optimized to achieve proper self-healing, injectable, glucose-sensitive, and 3D printing properties through the balance of boronate ester bond, hydrogen bond, and steric hinderance effect. The endothelial cells (ECs) can be directly embedded into sacrificial hydrogel and then bioprinted through a 110μm nozzle into the neural stem cell (NSC)-laden non-sacrificial hydrogel, forming the customized EC-laden vascularized microchannel (one-step). The EC-laden sacrificial hydrogel was dissolved immediately in the medium while cells kept growing. The ECs proliferated well within the vascularized microchannel structure and were able to migrate to the non-sacrificial hydrogel in one day. ECs and NSCs interacted around the vascularized microchannel to form capillary-like structure and vascular-like structure expressing CD31 in 14 d. The sacrificial hydrogel conveniently prepared from commercially available chemicals through simple mixing can be used in 3D bioprinting to create customized and complex but easily removable vascularized structure for tissue engineering applications.

Application of Shape Memory and Self-Healable Polymers/Composites in the Biomedical Field: A Review

Shape memory-assisted self-healing polymers have drawn attention over the past few years owing to their interdisciplinary and wide range of applications. Self-healing and shape memory are two approaches used to improve the applicability of polymers in the biomedical field. Combining both these approaches in a polymer composite opens new possibilities for its use in biomedical applications, such as the "close then heal" concept, which uses the shape memory capabilities of polymers to bring injured sections together to promote autonomous healing. This review focuses on using shape memory-assisted self-healing approaches along with their respective affecting factors for biomedical applications such as tissue engineering, drug delivery, biomaterial-inks, and 4D printed scaffolds, soft actuators, wearable electronics, etc. In addition, quantification of self-healing and shape memory efficiency is also discussed. The challenges and prospects of these polymers for biomedical applications have been summarized.

Recent patent-based review on the role of three-dimensional printing technology in pharmaceutical and biomedical applications

Three-dimensional printing (3DP) is emerging as an innovative manufacturing technology for biomedical and pharmaceutical applications, since the US FDA approval of Spritam as a 3D-printed drug. In the present review, we have highlighted the potential benefits of 3DP technology in healthcare, such as the ability to create patient-specific medical devices and implants, as well as the possibility of on-demand production of drugs and personalized dosage forms. We have further discussed future research to optimize 3DP processes and materials for pharmaceutical and biomedical applications. Cohesively, we have put forward the current state of active patents and applications related to 3DP technology in the healthcare and pharmaceutical industries including hearing aids, prostheses, medical devices and drug-delivery systems.

Self-healing hydrogel as an injectable implant: translation in brain diseases

Tissue engineering biomaterials are aimed to mimic natural tissue and promote new tissue formation for the treatment of impaired or diseased tissues. Highly porous biomaterial scaffolds are often used to carry cells or drugs to regenerate tissue-like structures. Meanwhile, self-healing hydrogel as a category of smart soft hydrogel with the ability to automatically repair its own structure after damage has been developed for various applications through designs of dynamic crosslinking networks. Due to flexibility, biocompatibility, and ease of functionalization, self-healing hydrogel has great potential in regenerative medicine, especially in restoring the structure and function of impaired neural tissue. Recent researchers have developed self-healing hydrogel as drug/cell carriers or tissue support matrices for targeted injection via minimally invasive surgery, which has become a promising strategy in treating brain diseases. In this review, the development history of self-healing hydrogel for biomedical applications and the design strategies according to different crosslinking (gel formation) mechanisms are summarized. The current therapeutic progress of self-healing hydrogels for brain diseases is described as well, with an emphasis on the potential therapeutic applications validated by in vivo experiments. The most recent aspect as well as the design rationale of self-healing hydrogel for different brain diseases is also addressed.

Additive manufacturing of peripheral nerve conduits - Fabrication methods, design considerations and clinical challenges

Tissue-engineered nerve guidance conduits (NGCs) are a viable clinical alternative to autografts and allografts and have been widely used to treat peripheral nerve injuries (PNIs). Although these NGCs are successful to some extent, they cannot aid in native regeneration by improving native-equivalent neural innervation or regrowth. Further, NGCs exhibit longer recovery period and high cost limiting their clinical applications. Additive manufacturing (AM) could be an alternative to the existing drawbacks of the conventional NGCs fabrication methods. The emergence of the AM technique has offered ease for developing personalized three-dimensional (3D) neural constructs with intricate features and higher accuracy on a larger scale, replicating the native feature of nerve tissue. This review introduces the structural organization of peripheral nerves, the classification of PNI, and limitations in clinical and conventional nerve scaffold fabrication strategies. The principles and advantages of AM-based techniques, including the combinatorial approaches utilized for manufacturing 3D nerve conduits, are briefly summarized. This review also outlines the crucial parameters, such as the choice of printable biomaterials, 3D microstructural design/model, conductivity, permeability, degradation, mechanical property, and sterilization required to fabricate large-scale additive-manufactured NGCs successfully. Finally, the challenges and future directions toward fabricating the 3D-printed/bioprinted NGCs for clinical translation are also discussed.

A self-healing hydrogel and injectable cryogel of gelatin methacryloyl-polyurethane double network for 3D printing

Three-dimensional (3D) printing of soft biomaterials facilitates the progress of personalized medicine. The development for different forms of 3D-printable biomaterials can promotes the potential manufacturing for artificial organs and provides biomaterials with the required properties. In this study, gelatin methacryloyl (GelMA) and dialdehyde-functionalized polyurethane (DFPU) were combined to create a double crosslinking system and develop 3D-printable GelMA-PU biodegradable hydrogel and cryogel. The GelMA-PU system demonstrates a combination of self-healing ability and 3D printability and provides two distinct forms of 3D-printable biomaterials with smart functions, high printing resolution, and biocompatibility. The hydrogel was printed into individual modules through an 80 µm or larger nozzle and further assembled into complex structures through adhesive and self-healing abilities, which could be stabilized by secondary photocrosslinking. The 3D-printed hydrogel was adhesive, light transmittable, and could embed a light emitting diode (LED). Furthermore, the hydrogel laden with human mesenchymal stem cells (hMSCs) was successfully printed and showed cell proliferation. Meanwhile, 3D-printed cryogel was achieved by printing on a subzero temperature platform through a 210 µm nozzle. After secondary photocrosslinking and drying, the cryogel was deliverable through a 16-gauge (1194 µm) syringe needle and can promote the proliferation of hMSCs. The GelMA-PU system extends the ink pool for 3D printing of biomaterials and has potential applications in tissue engineering scaffolds, minimally invasive surgery devices, and electronic wound dressings. STATEMENT OF SIGNIFICANCE: The 3D-printable biomaterials developed in this work are GelMA-based ink with smart funcitons and have potentials for various customized medical applications. The synthesized GelMA-polyurethane double network hydrogel can be 3D-printed into individual modules (e.g., 11 × 11 × 5 mm³) through an 80 μm or larger size nozzle, which are then assembled into a taller structure over five times of the initial height by self-healing and secondary photocrosslinking. The hydrogel is adhesive, light transmittable, and biocompatible that can either carry human mesenchymal stem cells (hMSCs) as bioink or embed a red light LED (620 nm) with potential applications in electronic skin dressing. Meanwhile, the 3D-printed highly compressible cryogel (e.g., 6 × 6 × 1 mm³) is deliverable by a 16-gauge (1194 μm) syringe needle and supports the proliferation of hMSCs also.

Development of double network polyurethane-chitosan composite bioinks for soft neural tissue engineering

Three-dimensional (3D) bioprinting is an emerging manufacturing technology to print materials with cells for tissue engineering applications. In this study, we prepared novel ternary soft segment-based biodegradable polyurethane (tPU) using waterborne processes. The ternary soft segment included poly(ε-caprolactone) (PCL), polylactide, and poly(3-hydroxybutyrate) (PHB). tPU2 with a soft segment of PCL, poly(D,L-lactide), and PHB in a molar ratio of 0.7 : 0.2 : 0.1 demonstrated lower stiffness (∼2.3 kPa) and a greater tan δ value (∼0.64) and maintained good vitality (91.3%) of neural stem cells (NSCs) among various tPUs. The bioprinted tPU2 constructs facilitated cell proliferation (∼200% in 7 days) and neural differentiation of NSCs. Meanwhile, tPU2 formed double network composite hydrogels with gelatin or agarose, and the composite hydrogels showed good biocompatibility and achieved high-resolution (∼80 μm nozzle) bioprinting. In addition, a new series of double network polyurethane-chitosan composite (PUC) hydrogels were developed by combining tPU2 with a self-healing chitosan hydrogel. The PUC hydrogel demonstrated self-healing properties and bioprintability without the need for a post-crosslinking process. The bioprinted PUC composite hydrogel promoted cell proliferation (∼300% in 7 days) and neural differentiation of NSCs better than the tPU2 bioink. This study revealed new formulae of a polyurethane bioink and a polyurethane-chitosan composite bioink for 3D bioprinting and tissue engineering applications.

Prospects for the use of olfactory mucosa cells in bioprinting for the treatment of spinal cord injuries

The review focuses on the most important areas of cell therapy for spinal cord injuries. Olfactory mucosa cells are promising for transplantation. Obtaining these cells is safe for patients. The use of olfactory mucosa cells is effective in restoring motor function due to the remyelination and regeneration of axons after spinal cord injuries. These cells express neurotrophic factors that play an important role in the functional recovery of nerve tissue after spinal cord injuries. In addition, it is possible to increase the content of neurotrophic factors, at the site of injury, exogenously by the direct injection of neurotrophic factors or their delivery using gene therapy. The advantages of olfactory mucosa cells, in combination with neurotrophic factors, open up wide possibilities for their application in three-dimensional and four-dimensional bioprinting technology treating spinal cord injuries.

Enhancement of Cell Behavior by the Polysaccharide Extract of Arthrospira and Potential Biomedical Applications

Arthrospira is one of the most studied cyanobacteria and has been reported with practical applications. Among the substances derived from Arthrospira, polysaccharides have received relatively less attention than phycocyanins, though they have more abundant structural variations and specific properties. Herein, a new Arthrospira-derived sulfated polysaccharide was explored for its potential bioactive functions. The ability of this sulfated polysaccharide to promote the behavior of neural stem cells (NSCs) in three-dimensional hydrogel was examined for the first time. NSCs encapsulated in the sulfated polysaccharide-containing hydrogel showed better proliferation than the control hydrogel as well as a unique cell clustering behavior, i.e., formation of multicellular spherical clusters (40-60 μm). The sulfated polysaccharide, in an appropriate range of concentration (5 mg/mL), also maintained the stemness of NSCs in hydrogel and facilitated their differentiation. In addition, the potentials of the new sulfated polysaccharide as a coating material and as a component for drug carrier were verified. The sulfated polysaccharide-modified substrate exhibited superhydrophilicity (contact angle ~9°) and promoted cell adhesion to the substrate. Composite nanoparticles composed of the sulfated polysaccharide and other differently charged polysaccharides were produced with an average diameter of ~240 nm and estimated drug loading of ~18%. The new Arthrospira-derived sulfated polysaccharide is a promising candidate for cell culture, surface-modification, and drug-delivery applications in the biomedical field.

Four-Dimensional Printing and Shape Memory Materials in Bone Tissue Engineering

The repair of severe bone defects is still a formidable clinical challenge, requiring the implantation of bone grafts or bone substitute materials. The development of three-dimensional (3D) bioprinting has received considerable attention in bone tissue engineering over the past decade. However, 3D printing has a limitation. It only takes into account the original form of the printed scaffold, which is inanimate and static, and is not suitable for dynamic organisms. With the emergence of stimuli-responsive materials, four-dimensional (4D) printing has become the next-generation solution for biological tissue engineering. It combines the concept of time with three-dimensional printing. Over time, 4D-printed scaffolds change their appearance or function in response to environmental stimuli (physical, chemical, and biological). In conclusion, 4D printing is the change of the fourth dimension (time) in 3D printing, which provides unprecedented potential for bone tissue repair. In this review, we will discuss the latest research on shape memory materials and 4D printing in bone tissue repair.

4D prints of flexible dosage forms using thermoplastic polyurethane with hybrid shape memory effect

Thermoplastic polyurethanes are versatile materials due to their flexible and elastic properties. In research, medicine, and pharmacy, they are used in dosage forms, implants or as components of medical devices. To gain a deeper understanding of the influences on unfolding or expanding dosage forms, in this publication, 3D printing was used to produce differently shaped and foldable objects from various technical thermoplastic polyurethane filaments. The shape memory behaviour of the dosage forms was exploited to fold and package them in water-soluble hard gelatin capsules. The unfolding time and dimensional recovery of the 3D printed dosage forms were investigated as a function of material properties and shape. As an example, for the use of flexible dosage forms, 3D models have been designed so that their unfolded size is suitable for possible gastric retention. Depending on the shape and material, different unfolding behaviours could be shown. Over a storage period of 60 days, a time related stress on the 4D printed objects was evaluated, which possibly affects the unfolding process. The results of this work aim to be used to evaluate the behaviour of 3D printed unfolding and expanding dosage forms and how they may be suitable for the development of innovative sustained drug delivery concepts or medicinal devices. The basic principle of a hybrid shape memory effect used here could possibly be applied to other drug delivery strategies besides gastric retention.

3D Bioprinting Using Hydrogels: Cell Inks and Tissue Engineering Applications

3D bioprinting is transforming tissue engineering in medicine by providing novel methods that are precise and highly customizable to create biological tissues. The selection of a "cell ink", a printable formulation, is an integral part of adapting 3D bioprinting processes to allow for process optimization and customization related to the target tissue. Bioprinting hydrogels allows for tailorable material, physical, chemical, and biological properties of the cell ink and is suited for biomedical applications. Hydrogel-based cell ink formulations are a promising option for the variety of techniques with which bioprinting can be achieved. In this review, we will examine some of the current hydrogel-based cell inks used in bioprinting, as well as their use in current and proposed future bioprinting methods. We will highlight some of the biological applications and discuss the development of new hydrogels and methods that can incorporate the completed print into the tissue or organ of interest.

4D Cell-Condensate Bioprinting

4D bioprinting techniques that facilitate formation of shape-changing scaffold-free cell condensates with prescribed geometries have yet been demonstrated. Here, a simple 4D bioprinting approach is presented that enables formation of a shape-morphing cell condensate-laden bilayer system. The strategy produces scaffold-free cell condensates which morph over time into predefined complex shapes. Cell condensate-laden bilayers with specific geometries are readily fabricated by bioprinting technologies. The bilayers have tunable deformability and microgel (MG) degradation, enabling controllable morphological transformations and on-demand liberation of deformed cell condensates. With this system, large cell condensate-laden constructs with various complex shapes are obtained. As a proof-of-concept study, the formation of the letter "C"- and helix-shaped robust cartilage-like tissues differentiated from human mesenchymal stem cells (hMSCs) is demonstrated. This system brings about a versatile 4D bioprinting platform idea that is anticipated to broaden and facilitate the applications of cell condensation-based 4D bioprinting.

Smart biomaterials: From 3D printing to 4D bioprinting

This century is blessed with enhanced medical facilities on the grounds of the development of smart biomaterials. The rise of the four-dimensional (4D) bioprinting technology is a shining example. Using inert biomaterials as the bioinks for the three-dimensional (3D) printing process, static objects that might not be able to mimic the dynamic nature of tissues would be fabricated; by contrast, 4D bioprinting can be used for the fabrication of stimuli-responsive cell-laden structures that can evolve with time and enable engineered tissues to undergo morphological changes in a pre-planned way. For all the aptitude of 4D bioprinting technology in tissue engineering, it is imperative to select suitable stimuli-responsive biomaterials with cell-supporting functionalities and responsiveness; as a result, in this article, recent advances and challenges in smart biomaterials for 4D bioprinting are briefly discussed. An overview perspective concerning the latest developments in 4D-bioprinting is also provided.

Using clinically derived human tissue to 3-dimensionally bioprint personalized testicular tubules for in vitro culturing: first report

OBJECTIVE

To study the feasibility and spermatogenic potential of 3-dimensional (3D) bioprinting personalized human testicular cells derived from a patient with nonobstructive azoospermia (NOA).

DESIGN

A human testicular biopsy from a single donor with NOA was dissociated into single cells, expanded in vitro, and 3D bioprinted into tubular structures akin to the seminiferous tubule using AGC-10 bioink and an RX1 bioprinter with a CENTRA coaxial microfluidic printhead from Aspect Biosystems. Three-dimensional organoid cultures were used as a nonbioprinted in vitro control.

SETTING

Academic medical center.

PATIENT(S)

A 31-year-old man with NOA with testis biopsy demonstrating Sertoli cell-only syndrome.

INTERVENTION(S)

Three-dimensional bioprinting and in vitro culturing of patient-derived testis cells.

MAIN OUTCOME MEASURE(S)

Cellular viability after printing was determined, along with the expression of phenotypic and spermatogenic functional genetic markers after 12 days of in vitro culture.

RESULT(S)

Testicular cultures were expandable in vitro and generated sufficiently large numbers for 3D bioprinting at 35 million cells per mL of bioink. Viability 24 hours after printing was determined to be 93.4% ± 2.4%. Immunofluorescence staining for the phenotype markers SRY-Box transcription factor 9, insulin-like 3, actin alpha 2 smooth muscle, and synaptonemal complex protein 3 after 12 days was positive, confirming the presence of Sertoli, Leydig, peritubular myoid, and meiotic germ cells. Reverse transcription qualitative polymerase chain reaction analysis showed that after 12 days in spermatogenic media, the bioprints substantially up-regulated spermatogenic gene expression on par with nonbioprinted controls and showed a particularly significant improvement in genes involved in spermatogonial stem cell maintenance: inhibitor of deoxyribonucleic acid binding 4 by 365-fold; fibroblast growth factor 3 by 94,152-fold; stem cell growth factor receptor KIT by twofold; stimulated by retinoic acid 8 by 125-fold; deleted in azoospermia-like by 114-fold; synaptonemal complex protein 3 by sevenfold; zona pellucida binding protein by twofold; transition protein 1 by 2,908-fold; and protamine 2 by 11-fold.

CONCLUSION(S)

This study demonstrates for the first time the feasibility of 3D bioprinting adult human testicular cells. We show that the bioprinting process is compatible with high testicular cell viability and without loss of the main somatic phenotypes within the testis tissue. We demonstrate an increase in germ cell markers in the 3D bioprinted tubules after 12 days of in vitro culture. This platform may carry future potential for disease modeling and regenerative opportunities in a personalized medicine framework.

A Review of 3D Printed Bone Implants

3D printing, that is, additive manufacturing, has solved many major problems in general manufacturing, such as three-dimensional tissue structure, microenvironment control difficulty, product production efficiency and repeatability, etc., improved the manufacturing speed and precision of personalized bone implants, and provided a lot of support for curing patients with bone injuries. The application of 3D printing technology in the medical field is gradually extensive, especially in orthopedics. The purpose of this review is to provide a report on the related achievements of bone implants based on 3D printing technology in recent years, including materials, molding methods, optimization of implant structure and performance, etc., in order to point out the existing shortcomings of 3D printing bone implants, promote the development of all aspects of bone implants, and make a prospect of 4D printing, hoping to provide some reference for the subsequent research of 3D printing bone implants.