Application of fibrin-based biomaterial for human ovarian tissue encapsulation and cryopreservation as alternative approach for fertility preservation

This study aimed to investigate the effects of fibrin-based hydrogel encapsulation, with or without vascular endothelial growth factor (VEGF), on follicle quality and cell survival signaling pathways after ovarian tissue cryopreservation. Ovarian cortex donated by seven patients (ages 44-47 years old) was divided into four groups: I) fresh control, II) ovarian tissue without encapsulation (non-FT), III) fibrin (10 mg/mL fibrinogen plus 50 IU/mL thrombin; 10FT) encapsulated tissue without VEGF, and IV) encapsulated tissue with 0.1 μg/mL VEGF (10FT-VEGF), followed by a slow freezing process. Evaluation criteria included normal follicle morphology, density, cell proliferation, apoptosis, and metabolism signaling pathways (BAX/BCL-2 ratio, CASPASE-3 and 9, ATP-6 genes, VEGF-A, and ERK-1/2 protein expression levels). Major outcomes revealed that the percentages of morphologically normal follicles and density were significantly decreased by cryopreservation. Ovarian tissue encapsulation using the 10FT formulation (with or without VEGF) could maintain the ERK-signaling cascade, which was comparable to the fresh control. Among the frozen-thawed cohorts, the BAX/BCL-2 ratio, CASPASE-3, CASPASE-9, and ATP-6 expression levels were unfavorable in the non-FT group. However, statistically different results, including VEGF-A expression levels, were not detected. Collectively, our present data demonstrated the first applicable biomaterial matrix for human ovarian tissue encapsulation which might create an optimal intra-ovarian cortex environment during cryopreservation. Further studies to optimize hydrogel polymerization should be expanded, given the potential benefits for cancer patients who wish to preserve fertility through ovarian tissue cryopreservation.

Bioprinting Technologies and Bioinks for Vascular Model Establishment

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

3D Bioprinting for Pancreas Engineering/Manufacturing

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

Synthetic Polymers for Organ 3D Printing

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

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

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

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

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

Bioartificial Organ Manufacturing Technologies

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

Natural Polymers for Organ 3D Bioprinting

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

Gelatin-Based Hydrogels for Organ 3D Bioprinting

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

3D Bioprinting Technologies for Hard Tissue and Organ Engineering

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

Biodegradable Polymers and Stem Cells for Bioprinting

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

A combined rotational mold for manufacturing a functional liver system

A combined rotational mold system for liver manufacturing was prepared. The combined rotational mold system was composed of a branched internal mold, a basement mold, and a series of external molds with increasing diameters. Semi-spindle constructs, consisting of multiple cell types, such as adipose-derived stem cells and hepatocytes encapsulated in a fibrin hydrogel, were created by sequentially sandwiching cell-laden fibrin hydrogels between the combined rotational mold system based on the Weissenberg effect of non-Newtonian fluid. A spindle liver lobe precursor was constructed, with a multi-scale vascular network including arteries, veins, and capillaries, by integrating the two semi-spindle constructs together and coating the spindle construct with a layer of poly(DL-lactide-co-glycolide acid) solution. The spindle liver lobe precursor was characterized by a series of in vivo experiments. This first report is the preparation of a functioning complex organ, such as the liver, that was produced using an inexpensive, simple, and effective method.

Optimizing the fabrication processes for manufacturing a hybrid hierarchical polyurethane–cell/hydrogel construct

It is essential to control the overall composition and internal architecture for complex organ manufacturing. In this study, several subprocesses were optimized to produce hybrid hierarchical polyurethane–cell/hydrogel constructs with an intrinsic network of grid and branched channels using a double-nozzle low-temperature deposition rapid prototyping system. The formation quality was mainly determined by the polymer concentration and composition. However, the cell viability was mainly determined by the formation time. Cell sensitivities to the inner nozzle diameter and extrusion flux were not significantly different within the given parameter ranges. The integrity of the two material systems can be varied by the formation routes and layer thickness. Under the optimal fabrication parameters, such as formation time within 20 min and gelatin:alginate:fibrinogen ratio of 2:1:1, a high cell survival rate of 80% was attained. The design and fabrication strategies used to create such a complex heterogeneous objects directly from a computer-aided design model represent a promising route for robotic hybrid hierarchical construct implementations, which would allow easy expansion of the subprocessing capabilities and scale up manufacturing capabilities.

Preparation of an adipose-derived stem cell/fibrin–poly(d,l-lactic-co-glycolic acid) construct based on a rapid prototyping technique

Currently, large, thick, and complex tissue vascularization is one of the research focuses of tissue engineering. Numerous studies have proven that microvascular systems can be developed by cultivating endothelial cells in a hydrogel/scaffold structure. As the sources of adult endothelial cells are very limited and very easily degraded, it is better to induce stem cells into endothelial cells. In this article, a grid poly(d,l-lactic- co-glycolic acid) structure with defined internal channels was fabricated using a low-temperature deposition manufacturing technique under computer direction. In a fibrinogen mixture, an aqueous adipose-derived stem cell fibrinogen mixture was incorporated into the internal walls of the poly(d,l-lactic- co-glycolic acid) scaffold and stabilized with thrombin solution. After several days of in vitro culture, the adipose-derived stem cells immobilized in the fibrin hydrogel were induced into endothelial-like cells with endothelial growth factor and basic fibroblast growth factor. Morphological and biological properties of the composite cell/fibrin–poly(d,l-lactic- co-glycolic acid) construct were characterized.

Rapid prototyping of tubular polyurethane and cell/hydrogel constructs

A tubular polyurethane (PU) sandwich-like, adipose-derived stem cell (ADSC)/gelatin/alginate/ fibrin construct was fabricated using a double-nozzle, low-temperature (—20°C) deposition technique. The ADSCs survived the fabrication and cryopreservation stages by incorporating a cryoprotectant (glycerol or dimethyl sulfoxide (DMSO)) in the cell/hydrogel system. With 5% DMSO or 10% glycerol alone in the hydrogel, the cell viabilities were retained (73% and 62%, respectively). The three-dimensional construct was effectively preserved below —80°C for more than 1 week. After the freeze/thaw processes, cell viability and proliferation ability were regained. This strategy has the potential to be widely used in complex organ manufacturing techniques.

Incorporation of DMSO and dextran-40 into a gelatin/alginate hydrogel for controlled assembled cell cryopreservation

A new cell cryopreservation strategy for cell-assembling constructs was proposed. With this strategy, different concentrations of dimethysulfoxide (DMSO) and dextran-40 were directly incorporated into the cell/gelatin/alginate systems, prototyped according to a predesigned structure, cryopreserved at -80 °C for 10 days and followed a thawing process at 17 °C. The rheological properties, bonding water contents and melting points of the gelatin/alginate hydrogel systems were changed with the addition of different amounts of DMSO. The microscopy analysis, (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrasodium bromide (MTT) and hematoxylin and eosin (HE) staining indicated that the cell numbers were progressively in a selected DMSO concentration range. With DMSO 5% (v/v) alone, the metabolic rate in the construct attained (81.3±5.7)%. A synergistic effect was achieved with the combination of the DMSO/gelatin/alginate and dextran-40/gelatin/alginate hydrogel systems. These results indicated that the inclusion of DMSO and dextran-40 in the hydrogel could effectively enhance the cell preservation effects. This cryopreservation strategy holds the ability to be widely used in organ manufacturing techniques.

Cryopreservation of Cell/Hydrogel Constructs Based on a New Cell-assembling Technique

Organ manufacturing is a promising method to replace failing complex organs. In this study, a new cell cryopreservation technique was developed with cryoprotectants being directly incorporated into the cell/hydrogel construct according to predesigned structures and then subjected to a special freezing/thaw process. The hydration of the gelatin/alginate hydrogel was greatly increased while the eutectic temperature was decreased by the adding glycerol. The addition of dextran-40 was found to also effectively improve the cell survival when incorporated with glycerol. The most favorable cryoprotectant concentration was 2.5% glycerol with 5% dextran-40 in a gelatin/alginate hydrogel. Under these conditions, the cell viability in the construct was >95%. Microscopic observations, MTT analysis, hematoxylin and eosin staining indicated that the cells proliferated immediately after thawing. The cells in the gelatin/alginate hydrogel with both glycerol and dextran-40 had proliferated more than with only glycerol or dextran-40 alone. This approach can be adapted for use in cell assembly in high-throughput drug screening and complex organ manufacturing areas.

Recent trends and challenges in complex organ manufacturing

Presently, there is a recognized and imperative need for bioartificial organs. The technological advances in transgenosis, tissue engineering, and rapid prototyping have led to the development of spatially complex tissues. An ideal artificial organ should provide nutrient transport system, mechanical stable architecture, and synergetic multicellular organization in one construct. The multinozzle rapid prototyping technique simultaneously assembles vascular systems including hierarchical multicellular structures in an automated and reproducible manner and offers an effective way for treating organ failures. In this article, a brief overview of the recent trends and outstanding challenges in organ manufacturing is provided. From the viewpoint of disciplinary crossing, integration, and development, future directions in the coming years were pointed out.