Latest Advances in 3D Bioprinting of Cardiac Tissues

Electrochemically Active Materials for Tissue-Interfaced Soft Biochemical Sensing

Tissue-interfaced soft biochemical sensing represents a crucial approach to personalized healthcare by employing electrochemically active materials to monitor biochemical signals at the tissue interface in real time, either noninvasively or through implantation. These soft biochemical sensors can be integrated with various biological tissues, such as neural, gastrointestinal, ocular, cardiac, skin, muscle, and bone, adapting to their unique mechanical and biochemical environments. Sensors employing materials like conductive polymers, composites, metals, metal oxides, and carbon-based nanomaterials have demonstrated capabilities in applications, such as continuous glucose monitoring, neural activity mapping, and real-time metabolite detection, enhancing diagnostics and treatment monitoring across a range of medical fields. Next-generation tissue-interfaced biosensors that enable multimodal and multiplexed measurement of biochemical markers and physiological parameters could be transformative for personalized medicine, allowing for high-resolution, time-resolved historical monitoring of an individual's health status. In this review, we summarize current trends in the field to provide insights into the challenges and future trajectory of tissue-interfaced soft biochemical sensors, highlighting their potential to revolutionize personalized medicine and improve patient outcomes.

Synergistic enhancement of toughness and biocompatibility in poly(l-lactide) via copolymerization with poly(ε-caprolactone) and multi-arm branched strategy for aortic stent applications

Poly(lactide) has demonstrated significant potential in small-diameter vascular stents, particularly in coronary artery applications. However, its limited toughness and suboptimal biocompatibility hinder its use in high-stress regions such as the aorta. To overcome these limitations, we have designed and synthesized multi-arm poly(l-lactide-b-ε-caprolactone) (PLCL) copolymers with enhanced toughness and biocompatibility through copolymerization with polycaprolactone and multi-arm branching strategies. This study comprehensively evaluates the chemical structure, crystallization properties, mechanical properties, adhesion properties, biocompatibility and in vivo degradation profiles of multi-armed PLCLs. Results show that PLCLs exhibit substantial tensile strength and toughness, with tensile strength ranging from 1.43 MPa (2a-PLCL) to 42.45 MPa (6a-PLCL), and elongation at break from 3.07 % (2a-PLCL) to 31.49 % (6a-PLCL). Both of them were positively correlated with the number of arms. In vitro studies revealed enhanced cell adhesion and proliferation for multi-armed PLCLs. Animal model evaluations confirmed excellent histocompatibility and as the number of polymer arms increased, inflammation decreased, and the degradation rate accelerated. Notably, the 6a-PLCL exhibited the best overall performance, making it more favorable for promoting aortic remodeling. In summary, this study suggests that multi-armed PLCLs are promising candidates for cardiovascular tissue engineering and absorbable medical devices due to their enhanced mechanical properties and biocompatibility.

Biomimetic Approaches in the Development of Optimised 3D Culture Environments for Drug Discovery in Cardiac Disease

Cardiovascular disease remains the leading cause of death worldwide, yet despite massive investment in drug discovery, the progress of cardiovascular drugs from lab to clinic remains slow. It is a complex, costly pathway from drug discovery to the clinic and failure becomes more expensive as a drug progresses along this pathway. The focus has begun to shift to optimisation of in vitro culture methodologies, not only because these must be undertaken are earlier on in the drug discovery pathway, but also because the principles of the 3Rs have become embedded in national and international legislation and regulation. Numerous studies have shown myocyte cell behaviour to be much more physiologically relevant in 3D culture compared to 2D culture, highlighting the advantages of using 3D-based models, whether microfluidic or otherwise, for preclinical drug screening. This review aims to provide an overview of the challenges in cardiovascular drug discovery, the limitations of traditional routes, and the successes in the field of preclinical models for cardiovascular drug discovery. It focuses on the particular role biomimicry can play, but also the challenges around implementation within commercial drug discovery.

Harnessing native blueprints for designing bioinks to bioprint functional cardiac tissue

Cardiac tissue lacks regenerative capacity, making heart transplantation the primary treatment for end-stage heart failure. Engineered cardiac tissues developed through three-dimensional bioprinting (3DBP) offer a promising alternative. However, reproducing the native structure, cellular diversity, and functionality of cardiac tissue requires advanced cardiac bioinks. Major obstacles in CTE (cardiac tissue engineering) include accurately characterizing bioink properties, replicating the cardiac microenvironment, and achieving precise spatial organization. Optimizing bioink properties to closely mimic the extracellular matrix (ECM) is essential, as deviations may result in pathological effects. This review encompasses the rheological and electromechanical properties of bioinks and the function of the cardiac microenvironment in the design of functional cardiac constructs. Furthermore, it focuses on improving the rheological characteristics, printability, and functionality of bioinks, offering valuable perspectives for developing new bioinks especially designed for CTE.

A critical review on advances and challenges of bioprinted cardiac patches

Myocardial infarction (MI), which causes irreversible myocardium necrosis, affects 0.25 billion people globally and has become one of the most significant epidemics of our time. Over the past few years, bioprinting has moved beyond a concept of simply incorporating cells into biomaterials, to strategically defining the microenvironment (e.g., architecture, biomolecular signalling, mechanical stimuli, etc.) within which the cells are printed. Among the different bioprinting applications, myocardial repair is a field that has seen some of the most significant advances towards the management of the repaired tissue microenvironment. This review critically assesses the most recent biomedical innovations being carried out in cardiac patch bioprinting, with specific considerations given to the biomaterial design parameters, growth factors/cytokines, biomechanical and bioelectrical conditioning, as well as innovative biomaterial-based "4D" bioprinting (3D scaffold structure + temporal morphology changes) of myocardial tissues, immunomodulation and sustained delivery systems used in myocardium bioprinting. Key challenges include the ability to generate large quantities of cardiac cells, achieve high-density capillary networks, establish biomaterial designs that are comparable to native cardiac extracellular matrix, and manage the sophisticated systems needed for combining cardiac tissue microenvironmental cues while simultaneously establishing bioprinting technologies yielding both high-speed and precision. This must be achieved while considering quality assurance towards enabling reproducibility and clinical translation. Moreover, this manuscript thoroughly discussed the current clinical translational hurdles and regulatory issues associated with the post-bioprinting evaluation, storage, delivery and implantation of the bioprinted myocardial patches. Overall, this paper provides insights into how the clinical feasibility and important regulatory concerns may influence the design of the bioink (biomaterials, cell sources), fabrication and post-fabrication processes associated with bioprinting of the cardiac patches. This paper emphasizes that cardiac patch bioprinting requires extensive collaborations from imaging and 3D modelling technical experts, biomaterial scientists, additive manufacturing experts and healthcare professionals. Further, the work can also guide the field of cardiac patch bioprinting moving forward, by shedding light on the potential use of robotics and automation to increase productivity, reduce financial cost, and enable standardization and true commercialization of bioprinted cardiac patches. STATEMENT OF SIGNIFICANCE: The manuscript provides a critical review of important themes currently pursued for heart patch bioprinting, including critical biomaterial design parameters, physiologically-relevant cardiac tissue stimulations, and newly emerging cardiac tissue bioprinting strategies. This review describes the limited number of studies, to date in the literature, that describe systemic approaches to combine multiple design parameters, including capabilities to yield high-density capillary networks, establish biomaterial composite designs similar to native cardiac extracellular matrix, and incorporate cardiac tissue microenvironmental cues, while simultaneously establishing bioprinting technologies that yield high-speed and precision. New tools such as artificial intelligence may provide the analytical power to consider multiple design parameters and identify an optimized work-flow(s) for enabling the clinical translation of bioprinted cardiac patches.

Improving Thermosensitive Bioink Scaffold Fabrication with a Temperature-Regulated Printhead in Robot-Assisted In Situ Bioprinting System

In situ bioprinting enables precise 3D printing inside the human body using modified bioprinters with thermosensitive bioinks such as gelatin methacrylate (GelMA). However, these devices lack refined temperature-regulated mechanisms essential for ensuring bioink viscosity, as compared to traditional bio-3D printers. Addressing this challenge, this study presents a temperature-regulated printhead designed to improve the fabrication of thermosensitive bioink scaffolds in in situ bioprinting, integrated into a UR5 robotic arm. Featuring a closed-loop system, it achieves a temperature steady error of 1 °C and a response time of approximately 1 min. The effectiveness of the printer was validated by bioprinting multilayer lattice 3D bioscaffolds. Comparisons were made with or without temperature control using different concentrations of GelMA + LAP. The deformation of the bioscaffolds under both conditions was analyzed, and cell culture tests were conducted to verify viability. Additionally, the rheology and mechanical properties of GelMA were tested. A final preliminary in situ bioprinting experiment was conducted on a model of a damaged femur to demonstrate practical application. The fabrication of this printhead is entirely open source, facilitating easy modifications to accommodate various robotic arms. We encourage readers to advance this prototype for application in increasingly complex in situ bioprinting situations, especially those utilizing thermosensitive bioinks.

Scaffolding fundamentals and recent advances in sustainable scaffolding techniques for cultured meat development

In cultured meat (CM) production, Scaffolding plays an important role by aiding cell adhesion, growth, differentiation, and alignment. The existence of fibrous microstructure in connective and muscle tissues has attracted considerable interest in the realm of tissue engineering and triggered the interest of researchers to implement scaffolding techniques. A wide array of research efforts is ongoing in scaffolding technologies for achieving the real meat structure on the principality of biomedical research and to replace serum free CM production. Scaffolds made of animal-derived biomaterials are found efficient in replicating the extracellular matrix (ECM), thus focus should be paid to utilize animal byproducts for this purpose. Proper identification and utilization of plant-derived scaffolding biomaterial could be helpful to add diversified options in addition to animal derived sources and reduce in cost of CM production through scaffolds. Furthermore, techniques like electrospinning, modified electrospinning and 3D bioprinting should be focused on to create 3D porous scaffolds to mimic the ECM of the muscle tissue and form real meat-like structures. This review discusses recent advances in cutting edge scaffolding techniques and edible biomaterials related to structured CM production.

Recent Advances in Hydrogel-Based 3D Bioprinting and Its Potential Application in the Treatment of Congenital Heart Disease

Congenital heart disease (CHD) is the most common birth defect, requiring invasive surgery often before a child's first birthday. Current materials used during CHD surgery lack the ability to grow, remodel, and regenerate. To solve those limitations, 3D bioprinting is an emerging tool with the capability to create tailored constructs based on patients' own imaging data with the ability to grow and remodel once implanted in children with CHD. It has the potential to integrate multiple bioinks with several cell types and biomolecules within 3D-bioprinted constructs that exhibit good structural fidelity, stability, and mechanical integrity. This review gives an overview of CHD and recent advancements in 3D bioprinting technologies with potential use in the treatment of CHD. Moreover, the selection of appropriate biomaterials based on their chemical, physical, and biological properties that are further manipulated to suit their application are also discussed. An introduction to bioink formulations composed of various biomaterials with emphasis on multiple cell types and biomolecules is briefly overviewed. Vasculogenesis and angiogenesis of prefabricated 3D-bioprinted structures and novel 4D printing technology are also summarized. Finally, we discuss several restrictions and our perspective on future directions in 3D bioprinting technologies in the treatment of CHD.

Skeletal Muscle Spheroids as Building Blocks for Engineered Muscle Tissue

Spheroids exhibit enhanced cell-cell interactions that facilitate improved survival and mimic the physiological cellular environment in vivo. Cell spheroids have been successfully used as building blocks for engineered tissues, yet the viability of this approach with skeletal muscle spheroids is poorly understood, particularly when incorporated into three-dimensional (3D) constructs. Bioprinting is a promising strategy to recapitulate the hierarchical organization of native tissue that is fundamental to its function. However, the influence of bioprinting on skeletal muscle cell spheroids and their function are yet to be interrogated. Using C2C12 mouse myoblasts and primary bovine muscle stem cells (MuSCs), we characterized spheroid formation as a function of duration and cell seeding density. We then investigated the potential of skeletal muscle spheroids entrapped in alginate bioink as tissue building blocks for bioprinting myogenic tissue. Both C2C12 and primary bovine MuSCs formed spheroids of similar sizes and remained viable after bioprinting. Spheroids of both cell types fused into larger tissue clusters over time within alginate and exhibited tissue formation comparable to monodisperse cells. Compared to monodisperse cells in alginate gels, C2C12 spheroids exhibited greater MyHC expression after 2 weeks, while cells within bovine MuSC spheroids displayed increased cell spreading. Both monodisperse and MuSC spheroids exhibited increased expression of genes denoting mid- and late-stage myogenic differentiation. Together, these data suggest that skeletal muscle spheroids have the potential for generating myogenic tissue via 3D bioprinting and reveal areas of research that could enhance myogenesis and myogenic differentiation in future studies.

Biomaterials Recycling: A Promising Pathway to Sustainability

Biomaterials undergo a transformative journey, from their origin as renewable resources to the manufacturing plants where they are processed and stored, until they fulfill their intended therapeutic or diagnostic purposes and become medical waste. However, during this life cycle, biomaterials can be susceptible to contamination and subsequent degradation through various mechanisms such as hydro-mechanical, thermal, or biochemical processes in water, soil, or air. These factors raise significant concerns regarding biological safety. Additional complexities arise from the potential amalgamation of biomaterials with other materials, either of the same kind or different types. Use of biomaterials influences their porosity, surface chemistry, and structural strength, and these factors affect biomaterials' reusability. Given the multitude of materials, processing parameters, sustainability requirements, and the limitation of natural resources, the recycling of biomaterials becomes necessary. Unfortunately, this topic has received limited attention thus far. In this context, this perspective provides a brief overview, analysis, and classification of reports on biomaterials recycling, aiming to initiate a discussion on this frequently overlooked subject. We highlight the challenges related to energy consumption and environmental pollution. However, the lack of established protocols and reporting on biomaterials recycling prevents a comprehensive understanding of these challenges and potential solutions. Nevertheless, addressing these issues can lead to more efficient resource use and reduced environmental impact in the field of biomaterials.

A Mucin-Based Bio-Ink for 3D Printing of Objects with Anti-Biofouling Properties

With its potential to revolutionize the field of personalized medicine by producing customized medical devices and constructs for tissue engineering at low costs, 3D printing has emerged as a highly promising technology. Recent advancements have sparked increasing interest in the printing of biopolymeric hydrogels. However, owing to the limited printability of those soft materials, the lack of variability in available bio-inks remains a major challenge. In this study, a novel bio-ink is developed based on functionalized mucin-a glycoprotein that exhibits a multitude of biomedically interesting properties such as immunomodulating activity and strong anti-biofouling behavior. To achieve sufficient printability of the mucin-based ink, its rheological properties are tuned by incorporating Laponite XLG as a stabilizing agent. It is shown that cured objects generated from this novel bio-ink exhibit mechanical properties partially similar to that of soft tissue, show strong anti-biofouling properties, good biocompatibility, tunable cell adhesion, and immunomodulating behavior. The presented findings suggest that this 3D printable bio-ink has a great potential for a wide range of biomedical applications, including tissue engineering, wound healing, and soft robotics.

Bioprinting of Cardiac Tissue in Space: Where Are We?

Bioprinting in space is the next frontier in tissue engineering. In the absence of gravity, novel opportunities arise, as well as new challenges. The cardiovascular system needs particular attention in tissue engineering, not only to develop safe countermeasures for astronauts in future deep and long-term space missions, but also to bring solutions to organ transplantation shortage. In this perspective, the challenges encountered when using bioprinting techniques in space and current gaps that need to be overcome are discussed. The recent developments that have been made in the bioprinting of heart tissues in space and an outlook on potential future bioprinting opportunities in space are described.

Trends and Challenges in the Development of 3D-Printed Heart Valves and Other Cardiac Implants: A Review of Current Advances

This article provides a comprehensive review of the current trends and challenges in the development of 3D-printed heart valves and other cardiac implants. By providing personalized solutions and pushing the limits of regenerative medicine, 3D printing technology has revolutionized the field of cardiac healthcare. The use of several organic and synthetic polymers in 3D printing heart valves is explored in this article, with emphasis on both their benefits and drawbacks. In cardiac tissue engineering, stem cells are essential, and their potential to lessen immunological rejection and thrombogenic consequences is highlighted. In the clinical applications section, the article emphasizes the importance of 3D printing in preoperative planning. Surgery results are enhanced when surgeons can visualize and assess the size and placement of implants using patient-specific anatomical models. Customized implants that are designed to match the anatomy of a particular patient reduce the likelihood of complications and enhance postoperative results. The development of physiologically active cardiac implants, made possible by 3D bioprinting, shows promise by eliminating the need for artificial valves. In conclusion, this paper highlights cutting-edge research and the promise of 3D-printed cardiac implants to improve patient outcomes and revolutionize cardiac treatment.

3D puzzle-inspired construction of large and complex organ structures for tissue engineering

3D printing as a powerful technology enables the fabrication of organ structures with a programmed geometry, but it is usually difficult to produce large-size tissues due to the limited working space of the 3D printer and the instability of bath or ink materials during long printing sessions. Moreover, most printing only allows preparation with a single ink, while a real organ generally consists of multiple materials. Inspired by the 3D puzzle toy, we developed a "building block-based printing" strategy, through which the preparation of 3D tissues can be realized by assembling 3D-printed "small and simple" bio-blocks into "large and complex" bioproducts. The structures that are difficult to print by conventional 3D printing such as a picture puzzle consisting of different materials and colors, a collagen "soccer" with a hollow yet closed structure, and even a full-size human heart model are successfully prepared. The 3D puzzle-inspired preparation strategy also allows for a reasonable combination of various cells in a specified order, facilitating investigation into the interaction between different kinds of cells. This strategy opens an alternative path for preparing organ structures with multiple materials, large size and complex geometry for tissue engineering applications.

3D Printing Approaches to Engineer Cardiac Tissue

PURPOSE OF REVIEW

Bioengineering of functional cardiac tissue composed of primary cardiomyocytes has great potential for myocardial regeneration and in vitro tissue modeling. 3D bioprinting was developed to create cardiac tissue in hydrogels that can mimic the structural, physiological, and functional features of native myocardium. Through a detailed review of the 3D printing technologies and bioink materials used in the creation of a heart tissue, this article discusses the potential of engineered heart tissues in biomedical applications.

RECENT FINDINGS

In this review, we discussed the recent progress in 3D bioprinting strategies for cardiac tissue engineering, including bioink and 3D bioprinting methods as well as examples of engineered cardiac tissue such as in vitro cardiac models and vascular channels. 3D printing is a powerful tool for creating in vitro cardiac tissues that are structurally and functionally similar to real tissues. The use of human-induced pluripotent stem cell-derived cardiomyocytes (iPSC-CM) enables the generation of patient-specific tissues. These tissues have the potential to be used for regenerative therapies, disease modeling, and drug testing.

Electric-Field-Driven Printed 3D Highly Ordered Microstructure with Cell Feature Size Promotes the Maturation of Engineered Cardiac Tissues

Engineered cardiac tissues (ECTs) derived from human induced pluripotent stem cells (hiPSCs) are viable alternatives for cardiac repair, patient-specific disease modeling, and drug discovery. However, the immature state of ECTs limits their clinical utility. The microenvironment fabricated using 3D scaffolds can affect cell fate, and is crucial for the maturation of ECTs. Herein, the authors demonstrate an electric-field-driven (EFD) printed 3D highly ordered microstructure with cell feature size to promote the maturation of ECTs. The simulation and experimental results demonstrate that the EFD jet microscale 3D printing overcomes the jet repulsion without any prior requirements for both conductive and insulating substrates. Furthermore, the 3D highly ordered microstructures with a fiber diameter of 10-20 µm and spacing of 60-80 µm have been fabricated by maintaining a vertical jet, achieving the largest ratio of fiber diameter/spacing of 0.29. The hiPSCs-derived cardiomyocytes formed ordered ECTs with their sarcomere growth along the fiber and developed synchronous functional ECTs inside the 3D-printed scaffold with matured calcium handling compared to the 2D coverslip. Therefore, the EFD jet 3D microscale printing process facilitates the fabrication of scaffolds providing a suitable microenvironment to promote the maturation of ECTs, thereby showing great potential for cardiac tissue engineering.