Introduction to 3D printing in medicine

Three-Dimensional Printing of Hydrogel as Skin Substitute and Comparative Evaluation of Melanin Production

Cell culture in two dimensions has been the main instrument in cellular and molecular biology. But there are limitations to two-dimensional culture when it comes to tissue engineering and in vivo reproduction. Tissue engineering technology enabled the creation of biomedical scaffolds, which are mostly utilized to biofabricate different artificial human organs. Tissue architecture that encourage cell proliferation can be produced using direct bioprinting technology. The development of bioinks for 3D bioprinting is consistently seen as a problem in the domains of biofabrication and tissue engineering. This study aimed to determine if Fibroblasts and Keratinocytes could grow on hydrogel scaffolds as efficiently as they can in the culture plates. Melanocytes were co-cultured, and the production of melanin was assessed in a two- and three-dimensional culture system. Scaffolds were fabricated using 8% alginate and 6% gelatin and 3D-printed using a cell link printer. FTIR was used to determine the precise composition of the gels. SEM analysis was performed for the cells present in gel and the topology of the cells. In addition, 8% alginate and 6% alginate gel scaffolds were analyzed for swelling and degradation over time in the cell growth medium and PBS. Furthermore, a gene expression study of cell cultures on scaffolds was performed through qPCR. A live/dead assay was performed to determine cell viability for cells grown on scaffolds for 7, 14, and 21 days. Most of the cells were shown to be viable, similar to the control cells grown on a plate. The findings from the SEM showed that cells were grown on the gel surface, remained viable even after 21 days, and displayed circular cells stacked three-dimensionally on the gel surface in the 3D scaffold. The MTT assay was performed to check the viability of cells cultured on a 3D-printed scaffold for 1, 5, and 15 days. We observed about 40% viable cells after 15 days, as shown by the MTT assay. Furthermore, a co-culture study with Melanocyte showed an increased production of melanin in a 3D culture as compared to a 2D culture. Our findings suggest that an alginate and gelatin polymer can be used as a cellular matrix for epithelial cell culture. Further, in vivo and ex vivo experiments are needed to validate the results for future applications in tissue engineering for wound healing and other tissue engineering domains.

Remote-Controlled Sensing and Drug Delivery via 3D-Printed Hollow Microneedles

Remote health monitoring and treatment serve as critical drivers for advancing health equity, bridging geographical and socioeconomic disparities, ensuring equitable access to quality healthcare for those in underserved or remote regions. By democratizing healthcare, this approach offers timely interventions, continuous monitoring, and personalized care independent of one's location or socioeconomic status, thereby striving for an equitable distribution of health resources and outcomes. Meanwhile, microneedle arrays (MNAs), revolutionize painless and minimally invasive access to interstitial fluid for drug delivery and diagnostics. This paper introduces an integrated theranostic MNA system employing an array of colorimetric sensors to quantitatively measure -pH, glucose, and lactate, alongside a remotely-triggered system enabling on-demand drug delivery. Integration of an ultrasonic atomizer streamlines the drug delivery, facilitating rapid, pumpless, and point-of-care drug delivery, enhancing system portability while reducing complexities. An accompanying smartphone application interfaces the sensing and drug delivery components. Demonstrated capabilities include detecting pH (3 to 8), glucose (up to 16 mm), and lactate (up to 1.6 mm), showcasing on-demand drug delivery, and assessing delivery system performance via a scratch assay. This innovative approach confronts drug delivery challenges, particularly in managing chronic diseases requiring long-term treatment, while also offering avenues for non-invasive health monitoring through microneedle-based sensors.

Optimization of 3D printing and in vitro characterization of alginate/gelatin lattice and angular scaffolds for potential cardiac tissue engineering

Background: Engineering cardiac tissue that mimics the hierarchical structure of cardiac tissue remains challenging, raising the need for developing novel methods capable of creating structures with high complexity. Three-dimensional (3D)-printing techniques are among promising methods for engineering complex tissue constructs with high precision. By means of 3D printing, this study aims to develop cardiac constructs with a novel angular structure mimicking cardiac architecture from alginate (Alg) and gelatin (Gel) composite. The 3D-printing conditions were optimized and the structures were characterized in vitro, with human umbilical vein endothelial cells (HUVECs) and cardiomyocytes (H9c2 cells), for potential cardiac tissue engineering. Methods: We synthesized the composites of Alg and Gel with varying concentrations and examined their cytotoxicity with both H9c2 cells and HUVECs, as well as their printability for creating 3D structures of varying fibre orientations (angular design). The 3D-printed structures were characterized in terms of morphology by both scanning electron microscopy (SEM) and synchrotron radiation propagation-based imaging computed tomography (SR-PBI-CT), and elastic modulus, swelling percentage, and mass loss percentage as well. The cell viability studies were conducted via measuring the metabolic activity of the live cells with MTT assay and visualizing the cells with live/dead assay kit. Results: Among the examined composite groups of Alg and Gel, two combinations with ratios of 2 to 1 and 3 to 1 (termed as Alg2Gel1 and Alg3Gel1) showed the highest cell survival; they accordingly were used to fabricate two different structures: a novel angular and a conventional lattice structure. Scaffolds made of Alg3Gel1 showed higher elastic modulus, lower swelling percentage, less mass loss, and higher cell survival compared to that of Alg2Gel1. Although the viability of H9c2 cells and HUVECs on all scaffolds composed of Alg3Gel1 was above 99%, the group of the constructs with the angular design maintained significantly more viable cells compared to other investigated groups. Conclusion: The group of angular 3D-ptinted constructs has illustrated promising properties for cardiac tissue engineering by providing high cell viability for both endothelial and cardiac cells, high mechanical strength as well as appropriate swelling, and degradation properties during 21 days of incubation. Statement of Significance: 3D-printing is an emerging method to create complex constructs with high precision in a large scale. In this study, we have demonstrated that 3D-printing can be used to create compatible constructs from the composite of Alg and Gel with endothelial cells and cardiac cells. Also, we have demonstrated that these constructs are able to enhance the viability of cardiac and endothelial cells via creating a 3D structure mimicking the alignment and orientation of the fibers in the native heart.

3D Printed Personalized Medicine for Cancer: Applications for Betterment of Diagnosis, Prognosis and Treatment

Cancer treatment is challenging due to the tumour heterogeneity that makes personalized medicine a suitable technique for providing better cancer treatment. Personalized medicine analyses patient-related factors like genetic make-up and lifestyle and designs treatments that offer the benefits of reduced side effects and efficient drug delivery. Personalized medicine aims to provide a holistic way for prevention, diagnosis and treatment. The customization desired in personalized medicine is produced accurately by 3D printing which is an established technique known for its precision. Different 3D printing techniques exhibit their capability in producing cancer-specific medications for breast, liver, thyroid and kidney tumours. Three-dimensional printing displays major influence on cancer modelling and studies using cancer models in treatment and diagnosis. Three-dimensional printed personalized tumour models like physical 3D models, bioprinted models and tumour-on-chip models demonstrate better in vitro and in vivo correlation in drug screening, cancer metastasis and prognosis studies. Three-dimensional printing helps in cancer modelling; moreover, it has also changed the facet of cancer treatment. Improved treatment via custom-made 3D printed devices, implants and dosage forms ensures the delivery of anticancer agents efficiently. This review covers recent applications of 3D printed personalized medicine in various cancer types and comments on the possible future directions like application of 4D printing and regularization of 3D printed personalized medicine in healthcare.

3D Printing of Physical Organ Models: Recent Developments and Challenges

Physical organ models are the objects that replicate the patient-specific anatomy and have played important roles in modern medical diagnosis and disease treatment. 3D printing, as a powerful multi-function manufacturing technology, breaks the limitations of traditional methods and provides a great potential for manufacturing organ models. However, the clinical application of organ model is still in small scale, facing the challenges including high cost, poor mimicking performance and insufficient accuracy. In this review, the mainstream 3D printing technologies are introduced, and the existing manufacturing methods are divided into "directly printing" and "indirectly printing", with an emphasis on choosing suitable techniques and materials. This review also summarizes the ideas to address these challenges and focuses on three points: 1) what are the characteristics and requirements of organ models in different application scenarios, 2) how to choose the suitable 3D printing methods and materials according to different application categories, and 3) how to reduce the cost of organ models and make the process simple and convenient. Moreover, the state-of-the-art in organ models are summarized and the contribution of 3D printed organ models to various surgical procedures is highlighted. Finally, current limitations, evaluation criteria and future perspectives for this emerging area are discussed.

Design and optimization of 3D-bioprinted scaffold framework based on a new natural polymeric bioink

OBJECTIVES

This aimed at the design and production of engineered 3D scaffold prototypes using a natural polymeric bioink made of chitosan and poly-γ-glutamic acid with a specific focus on 3D-bioprinting process and on 3D framework geometry.

METHODS

Prototypes were produced using a 3D bioprinter exploiting layer-by-layer deposition technology. The 3D scaffold prototypes were fully characterized concerning pore size and size distribution, stability in different experimental conditions, swelling capability, and human dermal fibroblasts viability.

KEY FINDINGS

Hexagonal framework combined with biopaper allowed stabilizing the 3-layers structure during process manufacturing and during incubation in cell culture conditions. The stability of 3-layers structure was well preserved for 48 h. Crosslinking percentages of 2-layers and 3-layers prototype were 88.2 and 68.39, respectively. The swelling study showed a controlled swelling capability for 2-layers and 3-layers prototype, ∼5%. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay results showed good biocompatibility of 3-layers prototype and their suitability for preserving 48 h cell viability in 3D cultures. Moreover, a significant increment of absorbance value was measured after 48 h, demonstrating cell growth.

CONCLUSIONS

Bioink obtained combining chitosan and poly-γ-glutamic acid represents a good option for 3D bioprinting. A stable 3D structure was realized by layer-by-layer deposition technology; compared with other papers, the present study succeeded in using medical healthcare-grade polymers, no-toxic crosslinker, and solvents according to ICH Topic Q3C (R4).

Constructing an Individualized Middle Cerebral Artery Model Using 3D Printing and Hydrogel for Bypass Training

The importance and complexity of cerebral bypass surgery (CBS) highlight the necessity for intense and dedicated training. Several available training models are yet to satisfy this need. In this technical note, we share the steps to construct a digital imaging and communications in medicine (DICOM)-based middle cerebral artery (MCA) model that is anatomically accurate, resembles handling properties of living tissue, and enables trainers to observe the cerebrovascular anatomy, improve and maintain microsurgical dexterity, and train in the essential steps of CBS. The internal and external molds were created from the geometry of DICOM-based MCA using Fusion 360 software (Autodesk, San Rafael, USA). They were then three-dimension (3D) printed using a polylactic acid filament. The 15% w/v solution of polyvinyl alcohol (PVA) was prepared and injected between the molds. Using five freeze-thaw cycles the solution was converted to tissue-mimicking cryo-gel. The model was then placed in a chloroform bath until the internal mold dissolved. To evaluate the accuracy of the MCA model, selected characteristics were measured and compared with the MCA mesh. The DICOM-based MCA model was produced using 3D printing that was available in the lab and the overall cost was less than $5 per model. The external mold required six and a half hours to be 3D printed, while the internal mold only required 23 minutes. Overall, the time required to 3D print the DICOM-based MCA model was just short of seven hours. The greatest statistically significant difference between the virtual MCA model and the DICOM-based MCA model was found in the length of the pre-bifurcation part of the M1 segment and the total length of the superior bifurcation trunk of M1 and superior branch of M2. The smallest statistically significant difference was found at the diameter of the inferior post-bifurcation trunk of the M1 segment and the diameter at the origin of the artery. This technical report aims to show the construction of a CBS training system involving the DICOM-based MCA model that demonstrates the shape of the vascular tree, resembles the handling/suturing properties of living tissue, and helps set up a homemade training station. We believe that our DICOM-based MCA model can serve as a valuable resource for CBS training throughout the world due to its cost-effectiveness and straightforward construction steps. Moreover, once the DICOM-based MCA model is used with our training station, it may offer an option for trainers to gain and maintain CBS skills despite limitations on time, cost, and space. This work was presented in February 2019 at the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Cerebrovascular Section Annual Meeting held in Honolulu, Hawaii.

Current standards and ethical landscape of engineered tissues-3D bioprinting perspective

Tissue engineering is an evolving multi-disciplinary field with cutting-edge technologies and innovative scientific perceptions that promise functional regeneration of damaged tissues/organs. Tissue engineered medical products (TEMPs) are biomaterial-cell products or a cell-drug combination which is injected, implanted or topically applied in the course of a therapeutic or diagnostic procedure. Current tissue engineering strategies aim at 3D printing/bioprinting that uses cells and polymers to construct living tissues/organs in a layer-by-layer fashion with high 3D precision. However, unlike conventional drugs or therapeutics, TEMPs and 3D bioprinted tissues are novel therapeutics and need different regulatory protocols for clinical trials and commercialization processes. Therefore, it is essential to understand the complexity of raw materials, cellular components, and manufacturing procedures to establish standards that can help to translate these products from bench to bedside. These complexities are reflected in the regulations and standards that are globally in practice to prevent any compromise or undue risks to patients. This review comprehensively describes the current legislations, standards for TEMPs with a special emphasis on 3D bioprinted tissues. Based on these overviews, challenges in the clinical translation of TEMPs & 3D bioprinted tissues/organs along with their ethical concerns and future perspectives are discussed.

Polylactic acid as a suitable material for 3D printing of protective masks in times of COVID-19 pandemic

A critical lack of personal protective equipment has occurred during the COVID-19 pandemic. Polylactic acid (PLA), a polyester made from renewable natural resources, can be exploited for 3D printing of protective face masks using the Fused Deposition Modelling technique. Since the possible high porosity of this material raised questions regarding its suitability for protection against viruses, we have investigated its microstructure using scanning electron microscopy and aerosol generator and photometer certified as the test system according to the standards EN 143 and EN 149. Moreover, the efficiency of decontaminating PLA surfaces by conventional chemical disinfectants including 96% ethanol, 70% isopropanol, and a commercial disinfectant containing 0.85% sodium hypochlorite has been determined. We confirmed that the structure of PLA protective masks is compact and can be considered a sufficient barrier protection against particles of a size corresponding to microorganisms including viruses. Complete decontamination of PLA surfaces from externally applied Staphylococcus epidermidis, Escherichia coli, Candida albicans and SARS-CoV-2 was achieved using all disinfectants tested, and human adenovirus was completely inactivated by sodium hypochlorite-containing disinfectant. Natural contamination of PLA masks worn by test persons was decontaminated easily and efficiently by ethanol. No disinfectant caused major changes to the PLA surface properties, and the pore size did not change despite severe mechanical damage of the surface. Therefore, PLA may be regarded as a suitable material for 3D printing of protective masks during the current or future pandemic crises.

Pharmaceutical Additive Manufacturing: a Novel Tool for Complex and Personalized Drug Delivery Systems

Inter-individual variability is always an issue when treating patients of different races, genders, ages, pharmacogenetics, and pharmacokinetic characteristics. However, the development of novel dosage forms is limited by the huge investments required for production line modifications and dosages diversity. Additive manufacturing (AM) or 3D printing can be a novel alternative solution for the development of controlled release dosages because it can produce personalized or unique dosage forms and more complex drug-release profiles. The primary objective of this manuscript is to review the 3D printing processes that have been used in the pharmaceutical area, including their general aspects, materials, and the operation of each AM technique. Advantages and shortcomings of the technologies are discussed with respect to practice and practical applications. Thus, this review will provide an overview and discussion on advanced pharmaceutical AM technologies, which can be used to produce unique controlled drug delivery systems and personalized dosages for the future of personalized medicine.