Free-form co-axial bioprinting of a gelatin methacryloyl bio-ink by direct in situ photo-crosslinking during extrusion

Hand-held bioprinters assistingin situbioprinting

Bioprinting, an advanced additive manufacturing technology, enables the fabrication of complex, viable three-dimensional (3D) tissues using bioinks composed of biomaterials and cells. This technology has transformative applications in regenerative medicine, drug screening, disease modeling, and biohybrid robotics. In particular,in situbioprinting has emerged as a promising approach for directly repairing damaged tissues or organs at the defect site. Unlike traditional 3D bioprinting, which is confined to flat surfaces and require complex equipment,in situtechniques accommodate irregular geometries, dynamic environments and simple apparatus, offering greater versatility for clinical applications.In situbioprinting via hand-held devices prioritize flexibility, portability, and real-time adaptability while allowing clinicians to directly deposit bioinks in anatomically complex areas, making them cost-effective, accessible, and suitable for diverse environments, including field surgeries. This review explores the principles, advancements, and comparative advantages of robotic and hand-heldin situbioprinting, emphasizing their clinical relevance. While robotic systems excel in precision and scalability, hand-held bioprinters offer unparalleled flexibility, affordability, and ease of use, making them a valuable tool for personalized and minimally invasive tissue engineering. Future research should focus on improving biosafety, aseptic properties, and bioink formulations to optimize these technologies for widespread clinical adoption.

Photocrosslinking of hyaluronic acid-based hydrogels through biotissue barriers

Photocrosslinkable hydrogels based on hyaluronic acid are promising biomaterials high in demand in tissue engineering. Typically, hydrogels are photocured under the action of UV or blue light strongly absorbed by biotissues, which limits prototyping under living organism conditions. To overcome this limitation, we propose the derivatives of well-known photosensitizers, namely chlorin p6, chlorin e6 and phthalocyanine, as those for radical polymerization in the transparency window of biotissues. Taking into account the efficiency of radical generation and dark and light cell toxicity, we evaluated water miscible pyridine phthalocyanine as a promising initiator for the intravital hydrogel photoprinting of hyaluronic acid glycidyl methacrylate (HAGM) under irradiation near 670 nm. Coinitiators (dithiothreitol or 2-mercaptoethanol) reduce the irradiation dose required for HAGM crosslinking from ∼405 J cm-2 to 80 J cm-2. Patterning by direct laser writing using a scanning 675 nm laser beam was performed to demonstrate the formation of complex shape structures. Young's moduli typical of soft tissue (∼270-460 kPa) were achieved for crosslinked hydrogels. The viability of human keratinocytes HaCaT cells within the photocrosslinking process was shown. To demonstrate scaffolding across the biotissue barrier, the subcutaneously injected photocomposition was crosslinked in BALB/c mice. The safety of the irradiation dose of 660-675 nm light (100 mW cm-2, 15 min) and the non-toxicity of the hydrogel components were confirmed by histomorphologic analysis. The intravitally photocrosslinked scaffolds maintained their shape and size for at least one month, accompanied by slow biodegradation. We conclude that the proposed technology provides a lucrative opportunity for minimally invasive scaffold formation through biotissue barriers.

In Situ Bioprinting: Process, Bioinks, and Applications

Traditional tissue engineering methods face challenges, such as fabrication, implantation of irregularly shaped scaffolds, and limited accessibility for immediate healthcare providers. In situ bioprinting, an alternate strategy, involves direct deposition of biomaterials, cells, and bioactive factors at the site, facilitating on-site fabrication of intricate tissue, which can offer a patient-specific personalized approach and align with the principles of precision medicine. It can be applied using a handled device and robotic arms to various tissues, including skin, bone, cartilage, muscle, and composite tissues. Bioinks, the critical components of bioprinting that support cell viability and tissue development, play a crucial role in the success of in situ bioprinting. This review discusses in situ bioprinting techniques, the materials used for bioinks, and their critical properties for successful applications. Finally, we discuss the challenges and future trends in accelerating in situ printing to translate this technology in a clinical settings for personalized regenerative medicine.

Recent trends in 3D bioprinting technology for skeletal muscle regeneration

Skeletal muscle is a pro-regenerative tissue, that utilizes a tissue-resident stem cell system to effect repair upon injury. Despite the demonstrated efficiency of this system in restoring muscle mass after many acute injuries, in conditions of severe trauma such as those evident in volumetric muscle loss (VML) (>20 % by mass), this self-repair capability is unable to restore tissue architecture, requiring interventions which currently are largely surgical. As a possible alternative, the generation of artificial muscle using tissue engineering approaches may also be of importance in the treatment of VML and muscle diseases such as dystrophies. Three-dimensional (3D) bioprinting has been identified as a promising technique for regeneration of the complex architecture of skeletal muscle. This review discusses existing treatment strategies following muscle damage, recent progress in bioprinting techniques, the bioinks used for muscle regeneration, the immunogenicity of scaffold materials, and in vitro and in vivo maturation techniques for 3D bio-printed muscle constructs. The pros and cons of these bioink formulations are also highlighted. Finally, we present the current limitations and challenges in the field and critical factors to consider for bioprinting approaches to become more translationa and to produce clinically relevant engineered muscle. STATEMENT OF SIGNIFICANCE: This review discusses the physiopathology of muscle injuries and existing clinical treatment strategies for muscle damage, the types of bioprinting techniques that have been applied to bioprinting of muscle, and the bioinks commonly used for muscle regeneration. The pros and cons of these bioinks are highlighted. We present a discussion of existing gaps in the literature and critical factors to consider for the translation of bioprinting approaches and to produce clinically relevant engineered muscle. Finally, we provide insights into what we believe will be the next steps required before the realization of the application of tissue-engineered muscle in humans. We believe this manuscript is an insightful, timely, and instructive review that will guide future muscle bioprinting research from a fundamental construct creation approach, down a translational pathway to achieve the desired impact in the clinic.

Advanced Additive Manufacturing of Structurally-Colored Architectures

Direct ink writing (DIW) stands out as a facile additive manufacturing method, minimizing material waste. Nonetheless, developing homogeneous Bingham inks with high yield stress and swift liquid-to-solid transitions for versatile 3D printing remains a challenge. In this study, high-performance Bingham inks are formulated by destabilizing silica particle suspensions in acrylate-based resin. A colloidal network forms in the shear-free state through interparticle attraction, achieved by disrupting the solvation layer of large resin molecules using polar molecules. The network is highly dense, with evenly distributed linkage strength as monodisperse particles undergo gelation at an ultra-high fraction. Crucially, the strength is calibrated to ensure a sufficiently large yield stress, while still allowing the network to reversibly melt under shear flow. The inks immediately undergo a liquid-to-solid transition upon discharge, while maintaining fluidity without nozzle clogging. The dense colloidal networks develop structural colors due to the short-range order. This enables the rapid and sophisticated drawing of structurally-colored 3D structures, relying solely on rheological properties. Moreover, the printed composite structures exhibit high mechanical stability due to the presence of the colloidal network, which expands the range of potential applications.

Automatic Photo-Cross-Linking System for Robotic-Based In Situ Bioprinting

This work reports the design and validation of an innovative automatic photo-cross-linking device for robotic-based in situ bioprinting. Photo-cross-linking is the most promising polymerization technique when considering biomaterial deposition directly inside a physiological environment, typical of the in situ bioprinting approach. The photo-cross-linking device was designed for the IMAGObot platform, a 5-degree-of-freedom robot re-engineered for in situ bioprinting applications. The system consists of a syringe pump extrusion module equipped with eight light-emitting diodes (LEDs) with a 405 nm wavelength. The hardware and software of the robot were purposely designed to manage the LEDs switching on and off during printing. To minimize the light exposure of the needle, thus avoiding its clogging, only the LEDs opposite the printing direction are switched on to irradiate the newly deposited filament. Moreover, the LED system can be adjusted in height to modulate substrate exposure. Different scaffolds were bioprinted using a GelMA-based hydrogel, varying the printing speed and light distance from the bed, and were characterized in terms of swelling and mechanical properties, proving the robustness of the photo-cross-linking system in various configurations. The system was finally validated onto anthropomorphic phantoms (i.e., a human humerus head and a human hand with defects) featuring complex nonplanar surfaces. The designed system was successfully used to fill these anatomical defects, thus resulting in a promising solution for in situ bioprinting applications.

3D bioprinting of complex tissue scaffolds with in situ homogeneously mixed alginate-chitosan-kaolin bioink using advanced portable biopen

Control of in situ 3D bioprinting of hydrogel without toxic crosslinker is ideal for tissue regeneration by reinforcing and homogeneously distributing biocompatible reinforcing agent during fabrication of large area and complex tissue engineering scaffolds. In this study, homogeneous mixing, and simultaneous 3D bioprinting of a multicomponent bioink based on alginate (AL)-chitosan (CH), and kaolin was obtained by an advanced pen-type extruder to ensure structural and biological homogeneity during the large area tissue reconstruction. The static, dynamic and cyclic mechanical properties as well as in situ self-standing printability significantly improved with the kaolin concentration for AL-CH bioink-printed samples due to polymer-kaolin nanoclay hydrogen bonding and cross-linking with less amount of calcium ions. The Biowork pen ensures better mixing effectiveness for the kaolin-dispersed AL-CH hydrogels (evident from computational fluid dynamics study, aluminosilicate nanoclay mapping and 3D printing of complex multilayered structures) than the conventional mixing process. Two different cell lines (osteoblast and fibroblast) introduced during large area multilayered 3D bioprinting have confirmed the suitability of such multicomponent bioinks for in vitro even tissue regeneration. The effect of kaolin to promote uniform growth and proliferation of the cells throughout the bioprinted gel matrix is more significant for this advanced pen-type extruder processed samples.

In-situ ionic crosslinking of 3D bioprinted cell-hydrogel constructs for mechanical reinforcement and improved cell growth

Hydrogels are commonly used in 3D bioprinting technology owing to their ability to encapsulate living cells. However, their inherent delicate properties limit their applicability in the fabrication of mechanically reliable tissue engineering constructs. Herein, we propose a novel reinvented layering integration method for the functional enhancement of 3D cell-hydrogel bioprinting. This was implemented by inserting electrospun microfiber sheets with a crosslinker between the 3D bioprinted layers. When surface-modified microfiber sheets were combined with Ca²⁺ ionic crosslinkers, the as-printed cell-hydrogel strand was immediately crosslinked when it contacted the sheet surface. The in-situ crosslinking in the bioprinting process not only improved the overall structural stability, but also reinforced the compressive strength and elastic modulus. The enhanced structural stability guaranteed the shape fidelity of the 3D architecture, which included the internal channel network, resulting in improved perfusion conditions for cell growth. The growth of NIH3T3 fibroblasts in 3D bioconstructs with in-situ crosslinking increased by up to five times compared to that of normally bioprinted constructs. The strengthened structural integrity was distinctly sustainable during the cell culture period owing to the sustained release of Ca²⁺ ions from the embedded microfiber sheets. The synergistic effect of the reinforced mechanical properties with enhanced cell growth is expected to extend the applicability of the proposed hydrogel-based bioprinting technique for soft tissue engineering.

Functional Skeletal Muscle Regeneration Using Muscle Mimetic Tissue Fabricated by Microvalve-Assisted Coaxial 3D Bioprinting

3D-printed artificial skeletal muscle, which mimics the structural and functional characteristics of native skeletal muscle, is a promising treatment method for muscle reconstruction. Although various fabrication techniques for skeletal muscle using 3D bio-printers are studied, it is still challenging to build a functional muscle structure. A strategy using microvalve-assisted coaxial 3D bioprinting in consideration of functional skeletal muscle fabrication is reported. The unit (artificial muscle fascicle: AMF) of muscle mimetic tissue is composed of a core filled with medium-based C2C12 myoblast aggregates as a role of muscle fibers and a photo cross-linkable hydrogel-based shell as a role of connective tissue in muscles that enhances printability and cell adhesion and proliferation. Especially, a microvalve system is applied for the core part with even cell distribution and strong cell-cell interaction. This system enhances myotube formation and consequently shows spontaneous contraction. A multi-printed AMF (artificial muscle tissue: AMT) as a piece of muscle is implanted into the anterior tibia (TA) muscle defect site of immunocompromised rats. As a result, the TA-implanted AMT responds to electrical stimulation and represents histologically regenerated muscle tissue. This microvalve-assisted coaxial 3D bioprinting shows a significant step forward to mimicking native skeletal muscle tissue.

Bipolar Electrochemical Stimulation Using Conducting Polymers for Wireless Electroceuticals and Future Directions

Electrochemistry has become a powerful strategy to modulate cellular behavior and biological activity by manipulating electrical signals. Subsequent electrical stimulus-responsive conducting polymers (CPs) have advanced traditional wired electrochemical stimulation (ES) systems and developed wireless cell stimulation systems due to their electroconductivity, biocompatibility, stability, and flexibility. Bipolar electrochemistry (BPE), i.e., wireless electrochemistry, offers an effective pathway to modify wired ES systems into a desirable contactless mode, turning out a potential technique to offer fundamental insights into neural cell stimulation and neural network formation. This review commences with a brief discussion of the BPE technique and also the advantages of a bipolar electrochemical stimulation (BPES) system compared to traditional wired ES systems and other wireless ES systems. Then, the BPES system is elucidated through four aspects: the benefits of BPES, the key factors to establish BPES platforms for cell stimulation, the limits/barriers to overcome for current rigid materials in particular metals-based systems, and a brief overview of the concept proved by CPs-based systems. Furthermore, how to refine the existing BPES system from materials/devices modification that combine CP compositions with 3D fabrication/bioprinting technologies is elaborately discussed as well. Finally, the review ends together with future research directions, picturing the potential of BPES system in biomedical applications.

In situ bioprinting: intraoperative implementation of regenerative medicine

Bioprinting has emerged as a strong tool for devising regenerative therapies to address unmet medical needs. However, the translation of conventional in vitro bioprinting approaches is partially hindered due to challenges associated with the fabrication and implantation of irregularly shaped scaffolds and their limited accessibility for immediate treatment by healthcare providers. An alternative strategy that has recently drawn significant attention is to directly print the bioink into the patient's body, so-called 'in situ bioprinting'. The bioprinting strategy and the associated bioink need to be specifically designed for in situ bioprinting to meet the particular requirements of direct deposition in vivo. In this review, we discuss the developed in situ bioprinting strategies, their advantages, challenges, and possible future improvements.

Advances in three-dimensional bioprinted stem cell-based tissue engineering for cardiovascular regeneration

Three-dimensional (3D) bioprinting of cellular or biological components are an emerging field to develop tissue structures that mimic the spatial, mechanochemical and temporal characteristics of cardiovascular tissues. 3D multi-cellular and multi-domain organotypic biological constructs can better recapitulate in vivo physiology and can be utilized in a variety of applications. Such applications include in vitro cellular studies, high-throughput drug screening, disease modeling, biocompatibility analysis, drug testing and regenerative medicine. A major challenge of 3D bioprinting strategies is the inability of matrix molecules to reconstitute the complexity of the extracellular matrix and the intrinsic cellular morphologies and functions. An important factor is the inclusion of a vascular network to facilitate oxygen and nutrient perfusion in scalable and patterned 3D bioprinted tissues to promote cell viability and functionality. In this review, we summarize the new generation of 3D bioprinting techniques, the kinds of bioinks and printing materials employed for 3D bioprinting, along with the current state-of-the-art in engineered cardiovascular tissue models. We also highlight the translational applications of 3D bioprinting in engineering the myocardium cardiac valves, and vascular grafts. Finally, we discuss current challenges and perspectives of designing effective 3D bioprinted constructs with native vasculature, architecture and functionality for clinical translation and cardiovascular regeneration.

Emerging Technologies in Multi-Material Bioprinting

Bioprinting, within the emerging field of biofabrication, aims at the fabrication of functional biomimetic constructs. Different 3D bioprinting techniques have been adapted to bioprint cell-laden bioinks. However, single-material bioprinting techniques oftentimes fail to reproduce the complex compositions and diversity of native tissues. Multi-material bioprinting as an emerging approach enables the fabrication of heterogeneous multi-cellular constructs that replicate their host microenvironments better than single-material approaches. Here, bioprinting modalities are reviewed, their being adapted to multi-material bioprinting is discussed, and their advantages and challenges, encompassing both custom-designed and commercially available technologies are analyzed. A perspective of how multi-material bioprinting opens up new opportunities for tissue engineering, tissue model engineering, therapeutics development, and personalized medicine is offered.

3D Printed Multiphasic Scaffolds for Osteochondral Repair: Challenges and Opportunities

Osteochondral (OC) defects are debilitating joint injuries characterized by the loss of full thickness articular cartilage along with the underlying calcified cartilage through to the subchondral bone. While current surgical treatments can provide some relief from pain, none can fully repair all the components of the OC unit and restore its native function. Engineering OC tissue is challenging due to the presence of the three distinct tissue regions. Recent advances in additive manufacturing provide unprecedented control over the internal microstructure of bioscaffolds, the patterning of growth factors and the encapsulation of potentially regenerative cells. These developments are ushering in a new paradigm of 'multiphasic' scaffold designs in which the optimal micro-environment for each tissue region is individually crafted. Although the adoption of these techniques provides new opportunities in OC research, it also introduces challenges, such as creating tissue interfaces, integrating multiple fabrication techniques and co-culturing different cells within the same construct. This review captures the considerations and capabilities in developing 3D printed OC scaffolds, including materials, fabrication techniques, mechanical function, biological components and design.

Reference Phantom Method for Ultrasonic Imaging of Thin Dynamic Constructs

Quantitative ultrasound has a great potential for the non-destructive evaluation of tissue engineered constructs, where the local attenuation and the integrated backscatter coefficient (IBC) can be used for monitoring the development of biological processes. The local determination of both parameters can be achieved using the reference phantom method (RPM). However, its accuracy can be affected when evaluating constructs of evolving sound speed, attenuation and thickness, for example, when evaluating biodegradable hydrogels developing neocartilage. To assess the feasibility of using the RPM under such dynamic conditions while employing a 50-MHz transducer, we conducted a series of experiments on 3-mm-thick acellular hydrogels laden with microspheres. The ultrasonic evaluation procedure used was validated by detecting and compensating for large attenuation variations occurring in the construct, up to 20-fold with respect to the reference phantom, with estimations errors below 1%. We found that sound speed mismatch does not affect the local attenuation estimation, but causes a strong diffraction effect by reducing the backscatter intensity. Such intensity reduction was compensated by determining the IBC percentage change (IBC_Δ) as function of sound speed mismatch with respect to the reference phantom (ΔSS), with the equation IBC_Δ = (0.63 ± 0.07) ΔSS + (8.54 ± 0.76) 10^-3 ΔSS². The investigated ΔSS interval was up to 120 m/s and using two different concentrations of microspheres, with estimation errors below 7% relative to the construct's actual IBC. Finally, we found that the spectral difference method is sufficient to measure within a few millimetres in depth mismatch, and when combining with sound speed mismatch, we found negligible additional effects. These results pave the way for the use of a generic reference phantom for the evaluation of thin dynamic constructs, thus simplifying the need for using different phantoms depending on the construct's properties.

In Situ 3D Printing: Opportunities with Silk Inks

In situ 3D printing is an emerging technique designed for patient-specific needs and performed directly in the patient's tissues in the operating room. While this technology has progressed rapidly, several improvements are needed to push it forward for widespread utility, including ink formulations and optimization for in situ context. Silk fibroin inks emerge as a viable option due to the diverse range of formulations, aqueous processability, robust and tunable mechanical properties, and self-assembly via biophysical adsorption to avoid exogenous chemical or photochemical sensitizer additives, among other features. In this review, we focus on this new frontier of 3D in situ printing for tissue regeneration, where silk is proposed as candidate biomaterial ink due to the unique and useful properties of this protein polymer.

Enhanced Electroactivity, Mechanical Properties, and Printability through the Addition of Graphene Oxide to Photo-Cross-linkable Gelatin Methacryloyl Hydrogel

The human tissues most sensitive to electrical activity such as neural and muscle tissues are relatively soft, and yet traditional conductive materials used to interface with them are typically stiffer by many orders of magnitude. Overcoming this mismatch, by creating both very soft and electroactive materials, is a major challenge in bioelectronics and biomaterials science. One strategy is to imbue soft materials, such as hydrogels, with electroactive properties by adding small amounts of highly conductive nanomaterials. However, electroactive hydrogels reported to date have required relatively large volume fractions (>1%) of added nanomaterial, have shown only modest electroactivity, and have not been processable via additive manufacturing to create 3D architectures. Here, we describe the development and characterization of improved biocompatible photo-cross-linkable soft hybrid electroactive hydrogels based on gelatin methacryloyol (GelMA) and large area graphene oxide (GO) flakes, which resolve each of these three limitations. The addition of very small amounts (less than a 0.07% volume fraction) of GO to a 5% w/v GelMA hydrogel resulted in a dramatic (∼35-fold) decrease in the impedance at 1 Hz compared with GelMA alone. The GelMA/GO coated indium tin oxide (ITO) electrode also showed a considerable reduction in the impedance at 1 kHz (down to 170 Ω compared with 340 Ω for the GelMA-coated ITO), while charge injection capacity increased more than 6-fold. We attribute this enhanced electroactivity to the increased electroactive surface area contributed by the GO. Despite this dramatic change in electroactivity, the GelMA/GO composite hydrogels' mechanical properties were only moderately affected. Mechanical properties increased by ∼2-fold, and therefore, the hydrogels' desired softness of <4 kPa was retained. Also, we demonstrate how light attenuation through the gel can be used to create a stiffness gradient with the exposed surface of the gel having an elastic modulus of <1.5 kPa. GO addition also enhanced the rheological properties of the GelMA composites, thus facilitating 3D extrusion printing. GelMA/GO enhanced filament formation as well as improved printability and the shape fidelity/integrity of 3D printed structures compared with GelMA alone. Additionally, the GelMA/GO 3D printed structures presented a higher electroactive behavior than nonprinted samples containing the same GelMA/GO amount, which can be attributed to the higher electroactive surface area of 3D printed structures. These findings provide new rational choices of electroactive hydrogel (EAH) compositions with broad potential applications in bioelectronics, tissue engineering, and drug delivery.