Engineering considerations on extrusion-based bioprinting: interactions of material behavior, mechanical forces and cells in the printing needle

Gelatin methacryloyl bioinks for bioprinting nasal cartilage: Balancing mechanical integrity and extracellular matrix formation

Gelatin methacryloyl (GelMA) is widely recognized as a versatile hydrogel, though few studies have examined its role in nasal cartilage engineering. In this study, we investigated how variations in GelMA concentration and lysyl oxidase-like 2 (LOXL2) supplementation would affect mechanical properties, extracellular matrix (ECM) deposition, and human nasoseptal chondrocyte remodeling in 3D bioprinted constructs. Using human serum-supplemented media to enhance clinical feasibility, we evaluated a Good Manufacturing Practices (GMP)-grade GelMA at 5, 10, and 15 % w/v. To improve mechanical properties, we investigated LOXL2's potential to enhance crosslinking of newly synthesized collagen, an approach not previously evaluated in gelatin biomaterials. After six weeks, higher GelMA concentrations increased stiffness, as demonstrated by suture pull-out, three-point bending, and compressive equilibrium moduli. However, improved mechanical performance accompanied a reduction in ECM deposition and elevated catabolic gene expression. These findings suggest that cells encapsulated in stiffer, more densely crosslinked constructs exhibited an altered anabolic-catabolic balance and chondrocyte behavior These results underscore the need to balance mechanical integrity with a microenvironment conducive to collagen synthesis and remodeling. By examining how GelMA concentration, crosslinking, and human serum-based conditions influence ECM deposition, this work advances macromolecular interactions in GelMA-based constructs in the development of clinically translatable cartilage grafts.

Optimizing extrusion-based 3D bioprinting of plant cells with enhanced resolution and cell viability

3D bioprinting of plant cells has emerged as a promising technology for plant cell immobilization and related applications. Despite the numerous progress in mammalian cell printing, the bioprinting of plant cells is still in its infancy and needs further investigation. Here, we present a systematic study on optimizing the 3D bioprinting of plant cells, using carrots as an example, towards enhanced resolution and cell viability. We mainly investigated the effects of cell cluster forms and nozzle size on the rheological, extrusion, and printability properties of plant cell bioinks, as well as on the resultant cell viability and growth. We found that when the printing nozzle is larger than 85% of the cell clusters embedded in the bioink, smooth extrusion and good printability can be achieved together with considerable cell viability and long-term growth. Specifically, we optimized a bioink composited with suspension-cultured carrot cells, which exhibited better uniformity, smoother extrusion, and higher cell viability over 1 month culture compared to those with the regular callus or fragmented callus. This work provides a practical guideline for optimizing plant cell bioprinting from the bioink development to the printing outcome assessment. It highlights the importance of selecting a matched nozzle and cell cluster and might provide insights for a better understanding and exploitation of plant cell bioprinting.

3D-printed microstructured alginate scaffolds for neural tissue engineering

Alginate (Alg) is a versatile biopolymer for scaffold engineering and a bioink component widely used for direct cell printing. However, due to a lack of intrinsic cell-binding sites, Alg must be functionalized for cellular adhesion when used as a scaffold. Moreover, direct cell-laden ink 3D printing requires tedious disinfection procedures and cell viability is compromised by shear stress. Here, we demonstrate proof-of-concept, bioactive additive-free, microstructured Alg (M-Alg) scaffolds for neuron culture. The M-Alg scaffold was formed by introducing tetrapod-shaped ZnO (t-ZnO) microparticles into the ink as structural templates for interconnected channels and textured surfaces in the 3D-printed Alg scaffold, which were subsequently removed. Neurons exhibited significantly improved adhesion and growth on these M-Alg scaffolds compared with pristine Alg (P-Alg) scaffolds, with extensive neurite outgrowth and spontaneous neural activity, indicating the maturation of neuronal networks. These transparent, porous, additive-free Alg-based scaffolds with neuron affinity are promising for neuroregenerative and organoid-related research.

Advancements in 3D skin bioprinting: processes, bioinks, applications and sensor integration

This comprehensive review explores the multifaceted landscape of skin bioprinting, revolutionizing dermatological research. The applications of skin bioprinting utilizing techniques like extrusion-, droplet-, laser- and light-based methods, with specialized bioinks for skin biofabrication have been critically reviewed along with the intricate aspects of bioprinting hair follicles, sweat glands, and achieving skin pigmentation. Challenges remain with the need for vascularization, safety concerns, and the integration of automated processes for effective clinical translation. The review further investigates the incorporation of biosensor technologies, emphasizing their role in monitoring and enhancing the wound healing process. While highlighting the remarkable progress in the field, critical limitations and concerns are critically examined to provide a balanced perspective. This synthesis aims to guide scientists, engineers, and healthcare providers, fostering a deeper understanding of the current state, challenges, and future directions in skin bioprinting for transformative applications in tissue engineering and regenerative medicine.

Insights on the role of cryoprotectants in enhancing the properties of bioinks required for cryobioprinting of biological constructs

Preservation and long-term storage of readily available cell-laden tissue-engineered products are major challenges in expanding their applications in healthcare. In recent years, there has been increasing interest in the development of off-the-shelf tissue-engineered products using the cryobioprinting approach. Here, bioinks are incorporated with cryoprotective agents (CPAs) to allow the fabrication of cryopreservable tissue constructs. Although this method has shown potential in the fabrication of cryopreservable tissue-engineered products, the impact of the CPAs on the viscoelastic behavior and printability of the bioinks at cryo conditions remains unexplored. In this study, we have evaluated the influence of CPAs such as glycerol and dimethyl sulfoxide (DMSO) on the rheological properties of pre-crosslinked alginate bioinks for cryoprinting applications. DMSO-incorporated bioinks showed a reduction in viscosity and yield stress, while the addition of glycerol improved both the properties due to interactions with the calcium chloride used for pre-crosslinking. Further, tube inversion and printability experiments were performed to identify suitable concentrations and cryobioprinting conditions for bioinks containing CPAs & pre-crosslinked with CaCl2. Finally, based on the printability analysis & cell recovery results, 10% glycerol was used for cryobioprinting and preservation of cell-laden constructs at -80 °C and the viability of cells within the printed structures were evaluated after recovery. Cell viability results indicate that the addition of 10% glycerol to the pre-crosslinked bioink significantly improved cell viability compared to bioinks without CPAs, confirming the suitability of the developed bioink combination to fabricate tissue constructs for on-demand applications.

A Universal Strategy to Construct High-Performance Homo- and Heterogeneous Microgel Assembly Bioinks

Three dimensional (3D) extrusion bioprinting aims to replicate the complex architectures and functions of natural tissues and organs. However, the conventional hydrogel and new-emerging microgel bioinks are both difficult in achieving simultaneously high shape-fidelity and good maintenance of cell viability/function, leading to limited amount of qualified hydrogel/microgel bioinks. Herein, a universal strategy is reported to construct high-performance microgel assembly (MA) bioinks by using epigallocatechin gallate-modified hyaluronic acid (HA-EGCG) as coating agent and phenylboronic acid grafted hyaluronic acid (HA-PBA) as assembling agent. HA-EGCG can spontaneously form uniform coating on the microgel surface via mussel-inspired chemistry, while HA-PBA quickly forms dynamic phenylborate bonds with HA-EGCG, conferring the as-prepared MA bioinks with excellent rheological properties, self-healing, and tissue-adhesion. More importantly, this strategy is applicable to various microgel materials, enabling the preparation of homo- and heterogeneous MA (homo-MA and hetero-MA) bioinks and the hierarchical printing of complicated structures with high fidelity by integration of different microgels containing multiple materials/cells in spatial and compositional levels. It further demonstrates the printing of breast cancer organoid in vitro using homo-MA and hetero-MA bioinks and its preliminary application for drug testing. This universal strategy offers a new solution to construct high-performance bioinks for extrusion bioprinting.

Leveraging Blood Components for 3D Printing Applications Through Programmable Ink Engineering Approaches

This study proposes a tunable ink engineering methodology to allow 3D printing processability of highly bioactive but otherwise low-viscous and unprintable blood-derived materials. The hypothesis relies on improving the viscoelasticity and shear thinning behavior of platelet lysates (PL) and albumins (BSA) solutions by covalent coupling, enabling simultaneous extrusion and photocrosslinking upon filament deposition. The available amine groups on proteins (PL and BSA) are exploited for coupling with carboxyl groups present in methacrylated proteins (hPLMA and BSAMA), by leveraging carbodiimide chemistry. This reaction enabled the creation of a pre-gel from these extremely low-viscous materials (≈ 1 Pa), with precise tuning of the reaction, resulting in inks with a range of controlled viscosities and elasticities. Shape-fidelity analysis is performed on 3D-printed multilayered constructs, demonstrating the ability to reach clinically relevant sizes (>2 cm in size). After photocrosslinking, the scaffolds showcased a mechanically robust structure with sustained protein release over time. Bioactivity is evaluated using human adipose-derived stem cells, resulting in increased viability and metabolic activity over time. The herein described research methodology widens the possibilities for the use of low-viscosity materials in 3D printing but also enables the direct application of patient and blood-derived materials in precision medicine.

Unlocking new possibilities: application of MXenes in 3D bioprinting for advanced therapy

3D bioprinting has become a leading contender among additive manufacturing techniques in biomedicine, offering the potential to create functional tissues and organs that could eliminate the need for transplants. However, for complex tissues like muscle, neural, bone, and heart, bioinks need significant improvements in properties like printability, mechanical strength, and functionalities crucial for mimicking natural tissues. Nanomaterial-based bioinks offer exciting possibilities. Among these, MXenes stand out due to their excellent biocompatibility, abundant surface groups for cell interaction, conductivity for electrical stimulation, and photothermal properties. This review delves into the potential of MXenes in 3D bioprinting. We explore the advantages of 3D printing for MXene-based biofabrication, followed by a deep dive into MXenes' properties that make them ideal for tissue engineering and regeneratice medicine. We also provide a concise overview of various 3D bioprinting techniques and the essential criteria for bioinks employed in this process. We then discuss the diverse applications of these MXene-incorporated bioprinted constructs. Finally, we address the current challenges and future directions in this promising field. This comprehensive analysis will provide valuable insights for researchers exploring the exciting potential of nanomaterials beyond MXenes in 3D bioprinting for biomedicine advancements.

Gel-Based Suspension Medium Used in 3D Bioprinting for Constructing Tissue/Organ Analogs

Constructing tissue/organ analogs with natural structures and cell types in vitro offers a valuable strategy for the in situ repair of damaged tissues/organs. Three-dimensional (3D) bioprinting is a flexible method for fabricating these analogs. However, extrusion-based 3D bioprinting faces the challenge of balancing the use of soft bioinks with the need for high-fidelity geometric shapes. To address these challenges, recent advancements have introduced various suspension mediums based on gelatin, agarose, and gellan gum microgels. The emergence of these gel-based suspension mediums has significantly advanced the fabrication of tissue/organ constructs using 3D bioprinting. They effectively stabilize and support soft bioinks, enabling the formation of complex spatial geometries. Moreover, they provide a stable, cell-friendly environment that maximizes cell viability during the printing process. This minireview will summarize the properties, preparation methods, and potential applications of gel-based suspension mediums in constructing tissue/organ analogs, while also addressing current challenges and providing an outlook on the future of 3D bioprinting.

Biofabrication of engineered tissues by 3D bioprinting of tissue specific high cell-density bioinks

Bioprinting of high cell-density bioinks is a promising technique for cellular condensation-based tissue engineering and regeneration medicine. However, it remains difficult to create precisely controlled complex structures and organization of tissues with high cell-density bioink-based bioprinting for tissue specific condensation. In this study, we present newly biofabricated tissues from directly assembled, tissue specific, high cell-density bioinks which have been three-dimensionally printed into a photocrosslinkable and biodegradable hydrogel microparticle supporting bath. Three types of tissue specific high cell-density bioinks have been prepared with individual stem cells or stem cell aggregates by incorporation of growth factor-loaded gelatin microparticles. The bioprinted tissue specific high cell-density bioinks in the photocrosslinked microgel supporting bath condense together and differentiate down tissue-specific lineages to form multi-phase tissues (e.g., osteochondral tissues). By changing the growth factors and cell types, these tissue specific high cell-density bioinks enable engineering of various functional tissues with controlled architecture and organization of cells.

Tumoroids, a valid preclinical screening platform for monitoring cancer angiogenesis

In recent years, biologists and clinicians have witnessed prominent advances in in vitro 3D culture techniques related to biomimetic human/animal tissue analogs. Numerous data have confirmed that unicellular and multicellular (tumoroids) tumor spheroids with dense native cells in certain matrices are sensitive and valid analytical tools for drug screening, cancer cell dynamic growth, behavior, etc. in laboratory settings. Angiogenesis/vascularization is a very critical biological phenomenon to support oxygen and nutrients to tumor cells within the deep layer of solid masses. It has been shown that endothelial cell (EC)-incorporated or -free spheroid/tumoroid systems provide a relatively reliable biological platform for monitoring the formation of nascent blood vessels in micron/micrometer scales. Besides, the paracrine angiogenic activity of cells within the spheroid/tumoroid systems can be monitored after being treated with different therapeutic approaches. Here, we aimed to collect recent advances and findings related to the monitoring of cancer angiogenesis using unicellular and multicellular tumor spheroids. Vascularized spheroids/tumoroids can help us in the elucidation of mechanisms related to cancer formation, development, and metastasis by monitoring the main influencing factors.

High Throughput Bioprinting Using Decellularized Adipose Tissue-Based Hydrogels for 3D Breast Cancer Modeling

3D bioprinting allows rapid automated fabrication and can be applied for high throughput generation of biomimetic constructs for in vitro drug screening. Decellularized extracellular matrix (dECM) hydrogel is a popular biomaterial choice for tissue engineering and studying carcinogenesis as a tumor microenvironmental mimetic. This study proposes a method for high throughput bioprinting with decellularized adipose tissue (DAT) based hydrogels for 3D breast cancer modeling. A comparative analysis of decellularization protocol using detergent-based and detergent-free decellularization methods for caprine-origin adipose tissue is performed, and the efficacy of dECM hydrogel for 3D cancer modeling is assessed. Histological, biochemical, morphological, and biological characterization and analysis showcase the cytocompatibility of DAT hydrogel. The rheological property of DAT hydrogel and printing process optimization is assessed to select a bioprinting window to attain 3D breast cancer models. The bioprinted tissues are characterized for cellular viability and tumor cell-matrix interactions. Additionally, an approach for breast cancer modeling is shown by performing rapid high throughput bioprinting in a 96-well plate format, and in vitro drug screening using 5-fluorouracil is performed on 3D bioprinted microtumors. The results of this study suggest that high throughput bioprinting of cancer models can potentially have downstream clinical applications like multi-drug screening platforms and personalized disease models.

Computational Fluid Dynamics (CFD) Analysis of Bioprinting

Regenerative medicine has evolved with the rise of tissue engineering due to advancements in healthcare and technology. In recent years, bioprinting has been an upcoming approach to traditional tissue engineering practices, through the fabrication of functional tissue by its layer-by-layer deposition process. This overcomes challenges such as irregular cell distribution and limited cell density, and it can potentially address organ shortages, increasing transplant options. Bioprinting fully functional organs is a long stretch but the advancement is rapidly growing due to its precision and compatibility with complex geometries. Computational Fluid Dynamics (CFD), a carestone of computer-aided engineering, has been instrumental in assisting bioprinting research and development by cutting costs and saving time. CFD optimizes bioprinting by testing parameters such as shear stress, diffusivity, and cell viability, reducing repetitive experiments and aiding in material selection and bioprinter nozzle design. This review discusses the current application of CFD in bioprinting and its potential to enhance the technology that can contribute to the evolution of regenerative medicine.

Optimising Bioprinting Nozzles through Computational Modelling and Design of Experiments

3D bioprinting is a promising technique for creating artificial tissues and organs. One of the main challenges of bioprinting is cell damage, due to high pressures and tensions. During the biofabrication process, extrusion bioprinting usually results in low cell viability, typically ranging from 40% to 80%, although better printing performance with higher cell viability can be achieved by optimising the experimental design and operating conditions, with nozzle geometry being a key factor. This article presents a review of studies that have used computational fluid dynamics (CFD) to optimise nozzle geometry. They show that the optimal ranges for diameter and length are 0.2 mm to 1 mm and 8 mm to 10 mm, respectively. In addition, it is recommended that the nozzle should have an internal angle of 20 to 30 degrees, an internal coating of ethylenediaminetetraacetic acid (EDTA), and a shear stress of less than 10 kPa. In addition, a design of experiments technique to obtain an optimal 3D bioprinting configuration for a bioink is also presented. This experimental design would identify bioprinting conditions that minimise cell damage and improve the viability of the printed cells.

Optimizing Printhead Design for Enhanced Temperature Control in Extrusion-Based Bioprinting

This study addresses critical challenges in the field of tissue engineering, specifically in the optimization of bioprinting technologies for the construction of complex, multicellular tissues. By utilizing a homemade piston-driven extrusion-based bioprinting (EBB) printhead, we performed detailed thermal and flow analyses to investigate the effects of temperature variations on the extrusion process of temperature-sensitive gelatin-alginate bioink. Through finite element method (FEM) simulations, we explored the temperature distribution within the printhead and its impact on bioink properties, such as viscosity, pressure, and shear stress. Key findings reveal significant temperature gradients from the printhead barrel to the nozzle tip, influencing bioink extrusion and filament morphology. This study further introduces an innovative hardware optimization with thermal insulators, designed to mitigate heat loss at the nozzle tip and ensure uniform temperature distribution. Both simulation and empirical printing experiments confirm the efficacy of thermal insulators in enhancing bioprinting fidelity and efficiency. This research contributes to the advancement of bioprinting technology by optimizing printhead design, with implications for improving the quality of bioprinted tissues and organs.

Assessment and process optimization of high throughput biofabrication of immunocompetent breast cancer model for drug screening applications

Recent advancements in 3D cancer modeling have significantly enhanced our ability to delve into the intricacies of carcinogenesis. Despite the pharmaceutical industry's substantial investment of both capital and time in the drug screening and development pipeline, a concerning trend persists: drug candidates screened on conventional cancer models exhibit a dismal success rate in clinical trials. One pivotal factor contributing to this discrepancy is the absence of drug testing on pathophysiologically biomimetic 3D cancer models during pre-clinical stages. Unfortunately, current manual methods of 3D cancer modeling, such as spheroids and organoids, suffer from limitations in reproducibility and scalability. In our study, we have meticulously developed 3D bioprinted breast cancer model utilizing decellularized adipose tissue-based hydrogel obtained via a detergent-free decellularization method. Our innovative printing techniques allows for rapid, high-throughput fabrication of 3D cancer models in a 96-well plate format, demonstrating unmatched scalability and reproducibility. Moreover, we have conducted extensive validation, showcasing the efficacy of our platform through drug screening assays involving two potent anti-cancer drugs, 5-Fluorouracil and PRIMA-1Met. Notably, our platform facilitates effortless imaging and gene expression analysis, streamlining the evaluation process. In a bid to enhance the relevance of our cancer model, we have introduced a heterogeneous cell population into the DAT-based bioink. Through meticulous optimization and characterization, we have successfully developed a biomimetic immunocompetent breast cancer model, complete with microenvironmental cues and diverse cell populations. This breakthrough paves the way for rapid multiplex drug screening and the development of personalized cancer models, marking a paradigm shift in cancer research and pharmaceutical development.

Biomaterials for extrusion-based bioprinting and biomedical applications

Amongst the range of bioprinting technologies currently available, bioprinting by material extrusion is gaining increasing popularity due to accessibility, low cost, and the absence of energy sources, such as lasers, which may significantly damage the cells. New applications of extrusion-based bioprinting are systematically emerging in the biomedical field in relation to tissue and organ fabrication. Extrusion-based bioprinting presents a series of specific challenges in relation to achievable resolutions, accuracy and speed. Resolution and accuracy in particular are of paramount importance for the realization of microstructures (for example, vascularization) within tissues and organs. Another major theme of research is cell survival and functional preservation, as extruded bioinks have cells subjected to considerable shear stresses as they travel through the extrusion apparatus. Here, an overview of the main available extrusion-based printing technologies and related families of bioprinting materials (bioinks) is provided. The main challenges related to achieving resolution and accuracy whilst assuring cell viability and function are discussed in relation to specific application contexts in the field of tissue and organ fabrication.

Computational Fluid Dynamics Analysis and Empirical Evaluation of Carboxymethylcellulose/Alginate 3D Bioprinting Inks for Screw-Based Microextrusion

Three-dimensional microextrusion bioprinting technology uses pneumatics, pistons, or screws to transfer and extrude bioinks containing biomaterials and cells to print biological tissues and organs. Computational fluid dynamics (CFD) analysis can simulate the flow characteristics of bioinks in a control volume, and the effect on cell viability can be predicted by calculating the physical quantities. In this study, we developed an analysis system to predict the effect of a screw-based dispenser system (SDS) on cell viability in bioinks through rheological and CFD analyses. Furthermore, carboxymethylcellulose/alginate-based bioinks were used for the empirical evaluation of high-viscous bioinks. The viscosity of bioinks was determined by rheological measurement, and the viscosity coefficient for the CFD analysis was derived from a correlation equation by non-linear regression analysis. The mass flow rate derived from the analysis was successfully validated by comparison with that from the empirical evaluation. Finally, the cell viability was confirmed after bioprinting with bioinks containing C2C12 cells, suggesting that the developed SDS may be suitable for application in the field of bioengineering. Consequently, the developed bioink analysis system is applicable to a wide range of systems and materials, contributing to time and cost savings in the bioengineering industry.

Three-Dimensional Bioprinting: The Ultimate Pinnacle of Tissue Engineering

Three-dimensional (3D) bioprinting has emerged as a revolutionary additive manufacturing technology that can potentially enable life-changing medical treatments in regenerative medicine. It applies the principles of tissue engineering for the printing of tissues and organs in a layer-by-layer manner. This review focuses on the various 3D bioprinting technologies currently available, the different biomaterials, cells, and growth factors that can be utilized to develop tissue-specific bioinks, the different venues for applying these technologies, and the challenges this technology faces.

Hydrodynamic shear stress' impact on mammalian cell properties and its applications in 3D bioprinting

As an effective cell assembly method, three-dimensional bioprinting has been widely used in building organ models and tissue repair over the past decade. However, different shear stresses induced throughout the entire printing process can cause complex impacts on cell integrity, including reducing cell viability, provoking morphological changes and altering cellular functionalities. The potential effects that may occur and the conditions under which these effects manifest are not clearly understood. Here, we review systematically how different mammalian cells respond under shear stress. We enumerate available experimental apparatus, and we categorise properties that can be affected under disparate stress patterns. We also summarise cell damaging mathematical models as a predicting reference for the design of bioprinting systems. We concluded that it is essential to quantify specific cell resistance to shear stress for the optimisation of bioprinting systems. Besides, as substantial positive impacts, including inducing cell alignment and promoting cell motility, can be generated by shear stress, we suggest that we find the proper range of shear stress and actively utilise its positive influences in the development of future systems.

Decellularized extracellular matrix and silk fibroin-based hybrid biomaterials: A comprehensive review on fabrication techniques and tissue-specific applications

Biomaterials play a fundamental role in tissue engineering by providing biochemical and physical cues that influence cellular fate and matrix development. Decellularized extracellular matrix (dECM) as a biomaterial is distinguished by its abundant composition of matrix proteins, such as collagen, elastin, fibronectin, and laminin, as well as glycosaminoglycans and proteoglycans. However, the mechanical properties of only dECM-based constructs may not always meet tissue-specific requirements. Recent advancements address this challenge by utilizing hybrid biomaterials that harness the strengths of silk fibroin (SF), which contributes the necessary mechanical properties, while dECM provides essential cellular cues for in vitro studies and tissue regeneration. This review discusses emerging trends in developing such biopolymer blends, aiming to synergistically combine the advantages of SF and dECM through optimal concentrations and desired cross-linking density. We focus on different fabrication techniques and cross-linking methods that have been utilized to fabricate various tissue-engineered hybrid constructs. Furthermore, we survey recent applications of such biomaterials for the regeneration of various tissues, including bone, cartilage, trachea, bladder, vascular graft, heart, skin, liver, and other soft tissues. Finally, the trajectory and prospects of the constructs derived from this blend in the tissue engineering field have been summarized, highlighting their potential for clinical translation.

A systematic approach to improve printability and cell viability of methylcellulose-based bioinks

Printability in 3D extrusion bioprinting encompasses extrudability, filament formation, and shape fidelity. Rheological properties can predict the shape fidelity of printed hydrogels. In particular, tan(δ), the ratio between loss (G'') and storage (G') modulus (G''/G'), is a powerful indicator of printability. This study explores the effect of different salt, sucrose, and MC concentrations on tan(δ), and therefore the printability of methylcellulose (MC) hydrogels. Salt and sucrose increased G', lowering tan(δ) and enabling printing of scaffolds with high shape fidelity. Conversely, MC concentration increased G'' and G', having a lesser effect on tan(δ). Shape fidelity of three formulations with similar G' but varying tan(δ) values were compared. Higher tan(δ) led to reduced height, while lower tan(δ) improved shape fidelity. Cell viability increased when reducing MC content, extrusion rate, and nozzle gauge. Higher MC concentration (G' > 1.5 kPa) increased the influence of needle size and extrusion rate on cell viability. Hydrogels with G' < 1 kPa could be extruded at high rates with small nozzles, minimally affecting cell viability. This work shows a direct relationship between tan(δ) and printability of MC-based hydrogels. Lowering the complex modulus of hydrogels, mitigates extrusion stress, thus improving cell survival.

Current Status of Auricular Reconstruction Strategy Development

Microtia has severe physical and psychological impacts on patients, and auricular reconstruction offers improved esthetics and function, alleviating psychological issues. Microtia is a congenital disease caused by a multifactorial interaction of environmental and genetic factors, with complex clinical manifestations. Classification assessment aids in determining treatment strategies. Auricular reconstruction is the primary treatment for severe microtia, focusing on the selection of auricular scaffold materials, the construction of auricular morphology, and skin and soft tissue scaffold coverage. Autologous rib cartilage and synthetic materials are both used as scaffold materials for auricular reconstruction, each with advantages and disadvantages. Methods for achieving skin and soft tissue scaffold coverage have been developed to include nonexpansion and expansion techniques. In recent years, the application of digital auxiliary technology such as finite element analysis has helped optimize surgical outcomes and reduce complications. Tissue-engineered cartilage scaffolds and 3-dimensional bioprinting technology have rapidly advanced in the field of ear reconstruction. This article discusses the prevalence and classification of microtia, the selection of auricular scaffolds, the evolution of surgical methods, and the current applications of digital auxiliary technology in ear reconstruction, with the aim of providing clinical physicians with a reference for individualized ear reconstruction surgery. The focus of this work is on the current applications and challenges of tissue engineering and 3-dimensional bioprinting technology in the field of ear reconstruction, as well as future prospects.

Development of a hyaluronic acid-collagen bioink for shear-induced fibers and cells alignment

Human tissues are characterized by complex composition and cellular and extracellular matrix (ECM) organization at microscopic level. In most of human tissues, cells and ECM show an anisotropic arrangement, which confers them specific properties.In vitro, the ability to closely mimic this complexity is limited. However, in the last years, extrusion bioprinting showed a certain potential for aligning cells and biomolecules, due to the application of shear stress during the bio-fabrication process. In this work, we propose a strategy to combine collagen (col) with tyramine-modified hyaluronic acid (THA) to obtain a printable col-THA bioink for extrusion bioprinting, solely-based on natural-derived components. Collagen fibers formation within the hybrid hydrogel, as well as collagen distribution and spatial organization before and after printing, were studied. For the validation of the biological outcome, fibroblasts were selected as cellular model and embedded in the col-THA matrix. Cell metabolic activity and cell viability, as well as cell distribution and alignment, were studied in the bioink before and after bioprinting. Results demonstrated successful collagen fibers formation within the bioink, as well as collagen anisotropic alignment along the printing direction. Furthermore, results revealed suitable biological properties, with a slightly reduced metabolic activity at day 1, fully recovered within the first 3 d post-cell embedding. Finally, results showed fibroblasts elongation and alignment along the bioprinting direction. Altogether, results validated the potential to obtain collagen-based bioprinted constructs, with both cellular and ECM anisotropy, without detrimental effects of the fabrication process on the biological outcome. This bioink can be potentially used for a wide range of applications in tissue engineering and regenerative medicine in which anisotropy is required.

Translational biomaterials of four-dimensional bioprinting for tissue regeneration

Bioprinting is an additive manufacturing technique that combines living cells, biomaterials, and biological molecules to develop biologically functional constructs. Three-dimensional (3D) bioprinting is commonly used as anin vitromodeling system and is a more accurate representation ofin vivoconditions in comparison to two-dimensional cell culture. Although 3D bioprinting has been utilized in various tissue engineering and clinical applications, it only takes into consideration the initial state of the printed scaffold or object. Four-dimensional (4D) bioprinting has emerged in recent years to incorporate the additional dimension of time within the printed 3D scaffolds. During the 4D bioprinting process, an external stimulus is exposed to the printed construct, which ultimately changes its shape or functionality. By studying how the structures and the embedded cells respond to various stimuli, researchers can gain a deeper understanding of the functionality of native tissues. This review paper will focus on the biomaterial breakthroughs in the newly advancing field of 4D bioprinting and their applications in tissue engineering and regeneration. In addition, the use of smart biomaterials and 4D printing mechanisms for tissue engineering applications is discussed to demonstrate potential insights for novel 4D bioprinting applications. To address the current challenges with this technology, we will conclude with future perspectives involving the incorporation of biological scaffolds and self-assembling nanomaterials in bioprinted tissue constructs.

Bioinks for Space Missions: The Influence of Long-Term Storage of Alginate-Methylcellulose-Based Bioinks on Printability as well as Cell Viability and Function

Bioprinting is considered a key technology for future space missions and is currently being established on the International Space Station (ISS). With the aim to perform bioink production as a critical and resource-consuming preparatory step already on Earth and transport a bioink cartridge "ready to use" to the ISS, the storability of bioinks is investigated. Hydrogel blends based on alginate and methylcellulose are laden with either green microalgae of the species Chlorella vulgaris or with different human cell lines including immortilized human mesenchymal stem cells, SaOS-2 and HepG2, as well as with primary human dental pulp stem cells. The bioinks are filled into printing cartridges and stored at 4°C for up to four weeks. Printability of the bioinks is maintained after storage. Viability and function of the cells embedded in constructs bioprinted from the stored bioinks are investigated during subsequent cultivation: The microalgae survive the storage period very well and show no loss of growth and functionality, however a significant decrease is visible for human cells, varying between the different cell types. The study demonstrates that storage of bioinks is in principle possible and is a promising starting point for future research, making complex printing processes more effective and reproducible.

Targeted micro-heterogeneity in bioinks allows for 3D printing of complex constructs with improved resolution and cell viability

Three-dimensional bioprinting is an evolving versatile technique for biomedical applications. Ideal bioinks have complex micro-environment that mimic human tissue, allow for good printing quality and provide high cell viability after printing. Here we present two strategies for enhancing gelatin-based bioinks heterogeneity on a 1-100µm length scale resulting in superior printing quality and high cell viability. A thorough spatial and micro-mechanical characterization of swollen hydrogel heterogeneity was done using multiple particle tracking microrheology. When poly(vinyl alcohol) is added to homogeneous gelatin gels, viscous inclusions are formed due to micro-phase separation. This phenomenon leads to pronounced slip and superior printing quality of complex 3D constructs as well as high human hepatocellular carcinoma (HepG2) and normal human dermal fibroblast (NHDF) cell viability due to reduced shear damage during extrusion. Similar printability and cell viability results are obtained with gelatin/nanoclay composites. The formation of polymer/nanoclay clusters reduces the critical stress of gel fracture, which facilitates extrusion, thus enhancing printing quality and cell viability. Targeted introduction of micro-heterogeneities in bioinks through micro-phase separation is an effective technique for high resolution 3D printing of complex constructs with high cell viability. The size of the heterogeneities, however, has to be substantially smaller than the desired feature size in order to achieve good printing quality.

Formulation and characterization of pressure-assisted microsyringe 3D-printed scaffolds for controlled intravaginal antibiotic release

Bacterial vaginosis (BV) is a highly recurrent vaginal condition linked with many health complications. Topical antibiotic treatments for BV are challenged with drug solubility in vaginal fluid, lack of convenience and user adherence to daily treatment protocols, among other factors. 3D-printed scaffolds can provide sustained antibiotic delivery to the female reproductive tract (FRT). Silicone vehicles have been shown to provide structural stability, flexibility, and biocompatibility, with favorable drug release kinetics. This study formulates and characterizes novel metronidazole-containing 3D-printed silicone scaffolds for eventual application to the FRT. Scaffolds were evaluated for degradation, swelling, compression, and metronidazole release in simulated vaginal fluid (SVF). Scaffolds retained high structural integrity and sustained release. Minimal mass loss (<6%) and swelling (<2%) were observed after 14 days in SVF, relative to initial post-cure measurements. Scaffolds cured for 24 hr (50 °C) demonstrated elastic behavior under 20% compression and 4.0 N load. Scaffolds cured for 4 hr (50 °C), followed by 72 hr (4 °C), demonstrated the highest, sustained, metronidazole release (4.0 and 27.0 µg/mg) after 24 hr and 14 days, respectively. Based upon daily release profiles, it was observed that the 24 hr timepoint had the greatest metronidazole release of 4.08 μg/mg for scaffolds cured at 4 hr at 50 °C followed by 72 hr at 4 °C. For all curing conditions, release of metronidazole after 1 and 7 days showed > 4.0-log reduction in Gardnerella concentration. Negligible cytotoxicity was observed in treated keratinocytes comparable to untreated cells, This study shows that pressure-assisted microsyringe 3D-printed silicone scaffolds may provide a versatile vehicle for sustained metronidazole delivery to the FRT.

Fabrication and characterization of bioprints with Lactobacillus crispatus for vaginal application

Bacterial vaginosis (BV) is characterized by low levels of lactobacilli and overgrowth of potential pathogens in the female genital tract. Current antibiotic treatments often fail to treat BV in a sustained manner, and > 50% of women experience recurrence within 6 months post-treatment. Recently, lactobacilli have shown promise for acting as probiotics by offering health benefits in BV. However, as with other active agents, probiotics often require intensive administration schedules incurring difficult user adherence. Three-dimensional (3D)-bioprinting enables fabrication of well-defined architectures with tunable release of active agents, including live mammalian cells, offering the potential for long-acting probiotic delivery. One promising bioink, gelatin alginate has been previously shown to provide structural stability, host compatibility, viable probiotic incorporation, and cellular nutrient diffusion. This study formulates and characterizes 3D-bioprinted Lactobacillus crispatus-containing gelatin alginate scaffolds for gynecologic applications. Different weight to volume (w/v) ratios of gelatin alginate were bioprinted to determine formulations with highest printing resolution, and different crosslinking reagents were evaluated for effect on scaffold integrity via mass loss and swelling measurements. Post-print viability, sustained-release, and vaginal keratinocyte cytotoxicity assays were conducted. A 10:2 (w/v) gelatin alginate formulation was selected based on line continuity and resolution, while degradation and swelling experiments demonstrated greatest structural stability with dual genipin and calcium crosslinking, showing minimal mass loss and swelling over 28 days. 3D-bioprinted L. crispatus-containing scaffolds demonstrated sustained release and proliferation of live bacteria over 28 days, without impacting viability of vaginal epithelial cells. This study provides in vitro evidence for 3D-bioprinted scaffolds as a novel strategy to sustain probiotic delivery with the ultimate goal of restoring vaginal lactobacilli following microbiological disturbances.

Fabrication of Hydrogel-Based Composite Fibers and Computer Simulation of the Filler Dynamics in the Composite Flow

Fibrous structures with anisotropic fillers as composites have found increasing interest in the field of biofabrication since they can mimic the extracellular matrix of anisotropic tissues such as skeletal muscle or nerve tissue. In the present work, the inclusion of anisotropic fillers in hydrogel-based filaments with an interpenetrating polymeric network (IPN) was evaluated and the dynamics of such fillers in the composite flow were analyzed using computational simulations. In the experimental part, microfabricated rods (200 and 400 μm length, 50 μm width) were used as anisotropic fillers in extrusion of composite filaments using two techniques of wet spinning and 3D printing. Hydrogels such as oxidized alginate (ADA) and methacrylated gelatin (GelMA) were used as matrices. In the computational simulation, a combination of computational fluid dynamics and coarse-grained molecular dynamics was used to study the dynamics of rod-like fillers in the flow field of a syringe. It showed that, during the extrusion process, microrods are far from being well aligned. Instead, many of them tumble on their way through the needle leading to a random orientation in the fiber which was confirmed experimentally.

Toward 3D Bioprinting of Osseous Tissue of Predefined Shape Using Single-Matrix Cell-Bioink Constructs

Engineering living bone tissue of defined shape on-demand has remained a challenge. 3D bioprinting (3DBP), a biofabrication process capable of yielding cell constructs of defined shape, when combined with developmental engineering can provide a possible path forward. Through the development of a bioink possessing appropriate rheological properties to carry a high cell load and concurrently yield physically stable structures, printing of stable, cell-laden, single-matrix constructs of anatomical shapes is realized without the need for fugitive or support phases. Using this bioink system, constructs of hypertrophic cartilage of predesigned geometry are engineered in vitro by printing human mesenchymal stromal cells at a high density to drive spontaneous condensation and implanted in nude mice to evoke endochondral ossification. The implanted constructs retain their prescribed shape over a 12-week period and undergo remodeling to yield ossicles of the designed shape with neovascularization. Microcomputed tomography, histological, and immunohistochemistry assessments confirm bone tissue characteristics and the presence of human cells. These results demonstrate the potential of 3DBP to fabricate complex bone tissue for clinical application.

Bioprinting-associated pulsatile hydrostatic pressure elicits a mild proinflammatory response in epi- and endothelial cells

During nozzle-based bioprinting, like inkjet and microextrusion, cells are subjected to hydrostatic pressure for up to several minutes. The modality of the bioprinting-related hydrostatic pressure is either constant or pulsatile depending on the technique. We hypothesized that the difference in the modality of hydrostatic pressure affects the biological response of the processed cells differently. To test this, we used a custom-made setup to apply either controlled constant or pulsatile hydrostatic pressure on endothelial and epithelial cells. Neither bioprinting procedure visibly altered the distribution of selected cytoskeletal filaments, cell-substrate adhesions, and cell-cell contacts in either cell type. In addition, pulsatile hydrostatic pressure led to an immediate increase of intracellular ATP in both cell types. However, the bioprinting-associated hydrostatic pressure triggered a pro-inflammatory response in only the endothelial cells, with an increase of interleukin 8 (IL-8) and a decrease of thrombomodulin (THBD) transcripts. These findings demonstrate that the settings adopted during nozzle-based bioprinting cause hydrostatic pressure that can trigger a pro-inflammatory response in different barrier-forming cell types. This response is cell-type and pressure-modality dependent. The immediate interaction of the printed cells with native tissue and the immune system in vivo might potentially trigger a cascade of events. Our findings, therefore, are of major relevance in particular for novel intra-operative, multicellular bioprinting approaches.

Rheology as a Tool for Fine-Tuning the Properties of Printable Bioinspired Gels

Over the last decade, efforts have been oriented toward the development of suitable gels for 3D printing, with controlled morphology and shear-thinning behavior in well-defined conditions. As a multidisciplinary approach to the fabrication of complex biomaterials, 3D bioprinting combines cells and biocompatible materials, which are subsequently printed in specific shapes to generate 3D structures for regenerative medicine or tissue engineering. A major interest is devoted to the printing of biomimetic materials with structural fidelity after their fabrication. Among some requirements imposed for bioinks, such as biocompatibility, nontoxicity, and the possibility to be sterilized, the nondamaging processability represents a critical issue for the stability and functioning of the 3D constructs. The major challenges in the field of printable gels are to mimic at different length scales the structures existing in nature and to reproduce the functions of the biological systems. Thus, a careful investigation of the rheological characteristics allows a fine-tuning of the material properties that are manufactured for targeted applications. The fluid-like or solid-like behavior of materials in conditions similar to those encountered in additive manufacturing can be monitored through the viscoelastic parameters determined in different shear conditions. The network strength, shear-thinning, yield point, and thixotropy govern bioprintability. An assessment of these rheological features provides significant insights for the design and characterization of printable gels. This review focuses on the rheological properties of printable bioinspired gels as a survey of cutting-edge research toward developing printed materials for additive manufacturing.

Egg white improves the biological properties of an alginate-methylcellulose bioink for 3D bioprinting of volumetric bone constructs

Three-dimensional microextrusion bioprinting has attracted great interest for fabrication of hierarchically structured, functional tissue substitutes with spatially defined cell distribution. Despite considerable progress, several significant limitations remain such as a lack of suitable bioinks which combine favorable cell response with high shape fidelity. Therefore, in this work a novel bioink of alginate-methylcellulose (AlgMC) blend functionalized with egg white (EW) was developed with the aim of solving this limitation. In this regard, a stepwise strategy was proposed to improve and examine the cell response in low-viscosity alginate inks (3%, w/v) with different EW concentrations, and in high-viscosity inks after gradual methylcellulose addition for enhancing printability. The rheological properties and printability of these cell-responsive bioinks were characterized to obtain an optimized formulation eliciting balanced physicochemical and biological properties for fabrication of volumetric scaffolds. The bioprinted AlgMC + EW constructs exhibited excellent shape fidelity while encapsulated human mesenchymal stem cells showed high post-printing viability as well as adhesion and spreading within the matrix. In a proof-of-concept experiment, the impact of these EW-mediated effects on osteogenesis of bioprinted primary human pre-osteoblasts (hOB) was evaluated. Results confirmed a high viability of hOB (93.7 ± 0.15%) post-fabrication in an EW-supported AlgMC bioink allowing cell adhesion, proliferation and migration. EW even promoted the expression of osteogenic genes, coding for bone sialoprotein (integrin binding sialoprotein/bone sialoprotein precursor (IBSP)) and osteocalcin (BGLAP) on mRNA level. To demonstrate the suitability of the novel ink for future fabrication of multi-zonal bone substitutes, AlgMC + EW was successfully co-printed together with a pasty calcium phosphate bone cement biomaterial ink to achieve a partly mineralized 3D volumetric environment with good cell viability and spreading. Along with the EW-mediated positive effects within bioprinted AlgMC-based scaffolds, this highlighted the promising potential of this novel ink for biofabrication of bone tissue substitutes in clinically relevant dimensions.

Effects of surface patterning and topography on the cellular functions of tissue engineered scaffolds with special reference to 3D bioprinting

The extracellular matrix (ECM) of the tissue organ exhibits a topography from the nano to micrometer range, and the design of scaffolds has been inspired by the host environment. Modern bioprinting aims to replicate the host tissue environment to mimic the native physiological functions. A detailed discussion on the topographical features controlling cell attachment, proliferation, migration, differentiation, and the effect of geometrical design on the wettability and mechanical properties of the scaffold are presented in this review. Moreover, geometrical pattern-mediated stiffness and pore arrangement variations for guiding cell functions have also been discussed. This review also covers the application of designed patterns, gradients, or topographic modulation on 3D bioprinted structures in fabricating the anisotropic features. Finally, this review accounts for the tissue-specific requirements that can be adopted for topography-motivated enhancement of cellular functions during the fabrication process with a special thrust on bioprinting.

Nanocomposite Bioprinting for Tissue Engineering Applications

Bioprinting aims to provide new avenues for regenerating damaged human tissues through the controlled printing of live cells and biocompatible materials that can function therapeutically. Polymeric hydrogels are commonly investigated ink materials for 3D and 4D bioprinting applications, as they can contain intrinsic properties relative to those of the native tissue extracellular matrix and can be printed to produce scaffolds of hierarchical organization. The incorporation of nanoscale material additives, such as nanoparticles, to the bulk of inks, has allowed for significant tunability of the mechanical, biological, structural, and physicochemical material properties during and after printing. The modulatory and biological effects of nanoparticles as bioink additives can derive from their shape, size, surface chemistry, concentration, and/or material source, making many configurations of nanoparticle additives of high interest to be thoroughly investigated for the improved design of bioactive tissue engineering constructs. This paper aims to review the incorporation of nanoparticles, as well as other nanoscale additive materials, to printable bioinks for tissue engineering applications, specifically bone, cartilage, dental, and cardiovascular tissues. An overview of the various bioinks and their classifications will be discussed with emphasis on cellular and mechanical material interactions, as well the various bioink formulation methodologies for 3D and 4D bioprinting techniques. The current advances and limitations within the field will be highlighted.

Tuning Shear Thinning Factors of 3D Bio-Printable Hydrogels Using Short Fiber

Among various available 3D bioprinting techniques, extrusion-based three-dimensional (3D) bioprinting allows the deposition of cell-laden bioink, ensuring predefined scaffold architecture that may offer living tissue regeneration. With a combination of unique characteristics such as biocompatibility, less cell toxicity, and high water content, natural hydrogels are a great candidate for bioink formulation for the extrusion-based 3D bioprinting process. However, due to its low mechanical integrity, hydrogel faces a common challenge in maintaining structural integrity. To tackle this challenge, the rheological properties, specifically the shear thinning behavior (reduction of viscosity with increasing the applied load/shear rate on hydrogels) of a set of hybrid hydrogels composed of cellulose-derived nanofiber (TEMPO-mediated nano-fibrillated cellulose, TO-NFC), carboxymethyl cellulose (CMC), and commonly used alginate, were explored. A total of 46 compositions were prepared using higher (0.5% and 1.0%) and lower percentages (0.005% and 0.01%) of TO-NFC, 1-4% of CMC, and 1-4% of alginate to analyze the shear thinning factors such as the values of n and K, which were determined for each composition from the flow diagram and co-related with the 3D printability. The ability to tune shear thinning factors with various ratios of a nanofiber can help achieve a 3D bio-printed scaffold with defined scaffold architecture.

3D Extrusion Printing of Biphasic Anthropomorphic Brain Phantoms Mimicking MR Relaxation Times Based on Alginate-Agarose-Carrageenan Blends

The availability of adapted phantoms mimicking different body parts is fundamental to establishing the stability and reliability of magnetic resonance imaging (MRI) methods. The primary purpose of such phantoms is the mimicking of physiologically relevant, contrast-creating relaxation times T1 and T2. For the head, frequently examined by MRI, an anthropomorphic design of brain phantoms would imply the discrimination of gray matter and white matter (WM) within defined, spatially distributed compartments. Multichannel extrusion printing allows the layer-by-layer fabrication of multiple pastelike materials in a spatially defined manner with a predefined shape. In this study, the advantages of this method are used to fabricate biphasic brain phantoms mimicking MR relaxation times and anthropomorphic geometry. The printable ink was based on purely naturally derived polymers: alginate as a calcium-cross-linkable gelling agent, agarose, ι-carrageenan, and GdCl3 in different concentrations (0-280 μmol kg-1) as the paramagnetic component. The suggested inks (e.g., 3Alg-1Agar-6Car) fulfilled the requirements of viscoelastic behavior and printability of large constructs (>150 mL). The microstructure and distribution of GdCl3 were assessed by scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDX). In closely monitored steps of technological development and characterization, from monophasic and biphasic samples as printable inks and cross-linked gels, we describe the construction of large-scale phantom models whose relaxation times were characterized and checked for stability over time.

Silylated biomolecules: Versatile components for bioinks

Physical hydrogels prepared from natural biopolymers are the most popular components for bioinks. However, to improve the mechanical properties of the network, in particular its durability for long-lasting tissue engineering applications or its stiffness for bone/cartilage applications, covalent chemical hydrogels have to be considered. For that purpose, biorthogonal reactions are required to allow the inclusion of living cells within the bioink reservoir before the 3D printing procedure. Interestingly, such reactions also unlock the possibility to further multifunctionalize the network, adding bioactive moieties to tune the biological properties of the resulting printed biomaterial. Surprisingly, compared to the huge number of studies disclosing novel bioink compositions, no extensive efforts have been made by the scientific community to develop new chemical reactions meeting the requirements of both cell encapsulation, chemical orthogonality and versatile enough to be applied to a wide range of molecular components, including fragile biomolecules. That could be explained by the domination of acrylate photocrosslinking in the bioprinting field. On the other hand, proceeding chemoselectively and allowing the polymerization of any type of silylated molecules, the sol-gel inorganic polymerization was used as a crosslinking reaction to prepare hydrogels. Recent development of this strategy includes the optimization of biocompatible catalytic conditions and the silylation of highly attractive biomolecules such as amino acids, bioactive peptides, proteins and oligosaccharides. When one combines the simplicity and the versatility of the process, with the ease of functionalization of any type of relevant silylated molecules that can be combined in an infinite manner, it was obvious that a family of bioinks could emerge quickly. This review presents the sol-gel process in biocompatible conditions and the various classes of relevant silylated molecules that can be used as bioink components. The preparation of hydrogels and the kinetic considerations of the sol-gel chemistry which at least allowed cell encapsulation and extrusion-based bioprinting are discussed.

Systematic review on the application of 3D-bioprinting technology in orthoregeneration: current achievements and open challenges

BACKGROUND

Joint degeneration and large or complex bone defects are a significant source of morbidity and diminished quality of life worldwide. There is an unmet need for a functional implant with near-native biomechanical properties. The potential for their generation using 3D bioprinting (3DBP)-based tissue engineering methods was assessed. We systematically reviewed the current state of 3DBP in orthoregeneration.

METHODS

This review was performed using PubMed and Web of Science. Primary research articles reporting 3DBP of cartilage, bone, vasculature, and their osteochondral and vascular bone composites were considered. Full text English articles were analyzed.

RESULTS

Over 1300 studies were retrieved, after removing duplicates, 1046 studies remained. After inclusion and exclusion criteria were applied, 114 articles were analyzed fully. Bioink material types and combinations were tallied. Cell types and testing methods were also analyzed. Nearly all papers determined the effect of 3DBP on cell survival. Bioink material physical characterization using gelation and rheology, and construct biomechanics were performed. In vitro testing methods assessed biochemistry, markers of extracellular matrix production and/or cell differentiation into respective lineages. In vivo proof-of-concept studies included full-thickness bone and joint defects as well as subcutaneous implantation in rodents followed by histological and µCT analyses to demonstrate implant growth and integration into surrounding native tissues.

CONCLUSIONS

Despite its relative infancy, 3DBP is making an impact in joint and bone engineering. Several groups have demonstrated preclinical efficacy of mechanically robust constructs which integrate into articular joint defects in small animals. However, notable obstacles remain. Notably, researchers encountered pitfalls in scaling up constructs and establishing implant function and viability in long term animal models. Further, to translate from the laboratory to the clinic, standardized quality control metrics such as construct stiffness and graft integration metrics should be established with investigator consensus. While there is much work to be done, 3DBP implants have great potential to treat degenerative joint diseases and provide benefit to patients globally.

Formulation of Dermal Tissue Matrix Bioink by a Facile Decellularization Method and Process Optimization for 3D Bioprinting toward Translation Research

Decellularized extracellular matrices (ECMs) are being extensively used for tissue engineering purposes and detergents are predominantly used for this. A facile detergent-free decellularization method is developed for dermal matrix and compared it with the most used detergent-based decellularization methods. An optimized, single-step, cost-effective Hypotonic/Hypertonic (H/H) Sodium Chloride (NaCl) solutions-based method is employed to decellularize goat skin that resulted in much higher yield than other methods. The ECM composition, mechanical property, and cytocompatibility are evaluated and compared with other decellularization methods. Furthermore, this H/H-treated decellularized dermal ECM (ddECM) exhibits a residual DNA content of <50 ng mg^-1  of dry tissue. Moreover, 85.64 ± 3.01% of glycosaminoglycans and 65.53 ± 2.9% collagen are retained compared to the native tissue, which is higher than the ddECMs prepared by other methods. The cellular response is superior in ddECM (H/H) than other ddECMs prepared by detergent-based methods. Additionally, a bioink is formulated with the ddECM (H/H), showing good shear thinning and shear recovery properties. Process optimization in terms of print speed, flow rate, and viscosity is done to obtain a bioprinting window for ddECM bioink. The printed constructs with optimized parameters have adequate mechanical and cell adhesive properties and excellent isotropic cellular alignment.

Viability and Functionality of Neonatal Porcine Islet-like Cell Clusters Bioprinted in Alginate-Based Bioinks

The transplantation of pancreatic islets can prevent severe long-term complications in diabetes mellitus type 1 patients. With respect to a shortage of donor organs, the transplantation of xenogeneic islets is highly attractive. To avoid rejection, islets can be encapsulated in immuno-protective hydrogel-macrocapsules, whereby 3D bioprinted structures with macropores allow for a high surface-to-volume ratio and reduced diffusion distances. In the present study, we applied 3D bioprinting to encapsulate the potentially clinically applicable neonatal porcine islet-like cell clusters (NICC) in alginate-methylcellulose. The material was additionally supplemented with bovine serum albumin or the human blood plasma derivatives platelet lysate and fresh frozen plasma. NICC were analysed for viability, proliferation, the presence of hormones, and the release of insulin in reaction to glucose stimulation. Bioprinted NICC are homogeneously distributed, remain morphologically intact, and show a comparable viability and proliferation to control NICC. The number of insulin-positive cells is comparable between the groups and over time. The amount of insulin release increases over time and is released in response to glucose stimulation over 4 weeks. In summary, we show the successful bioprinting of NICC and could demonstrate functionality over the long-term in vitro. Supplementation resulted in a trend for higher viability, but no additional benefit on functionality was observed.

3D printing of MXene composite hydrogel scaffolds for photothermal antibacterial activity and bone regeneration in infected bone defect models

The repair of infected bone defects with irregular shapes is still a challenge in clinical work. Infected bone defects are faced with several major concerns: the complex shapes of bone defects, intractable bacterial infection and insufficient osseointegration. To solve these problems, we developed a personalized MXene composite hydrogel scaffold GelMA/β-TCP/sodium alginate (Sr²⁺)/MXene (Ti₃C₂) (GTAM) with photothermal antibacterial and osteogenic abilities by 3D printing. In vitro, GTAM scaffolds could kill both Gram-positive and Gram-negative bacteria by NIR irradiation due to the excellent photothermal effects of MXene. Furthermore, rat bone marrow mesenchymal stem cells were mixed into GTAM bioinks for 3D bioprinting. The cell-laden 3D printed GTAM scaffolds showed biocompatibility and bone formation ability depending on MXene, crosslinked Sr²⁺, and β-TCP. In vivo, we implanted 3D printed GTAM scaffolds in S. aureus-infected mandible defects of rats with NIR irradiation. GTAM scaffolds could accelerate the healing of infection and bone regeneration, and play synergistic roles in antibacterial and osteogenic effects. This study not only provides a strategy for the precise osteogenesis of infected bone defects, but also broadens the biomedical applications of MXene photothermal materials.

Computational Modeling and Experimental Characterization of Extrusion Printing into Suspension Baths

The extrusion printing of inks into suspension baths is an exciting tool, as it allows the printing of diverse and soft hydrogel inks into 3D space without the need for layer-by-layer fabrication. However, this printing process is complex and there have been limited studies to experimentally and computationally characterize the process. In this work, hydrogel inks (i.e., gelatin methacrylamide (GelMA)), suspension baths (i.e., agarose, Carbopol), and the printing process are examined via rheological, computational, and experimental analyses. Rheological data on various hydrogel inks and suspension baths is utilized to develop computational printing simulations based on Carreau constitutive viscosity models of the printing of inks within suspension baths. These results are then compared to experimental outcomes using custom print designs where features such as needle translation speed, defined in this work as print speed, are varied and printed filament resolution is quantified. Results are then used to identify print parameters for the printing of a GelMA ink into a unique guest-host hyaluronic acid suspension bath. This work emphasizes the importance of key rheological properties and print parameters for suspension bath printing and provides a computational model and experimental tools that can be used to inform the selection of print settings.

Micropatterning of acoustic droplet vaporization in acoustically-responsive scaffolds using extrusion-based bioprinting

Acoustically-responsive scaffolds (ARSs) are composite hydrogels that respond to ultrasound in an on-demand, spatiotemporally-controlled manner due to the presence of a phase-shift emulsion. When exposed to ultrasound, a gas bubble is formed within each emulsion droplet via a mechanism termed acoustic droplet vaporization (ADV). In previous in vitro and in vivo studies, we demonstrated that ADV can control regenerative processes by releasing growth factors and/or modulating micromechanics in ARSs. Precise, spatial patterning of emulsion within an ARS could be beneficial for ADV-induced modulation of biochemical and biophysical cues. However, precise patterning is limited using conventional bulk polymerization techniques. Here, we developed an extrusion-based method for bioprinting ARSs with micropatterned structures. Emulsions were loaded within bioink formulations containing fibrin, hyaluronic acid and/or alginate. Experimental as well as theoretical studies elucidated the interrelations between printing parameters, needle geometry, rheological properties of the bioink, and the process-induced mechanical stresses during bioprinting. The shear thinning properties of the bioinks enabled use of lower extrusion pressures resulting in decreased shear stresses and shorter residence times, thereby facilitating high viability for cell-loaded bioinks. Bioprinting yielded greater alignment of fibrin fibers in ARSs compared to conventionally polymerized ARSs. Bioprinted ARSs also enabled generation of ADV at high spatial resolutions, which were otherwise not achievable in conventional ARSs, and acoustically-driven collapse of ADV-induced bubbles. Overall, bioprinting could aid in optimizing ARSs for therapeutic applications.

Unraveling of Advances in 3D-Printed Polymer-Based Bone Scaffolds

The repair of large-area irregular bone defects is one of the complex problems in orthopedic clinical treatment. The bone repair scaffolds currently studied include electrospun membrane, hydrogel, bone cement, 3D printed bone tissue scaffolds, etc., among which 3D printed polymer-based scaffolds Bone scaffolds are the most promising for clinical applications. This is because 3D printing is modeled based on the im-aging results of actual bone defects so that the printed scaffolds can perfectly fit the bone defect, and the printed components can be adjusted to promote Osteogenesis. This review introduces a variety of 3D printing technologies and bone healing processes, reviews previous studies on the characteristics of commonly used natural or synthetic polymers, and clinical applications of 3D printed bone tissue scaffolds, analyzes and elaborates the characteristics of ideal bone tissue scaffolds, from t he progress of 3D printing bone tissue scaffolds were summarized in many aspects. The challenges and potential prospects in this direction were discussed.

Cross-Linked Gelatine by Modified Dextran as a Potential Bioink Prepared by a Simple and Non-Toxic Process

Essential features of well-designed materials intended for 3D bioprinting via microextrusion are the appropriate rheological behavior and cell-friendly environment. Despite the rapid development, few materials are utilizable as bioinks. The aim of our work was to design a novel cytocompatible material facilitating extrusion-based 3D printing while maintaining a relatively simple and straightforward preparation process without the need for harsh chemicals or radiation. Specifically, hydrogels were prepared from gelatines coming from three sources—bovine, rabbit, and chicken—cross-linked by dextran polyaldehyde. The influence of dextran concentration on the properties of hydrogels was studied. Rheological measurements not only confirmed the strong shear-thinning behavior of prepared inks but were also used for capturing cross-linking reaction kinetics and demonstrated quick achievement of gelation point (in most cases < 3 min). Their viscoelastic properties allowed satisfactory extrusion, forming a self-supported multi-layered uniformly porous structure. All gelatin-based hydrogels were non-cytototoxic. Homogeneous cells distribution within the printed scaffold was confirmed by fluorescence confocal microscopy. In addition, no disruption of cells structure was observed. The results demonstrate the great potential of the presented hydrogels for applications related to 3D bioprinting.