Multicellular bioprinted skin facilitates human-like skin architecture in vivo

3D bioprinted thick hepatic constructs with vascular network as a physiologically relevant in vitro organ model

Establishing adequate vascularization to engineered organs remains a significant challenge that must be addressed. This study presents a novel approach to fabricating viable thick metabolic tissue (>1 cm3) for applications in human physiology, fundamental biology, and medicine. We designed a tissue construct with a gyroid-shaped architecture to enable uniform flow and surface shear stress that adequately covers the inner surfaces of cell-laden constructs. The constructs (1 × 1 × 1 cm3) were fabricated using a digital light projection (DLP) printer with a cell-laden poly(ethylene glycol) (PEG)/gelatin methacryloyl (GelMA) bioink combined with human hepatocytes (HepG2), followed by coating the interconnected vascular channels with human endothelial cells (ECs). These constructs were then placed in flow chambers connected to a medium reservoir for continuous perfusion for up to 30 days. The constructs retained their original dimensions, and the cells maintained a greater than 85 % viability at all time points. Immunofluorescent staining confirmed hepatocytes and ECs using cell-specific markers (HNF4-α/albumin for hepatocytes and vWF for ECs). The EC layer effectively lined the vascular lumens, while viable hepatocyte aggregates populated the interior of the constructs. Functional assays demonstrated that the hepatocytes produced albumin and bilirubin at levels comparable to those observed in humans, validating the metabolic functionality of the hepatic tissue constructs. This study successfully developed thick, vascularized human hepatic tissue in an in vitro environment, maintaining functionality comparable to native liver cells over 30 days. The innovative gyroid design applied in these organ constructs represents a significant advancement in developing physiologically relevant in vitro vascularized organ models.

First-in-kind 3D bioprinted human skin model using recombinant human collagen

Reliable translational human skin models are lacking for modeling skin diseases and screening effective therapeutics. 3D bioprinting is an emerging technology that enables the fabrication of human skin models that mimic the structure and functions of human skin in a dish (in-vitro). As a prototype, we present a first-in-kind fully humanized 3D bioprinted skin model as an alternative to animal testing for preclinical research. This model utilizes a plant-derived recombinant human collagen and human skin fibroblasts, melanocytes, and keratinocytes. The 3D bioprinted human skin model expresses involucrin and cytokeratin 14, contains melanin granules, and structurally resembles human skin. However, the morphology of keratinocytes is slightly different, containing a thicker layer of proliferative keratinocytes and a thinner layer of differentiated, cornified keratinocytes. Nevertheless, the model shows epidermal stratification, which indicates skin maturation. Further, the model lacks skin appendages such as hair follicles and sweat glands, as current bioprinting technology cannot deliver distinct cells at the single-cell resolution. Recent advances in 3D bioprinting such as spheroid-based bioprinting show potential to address these limitations. Hence, 3D bioprinting of skin using plant-derived recombinant human collagen, presents significant advantages, including high-throughput production of personalized human skin models, reduction of animal testing, and potential applications in regenerative medicine.

A bioactive three-layered skin substitute based on ECM components effectively promotes skin wound healing and regeneration

To overcome the limitations of conventional skin tissue engineering (TE), 3D biofabrication approaches are being developed. However, tissue mimicry should be further improved in skin models. Here, we developed and characterized biomimetic hydrogels to obtain a biofabricated three-layered (BT) skin substitute based on the main components found in the epidermal, dermal, and hypodermal skin layers. Hydrogels for dermal and hypodermal skin layers were based on a mix of agarose and type I collagen, supplemented with skin-related extracellular matrix (ECM) components (dermatan sulfate, hyaluronic acid, and elastin) and loaded with human dermal fibroblasts (hDFs) or human mesenchymal stem/stromal cells (hMSCs), respectively. The epidermal hydrogel was formulated using type I collagen supplemented with keratin and sphingolipids, and seeded with human epidermal keratinocytes (hEKs). Physicochemical results revealed adequate viscosity, gelling times, and pH for each hydrogel solution. The BT Skin also showed good swelling and degradation kinetics, and mechanical properties in a similar range of human skin. The hydrogels and BT Skin demonstrated stable cell viability and metabolic activity, as well as intercellular communication through the release of growth factors. Moreover, the BT Skin demonstrated controlled inflammation in vivo, and produced results comparable to autografting in a mouse skin wound model. This bioactive and biomimetic three-layered BT Skin has a composition that attempts to mimic the natural ECM of the skin, formulated with the characteristic cells and biomolecules present in each skin layer, and offers promising properties for its clinical application in the treatment of patients with skin injuries.

Functional regeneration strategies of hair follicles: advances and challenges

Hair follicles are essential appendages of human skin that function in protection, sensation, thermoregulation and social interactions. The multicellular components, particularly the dermal papilla, matrix and bulge housing stem cells, enable cyclic hair growth postnatally. However, miniaturization and loss of hair follicles can occur in the context of ageing, trauma and various alopecia-related diseases. Conventional treatments involve the redistribution of existing follicles, which may not be viable in patients lacking follicular resources. Recent progress in the comprehension of morphogenesis and the development of biomaterials has significantly advanced follicle reconstruction, incorporating organ germ assembling, stem cell induction and bioprinting techniques. Despite these advancements, fully restoring hair follicles remains challenging due to the complexities of replicating embryonic signals and sustaining growth cycles. Identifying suitable cell sources for clinical applications also presents a hurdle. Here, we retrospect the progress made in the field of hair follicle regeneration, aiming to offer an exhaustive analysis on the benefits and limitations of these methods, and to foster the development of innovative solutions.

Bioprinting-By-Design of Hydrogel-Based Biomaterials for In Situ Skin Tissue Engineering

Burns are one of the most common trauma injuries worldwide and have detrimental effects on the entire body. However, the current standard of care is autologous split thickness skin grafts (STSGs), which induces additional injuries to the patient. Therefore, the development of alternative treatments to replace traditional STSGs is critical, and bioprinting could be the future of burn care. Specifically, in situ bioprinting offers several advantages in clinical applications compared to conventional in vitro bioprinting, primarily due to its ability to deposit bioink directly onto the wound. This review provides an in-depth discussion of the aspects involved in in situ bioprinting for skin regeneration, including crosslinking mechanisms, properties of natural and synthetic hydrogel-based bioinks, various in situ bioprinting methods, and the clinical translation of in situ bioprinting. The current limitations of in situ bioprinting is the ideal combination of bioink and printing mechanism to allow multi-material dispensing or to produce well-orchestrated constructs in a timely manner in clinical settings. However, extensive ongoing research is focused on addressing these challenges, and they do not diminish the significant potential of in situ bioprinting for skin regeneration.

Optimization of Gelatin and Crosslinker Concentrations in a Gelatin/Alginate-Based Bioink with Potential Applications in a Simplified Skin Model

Three-dimensional bioprinting allows for the fabrication of structures mimicking tissue architecture. This study aimed to develop a gelatin-based bioink for a bioprinted simplified skin model. The bioink printability and chemical-physical properties were evaluated by varying the concentrations of gelatin (10, 15, and 20%) in a semi-crosslinked alginate-based bioink and calcium chloride (100, 150, and 200 mM) in post-printing crosslinking. For increasing the gelatin concentration, the gelatin-based formulations have a shear thinning behavior with increasing viscosity, and the filament bending angle increases, the spreading ratio value approaches 1, and the shape fidelity and the printing resolution improve. However, the formulation containing 20% of gelatin was not homogeneous, resulting also in poor printability properties. The morphology of the pores, degradation, and swelling depend on gelatin and CaCl2 concentrations, but not in a significant way. The samples containing 15% of gelatin and crosslinked with 150 mM CaCl2 have been selected for the bioprinting of a bilayer skin model containing human fibroblasts and keratinocytes. The model showed a homogeneous distribution of viable and proliferating cells over up to 14 days of in vitro culture. The gelatin-based bioink allowed for the 3D bioprinting of a simplified skin model, with potential applications in the bioactivity of pro-reparative molecules and drug evaluation.

Organoids in skin wound healing

Stem cells (SCs) can self-replicate and differentiate into multiple lineages. Organoids, 3D cultures derived from SCs, can replicate the spatial structure and physiological characteristics of organs in vitro. Skin organoids can effectively simulate the physiological structure and function of skin tissue, reliably restoring the natural skin ecology in various in vitro environments. Skin organoids have been employed extensively in skin development and pathology research, offering valuable insights for drug screening. Moreover, they play crucial roles in skin regeneration and tissue repair. This in-depth review explores the construction and applications of skin organoids in wound healing, with a focus on their construction process, including skin appendage integration, and significant advancements in wound-healing research.

3D Bioprinting for Engineered Tissue Constructs and Patient-Specific Models: Current Progress and Prospects in Clinical Applications

Advancements in bioprinting technology are driving the creation of complex, functional tissue constructs for use in tissue engineering and regenerative medicine. Various methods, including extrusion, jetting, and light-based bioprinting, have their unique advantages and drawbacks. Over the years, researchers and industry leaders have made significant progress in enhancing bioprinting techniques and materials, resulting in the production of increasingly sophisticated tissue constructs. Despite this progress, challenges still need to be addressed in achieving clinically relevant, human-scale tissue constructs, presenting a hurdle to widespread clinical translation. However, with ongoing interdisciplinary research and collaboration, the field is rapidly evolving and holds promise for personalized medical interventions. Continued development and refinement of bioprinting technologies have the potential to address complex medical needs, enabling the development of functional, transplantable tissues and organs, as well as advanced in vitro tissue models.

Targeting the Complexity of In Vitro Skin Models: A Review of Cutting-Edge Developments

Skin in vitro models offer much promise for research, testing drugs, cosmetics, and medical devices, reducing animal testing and extensive clinical trials. There are several in vitro approaches to mimicking human skin behavior, ranging from simple cell monolayer to complex organotypic and bioengineered 3-dimensional models. Some have been approved for preclinical studies in cosmetics, pharmaceuticals, and chemicals. However, development of physiologically reliable in vitro human skin models remains in its infancy. This review reports on advances in in vitro complex skin models to study skin homeostasis, aging, and skin disease.

Exosomes from mesenchymal stem cells: Potential applications in wound healing

Wound healing is a continuous and complex process regulated by multiple factors, which has become an intractable clinical burden. Mesenchymal stem cell-derived exosomes (MSC-exos) possess low immunogenicity, easy preservation, and potent bioactivity, which is a mirror to their parental cells MSC-exos are important tools for regulating the biological behaviors of wound healing-associated cells, including fibroblasts, keratinocytes, immune cells, and endothelial cells. MSC-exos accelerate the wound healing process at cellular and animal levels by modulating inflammatory responses, promoting collagen deposition and vascularization. MSC-exos accelerate wound healing at the cellular and animal levels by modulating inflammatory responses and promoting collagen deposition and vascularization. This review summarizes the roles and mechanisms of MSC-exos originating from various sources in promoting the healing efficacy of general wounds, diabetic wounds, burn wounds, and healing-related scars. It also discusses the limitations and perspectives of MSC-exos in wound healing, in terms of exosome acquisition, mechanistic complexity, and exosome potentiation modalities. A deeper understanding of the properties and functions of MSC-exos is beneficial to advance the therapeutic approaches for achieving optimal wound healing.

Unveiling the impact of hypodermis on gene expression for advancing bioprinted full-thickness 3D skin models

3D skin models have been explored as an alternative method to the use of animals in research and development. Usually, human skin equivalents comprise only epidermis or epidermis/dermis layers. Herein, we leverage 3D bioprinting technology to fabricate a full-thickness human skin equivalent with hypodermis (HSEH). The collagen hydrogel-based structure provides a mimetic environment for skin cells to adhere, proliferate and differentiate. The effective incorporation of the hypodermis layer is evidenced by scanning electron microscopy, immunofluorescence, and hematoxylin and eosin staining. The transcriptome results underscore the pivotal role of the hypodermis in orchestrating the genetic expression of a multitude of genes vital for skin functionality, including hydration, development and differentiation. Accordingly, we evidence the paramount significance of full-thickness human skin equivalents with hypodermis layer to provide an accurate in vitro platform for disease modeling and toxicology studies.

Photothermal Fish Gelatin-Graphene Microneedle Patches for Chronic Wound Treatment

Microneedles are demonstrated as an effective strategy for chronic wound treatment. Great endeavors are devoted to developing microneedles with natural compositions and potent functions to promote therapeutic effects for wound healing. Herein, a novel graphene oxide-integrated methacrylated fish gelatin (GO-FGelMA) microneedle patch encapsulated with bacitracin and vascular endothelial growth factor (VEGF) is developed for chronic wound management. As the natural components and porous structures of FGelMA, the fabricated microneedle patches display satisfactory biocompatibility and drug-loading ability. Owing to the integration of graphene oxide, the microneedle patches can realize promoted drug release via near-infrared (NIR) irradiation. Besides, the encapsulated bacitracin and VEGF endow the microneedle patches with the ability to inhibit bacterial growth and promote angiogenesis. It is demonstrated that the GO-FGelMA microneedle patches with efficient drug release exert a positive influence on the wound healing process through reduced inflammation, enhanced wound closure, and improved tissue regeneration. Thus, it is believed that the proposed drugs-loaded GO-FGelMA microneedle patches will hold great potential in future chronic wound treatment.

Three-dimensional bioprinted cell-adaptive hydrogel with anisotropic micropores for enhancing skin wound healing

Engineered matrices with aligned microarchitectures are pivotal in regulating the fibroblast-to-myofibroblast transition, a critical process for wound healing and scar reduction. However, developing a three-dimensional (3D) aligned matrix capable of effectively controlling this transition remains challenging. Herein, we developed a cell-adaptive hydrogel with highly oriented microporous structures, fabricated through bioprinting of thermo/ion/photo-crosslinked gelatin methacrylate/sodium alginate (GelMA/SA) incorporating shear-oriented polyethylene oxide (PEO) filler. The synergistic interactions among GelMA, PEO, and SA yield a homogeneous mixture conducive to the printing of biomimetic 3D constructs with anisotropic micropores. These anisotropic micropores, along with the biochemical cues provided by the GelMA/PEO/SA scaffolds, enhance the oriented spreading and organization of fibroblasts. The resultant spread and aligned cellular morphologies promote the transition of fibroblasts into myofibroblasts. By co-culturing human keratinocytes on the engineered dermal layer, we successfully create a bilayer skin construct, wherein the keratinocytes establish tight junctions accompanied by elevated expression of cytokeratin-14, while the fibroblasts display a highly spread morphology with increased fibronectin expression. The printed hydrogels accelerate full-thickness wound closure by establishing a bioactive microenvironment that mitigate inflammation and stimulate angiogenesis, myofibroblast transition, and extracellular matrix remodeling. This anisotropic hydrogel demonstrates substantial promise for applications in skin tissue engineering.

A critical review on advances and challenges of bioprinted cardiac patches

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

The cutting-edge progress in bioprinting for biomedicine: principles, applications, and future perspectives

Bioprinting is a highly promising application area of additive manufacturing technology that has been widely used in various fields, including tissue engineering, drug screening, organ regeneration, and biosensing. Its primary goal is to produce biomedical products such as artificial implant scaffolds, tissues and organs, and medical assistive devices through software-layered discrete and numerical control molding. Despite its immense potential, bioprinting technology still faces several challenges. It requires concerted efforts from researchers, engineers, regulatory bodies, and industry stakeholders are principal to overcome these challenges and unlock the full potential of bioprinting. This review systematically discusses bioprinting principles, applications, and future perspectives while also providing a topical overview of research progress in bioprinting over the past two decades. The most recent advancements in bioprinting are comprehensively reviewed here. First, printing techniques and methods are summarized along with advancements related to bioinks and supporting structures. Second, interesting and representative cases regarding the applications of bioprinting in tissue engineering, drug screening, organ regeneration, and biosensing are introduced in detail. Finally, the remaining challenges and suggestions for future directions of bioprinting technology are proposed and discussed. Bioprinting is one of the most promising application areas of additive manufacturing technology that has been widely used in various fields. It aims to produce biomedical products such as artificial implant scaffolds, tissues and organs, and medical assistive devices. This review systematically discusses bioprinting principles, applications, and future perspectives, which provides a topical description of the research progress of bioprinting.

Biological properties and characterization of several variations of a clinical human plasma-based skin substitute model and its manufacturing process

Human plasma is a natural biomaterial that due to their protein composition is widely used for the development of clinical products, especially in the field of dermatology. In this context, this biomaterial has been used as a scaffold alone or combined with others for the development of cellular human plasma-based skin substitutes (HPSSs). Herein, the biological properties (cell viability, cell metabolic activity, protein secretion profile and histology) of several variations of a clinical HPSS model, regarding the biomaterial composition (alone or combined with six secondary biomaterials - serine, fibronectin, collagen, two types of laminins and hyaluronic acid), the cellular structure (trilayer, bilayer, monolayer and control without cells) and their skin tissue of origin (abdominal or foreskin cells) and the manufacturing process [effect of partial dehydration process in cell viability and comparison between submerged (SUB) and air/liquid interface (ALI) methodologies] have been evaluated and compared. Results reveal that the use of human plasma as a main biomaterial determines the in vitro properties, rather than the secondary biomaterials added. Moreover, the characteristics are similar regardless of the skin cells used (from abdomen or foreskin). However, the manufacture of more complex cellular substitutes (trilayer and bilayer) has been demonstrated to be better in terms of cell viability, metabolic activity and wound healing protein secretion (bFGF, EGF, VEGF-A, CCL5) than monolayer HPSSs, especially when ALI culture methodology is applied. Moreover, the application of the dehydration, although required to achieve an appropriate clinical structure, reduce cell viability in all cases. These data indicate that this HPSS model is robust and reliable and that the several subtypes here analysed could be promising clinical approaches depending on the target dermatological disease.

Light-based 3D bioprinting technology applied to repair and regeneration of different tissues: A rational proposal for biomedical applications

3D bioprinting technology, a subset of 3D printing technology, is currently witnessing widespread utilization in tissue repair and regeneration endeavors. In particular, light-based 3D bioprinting technology has garnered significant interest and favor. Central to its successful implementation lies the judicious selection of photosensitive polymers. Moreover, by fine-tuning parameters such as light irradiation time, choice of photoinitiators and crosslinkers, and their concentrations, the properties of the scaffolds can be tailored to suit the specific requirements of the targeted tissue repair sites. In this comprehensive review, we provide an overview of commonly utilized bio-inks suitable for light-based 3D bioprinting, delving into the distinctive characteristics of each material. Furthermore, we delineate strategies for bio-ink selection tailored to diverse repair locations, alongside methods for optimizing printing parameters. Ultimately, we present a coherent synthesis aimed at enhancing the practical application of light-based 3D bioprinting technology in tissue engineering, while also addressing current challenges and future prospects.

3D Bioprinting of Artificial Skin Substitute with Improved Mechanical Property and Regulated Cell Behavior through Integrating Patterned Nanofibrous Films

Three-dimensional (3D) bioprinting has advantages for constructing artificial skin tissues in replicating the structures and functions of native skin. Although many studies have presented improved effect of printing skin substitutes in wound healing, using hydrogel inks to fabricate 3D bioprinting architectures with complicated structures, mimicking mechanical properties, and appropriate cellular environments is still challenging. Inspired by collagen nanofibers withstanding stress and regulating cell behavior, a patterned nanofibrous film was introduced to the printed hydrogel scaffold to fabricate a composite artificial skin substitute (CASS). The artificial dermis was printed using gelatin-hyaluronan hybrid hydrogels containing human dermal fibroblasts with gradient porosity and integrated with patterned nanofibrous films simultaneously, while the artificial epidermis was formed by seeding human keratinocytes upon the dermis. The collagen-mimicking nanofibrous film effectively improved the tensile strength and fracture resistance of the CASS, making it sewable for firm implantation into skin defects. Meanwhile, the patterned nanofibrous film also provided the biological cues to guide cell behavior. Consequently, CASS could effectively accelerate the regeneration of large-area skin defects in mouse and pig models by promoting re-epithelialization and collagen deposition. This research developed an effective strategy to prepare composite bioprinting architectures for enhancing mechanical property and regulating cell behavior, and CASS could be a promising skin substitute for treating large-area skin defects.

The Necessity to Investigate In Vivo Fate of Nanoparticle-Loaded Dissolving Microneedles

Transdermal drug delivery systems are rapidly gaining prominence and have found widespread application in the treatment of numerous diseases. However, they encounter the challenge of a low transdermal absorption rate. Microneedles can overcome the stratum corneum barrier to enhance the transdermal absorption rate. Among various types of microneedles, nanoparticle-loaded dissolving microneedles (DMNs) present a unique combination of advantages, leveraging the strengths of DMNs (high payload, good mechanical properties, and easy fabrication) and nanocarriers (satisfactory solubilization capacity and a controlled release profile). Consequently, they hold considerable clinical application potential in the precision medicine era. Despite this promise, no nanoparticle-loaded DMN products have been approved thus far. The lack of understanding regarding their in vivo fate represents a critical bottleneck impeding the clinical translation of relevant products. This review aims to elucidate the current research status of the in vivo fate of nanoparticle-loaded DMNs and elaborate the necessity to investigate the in vivo fate of nanoparticle-loaded DMNs from diverse aspects. Furthermore, it offers insights into potential entry points for research into the in vivo fate of nanoparticle-loaded DMNs, aiming to foster further advancements in this field.