Review of additive manufactured tissue engineering scaffolds: relationship between geometry and performance

A bioactive hydrogel patch accelerates revascularization in ischemic lesions for tissue repair

Background

Magnesium ions play crucial roles in maintaining cellular functions. Research has shown that Mg2+ can promote angiogenesis, indicating its potential for treating cardiovascular ischemic diseases. However, conventional intravenous or oral administration of Mg2+ presents several challenges, including the risk of systemic side effects, diminished bioavailability, and a lack of targeted delivery mechanisms. In this study, we designed an Mg2+-releasing adhesive tissue patch (MgAP) that enables the dural release of Mg2+ ions.

Methods

A novel MgAP was developed on the basis of ionic crosslinking. Fourier transform infrared spectroscopy confirmed the chemical structure, whereas rheological analysis demonstrated stable mechanical properties and adaptability to dynamic loads. Sustained Mg2+ release was quantified over 7 days by inductively coupled plasma-mass spectrometry. In a rat acute myocardial infarction model, we performed echocardiography and strain analysis to assess cardiac function and histological staining to evaluate adverse remodeling. We also verified the proangiogenic effect through in vitro tube formation and in vivo immunofluorescence assays. Furthermore, transcriptomics and Western blotting were performed to explore the underlying mechanism. Additional assessments were also carried out in a rat model of lower limb ischemia.

Results

Compared with intravenous administration of magnesium chloride, MgAP application effectively improved cardiac function and reduced adverse remodeling in the myocardial infarction rat model. The left ventricular ejection fraction increased by 20.3 ± 6.6%, and the cardiac radial strain improved by 27.4 ± 4.1%. The cardiac fibrosis area and cell apoptosis rate decreased by 10.9 ± 1.2% and 32.1 ± 5.5%, respectively. RNA sequencing analysis also highlighted the upregulation of genes related to cardiac electrophysiological properties, structural and functional intercellular connections, and revascularization. The increased gap junction protein expression and restored local blood supply could contribute to the cardiac repair process posttreatment. The proangiogenic effect of MgAP was also observed in the rat limb ischemia model.

Conclusions

The above results revealed the convincing vascular regeneration effect of an ion therapy-based hydrogel, which enabled the local delivery of Mg2+ to the targeted ischemic tissue, aiding in cardiac and lower limb repair. This study presents a novel strategy and highlights its potential for use across various ischemic conditions.

Mechanical and biological characteristics of 3D-printed auxetic structure in bone tissue engineering

The auxetic structures are highly effective in bone implants due to their unique deformation characteristics. However, ideal tissue engineering scaffolds must possess suitable mechanical properties and biocompatibility. The biological effects of auxetic structures require further study. In this study, three types of 3D re-entrant honeycomb structures with varying angles of 75°, 90°, and 105° were designed. These structures were fabricated by stereolithography 3D printing technology. Finite element simulations and compression tests were conducted to evaluate their mechanical properties. Scaffolds were inoculated with preosteoblast MC3T3-E1 cells, and cyclic loading was applied to investigate the influence of structural and mechanical stimulation on cell arrangement and proliferation. The results demonstrated that the 75° scaffold exhibited auxetic characteristics in all compression directions and possessed anti-fracture properties. The 75° scaffold also promoted cell proliferation by structural design. Cyclic compression facilitated the nuclear translocation of YAP, further enhancing cell growth. The combination of anti-fracture properties and the promotion of cell proliferation makes auxetic structures highly promising for extensive applications.

3D printed Aloe barbadensis loaded alginate-gelatin hydrogel for wound healing and scar reduction: In vitro and in vivo study

Wounds are one of the most critical clinical issues in plastic surgery repair and restoration. Conventional wound dressing materials cannot absorb enough wound exudates and shield the site from microbial infection. Also, despite their healing prowess, bioactive molecules from medicinal plants are less bioavailable at the wound sites. This study developed a 3D-printed hydrogel of sodium alginate and gelatin loaded with freeze-dried Aloe barbadensis extract for enhanced wound healing. The hydrogel was hydrophilic and showed an average pore size of 163.66 ± 14.45 μm, moderate swellability, and ideal mechanical properties with tensile strength(σ) of 16.39 ± 0.98 MPa, and Young's modulus of 17.43 ± 1.41 MPa. They showed potential antibacterial activity against Staphylococcus aureus (87.7 ± 4 % inhibition) and Pseudomonas aeruginosa (84.4 ± 6 % inhibition). These hydrogels were hemocompatible, biocompatible, and biodegradable. Cell cytotoxicity assay and scratch assay showed effective Normal Human Dermal Fibroblast cells (NHDF) viability, proliferation, and migration on the hydrogel. In vivo studies of the 3D-printed hydrogel demonstrated significantly improved wound closure, reduced wound contraction, enhanced epithelial regeneration with minimal inflammation, and decreased scar formation after 14 days of treatment. Therefore, this 3D-printed hydrogel can be promising for wound healing with scar reduction.

3D printed sodium Alginate-Gelatin hydrogel loaded with Santalum album oil as an antibacterial Full-Thickness wound healing and scar reduction Scaffold: In vitro and in vivo study

Managing wounds and accompanying consequences like exudation and microbiological infections is challenging in clinical practice. Bioactive compounds from traditional medicinal plants help heal wounds, although their bioavailability is low. This study uses sodium alginate (SA), gelatin (G), and Santalum album oil (SAL) to 3D print a polymeric hydrogel scaffold to circumvent these difficulties. The 3D printed scaffolds showed hydrophilicity, an average pore size of 221.30 ± 19.83 µm, adequate swelling, higher mechanical strength with tensile strength (σ) of 13.5 ± 1.08 MPa, a Young's modulus of 17.53 ± 1.61 MPa, andpotential antibacterial activity against skin infection causing bacteria viz. Staphylococcus aureus (87.7 ± 4 % growth inhibition) and Pseudomonas aeruginosa (i.e. 81.96 ± 3.94 % growth inhibition). The scaffolds showed hemocompatibility, biocompatibility, and moderate biodegradability. Cytotoxicity and scratch assay showed significantly improved fibroblast viability, proliferation, and migration. In the in vivo study, the scaffolds were applied to full-thickness wounds in rat models. After 7 and 14 days of treatment, the wounds treated with the 3D-printed SA-G-SAL scaffold showed higher closure rates, lower contraction, higher-regenerated epithelium with minimal inflammation, and less scar formation compared to control groups. Thus, the 3D-printed SA-G-SAL scaffold is a promising biomaterial for wound healing with reduced scar formation.

Electrohydrodynamic Direct-Writing Micro/Nanofibrous Architectures: Principle, Materials, and Biomedical Applications

Electrohydrodynamic (EHD) direct-writing has recently gained attention as a highly promising additive manufacturing strategy for fabricating intricate micro/nanoscale architectures. This technique is particularly well-suited for mimicking the extracellular matrix (ECM) present in biological tissue, which serves a vital function in facilitating cell colonization, migration, and growth. The integration of EHD direct-writing with other techniques has been employed to enhance the biological performance of scaffolds, and significant advancements have been made in the development of tailored scaffold architectures and constituents to meet the specific requirements of various biomedical applications. Here, a comprehensive overview of EHD direct-writing is provided, including its underlying principles, demonstrated materials systems, and biomedical applications. A brief chronology of EHD direct-writing is provided, along with an examination of the observed phenomena that occur during the printing process. The impact of biomaterial selection and architectural topographic cues on biological performance is also highlighted. Finally, the major limitations associated with EHD direct-writing are discussed.

Bio-mechanical analysis of porous Ti-6Al-4V scaffold: a comprehensive review on unit cell structures in orthopaedic application

A scaffold is a three-dimensional porous structure that is used as a template to provide structural support for cell adhesion and the formation of new cells. Metallic cellular scaffolds are a good choice as a replacement for human bones in orthopaedic implants, which enhances the quality and longevity of human life. In contrast to conventional methods that produce irregular pore distributions, 3D printing, or additive manufacturing, is characterized by high precision and controlled manufacturing processes. AM processes can precisely control the scaffold's porosity, which makes it possible to produce patient specific implants and achieve regular pore distribution. This review paper explores the potential of Ti-6Al-4V scaffolds produced via the SLM method as a bone substitute. A state-of-the-art review on the effect of design parameters, material, and surface modification on biological and mechanical properties is presented. The desired features of the human tibia and femur bones are compared to bulk and porous Ti6Al4V scaffold. Furthermore, the properties of various porous scaffolds with varying unit cell structures and design parameters are compared to find out the designs that can mimic human bone properties. Porosity up to 65% and pore size of 600 μm was found to give optimum trade-off between mechanical and biological properties. Current manufacturing constraints, biocompatibility of Ti-6Al-4V material, influence of various factors on bio-mechanical properties, and complex interrelation between design parameters are discussed herein. Finally, the most appropriate combination of design parameters that offers a good trade-off between mechanical strength and cell ingrowth are summarized.

Crack propagation in TPMS scaffolds under monotonic axial load: Effect of morphology

In this paper, the mechanical behaviour and failure of porous additively manufactured (AM) polylactide (PLA) scaffolds based on the triply periodic minimal surfaces (TPMS) is investigated using numerical calculations of their unit cells and representative volumes. The strain-amplification factor is chosen as the main parameter, and the most critical locations for failure of different types of scaffold structures are evaluated. The results obtained are presented in comparison with a multiple-crack-growth algorithm using the extended finite element method (XFEM), underpinned by the experimentally obtained fracture properties of PLA. The effect of morphology of TPMS structures on the pre-critical, critical and post-critical behaviours of scaffolds under monotonic loading regimes is assessed. The results provide an understanding of the fracture behaviour and main risk points for crack initiation in structures of AM-PLA scaffolds based on typical commonly used types of TPMS, as well as the influence of structure type and external load on this behaviour.

Enhanced Bone Healing in Critical-Sized Rabbit Femoral Defects: Impact of Helical and Alternate Scaffold Architectures

This study investigates the effect of scaffold architecture on bone regeneration, focusing on 3D-printed polylactic acid-bioceramic calcium phosphate (PLA-bioCaP) composite scaffolds in rabbit femoral condyle critical defects. We explored two distinct scaffold designs to assess their influence on bone healing and scaffold performance. Structures with alternate (0°/90°) and helical (0°/45°/90°/135°/180°) laydown patterns were manufactured with a 3D printer using a fused deposition modeling technique. The scaffolds were meticulously characterized for pore size, strut thickness, porosity, pore accessibility, and mechanical properties. The in vivo efficacy of these scaffolds was evaluated using a femoral condyle critical defect model in eight skeletally mature New Zealand White rabbits. Then, the results were analyzed micro-tomographically, histologically, and histomorphometrically. Our findings indicate that both scaffold architectures are biocompatible and support bone formation. The helical scaffolds, characterized by larger pore sizes and higher porosity, demonstrated significantly greater bone regeneration than the alternate structures. However, their lower mechanical strength presented limitations for use in load-bearing sites.

Effect of three-dimensionally printed surface patterns on the peak tensile load of a plasticized acrylic-resin resilient liner

STATEMENT OF PROBLEM

Stereolithographic (SLA) three-dimensional (3D) printing is considered a reliable manufacturing method for immediate complete dentures. However, studies on the implementation of computer-generated surface patterns to promote the union between printed denture base polymers and dental materials with different chemistries such as plasticized acrylic-resin resilient liners are lacking.

PURPOSE

The purpose of this in vitro study was to assess the effect of 3D printed surface patterns on the peak tensile load of a short-term plasticized acrylic-resin resilient liner.

MATERIAL AND METHODS

A total of 30 denture base specimens (Denture Base LP; FormLabs) were fabricated with 3 adhesive surface designs by using an SLA 3D printer (Forms2; FormLabs). Twenty specimens were designed with surface patterns in the adhesive areas (grid and spheres); 10 specimens comprised each surface pattern group. The remaining specimens were roughened with 220-grit silicon carbide paper and served as a control. A commonly used short-term resilient liner (CoeSoft; GC-America) was applied to the adhesive surface of all the specimens. Subsequently, the specimens were kept in distilled water at 37 °C for 48 hours. The specimens were tested in a universal testing machine, and the resulting peak tensile load data were analyzed by using a 1-way analysis of variance (ANOVA) and a post hoc Tukey test (α=.05).

RESULTS

The groups with surface patterns on the adhesive surface displayed higher peak tensile load values than the control group. The mean peak tensile load of the grid group was 6.73 ±0.43 N, and that for the spheres group was 6.58 ±0.33 N. The control group displayed the lowest mean peak tensile load (2.71 ±0.51 N). Statistically significant differences were detected between the mean peak tensile loads of the surface pattern groups and the control group (P<.001) No statistically significant difference was found between the mean peak tensile loads of the grid and spheres groups (P=.893).

CONCLUSIONS

Incorporating surface patterns on the intaglio surface of denture bases made with Denture Base LP via SLA 3D printing can enhance their union to a plasticized acrylic-resin resilient liner. Surface patterns generated higher peak tensile load values than slightly roughening the surface of a 3D printed denture with a 220-grit silicon carbide paper. No significant differences in the mean peak tensile loads were observed between the 2 types of surface patterns.

Scaffold geometry and computational fluid dynamics simulation supporting osteogenic differentiation in dynamic culture

Geometry of porous scaffolds is critical to the success of cell adhesion, proliferation, and differentiation in bone tissue engineering. In this study, the effect of scaffold geometry on osteogenic differentiation of MC3T3-E1 pre-osteoblasts in a perfusion bioreactor was investigated. Three geometries of oligolactide-HA scaffolds, named Woodpile, LC-1000, and LC-1400, were fabricated with uniform pore size distribution and interconnectivity using stereolithography (SL) technique, and tested to evaluate for the most suitable scaffold geometry. Compressive tests revealed sufficiently high strength of all scaffolds to support new bone formation. The LC-1400 scaffold showed the highest cell proliferation in accordance with the highest level of osteoblast-specific gene expression after 21 days of dynamic culture in a perfusion bioreactor; however, it deposited less amount of calcium than the LC-1000 scaffold. Computational fluid dynamics (CFD) simulation was employed to predict and explain the effect of flow behavior on cell response under dynamic culture. The findings concluded that appropriate flow shear stress enhanced cell differentiation and mineralization in the scaffold, with the LC-1000 scaffold performing best due to its optimal balance between permeability and flow-induced shear stress.

Alginate-waterborne polyurethane 3D bioprinted scaffolds for articular cartilage tissue engineering

Articular cartilage defects comprise a spectrum of diseases associated with degeneration or damage of the connective tissue present in particular joints, presenting progressive osteoarthritis if left untreated. In vitro tissue regeneration is an innovative treatment for articular cartilage injuries that is attracting not only clinical attention, but also great interest in the development of novel biomaterials, since this procedure involves the formation of a neotissue with the help of material support. In this work, functional alginate and waterborne polyurethane (WBPU) scaffolds have been developed for articular cartilage regeneration using 3D bioprinting technology. The particular properties of alginate-WBPU blends, like mechanical strength, elasticity and moistening, mimic the original cartilage tissue characteristics, being ideal for this application. To fabricate the scaffolds, mature chondrocytes were loaded into different alginate-WBPU inks with rheological properties suitable for 3D bioprinting. Bioinks with high alginate content showed better 3D printing performance, as well as structural integrity and cell viability, being most suitable for scaffolds fabrication. After 28 days of in vitro cartilage formation experiments, scaffolds containing 3.2 and 6.4 % alginate resulted in the maintenance of cell number in the range of 104 chondrocytes/scaffold in differentiated phenotypes, capable of synthesizing specialized extracellular matrix (ECM) up to 6 μg of glycosaminoglycans (GAG) and thus, showing a potential application of these scaffolds for in vitro regeneration of articular cartilage tissue.

Three-Dimensional Printing of Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) [P(3HB-co-3HV)] Biodegradable Scaffolds: Properties, In Vitro and In Vivo Evaluation

The results of constructing 3D scaffolds from degradable poly(3-hydrosbutyrpate-co-3-hydroxyvalerate) using FDM technology and studying the structure, mechanical properties, biocompatibility in vitro, and osteoplastic properties in vivo are presented. In the process of obtaining granules, filaments, and scaffolds from the initial polymer material, a slight change in the crystallization and glass transition temperature and a noticeable decrease in molecular weight (by 40%) were registered. During the compression test, depending on the direction of load application (parallel or perpendicular to the layers of the scaffold), the 3D scaffolds had a Young's modulus of 207.52 ± 19.12 and 241.34 ± 7.62 MPa and compressive stress tensile strength of 19.45 ± 2.10 and 22.43 ± 1.89 MPa, respectively. SEM, fluorescent staining with DAPI, and calorimetric MTT tests showed the high biological compatibility of scaffolds and active colonization by NIH 3T3 fibroblasts, which retained their metabolic activity for a long time (up to 10 days). The osteoplastic properties of the 3D scaffolds were studied in the segmental osteotomy test on a model defect in the diaphyseal zone of the femur in domestic Landrace pigs. X-ray and histological analysis confirmed the formation of fully mature bone tissue and complete restoration of the defect in 150 days of observation. The results allow us to conclude that the constructed resorbable 3D scaffolds are promising for bone grafting.

Printing tissue-engineered scaffolds made of polycaprolactone and nano-hydroxyapatite with mechanical properties appropriate for trabecular bone substitutes

BACKGROUND

Bone tissue engineering, based on three-dimensional (3D) printing technology, has emerged as a promising approach to treat bone defects using scaffolds. The objective of this study was to investigate the influence of porosity and internal structure on the mechanical properties of scaffolds.

METHODS

We fabricated composite scaffolds (which aimed to replicate trabecular bone) from polycaprolactone (PCL) reinforced with 30% (wt.) nano-hydroxyapatite (nHAp) by extrusion printing. Scaffolds with various porosities were designed and fabricated with and without an interlayer offset, termed as staggered and lattice structure, respectively. Mechanical compressive testing was performed to determine scaffold elastic modulus and yield strength. Linear regression was used to evaluate mechanical properties as a function of scaffold porosity.

RESULTS

Different relationships between mechanical properties and porosities were noted for the staggered and lattice structures. For elastic moduli, the two relationships intersected (porosity = 55%) such that the lattice structure exhibited higher moduli with porosity values greater than the intersection point; vice versa for the staggered structure. The lattice structure exhibited higher yield strength at all porosities. Mechanical testing results also indicated elastic moduli and yield strength properties comparable to trabecular bone (elastic moduli: 14-165 MPa; yield strength: 0.9-10 MPa).

CONCLUSIONS

Taken together, this study demonstrates that scaffolds printed from PCL/30% (wt.) nHAp with lattice and staggered structure offer promise for treating trabecular bone defects. This study identified the effect of porosity and internal structure on scaffold mechanical properties and provided suggestions for developing scaffolds with mechanical properties for substituting trabecular bone.

A Novel Approach for Design and Manufacturing of Curvature-Featuring Scaffolds for Osteochondral Repair

Osteochondral (OC) defects affect both articular cartilage and the underlying subchondral bone. Due to limitations in the cartilage tissue's self-healing capabilities, OC defects exhibit a degenerative progression to which current therapies have not yet found a suitable long-term solution. Tissue engineering (TE) strategies aim to fabricate tissue substitutes that recreate natural tissue features to offer better alternatives to the existing inefficient treatments. Scaffold design is a key element in providing appropriate structures for tissue growth and maturation. This study presents a novel method for designing scaffolds with a mathematically defined curvature, based on the geometry of a sphere, to obtain TE constructs mimicking native OC tissue shape. The lower the designed radius, the more curved the scaffold obtained. The printability of the scaffolds using fused filament fabrication (FFF) was evaluated. For the case-study scaffold size (20.1 mm × 20.1 mm projected dimensions), a limit sphere radius of 17.064 mm was determined to ensure printability feasibility, as confirmed by scanning electron microscopy (SEM) and micro-computed tomography (μ-CT) analysis. The FFF method proved suitable to reproduce the curved designs, showing good shape fidelity and replicating the expected variation in porosity. Additionally, the mechanical behavior was evaluated experimentally and by numerical modelling. Experimentally, curved scaffolds showed strength comparable to conventional orthogonal scaffolds, and finite element analysis was used to identify the scaffold regions more susceptible to higher loads.

3D printed TPMS structural PLA/GO scaffold: Process parameter optimization, porous structure, mechanical and biological properties

Bone scaffolds should have good biocompatibility and mechanical and biological properties, which are primarily by the material design, porous structure, and preparation process. In this study, we proposed polylactic acid (PLA) as the base material, graphene oxide (GO) as an enhancing filler, triply periodic minimal surface (TPMS) as a porous structure, and fused deposition modeling (FDM) 3D printing as a preparation technology to develop a TPMS structural PLA/GO scaffold and evaluate their porous structures, mechanical properties, and biological properties towards bone tissue engineering. Firstly, the influence of the FDM 3D printing process parameters on the forming quality and mechanical properties of PLA was studied by orthogonal experimental design, based on which the process parameters were optimized. Then, GO was composited with PLA, and PLA/GO nanocomposites were prepared by FDM. The mechanical tests showed that GO can effectively improve the tensile and compression strength of PLA; only by adding 0.1% GO the tensile and compression modulus was increased by 35.6% and 35.8%, respectively. Then, TPMS structural (Schwarz-P, Gyroid) scaffold models were designed and TPMS structural PLA/0.1%GO nanocomposite scaffolds were prepared by FDM. The compression test showed that the TPMS structural scaffolds had higher compression strength than the Grid structure; This was owing to the fact that the continuous curved structure of TMPS alleviated stress concentration and had a more uniform stress bearing. Moreover, cell culture indicated bone marrow stromal cells (BMSCs) showed better adhesion, proliferation, and osteogenic differentiation behaviors on the TPMS structural scaffolds as the continuous surface structure of TPMS had better connectivity and larger specific surface area. These results suggest that the TPMS structural PLA/GO scaffold has potential application in bone repair. This article suggests the feasibility of co-designing the material, structure, and technology for achieving the good comprehensive performance of polymer bone scaffolds.

Bioceramic scaffolds with triply periodic minimal surface architectures guide early-stage bone regeneration

The pore architecture of porous scaffolds is a critical factor in osteogenesis, but it is a challenge to precisely configure strut-based scaffolds because of the inevitable filament corner and pore geometry deformation. This study provides a pore architecture tailoring strategy in which a series of Mg-doped wollastonite scaffolds with fully interconnected pore networks and curved pore architectures called triply periodic minimal surfaces (TPMS), which are similar to cancellous bone, are fabricated by a digital light processing technique. The sheet-TPMS pore geometries (s-Diamond, s-Gyroid) contribute to a 3‒4-fold higher initial compressive strength and 20%-40% faster Mg-ion-release rate compared to the other-TPMS scaffolds, including Diamond, Gyroid, and the Schoen's I-graph-Wrapped Package (IWP) in vitro. However, we found that Gyroid and Diamond pore scaffolds can significantly induce osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). Analyses of rabbit experiments in vivo show that the regeneration of bone tissue in the sheet-TPMS pore geometry is delayed; on the other hand, Diamond and Gyroid pore scaffolds show notable neo-bone tissue in the center pore regions during the early stages (3-5 weeks) and the bone tissue uniformly fills the whole porous network after 7 weeks. Collectively, the design methods in this study provide an important perspective for optimizing the pore architecture design of bioceramic scaffolds to accelerate the rate of osteogenesis and promote the clinical translation of bioceramic scaffolds in the repair of bone defects.

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.

Additive Manufacturing of Polyhydroxyalkanoate-Based Blends Using Fused Deposition Modelling for the Development of Biomedical Devices

In the last few decades Additive Manufacturing has advanced and is becoming important for biomedical applications. In this study we look at a variety of biomedical devices including, bone implants, tooth implants, osteochondral tissue repair patches, general tissue repair patches, nerve guidance conduits (NGCs) and coronary artery stents to which fused deposition modelling (FDM) can be applied. We have proposed CAD designs for these devices and employed a cost-effective 3D printer to fabricate proof-of-concept prototypes. We highlight issues with current CAD design and slicing and suggest optimisations of more complex designs targeted towards biomedical applications. We demonstrate the ability to print patient specific implants from real CT scans and reconstruct missing structures by means of mirroring and mesh mixing. A blend of Polyhydroxyalkanoates (PHAs), a family of biocompatible and bioresorbable natural polymers and Poly(L-lactic acid) (PLLA), a known bioresorbable medical polymer is used. Our characterisation of the PLA/PHA filament suggest that its tensile properties might be useful to applications such as stents, NGCs, and bone scaffolds. In addition to this, the proof-of-concept work for other applications shows that FDM is very useful for a large variety of other soft tissue applications, however other more elastomeric MCL-PHAs need to be used.

New frontiers of tendon augmentation technology in tissue engineering and regenerative medicine: a concise literature review

Tissue banking programs fail to meet the demand for human organs and tissues for transplantation into patients with congenital defects, injuries, chronic diseases, and end-stage organ failure. Tendons and ligaments are among the most frequently ruptured and/or worn-out body tissues owing to their frequent use, especially in athletes and the elderly population. Surgical repair has remained the mainstay management approach, regardless of scarring and adhesion formation during healing, which then compromises the gliding motion of the joint and reduces the quality of life for patients. Tissue engineering and regenerative medicine approaches, such as tendon augmentation, are promising as they may provide superior outcomes by inducing host-tissue ingrowth and tendon regeneration during degradation, thereby decreasing failure rates and morbidity. However, to date, tendon tissue engineering and regeneration research has been limited and lacks the much-needed human clinical evidence to translate most laboratory augmentation approaches to therapeutics. This narrative review summarizes the current treatment options for various tendon pathologies, future of tendon augmentation, cell therapy, gene therapy, 3D/4D bioprinting, scaffolding, and cell signals.

Geometry-Based Computational Fluid Dynamic Model for Predicting the Biological Behavior of Bone Tissue Engineering Scaffolds

The use of biocompatible and biodegradable porous scaffolds produced via additive manufacturing is one of the most common approaches in tissue engineering. The geometric design of tissue engineering scaffolds (e.g., pore size, pore shape, and pore distribution) has a significant impact on their biological behavior. Fluid flow dynamics are important for understanding blood flow through a porous structure, as they determine the transport of nutrients and oxygen to cells and the flushing of toxic waste. The aim of this study is to investigate the impact of the scaffold architecture, pore size and distribution on its biological performance using Computational Fluid Dynamics (CFD). Different blood flow velocities (BFV) induce wall shear stresses (WSS) on cells. WSS values above 30 mPa are detrimental to their growth. In this study, two scaffold designs were considered: rectangular scaffolds with uniform square pores (300, 350, and 450 µm), and anatomically designed circular scaffolds with a bone-like structure and pore size gradient (476-979 µm). The anatomically designed scaffolds provided the best fluid flow conditions, suggesting a 24.21% improvement in the biological performance compared to the rectangular scaffolds. The numerical observations are aligned with those of previously reported biological studies.

Osteoblast-like Cell Differentiation on 3D-Printed Scaffolds Using Various Concentrations of Tetra-Polymers

New bone formation starts from the initial reaction between a scaffold surface and the extracellular matrix. This research aimed to evaluate the effects of various amounts of calcium, phosphate, sodium, sulfur, and chloride ions on osteoblast-like cell differentiation using tetra-polymers of amorphous calcium phosphate (ACP), calcium sulfate hemihydrate (CSH), alginic acid, and hydroxypropyl methylcellulose. Moreover, 3D-printed scaffolds were fabricated to determine the ion distribution and cell differentiation. Various proportions of ACP/CSH were prepared in ratios of 0%, 13%, 15%, 18%, 20%, and 23%. SEM was used to observe the morphology, cell spreading, and ion complements. The scaffolds were also examined for calcium ion release. The mouse osteoblast-like cell line MC3T3-E1 was cultured to monitor the osteogenic differentiation, alkaline phosphatase (ALP) activity, total protein synthesis, osteocalcin expression (OCN), and calcium deposition. All 3D-printed scaffolds exhibited staggered filaments, except for the 0% group. The amounts of calcium, phosphate, sodium, and sulfur ions increased as the amounts of ACP/CSH increased. The 18%ACP/CSH group significantly exhibited the most ALP on days 7, 14, and 21, and the most OCN on days 14 and 21. Moreover, calcium deposition and mineralization showed the highest peak after 7 days. In conclusion, the 18%ACP/CSH group is capable of promoting osteoblast-like cell differentiation on 3D-printed scaffolds.

3D Printing of Calcium Phosphate/Calcium Sulfate with Alginate/Cellulose-Based Scaffolds for Bone Regeneration: Multilayer Fabrication and Characterization

Congenital abnormalities, trauma, and disease result in significant demands for bone replacement in the craniofacial region and across the body. Tetra-compositions of organic and inorganic scaffolds could provide advantages for bone regeneration. This research aimed to fabricate and characterize amorphous calcium phosphate (ACP)/calcium sulfate hemihydrate (CSH) with alginate/cellulose composite scaffolds using 3D printing. Alginate/cellulose gels were incorporated with 0%, 13%, 15%, 18%, 20%, and 23% ACP/CSH using the one-pot process to improve morphological, physiochemical, mechanical, and biological properties. SEM displayed multi-staggered filament layers with mean pore sizes from 298 to 377 μm. A profilometer revealed mean surface roughness values from 43 to 62 nm that were not statistically different. A universal test machine displayed the highest compressive strength and modulus with a statistical significance in the 20% CP/CS group. FTIR spectroscopy showed peaks in carbonate, phosphate, and sulfate groups that increased as more ACP/CSH was added. Zero percent of ACP/CSH showed the highest swelling and lowest remaining weight after degradation. The 23% ACP/CSH groups cracked after 60 days. In vitro biocompatibility testing used the mouse osteoblast-like cell line MC3T3-E1. The 18% and 20% ACP/CSH groups showed the highest cell proliferation on days five and seven. The 20% ACP/CSH was most suitable for bone cell regeneration.

Bio-inspired zonal-structured matrices for bone-cartilage interface engineering

Design and development of scaffold structures for osteochondral (OC) interface regeneration is a significant engineering challenge. Recent efforts are aimed at recapitulating the unique compositional and hierarchical structure of an OC interface. Conventional scaffold fabrication techniques often have limited design control and reproducibility, and the development of OC scaffolds with zonal hierarchy and structural integrity between zones is especially challenging. In this study, a series of multi-zonal and gradient structures were designed and fabricated using three-dimensional bioprinting. We developed OC scaffolds with bi-phasic and tri-phasic configurations to support the zonal structure of OC tissue, and gradient scaffold configurations to enable smooth transitions between the zones to more closely mimic a bone-cartilage interface. A biodegradable polymer, polylactic acid, was used for the fabrication of zonal/gradient scaffolds to provide mechanical strength and support OC function. The formation of the multi-zonal and gradient scaffolds was confirmed through scanning electron microscopy imaging and micro-computed tomography scanning. Precisely controlled hierarchy with tunable porosity along the scaffold length established the formation of the bio-inspired scaffolds with different zones/gradient structure. In addition, we also developed a novel bioprinting method to selectively introduce cells into desired scaffold zones of the zonal/gradient scaffolds via concurrent printing of a cell-laden hydrogel within the porous template. Live/dead staining of the cell-laden hydrogel introduced in the cartilage zone showed uniform cell distribution with high cell viability. Overall, our study developed bio-inspired scaffold structures with structural hierarchy and mechanical integrity for bone-cartilage interface engineering.

Light activation of 3D-printed structures: from millimeter to sub-micrometer scale

Three-dimensional (3D) printing enables the fabrication of complex, highly customizable structures, which are difficult to fabricate using conventional fabrication methods. Recently, the concept of four-dimensional (4D) printing has emerged, which adds active and responsive functions to 3D-printed structures. Deployable or adaptive structures with desired structural and functional changes can be fabricated using 4D printing; thus, 4D printing can be applied to actuators, soft robots, sensors, medical devices, and active and reconfigurable photonic devices. The shape of 3D-printed structures can be transformed in response to external stimuli, such as heat, light, electric and magnetic fields, and humidity. Light has unique advantages as a stimulus for active devices because it can remotely and selectively induce structural changes. There have been studies on the light activation of nanomaterial composites, but they were limited to rather simple planar structures. Recently, the light activation of 3D-printed complex structures has attracted increasing attention. However, there has been no comprehensive review of this emerging topic yet. In this paper, we present a comprehensive review of the light activation of 3D-printed structures. First, we introduce representative smart materials and general shape-changing mechanisms in 4D printing. Then, we focus on the design and recent demonstration of remote light activation, particularly detailing photothermal activations based on nanomaterial composites. We explain the light activation of 3D-printed structures from the millimeter to sub-micrometer scale.

Tunable Biomaterials for Myocardial Tissue Regeneration: Promising New Strategies for Advanced Biointerface Control and Improved Therapeutic Outcomes

Following myocardial infarction (MI) and the natural healing process, the cardiac mechanostructure changes significantly leading to reduced contractile ability and putting additional pressure on the heart muscle thereby increasing the...

On the application of additive manufacturing methods for auxetic structures: a review

Auxetic structures are a special class of structural components that exhibit a negative Poisson's ratio (NPR) because of their constituent materials, internal microstructure, or structural geometry. To realize such structures, specialized manufacturing processes are required to achieve a dimensional accuracy, reduction of material wastage, and a quicker fabrication. Hence, additive manufacturing (AM) techniques play a pivotal role in this context. AM is a layer-wise manufacturing process and builds the structure as per the designed geometry with appreciable precision and accuracy. Hence, it is extremely beneficial to fabricate auxetic structures using AM, which is otherwise a tedious and expensive task. In this study, a detailed discussion of the various AM techniques used in the fabrication of auxetic structures is presented. The advancements and advantages put forward by the AM domain have offered a plethora of opportunities for the fabrication and development of unconventional structures. Therefore, the authors have attempted to provide a meaningful encapsulation and a detailed discussion of the most recent of such advancements pertaining to auxetic structures. The article opens with a brief history of the growth of auxetic materials and later auxetic structures. Subsequently, discussions centering on the different AM techniques employed for the realization of auxetic structures are conducted. The basic principle, advantages, and disadvantages of these processes are discussed to provide an in-depth understanding of the current level of research. Furthermore, the performance of some of the prominent auxetic structures realized through these methods is discussed to compare their benefits and shortcomings. In addition, the influences of geometric and process parameters on such structures are evaluated through a comprehensive review to assess their feasibility for the later-mentioned applications. Finally, valuable insights into the applications, limitations, and prospects of AM for auxetic structures are provided to enable the readers to gauge the vitality of such manufacturing as a production method.

The Evolution of Fabrication Methods in Human Retina Regeneration

Optic nerve and retinal diseases such as age-related macular degeneration and inherited retinal dystrophies (IRDs) often cause permanent sight loss. Currently, a limited number of retinal diseases can be treated. Hence, new strategies are needed. Regenerative medicine and especially tissue engineering have recently emerged as promising alternatives to repair retinal degeneration and recover vision. Here, we provide an overview of retinal anatomy and diseases and a comprehensive review of retinal regeneration approaches. In the first part of the review, we present scaffold-free approaches such as gene therapy and cell sheet technology while in the second part, we focus on fabrication techniques to produce a retinal scaffold with a particular emphasis on recent trends and advances in fabrication techniques. To this end, the use of electrospinning, 3D bioprinting and lithography in retinal regeneration was explored.

Gradient scaffolds for osteochondral tissue engineering and regeneration

The tissue engineering approach for repairing osteochondral (OC) defects involves the fabrication of a biological tissue scaffold that mimics the physiological properties of natural OC tissue (e.g., the gradient transition between the cartilage surface and the subchondral bone). The OC tissue scaffolds described in many research studies exhibit a discrete gradient (e.g., a biphasic or tri/multiphasic structure) or a continuous gradient to mimic OC tissue attributes such as biochemical composition, structure, and mechanical properties. One advantage of a continuous gradient scaffold over biphasic or tri/multiphasic tissue scaffolds is that it more closely mimics natural OC tissue since there is no distinct interface between each layer. Although research studies to this point have yielded good results related to OC regeneration with tissue scaffolds, differences between engineered scaffolds and natural OC tissue remain; due to these differences, current clinical therapies to repair OC defects with engineered scaffolds have not been successful. This paper provides an overview of both discrete and continuous gradient OC tissue scaffolds in terms of cell type, scaffold material, microscale structure, mechanical properties, fabrication methods, and scaffold stimuli. Fabrication of gradient scaffolds with three-dimensional (3D) printing is given special emphasis due to its ability to accurately control scaffold pore geometry. Moreover, the application of computational modeling in OC tissue engineering is considered; for example, efforts to optimize the scaffold structure, mechanical properties, and physical stimuli generated within the scaffold-bioreactor system to predict tissue regeneration are considered. Finally, challenges associated with the repair of OC defects and recommendations for future directions in OC tissue regeneration are proposed.

Engineering multi-tissue units for regenerative Medicine: Bone-tendon-muscle units of the rotator cuff

Our body systems are comprised of numerous multi-tissue units. For the musculoskeletal system, one of the predominant functional units is comprised of bone, tendon/ligament, and muscle tissues working in tandem to facilitate locomotion. To successfully treat musculoskeletal injuries and diseases, critical consideration and thoughtful integration of clinical, biological, and engineering aspects are necessary to achieve translational bench-to-bedside research. In particular, identifying ideal biomaterial design specifications, understanding prior and recent tissue engineering advances, and judicious application of biomaterial and fabrication technologies will be crucial for addressing current clinical challenges in engineering multi-tissue units. Using rotator cuff tears as an example, insights relevant for engineering a bone-tendon-muscle multi-tissue unit are presented. This review highlights the tissue engineering strategies for musculoskeletal repair and regeneration with implications for other bone-tendon-muscle units, their derivatives, and analogous non-musculoskeletal tissue structures.

Next generation human brain models: engineered flat brain organoids featuring gyrification

Brain organoids are considered to be a highly promising in vitro model for the study of the human brain and, despite their various shortcomings, have already been used widely in neurobiological studies. Especially for drug screening applications, a highly reproducible protocol with simple tissue culture steps and consistent output, is required. Here we present an engineering approach that addresses several existing shortcomings of brain organoids. By culturing brain organoids with a polycaprolactone scaffold, we were able to modify their shape into a flat morphology. Engineered flat brain organoids (efBOs) possess advantageous diffusion conditions and thus their tissue is better supplied with oxygen and nutrients, preventing the formation of a necrotic tissue core. Moreover, the efBO protocol is highly simplified and allows to customize the organoid size directly from the start. By seeding cells onto 12 by 12 mm scaffolds, the brain organoid size can be significantly increased. In addition, we were able to observe folding reminiscent of gyrification around day 20, which was self-generated by the tissue. To our knowledge, this is the first study that reports intrinsically caused gyrification of neuronal tissue in vitro. We consider our efBO protocol as a next step towards the generation of a stable and reliable human brain model for drug screening applications and spatial patterning experiments.

Printability in extrusion bioprinting

Extrusion bioprinting has been widely used to extrude continuous filaments of bioink (or the mixture of biomaterial and living cells), layer-by-layer, to build three-dimensional (3D) constructs for biomedical applications. In extrusion bioprinting, printability is an important parameter used to measure the difference between the designed construct and the one actually printed. This difference could be caused by the extrudability of printed bioink and/or the structural formability and stability of printed constructs. Although studies have reported in characterizing printability based on the bioink properties and printing process, the concept of printability is often confusingly and, sometimes, conflictingly used in the literature. The objective of this perspective is to define the printability for extrusion bioprinting in terms of extrudability, filament fidelity, and structural integrity, as well as to review the effect of bioink properties, bioprinting process, and construct design on the printability. Challenges related to the printability of extrusion bioprinting are also discussed, along with recommendations for improvements.

Mechanical and hydrolytic properties of thin polylactic acid films by fused filament fabrication

Thin polymeric films are widely used as medical applications such as cell culture, stent, drug delivery and mechanical fixation. One of the most commonly used materials is polylactic acid (PLA) - a material, which is non-toxic, biodegradable and biocompatible. Fused filament fabrication (FFF) is a preferable additive manufacturing technique to manufacture polymers, where PLA is one of the most common materials. FFF is a promising technique for customised biomedical applications due to its relatively low cost and geometrical flexibility where biomedical applications are patient tailored. This study is the first to consider FFF monolayered thin films of PLA in terms of mechanical and hydrolytic properties at 37 °C in vitro degradation. Throughout degradation, the reduction in mechanical properties was examined by analysing molecular weight and thermal properties. FFF monolayered PLA underwent autocatalytic bulk degradation with no proof of significant mass loss. Young's modulus, ultimate tensile strength and molecular weight reduced by approximately 60%, 86%, and 80% after 280 days, respectively, while the degree of crystallinity increased by 143% in comparison to benchmark thin films at day 0. It was found that the decrease in mechanical properties was more sensitive to the increase in crystallinity in the early stage of the degradation, while the molecular weight was more dominant in the late stage of the degradation. This study provides practical information in terms of mechanical properties to support medical device designers in a range of potential end-use biomedical applications to achieve safe functional products over the required degradation lifetime.

Morphological and mechanical characterization of 3D printed PLA scaffolds with controlled porosity for trabecular bone tissue replacement

Bone transplant is still the gold standard approach when dealing with orthopedic trauma or disease. When this solution is not possible, scaffolding is a possibility provided by bone tissue engineering. To support the regeneration process, damaged bone tissue is removed and replaced by porous scaffold structures. In recent years, additive manufacturing has shown huge potential to produce scaffold structures with the required performance. In the current work, PLA scaffolds with different designs were 3D printed, using optimal manufacturing parameters. Scaffolds with three different porosity values were obtained by changing the filament offset from 571 to 1333 μm. A total of twelve designs were tested under monotonic and dynamic compression conditions. Numerical analysis showed good correlation with experimental results, allowing for a better assessment of scaffold mechanical behavior. Stress relaxation was measured on four different strain levels, assessing scaffold's behavior after implantation and consequent static response over time. Overall, orthogonal design provided better performance, due to improved material deposition. With lower porosity scaffolds equilibrium stress reached 24 MPa after 300 s relaxation time under 4% deformation, and the obtained equilibrium modulus was 428 MPa. Overall, attained results show that 3D printing with PLA can be applied in the manufacture of scaffolds for trabecular bone replacement.

An Algorithm to Optimize the Micro-Geometrical Dimensions of Scaffolds with Spherical Pores

Despite the wide use of scaffolds with spherical pores in the clinical context, no studies are reported in the literature that optimize the micro-architecture dimensions of such scaffolds to maximize the amounts of neo-formed bone. In this study, a mechanobiology-based optimization algorithm was implemented to determine the optimal geometry of scaffolds with spherical pores subjected to both compression and shear loading. We found that these scaffolds are particularly suited to bear shear loads; the amounts of bone predicted to form for this load type are, in fact, larger than those predicted in other scaffold geometries. Knowing the anthropometric characteristics of the patient, one can hypothesize the possible value of load acting on the scaffold that will be implanted and, through the proposed algorithm, determine the optimal dimensions of the scaffold that favor the formation of the largest amounts of bone. The proposed algorithm can guide and support the surgeon in the choice of a "personalized" scaffold that better suits the anthropometric characteristics of the patient, thus allowing to achieve a successful follow-up in the shortest possible time.

Investigating Commercial Filaments for 3D Printing of Stiff and Elastic Constructs with Ligament-Like Mechanics

The current gold standard technique for treatment of anterior cruciate ligament (ACL) injury is reconstruction with autograft. These treatments have a relatively high failure and re-tear rate. To overcome this, tissue engineering and additive manufacturing are being used to explore the potential of 3D scaffolds as autograft substitutes. However, mechanically optimal polymers for this have yet to be identified. Here, we use 3D printing technology and various materials with the aim of fabricating constructs better matching the mechanical properties of the native ACL. A fused deposition modeling (FDM) 3D printer was used to microfabricate dog bone-shaped specimens from six different polymers—PLA, PETG, Lay FOMM 60, NinjaFlex, NinjaFlex-SemiFlex, and FlexiFil—at three different raster angles. The tensile mechanical properties of these polymers were determined from stress–strain curves. Our results indicate that no single material came close enough to successfully match reported mechanical properties of the native ACL. However, PLA and PETG had similar ultimate tensile strengths. Lay FOMM 60 displayed a percentage strain at failure similar to reported values for native ACL. Furthermore, raster angle had a significant impact on some mechanical properties for all of the materials except for FlexiFil. We therefore conclude that while none of these materials alone is optimal for mimicking ACL mechanical properties, there may be potential for creating a 3D-printed composite constructs to match ACL mechanical properties. Further investigations involving co-printing of stiff and elastomeric materials must be explored.

Experimental Characterization and Finite Element Modeling of the Effects of 3D Bioplotting Process Parameters on Structural and Tensile Properties of Polycaprolactone (PCL) Scaffolds

In this study we characterized the process–structure interactions in melt extrusion-based 3D bioplotting of polycaprolactone (PCL) and developed predictive models to enable the efficient design and processing of scaffolds for tissue engineering applications. First, the effects of pneumatic extrusion pressure (0.3, 0.4, 0.5, 0.6 N/mm2), nozzle speed (0.1, 0.4, 1.0, 1.4 mm/s), strand lay orientation (0°, 45°, 90°, 135°), and strand length (10, 20, 30 mm) on the strand width were investigated and a regression model was developed to map strand width to the two significant parameters (extrusion pressure and nozzle speed; p < 0.05). Then, proliferation of NIH/3T3 fibroblast cells in scaffolds with two different stand widths fabricated with different combinations of the two significant parameters was assessed over 7 days, which showed that the strand width had a significant effect on proliferation (p < 0.05). The effect of strand lay orientation (0° and 90°) on tensile properties of non-porous PCL specimens was determined and was found to be significantly higher for specimens with 0° lay orientation (p < 0.05). Finally, these data were used to develop and experimentally validate a finite element model for a porous PCL specimen with 1:1 ratio of inter-strand spacing to strand width.

Stiffness-mediated mesenchymal stem cell fate decision in 3D-bioprinted hydrogels

Background

Hydrogels with tuneable mechanical properties are an attractive material platform for 3D bioprinting. Thus far, numerous studies have confirmed that the biophysical cues of hydrogels, such as stiffness, are known to have a profound impact on mesenchymal stem cell (MSC) differentiation; however, their differentiation potential within 3D-bioprinted hydrogels is not completely understood. Here, we propose a protocol for the exploration of how the stiffness of alginate-gelatin (Alg-Gel) composite hydrogels (the widely used bioink) affects the differentiation of MSCs in the presence or absence of differentiation inducing factors.

Methods

Two types of Alg-Gel composite hydrogels (Young's modulus: 50 kPa vs. 225 kPa) were bioprinted independently of porosity. Then, stiffness-induced biases towards adipogenic and osteogenic differentiation of the embedded MSCs were analysed by co-staining with alkaline phosphatase (ALP) and oil red O. The expression of specific markers at the gene level was detected after a 3-day culture.

Results

Confocal microscopy indicated that all tested hydrogels supported MSC growth and viability during the culture period. Higher expression of adipogenic and osteogenic markers (ALP and lipoprotein lipase (LPL)) in stiffer 3D-bioprinted matrices demonstrated a more significant response of MSCs to stiffer hydrogels with respect to differentiation, which was more robust in differentiation-inducing medium. However, the LPL expression in stiffer 3D-bioprinted constructs was reduced at day 3 regardless of the presence of differentiation-inducing factors. Although MSCs embedded in softer hydrogels to some extent proceeded toward adipogenic and osteogenic lineages within a few days, their differentiation seemed to be slower and more limited. Interestingly, the hydrogel itself (without differentiation-inducing factors) exhibited a slight effect on whether MSCs differentiated towards an adipogenic or an osteogenic fate. Considering that the mechano-regulated protein Yes-associated protein (YAP) is involved in MSC fate decisions, we further found that inhibition of YAP significantly downregulated the expression of ALP and LPL in MSCs in stiffer constructs regardless of the induced growth factors present.

Conclusions

These results demonstrate that the differentiation of MSCs in 3D-bioprinted matrices is dependent on hydrogel stiffness, which emphasizes the importance of biophysical cues as a determinant of cellular behaviour.

Advances in Tissue Engineering and Innovative Fabrication Techniques for 3-D-Structures: Translational Applications in Neurodegenerative Diseases

In the field of regenerative medicine applied to neurodegenerative diseases, one of the most important challenges is the obtainment of innovative scaffolds aimed at improving the development of new frontiers in stem-cell therapy. In recent years, additive manufacturing techniques have gained more and more relevance proving the great potential of the fabrication of precision 3-D scaffolds. In this review, recent advances in additive manufacturing techniques are presented and discussed, with an overview on stimulus-triggered approaches, such as 3-D Printing and laser-based techniques, and deposition-based approaches. Innovative 3-D bioprinting techniques, which allow the production of cell/molecule-laden scaffolds, are becoming a promising frontier in disease modelling and therapy. In this context, the specific biomaterial, stiffness, precise geometrical patterns, and structural properties are to be considered of great relevance for their subsequent translational applications. Moreover, this work reports numerous recent advances in neural diseases modelling and specifically focuses on pre-clinical and clinical translation for scaffolding technology in multiple neurodegenerative diseases.

Influence of Geometry and Architecture on the In Vivo Success of 3D-Printed Scaffolds for Spinal Fusion

We previously developed a recombinant growth factor-free, three-dimensional (3D)-printed material comprising hydroxyapatite (HA) and demineralized bone matrix (DBM) for bone regeneration. This material has demonstrated the capacity to promote re-mineralization of the DBM particles within the scaffold struts and shows potential to promote successful spine fusion. Here, we investigate the role of geometry and architecture in osteointegration, vascularization, and facilitation of spine fusion in a preclinical model. Inks containing HA and DBM particles in a poly(lactide-co-glycolide) elastomer were 3D-printed into scaffolds with varying relative strut angles (90° vs. 45° advancing angle), macropore size (0 μm vs. 500 μm vs. 1000 μm), and strut alignment (aligned vs. offset). The following configurations were compared with scaffolds containing no macropores: 90°/500 μm/aligned, 45°/500 μm/aligned, 90°/1000 μm/aligned, 45°/1000 μm/aligned, 90°/1000 μm/offset, and 45°/1000 μm/offset. Eighty-four female Sprague-Dawley rats underwent spine fusion with bilateral placement of the various scaffold configurations (n = 12/configuration). Osteointegration and vascularization were assessed by using microComputed Tomography and histology, and spine fusion was assessed via blinded manual palpation. The 45°/1000 μm scaffolds with aligned struts achieved the highest average fusion score (1.61/2) as well as the highest osteointegration score. Both the 45°/1000 μm/aligned and 90°/1000 μm/aligned scaffolds elicited fusion rates of 100%, which was significantly greater than the 45°/500 μm/aligned iteration (p < 0.05). All porous scaffolds were fully vascularized, with blood vessels present in every macropore. Vessels were also observed extending from the native transverse process bone, through the protrusions of new bone, and into the macropores of the scaffolds. When viewed independently, scaffolds printed with relative strut angles of 45° and 90° each allowed for osteointegration sufficient to stabilize the spine at L4-L5. Within those parameters, a pore size of 500 μm or greater was generally sufficient to achieve unilateral fusion. However, our results suggest that scaffolds printed with the larger pore size and with aligned struts at an advancing angle of 45° may represent the optimal configuration to maximize osteointegration and fusion capacity. Overall, this work suggests that the HA/DBM composite scaffolds provide a conducive environment for bone regeneration as well as vascular infiltration. This technology, therefore, represents a novel, growth-factor-free biomaterial with significant potential as a bone graft substitute for use in spinal surgery. Impact statement We previously developed a recombinant growth factor-free, three-dimensional (3D)-printed composite material comprising hydroxyapatite and demineralized bone matrix for bone regeneration. Here, we identify a range of 3D geometric and architectural parameters that support the preclinical success of the scaffold, including efficient vascularization, osteointegration, and, ultimately, spinal fusion. Our results suggest that this material holds great promise as a clinically translatable biomaterial for use as a bone graft substitute in orthopedic procedures requiring bone regeneration.

Three-dimensional printed multiphasic scaffolds with stratified cell-laden gelatin methacrylate hydrogels for biomimetic tendon-to-bone interface engineering

Background

The anatomical properties of the enthesis of the rotator cuff are hardly regained during the process of healing. The tendon-to-bone interface is normally replaced by fibrovascular tissue instead of interposition fibrocartilage, which impairs biomechanics in the shoulder and causes dysfunction. Tissue engineering offers a promising strategy to regenerate a biomimetic interface. Here, we report heterogeneous tendon-to-bone interface engineering based on a 3D-printed multiphasic scaffold.

Methods

A multiphasic poly(ε-caprolactone) (PCL)–PCL/tricalcium phosphate (TCP)–PCL/TCP porous scaffold was manufactured using 3D printing technology. The three phases of the scaffold were designed to mimic the graded tissue regions in the tendon-to-bone interface—tendon, fibrocartilage, and bone. Fibroblasts, bone marrow–derived mesenchymal stem cells, and osteoblasts were separately encapsulated in gelatin methacrylate (GelMA) and loaded seriatim on the relevant phases of the scaffold, by which a cells/GelMA-multiphasic scaffold (C/G-MS) construct, replicating the native interface, was fabricated. Cell proliferation, viability, and chondrogenic differentiation were evaluated in vitro. The C/G-MS constructs were further examined to determine the potential of regenerating a continuous interface with gradual transition of teno-, fibrocartilage- and osteo-like tissues in vivo.

Results

In vitro tests confirmed the good cytocompatibility of the constructs. After seven days in culture, cellular microfilament staining indicated that not only could cells well proliferate in GelMA hydrogels ​but also efficiently attach to and grow on scaffold fibres. Moreover, by immunolocalizing collagen type II, chondrogenesis was identified in the intermediate phase of the C/G-MS construct that had been treated with transforming growth factor β3 for 21 days. After subcutaneous implantation in mice, the C/G-MS construct exhibited a heterogeneous and graded structure up to eight weeks, with distinguished matrix distribution observed at one week. Overall, gene expression of tenogenic, chondrogenic, and osteogenic markers showed increasing patterns for eight weeks. Among them, expression of collagen type X gene was found drastically increasing during eight weeks, indicating progressive formation of calcifying cartilage within the constructs.

Conclusion

Our findings demonstrate that the stratified manner of fabrication based on the 3D-printed multiphasic scaffold is an effective strategy for tendon-to-bone interface engineering in terms of efficient cell seeding, chondrogenic potential, and distinct matrix deposition in varying phases.

The translational potential of this article

We fabricated a biomimetic tendon-to-bone interface by using a 3D-printed multiphasic scaffold and adopting a stratified cell-seeding manner with GelMA. The biomimetic interface might have applications in tendon-to-bone repair in the rotator cuff. It can not only be an alternative to a biological fixation device ​but also offer an ex vivo living graft to replace the damaged enthesis.