Artificial Auricular Cartilage Using Silk Fibroin and Polyvinyl Alcohol Hydrogel

Enhancing auricular reconstruction: A biomimetic scaffold with 3D-printed multiscale porous structure utilizing chondrogenic activity ink

Auricular defects are highly prevalent and have a significant impact on the physical and mental well-being of patients. However, due to the intricate anatomy of the auricle, achieving personalized and precise reconstruction poses a major challenge. Currently, tissue engineering auricle scaffolds based on rigid materials are an effective therapeutic approach for auricle reconstruction. Nevertheless, these auricular scaffolds often fail to meet biomechanical requirements and lack biological activity, resulting in suboptimal treatment outcomes. In this study, polyvinyl alcohol and gelatin were used as printing inks, and nano-silica was employed as a filler to optimize the printability of the inks. Through layer-by-layer 3D printing, auricle scaffolds were fabricated that closely mimic human auricular biomechanical properties and possess a multi-scale pore structure. Subsequent in vitro experiments confirmed the biocompatibility of the scaffolds. Furthermore, a rabbit auricular cartilage defect model was established to evaluate the therapeutic efficacy of this bionic scaffold featuring a multi-scale pore structure for auricle defects. The findings demonstrated that the developed auricle scaffold not only exhibited excellent biomechanical strength and favorable biocompatibility but also provided an advantageous environment for chondrocyte growth due to its multi-scale pore structure, thereby significantly promoting chondrocyte proliferation. Overall, the 3D printed tissue engineering bionic scaffold with a multi-scale pore structure developed in this study is anticipated to significantly enhance the therapeutic efficacy for auricle defects and offer a novel therapeutic strategy for such defects.

The rational design, biofunctionalization and biological properties of orthopedic porous titanium implants: a review

Porous titanium implants are becoming an important tool in orthopedic clinical applications. This review provides a comprehensive survey of recent advances in porous titanium implants for orthopedic use. First, the review briefly describes the characteristics of bone and the design requirements of orthopedic implants. Subsequently, the pore size and structural design of porous titanium alloy materials are presented, then we introduce the application of porous titanium alloy implants in orthopedic clinical practice, including spine surgery, joint surgery, and the treatment of bone tumors. Following that, we describe the surface modifications applied to porous titanium implants to obtain better biological functions. Finally, we discuss incorporating environmental responsive mechanisms into porous titanium alloy materials to achieve additional functionalities.

Silk fibroin-based hydrogels for cartilage organoids in osteoarthritis treatment

Osteoarthritis (OA) is a common joint disease characterized by cartilage degeneration. It can cause severe pain, deformity and even amputation risk. However, existing clinical treatment methods for cartilage repair present certain deficiencies. Meanwhile, the repair effect of cartilage tissue engineering is also unsatisfactory. Cartilage organoids are multicellular aggregates with cartilage-like three-dimensional structure and function. On the one hand, cartilage organoids can be used to explore the pathogenesis of OA by constructing disease models. On the other hand, it can be used as filler for rapid cartilage repair. Extracellular matrix (ECM)-like three-dimensional environment is the key to construct cartilage organoids. Silk fibroin (SF)-based hydrogels not only have ECM-like structure, but also have unique mechanical properties and remarkable biocompatibility. Therefore, SF-based hydrogels are considered as ideal biomaterials for constructing cartilage organoids. In this review, we reviewed the studies of cartilage organoids and SF-based hydrogels. The advantages of SF-based hydrogels in constructing cartilage organoids and the iterative optimization of cartilage organoids through designing hydrogels by using artificial intelligence (AI) calculation are also discussed. This review aims to provide a theoretical basis for the treatment of OA using SF-based biomaterials and cartilage organoids.

Recent advancements and perspectives on processable natural biopolymers: Cellulose, chitosan, eggshell membrane, and silk fibroin

With the rapid development of the global economy and the continuous consumption of fossil resources, sustainable and biodegradable natural biomass has garnered extensive attention as a promising substitute for synthetic polymers. Due to their hierarchical and nanoscale structures, natural biopolymers exhibit remarkable mechanical properties, along with excellent innate biocompatibility and biodegradability, demonstrating significant potential in various application scenarios. Among these biopolymers, proteins and polysaccharides are the most commonly studied due to their low cost, abundance, and ease of use. However, the direct processing/conversion of proteins and polysaccharides into their final products has been a long-standing challenge due to their natural morphology and compositions. In this review, we emphasize the importance of processing natural biopolymers into high-value-added products through sustainable and cost-effective methods. We begin with the extraction of four types of natural biopolymers: cellulose, chitosan, eggshell membrane, and silk fibroin. The processing and post-functionalization strategies for these natural biopolymers are then highlighted. Alongside their unique structures, the versatile potential applications of these processable natural biopolymers in biomedical engineering, biosensors, environmental engineering, and energy applications are illustrated. Finally, we provide a summary and future outlook on processable natural biopolymers, underscoring the significance of converting natural biopolymers into valuable biomaterial platforms.

Comparative Analysis and Regeneration Strategies for Three Types of Cartilage

Cartilage tissue, encompassing hyaline cartilage, fibrocartilage, and elastic cartilage, plays a pivotal role in the human body because of its unique composition, structure, and biomechanical properties. However, the inherent avascularity and limited regenerative capacity of cartilage present significant challenges to its healing following injury. This review provides a comprehensive analysis of the current state of cartilage tissue engineering, focusing on the critical components of cell sources, scaffolds, and growth factors tailored to the regeneration of each cartilage type. We explore the similarities and differences in the composition, structure, and biomechanical properties of the three cartilage types and their implications for tissue engineering. A significant emphasis is placed on innovative strategies for cartilage regeneration, including the potential for in situ transformation of cartilage types through microenvironmental manipulation, which may offer novel avenues for repair and rehabilitation. The review underscores the necessity of a nuanced approach to cartilage tissue engineering, recognizing the distinct requirements of each cartilage type while exploring the potential of transforming one cartilage type into another as a flexible and adaptive repair strategy. Through this detailed examination, we aim to broaden the understanding of cartilage tissue engineering and inspire further research and development in this promising field.

Harnessing the potential of hydrogels for advanced therapeutic applications: current achievements and future directions

The applications of hydrogels have expanded significantly due to their versatile, highly tunable properties and breakthroughs in biomaterial technologies. In this review, we cover the major achievements and the potential of hydrogels in therapeutic applications, focusing primarily on two areas: emerging cell-based therapies and promising non-cell therapeutic modalities. Within the context of cell therapy, we discuss the capacity of hydrogels to overcome the existing translational challenges faced by mainstream cell therapy paradigms, provide a detailed discussion on the advantages and principal design considerations of hydrogels for boosting the efficacy of cell therapy, as well as list specific examples of their applications in different disease scenarios. We then explore the potential of hydrogels in drug delivery, physical intervention therapies, and other non-cell therapeutic areas (e.g., bioadhesives, artificial tissues, and biosensors), emphasizing their utility beyond mere delivery vehicles. Additionally, we complement our discussion on the latest progress and challenges in the clinical application of hydrogels and outline future research directions, particularly in terms of integration with advanced biomanufacturing technologies. This review aims to present a comprehensive view and critical insights into the design and selection of hydrogels for both cell therapy and non-cell therapies, tailored to meet the therapeutic requirements of diverse diseases and situations.

Trends and advances in silk based 3D printing/bioprinting towards cartilage tissue engineering and regeneration

Cartilage repair remains a significant clinical challenge in orthopedics due to its limited self- regeneration potential and often progresses to osteoarthritis which reduces the quality of life. 3D printing/bioprinting has received vast attention in biofabrication of functional tissue substitutes due to its ability to develop complex structures such as zonally structured cartilage and osteochondral tissue as per patient specifications with precise biomimetic control. Towards a suitable bioink development for 3D printing/bioprinting, silk fibroin has garnered much attention due to its advantageous characteristics such as shear thinning behavior, cytocompatibility, good printability, structural fidelity, affordability, and ease of availability and processing. This review attempts to provide an overview of current trends/strategies and recent advancements in utilizing silk-based bioinks/biomaterial-inks for cartilage bioprinting. Herein, the development of silk-based bioinks/biomaterial-inks, its components and the associated challenges, along with different bioprinting techniques have been elaborated and reviewed. Furthermore, the applications of silk-based bioinks/biomaterial-inks in cartilage repair followed by challenges and future directions are discussed towards its clinical translations and production of next-generation biological implants.

A new strategy for intervertebral disc regeneration: The synergistic potential of mesenchymal stem cells and their extracellular vesicles with hydrogel scaffolds

Intervertebral disc degeneration (IDD) is a disease that severely affects spinal health and is prevalent worldwide. Mesenchymal stem cells (MSCs) and their derived extracellular vesicles (EVs) have regenerative potential and have emerged as promising therapeutic tools for treating degenerative discs. However, challenges such as the harsh microenvironment of degenerated intervertebral discs and EVs' limited stability and efficacy have hindered their clinical application. In recent years, hydrogels have attracted much attention in the field of IDD therapy because they can mimic the physiologic microenvironment of the disc and provide a potential solution by providing a suitable growth environment for MSCs and EVs. This review introduced the biological properties of MSCs and their derived EVs, summarized the research on the application of MSCs and EVs in IDD, summarized the current clinical trial studies of MSCs and EVs, and also explored the mechanism of action of MSCs and EVs in intervertebral discs. In addition, plenty of research elaborated on the mechanism of action of different classified hydrogels in tissue engineering, the synergistic effect of MSCs and EVs in promoting intervertebral disc regeneration, and their wide application in treating IDD. Finally, the challenges and problems still faced by hydrogel-loaded MSCs and EVs in the treatment of IDD are summarized, and potential solutions are proposed. This paper outlines the synergistic effects of MSCs and EVs in treating IDD in combination with hydrogels and aims to provide theoretical references for future related studies.

Hydrogel Based on Chitosan/Gelatin/Poly(Vinyl Alcohol) for In Vitro Human Auricular Chondrocyte Culture

Three-dimensional (3D) hydrogels provide tissue-like complexities and allow for the spatial orientation of cells, leading to more realistic cellular responses in pathophysiological environments. There is a growing interest in developing multifunctional hydrogels using ternary mixtures for biomedical applications. This study examined the biocompatibility and suitability of human auricular chondrocytes from microtia cultured onto steam-sterilized 3D Chitosan/Gelatin/Poly(Vinyl Alcohol) (CS/Gel/PVA) hydrogels as scaffolds for tissue engineering applications. Hydrogels were prepared in a polymer ratio (1:1:1) through freezing/thawing and freeze-drying and were sterilized by autoclaving. The macrostructure of the resulting hydrogels was investigated by scanning electron microscopy (SEM), showing a heterogeneous macroporous structure with a pore size between 50 and 500 μm. Fourier-transform infrared (FTIR) spectra showed that the three polymers interacted through hydrogen bonding between the amino and hydroxyl moieties. The profile of amino acids present in the gelatin and the hydrogel was determined by ultra-performance liquid chromatography (UPLC), suggesting that the majority of amino acids interacted during the formation of the hydrogel. The cytocompatibility, viability, cell growth and formation of extracellular matrix (ECM) proteins were evaluated to demonstrate the suitability and functionality of the 3D hydrogels for the culture of auricular chondrocytes. The cytocompatibility of the 3D hydrogels was confirmed using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, reaching 100% viability after 72 h. Chondrocyte viability showed a high affinity of chondrocytes for the hydrogel after 14 days, using the Live/Dead assay. The chondrocyte attachment onto the 3D hydrogels and the formation of an ECM were observed using SEM. Immunofluorescence confirmed the expression of elastin, aggrecan and type II collagen, three of the main components found in an elastic cartilage extracellular matrix. These results demonstrate the suitability and functionality of a CS/Gel/PVA hydrogel as a 3D support for the auricular chondrocytes culture, suggesting that these hydrogels are a potential biomaterial for cartilage tissue engineering applications, aimed at the regeneration of elastic cartilage.

Functional modification of silk fibroin from silkworms and its application to medical biomaterials: A review

Silk fibroin (SF) from the silkworm Bombyx mori is a fibrous protein identified as a widely suitable biomaterial due to its biocompatibility, tunable degradation, and mechanical strength. Various modifications of SF protein can give SF fibers new properties and functions, broadening their applications in textile and biomedical industries. A diverse array of functional modifications on various forms of SF has been reported. In order to provide researchers with a more systematic understanding of the types of functional modifications of SF protein, as well as the corresponding applications, we comprehensively review the different types of functional modifications, including transgenic modification, modifications with chemical groups or biologically active substance, cross-linking and copolymerization without chemical reactions, their specific modification methods and applications. Furthermore, recent applications of SF in various medical biomaterials are briefly discussed.

Development of a highly concentrated collagen ink for the creation of a 3D printed meniscus

The most prevalent extracellular matrix (ECM) protein in the meniscus is collagen, which controls cell activity and aids in preserving the biological and structural integrity of the ECM. To create stable and high-precision 3D printed collagen scaffolds, ink formulations must possess good printability and cytocompatibility. This study aims to overlap the limitation in the 3D printing of pure collagen, and to develop a highly concentrated collagen ink for meniscus fabrication. The extrusion test revealed that 12.5 % collagen ink had the best combination of high collagen concentration and printability. The ink was specifically designed to have load-bearing capacity upon printing and characterized with respect to rheological and extrusion properties. Following printing of structures with different infill, a series of post-processing steps, including salt stabilization, pH shifting, washing, freeze-drying, crosslinking and sterilization were performed, and optimised to maintain the stability of the engineered construct. Mechanical testing highlighted a storage modulus of 70 kPa for the lower porous structure while swelling properties showed swelling ratio between 9 and 11 after 15 min of soaking. Moreover, human avascular and vascular meniscus cells cultured on the scaffolds deposited a meniscus-like matrix containing collagen I, II and glycosaminoglycans after 28 days of culture. Finally, as proof-of-concept, human size 3D printed meniscus scaffold were created.

Medical Applications of 3D Printing and Standardization Issues

The three-dimensional (3D) printing itself is not a novel technology, it is more than 30 years old. Stereolithographic (SLA) technology has been used as the first and popular technology for medical application of 3D printing. Since 1991 Radiology and Plastic Surgery have published articles about SLA for rapid prototyping anatomical 3D models. Medical applications of 3D printing have been popularizing and stabilizing so far. Implantable medical devices such as metal or absorbable implants, surgical guide systems, prosthesis and orthosis, and 3D anatomical models for normal or diseased anatomy have been developing and expanding its markets so far. There are many obstacles, such as insurance, authorization as a medical device, and lack of standards technology for further expansion of medical applications. Many technical specifications and guidelines for authorization as medical device have been published by regulatory bodies from many countries. Even though international standards for 3D printing have been developing more and more, there have been few standards for medical application of 3D printing. In this harsh environment academia, company, research institute, regulatory bodies, and government have been doing good job for the development of 3D printing industry.

Application of Silk-Fibroin-Based Hydrogels in Tissue Engineering

Silk fibroin (SF) is an excellent protein-based biomaterial produced by the degumming and purification of silk from cocoons of the Bombyx mori through alkali or enzymatic treatments. SF exhibits excellent biological properties, such as mechanical properties, biocompatibility, biodegradability, bioabsorbability, low immunogenicity, and tunability, making it a versatile material widely applied in biological fields, particularly in tissue engineering. In tissue engineering, SF is often fabricated into hydrogel form, with the advantages of added materials. SF hydrogels have mostly been studied for their use in tissue regeneration by enhancing cell activity at the tissue defect site or counteracting tissue-damage-related factors. This review focuses on SF hydrogels, firstly summarizing the fabrication and properties of SF and SF hydrogels and then detailing the regenerative effects of SF hydrogels as scaffolds in cartilage, bone, skin, cornea, teeth, and eardrum in recent years.

Enhancing cartilage repair with optimized supramolecular hydrogel-based scaffold and pulsed electromagnetic field

Functional tissue engineering strategies provide innovative approach for the repair and regeneration of damaged cartilage. Hydrogel is widely used because it could provide rapid defect filling and proper structure support, and is biocompatible for cell aggregation and matrix deposition. Efforts have been made to seek suitable scaffolds for cartilage tissue engineering. Here Alg-DA/Ac-β-CD/gelatin hydrogel was designed with the features of physical and chemical multiple crosslinking and self-healing properties. Gelation time, swelling ratio, biodegradability and biocompatibility of the hydrogels were systematically characterized, and the injectable self-healing adhesive hydrogel were demonstrated to exhibit ideal properties for cartilage repair. Furthermore, the new hydrogel design introduces a pre-gel state before photo-crosslinking, where increased viscosity and decreased fluidity allow the gel to remain in a semi-solid condition. This granted multiple administration routes to the hydrogels, which brings hydrogels the ability to adapt to complex clinical situations. Pulsed electromagnetic fields (PEMF) have been recognized as a promising solution to various health problems owing to their noninvasive properties and therapeutic potentials. PEMF treatment offers a better clinical outcome with fewer, if any, side effects, and wildly used in musculoskeletal tissue repair. Thereby we propose PEMF as an effective biophysical stimulation to be 4th key element in cartilage tissue engineering. In this study, the as-prepared Alg-DA/Ac-β-CD/gelatin hydrogels were utilized in the rat osteochondral defect model, and the potential application of PEMF in cartilage tissue engineering were investigated. PEMF treatment were proven to enhance the quality of engineered chondrogenic constructs in vitro, and facilitate chondrogenesis and cartilage repair in vivo. All of the results suggested that with the injectable self-healing adhesive hydrogel and PEMF treatment, this newly proposed tissue engineering strategy revealed superior clinical potential for cartilage defect treatment.

Fabrication of 3D-Printed Implant for Two-Stage Ear Reconstruction Surgery and Its Clinical Application

PURPOSE

Ear reconstruction is one of the most difficult areas in the field of reconstructive surgery. Due to limitations of the current practice, a novel method of auricular reconstruction is needed. Major advancements in three-dimensional (3D) printing technique have rendered the process of ear reconstruction more favorable. Herein, we present our experience in designing and clinically using 3D implants in both 1st and 2nd stage ear reconstruction surgery.

MATERIALS AND METHODS

After obtaining 3D CT data from each patient, a 3D geometric ear model was created using mirroring and segmentation processes. The 3D-printed implant design resembles but does not exactly match the normal ear shape, and can be inserted in harmony with the currently used surgical technique. The 2nd stage implant was designed to minimize dead space and support the posterior ear helix. The 3D implants were finally fabricated with a 3D printing system and used in ear reconstruction surgery in our institute.

RESULTS

The 3D implants were manufactured for application to the currently used two-stage technique while maintaining the shape of the patient's normal ear. The implants were successfully used for ear reconstruction surgery in microtia patients. A few months later, the 2nd stage implant was used in the 2nd stage operation.

CONCLUSION

The authors were able to design, fabricate, and apply patient-specific 3D-printed ear implants for 1st and 2nd stage ear reconstruction surgeries. This design, combined with 3D bioprinting technique, may be a future alternative for ear reconstruction.

3D-Printing of Silk Nanofibrils Reinforced Alginate for Soft Tissue Engineering

The main challenge of extrusion 3D bioprinting is the development of bioinks with the desired rheological and mechanical performance and biocompatibility to create complex and patient-specific scaffolds in a repeatable and accurate manner. This study aims to introduce non-synthetic bioinks based on alginate (Alg) incorporated with various concentrations of silk nanofibrils (SNF, 1, 2, and 3 wt.%) and optimize their properties for soft tissue engineering. Alg-SNF inks demonstrated a high degree of shear-thinning with reversible stress softening behavior contributing to extrusion in pre-designed shapes. In addition, our results confirmed the good interaction between SNFs and alginate matrix resulted in significantly improved mechanical and biological characteristics and controlled degradation rate. Noticeably, the addition of 2 wt.% SNF improved the compressive strength (2.2 times), tensile strength (5 times), and elastic modulus (3 times) of alginate. In addition, reinforcing 3D-printed alginate with 2 wt.% SNF resulted in increased cell viability (1.5 times) and proliferation (5.6 times) after 5 days of culturing. In summary, our study highlights the favorable rheological and mechanical performances, degradation rate, swelling, and biocompatibility of Alg-2SNF ink containing 2 wt.% SNF for extrusion-based bioprinting.

Designing Silk-Based Cryogels for Biomedical Applications

There is a need to develop the next generation of medical products that require biomaterials with improved properties. The versatility of various gels has pushed them to the forefront of biomaterials research. Cryogels, a type of gel scaffold made by controlled crosslinking under subzero or freezing temperatures, have great potential to address many current challenges. Unlike their hydrogel counterparts, which are also able to hold large amounts of biologically relevant fluids such as water, cryogels are often characterized by highly dense and crosslinked polymer walls, macroporous structures, and often improved properties. Recently, one biomaterial that has garnered a lot of interest for cryogel fabrication is silk and its derivatives. In this review, we provide a brief overview of silk-based biomaterials and how cryogelation can be used for novel scaffold design. We discuss how various parameters and fabrication strategies can be used to tune the properties of silk-based biomaterials. Finally, we discuss specific biomedical applications of silk-based biomaterials. Ultimately, we aim to demonstrate how the latest advances in silk-based cryogel scaffolds can be used to address challenges in numerous bioengineering disciplines.

Silk fibroin hydrogels for biomedical applications

Silk fibroin hydrogels occupy an essential position in the biomedical field due to their remarkable biological properties, excellent mechanical properties, flexible processing properties, as well as abundant sources and low cost. Herein, we introduce the unique structures and physicochemical characteristics of silk fibroin, including mechanical properties, biocompatibility, and biodegradability. Then, various preparation strategies of silk fibroin hydrogels are summarized, which can be divided into physical cross-linking and chemical cross-linking. Emphatically, the applications of silk fibroin hydrogel biomaterials in various biomedical fields, including tissue engineering, drug delivery, and wearable sensors, are systematically summarized. At last, the challenges and future prospects of silk fibroin hydrogels in biomedical applications are discussed.

Porous biomaterials for tissue engineering: a review

The field of biomaterials has grown rapidly over the past decades. Within this field, porous biomaterials have played a remarkable role in: (i) enabling the manufacture of complex three-dimensional structures; (ii) recreating mechanical properties close to those of the host tissues; (iii) facilitating interconnected structures for the transport of macromolecules and cells; and (iv) behaving as biocompatible inserts, tailored to either interact or not with the host body. This review outlines a brief history of the development of biomaterials, before discussing current materials proposed for use as porous biomaterials and exploring the state-of-the-art in their manufacture. The wide clinical applications of these materials are extensively discussed, drawing on specific examples of how the porous features of such biomaterials impact their behaviours, as well as the advantages and challenges faced, for each class of the materials.

3D bioprinted silk fibroin hydrogels for tissue engineering

The development of biocompatible and precisely printable bioink addresses the growing demand for three-dimensional (3D) bioprinting applications in the field of tissue engineering. We developed a methacrylated photocurable silk fibroin (SF) bioink for digital light processing 3D bioprinting to generate structures with high mechanical stability and biocompatibility for tissue engineering applications. Procedure 1 describes the synthesis of photocurable methacrylated SF bioink, which takes 2 weeks to complete. Digital light processing is used to fabricate 3D hydrogels using the bioink (1.5 h), which are characterized in terms of methacrylation, printability, mechanical and rheological properties, and biocompatibility. The physicochemical properties of the bioink can be modulated by varying photopolymerization conditions such as the degree of methacrylation, light intensity, and concentration of the photoinitiator and bioink. The versatile bioink can be used broadly in a range of applications, including nerve tissue engineering through co-polymerization of the bioink with graphene oxide, and for wound healing as a sealant. Procedure 2 outlines how to apply 3D-printed SF hydrogels embedded with chondrocytes and turbinate-derived mesenchymal stem cells in one specific in vivo application, trachea tissue engineering, which takes 2-9 weeks.

Poly(vinyl alcohol) Hydrogels: The Old and New Functional Materials

Hydrogels have three-dimensional network structures, high water content, good flexibility, biocompatibility, and stimulation response, which have provided a unique role in many fields such as industry, agriculture, and medical treatment. Poly(vinyl alcohol) PVA hydrogel is one of the oldest composite hydrogels. It has been extensively explored due to its chemical stability, nontoxic, good biocompatibility, biological aging resistance, high water-absorbing capacity, and easy processing. PVA-based hydrogels have been widely investigated in drug carriers, articular cartilage, wound dressings, tissue engineering, and other intelligent materials, such as self-healing and shape-memory materials, supercapacitors, sensors, and other fields. In this paper, the discovery, development, preparation, modification methods, and applications of PVA functionalized hydrogels are reviewed, and their potential applications and future research trends are also prospected.

Silk Fibroin: A Promising Tool for Wound Healing and Skin Regeneration

Silk is a functional protein biomaterial produced by a variety of insects like flies, silkworms, scorpions, spiders, and mites. Silk synthesized by silkworms is extensively studied for its applications in tissue engineering and wound healing. Silk is undoubtedly a natural biocompatible material with humans and has its role in medical treatments from ancient times. The silk worm protein comprises two types of proteins namely fibroin and sericin. Silk fibroin makes up approximately 70% of cocoon weight and has wide applications in textiles and in all biomedical applications owing to its biocompatible, nontoxic, biodegradable, less immunogenic, and noncarcinogenic nature. It possesses outstanding toughness and mechanical strength, while silk sericin possesses high defensive ability against ultraviolet light and oxidation. Silk fibroin has been known to induce wound healing by increasing cell proliferation and growth and migrating various types of cells which are involved in different stages of wound healing process. With several silk varieties like silk worm fibroin, silk sericin, recombinant silk materials, and native spider silk have been investigated for its wound healing applications over the last several decades. With an objective of harnessing the silk regenerative properties, plentiful strategies have been studied and applied to develop bioartificial skin grafts and bioactive wound dressings in recent times. This review gives a detailed insight into the structure, general properties, fibroin structure-properties relationship, and biomedical applications of silk fibroin.

Functional silk fibroin hydrogels: preparation, properties and applications

Over the past decade, the hydrogels prepared from silk fibroin have received immense research attention due to the advantages of safe nature, biocompatibility, controllable degradation and capability to combine with other materials. They have broad application prospects in biomedicine and other fields. However, the traditional silk protein hydrogels have a simple network structure and single functionality, thus, leading to poor adaptability towards complex application environments. As a result, the application fields and development have been significantly restricted. However, the development of functional silk protein hydrogels has provided the opportunities to overcome the limitations of the silk protein hydrogels. In recent years, the functional design of the silk protein hydrogels and their potential applications have attracted the attention of scholars worldwide. Nevertheless, a comprehensive review on functional silk protein hydrogels is missing so far. In order to gain an in-depth understanding of the development status of the functional silk protein hydrogels, this article reviews the current status of the preparation, properties and application of the functional silk protein hydrogels. The article first briefly introduces the current cross-linking methods (including physical and chemical cross-linking), principles, advantages and limitations of the silk protein hydrogels. Subsequently, the types of functional silk protein hydrogels (e.g., high strength, injectable, self-healing, adhesive, conductive, environmental stimuli-responsive, 3D printable, etc.) and design principles for functional implementation have been introduced. Next, based on the advantages of the various functional aspects of the silk protein hydrogels, the applications of these hydrogels in the biomedical field (tissue engineering, sustained drug release, wound repair, adhesives, etc.) and bioelectronics are reviewed. Finally, the development prospects and challenges associated with silk protein functional hydrogels have been analyzed. It is hoped that this study will contribute towards the future innovation of the silk protein hydrogels by promoting the rational design of new mechanisms and successful realization of the target applications.

Bioartificial injectable cartilage implants from demineralized bone matrix/PVA and related studies in rabbit animal model

Functional cartilage tissue engineering needs a substantial, easy to handle scaffold with proper mechanical strength to repair defected area in articular cartilage. In this study, we report the development and characterization of demineralized bone matrix (DBM) in with a poly vinyl alcohol (PVA) to have a proper homogenous injectable scaffold. Injectabiliy of the biodegradable scaffolds, degradation rate, swelling ratio compression and tensile mechanical properties, and viability and proliferation of bone marrow mesenchymal stem cells (BM-MSCs) followed by differentiation of them In-vitro and In-vivo seeded within the scaffold were studied. It demonstrated that the PVA 20% could increase significantly (p < 0.05) the biodegradability of DBM after 720 hours.DBM with 20% of PVA scaffold has significantly higher (p < 0.05) compression and tensile mechanical strength and viscosity. SEM images showed a multilayer of cells on DBM scaffold incorporated with PVA 20%.BM-MSCs on scaffolds, DBM+PVA 20% had a significant growth rate (p < 0.0001) compare to 2D and low concentration of PVA after 21 days of culture. Viability of cells was significantly higher (p < 0.05) on DBM+PVA scaffold compare to DBM. DBM+PVA 20% enhanced cell viability (P < 0.05) compare to DBM scaffold. The PVA presence enhanced chondrogenesis differentiation at the cellular and molecular levels, as evidenced by increased COL II (P < 0.05) and SOX2 upregulation of Chondrogensis-specific genes (p < 0.001). Hyline-like cartilage covered the defect which was confirmed by microscopy and histology assessments. Having considered percentages of PVA with a constant amount of DBM, injectability, compressive mechanical properties, homogeneity of the scaffold, and providing sufficient surface area (12.25 cm2/ml) for cell attachment; 0.35 g/ml of DBM in 20% PVA (w/v) has applicable properties within the ranges of studies which can be proposed for the injectable engineered articular cartilage.

Wear Behavior Characterization of Hydrogels Constructs for Cartilage Tissue Replacement

This paper aims to characterize the wear behavior of hydrogel constructs designed for human articular cartilage replacement. To this purpose, poly (ethylene glycol) diacrylate (PEGDA) 10% w/v and gellan gum (GG) 1.5% w/v were used to reproduce the superior (SUP) cartilage layer and PEGDA 15% w/v and GG 1.5% w/v were used to reproduce the deep (DEEP) cartilage layer, with or without graphene oxide (GO). These materials (SUP and DEEP) were analyzed alone and in combination to mimic the zonal architecture of human articular cartilage. The developed constructs were tested using a four-station displacement control knee joint simulator under bovine calf serum. Roughness and micro-computer tomography (µ-CT) measurements evidenced that the hydrogels with 10% w/v of PEGDA showed a worse behavior both in terms of roughness increase and loss of uniformly distributed density than 15% w/v of PEGDA. The simultaneous presence of GO and 15% w/v PEGDA contributed to keeping the hydrogel construct's characteristics. The Raman spectra of the control samples showed the presence of unreacted C=C bonds in all the hydrogels. The degree of crosslinking increased along the series SUP < DEEP + SUP < DEEP without GO. The Raman spectra of the tested hydrogels showed the loss of diacrylate groups in all the samples, due to the washout of unreacted PEGDA in bovine calf serum aqueous environment. The loss decreased along the series SUP > DEEP + SUP > DEEP, further confirming that the degree of photo-crosslinking of the starting materials plays a key role in determining their wear behavior. μ-CT and Raman spectroscopy proved to be suitable techniques to characterize the structure and composition of hydrogels.

Advanced hydrogels for the repair of cartilage defects and regeneration

Cartilage defects are one of the most common symptoms of osteoarthritis (OA), a degenerative disease that affects millions of people world-wide and places a significant socio-economic burden on society. Hydrogels, which are a class of biomaterials that are elastic, and display smooth surfaces while exhibiting high water content, are promising candidates for cartilage regeneration. In recent years, various kinds of hydrogels have been developed and applied for the repair of cartilage defects in vitro or in vivo, some of which are hopeful to enter clinical trials. In this review, recent research findings and developments of hydrogels for cartilage defects repair are summarized. We discuss the principle of cartilage regeneration, and outline the requirements that have to be fulfilled for the deployment of hydrogels for medical applications. We also highlight the development of advanced hydrogels with tailored properties for different kinds of cartilage defects to meet the requirements of cartilage tissue engineering and precision medicine.

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The biotechnology of developing hydrogels for cartilage defects repair is promising.

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The principle for cartilage regeneration using hydrogels and requirements for clinical transformation are summarized.

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Advanced hydrogels with tailored properties for different kinds of cartilage defects are discussed.

Reinforced-hydrogel encapsulated hMSCs towards brain injury treatment by trans-septal approach

Encapsulated stem cells in various biomaterials have become a potentially promising cell transplantation strategy in the treatment of various neurologic disorders. However, there is no ideal cell delivery material and method for clinical application in brain diseases. Here we show silk fibroin (SF)-based hydrogel encapsulated engineered human mesenchymal stem cells (hMSCs) to overproduce brain-derived neurotrophic factor (BDNF) (BDNF-hMSC) is an effective approach to treat brain injury through trans-septal cell transplantation in the rat model. In this study, we observed SF induced sustained BDNF production by BDNF-hMSC both in 2D (9.367 ± 1.969 ng/ml) and 3D (7.319 ± 0.1025 ng/ml) culture conditions for 3 days. Through immunohistochemistry using α-tubulin, BDNF-hMSCs showed a significant increased average neurite length of co-cultured neuro 2a (N2a) cells, suggested that BDNF-hMSCs induced neurogenesis in vitro. Encapsulated BDNF-hMSC, pre-labeled with the red fluorescent dye PKH-26, exhibited intense fluorescence up to 14 days trans-septal transplantation, indicated excellent viability of the transplanted cells. Compared to the vehicle-treated, encapsulated BDNF- hMSC demonstrated significantly increased BDNF level both in the sham-operated and injured hippocampus (Hip) through immunoblot analysis after 7 days implantation. Transplantation of the encapsulated BDNF-hMSC promoted neurological functional recovery via significantly reduced neuronal death in the Hip 7 days post-injury. Using magnetic resonance imaging (MRI) analysis, we demonstrated that encapsulated BDNF-hMSC reduced lesion area significantly at 14 and 21 days in the damaged brain following trans-septal implantation. This stem cell transplantation approach represents a critical set up towards brain injury treatment for clinical application.

From Silk Spinning to 3D Printing: Polymer Manufacturing using Directed Hierarchical Molecular Assembly

Silk spinning offers an evolution-based manufacturing strategy for industrial polymer manufacturing, yet remains largely inaccessible as the manufacturing mechanisms in biological and synthetic systems, especially at the molecular level, are fundamentally different. The appealing characteristics of silk spinning include the sustainable sourcing of the protein material, the all-aqueous processing into fibers, and the unique material properties of silks in various formats. Substantial progress has been made to mimic silk spinning in artificial manufacturing processes, despite the gap between natural and artificial systems. This report emphasizes the universal spinning conditions utilized by both spiders and silkworms to generate silk fibers in nature, as a scientific and technical framework for directing molecular assembly into high-performance structures. The preparation of regenerated silk feedstocks and mimicking native spinning conditions in artificial manufacturing are discussed, as is progress and challenges in fiber spinning and 3D printing of silk-composites. Silk spinning is a biomimetic model for advanced and sustainable artificial polymer manufacturing, offering benefits in biomedical applications for tissue scaffolds and implantable devices.

Tissue engineering applications in otolaryngology-The state of translation

While tissue engineering holds significant potential to address current limitations in reconstructive surgery of the head and neck, few constructs have made their way into routine clinical use. In this review, we aim to appraise the state of head and neck tissue engineering over the past five years, with a specific focus on otologic, nasal, craniofacial bone, and laryngotracheal applications. A comprehensive scoping search of the PubMed database was performed and over 2000 article hits were returned with 290 articles included in the final review. These publications have addressed the hallmark characteristics of tissue engineering (cellular source, scaffold, and growth signaling) for head and neck anatomical sites. While there have been promising reports of effective tissue engineered interventions in small groups of human patients, the majority of research remains constrained to in vitro and in vivo studies aimed at furthering the understanding of the biological processes involved in tissue engineering. Further, differences in functional and cosmetic properties of the ear, nose, airway, and craniofacial bone affect the emphasis of investigation at each site. While otolaryngologists currently play a role in tissue engineering translational research, continued multidisciplinary efforts will likely be required to push the state of translation towards tissue-engineered constructs available for routine clinical use.

LEVEL OF EVIDENCE

NA.

New Developments in Medical Applications of Hybrid Hydrogels Containing Natural Polymers

New trends in biomedical applications of the hybrid polymeric hydrogels, obtained by combining natural polymers with synthetic ones, have been reviewed. Homopolysaccharides, heteropolysaccharides, as well as polypeptides, proteins and nucleic acids, are presented from the point of view of their ability to form hydrogels with synthetic polymers, the preparation procedures for polymeric organic hybrid hydrogels, general physico-chemical properties and main biomedical applications (i.e., tissue engineering, wound dressing, drug delivery, etc.).

Osteogenic Differentiation of Mesenchymal Stem Cells with Silica-Coated Gold Nanoparticles for Bone Tissue Engineering

Multifunctional nanofibrous scaffolds for effective bone tissue engineering (BTE) application must incorporate factors to promote neovascularization and tissue regeneration. In this study, silica-coated gold nanoparticles Au(SiO2) were tested for their ability to promote differentiation of human mesenchymal stem cells (hMSCs) into osteoblasts. Biocompatible poly-ε-caprolactone (PCL), PCL/silk fibroin (SF) and PCL/SF/Au(SiO2) loaded nanofibrous scaffolds were first fabricated by an electrospinning method. Electrospun nanofibrous scaffolds were characterized for fiber architecture, porosity, pore size distribution, fiber wettability and the relevant mechanical properties using field emission scanning electron microscopy (FESEM), porosimetry, determination of water contact angle, measurements by a surface analyzer and tabletop tensile-tester measurements. FESEM images of the scaffolds revealed beadless, porous, uniform fibers with diameters in the range of 164 ± 18.65 nm to 215 ± 32.12 nm and porosity of around 88-92% and pore size distribution around 1.45-2.35 µm. Following hMSCs were cultured on the composite scaffolds. Cell-scaffold interaction, morphology and proliferation of were analyzed by FESEM analysis, MTS (3-(4,5-dimethyl thiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium inner salt) and CMFDA (5-choromethyl fluorescein acetate) dye assays. Osteogenic differentiation of MSCs into osteogenic cells were determined by alkaline phosphatase (ALP) activity, mineralization by alizarin red S (ARS) staining and osteocalcin expression by immunofluorescence staining. The results revealed that the addition of SF and Au(SiO2) to PCL scaffolds enhanced the mechanical strength, interconnecting porous structure and surface roughness of the scaffolds. This, in turn, led to successful osteogenic differentiation of hMSCs with improved cell adhesion, proliferation, differentiation, mineralization and expression of pro-osteogenic cellular proteins. This provides huge support for Au(SiO2) as a suitable material in BTE.

Physically Cross-Linked Gels of PVA with Natural Polymers as Matrices for Manuka Honey Release in Wound-Care Applications

Manuka honey is a well-known natural material from New Zealand, considered to have properties beneficial for burn treatment. Gels created from polyvinyl alcohol (PVA) blended with natural polymers are potential burn-care dressings, combining biocompatibility with high fluid uptake. Controlled release of manuka honey from such materials is a possible strategy for improving burn healing. This work aimed to produce polyvinyl alcohol (PVA), PVA⁻sodium carboxymethylcellulose (PVA-CMC), PVA⁻gelatin (PVA-G), and PVA⁻starch (PVA-S) cryogels infused with honey and to characterize these materials physicochemically, morphologically, and thermally, followed by in vitro analysis of swelling capacity, degradation/weight loss, honey delivery kinetics, and possible activity against Staphylococcus aureus. The addition of honey to PVA led to many PVA crystals with defects, while PVA⁻starch⁻honey and PVA⁻sodium carboxymethylcellulose⁻honey (PVA-CMC-H) formed amorphous gels. PVA-CMC presented the highest swelling degree of all. PVA-CMC-H and PVA⁻gelatin⁻honey presented the highest swelling capacities of the honey-laden samples. Weight loss/degradation was significantly higher for samples containing honey. Layers submitted to more freeze⁻thawing cycles were less porous in SEM images. With the honey concentration used, samples did not inhibit S. aureus, but pure manuka honey was bactericidal and dilutions superior to 25% honey were bacteriostatic, indicating the need for higher concentrations to be more effective.

Thermal annealed silk fibroin membranes for periodontal guided tissue regeneration

Guided tissue regeneration (GTR) is a surgical procedure applied in the reconstruction of periodontal defects, where an occlusive membrane is used to prevent the fast-growing connective tissue from migrating into the defect. In this work, silk fibroin (SF) membranes were developed for periodontal guided tissue regeneration. Solutions of SF with glycerol (GLY) or polyvinyl alcohol (PVA) where prepared at several weight ratios up to 30%, followed by solvent casting and thermal annealing at 85 °C for periods of 6 and 12 h to produce high flexible and stable membranes. These were characterized in terms of their morphology, physical integrity, chemical structure, mechanical and thermal properties, swelling capability and in vitro degradation behavior. The developed blended membranes exhibited high ductility, which is particular relevant considering the need for physical handling and adaptability to the defect. Moreover, the membranes were cultured with human periodontal ligament fibroblast cells (hPDLs) up to 7 days. Also, the higher hydrophilicity and consequent in vitro proteolytic degradability of these blends was superior to pure silk fibroin membranes. In particular SF/GLY blends demonstrated to support high cell adhesion and viability with an adequate hPDLs' morphology, make them excellent candidates for applications in periodontal regeneration.

Design and performance of a poly(vinyl alcohol)/silk fibroin enzymatically crosslinked semi-interpenetrating hydrogel for a potential hydrophobic drug delivery

In this study, in order to obtain hydrogels with good properties for sustained release of hydrophobic drugs or for tissue engineering, poly(vinyl alcohol) (PVA)/silk fibroin (SF) semi-interpenetrating (semi-IPN) hydrogels with varied ratios of PVA/SF were enzymatically cross-linked using horseradish peroxidase. A vial inversion test determined approximate gelation times of PVA/SF hydrogels ranging from 5 to 10 min. The hydrogels with varied ratios showed differences in pore size and morphology. Mass loss rate of hydrogels increased from 15% to 58% with increasing PVA concentration. Stable hydrogels with PVA/SF at 0.5 : 1 w/w showed the best swelling ratio values in distilled water (7.36). FTIR analysis revealed that silk fibroin in these hydrogels exhibited the coexistence of amorphous and silk I crystalline structures and the SF and PVA molecules interacted with each other well. The mechanical properties of the composite hydrogels were controlled by the SF content. From the cell viability results, it was found that the hydrogels exerted very low cytotoxicity. Paeonol was chosen as the hydrophobic drug model for release studies from the hydrogels. Paeonol can be uniformly loaded into the composite hydrogels using the emulsifying property of PVA and paeonol release from the hydrogels was dependent on the PVA/SF ratio. This study applied a novel type of enzymatically crosslinked semi-IPN hydrogel that may have potential applications in drug delivery.

Enzymatically cross-linked PVA/SF semi-IPN hydrogels with tunable pore structure have potential applications in sustained release of hydrophobic drug.

Recirculating peritoneal dialysis system using urease-fixed silk fibroin membrane filter with spherical carbonaceous adsorbent

The chronic kidney disease (CKD) patients are undergoing continuous ambulatory peritoneal dialysis (CAPD). However, there are some constraints, the frequent exchange of the dialysate and limitation of outside activity, associated with CAPD remain to be solved. In this study, we designed the wearable artificial kidney (WAK) system for peritoneal dialysis (PD) using urease-immobilized silk fibroin (SF) membrane and polymer-based spherical carbonaceous adsorbent (PSCA). We evaluated this kit's removal abilities of uremic toxins such as urea, creatinine, uric acid, phosphorus, and β2-microglobulin from the dialysate of end-stage renal disease (ESRD) patients in vitro. The uremic toxins including urea, creatinine, uric acid, and phosphorus were removed about 99% by immobilized SF membrane and PSCA filter after 24 h treatment. However, only 50% of β2-microglobulin was removed by this filtering system after 24 h treatment. In vivo study result shows that our filtering system has more uremic toxins removal efficiency than exchanged dialysate at every 6 h. We suggest that recirculating PD system using urease-immobilized SF membrane with PSCA could be more efficient than traditional dialysate exchange system for a WAK for PD.

In Vivo Investigation of Soft Tissue Response of Novel Silver/Poly(Vinyl Alcohol)/ Graphene and Silver/Poly(Vinyl Alcohol)/Chitosan/Graphene Hydrogels Aimed for Medical Applications – The First Experience

In this paper, we have shown for the fi rst time the soft tissue response of novel silver/ poly(vinyl alcohol)/graphene (Ag/PVA/Gr) and silver/poly(vinyl alcohol)/chitosan/ graphene (Ag/PVA/CHI/Gr) nanocomposite hydrogels aimed for medical applications. These novel hydrogels were produced by in situ electrochemical synthesis of silver nanoparticles in the polymer matrices as described in our previously published works. Both Ag/PVA/Gr and Ag/PVA/CHI/Gr, as well as controls Ag/PVA, Ag/PVA/CHI and commercial Suprasorb©hydrogel discs, were implanted in the subcutaneous tissue of rats. Implants with the surrounding tissue were dissected after post-implantation on days 7, 15, 30 and 60, and then processed for histological examination. The tissue irritation index (TIrI) score, according to ISO 10993-6, 2007, as well as the number of leukocytes in the peri-implant zone and connective tissue capsule thickness were examined. The results show that each TIrI score, the leukocyte number around the implanted materials and capsule thickness gradually decreased during the observation period. At the endpoint of follow-up, the Ag/PVA/CHI/Gr implant was surrounded with a thinner capsule, while both the TIrI score and the number of leukocytes of the peri-implant zone were greater compared to the Ag/PVA/Gr implant. Despite the observed differences, we can conclude that our in vivo experiment suggested that both novel hydrogels were biocompatible and suitable for medical use.

Chitosan-Based Nanofibrous Membrane Unit with Gradient Compositional and Structural Features for Mimicking Calcified Layer in Osteochondral Matrix

Chitosan (CH), silk fibroin (SF), and hydroxyapatite (HA) were used to prepare CH/SF/HA composites and the resulting composites were electrospun into nanofibrous membrane units with gradient compositional and structural features. The optimal membrane unit was used together with CH/HA and CH/SF composites to fabricate a type of three-layer scaffold that is intended for osteochondral repair. The bottom layer of the scaffold was built with CH/HA composites and it served as a subchondral layer, the integrated nanofibrous membrane unit functioned as the middle layer for mimicking the calcified layer and the top layer was constructed using CH/SF composites for acting as a chondral layer. The nanofibrous membrane unit was found to be permeable to some molecules with limited molecular weight and was able to prevent the seeded cells from migrating cross the unit, functioning approximately like the calcified layer in the osteochondral matrix. Layered scaffolds showed abilities to promote the growth of both chondrocytes and osteoblasts that were seeded in their chondral layer and bony layer, respectively, and they were also able to support the phenotype preservation of seeded chondrocytes and the mineralization of neotissue in the bony layer. Results suggest that this type of layered scaffolds can function as an analogue of the osteochondral matrix and it has potential in osteochondral repair.

Study on the morphological and biocompatible properties of chitosan grafted silk fibre reinforced PVA films for tissue engineering applications

The current study delineates the preparation of novel chitosan grafted silk fibre reinforced Poly (vinyl alcohol) (PVA) composite films with desirable properties. Although silk fibroin has been extensively used for various biomedical applications, its properties could be further re-tailored for its suitability in the field of regenerative medicine. Chitosan was successfully grafted over silk, via acylation with succinic anhydride and thereby the fibres were incised and used for the preparation of the films. The grafted silk fibre reinforced PVA films were subjected to FTIR studies, microscopic analysis by atomic force microscopy (AFM) and optical microscopy techniques, X-ray diffraction (XRD) analysis and further evaluated for in vitro biocompatibility studies. The composite films demonstrated improved surface roughness with increasing concentration of the fibre and its dispersion in the polymer matrix was observed. Furthermore, in vitro biocompatibility and cellular behaviour such as adhesion and proliferation of mouse fibroblasts as well as astrocyte cells was studied and the results showed improved proliferative activity, when compared to the pristine PVA films. These results were further supported by the results confirmed by MTT assay demonstrating the films to be non-toxic. The efficiency and feasibility of the films to be used for tissue engineering, was further evaluated by haemocompatibility studies using human erythrocytes, thus making them a potential material to be used for biomedical applications.