3D Bioprinted Chitosan-Based Hydrogel Scaffolds in Tissue Engineering and Localised Drug Delivery

"Biological evaluation of 3D-Printed chitosan-based scaffolds for tissue engineering"

Chitosan is a natural polysaccharide with excellent biocompatibility, biodegradability, and antibacterial capabilities, making it a good candidate for tissue engineering. 3D printing has revolutionized biomaterial fabrication owing to its precision, customization, and ability to create complex structures. This article aims to provide an overview of the current advances in 3D printing techniques for fabricating scaffolds based on chitosan and its derivatives. It also describes various printing methods, including extrusion bioprinting technique, inkjet bioprinting, stereolithography, digital light processing, and indirect 3D printing for controlling porosity, mechanical strength, and biological characteristics of chitosan scaffolds for a variety of tissues, like bone, vascular, cardiac, cartilage, and skin. This review also examines the biological properties of 3D-printed chitosan scaffolds. The advancements in biological performance and 3D printing technology indicate a promising future for developing flexible, customized scaffolds consisting of chitosan.

Carboxymethyl Chitosan and Chitosan as a Bioactive Delivery System: A Review

The functionality and mechanism of bioactive agents (BA) in treating various diseases have been studied as a progressive route. Designing an effective delivery system for transferring these molecules and components is a major challenge. For that reason, a wide range of biomaterials has been introduced to deliver BA to the target tissue or cells. Chitosan (CTS) is a nontoxic, biocompatible, biodegradable, and notable point low-cost polymer, and, as a result, can be effectively utilized in the formulation of diverse delivery systems, in biomedical applications. However, CTS has some limitations, such as poor solubility in aqueous and alkaline media, rapid swelling and degradation, and consequence fast release agent. The CTS derivative carboxymethyl chitosan (CMC) is an acceptable candidate for overcoming these limitations. CMC is a high-impact grade for pharmaceutical and biomedical applications because of its nontoxic, biocompatible, biodegradable, gelation, mucoadhesive, antibacterial, and antifungal. CMC bioactivity potentials are related to carboxyl and methyl groups added through chemical modification in the CTS backbone. In this review, the physical and chemical properties of CTS and CMC have been introduced and discussed. Afterward, its biomedical applications with delivery approaches for various BA (drugs, genes, proteins), microfluidic, and cancer have been considered.

Innovating chitosan-based bioinks for dermal wound healing: Current progress and future prospects

The field of three-dimensional (3D) bio/printing, known as additive manufacturing (AM), heavily relies on bioinks possessing suitable mechanical properties and compatibility with living cells. Among the array of potential hydrogel precursor materials, chitosan (CS) has garnered significant attention due to its remarkable physicochemical and biological attributes. These attributes include biodegradability, nontoxicity, antimicrobial properties, wound healing promotion, and immune system activation, making CS a highly appealing hydrogel-based bioink candidate. This review explores the transformative potential of CS-based bioink for enhancing dermal wound healing therapies. We highlight CS's unique qualities that make it an optimal choice for bioink development. Advancements in 3D bio/printing technology for tissue engineering (TE) are discussed, followed by an examination of strategies for CS-based bioink formulation and their impacts on wound healing. To address the progress in translating advanced wound healing from lab to clinic, we highlight the current and ongoing research in CS-based bioink for 3D bio/printing in skin wound healing applications. Finally, we explore current evidence, commercialization prospects, emerging innovations like 4D printing, and the challenges and future directions in this promising field.

Chitosan-based structures for skin repair: A literature review

The use of chitosan in technological and biomedical applications has gained significant relevance due to its functional properties. Among its biological activities, its hemostatic, analgesic, antibacterial and anti-inflammatory activities make this natural biopolymer one of the most promising in the development of structures for skin repair. Its application and effects can be optimized by exploring efficient structuring techniques. In this context, this review is based on scientific evidence reported in the last decade regarding the development and use of chitosan-based structures in the skin repair process to show the most common structuring methods, the main mechanisms of action of chitosan, and its potential applications in skin repair processes. Additionally, this article brings a compilation of scientific and commercial works on the use of chitosan-based structures, in addition to vitro and/or in vivo results.

Harnessing Theraoenergetics for Cartilage Regeneration: Development of a Therapeutic and Bioenergetic Loaded Janus Nanofiber Reinforced Hydrogel Composite for Cartilage Regeneration

Advancements in tissue engineering and regenerative medicine have highlighted different strategies of engineering and designing hydrogels to replicate the intricate structure of cartilage extracellular matrix (ECM) for effective cartilage regeneration. However, despite efforts to meet the elevated structural and mechanical demands of cartilage repair, researchers often overlook the challenging environmental conditions at damaged cartilage sites such as inflammation, hypoxia, and the limited availability of nutrients and energy, which are critical for supporting tissue regeneration. The insufficient oxygen, nutrient availability, and oxidative stress in avascular cartilage limit the oxidative phosphorylation-mediated bioenergetics in cells needed for energy demands required for anabolic biosynthesis, cell division, and migration during tissue repair. Thus, there is a need to develop an advanced approach to engineer a unique hydrogel system that not only provides intricate structural properties but also integrates therapeutics (like anti-inflammatory, reactive oxygen species (ROS) scavenging) and bioenergetics (like oxygen, energy demand) into the hydrogel, which may offer a holistic and effective solution for repairing cartilage defects under a harsh microenvironment. In this study, we engineered an innovative approach to develop a new class of theraoenergetic hydrogel system by reinforcing a Janus nanofiber (JNF) carrying therapeutic (MgO) and bioenergetic (polyglutamic acid), PGA) components into a dual network photo-crosslinkable hydrogel. Reinforcement of JNF microfragments and the photo-crosslinking dual network of synthesized gelatin methacryloyl (GelMA) and carboxymethyl chitosan (CMCh) not only enhances the hydrogel's mechanical properties by 800% to withstand mechanical load but also ensures a controlled release of magnesium, oxygen, and PGA over 30 days. Co-delivery of magnesium and bioenergetic PGA with oxygen helped synergistically to reduce intracellular ROS and inflammatory markers IL-6 and TNF-α, providing a supportive environment for enhancing cell mitochondrial oxidative metabolism leading to active proliferation and chondrogenic differentiation of stem cells to deposit glycosaminoglycan (GAG)-rich extracellular matrix to regenerate cartilage. The developed theraoenergetic hydrogel system represents a promising solution for regenerating cartilage under a harsh microenvironment to treat osteoarthritis, a rising global health burden.

Advances in 3D bioprinting to enhance translational applications in bone tissue engineering and regenerative medicine

Bone defects are due to trauma, infections, tumors, or aging, including bone fractures, bone metastases, osteoporosis, or osteoarthritis. The global burden of these demands research into innovative strategies that overcome the limitations of conventional autografts. In this sense, the development of three-dimensional (3D) bioprinting has emerged as a promising approach in the field of tissue engineering and regenerative medicine (TERM) for the on-demand generation and transplantation of tissues and organs, including bone. It combines biological materials and living cells, which are precisely positioned layer by layer. Despite obtaining some promising results, 3D bioprinting of bone tissue still faces several challenges, such as generating an effective vascular network to increase tissue viability. In this review, we aim to collect the main knowledge on methods and techniques of 3D bioprinting. Then, we will review the main biomaterials, their composition, and the rationale for their application in 3D bioprinting for the TERM of bone.

3D Bioprinting a Novel Skin Co-Culture Model Using Human Keratinocytes and Fibroblasts

3D bioprinting can generate the organized structures found in human skin for a variety of biological, medical, and pharmaceutical applications. Challenges in bioprinting skin include printing different types of cells in the same construct while maintaining their viability, which depends on the type of bioprinter and bioinks used. This study evaluated a novel 3D bioprinted skin model containing human keratinocytes (HEKa) and human dermal fibroblasts (HDF) in co-culture (CC) using a high-viscosity fibrin-based bioink produced using the BioX extrusion-based bioprinter. The constructs containing HEKa or HDF cells alone (control groups) and in CC were evaluated at 1, 10, and 20 days after bioprinting for viability, immunocytochemistry for specific markers (K5 and K10 for keratinocytes; vimentin and fibroblast specific protein [FSP] for fibroblasts). The storage, loss modulus, and viscosity properties of the constructs were also assessed to compare the effects of keratinocytes and fibroblasts individually and combined, providing important insights when bioprinting skin. Our findings revealed significantly higher cell viability in the CC group compared to individual keratinocyte and fibroblast groups, suggesting the combined cell presence enhanced survival rates. Additionally, proliferation rates of both cell types remained consistent over time, indicating non-competitive growth within the construct. Interestingly, keratinocytes exhibited a greater impact on the viscoelastic properties of the construct compared to fibroblasts, likely due to their larger size and arrangement. These insights contribute to optimizing bioprinting strategies for skin tissue engineering and emphasize the important role of different cell types in 3D skin models.

Chitosan-Based Hydrogels as Antibacterial/Antioxidant/Anti-Inflammation Multifunctional Dressings for Chronic Wound Healing

Due to repeated microbial infection, persistent inflammation, excessive oxidative stress, and cell dysfunction, chronic wounds are difficult to heal, posing a serious threat to public health. Therefore, developing multifunctional wound dressings that can regulate the complex microenvironment of chronic wounds and enhance cellular function holds great significance. Recently, chitosan has emerged as a promising biopolymer for wound healing due to its excellent biocompatibility, biodegradability, and versatile bioactivity. The aim of this review is to provide a comprehensive understanding of the mechanisms of delayed chronic wound healing and discuss the healing-promoting properties of chitosan and its derivatives, such as good biocompatibility, antibacterial activity, hemostatic capacity, and the ability to promote tissue regeneration. On this basis, the potential applications of chitosan-based hydrogels are summarized in chronic wound healing, including providing a suitable microenvironment, eliminating bacterial infections, promoting hemostasis, inhibiting chronic inflammation, alleviating oxidative stress, and promoting tissue regeneration. In addition, the concerns and perspectives for the clinical application of chitosan-based hydrogels are also discussed.

Gelatin Methacrylic Acid Hydrogel-Based Nerve Growth Factors Enhances Neural Stem Cell Growth and Differentiation to Promote Repair of Spinal Cord Injury

Background

The challenge in treating irreversible nerve tissue damage has resulted in suboptimal outcomes for spinal cord injuries (SCI), underscoring the critical need for innovative treatment strategies to offer hope to patients.

Methods

In this study, gelatin methacrylic acid hydrogel scaffolds loaded with nerve growth factors (GMNF) were prepared and used to verify the performance of SCI. The physicochemical and biological properties of the GMNF were tested. The effect of GMNF on activity of neuronal progenitor cells (NPCs) was investigated in vitro. Histological staining and motor ability was carried out to assess the ability of SCI repair in SCI animal models.

Results

Achieving nerve growth factors sustained release, GMNF had good biocompatibility and could effectively penetrate into the cells with good targeting permeability. GMNF could better enhance the activity of NPCs and promote their directional differentiation into mature neuronal cells in vitro, which could exert a good neural repair function. In vivo, SCI mice treated with GMNF recovered their motor abilities more effectively and showed better wound healing by macroscopic observation of the coronal surface of their SCI area. Meanwhile, the immunohistochemistry demonstrated that the GMNF scaffolds effectively promoted SCI repair by better promoting the colonization and proliferation of neural stem cells (NSCs) in the SCI region and targeted differentiation into mature neurons.

Conclusion

The application of GMNF composite scaffolds shows great potential in SCI treatment, which are anticipated to be a potential therapeutic bioactive material for clinical application in repairing SCI in the future.

Advances and Challenges of Bioassembly Strategies in Neurovascular In Vitro Modeling: An Overview of Current Technologies with a Focus on Three-Dimensional Bioprinting

Bioassembly encompasses various techniques such as bioprinting, microfluidics, organoids, and self-assembly, enabling advances in tissue engineering and regenerative medicine. Advancements in bioassembly technologies have enabled the precise arrangement and integration of various cell types to more closely mimic the complexity functionality of the neurovascular unit (NVU) and that of other biodiverse multicellular tissue structures. In this context, bioprinting offers the ability to deposit cells in a spatially controlled manner, facilitating the construction of interconnected networks. Scaffold-based assembly strategies provide structural support and guidance cues for cell growth, enabling the formation of complex bio-constructs. Self-assembly approaches utilize the inherent properties of cells to drive the spontaneous organization and interaction of neuronal and vascular components. However, recreating the intricate microarchitecture and functional characteristics of a tissue/organ poses additional challenges. Advancements in bioassembly techniques and materials hold great promise for addressing these challenges. The further refinement of bioprinting technologies, such as improved resolution and the incorporation of multiple cell types, can enhance the accuracy and complexity of the biological constructs; however, developing bioinks that support the growth of cells, viability, and functionality while maintaining compatibility with the bioassembly process remains an unmet need in the field, and further advancements in the design of bioactive and biodegradable scaffolds will aid in controlling cell adhesion, differentiation, and vascularization within the engineered tissue. Additionally, integrating advanced imaging and analytical techniques can provide real-time monitoring and characterization of bioassembly, aiding in quality control and optimization. While challenges remain, ongoing research and technological advancements propel the field forward, paving the way for transformative developments in neurovascular research and tissue engineering. This work provides an overview of the advancements, challenges, and future perspectives in bioassembly for fabricating neurovascular constructs with an add-on focus on bioprinting technologies.

Chitosan/poly-γ-glutamic acid crosslinked hydrogels: Characterization and application as bio-glues

Ecofriendly hydrogels were prepared using chitosan (CH, 285 kDa) and two fractions of low molecular weight microbial poly-γ-glutamic acid (γ-PGA) (R1 and R2 of 59 kDa and 20 kDa, respectively). The hydrogels were synthesized through sustainable physical blending, employing three CH/γ-PGA mass ratios (1/9, 2/8, and 3/7), resulting in the formation of physically crosslinked materials. The six resulting CH/R1 and CH/R2 hydrogels were physico-chemically characterized and the ones with the highest yields (CH/R1 and CH/R2 ratio of 3/7), analyzed for rheological and morphological properties, showed to act as bio-glues on wood and aluminum compared to commercial vinyl- (V1) and acetovinyl (V2) glues. Lap shear analyses of CH/R1 and CH/R2 blends exhibited adhesive strength on wood, as well as adhesive/cohesive failure like that of V1 and V2. Conversely, CH/R2 had higher adhesive strength and adhesive/cohesive failure on aluminum, while CH/R1 showed an adhesion strength with adhesive failure on the metal similar to that of V1 and V2. Scanning electron microscopy revealed the formation of strong physical bonds between the hydrogels and both substrates. Beyond their use as bio-adhesives, the unique properties of the resulting crosslinked materials make them potentially suitable for various applications in paint, coatings, heritage preservation, and medical sector.

Natural Rubber Films Reinforced with Cellulose and Chitosan Prepared by Latex Aqueous Microdispersion

In this paper, green composite films comprising natural rubber (NR), cellulose (CE), and chitosan (CS) were successfully fabricated through a simple, facile, cost-effective method in order to improve mechanical, chemical, and antimicrobial properties of NR composite films. Chitosan with a low molecular weight of 30,000-50,000 g/mol (CS-L) and a medium molecular weight of 300,000-500,000 g/mol (CS-M) was used for the fabrication. The composite films were prepared via a latex aqueous microdispersion method with different weight ratios of NR:CE:CS-L/CS-M. Fourier transform infrared spectroscopy (FTIR) results demonstrated strong interactions of hydrogen bonds between CE and CS-L/CS-M in the composite films. The tensile strength and the modulus of the composite films in dried form were found to significantly increase with the reinforcement of CE and CS-L/CS-M. The maximum tensile strength (13.8 MPa) and Young's modulus (12.7 MPa) were obtained from the composite films reinforced with CE at 10 wt.% and CS-L at 10 wt.%. The high elongation of 500-526% was obtained from the composite films reinforced with CE at 10 wt.% and CS (CS-L or CS-M) at 5.0 wt.%. The modification could also significantly promote antimicrobial activities and chemical resistance against non-polar solvents in the composite films. The NR composite films have potential uses as flexible films for sustainable green packaging.

A Microenvironment-Responsive, Controlled Release Hydrogel Delivering Embelin to Promote Bone Repair of Periodontitis via Anti-Infection and Osteo-Immune Modulation

Periodontitis, a prevalent chronic inflammatory disease, poses significant challenges for effective treatment due to its complex etiology involving specific bacteria and the inflammatory immune microenvironment. Here, this study presents a novel approach for the targeted treatment of periodontitis utilizing the immunomodulatory and antibacterial properties of Embelin, a plant-derived compound, within an injectable hydrogel system. The developed Carboxymethyl Chitosan-Oxidized Dextran (CMCS-OD) hydrogel formed via dynamic chemical bonds exhibited self-healing capabilities and pH-responsive behavior, thereby facilitating the controlled release of Embelin and enhancing its efficacy in a dynamic oral periodontitis microenvironment. This study demonstrates that this hydrogel system effectively prevents bacterial invasion and mitigates excessive immune response activation. Moreover, it precisely modulates macrophage M1/M2 phenotypes and suppresses inflammatory cytokine expression, thereby fostering a conducive environment for bone regeneration and addressing periodontitis-induced bone loss. These findings highlight the potential of the approach as a promising strategy for the clinical management of periodontitis-induced bone destruction.

The Impact of the Methacrylation Process on the Usefulness of Chitosan as a Biomaterial Component for 3D Printing

Chitosan is a very promising material for tissue model printing. It is also known that the introduction of chemical modifications to the structure of the material in the form of methacrylate groups makes it very attractive for application in the bioprinting of tissue models. The aim of this work is to study the characteristics of biomaterials containing chitosan (BCH) and its methacrylated equivalent (BCM) in order to identify differences in their usefulness in 3D bioprinting technology. It has been shown that the BCM material containing methacrylic chitosan is three times more viscous than its non-methacrylated BCH counterpart. Additionally, the BCM material is characterized by stability in a larger range of stresses, as well as better printability, resolution, and fiber stability. The BCM material has higher mechanical parameters, both mechanical strength and Young's modulus, than the BCH material. Both materials are ideal for bioprinting, but BCM has unique rheological properties and significant mechanical resistance. In addition, biological tests have shown that the addition of chitosan to biomaterials increases cell proliferation, particularly in 3D-printed models. Moreover, modification in the form of methacrylation encourages reduced toxicity of the biomaterial in 3D constructs. Our investigation demonstrates the suitability of a chitosan-enhanced biomaterial, specifically methacrylate-treated, for application in tissue engineering, and particularly for tissues requiring resistance to high stress, i.e., vascular or cartilage models.

Bioinks for bioprinting using plant-derived biomaterials

Three-dimensional (3D) bioprinting has revolutionized tissue engineering by enabling the fabrication of complex and functional human tissues and organs. An essential component of successful 3D bioprinting is the selection of an appropriate bioink capable of supporting cell proliferation and viability. Plant-derived biomaterials, because of their abundance, biocompatibility, and tunable properties, hold promise as bioink sources, thus offering advantages over animal-derived biomaterials, which carry immunogenic concerns. This comprehensive review explores and analyzes the potential of plant-derived biomaterials as bioinks for 3D bioprinting of human tissues. Modification and optimization of these materials to enhance printability and biological functionality are discussed. Furthermore, cancer research and drug testing applications of the use of plant-based biomaterials in bioprinting various human tissues such as bone, cartilage, skin, and vascular tissues are described. Challenges and limitations, including mechanical integrity, cell viability, resolution, and regulatory concerns, along with potential strategies to overcome them, are discussed. Additionally, this review provides insights into the potential use of plant-based decellularized ECM (dECM) as bioinks, future prospects, and emerging trends in the use of plant-derived biomaterials for 3D bioprinting applications. The potential of plant-derived biomaterials as bioinks for 3D bioprinting of human tissues is highlighted herein. However, further research is necessary to optimize their processing, standardize their properties, and evaluate their long-termin vivoperformance. Continued advancements in plant-derived biomaterials have the potential to revolutionize tissue engineering and facilitate the development of functional and regenerative therapies for diverse clinical applications.

Harnessing Biopolymer Gels for Theranostic Applications: Imaging Agent Integration and Real-Time Monitoring of Drug Delivery

Biopolymer gels have gained tremendous potential for therapeutic applications due to their biocompatibility, biodegradability, and ability to adsorb and bind biological fluids, making them attractive for drug delivery and therapy. In this study, the versatility of biopolymer gels is explored in theranostic backgrounds, with a focus on integrating imaging features and facilitating real-time monitoring of drug delivery. Different methods of delivery are explored for incorporating imaging agents into biopolymer gels, including encapsulation, surface functionalization, nanoparticle encapsulation, and layer-by-layer assembly techniques. These methods exhibit the integration of agents and real-time monitoring drug delivery. We summarize the synthesis methods, general properties, and functional mechanisms of biopolymer gels, demonstrating their broad applications as multimodal systems for imaging-based therapeutics. These techniques not only enable multiple imaging but also provide signal enhancement and facilitate imaging targets, increasing the diagnostic accuracy and therapeutic efficacy. In addition, current techniques for incorporating imaging agents into biopolymer gels are discussed, as well as their role in precise drug delivery and monitoring.

Bioprinting: Mechanical Stabilization and Reinforcement Strategies in Regenerative Medicine

Bioprinting describes the printing of biomaterials and cell-laden or cell-free hydrogels with various combinations of embedded bioactive molecules. It encompasses the precise patterning of biomaterials and cells to create scaffolds for different biomedical needs. There are many requirements that bioprinting scaffolds face, and it is ultimately the interplay between the scaffold's structure, properties, processing, and performance that will lead to its successful translation. Among the essential properties that the scaffolds must possess-adequate and appropriate application-specific chemical, mechanical, and biological performance-the mechanical behavior of hydrogel-based bioprinted scaffolds is the key to their stable performance in vivo at the site of implantation. Hydrogels that typically constitute the main scaffold material and the medium for the cells and biomolecules are very soft, and often lack sufficient mechanical stability, which reduces their printability and, therefore, the bioprinting potential. The aim of this review article is to highlight the reinforcement strategies that are used in different bioprinting approaches to achieve enhanced mechanical stability of the bioinks and the printed scaffolds. Enabling stable and robust materials for the bioprinting processes will lead to the creation of truly complex and remarkable printed structures that could accelerate the application of smart, functional scaffolds in biomedical settings. Impact statement Bioprinting is a powerful tool for the fabrication of 3D structures and scaffolds for biomedical applications. It has gained tremendous attention in recent years, and the bioink library is expanding to include more and more material combinations. From the practical application perspective, different properties need to be considered, such as the printed structure's chemical, mechanical, and biological performances. Among these, the mechanical behavior of the printed constructs is critical for their successful translation into the clinic. The aim of this review article is to explore the different reinforcement strategies used for the mechanical stabilization of bioinks and bioprinted structures.

Electrospun Gelatin Scaffolds with Incorporated Antibiotics for Skin Wound Healing

Recent advances in regenerative medicine provide encouraging strategies to produce artificial skin substitutes. Gelatin scaffolds are successfully used as wound-dressing materials due to their superior properties, such as biocompatibility and the ability to mimic the extracellular matrix of the surrounding environment. In this study, five gelatin combination solutions were prepared and successfully electrospun using an electrospinning technique. After careful screening, the optimal concentration of the most promising combination was selected for further investigation. The obtained scaffolds were crosslinked with 25% glutaraldehyde vapor and characterized by scanning electron microscopy, energy-dispersive X-ray spectroscopy, and Fourier-transform infrared spectroscopy. The incorporation of antibiotic agents such as ciprofloxacin hydrochloride and gentamicin sulfate into gelatin membranes improved the already existing antibacterial properties of antibiotic-free gelatin scaffolds against Pseudomonas aeruginosa and Staphylococcus aureus. Also, the outcomes from the in vivo model study revealed that skin regeneration was significantly accelerated with gelatin/ciprofloxacin scaffold treatment. Moreover, the gelatin nanofibers were found to strongly promote the neoangiogenic process in the in vivo chick embryo chorioallantoic membrane assay. Finally, the combination of gelatin's extracellular matrix and antibacterial agents in the scaffold suggests its potential for effective wound-healing treatments, emphasizing the importance of gelatin scaffolds in tissue engineering.

Hydrogels in Gene Delivery Techniques for Regenerative Medicine and Tissue Engineering

Hydrogels are 3D networks swollen with water. They are biocompatible, strong, and moldable and are emerging as a promising biomedical material for regenerative medicine and tissue engineering to deliver therapeutic genes. The excellent natural extracellular matrix simulation properties of hydrogels enable them to be co-cultured with cells or enhance the expression of viral or non-viral vectors. Its biocompatibility, high strength, and degradation performance also make the action process of carriers in tissues more ideal, making it an ideal biomedical material. It has been shown that hydrogel-based gene delivery technologies have the potential to play therapy-relevant roles in organs such as bone, cartilage, nerve, skin, reproductive organs, and liver in animal experiments and preclinical trials. This paper reviews recent articles on hydrogels in gene delivery and explains the manufacture, applications, developmental timeline, limitations, and future directions of hydrogel-based gene delivery techniques.

Engineered Bio-Based Hydrogels for Cancer Immunotherapy

Immunotherapy represents a revolutionary paradigm in cancer management, showcasing its potential to impede tumor metastasis and recurrence. Nonetheless, challenges including limited therapeutic efficacy and severe immune-related side effects are frequently encountered, especially in solid tumors. Hydrogels, a class of versatile materials featuring well-hydrated structures widely used in biomedicine, offer a promising platform for encapsulating and releasing small molecule drugs, biomacromolecules, and cells in a controlled manner. Immunomodulatory hydrogels present a unique capability for augmenting immune activation and mitigating systemic toxicity through encapsulation of multiple components and localized administration. Notably, hydrogels based on biopolymers have gained significant interest owing to their biocompatibility, environmental friendliness, and ease of production. This review delves into the recent advances in bio-based hydrogels in cancer immunotherapy and synergistic combinatorial approaches, highlighting their diverse applications. It is anticipated that this review will guide the rational design of hydrogels in the field of cancer immunotherapy, fostering clinical translation and ultimately benefiting patients.

Advancements in application of chitosan and cyclodextrins in biomedicine and pharmaceutics: recent progress and future trends

The global community is faced with numerous health concerns such as cancer, cardiovascular and neurological diseases, diabetes, joint pain, osteoporosis, among others. With the advancement of research in the fields of materials chemistry and medicine, pharmaceutical technology and biomedical analysis have entered a new stage of development. The utilization of natural oligosaccharides and polysaccharides in pharmaceutical/biomedical studies has gained significant attention. Over the past decade, several studies have shown that chitosan and cyclodextrin have promising biomedical implications in background analysis, ongoing development, and critical applications in biomedical and pharmaceutical research fields. This review introduces different types of saccharides/natural biopolymers such as chitosan and cyclodextrin and discusses their wide-ranging applications in the biomedical/pharmaceutical research area. Recent research advances in pharmaceutics and drug delivery based on cyclodextrin, and their response to smart stimuli, as well as the biological functions of cyclodextrin and chitosan, such as the immunomodulatory effects, antioxidant, and antibacterial properties, have also been discussed, along with their applications in tissue engineering, wound dressing, and drug delivery systems. Finally, the innovative applications of chitosan and cyclodextrin in the pharmaceutical/biomedicine were reviewed, and current challenges, research/technological gaps, and future development opportunities were surveyed.

Core-Shell Structure of Photopolymer-Grafted Polyurethane as a Controlled Drug Delivery Vehicle for Biomedical Application

Functionalized ultraviolet photocurable bisphenol A-glycerolate dimethacrylates with tailorable size have been synthesized as the core, which have further been grafted using the diisocyanate chain end of polyurethane (PU) as the shell to create a core-shell structure of tunable size for a controlled drug delivery vehicle. The core-shell structure has been elucidated through spectroscopic techniques like 1H NMR, FTIR, and UV-vis and their relative shape and size through TEM and AFM morphology. The greater cross-link density of the core is reflected in the higher glass transition temperature, and the improved thermal stability of the graft copolymer is proven from its thermogravimetric analyses. The flow behavior and enhanced strength of the graft copolymers have been revealed from rheological measurements. The graft copolymer exhibits sustained release of the drug, as compared to pure polyurethane and photopolymer, arising from its core-shell structure and strong interaction between the copolymer and drug, as observed through a significant shifting of absorption peaks in FTIR and UV-vis measurements. Biocompatibility has been tested for the real application of the novel graft copolymer in medical fields, as revealed from MTT assay, cell imaging, and cell adhesion studies. The efficacy of controlled release from a graft copolymer has been verified from the gradual cell killing and ∼70% killing in 3 days vs meager cell killing of ∼25% very quickly in 1 day, followed by the increased cell viability of the system treated with the pure drug. The mechanism of slow and controlled drug release from the core-shell structure has been explored. The fluorescence images support the higher cell-killing efficiency as opposed to a pure drug or a drug embedded in polyurethane. Cells seeded on 3D scaffolds have been developed by embedding a graft copolymer, and fluorescence imaging confirms the successful growth of cells within the scaffold, realizing the potential of the core-shell graft copolymer in the biomedical arena.

Chitosan-based nanofibrous scaffolds for biomedical and pharmaceutical applications: A comprehensive review

Nowadays, there is a wide range of deficiencies in treatment of diseases. These limitations are correlated with the inefficient ability of current modalities in the prognosis, diagnosis, and treatment of diseases. Therefore, there is a fundamental need for the development of novel approaches to overcome the mentioned restrictions. Chitosan (CS) nanoparticles, with remarkable physicochemical and mechanical properties, are FDA-approved biomaterials with potential biomedical aspects, like serum stability, biocompatibility, biodegradability, mucoadhesivity, non-immunogenicity, anti-inflammatory, desirable pharmacokinetics and pharmacodynamics, etc. CS-based materials are mentioned as ideal bioactive materials for fabricating nanofibrous scaffolds. Sustained and controlled drug release and in situ gelation are other potential advantages of these scaffolds. This review highlights the latest advances in the fabrication of innovative CS-based nanofibrous scaffolds as potential bioactive materials in regenerative medicine and drug delivery systems, with an outlook on their future applications.

Three-Dimensional Bioprinting: The Ultimate Pinnacle of Tissue Engineering

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

The 3-dimensional printing for dental tissue regeneration: the state of the art and future challenges

Tooth loss or damage poses great threaten to oral and general health. While contemporary clinical treatments have enabled tooth restoration to a certain extent, achieving functional tooth regeneration remains a challenging task due to the intricate and hierarchically organized architecture of teeth. The past few decades have seen a rapid development of three-dimensional (3D) printing technology, which has provided new breakthroughs in the field of tissue engineering and regenerative dentistry. This review outlined the bioactive materials and stem/progenitor cells used in dental regeneration, summarized recent advancements in the application of 3D printing technology for tooth and tooth-supporting tissue regeneration, including dental pulp, dentin, periodontal ligament, alveolar bone and so on. It also discussed current obstacles and potential future directions, aiming to inspire innovative ideas and encourage further development in regenerative medicine.

Hydrogel-mediated extracellular vesicles for enhanced wound healing: the latest progress, and their prospects for 3D bioprinting

Extracellular vesicles have shown promising tissue recovery-promoting effects, making them increasingly sought-after for their therapeutic potential in wound treatment. However, traditional extracellular vesicle applications suffer from limitations such as rapid degradation and short maintenance during wound administration. To address these challenges, a growing body of research highlights the role of hydrogels as effective carriers for sustained extracellular vesicle release, thereby facilitating wound healing. The combination of extracellular vesicles with hydrogels and the development of 3D bioprinting create composite hydrogel systems boasting excellent mechanical properties and biological activity, presenting a novel approach to wound healing and skin dressing. This comprehensive review explores the remarkable mechanical properties of hydrogels, specifically suited for loading extracellular vesicles. We delve into the diverse sources of extracellular vesicles and hydrogels, analyzing their integration within composite hydrogel formulations for wound treatment. Different composite methods as well as 3D bioprinting, adapted to varying conditions and construction strategies, are examined for their roles in promoting wound healing. The results highlight the potential of extracellular vesicle-laden hydrogels as advanced therapeutic tools in the field of wound treatment, offering both mechanical support and bioactive functions. By providing an in-depth examination of the various roles that these composite hydrogels can play in wound healing, this review sheds light on the promising directions for further research and development. Finally, we address the challenges associated with the application of composite hydrogels, along with emerging trends of 3D bioprinting in this domain. The discussion covers issues such as scalability, regulatory considerations, and the translation of this technology into practical clinical settings. In conclusion, this review underlines the significant contributions of hydrogel-mediated extracellular vesicle therapy to the field of 3D bioprinting and wound healing and tissue regeneration. It serves as a valuable resource for researchers and practitioners alike, fostering a deeper understanding of the potential benefits, applications, and challenges involved in utilizing composite hydrogels for wound treatment.

The Electrical and Mechanical Characteristics of Conductive PVA/PEDOT:PSS Hydrogel Foams for Soft Strain Sensors

Conductive hydrogels are of interest for highly flexible sensor elements. We compare conductive hydrogels and hydrogel foams in view of strain-sensing applications. Polyvinyl alcool (PVA) and poly(3,4-ethylenedioxythiophene (PEDOT:PSS) are used for the formulation of conductive hydrogels. For hydrogel foaming, we have investigated the influence of dodecylbenzenesulfonate (DBSA) as foaming agent, as well as the influence of air incorporation at various mixing speeds. We showed that DBSA acting as a surfactant, already at a concentration of 1.12wt%, efficiently stabilizes air bubbles, allowing for the formulation of conductive PVA and PVA/PEDOT:PSS hydrogel foams with low density (<400 kg/m3) and high water uptake capacity (swelling ratio > 1500%). The resulting Young moduli depend on the air-bubble incorporation from mixing, and are affected by freeze-drying/rehydration. Using dielectric broadband spectroscopy under mechanical load, we demonstrate that PVA/PEDOT:PSS hydrogel foams exhibit a significant decrease in conductivity under mechanical compression, compared to dense hydrogels. The frequency-dependent conductivity of the hydrogels exhibits two plateaus, one in the low frequency range, and one in the high frequency range. We find that the conductivity of the PVA/PEDOT:PSS hydrogels decreases linearly as a function of pressure in each of the frequency regions, which makes the hydrogel foams highly interesting in view of compressive strain-sensing applications.

Review on chitosan-based antibacterial hydrogels: Preparation, mechanisms, and applications

Chitosan (CS) is known for its remarkable properties, such as good biocompatibility, biodegradability, and renewability, in addition to its antibacterial and biological activities. However, as CS is insoluble in water, it displays limited antibacterial performance under neutral and physiological conditions. A viable solution to this problem is grafting chemically modified groups onto the CS framework, thereby increasing its solubility and enhancing its antibacterial effect. Herein, the antibacterial action mechanism of CS and its derivatives is reviewed, confirming the prevalent use of composite materials comprising CS and its derivatives as an antibacterial agent. Generally, the antimicrobial ability of CS-based biomaterials can be enhanced by incorporating supplementary polymers and antimicrobial agents. Research on CS-based composite biomaterials is ongoing and numerous types of biomaterials have been reported, including inorganic nanoparticles, antibacterial agents, and CS derivatives. The development of these composite materials has considerably expanded the application of CS-based antibacterial materials. This study reviews the latest progress in research regarding CS-based composite hydrogels for wound repair, tissue engineering, drug release, water purification, and three-dimensional printing applications. Finally, the summary and future outlook of CS-based antibacterial hydrogels are presented in anticipation of a broader range of applications of CS-based antibacterial hydrogels.

Recent advances in chitosan-based materials; The synthesis, modifications and biomedical applications

The attention to polymer-based biomaterials, for instance, chitosan and its derivatives, as well as the techniques for using them in numerous scientific domains, is continuously rising. Chitosan is a decomposable naturally occurring polymeric material that is mostly obtained from seafood waste. Because of its special ecofriendly, biocompatible, non- toxic nature as well as antimicrobial properties, chitosan-based materials have received a lot of interest in the field of biomedical applications. The reactivity of chitosan is mainly because of the amino and hydroxyl groups in its composition, which makes it further fascinating for various uses, including biosensing, textile finishing, antimicrobial wound dressing, tissue engineering, bioimaging, gene, DNA and drug delivery and as a coating material for medical implants. This study is an overview of the different types of chitosan-based materials which now a days have been fabricated by applying different techniques and modifications that include etherification, esterification, crosslinking, graft copolymerization and o-acetylation etc. for hydroxyl groups' processes and acetylation, quaternization, Schiff's base reaction, and grafting for amino groups' reactions. Furthermore, this overview summarizes the literature from recent years related to the important applications of chitosan-based materials (i.e., thin films, nanocomposites or nanoparticles, sponges and hydrogels) in different biomedical applications.

Biopolymers for Tissue Engineering: Crosslinking, Printing Techniques, and Applications

Currently, tissue engineering has been dedicated to the development of 3D structures through bioprinting techniques that aim to obtain personalized, dynamic, and complex hydrogel 3D structures. Among the different materials used for the fabrication of such structures, proteins and polysaccharides are the main biological compounds (biopolymers) selected for the bioink formulation. These biomaterials obtained from natural sources are commonly compatible with tissues and cells (biocompatibility), friendly with biological digestion processes (biodegradability), and provide specific macromolecular structural and mechanical properties (biomimicry). However, the rheological behaviors of these natural-based bioinks constitute the main challenge of the cell-laden printing process (bioprinting). For this reason, bioprinting usually requires chemical modifications and/or inter-macromolecular crosslinking. In this sense, a comprehensive analysis describing these biopolymers (natural proteins and polysaccharides)-based bioinks, their modifications, and their stimuli-responsive nature is performed. This manuscript is organized into three sections: (1) tissue engineering application, (2) crosslinking, and (3) bioprinting techniques, analyzing the current challenges and strengths of biopolymers in bioprinting. In conclusion, all hydrogels try to resemble extracellular matrix properties for bioprinted structures while maintaining good printability and stability during the printing process.

The role of microfluidics and 3D-bioprinting in the future of exosome therapy

Exosome-based strategies constitute a promising tool for therapeutics, avoiding potential immunogenic and tumorigenic side-effects of cell therapies. However, the collection of a suitable exosome pool, and the need for high doses with conventional administration approaches, hamper their clinical translation. To overcome these challenges, versatile exosome collection strategies together with advanced delivery platforms may represent major progress in this field. Microfluidics enables large-scale gathering of both natural and synthetic exosomes for their implementation into bioinks, while 3D-bioprinting holds great promise in regenerative medicine with the use of exosome-loaded scaffolds that mimic the target tissue with controlled pharmacokinetics and pharmacodynamics. Hence, the combination of both strategies might become the key for the translation of exosome therapies to clinical practice.

Biocomposites containing poly(lactic acid) and chitosan for 3D printing - Assessment of mechanical, antibacterial and in vitro biodegradability properties

New bone repair materials are needed for treatment of trauma- and disease-related skeletal defects as they still represent a major challenge in clinical practice. Additionally, new strategies are required to combat orthopedic device-related infections (ODRI), given the rising incidence of total joint replacement and fracture fixation surgeries in increasingly elderly populations. Recently, the convergence of additive manufacturing (AM) and bone tissue engineering (BTE) has facilitated the development of bone healthcare to achieve personalized three-dimensional (3D) scaffolds. This study focused on the development of a 3D printable bone repair material, based on the biopolymers poly(lactic acid) (PLA) and chitosan. Two different types of PLA and chitosan differing in their molecular weight (MW) were explored. The novel feature of this research was the successful 3D printing using biocomposite filaments composed of PLA and 10 wt% chitosan, with clear chitosan entrapment within the PLA matrix confirmed by Scanning Electron Microscopy (SEM) images. Tensile testing of injection molded samples indicated an increase in stiffness, compared to pure PLA scaffolds, suggesting potential for improved load-bearing characteristics in bone scaffolds. However, the potential benefit of chitosan on the biocomposite stiffness could not be reproduced in compression testing of 3D printed cylinders. The antibacterial assays confirmed antibacterial activity of chitosan when dissolved in acetic acid. The study also verified the biodegradability of the scaffolds, with a process producing an acidic environment that could potentially be neutralized by chitosan. In conclusion, the study indicated the feasibility of the proposed PLA/chitosan biocomposite for 3D printing, demonstrating adequate mechanical strength, antibacterial properties and biodegradability, which could serve as a new material for bone repair.

Biomaterials / bioinks and extrusion bioprinting

Bioinks are formulations of biomaterials and living cells, sometimes with growth factors or other biomolecules, while extrusion bioprinting is an emerging technique to apply or deposit these bioinks or biomaterial solutions to create three-dimensional (3D) constructs with architectures and mechanical/biological properties that mimic those of native human tissue or organs. Printed constructs have found wide applications in tissue engineering for repairing or treating tissue/organ injuries, as well as in vitro tissue modelling for testing or validating newly developed therapeutics and vaccines prior to their use in humans. Successful printing of constructs and their subsequent applications rely on the properties of the formulated bioinks, including the rheological, mechanical, and biological properties, as well as the printing process. This article critically reviews the latest developments in bioinks and biomaterial solutions for extrusion bioprinting, focusing on bioink synthesis and characterization, as well as the influence of bioink properties on the printing process. Key issues and challenges are also discussed along with recommendations for future research.

3D-Printed Chitosan-Based Hydrogels Loaded with Levofloxacin for Tissue Engineering Applications

Herein, we demonstrate the feasibility of a three-dimensional printed chitosan (CS)-poly(vinyl alcohol) (PVA)-gelatin (Gel) hydrogel incorporating the antimicrobial drug levofloxacin (LEV) as a potential tissue engineering scaffold. Hydrogels were prepared by physically cross-linking the polymers, and the printability of the prepared hydrogels was determined. The hydrogel with 3% w/v of CS, 3% w/v of PVA, and 2% w/v of Gel presented the best printability, producing smooth and uniform scaffolds. The integrity of 3D-printed scaffolds was improved via a neutralization process since after testing three different neutralized agents, i.e., NH3 vapors, EtOH/NaOH, and KOH solutions. It was proved that the CS/PVA/Gel hydrogel was formed by hydrogen bonds and remained amorphous in the 3D-printed structures. Drug loading studies confirmed the successful incorporation of LEV, and its in vitro release continued for 48 h. The cytotoxicity/cytocompatibility tests showed that all prepared scaffolds were cytocompatible.

Chitosan and its derivatives in 3D/4D (bio) printing for tissue engineering and drug delivery applications

Tissue engineering research has undergone to a revolutionary improvement, thanks to technological advancements, such as the introduction of bioprinting technologies. The ability to develop suitable customized biomaterial inks/bioinks, with excellent printability and ability to promote cell proliferation and function, has a deep impact on such improvements. In this context, printing inks based on chitosan and its derivatives have been instrumental. Thus, the current review aims at providing a comprehensive overview on chitosan-based materials as suitable inks for 3D/4D (bio)printing and their applicability in creating advanced drug delivery platforms and tissue engineered constructs. Furthermore, relevant strategies to improve the mechanical and biological performances of this biomaterial are also highlighted.

Advances in Gelatin Bioinks to Optimize Bioprinted Cell Functions

Gelatin is a widely utilized bioprinting biomaterial due to its cell-adhesive and enzymatically cleavable properties, which improve cell adhesion and growth. Gelatin is often covalently cross-linked to stabilize bioprinted structures, yet the covalently cross-linked matrix is unable to recapitulate the dynamic microenvironment of the natural extracellular matrix (ECM), thereby limiting the functions of bioprinted cells. To some extent, a double network bioink can provide a more ECM-mimetic, bioprinted niche for cell growth. More recently, gelatin matrices are being designed using reversible cross-linking methods that can emulate the dynamic mechanical properties of the ECM. This review analyzes the progress in developing gelatin bioink formulations for 3D cell culture, and critically analyzes the bioprinting and cross-linking techniques, with a focus on strategies to optimize the functions of bioprinted cells. This review discusses new cross-linking chemistries that recapitulate the viscoelastic, stress-relaxing microenvironment of the ECM, and enable advanced cell functions, yet are less explored in engineering the gelatin bioink. Finally, this work presents the perspective on the areas of future research and argues that the next generation of gelatin bioinks should be designed by considering cell-matrix interactions, and bioprinted constructs should be validated against currently established 3D cell culture standards to achieve improved therapeutic outcomes.

Open-Spaced Ridged Hydrogel Scaffolds Containing TiO2-Self-Assembled Monolayer of Phosphonates Promote Regeneration and Recovery Following Spinal Cord Injury

The spinal cord has a poor ability to regenerate after an injury, which may be due to cell loss, cyst formation, inflammation, and scarring. A promising approach to treating a spinal cord injury (SCI) is the use of biomaterials. We have developed a novel hydrogel scaffold fabricated from oligo(poly(ethylene glycol) fumarate) (OPF) as a 0.08 mm thick sheet containing polymer ridges and a cell-attractive surface on the other side. When the cells are cultured on OPF via chemical patterning, the cells attach, align, and deposit ECM along the direction of the pattern. Animals implanted with the rolled scaffold sheets had greater hindlimb recovery compared to that of the multichannel scaffold control, which is likely due to the greater number of axons growing across it. The immune cell number (microglia or hemopoietic cells: 50-120 cells/mm² in all conditions), scarring (5-10% in all conditions), and ECM deposits (Laminin or Fibronectin: approximately 10-20% in all conditions) were equal in all conditions. Overall, the results suggest that the scaffold sheets promote axon outgrowth that can be guided across the scaffold, thereby promoting hindlimb recovery. This study provides a hydrogel scaffold construct that can be used in vitro for cell characterization or in vivo for future neuroprosthetics, devices, or cell and ECM delivery.

Global hotspots and emerging trends in 3D bioprinting research

Three-dimensional (3D) bioprinting is an advanced tissue engineering technique that has received a lot of interest in the past years. We aimed to highlight the characteristics of articles on 3D bioprinting, especially in terms of research hotspots and focus. Publications related to 3D bioprinting from 2007 to 2022 were acquired from the Web of Science Core Collection database. We have used VOSviewer, CiteSpace, and R-bibliometrix to perform various analyses on 3,327 published articles. The number of annual publications is increasing globally, a trend expected to continue. The United States and China were the most productive countries with the closest cooperation and the most research and development investment funds in this field. Harvard Medical School and Tsinghua University are the top-ranked institutions in the United States and China, respectively. Dr. Anthony Atala and Dr. Ali Khademhosseini, the most productive researchers in 3D bioprinting, may provide cooperation opportunities for interested researchers. Tissue Engineering Part A contributed the largest publication number, while Frontiers in Bioengineering and Biotechnology was the most attractive journal with the most potential. As for the keywords in 3D bioprinting, Bio-ink, Hydrogels (especially GelMA and Gelatin), Scaffold (especially decellularized extracellular matrix), extrusion-based bioprinting, tissue engineering, and in vitro models (organoids particularly) are research hotspots analyzed in the current study. Specifically, the research topics "new bio-ink investigation," "modification of extrusion-based bioprinting for cell viability and vascularization," "application of 3D bioprinting in organoids and in vitro model" and "research in personalized and regenerative medicine" were predicted to be hotspots for future research.

A self-healing nanocomposite double network bacterial nanocellulose/gelatin hydrogel for three dimensional printing

Extrusion-based three-dimensional (3D) printing of gelatin is important for additive manufactured tissue engineering scaffolds, but gelatin's thermal instability has remained an ongoing challenge. The gelatin tends to suddenly collapse at mild temperatures, which is a significant limitation for using it at physiological temperature of 37 °C. Hence, fabrication of a thermo-processable gelatin hydrogel adapted for extrusion-based additive manufacturing is still a challenge. To achieve this, a self-healing nanocomposite double-network (ncDN) gelatin hydrogel was fabricated with high thermo-processability, shear-thinning, mechanical strength, self-healing, self-recovery, and biocompatibility. To do this, amino group-rich gelatin was first created by combining gelatin with carboxyl methyl chitosan. Afterwards, a self-healing ncDN gelatin hydrogel was formed via an in-situ formation of imine bonds between the blend of gelatin/carboxyl methyl chitosan (Gel/CMCh) and dialdehyde-functionalized bacterial nanocellulose (dBNC). dBNC plays as nanofiber cross-linkers capable of simultaneously crosslinking and reinforcing the double networks of Gel/CMCh through formation of dynamic 3D imine bonds. Based on our findings, our self-healing ncDA gelatin hydrogel displayed great potential as a promising ink for additive manufactured tissue engineering scaffolds.

Chitosan-Based Biomaterials: Insights into Chemistry, Properties, Devices, and Their Biomedical Applications

Chitosan is a marine-origin polysaccharide obtained from the deacetylation of chitin, the main component of crustaceans’ exoskeleton, and the second most abundant in nature. Although this biopolymer has received limited attention for several decades right after its discovery, since the new millennium chitosan has emerged owing to its physicochemical, structural and biological properties, multifunctionalities and applications in several sectors. This review aims at providing an overview of chitosan properties, chemical functionalization, and the innovative biomaterials obtained thereof. Firstly, the chemical functionalization of chitosan backbone in the amino and hydroxyl groups will be addressed. Then, the review will focus on the bottom-up strategies to process a wide array of chitosan-based biomaterials. In particular, the preparation of chitosan-based hydrogels, organic–inorganic hybrids, layer-by-layer assemblies, (bio)inks and their use in the biomedical field will be covered aiming to elucidate and inspire the community to keep on exploring the unique features and properties imparted by chitosan to develop advanced biomedical devices. Given the wide body of literature that has appeared in past years, this review is far from being exhaustive. Selected works in the last 10 years will be considered.

3D-Printed Soft Membrane for Periodontal Guided Tissue Regeneration

OBJECTIVES

The current study aimed to perform an in vivo examination using a critical-size periodontal canine model to investigate the capability of a 3D-printed soft membrane for guided tissue regeneration (GTR). This membrane is made of a specific composition of gelatin, elastin, and sodium hyaluronate that was fine-tuned and fully characterized in vitro in our previous study. The value of this composition is its potential to be employed as a suitable replacement for collagen, which is the main component of conventional GTR membranes, to overcome the cost issue with collagen.

METHODS

Critical-size dehiscence defects were surgically created on the buccal surface of the roots of canine bilateral mandibular teeth. GTR treatment was performed with the 3D-printed membrane and two commercially available collagen membranes (Botiss Jason® and Smartbrane-Regedent membranes) and a group without any membrane placement was considered as the control group. The defects were submerged with tension-free closure of the gingival flaps. Histologic and histometric analyses were employed to assess the periodontal healing over an 8-week experimental period.

RESULTS

Histometric evaluations confirmed higher levels of new bone formation in the 3D-printed membrane group. Moreover, in all defects treated with the membranes, the formation of periodontal tissues, bone, periodontal ligaments, and cementum was observed after 8 weeks, while in the control group, only connective tissue was found in the defect sites. There was no clinical sign of inflammation or recession of gingiva in any of the groups.

SIGNIFICANCE

The 3D-printed gelatin/elastin/sodium hyaluronate membrane can be safe and effective for use in GTR for periodontal tissue regeneration therapies, with better or comparable results to the commercial collagen membranes.

Preparation and Characterization of Biomimetic Functional Scaffold with Gradient Structure for Osteochondral Defect Repair

Osteochondral (OC) defects cannot adequately repair themselves due to their sophisticated layered structure and lack of blood supply in cartilage. Although therapeutic interventions are reaching an advanced stage, current clinical therapies to repair defects are in their infancy. Among the possible therapies, OC tissue engineering has shown considerable promise, and multiple approaches utilizing scaffolds, cells, and bioactive factors have been pursued. The most recent trend in OC tissue engineering has been to design gradient scaffolds using different materials and construction strategies (such as bi-layered, multi-layered, and continuous gradient structures) to mimic the physiological and mechanical properties of OC tissues while further enabling OC repair. This review focuses specifically on design and construction strategies for gradient scaffolds and their role in the successful engineering of OC tissues. The current dilemmas in the field of OC defect repair and the efforts of tissue engineering to address these challenges were reviewed. In addition, the advantages and limitations of the typical fabrication techniques for gradient scaffolds were discussed, with examples of recent studies summarizing the future prospects for integrated gradient scaffold construction. This updated and enlightening review could provide insights into our current understanding of gradient scaffolds in OC tissue engineering.

3D Printing Technologies in Personalized Medicine, Nanomedicines, and Biopharmaceuticals

3D printing technologies enable medicine customization adapted to patients' needs. There are several 3D printing techniques available, but majority of dosage forms and medical devices are printed using nozzle-based extrusion, laser-writing systems, and powder binder jetting. 3D printing has been demonstrated for a broad range of applications in development and targeting solid, semi-solid, and locally applied or implanted medicines. 3D-printed solid dosage forms allow the combination of one or more drugs within the same solid dosage form to improve patient compliance, facilitate deglutition, tailor the release profile, or fabricate new medicines for which no dosage form is available. Sustained-release 3D-printed implants, stents, and medical devices have been used mainly for joint replacement therapies, medical prostheses, and cardiovascular applications. Locally applied medicines, such as wound dressing, microneedles, and medicated contact lenses, have also been manufactured using 3D printing techniques. The challenge is to select the 3D printing technique most suitable for each application and the type of pharmaceutical ink that should be developed that possesses the required physicochemical and biological performance. The integration of biopharmaceuticals and nanotechnology-based drugs along with 3D printing ("nanoprinting") brings printed personalized nanomedicines within the most innovative perspectives for the coming years. Continuous manufacturing through the use of 3D-printed microfluidic chips facilitates their translation into clinical practice.

Improving Chitosan Hydrogels Printability: A Comprehensive Study on Printing Scaffolds for Customized Drug Delivery

Chitosan is an interesting polymer to produce hydrogels suitable for the 3D printing of customized drug delivery systems. This study aimed at the achievement of chitosan-based scaffolds suitable for the incorporation of active components in the matrix or loaded into the pores. Several scaffolds were printed using different chitosan-based hydrogels. To understand which parameters would have a greater impact on printability, an optimization study was conducted. The scaffolds with the highest printability were obtained with a chitosan hydrogel at 2.5 wt%, a flow speed of 0.15 mm/s and a layer height of 0.41 mm. To improve the chitosan hydrogel printability, starch was added, and a design of experiments with three factors and two responses was carried out to find out the optimal starch supplementation. It was possible to conclude that the addition of starch (13 wt%) to the chitosan hydrogel improved the structural characteristics of the chitosan-based scaffolds. These scaffolds showed potential to be tested in the future as drug-delivery systems.

Advances in Stimuli-responsive Hydrogels for Tissue Engineering and Regenerative Medicine Applications: A Review Towards Improving Structural Design for 3D Printing

The physicochemical properties of polymeric hydrogels render them attractive for the development of 3D printed prototypes for tissue engineering in regenerative medicine. Significant effort has been made to design hydrogels with desirable attributes that facilitate 3D printability. In addition, there is significant interest in exploring stimuli-responsive hydrogels to support automated 3D printing into more structurally organised prototypes such as customizable bio-scaffolds for regenerative medicine applications. Synthesizing stimuli-responsive hydrogels is dependent on the type of design and modulation of various polymeric materials to open novel opportunities for applications in biomedicine and bio-engineering. In this review, the salient advances made in the design of stimuli-responsive polymeric hydrogels for 3D printing in tissue engineering are discussed with a specific focus on the different methods of manipulation to develop 3D printed stimuli-responsive polymeric hydrogels. Polymeric functionalisation, nano-enabling and crosslinking are amongst the most common manipulative attributes that affect the assembly and structure of 3D printed bio-scaffolds and their stimuli- responsiveness. The review also provides a concise incursion into the various applications of stimuli to enhance the automated production of structurally organized 3D printed medical prototypes.