3D Bioprinting for Reconstructive Surgery

Techniques and Applications

Daniel J. Thomas, Zita M. Jessop, Iain S. Whitaker, Daniel Thomas

• Publisher: Woodhead Publishing
• Year: 2017
• Print ISBN: 9780081011034
• eBook ISBN: 9780081012161
• Topic: Technology & Engineering
• Subtopic: Materials Science
• Index: Technology & Engineering

3D Bioprinting for Reconstructive Surgery: Techniques and Applications examines the combined use of materials, procedures and tools necessary for creating structural tissue constructs for reconstructive purposes. Offering a broad analysis of the field, the first set of chapters review the range of biomaterials which can be used to create 3D-printed tissue constructs. Part Two looks at the techniques needed to prepare biomaterials and biological materials for 3D printing, while the final set of chapters examines application-specific examples of tissues formed from 3D printed biomaterials.3D printing of biomaterials for tissue engineering applications is becoming increasingly popular due to its ability to offer unique, patient-specific parts—on demand—at a relatively low cost. This book is a valuable resource for biomaterials scientists, biomedical engineers, practitioners and students wishing to broaden their knowledge in the allied field.- Discusses new possibilities in tissue engineering with 3D printing- Presents a comprehensive coverage of the materials, techniques and tools needed for producing bioprinted tissues- Reviews emerging technologies in addition to commercial techniques

1

Introduction: Inception, evolution and future of 3D bioprinting

Z.M. Jessop*; D.J. Thomas^†; I.S. Whitaker* ^* Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
^† 3Dynamic Systems Group, Swansea, United Kingdom

Abstract

Regenerative medicine and tissue engineering, underpinned by the core principles of rejuvenation, regeneration, and replacement, are shifting the paradigm in healthcare from symptomatic treatment of the 20th century to curative treatment of the 21st century. The current dilemmas for modern day healthcare, such as an aging population and the increasing prevalence of chronic disease require solutions that limit organ dysfunction and tissue degeneration and potentially offer replacement. These challenges, that were first addressed through transplantation, are now being tackled by tissue engineering which seeks to apply stem cell research with developmental biology principles to regenerate cells, tissues, and organs de novo. By reproducing nano-, micro- and macrostructure, 3D bioprinting may replicate complex native-like tissue architecture more faithfully in the laboratory and succeed in areas where tissue engineering has not been able to. The ability to bioprint physiologically relevant multicellular tissue constructs on demand would obviate the need for autologous tissue harvest and dependency on organ donors as well as transform reconstructive surgery.

Keywords

3D bioprinting; Regenerative medicine; Tissue Engineering; Cell; Tissue; Organ.

Regenerative medicine and tissue engineering, underpinned by the core principles of rejuvenation, regeneration, and replacement, are shifting the paradigm in healthcare from symptomatic treatment of the 20th century to curative treatment of the 21st century [1–3]. The current dilemmas for modern day healthcare, such as an aging population and the increasing prevalence of chronic disease require solutions that limit organ dysfunction and tissue degeneration and potentially offer replacement [4]. This was first addressed through transplantation, a field that advanced rapidly in the 1950s through a combination of surgical innovations and fundamental scientific breakthroughs in immunosuppression [5]. In contrast to the allogenic replacement of transplantation, tissue engineering seeks to apply stem cell research with developmental biology principles to regenerate cells, tissues, and organs de novo [6,7]. Regenerative medicine and tissue engineering have been recognized worldwide as “emerging disciplines that hold promise of revolutionizing patient care in the 21st century” [1,2,8].

The principles of tissue engineering are underpinned by the incorporation of cells with biodegradable scaffolds to engineer replacement tissues. Clinically used examples range from individual tissues such as dermis or cartilage [9] to organs such as the trachea and bladder [10,11]. The long-term outcomes have been mixed. Limitations of synthetic polymer scaffolds, such as infection, extrusion, and degradation product toxicity have encouraged interest in decellularized matrices as well biologics for use as scaffolds, as one of the more effective ways of replicating native tissue anisotropy [1,2,12,13]. Decellularized matrices provide durability, enhanced integration, and biocompatibility whilst avoiding allosensitization [11,13]. This may explain why many of the significant breakthroughs and first in man studies have utilized this technique combined with autologous cell-seeding with varying success [10,11,14,15] and even showed promise in vitro for more complex structures such as pulmonary and aortic valves as well as whole organs such as heart and liver [16–18]. Despite early interest and investment in tissue-engineering research, with annual R&D spending estimated at US$580 million [19], initial clinically applicable product release has been slow but steady [20].

The ability to print biological “inks,” rather than the plastic and metal inks of traditional 3D printing, has resulted in the birth of the exciting new bioprinting research field [21]. The global 3D bioprinting market was estimated to be $487 million in 2014 and this is predicted to reach $1.82 billion by 2022 [22]. The bioprinter, used to dispense “bioinks,” consisting of cells, scaffolds, and biomolecules in a spatially controlled manner, gives multiple advantages over traditional tissue-engineering methods of assembly, consisting of nonspecific cell seeding of scaffolds [23]. By controlling the nano-, micro- and macrostructure, 3D bioprinting may replicate complex native-like tissue architecture more faithfully in the laboratory [24,25]. The ability to bioprint physiologically relevant multicellular tissue constructs on demand would obviate the need for autologous tissue harvest and dependency on organ donors as well as transform reconstructive surgery [26,27].

The success of this platform technology ultimately depends not only on the process itself, but answers to the fundamental scientific questions regarding the correct blend of cell source, suitable scaffold, and ideal microenvironment [25]. The potential benefits of bioprinting over other types of tissue assembly include repeatability, customization (personalized medicine), the incorporation of channels for vascularization, high-resolution manufacture, automation, and ability to scale-up production [28,29]. These features may provide the key for successful clinical translation. Given the future potential and synergistic goals of bioprinting and reconstructive surgery in restoring “form and function” [30], we propose that surgeons together with cell biologists, material scientists, computer scientists, and engineers, should be well versed in the principles and intimately involved in the future developments of 3D bioprinting to ensure it maintains clinical applicability [25].

Medical breakthroughs require the convergence of multiple scientific advances for which interdisciplinary collaboration is fundamental. Similar to transplant medicine, tissue engineering through bioprinting requires the convergence of a number of complementary technological advances such as stem cell biology, biomaterial science, reconstructive surgery, biochemistry, computer science, engineering, rheology as well as improved understanding of developmental and molecular biology, before the emergence of a new era in healthcare research.

Despite the significant worldwide laboratory research in the field, there are few reports of successful translation into surgical practice. This text, written by international experts in their respective fields, is a synopsis or current knowledge. The advantages of 3D bioprinting over traditional tissue-engineering techniques in assembling cells, biomaterials and biomolecules in a spatially controlled manner to reproduce native tissue macro-, micro- and nanoarchitectures are discussed, together some examples of ongoing work related to a range of tissue types.

If successful, 3D bioprinting has the potential to manufacture autologous tissue for reconstruction, remove the need for donor tissues, and transform personalized medicine [1,2,31]. We believe this text will be another step towards overcoming the biological, technological, and regulatory challenges ahead by encouraging an integrated approach from a variety of fields and will be a valuable reference book for clinicians, biomaterials scientists, biomedical engineers, and students who wish to broaden their knowledge of 3D bioprinting technology.

References

[1] Jessop Z.M., Al-Sabah A., Francis W.R., Whitaker I.S. Transforming healthcare through regenerative medicine. BMC Med. 2016;14:115.

[2] Jessop Z.M., Javed M., Otto I.A., Combellack E.J., Morgan S., Breugem C.C., et al. Combining regenerative medicine strategies to provide durable reconstructive options: auricular cartilage tissue engineering. Stem Cell Res Ther. 2016;7:19.

[3] Nelson T.J., Behfar A., Terzic A. Strategies for therapeutic repair: the “R3” regenerative medicine paradigm. Clin Transl Sci. 2008;1:168–171.

[4] Trounson A. New perspectives in human stem cell therapeutic research. BMC Med. 2009;7:29.

[5] Calne R. The history and development of organ transplantation: biology and rejection. Baillieres Clin Gastroenterol. 1994;8:389–397.

[6] Haseltine W. Regenerative medicine 2003: an overview. J Regen Med. 2003;4:15–18.

[7] Mironov V., Visconti R.P., Markwald R.R. What is regenerative medicine? Emergence of applied stem cell and developmental biology. Expert Opin Biol Ther. 2004;4:773–781.

[8] O’Dowd A. Peers call for UK to harness “enormous” potential of regenerative medicin...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• List of contributors
• Foreword
• Preface
• 1: Introduction: Inception, evolution and future of 3D bioprinting
• Part A: 3D Bioprinting Techniques
• Part B: 3D Bioprinting Applications
• Index