Application of 3D-Printed Bioinks in Chronic Wound Healing: A Scoping Review
Abstract
:1. Introduction
Type of Bioprinting | Sub-Type | Definitions | Advantages | Limitations | Applications | References |
---|---|---|---|---|---|---|
Droplet-based Bioprinting (DBB) | Inkjet-based bioprinting | Inkjet-based bioprinting is a method that uses droplets to create tissue and organ constructs on a substrate. | low cost, high precision, fast fabrication speed, high resolution, and high throughput | High-viscosity ink has poor printability, small inkjet apertures, easy clogging, and high shear stress. | Fabrication of scaffold for tissue engineering | [19,34,35] |
Laser-assisted bioprinting (LAB) | LAB uses the Laser-Induced Forward Transfer (LIFT) technique, where a pulsed laser beam is focused onto a bioink-coated substrate, creating a high-pressure bubble. | high resolution, no nozzle clogging, and non-contact printing | Thermal damage and slow gelation limit high-throughput printing and expensive equipment | Fabrication of scaffold for tissue engineering | [34,36] | |
Electrohydrodynamic Jetting (EHDJ) | EHDJ uses high voltage to create an electric field that shapes bioink into a cone shape at the nozzle tip. | Preventing excessive pressure, protecting cell viability, high cell concentration, and high weight-to-volume ratio in bioink | Affecting cell viability and limited material propagation for larger droplet sizes (>400 µm) | Fabrication of scaffold for tissue engineering | [27,37] | |
Photocuring-based Bioprinting (PBB) | stereolithography | Stereolithography (SLA) is a photochemical additive manufacturing technique that creates three-dimensional objects by curing a liquid photopolymer resin with a focused UV laser or light source. | High resolution, rapid printing with high cell viability (>85%), no shear stress on cells, and free clogging process | Requires transparent liquids for uniform crosslinking, cell contamination, and Restricted maximum cell density | Fabrication of scaffold for tissue engineering | [36,38,39] |
Digital Light Processing (DLP) | DLP uses a digital light source to cure photosensitive polymers layer-by-layer using a dynamic mask that projects the desired pattern onto the bioink. | High-speed printing, production of complex structures without increasing time, Smoother 3D structures, and improving mechanical strength | Less suitable for applications requiring varying layer thicknesses, require complex setup and software for mask design and light pattern transmission | Fabrication of scaffold for tissue engineering | [30,40] | |
Extrusion-based bioprinting (EBB) | Piston, Screw, Pneumatic-driven | Extrusion-based bioprinting techniques utilize the usage of a nozzle or syringe to extrude the bioink via piston, pressure, and screw-driven approach. | High-viscosity bioinks - Versatile for different bioink types - Better printing speed and mechanical strength compared to DBB | Limited printing resolution limits cell patterning and organization, and High shear stress | Fabrication of scaffold for tissue engineering | [24,41,42] |
2. Methods
2.1. Search Strategy
2.2. Study Selection
2.3. Data Extraction and Analysis
2.4. Data Charting and Synthesis
3. Results
3.1. Study Selection
3.2. Characteristics of Included Studies
3.3. Characteristics of the 3D Bioprinting Techniques
3.4. Bioink Composition and Characteristics
3.5. Applications and Effectiveness of 3D Bioprinted Bioinks
3.6. Summary of In Vivo Model Characteristics
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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No. | Study | Country | Study Design | 3D Bioprinting Technique | Bioink Components | Wound Type | Assay Conducted | Key Outcomes | Study Limitations |
---|---|---|---|---|---|---|---|---|---|
1 | [52] | USA | In vitro | Extrusion | Methacrylated Collagen (CMA) | Chronic wounds | Alamar blue assay | Sustained cytokine release, High cell viability, maintained print fidelity and stability | Limited in vivo data |
2 | [53] | Brazil | In vivo | Extrusion | Alginate Hydrogel | Chronic diabetic ulcers | Bioluminescence assay | Accelerated wound healing, increased mast cells, improved regenerative profile | Short-term study, limited to mice |
3 | [54] | Malaysia | Single-arm pilot study | Extrusion | Fibrin gel | Diabetic foot ulcers | Not stated (Clinical study) | 70% complete healing within 12 weeks, significant wound size reduction, no adverse events | Small sample size, lack of control group, short follow-up period |
4 | [55] | Pakistan | In vivo | Extrusion | polyethylene oxide-co-Chitosan-co-poly (methylmethacrylic acid) (PEO-CS-PMMA), Nicotinamide | Full-thickness skin defect | Not stated | High reproducibility, improved mechanical properties, increased cell viability | lack of detailed methodology and analysis of biological interactions |
5 | [56] | China | In vitro and in vivo | Extrusion | Gelatin methacryloyl (GelMA), Curcumin | Diabetic wounds | Live/dead assay Apoptosis assay Western blot Caspase-3 activity assay | Reduced ROS, decreased apoptosis; improved ADSC cell survival, accelerated wound healing | Limited in vivo studies, need for long-term analysis, lack of comparison with other materials |
6 | [57] | China | In vitro and in vivo | Extrusion | SS-GAM (Strontium Silicate-Gellan Gum-Sodium Alginate—Methyl Cellulose) | Acute and chronic wounds | Live/dead assay Proliferation assay | Blood vessel formation, graft-host integration, enhanced cell proliferation, wound repair in vivo | short-term study |
7 | [58] | Malaysia | In vitro | Extrusion | Gelatin, Polyvinyl alcohol (PVA), Genipin | Potential for Chronic wounds | Live/dead assay Cell proliferation assay 3D cell migration In vitro wound scratch assay Immunocytochemistry DPPH and ABTS assay | Improved printability, high cell viability, increased wound healing rates | Limited in vivo studies, need for comparison with other materials |
8 | [59] | Malaysia | In vitro | Extrusion | Gelatin, Polyvinyl alcohol (PVA), Genipin | Potential for Chronic wounds | Live/dead assay Proliferation assay Scratch wound assays | Improved rheological properties, high cell viability (>90%), enhanced wound healing, reduced inflammation, optimal WVTR, slow biodegradation rate | Limited in vivo studies |
9 | [60] | USA | In vivo | Mobile in situ skin inkjet-based bioprinting with integrated imaging technology | Fibrin gel: fibrinogen- collagen | Acute and chronic wounds | Not stated | Improved wound closure, re-epithelialization, reduced contraction, formation of healthy, mature skin | potential for variability in outcomes due to the manual aspects of the bioprinting process and the limited sample size |
Study | Cell-Laden Bioink | Type of Polymer | 3D Bioprinter Model | 3D Bioprinting Technique | Type of Construct | Nozzle Size (mm) | Printing Speed (mm/s) | Printing Pressure (kPa) | Crosslinking Method | Printing Environment | Printing Shape | Crosslink Time (Min) |
---|---|---|---|---|---|---|---|---|---|---|---|---|
[52] | Microfat-laden Methacrylated Collagen (CMA) | Natural | REGEMAT3D (Granada, Spain) | Extrusion | Collagen construct | 0.965 | 5 | Not Available | UV crosslinking | Room temperature | Cube | 1 |
[53] | MSCs-Laden Alginate Hydrogel | Natural | Available by the startup In Situ Cell Therapy | Extrusion | Hydrogel | Not Available | Not Available | Not Available | Not Available | Not Available | Not Available | Not Available |
[54] | Autologous adipose tissue and fibrin gel | Natural | Dr. INVIVO clean chamber 3D bioprinter (ROKIT Healthcare, Seoul, Republic of Korea) | Extrusion | Graft | Not Available | Not Available | Not Available | Fibrin gel crosslinking | Clean chamber | According to wound size | Not Available |
[55] | Fibroblast-PEO-CS-PMMA | Synthetic | Not Available | Extrusion | Hydrogel | 0.25 | 5–8 | 20–45 | Thermal initiation and chemical crosslinking with carbohydrazide (CH) | 37 °C | Skin-tissue constructs | 600 |
[56] | ADSCs (Adipose-Derived Stem Cells)-Gelatin Methacryloyl (GelMA) | Natural | BioArchitect Pro (Regenovo, Hangzhou, China) | Extrusion | Hydrogel | 0.21 | 5 | 200 | Blue light | 20 °C nozzle, 18 °C platform | Circular mesh structure | 0.33–0.5 |
[57] | HDF-HUVEC-GAM-SS | Natural | BioScaffolder 3.2 (GeSiM, Radeberg, Germany) | Extrusion | Hydrogel | 0.25 | Not Available | 230–280 | Ionic crosslinking with 1.6% CaCl2 | Room temperature | hexagonal prism, 8mm side length, 1.4mm thickness | 60 |
[58] | HDF-Gelatin-PVA | Hybrid (Natural and Synthetic) | Biogens XI (3D Gens, Shah Alam, Malaysia) | Extrusion | Hydrogel | 0.3 | 5–10 | 150–200 | Chemical crosslinking with Genipin | 23 ± 2 °C, Sterile | Layer-by-layer 3D structures, Grid-like patterns | 3 |
[59] | HDF-Gelatin-PVA | Hybrid (Natural and Synthetic) | Biogens XI (3D Gens, Malaysia) | Extrusion | Hydrogel | 0.3 | 4000 | Not Available | Chemical crosslinking with Genipin | 23 ± 2 °C, Sterile | Grid-like patterns, 2.5 cm × 0.3 mm | Not Available |
[60] | Fibroblasts-Keratinocytes-Fibrin Gel | Fibrinogen, collagen Natural | Custom-designed mobile bioprinter | inkjet | Hydrogel | 0.26 | 1130.09–9417.45 | 6.89 | Chemical crosslinking with Thrombin-induced gelation | Sterile, mobile operating room setup | Tailored to individual wound topography | 15 |
Study | Cell-Laden Bioink | Cell Type | Cell Density | Max Cell Viability (%) | Bioink Preparation Method | Bioink Properties (e.g., Viscosity, Stiffness) | Biodegradability |
---|---|---|---|---|---|---|---|
[52] | Microfat-laden methacrylated collagen (CMA) | Adipose stromal cells (ASCs), Endothelial progenitor cells (EPCs) | 1 × 106 cells/gram | maintained for up to 10 days | Mixing | Not specified | Not specified |
[53] | MSCs- Laden Alginate Hydrogel | Mesenchymal stem cells (MSCs, derived from the human umbilical cord) | 1 × 105 cells/cm² | Not specified | Mixing | Not specified | Not specified |
[54] | Autologous adipose tissue and fibrin gel | Adipose stem cells | Not specified | Not specified | Mixed autologous adipose tissue with fibrin gel | Not specified | Biodegradable scaffold |
[55] | Fibroblast-PEO-CS-PMMA Nicotinamide | Human Dermal Fibroblasts (HDFs) | 0.1 × 106 cells/mL | 92% | Free radical copolymerization | Viscosity: 500–550 Pa·s, Thermal stability | 85% weight loss |
[56] | Gelatin methacryloyl (GelMA), Curcumin | Adipose-derived stem cells (ADSCs) | 5 × 105 cells/mL | 90% | Mixing ADSCs with GelMA and Cur, crosslinked with blue light | High porosity, suitable mechanical properties | Yes |
[57] | Strontium silicate microcylinders, Alginate, Gelatin | human umbilical vascular endothelial cells (HUVECs), human dermal fibroblasts (HDFs), murine umbilical vein endothelial cells (MUVEC), BALB/3T3 fibroblast | 1 × 104 cells/mL | Not specified | Mixing and ionic crosslinking | High viscosity, cell adhesion, high cellular activity, excellent proliferation, good mechanical strength | Not specified |
[58] | HDF-Gelatin,(PVA) | Human dermal fibroblasts (HDFs) | 1.5 × 106 cells/mL | >90% | Mixed cells with hydrogel, chemical crosslinking with genipin | Appropriate mechanical properties, high porosity | 0.02 ± 0.005 mg/h |
[59] | HDF-Gelatin-PVA | Human dermal fibroblasts (HDFs) | 1.5 × 106 cells/mL | >90% | Mixed cells with hydrogel, chemical crosslinking with genipin | High viscosity, optimal WVTR, slow biodegradation rate, excellent interconnected porosity, achieve optimum printability | Slow, 0.018 ± 0.08 mg/h |
[60] | Fibroblasts-Keratinocytes- Fibrin Gel | Dermal fibroblasts, epidermal keratinocytes | 3.75 × 106 cells/mL fibroblasts, 7.5 × 106 cells/mL keratinocytes | High viability | Fibrinogen/collagen solution with cells printed directly onto the wound, followed by thrombin printing to form a gel | Suitable support for cellular viability, rapid crosslinking | Not specified |
Study | Objective/Novelty | Print Fidelity and Stability | Biological Functionality | Additional Findings |
---|---|---|---|---|
[52] | First application of 3D bioprinting using microfat tissue with a collagen-based bioink | Maintained over time | Release proinflammatory cytokines, Temporal release of IL-6, IL-8, FGF-2, supports wound healing | Potential for weekly application of custom-designed autologous microfat grafts with bandage changes |
[53] | Use of xenogeneic MSCs in biocuratives | Stable in the wound environment | Promotes M2 macrophage polarization, supports wound healing, promotes an anti-inflammatory environment (Increased TGF-β, IL-33, M2 markers) | Potential for restoring mast cells in diabetic skin |
[54] | Use of 3D-AMHAT with fibrin gel for diabetic foot ulcers (DFUs) | High print fidelity and stability | Promoted wound healing with high-quality skin reconstruction | Significant wound size reduction, no adverse events, enhanced quality of healed skin |
[55] | Use of PEO-CS-PMMA bioink with nicotinamide for skin regeneration | High print fidelity and stability | Enhanced skin regeneration | Effective DNA interaction |
[56] | First study to incorporate curcumin in a 3D printed GelMA scaffold for diabetic wound healing | High print fidelity and stability | Reduced ROS, decreased apoptosis, improved ADSC survival, improved wound healing | Curcumin significantly downregulated AGER and inhibited ROS production and apoptosis in ADSCs |
[57] | Combination of strontium silicate (SS) with bioink for vascularized skin regeneration | High print fidelity and stability | Enhanced cell proliferation, increased expression of angiogenic genes (VEGF, VE-cad, HIF-1α, eNOS-1), blood vessel formation, graft-host integration, and skin reconstruction | Improved mechanical properties |
[58] | Comparison of injectable vs. 3D bioprinted hydrogels | High print fidelity and stability | Enhanced wound healing, antioxidant properties, improved cell migration, Promoted cell proliferation and adhesion | High antioxidant capacity |
[59] | Detailed evaluation of hybrid bioinks’ physicochemical properties | High print fidelity and stability | Enhanced wound healing, antioxidant properties, improved cell migration, Promoted cell proliferation | Improved rheological properties, High antioxidant capacity, optimal WVTR, slow biodegradation rate, suitable for wound healing |
[60] | Use of a mobile bioprinter with integrated imaging technology to create bilayered skin constructs directly on wounds, potentially improving wound healing outcomes compared to traditional methods. | High-precision delivery to specific locations of the wound | Rapid wound closure, formation of normal skin, reduced contraction | Early formation of defined epidermis and mature dermis layers in bioprinted wounds compared to cell-sprayed wounds |
Study | Model | Sex | Age | Defect Area | Defect Size (cm2) | Time of Sacrifice (days) | Health Status | Post-Operative Care |
---|---|---|---|---|---|---|---|---|
[53] | C57BL/6 mice | >24 Male | 8 weeks | Dorsal surface, Back skin | 1 cm2 | 15 Days | Diabetic (T1D) induced by STZ | The pathogen-free condition housing room was set to a 12 h light/dark cycle with a temperature of about 22 °C |
[54] | patients | Seven male, three female | 48.7 ± 14.9 year | Foot ulcers | 27.00 ± 43.99 cm2 | Not applicable | Type II diabetes mellitus | 12 weeks of follow-up. No keloid formation, scarring, tissue contracture, or infection noted |
[56] | Nu/nu athymic nude mice | 30 mice, Not specified | 6 weeks | Dorsal surface/Full skin defect | 1.5 cm2 | 14 and 21 days | diabetic (STZ-induced) | Covered with Vaseline gauze and transparent film, changed every 2 days |
[57] | C57BL/6 mice | 25 Male | 7–8 weeks | Dorsal surface | 1.5 cm2 diameter, circular full thickness | 15 days | Diabetic (T1D) induced by STZ | The wound site was covered by a scaffold and bound up by sterile gauze and medical transparent dressing |
[60] | outbred athymic Nu/nu nude mice, Specific Pathogen Free (SPF) Yorkshire pigs | 36 female mice, six pigs | Not specified | Dorsal surface | 7.5 cm2 for murine model, 100 cm2 for porcine model | 6 weeks for a murine model; 8 weeks for a porcine model | Specific Pathogen Free (SPF) Yorkshire pigs, female outbred athymic nude (Nu/nu) mice | Bandaging with sterile gauze and surgical tape, dressing changes every 3 days under anesthesia |
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Abuhamad, A.Y.; Masri, S.; Fadilah, N.I.M.; Alamassi, M.N.; Maarof, M.; Fauzi, M.B. Application of 3D-Printed Bioinks in Chronic Wound Healing: A Scoping Review. Polymers 2024, 16, 2456. https://doi.org/10.3390/polym16172456
Abuhamad AY, Masri S, Fadilah NIM, Alamassi MN, Maarof M, Fauzi MB. Application of 3D-Printed Bioinks in Chronic Wound Healing: A Scoping Review. Polymers. 2024; 16(17):2456. https://doi.org/10.3390/polym16172456
Chicago/Turabian StyleAbuhamad, Asmaa Y., Syafira Masri, Nur Izzah Md Fadilah, Mohammed Numan Alamassi, Manira Maarof, and Mh Busra Fauzi. 2024. "Application of 3D-Printed Bioinks in Chronic Wound Healing: A Scoping Review" Polymers 16, no. 17: 2456. https://doi.org/10.3390/polym16172456