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Jan 27, 2015

Researchers at The Feinstein Institute for Medical Research, part of the North Shore-LIJ Health System have made a medical breakthrough using a Makerbot 3D printer to create cartilage designed for tracheal repair or replacement. The team uses regular MakerBot PLA Filament to 3D print a custom tracheal scaffolding, which was combined with living cells to create a tracheal segment.

Tracheal damage can be caused by tumor, endotracheal intubation, blunt trauma, and other injuries. Narrowing and weakness of the trachea can occur and are often difficult to repair. There have been two traditional means of reconstructing a damaged trachea, but both techniques have limitations.

Mr. Goldstein, a PhD candidate at the Hofstra North Shore-LIJ School of Medicine, has been working with a team of surgeons at the North Shore-LIJ Health System for the past year on determining if 3D printing and tissue engineering could be used for tracheal repair and replacement. Surgeons originally surmised that it might be possible in 10 to 20 years, but Mr. Goldstein and the Feinstein Institute team did it in a month.

Researchers at the Feinstein Institute know how to make cartilage from a mixture of cells called chondrocytes, nutrients to feed them, and collagen, which holds it all together. But shaping that cartilage into a nose or a windpipe needs the help of 3D printing. A 3D printer can construct scaffolding, which can be covered in a mixture of chondrocytes and collagen, which then grows into cartilage.

"Making a windpipe or trachea is uncharted territory," noted Mr. Goldstein. "It has to be rigid enough to withstand coughs, sneezes and other shifts in pressure, yet flexible enough to allow the neck to move freely. With 3D printing, we were able to construct 3D-printed scaffolding that the surgeons could immediately examine and then we could work together in real time to modify the designs."

The team modified the MakerBot Replicator 2X to print with PLA with one extruder and the biomaterial with the other extruder. "The ability to prototype, examine, touch, feel and then redesign within minutes, within hours, allows for the creation of this type of technology," says Dr. Lee Smith, MD, chief of pediatric otolaryngology at Cohen Children's Medical Center. "If we had to send out these designs to a commercial printer far away and get the designs back several weeks later, we'd never be where we are today."

The Feinstein Institute had looked previously at other 3D printers that can extrude living cells, but the options are few and expensive. One special bio printer cost $180,000. They wanted to test their concept and see if it would be viable, so they decided to use the more affordable and accessible MakerBot.

Originally, Mr. Goldstein thought that he would need special PLA to maintain sterility and have the ability to dissolve in the body. However, in light of time, they decided to try regular MakerBot PLA Filament. "The advantage of PLA is that it's used in all kinds of surgical implant devices," says Dr. Smith. Through testing, Mr. Goldstein found that the heat from the extruder head sterilized the PLA as it printed, so he was able to use ordinary MakerBot PLA Filament.

The bio-ink, which stays at room temperature, is extruded during the 3D printing process and fills in gaps in the PLA scaffolding, then cures into a gel on the heated build plate of the MakerBot. A two-inch-long section of windpipe — shaped like a hollowed-out Tootsie Roll — takes less than two hours to print. Once the bio-ink adheres to the scaffolding, it goes into a bioreactor, an appliance like a rotisserie oven that keeps the cells warm and growing evenly. A new bioreactor costs between $50,000 and $150,000, so Mr. Goldstein customized an incubator for his needs, making gears and other parts on their 3D printer to produce a brand new bioreactor.

The results of the study, as presented by Mr. Goldstein and Dr. Zeltsman at the 51st Annual Meeting of The Society of Thoracic Surgeons in San Diego, illustrate how the 3D printed windpipe or trachea segments held up for four weeks in an incubator. According to Mr. Goldstein's abstract, "The cells survived the 3D printing process, were able to continue dividing, and produced the extracellular matrix expected of tracheal chondrocytes." In other words, they were growing just like windpipe cartilage.

The Feinstein Institute's work is still a "proof of concept." The team still has work to do before establishing a new protocol for repairing damaged windpipes.

Dr. Smith expects in the next five years to harvest a patient's cells, grow them on a scaffolding, and repair a windpipe. This customized approach may prove to be especially useful for treating children, says Dr. Smith. "There's really a limitless number of sizes and permutations you might need to reconstruct an airway in a child."

"Knowing that I can make a part that will save someone's child — that's life-changing," said Mr. Goldstein.

 

 

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