Jan 21, 2016 | By Alec

Medical 3D printing innovations have been under development for a long time, and the first results are finally coming in. However, it’s also clear that the 3D printing community was perhaps a bit too optimistic about its progress, and especially in the case of 3D bioprinting innovations. As veteran hobbyists might recall, expectations rose massively back in 2013 when Dutch researchers from the VU medical center (the VUmc) began working with a biomaterials 3D printer and it seemed as though 3D printed organs were just around the corner. Fortunately, the results of all that hard work are now finally becoming visible, though complex organ and blood vessel structures are not possible yet. Instead, the VUmc team is focused on 3D printing easier cartilage structures for nose and ear reconstruction procedures and believes it could be implemented within a few years.

As doctor-researcher Ernst Jan Bos from the plastic surgery department of the VUmc recently said, the mainstream audience became far too optimistic about what 3D printing could do. Bos reached headlines all across Dutch media, and internationally on science websites, for purchasing a 3D bioprinter through crowdfunding on Flintwave and with backing from the Dutch Burn Victim Institute and the VUmc. Most of the buzz centered on the possibility to 3D print human tissue, specifically with the purpose of helping burn victims.

But this isn’t so easy. “We are studying the reconstruction possibilities for human tissue and the options provided by 3D printing,” the researcher said in an interview last year, adding that the 3D printer is just a tool and not the solution. The solution is far more difficult, and can be found in regenerating human tissue and make it 3D printable. “A lot is happening in the field of regenerative medicine already, which focuses on helping the natural human ability to heal. We can achieve much through stem cell transplants and by using a patient’s own cells to restore cartilage defects,” he explains. 3D printing is seen as a solution to speed up that process, but simply requires a lot of cellular research to ensure that tissue can be mimicked, that cells can start interacting and surviving.

Fortunately, a lot has been achieved over the last two years, giving patients the hope that the most basic 3D printed human tissue constructions – cartilage – can now finally replace prosthetics. In the current situation, some success can be had by transplanting a patient’s own cartilage to another location, but that is usually only available in small quantities. Patients are therefore usually restructured to wearing silicone prosthetics to replace missing ears and noses. “But those tend to start discoloring, can shift from their original positions and need to be replaced frequently. Whatever way you look at it, it remains a rubber construct pressed against your skull,” Bos says.

This is exactly where 3D printing can make a difference. “3D printing is ideal for ear replacements, because cartilage is a relatively simple tissue and it doesn’t involve blood vessels or other complex structures. 3D printing complex organs such as kidneys and livers is still years away,” Bos reveals. Currently, they’re envisioning a process that involves making a biodegradable mold, based on a 3D scan of the patient’s remaining ear or nose portions. Alternatively, they sculpt one to match a patient’s features. This mold is then filled with biocompatible materials: a gel, cartilage particles and fat stem cells taken from the abdominal wall. 3D printed layer-by-layer, an ear or a nose is formed and can sewed onto the face with the help of a bit of skin.

So far, laboratory tests have revealed that this mixture can be used to grow new cartilage tissue, and over time the mold will dissolve, leaving nothing but the cartilage on a patient’s face. Research is still underway, especially focusing on growing that cartilage and finding the most suitable biodegradable bioplastics. However, the 3D printing phase is still problematic too, Bos adds. “The technical aspect is often underestimated, but a 3D printer actually has quite a few limitations. For instance, you need to mix different materials and each of those materials requires another 3D printing technique to gain optimal results. You also need to know exactly what the artificial ear is exposed to. To find out, we’re working together with colleagues from the TU Delft and the VUmc’s 3D innovation lab."

While ears are first on the agenda, Bos says that noses can be created in a similar fashion. Though their exterior shape is quite easy to create, their interior anatomy is far more complex. “There are a lot of factors that determine the end results,” he says. Similarly, bone could also be 3D printed though that would require several hardware modifications. “Bone requires a hard material, such as ceramic. But that needs to be fired up in a kiln to turn hard, something that the natural blood vessels found in bone can’t withstand. So those would need to be introduced at a later date, making the process far more complex. But 3D printing bone could definitely be used, for instance as a replacement for cartilage.”

So the real question is: when will this be adopted as a medical procedure? While the technique is thus nearing completion, Bos reminds us that new medical procedures are always bogged down by financial and testing concerns. “First we need to find out if this is financially viable, how quickly the mold dissolves and how many operations will be involved. After that, we can seek approval, which can be a very long process as well.” In the worst case scenario, it could take ten years before this becomes a normal medical procedure.

 

 

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