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3-D printing has applications across the field of medicine and will drastically change training, treatment, and even transplantation.
In the early 2000s, bioengineer Dr. Thomas Boland, one of the forefathers of bioprinting, retrofitted a standard inkjet printer so that it would use cells as ink. By 2003 he had started to develop “organ printers” with the concept that a desktop printer could print gels, single cells, and aggregates of cells in a sequential layer-by-layer manner so that organs could be printed and assembled de novo.1 In a thought-provoking paper, Boland and collaborators state that the “combination of an engineering approach with the developmental biology concept of embryonic tissue fluidity enables the creation of a new rapid prototyping 3-D organ printing technology, which will dramatically accelerate and optimize tissue and organ assembly.”
Dr. Thomas Boland; Photo courtesy of Clemson University
More than 10 years later, 3-dimensional (3-D) printing and bioprinting are a reality and will be commonplace in the very near future. In a report released by Goldman Sachs last summer titled “The Search for Creative Destruction,” 3-D printing was among 8 industries highlighted for their disruptive capabilities.2 The report states that the 3-D printing industry is already a $2.2 billion market; analysts estimate that the industry will grow to more than $10 billion by 2021. Although it makes up less than 20% of the current market, the 3-D printing industry has the potential to revolutionize many aspects of health care.
It is important to recognize that 3-D printing and bioprinting are 2 different yet interrelated concepts. 3-D printing, a technology that has been around for more than 20 years, takes computer-based digital information and creates a 3-D solid object by adding layers of a material in structured sequence. The printing typically requires architectural design or computer-aided design (CAD) software, but once the 3-D blueprint has been assembled, all you have to do is push the print button! At Yale University’s Center for Engineering Innovation and Design (CEID), more than 500 students and faculty have been trained in the use of 3-D printers. According to Dr. Joseph Zinter, the assistant director of CEID, “In the past year, we have 3-D-printed everything from scientific research tools to key chains, ancient Egyptian artifacts to trombone mouthpieces, race car parts to human tumors.”3
Part of the excitement about the biomedical applications of 3-D printing is generated by the ability to recreate objects that have precise sizes, contours, and measurements. For example, radiographic data can be used to create segments of missing bone for trauma patients, teeth can be perfectly printed for those who need dental implants, and prosthetic eyes can be printed in a matter of minutes, as opposed to the hours or days required for handmade/hand-painted prosthetic eyes.4
Bioprinting builds upon the technology used in the printing of sequential layers. In this setting, cells are laid upon the scaffold and become self-supporting, with the potential for continued cellular growth. The backbone of the structure can be either a living scaffold composed of cells or a dissolvable scaffold, allowing the structure to become self-supporting with continued cellular growth.
In 2011, Dr. Anthony Atala, speaking at a TED (technology, entertainment, design) conference, reported that soon it may be possible to “print” a functional kidney.5 (To see Dr. Atala’s talk, visit www.ted.com/talks/anthony_atala_printing_a_human_kidney.html.) With more than 120,000 US patients now waiting for organ donations, the possibility of printing a perfectly matched kidney is a goal of many bioprinting engineers. Although it is conceptually plausible, the printing of a functional organ requires not only producing the required size and shape, but also laying down the microscopic architecture and function of the organ (ie, tubules, blood vessels, etc.).
Because of the commercial potential of such technologies, many companies have entered this new space, and representatives from companies such as Organovo have openly said that they are focused on “building human tissues for surgical therapy and transplantation.”6 Other companies are working on developing biologically active skin grafts, vessel grafts, replacement valves, and almost every other structure that can be replaced in the body.
Beyond solid organ transplantation, bioprinting functional liver samples may allow researchers to perform research and development at levels of scrutiny that were previously attainable only through patient-derived studies. This could not only accelerate the pace and economics of pharmaceutical development, but also potentially protect many patients from the risks of toxicity in early drug studies.
In the training and evaluation of surgeons,7 bioprinters can be used to print 3-D replicas of tumors on which residents can outline surgical approaches and even practice resections. By combining printing media, it is possible to create 3-D structures that have multiple textures and tissue types, which could adequately and reproducibly simulate a surgery. Therefore, 3-D printers may improve the ability to simulate many of the surgical skills that need to be mastered before completing training.
Within our field, the potential applications of 3-D printing and bioprinting are boundless. In fact, we would argue that ob/gyns have the most to gain from this technology.
It is easy to imagine the use of such technology in training future ob/gyns, creating size-appropriate prostheses and/or organs or tissues for fetuses with anomalies (ie, defective heart valves, cleft lips, etc.), mapping out gynecological oncologic surgeries, creating urogynecologic surgical adjuvants, and creating perfectly contoured embryo catheters. The future is ours to print (in 3-D)!
1. Mironov V, et al, Organ printing: computer-aided jet-based 3-D tissue engineering. Trends Biotechnol. 2003;21(4):157–161.
2. Durden T. Goldman’s top disruptive themes. www.zerohedge.com/news/2013-08-08/goldmans-top-disruptive-themes. Accessed December 17, 2013.
3. Shelton J. 3-D printing at Yale is a sight to behold. www.nhregister.com/general-news/20131202/3-D-printing-at-yale-is-a-sight-to-behold. Accessed December 17, 2013.
4. Owano N. British project uses 3D printing for prosthetic eyes. http://phys.org/news/2013-11-british-3-D-prosthetic-eyes.html. Accessed December 17, 2013.
5. Printing a human kidney-Anthony Atala. http://ed.ted.com/lessons/printing-a-human-kidney-anthony-atala. Accessed December 17, 2013.
6. Utilizing Organovo Novotissues in research: living, three-dimensional human tissue models for research and therapeutic applications. http://www.organovo.com/3-D-human-tissues. Accessed December 17, 2013.
7. Chen PW. Are today’s new surgeons unprepared? http://well.blogs.nytimes.com/2013/12/12/are-todays-new-surgeons-unprepared/?_r=0. Accessed December 17, 2013.