Spotlight
Feature Printing organs on demand
Dariush M/Shutterstock.com
For the case report see N Engl J Med 2013; 368: 2043–45
The ability to custom-create new bodies or spare body parts has long been a staple of science fiction stories. But recent developments in 3D printing have shown that we are now well on the way to making on-demand repair, or even creation, of vital organs a reality. 3D printing has been around for almost 30 years, and is most well known for its use in custom-creating prototypes and spare parts for industry using standard materials such as plastics, metals, or rubber. It has also been used to print food using powders and oils, and NASA has recently offered a cash prize to the creators of a 3D printer that can fabricate pizza in space during long-duration missions. The technology has not been without controversy, when earlier this year a working prototype of a gun was printed in high-density plastic. Blueprints were posted online, sparking intense criticism and highlighting the lack of regulation for the creation of homemade firearms. A version of the weapon is currently on display at London’s Science Museum. However, 3D printing has also been successfully used in the health-care sector to make prosthetic limbs, repair bones, and create surgical implants. Recently, improvements in bioengineering techniques and a substantial fall in price of equipment have meant that the use of 3D printing to create soft tissue and organs has become an increasingly viable area of research. In February, 2013, researchers at Cornell University (Ithica, NY, USA) announced that they had used the technology to create an artificial ear. In May, doctors at the University of Michigan (Ann Arbor, MI, USA) reported the success of an operation on a baby with tracheobronchomalacia, a disorder that occurs when the tracheal support cartilage is weak and the airways collapse. In their case report, published in the New England Journal of Medicine, Glenn Green and colleagues outlined how, with the
aid of a 3D printer and CT imagery of the patient’s airway, they were able to fabricate and implant a precisely modelled, bioresorbable tracheal splint onto the baby’s left bronchial tube. The patient recovered, and full resorption of the splint is estimated to occur within 3 years. “We are able to create a new device within 24 h and customise it to a patient’s specific anatomical problem with precision”, says Green. “Previously, surgeons were forced to jury-rig existing devices: using scalpels and drills to shave pieces of metal and plastic to a desired shape and size. Beyond anything that I even dreamt about during my early training, 3D printing offers the ability to create medical devices to improve the lives of our patients.” An increasing number of private biotech companies are also focusing their efforts on creating tissues and organs for medical research and therapeutic applications. Scientists at one such company, the US-based Organovo, are developing strips of printed liver tissue, which they predict will soon be advanced enough to be used to test new drug treatments. The printers use a type of modified inkjet technology to build various tissue and organ prototypes layer by layer. Living cells can be mixed with a gel to produce a biopolymer that acts as a scaffold material. Cells are isolated from small tissue samples, and then mixed with growth factors and multiplied in the laboratory. These cells could eventually be scaled up to create an organ with a working vascular system, opening up the potential for creating organs for transplantation. During a TED (Technology, Entertainment, Design) talk in 2011, Director of the Wake Forest Institute for Regenerative Medicine (Winston-Salem, NC, USA) Anthony Atala demonstrated an early-stage experiment during which a rudimentary kidney was printed on stage. Despite the success of these biomedical applications, Green warns that there are also other large barriers to their implementation. “These barriers include securing timely approvals from regulators, insurance company policies, securing funding for applications in niche markets, high initial costs to set up local manufacturing, and a desire to avoid improper use of the devices during this early phase when complications could hamper the entire field.” The long term safety will also need to be assessed and monitored. The reality of made-to-order organs is still some way off, and the ability to create the complex vascular system needed to keep the tissue alive remains a particular challenge. However, the progress made so far is promising. As more companies begin to see the potential of 3D printing for theraputic applications, such technology might well herald the future of medicine.
Stephanie Bartlett 684
www.thelancet.com/respiratory Vol 1 November 2013
Feature Printing organs on demand
Dariush M/Shutterstock.com
For the case report see N Engl J Med 2013; 368: 2043–45
The ability to custom-create new bodies or spare body parts has long been a staple of science fiction stories. But recent developments in 3D printing have shown that we are now well on the way to making on-demand repair, or even creation, of vital organs a reality. 3D printing has been around for almost 30 years, and is most well known for its use in custom-creating prototypes and spare parts for industry using standard materials such as plastics, metals, or rubber. It has also been used to print food using powders and oils, and NASA has recently offered a cash prize to the creators of a 3D printer that can fabricate pizza in space during long-duration missions. The technology has not been without controversy, when earlier this year a working prototype of a gun was printed in high-density plastic. Blueprints were posted online, sparking intense criticism and highlighting the lack of regulation for the creation of homemade firearms. A version of the weapon is currently on display at London’s Science Museum. However, 3D printing has also been successfully used in the health-care sector to make prosthetic limbs, repair bones, and create surgical implants. Recently, improvements in bioengineering techniques and a substantial fall in price of equipment have meant that the use of 3D printing to create soft tissue and organs has become an increasingly viable area of research. In February, 2013, researchers at Cornell University (Ithica, NY, USA) announced that they had used the technology to create an artificial ear. In May, doctors at the University of Michigan (Ann Arbor, MI, USA) reported the success of an operation on a baby with tracheobronchomalacia, a disorder that occurs when the tracheal support cartilage is weak and the airways collapse. In their case report, published in the New England Journal of Medicine, Glenn Green and colleagues outlined how, with the
aid of a 3D printer and CT imagery of the patient’s airway, they were able to fabricate and implant a precisely modelled, bioresorbable tracheal splint onto the baby’s left bronchial tube. The patient recovered, and full resorption of the splint is estimated to occur within 3 years. “We are able to create a new device within 24 h and customise it to a patient’s specific anatomical problem with precision”, says Green. “Previously, surgeons were forced to jury-rig existing devices: using scalpels and drills to shave pieces of metal and plastic to a desired shape and size. Beyond anything that I even dreamt about during my early training, 3D printing offers the ability to create medical devices to improve the lives of our patients.” An increasing number of private biotech companies are also focusing their efforts on creating tissues and organs for medical research and therapeutic applications. Scientists at one such company, the US-based Organovo, are developing strips of printed liver tissue, which they predict will soon be advanced enough to be used to test new drug treatments. The printers use a type of modified inkjet technology to build various tissue and organ prototypes layer by layer. Living cells can be mixed with a gel to produce a biopolymer that acts as a scaffold material. Cells are isolated from small tissue samples, and then mixed with growth factors and multiplied in the laboratory. These cells could eventually be scaled up to create an organ with a working vascular system, opening up the potential for creating organs for transplantation. During a TED (Technology, Entertainment, Design) talk in 2011, Director of the Wake Forest Institute for Regenerative Medicine (Winston-Salem, NC, USA) Anthony Atala demonstrated an early-stage experiment during which a rudimentary kidney was printed on stage. Despite the success of these biomedical applications, Green warns that there are also other large barriers to their implementation. “These barriers include securing timely approvals from regulators, insurance company policies, securing funding for applications in niche markets, high initial costs to set up local manufacturing, and a desire to avoid improper use of the devices during this early phase when complications could hamper the entire field.” The long term safety will also need to be assessed and monitored. The reality of made-to-order organs is still some way off, and the ability to create the complex vascular system needed to keep the tissue alive remains a particular challenge. However, the progress made so far is promising. As more companies begin to see the potential of 3D printing for theraputic applications, such technology might well herald the future of medicine.
Stephanie Bartlett 684
www.thelancet.com/respiratory Vol 1 November 2013
