Avantika Aggarwal & Hanna Boughanem
History of Biofabrication
There have been drastic advancements, discoveries, and changes in the field of biofabrication in the last two decades. In our increasingly digitized world, technology has been rapidly changing and advancing, and so has the medical field. Since the late 1980s, when the 3D printer was first created and commercialized, scientists have been exploring ways to replicate biological structures through printing. Though much progress was made in the latter half of the 20th century, it was not until 3D printers became far more advanced within the last two decades that significant progress was made in the realm of biofabrication. Biofabrication can be classified as using cells, proteins, and biological material as building blocks to form biological models, systems, or therapeutic products. Over the last few years, researchers have made significant progress in biotechnological advancements pertaining to biofabrication. This has included printing mini-organs, such as hearts and livers, and printing skin and tissue, allowing for the use of heart patches and bridging injured nerves. Such technology can potentially revolutionize the medical field considering persistent issues such as the current nationwide organ shortage and limited number of donors. Currently, approximately 120,000 people in the U.S. need organs, and every ten minutes, a new name is added to the list. However, over 20 people die on average per day because of the failure of organ availability. This can create many difficult situations and choices for patients and their families; subsequently, it seems very self-explanatory that considering the lack of organs available for those who need organ transplants, biofabrication and organ printing seem like a great and feasible fix to this problem. However, with this revolutionary advancement come many ethical implications to consider regarding human enhancement, safety, efficacy, cost, and healthcare disparities regarding access.
Evolution and How it Works
Though the field of bioprinting is relatively new, it has seen considerable growth over the past two decades. Using a digital blueprint, bioprinters can deposit cells and other biomaterials into molds of various shapes. Theoretically, they can be used to create tissue patterns, organs, and other anatomical structures. From kidneys to heart patches, bioprinting can revolutionize patient care, especially regarding organ donation.
Bioprinting saw its practical start at Clemson University, where researchers modified a traditional printer to deposit cells instead of ink. Though the printing began in two dimensions, it wasn’t long until these very same tools could be used to create 3D structures. These techniques were further explored at the University of Missouri, where bioengineer Gabor Forgacs assembled thicker and more realistic tissues than in the past. From Forgacs’ lab emerged Organovo, the very first 3D bioprinting company. Founded in 2007, the company aimed to create tissue models for commercial use. Other companies quickly followed suit, and several new startups emerged on the scene. Businesses like EnvisionTec and RegenHu manufacture large bioprinting systems developed specifically for use in research labs. Other companies have found success in selling bio-ink, while some have instead commercialized their own bioprinting techniques. Unfortunately, the technology itself is quite expensive. In an attempt to make bioprinting more accessible, researchers have recently banded together to develop lower-cost printers. The industry has since expanded and is now more promising than ever.
As printing techniques evolved, researchers discovered how to use tissue models to fabricate larger, more complex structures. In 2018, a team at the University of Newcastle printed the first human corneas. Meanwhile, a group at Tel Aviv University successfully used human cardiac tissue to print a mini heart. At Wake Forest, researchers integrated working nerve cells into printed muscles, illustrating the potential to restore muscle control in patients with neurological injuries. Further progress has been made in printing a fully functioning ear, a pancreas, ovaries, and heart patches. Bioprinting, and particularly tissue engineering, may also be useful in bridging injured nerves and combatting neurodegeneration. Unfortunately, researchers have yet to construct an organ capable of functioning in the human body. Still, advancements continue to be made, and scientists remain hopeful that they will one day be able to develop structures ready for transplantation.
Ethical Implications
Scientists, researchers, and engineers are at the stage in which they've developed an understanding of how to employ biofabrication. It is time to potentially apply this technology to make medical progress after conducting more clinical trials. Biofabrication is very complex, and there are many reasons why we should invest in further research. The number of patients in the last decade who need organ transplants has nearly doubled, but the amount of donors has stayed relatively the same. Additionally, using a patient’s cells in bioprinting would reduce the chance that the organ is rejected and minimize animal testing in labs. This technology can also revolutionize the medical field by reducing the cost of prosthetics or certain surgeries for patients and tailoring treatments specifically to them. However, there are concerns that must be addressed. Human enhancement is a concern of biofabrication, and it is very possible that while organ printing is ideally intended to help patients suffering from illnesses, it can be used as a vehicle to enhance body structure and function. For example, what would be the implications of replacing our current bones with bones that have been bio-printed to be less susceptible to breaking, or printing muscles that are stronger and more resilient? Similarly, what would be the implications of implanting new lungs or a heart that oxygenates blood more efficiently? Additionally, we must consider the importance of implementing a solid legal framework, including laws and regulations, as biofabrication causes many changes to healthcare practices. For one, the practice of organ printing could further amplify the socioeconomic and racial disparities that already exist in the healthcare industry today. Before any kind of biofabrication is used in patient care, there is a need for further clinical testing and specific legal frameworks to regulate how and when this technology will be employed. If 3D printing practices are to be implemented at a large scale, it is necessary first to develop requirements for the safety, quality, and efficiency of these 3D printing procedures.
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