Next Out of the Printer, Living Tissue

Sandy Huffaker for The New York Times

Darryl D'Lima, an orthopedic specialist, worked with a bioprinter in his research on cartilage at Scripps Clinic in San Diego.

SAN DIEGO — Someday, perhaps, printers will revolutionize the world of medicine, churning out hearts, livers and other organs to ease transplantation shortages. For now, though, Darryl D'Lima would settle for a little bit of knee cartilage.

Dr. D'Lima, who heads an orthopedic research lab at the Scripps Clinic here, has already made bioartificial cartilage in cow tissue, modifying an old inkjet printer to put down layer after layer of a gel containing living cells. He has also printed cartilage in tissue removed from patients who have undergone knee replacement surgery.

There is much work to do to perfect the process, get regulatory approvals and conduct clinical trials, but his eventual goal sounds like something from science fiction: to have a printer in the operating room that could custom-print new cartilage directly in the body to repair or replace tissue that is missing because of injury or arthritis.

Just as 3-D printers have gained in popularity among hobbyists and companies who use them to create everyday objects, prototypes and spare parts (and even a crude gun), there has been a rise in interest in using similar technology in medicine. Instead of the plastics or powders used in conventional 3-D printers to build an object layer by layer, so-called bioprinters print cells, usually in a liquid or gel. The goal isn't to create a widget or a toy, but to assemble living tissue.

At labs around the world, researchers have been experimenting with bioprinting, first just to see whether it was possible to push cells through a printhead without killing them (in most cases it is), and then trying to make cartilage, bone, skin, blood vessels, small bits of liver and other tissues. There are other ways to try to "engineer" tissue — one involves creating a scaffold out of plastics or other materials and adding cells to it. In theory, at least, a bioprinter has advantages in that it can control the placement of cells and other components to mimic natural structures.

But just as the claims made for 3-D printing technology sometimes exceed the reality, the field of bioprinting has seen its share of hype. News releases, TED talks and news reports often imply that the age of print-on-demand organs is just around the corner. (Accompanying illustrations can be fanciful as well — one shows a complete heart, seemingly filled with blood, as the end product in a printer).

The reality is that, although bioprinting researchers have made great strides, there are many formidable obstacles to overcome.

"Nobody who has any credibility claims they can print organs, or believes in their heart of hearts that that will happen in the next 20 years," said Brian Derby, a researcher at the University of Manchester in Britain who reviewed the field last year in an article in the journal Science.

For now, researchers have set their sights lower. Organovo, for instance, a San Diego company that has developed a bioprinter, is making strips of liver tissue, about 20 cells thick, that the company says could be used to test drugs under development.

A lab at the Hannover Medical School in Germany is one of several experimenting with 3-D printing of skin cells; another German lab has printed sheets of heart cells that might some day be used as patches to help repair damage from heart attacks. A researcher at the University of Texas at El Paso, Thomas Boland, has developed a method to print fat tissue that may someday be used to create small implants for women who have had breast lumpectomies. Dr. Boland has also done much of the basic research on bioprinting technologies. "I think it is the future for regenerative medicine," he said.

Dr. D'Lima acknowledges that his dream of a cartilage printer — perhaps a printhead attached to a robotic arm for precise positioning — is years away. But he thinks the project has more chance of becoming reality than some others.

"Printing a whole heart or a whole bladder is glamorous and exciting," he said. "But cartilage might be the low-hanging fruit to get 3-D printing into the clinic."

One reason, he said, is that cartilage is in some ways simpler than other tissues. Cells called chondrocytes sit in a matrix of fibrous collagens and other compounds secreted by the cells. As cells go, chondrocytes are relatively low maintenance — they do not need much nourishment, which simplifies the printing process.

Keeping printed tissue nourished, and thus alive, is one of the most difficult challenges facing researchers. Most cells need to be within a short distance — usually a couple of cell widths — of a source of nutrients. Nature accomplishes this through a network of microscopic blood vessels, or capillaries.

But trying to emulate capillaries in bioprinted tissue is difficult. With his fat tissue, Dr. Boland's approach is to build channels into the degradable gel containing the fat cells, and line the channels with the kind of cells found in blood vessels. When the printed fat is implanted, the tubes "start to behave as micro blood vessels," he said.

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