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     3D freeform printing of nanocomposite hydrogels
                        A                                    B
                        C                                    D
           Figure 7. Quantitative gene expression of four markers for in vitro cell differentiation. (A) Collagen
           type 1, (B) RunX2, (C) osteocalcin, and (D) osteopontin of MC3T3-E1 cells after 14 days of culturing
           on well plate (Control) or three-dimensional printed hyaluronic acid-alginate/30 wt% calcium phosphate
           composite hydrogel scaffolds with cell maintenance medium or osteogenic medium (n > 3, *P < 0.05
           and **P < 0.01).
           sites in rats and found no significant mineralization   reinforcement agents (e.g.,  increased mineral or
           or  calcification  (despite  the  strong  promotion  of   Alg contents) to the hydrogel inks may be essential.
           soft-tissue regeneration) .  Moreover,  the  cell/  In  fact,  DCPD/OCP  has  been  reported  to  show
                                  [5]
           matrix interaction is intricate, and numerous       lower bioactivity than DCPD with bioglass silica or
           factors influence cell differentiation. For instance,   magnesium . Our follow-up research will expand
                                                                         [45]
           the elastic modulus of hydrogels (11 – 30 kPa)      the applicability of this system with extensive in
           was found to lead to osteogenic differentiation of   vitro and in vivo assessments.
           primary human mesenchymal stem cells (hMSCs),
           whereas softer hydrogels with elastic modulus <5    3.6  3D freeform printing for multiphase
           kPa induce adipogenic lineage of hMSCs [43,44] . The   composite scaffolds
           elastic modulus of HAc-30 wt% CaP hydrogel
           scaffolds  was  ~  6  kPa,  thus  might  fail  to  induce   Multi-material 3D printing with nanocomposite
           osteogenic lineage of pre-osteoblasts due to        hydrogels is challenging because the nanoparticle
           insufficient  matrix  stiffness  (Table  2). Thus,  to   additives may change the rheological behavior of the
           enhance the osteoconductive and osteoinductive      composite hydrogel inks depending on the loading
           properties of HAc-Alg/CaP scaffolds, incorporation   amount of the additives . Furthermore, the uniform
                                                                                    [6]
           of additional bioactive additives (e.g.,  osteogenic   distribution of nanoparticles requires considerable
           reagents and bone growth factors) or mechanical     care when the composite inks are prepared.
           44                          International Journal of Bioprinting (2020)–Volume 6, Issue 2
     	
