Regeneration in humans refers to the restoration and sometimes limited regrowth of tissue following injury or as part of natural body processes. This is in contrast to wound healing, which involves closing up the injury site with some gradation of scar tissue. Some tissues such as skin, the vas deferens, and large organs including the liver can regrow quite readily, while others have been thought to have little or no capacity for regeneration following an injury.
Numerous tissues and organs have been induced to regenerate. Bladders have been 3D-printed in the lab since 1999. Skin tissue can be regenerated in vivo or in vitro. Other organs and body parts that have been procured to regenerate include: penis, fats, vagina, brain tissue, thymus, and a scaled down human heart. One goal of scientists is to induce full regeneration in more human organs.
There are various techniques that can induce regeneration. By 2016, regeneration of tissue had been induced and operationalized by science. There are four main techniques: regeneration by instrument; regeneration by materials; regeneration by drugs and regeneration by in vitro 3D printing.
History of human tissue In humans with non-injured tissues, the tissue naturally regenerates over time; by default, new available cells replace expended cells. For example, the body regenerates a full bone within ten years, while non-injured skin tissue is regenerated within two weeks. With injured tissue, the body usually has a different response. This emergency response usually involves building a degree of scar tissue over a time period longer than a regenerative response, as has been proven clinically and via observation. There are many more historical and nuanced understandings about regeneration processes. In full thickness wounds that are under 2 mm, regeneration generally occurs before scarring. In 2008, in full thickness wounds over 3 mm, it was found that a wound needed inserted in order to induce full tissue regeneration.
Whereas third degree burns heal slowly by scarring, in 2016 it was known that full thickness fractional photothermolysis holes heal without scarring. Up to 40% of full thickness skin can be removed without scarring in an area, in a fractional pattern via coring of tissue.
Some human organs and tissues regenerate rather than simply scar, as a result of injury. These include the liver, fingertips, and endometrium. More information is now known regarding the passive replacement of tissues in the human body, as well as the mechanics of stem cells. Advances in research have enabled the induced regeneration of many more tissues and organs than previously thought possible. The aim for these techniques is to use these techniques in the near future for the purpose of regenerating any tissue type in the human body.
Regeneration techniques
By 2016, regeneration had been operationalised and induced by four main techniques: regeneration by instrument; regeneration by materials; regeneration by 3D printing; and regeneration by drugs. By 2016, regeneration by instrument, regeneration by materials and by regeneration drugs had been generally operationalised in vivo (inside living tissues), while regeneration by 3D printing had been generally operationalised in vitro (inside the lab) in order to create and prepare tissue for transplantation.
By instrument A cut by a knife or a scalpel generally scars, though a piercing by a needle does not. In 1976, a 3 by 3 cm scar on a non-diabetic was regenerated by insulin injections and the researchers, highlighting earlier research, argued that the insulin was regenerating the tissue. The anecdotal evidence also highlighted that a syringe was one of two variables that helped bring regeneration of the arm scar. The syringe was injected into the four quadrants three times a day for eighty-two days. After eighty-two days, after many consecutive injections, the scar was resolved and it was noted no scar was observable by the human eye. After seven months the area was checked again and it was once again noted that no scar could be seen.
In 1997, it was proven that wounds created with an instrument that are under 2mm can heal scar free, but larger wounds that are larger than 2mm healed with a scar.
In 2013, it was proven in pig tissue that full thickness micro columns of tissue, less than 0.5mm in diameter could be removed and that the replacement tissue, was regenerative tissue, not scar. The tissue was removed in a fractional pattern, with over 40% of a square area removed; and all of the fractional full thickness holes in the square area healed without scarring. In 2016 this fractional pattern technique was also proven in human tissue. In 2021, more people were paying attention to the possibility of scar free healing alongside new technologies involving instruments.
With materials Generally, humans can regenerate injured tissues in vivo for limited distances of up to 2mm. The further the wound distance is from 2mm the more the wound regeneration will need inducement. By 2009, via the use of materials, a max induced regeneration could be achieved inside a 1 cm tissue rupture. Bridging the wound, the material allowed cells to cross the wound gap; the material then degraded. This technology was first used inside a broken urethra in 1996. In 2012, using materials, a full urethra was restored in vivo.
Macrophage polarization is a strategy for skin regeneration. Macrophages are differentiated from circulating monocytes. Macrophages display a range of phenotypes varying from the M1, pro-inflammatory type to the M2, pro-regenerative type. Material hydrogels polarise macrophages into the key M2 regenerative phenotype in vitro. In 2017, hydrogels provided full regeneration of skin, with hair follicles, after partial excision of scars in pigs and after full thickness wound incisions in pigs.
By 3D printing In 2009, the regeneration of hollow organs and tissues with a long diffusion distance, was a little more challenging. Therefore, to regenerate hollow organs and tissues with a long diffusion distance, the tissue had to be regenerated inside the lab, via the use of a 3D printer.
Various tissues that have been regenerated by in vitro 3D printing include:
The first organ ever induced and made in the lab was the bladder, which was created in 1999. By 2014, there had been various tissues regenerated by the 3D printer and these tissues included: muscle, vagina, penis and the thymus. In 2014, a conceptual human lung was first bioengineered in the lab. In 2015, the lab robustly tested its technique and regenerated a pig lung. The pig lung was then successfully transplanted into a pig without the use of immunosuppressive drugs. In 2015, researchers developed a proof of principle biolimb inside a laboratory; they also estimated that it would be at least a decade for any testing of limbs in humans. The limb demonstrated fully functioning skin, muscles, blood vessels and bones. In April 2019, researchers 3D printed a human heart. The prototype heart was made by human stem cells but only to the size of a rabbit's heart. In 2019, the researchers hoped to one day place a scaled up version of the heart inside humans.
Types of 3D printing used in manufacturing vascularized organs Extrusion
Extrusion based printing is a type of printing in which material is pushed through a nozzle and extruded onto a surface or medium. While material is being extruded, either the nozzle or the print bed is moved so that the material can be placed in complex shapes across it medium. Layers upon layers of material are placed until a 3D structure is formed. The extruded material comes out as a liquid and is solidified through varies means depending on the chemical or physical properties of the material. For example, the material could be solidified through the use of photoreceptive polymerization, in which light activates the material to solidify. The material could also be hardened through the use of chemicals or enzymes. Some examples of bioinks used in extrusion based printing include some alginates, hyaluronic acid, and gellan gum.
Inkjet
Inkjet printing is similar to extrusion-based printing in that layers of materials are placed upon one another and can be hardened using various methods. Ink jet based printing differs however, in that the material is sprayed in droplets to selective locations to form layers, rather than placed as a stream of material. Inkjet printers can often contain multiple types of inks at once and can rapidly switch between them. Examples of bioinks used in inkjet based printing are fibrinogen and hydroxy-apatite.
SLA
SLA printing is a method in which a laser is shined upon a photoreactive liquid material to harden or polymerize. Instead of material being pushed through a nozzle or jet, material sits in a large basin and is slowly hardened. Due to its use of light to harden the material, SLA printers can offer a very high resolution at a lower speed when compared to other methods. This method is often used for protein scaffolding and providing structural support for other printed biological materials. Examples of bioinks used in SLA printers include fibrin, collagen, and some alginates.
Gradations of complexity Level 1 Level 2 Level 3 Level 4 Skin Blood vessel Bladder Heart Muscle Trachea Liver Nails Urethra Pancreas Corneal Endothelium Penis
With printing tissues, by 2012, there were four accepted standard levels of regenerative complexity that were acknowledged in various academic institutions:
Level one, flat tissue like skin was the simplest to recreate; Level two was tubular structures such as blood vessels; Level three was hollow non-tubular structures; Level four was solid organs, which were by far the most complex to recreate due to the vascularity.
In 2012, within 60 days it was possible, inside the lab, to grow tissue the size of half a postage stamp to the size of a football field. Most cell types could be grown and expanded outside of the body, with the exception of the liver, nerve and pancreas, as these tissue types need stem cell populations.
Manufactured vascularized organs Heart In 2024, researchers were able to 3D print a human heart with a biphasic bioink containing pluripotent stem cells (PSC). The technique they proposed and tested would first print the external features of the organ before then printing the internal features such as internal vasculature inside the previously printed structure. Both sets of printing were performed by extruding the bioink filament into layered structures set in a microgel medium. This technique was called the "SPIRIT" technique and allowed for the printing of a full-sized heart at significantly faster speeds than previous methods.
Liver In 2022, researchers proposed a new method for printing vascularized human liver tissue. This new method consisted of using a 3D printer capable of holding seven different bioinks, with the ability to switch rapidly between these different bioinks to print different structures and shapes in the liver tissue. Due to the overall complexity of the organ, they were unable to print an entire liver but were still able to successfully print pieces of densely vascularized liver tissue.
Kidney A new technique for 3D printing kidney tissue was developed in 2020 which resulted in the successful creation of a miniature, vascularized kidney. To do this, they used an extrusion method printer that could be fed two bioinks and would extrude the bioink as hollow tubes with one tube coating the other. In 2021, researchers expanded upon this technique by using PSCs differentiated into the correct cell type in the bioink. Using the PSC's allowed for increased vascularization, as the PSCs would differentiate into the correct cell types to build the structures of the blood vessels, rather than already differentiated cells having to be placed in the right locations.
Lung