The printed body

Replacement hips, skull implants, ears and noses: the use of 3D printing in healthcare is growing rapidly. Could functioning organs be the next step?

The use of 3D printing in healthcare is no longer science fiction, it’s science fact. Over 5.5 million people worldwide have already been treated using 3D printed medical parts, according to the Science Museum in London.

No longer the preserve of over-excited articles on tech blogs and TED talks, 3D printing is having a genuine impact on a wide array of treatments. Last year, for example, surgeons in Newcastle upon Tyne used 3D printing to create a titanium pelvis for a man who had lost half his original one to a rare bone cancer, while a combined team from the University of Southampton and the city’s hospital completed their first hip surgery with a 3D printed implant and bone stem cell graft.

The market is expanding rapidly. A report from Cambridge-based market research firm IDTechEx in 2014 predicted that the dental and medical market for 3D printers would expand by 365% to £523m by 2025. That growth will increase even more spectacularly once (or should we say if) 3D bioprinting technology, more on which later, becomes suitable for commercial use. Add that, and the medical market for 3D printing could reach a value of £4bn or more within 10 years.

The Science Museum’s touring show, 3D: Printing the Future, which is currently at Manchester’s Museum of Science and Industry, provides an overview of the current and possible future state of 3D printing as it applies to healthcare. As well as use for dental implants and for replacement bones, the exhibition includes 3D printing being used for skeleton support. The Wilmington Robotic Exoskeleton (WREX) helps those suffering from neuromuscular disabilities which typically manifest themselves as difficulties in raising the arms. WREX’s Tariq Rahman explained to the Science Museum how 3D printing helped create a version of WREX that could be used by a two-year-old girl: “Emma has a condition that makes it nearly impossible for her to move her arms,” he said. “The original WREX was too large and heavy, so we 3D printed a smaller version in lightweight plastic. Emma now calls them her ‘magic arms’. It’s quick and easy to 3D print WREX for young growing children.”

3D printing is also being used for reconstructive surgery for those involved in accidents as it can provide implants tailored to each unique case. In, for example, serious motorbike accidents, bones may be crushed beyond repair with patients needing extensive reconstructive surgery. Adrian Sugar is a maxillofacial (mouth, jaws, face and neck) surgeon at Morriston hospital in Swansea who works with researchers at Cardiff

Metropolitan University to make 3D printed implants for use in such cases. 3D printing techniques allow Sugar to create unique implants that fit the patient perfectly and can be created quickly, which is ideal for trauma cases. Sugar can even practise the surgery in advance. “I can see that the reconstruction works on the computer,” he explained to the Science Museum. “I then print a physical model of the damaged skull and replicate the surgery. This helps us design the implants required. We can also design guides to use in surgery that tell me exactly where I need to cut and position the bones.”

The Science Museum show also features examples of how researchers around the world are 3D printing ‘scaffolds’ to replace, reconstruct and regenerate parts of the body. These scaffold structures resemble wireframes over which ‘engineered’ tissue can be ‘printed’ or natural bone or tissue can grow. They are already in use to replace body parts such as ears or noses.

The next step for 3D printing, and one which has been the subject of much speculation, is the ability to ‘print’ entire replacement organs for transplants. Even compared to creating pelvises or jawbones, 3D bioprinting is an incredibly complex challenge. In order to separate the hype surrounding 3D bioprinting from reality, CR’s sister magazine The Engineer recently spoke to some leading researchers in the field.

The Wake Forest Institute of Regenerative Medicine in North Carolina is one of the main research facilities in this area. It’s currently engaged on a long-term project to print a human kidney and, for a project funded by the Defense Threat Reduction Agency, which is part of the US Department of Defense, is working to print miniaturised liver and heart tissue that could be used to test drugs. Its director, Dr Anthony Atalla, believes that 3D bioprinted versions of the body’s ‘solid organs’ – the liver, kidney, pancreas and heart – could be possible. “However, engineering any organ – whether by printing or another method – requires many years of scientific endeavour. The central challenge is to reproduce the complex micro-architecture of living tissue to ensure that printed tissues have biological function.”

Vijayan Manoharan of Harvard-MIT Health Science and Technology was also optimistic. “In the next 10 years, bioprinting definitely has the potential to bring us close to the generation of artificial organs, but,” he cautioned, “to bring about the complete success of [such] tissue engineering, the advances made in bioprinting have to be accompanied by advances in the other tools involved.”

However, Dr Dan Thomas of Swansea University was less certain: “Currently, I am not convinced that whole functional organs will ever be printed,” he told The Engineer’s Stuart Nathan. “The biggest challenge is that every cell in your body constantly communicates with the cells around it. This biochemical communication is especially intense during tissue growth phases. The reason that this is necessary is that organs are made up of hundreds of different cell types. Any defect in a group of cells or any defect that causes part of the tissue to die could be catastrophic if a tissue was to be transplanted,” Thomas warned.

So the point at which, if we need a new heart or liver, we can simply print off a replacement is at least decades away and may never happen at all. But 3D printing in healthcare has come a huge distance in a very short time and is already making a significant contribution to the treatment of a wide range of conditions.

3D: Printing the Future is at the Museum of Science and Industry, Liverpool Road, Manchester M3 until April 19. Mosi.org.uk. For more from The Engineer, see theengineer.co.uk

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