Development Of A Vascularized Cardiac Patch Using 3D Bioprinting To Regenerate Injured Myocardium

Introduction: Regeneration of the myocardium after ischemic injuries has remained a challenge due to the low proliferative capacity of cardiomyocytes (CMs). With the advance of tissue engineering, various cardiac patch devices have been developed and shown to improve cardiac tissue structure/function after myocardial infarction (MI). However, the therapeutic outcomes of patch devices have been limited by the lack of biological and structural complexity. Leveraging 3D bioprinting and stem cell technologies, this study presents the development of a next generation cardiac patch, integrated with heterogenous multi-cellular architecture, perfusable vasculature, and pro-proliferative molecules. Methods: A hybrid functional bioink, consisting of gelatin methacrylate (GelMA), gelatin, and fibrin, was optimized to fabricate the patch constructs. Two small molecule-based CM expansion techniques were employed, utilizing follistatin-like protein 1 (FSTL1) and CHIR99021 (CHIR), to further enhance the regenerative capacity of the patch. Complex vascular geometries were created by bioprinting sacrificial pluronic bioink in between two cellular composite bioink layers, containing human induced pluripotent stem cell-derived CMs (hiPSC-CMs) and endothelial cells (ECs). The sacrificial ink was subsequently removed to create vascular channels, which were then endothelialized with ECs. Results: Bioprinted patches were successfully cultured under static and dynamic (physiologic flow) culture in vitro . The hiPSC-CMs encapsulated in gelMA-gelatin-fibrin bioink showed adequate long-term viability and function within the 3D environment. The printed vascular channels formed rather uniform endothelium. Both the FSTL1 and CHIR treatments resulted in significant in-situ expansion of hiPSC-CMs within bioprinted cardiac constructs. Further, testing the engineered patch in a rat MI model demonstrated the significant cardioprotective effect of patch. Conclusion: Together, this study introduces a new generation of bioprinted myocardial tissue analogues as a robust research-enabling platform for in vitro testing, and as a novel patch device with markedly enhanced regenerative capacity to treat diseased/damaged adult mammalian heart.