In a small, unremarkable laboratory on the first floor at Melbourne’s St Vincent’s Hospital, a dozen people are working on an elegant, transparent device that resembles a paper shredder. But instead of chucking out threads of paper, it could give birth to the next scientific breakthrough.

With the word INKREDIBLE scrawled across it, the apparatus – a bioprinter – has attracted researchers like Professor Peter Choong to do something like the stuff of medical science fiction.

In a world hijacked by COVID-19, Choong and his colleagues have directed their microscopes away from the pandemic. Instead, they are focused on bioprinting and its clinical applications. From the production of mini-hearts to engineering remedies for arthritis, cancer, heart diseases, and burn victims, bioprinting researchers in Australia are on the frontline of the next possible advancement in medical technology: printing full-size human organs.

Although bioprinting an organ for use in humans is an ambitious goal, the fundamentals are similar to standard 3D printing, but instead of using plastic and inorganic materials, bioprinters use organic components to construct tissue and cell structures.

Biological ink (bioink) is a vital element for tissue engineering and is, therefore, a familiar component in Choong’s work.

On a normal day, as a surgeon at St Vincent’s Hospital, he performs orthopaedic procedures and then resumes his other role as a chief investigator with the ARC Industrial Transformation Training Centre in Additive Biomanufacturing, where he creates treatments to help patients with bone defects.

The $3.7 million project was established in 2016 by the Australian government to push research efforts towards 3D bioprinting advancements.

Six years later, Choong and his peers – locked away in their laboratories – have realised the scope of bioprinting.

Personalised treatment

He hoped for a way forward for patients burdened with osteoarthritis, a degenerative disease affecting the joints, which led him to collaborate with other experts to pioneer the AxceldaPen. A mobile bioprinter, the pen is currently under development and enables surgeons to repair cartilage damage by printing stem cells into the defect site. The bioink is the patient’s own cells that are surrounded by specialised biomaterials, creating the exact type of cartilage required.

The handheld device allows doctors to tailor treatment to the size of the defect.

The ability to personalize implants to patient specifications, as the AxceldaPen does, is proving to be the top selling point for bioprinting.

“It is about finding exactly what your body needs,” says William Harley, a PhD candidate in biomedical engineering at the University of Melbourne.

“There is a shift from traditional off-the-shelf component models that fit everyone, towards making a model that is not only more personalised to you as a person, but also personalised to each tissue type in your body,” says Harley.

Choong believes that personalisation aside, bioprinting has massive potential. As a cautiously optimistic individual, he talks about the possibility of handling the COVID-19 pandemic and the vaccination drive by pairing them up with bioprinting.

You can’t print out a vaccine, but you may be able to print something with a vaccine in it, he says.

“Is it possible to have a vaccine sticker that you stick on people, and it just loops out into their bodies? I don’t know. But that’s how I see 3D printing, working with materials, smart materials.”

However, he continues with caution: could the possibility be truly meaningful, he ponders, and would bioprinting fit with vaccine development? In 2020, the Wake Forest Institute for Regenerative Medicine, in the USA, bioprinted small-scale lungs and colons to test the efficacy of drugs against COVID-19.

Despite its efforts, the vaccines currently in circulation were developed without the use of bioprinting and in “very, very traditional ways,” according to Choong.

Tight regulation

In the short term – and certainly in pandemic circumstances – tight regulation is paramount. In the future, bioprinting developments in the vaccination space will be subjected to close attention from authorities.

“The regulators, Therapeutic Goods Administration and Food and Drug Administration, can only regulate based on a set of rules. If we create a completely new paradigm, which they just don’t understand, they will not be able to give it the green flag.”

Regulating bioprinting products is not the only challenge the field is predicted to face. There are various ethical concerns that researchers must address as they keep working towards modifying and validating the technology. Critics have claimed that the nature of bioprinting – an expensive technoscientific technology, will make it unaffordable for poorer countries. There is also the risk of harming individuals by inserting living cells into their bodies.

Choong says that the answer to these problems is to change from a “mine” mindset to more of an “our” mindset.

He says that if we accept our global interconnectedness, we can embrace new and expensive technologies and use them to support middle and lower-income nations when we can.

Acknowledging there are risks, he says the only way forward is to keep experimenting: to produce reliable and safe products.

He says, as a surgeon the last thing he would want to do is put someone at risk. “First, do no harm,” he says, recalling the Hippocratic oath he took decades ago.

“Sometimes bad things happen, despite your wanting it to be good,” he says, believing that faith in science and young PhD researchers like Harley is paramount.

As a sci-fi admirer, Choong says that people like to believe that bioprinting is something out of the movies he’s grown up watching. But unlike screen fiction, his team is operating under a tight ethical framework, which guarantees a level of safety.

“This should give people hope, not take it away from them.”

Come tomorrow, Choong will go back to the lab in the Clinical Sciences Building of the hospital and will resume working with the bioprinter that has a plastic model of a heart sitting on its base plate – a hopeful snapshot of the future.