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Bioprinted Ear and Nose Cartilage Reconstruction Closer Than Ever to Clinical Trials in the UK

After more than two decades of life-changing medical research for people with disfigurement from major trauma and burns, the UK fundraising charity Scar Free Foundation announced a pioneering £2.5 million research program that aims to revolutionize ear and nose cartilage reconstruction using bioprinting and patients’ own cells. The three-year program at Swansea University in Wales could advance 3D bioprinting of cartilage for facial reconstruction while examining how facial scarring affects mental health by analyzing data from the world’s largest cohort of people living with this visible difference.

Along with the Welsh government organization Health and Care Research Wales, Scar Free revealed that the new “Programme of Facial Reconstruction and Regeneration Research” at Swansea University would advance the development of 3D bioprinted facial cartilage using human cells and plant-based materials for future treatment of people in the UK and across the world who are either born without body parts or live with facial scarring as a result of burns, trauma or cancer.

Cynthia de Courcey using the 3D bioprinter for the Scar Free Foundation Research at Swansea University to advance the development of 3D bioprinted facial cartilage. Image courtesy of Adrian White Photography/Scar Free Foundation.

According to Scar Free, scarring affects over 20 million people in the UK. Moreover, the physical impact of severe scarring can require frequent operations, skin grafts, and daily physiotherapy, not to mention the psychological impact on patients and their families. Some of the most common causes of scarring arise from cancer surgeries and burn injuries. However, this is an area of medical research that has been critically underfunded.

Scar Free is out to change that by supporting research that alleviates the physical and psychological burden of scarring. For example, the foundation explained that patients living with the loss of ears or noses had told researchers that existing plastic prostheses didn’t feel “part of them” and would prefer that their own tissue is used for reconstruction. By creating a custom cartilage scaffold which the patient’s own stem cells grow onto, surgeons would avoid the need to take cartilage from elsewhere in the body (which would otherwise lead to painful surgery and further scarring).

Scar Free Foundation Infographics. Image courtesy of the Scar Free Foundation.

Led by Iain Whitaker, Chair of Plastic Surgery at Swansea University Medical School and Surgical Specialty Lead for Health and Care Research Wales, the pioneering program builds on an initial study supported by the Royal College of Surgeons and based on the Medical Research Council-funded work of Zita Jessop, now a Senior Lecturer in Whitaker’s team. Her specific research called 3D BIO-FACE will be taken to the next stage and include scientific studies to determine the ideal combination of cells to grow new cartilage, optimize nanocellulose bioinks for 3D bioprinting patient-specific cartilage constructs, and show that they are safe, non-toxic, and well-tolerated by the immune system.

Whitaker’s lab, known as the Reconstructive Surgery & Regenerative Medicine Research Group (ReconRegen), established in 2012, has developed into the largest single-center reconstructive surgery research group in the UK and has been leveraging bioprinting technologies for years. Including five-year-old groundbreaking UK-funded research shows how nanocellulose is compatible with human cells that can be 3D printed as a support structure in bioprinting – and also that living cells can also survive the printing process. Whitaker and his group’s goal has been to develop anatomically shaped tissue tailored to individual patients that can survive long-term. Thanks to 3D bioprinting, this is becoming a reality.

By developing 3D bioprinted facial cartilage using human cartilage-specific stem-progenitor cells and nanocellulose as a bioink for facial reconstruction, surgeons could create durable cartilage constructs that can be safely and effectively implemented in human clinical trials. If successful, the outcomes could revolutionize reconstruction in patients affected by facial deformities and eliminate donor site scarring and other complications.

Whitaker highlighted that a successful translation of this research program would “transform the future of surgery,” since the scientific concepts and platform technologies of their work can be applied to tissue types such as blood vessels, nerves, bones, skin, and fat, not just cartilage. In the UK, the ability to successfully 3D print living tissue has been highlighted by the Royal College of Surgeons as one of the futures of surgery, and the UK Government selected regenerative medicine as one of the “eight great technologies” to propel the UK to the future growth, went on Whitaker.

Scar Free Foundation Research at Swansea University uses Cellink technology and bioinks to advance the development of 3D bioprinted facial cartilage. Image courtesy of Adrian White Photography/Scar Free Foundation.

On a more personal note, Scar Free’s Lead Ambassador, Simon Weston, a veteran of the British Army who endured years of reconstructive surgery following a life-threatening injury during the 1982 Falkland War, said this research would have made a big difference to him.

“There simply wasn’t the research or capability at the time to rebuild my ears – I literally had to watch them fall off. This research also avoids the need for skin grafts taken from other parts of the body – a process which itself can be very painful and leaves behind new scars,” said Weston, who went on to become a patron of several charities that support people living with disfigurements, and was appointed Officer of the Order of the British Empire (OBE) for his courage and charity work.

Simon Weston CBE, Lead Ambassador for The Scar Free Foundation. Image courtesy of the Scar Free Foundation.

Developing cutting-edge research to reconstruct defects in a way that was impossible before has the potential to change patients’ lives. Bioprinting technologies are an ideal vessel to deliver highly anticipated advances in facial reconstruction through human cells but without any invasive procedures. As a result, the advance could limit the consequences of facial scarring both physically and emotionally, giving surgeons the revolutionary ability to reconstruct people’s faces using their own cells without the need for further scarring.

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