Researchers working toward ambitious goals — increasing surgical successes, improving drug safety and eliminating the organ shortage — have something in common.
They’re taking a layered approach to medicine.
And the possibilities are huge.
Three-dimensional printing, which builds objects from digital files one layer at a time, was first developed in the 1980s, but advances in this technology have accelerated its use over the last decade and a half. Florida researchers are joining nationwide efforts to tackle ongoing medical issues, and seniors are poised to reap the benefits.
Medical professionals are increasingly using the tool to plan complex surgeries and develop prosthetic devices. Researchers are also eyeing other potential applications, such as the creation of 3-D-printed organs.
“It would be a game-changer, no question,” said Carol Buckley, who, while not waiting for a kidney herself, co-coordinates the Kidney Support Group in The Villages. “I hope I’m around to see that.”
Printing organs may be a bit further off, but researchers are confident the technology will benefit many medical areas sooner than we think.
“It is the future,” said Jack Stubbs, director of the Prototype Development and 3D Print Lab at the University of Central Florida. “I think it’s going to be a very fun ride over the next few years to see how quickly it is accepted.”
Evolution Of 3-D Printing
Despite a recent rush to the field, 3-D printing has been available for decades.
Engineer Charles “Chuck” Hull invented the first type of 3-D-printing technology in 1983, opening the doors for a new means of production, according to his website.
Since then, these multi-dimensional printers have evolved in capability, including increasing the types of material that can be used to create. And costs have dropped, allowing consumers to purchase printers for their homes.
Traditionally, manufacturing begins with a block of material that is shaped down with various tools, known as subtractive manufacturing.
For 3-D printing, or additive manufacturing, thin layers of material are stacked in succession to form an object based on a digital file.
“You can design things that change shape or have more functionality at lower cost and lighter weight and less material through a 3-D printing approach,” Stubbs said.
It also cuts down on wasted material because the printers are only using what’s needed.
But many experts don’t foresee 3-D printing overtaking the mass production of simple parts at this time, according to a 2019 report by the Congressional Research Service, a nonpartisan research group for the U.S. Congress.
The report estimated 3-D printing could account for 5-to-10% of manufacturing long term.
But it’s found purpose in the medical realm for advancing patient-specific, personalized medicine.
Putting It Into Practice
One area where medical 3-D printing is starting to take off is surgical planning, adjusting strategies to fit patient needs before even entering the operating room.
Surgeons working with complex cases benefit from this technique, said Ciprian Ionita, assistant professor of biomedical engineering and neurosurgery at the University at Buffalo.
Ionita uses brain scans to make a personalized, 3-D-printed model of the brain. Surgeons then can use these models to test their approach to treating complicated cases before cutting into a patient.
“It is something with human nature that we do a lot better when we have something that we hold in our hands,” Ionita said. “We feel the mechanics of the surgery.”
After practicing with these models, Ionita said surgeons typically change their original approach by 70%. They also use fewer devices like stents, which are tubes that open blocked passageways, and subsequently subtract 25% of their surgical time.
“That’s a big improvement, because any time you spend in the surgery room increases the chance of complications,” Ionita said. “It is going to probably become a standard.”
UCF’s lab is printing models for Nemours Children’s Hospital in Orlando to help physicians plan surgeries for pediatric patients.
So when planning to remove a tumor, surgeons can use a 3-D model to get a better sense of how to reach it, what instruments they’ll use and how the patient should be positioned, Stubbs said.
Fluvio Lobo, principal research and development engineer at UCF’s Prototype Development and 3D Print Lab, said providers may turn to exploratory surgery now to understand what’s really going on in the body and make a diagnosis.
“With 3-D printing, that’s one of the things that hopefully in the future will be completely eradicated,” he said.
Another application, Ionita said, is printing patient-specific guides for surgeries.
“It snaps onto the patient, and you orient your cutting or drilling only to that direction,” he said.
Village Dental is among providers using 3-D printing to make surgical guides. The dental practice got a 3-D printer at its Southern Trace Plaza office in December 2018.
Dentists plan and coordinate with a partner lab to design the tools, which are used to ensure precise placement.
After the planning is complete, the guides are printed on site.
Village Dental also uses 3D printing to make study models for dentists to evaluate patients.
“We can hold it in our hand and see what the bone structure looks like,” said Dr. Ed Farrell. “It’s all a benefit for the patient, and it’s nice to have it right here in The Villages.”
With a scan and digital impression, they can complete the entire process in an hour and a half, said Jessica Earls, Villages Dental clinical coordinator. Before, it took days to take goopy impressions and then pour and mount models.
“It’s speeding up our processes across the board,” Earls said.
And in two months, the uses will expand when the practice starts 3-D printing temporary crowns, too. The goal is to also print permanent crowns, caps used to restore teeth, once those materials are approved by the U.S. Food and Drug Administration, Farrell said. And they are looking to printing other tools, such as dentures, in the future, he said.
While Villagers are being touched by these uses, some researchers are looking into how other custom-printed devices can benefit younger patients.
At UCF, they’re working to make 3D-printed laryngoscope blades, devices doctors use for examinations and for breathing-tube insertions, for infants who can’t breathe on their own.
“If you’re looking at a premature child born three months early and weighing two and a half pounds, there are no standard medical instruments that fit that kid,” Stubbs said.
Manufacturers don’t make laryngoscope blades for infant patients because of the low number of cases, Stubbs said. So they’re researching the possibility of quickly printing a custom laryngoscope blade based on a CT or MRI scan for those patients.
Other researchers are working on custom parts for the human body.
A New Dimension Of Prosthetics
Albert Manero took an interest in this use for 3D printing as a high school student in 2006.
“It was really exciting to be able to see what you could design on the computer and then be able to hit print and bring it to life,” he said.
Manero went on to co-found Limbitless Solutions, a nonprofit at UCF that makes 3-D-printed prosthetic arms for children.
Limbitless printed its first arm in 2014. In total, it has given 40 arms to 36 kids and teens.
The team uses measurements provided by the child’s family to create a custom socket and works with hospital partners to ensure it fits his or her needs.
The kids get to help design the artistic components or the arms by choosing color palettes and altering the shape of the outer sleeve.
In 2015, Iron Man himself, actor Robert Downey Jr., delivered a Limbitless gold and red 3-D printed arm to a then 7-year-old boy who loved superheroes.
Customized aesthetics are a bonus for a life-changing device — a device that’s sometimes difficult to get a hold of.
For children, high cost and continued growth can limit their access to traditional prostheses.
However, Limbitless arms are 3D-printed using a plastic material that allows them to be made at lower cost than other prosthetics in the medical market.
And the arms can be printed with spacers to allow for further growth of the child, instead of requiring additional prosthetic arms as they age.
To increase access to the 3-D-printed arms, Limbitless is undergoing its first clinical trial on the road to getting approval from the FDA.
“Our aim is to eventually have the arms come in at a lot less than what is currently on the market,” Manero said. “That way, insurance companies can cover the cost in its entirety and families aren’t financially burdened.”
But having a 3-D printed limb isn’t that straightforward for someone needing a prosthetic leg.
While there are some 3-D printed prosthetic foot designs available online for at-home printing, there are not a large number of prosthetic legs because most 3-D printing plastics aren’t strong enough to support body weight, according to the Amputee Coalition.
But researchers with access to more advanced 3-D printers capable of using materials like titanium have successfully developed some prosthetic leg models.
Rich Cole, who leads the Amputee Support Group in The Villages, had a leg amputated. And while not in the process of seeking a printed prosthesis for himself, Cole is hopeful they will be available for amputees in the future.
“Without question 3-D printing is an emerging technology that will have many benefits, including improving the fit and function of prosthetic limbs in the future,” Cole said. “The only real question is how far?”
Potential For Implants
As some researchers make gains with external devices, others like Dr. Daniel Penello are looking to internal uses.
The hand surgeon with Alexander Orthopaedic Associates in St. Petersburg designed a first-of-its-kind 3-D printed implant last year while treating a patient, an iron worker by trade, after a steel beam landed on a finger.
The flesh healed, but the bone at the tip of his finger didn’t. He tried to live without it, but found the tip would flop around when he tried to type.
They discussed amputating the finger tip as an option.
“He didn’t like the idea,” Penello said.
So Penello came up with a different option: replacing the bone that had been crushed with an artificial bone made of titanium.
The hand surgeon spent five months working with a design team to make models of bone, using CT scans of the patient’s left hand as a guide.
The final 3-D-printed piece was implanted in the patient. Penello said it worked better than the patient — an early skeptic — expected.
Penello said 3-D printing was ideal for the concept because it was such a small part, and he’s excited to see researchers unlock other uses for the technology, like 3-D printing organs.
“That’s down the road, but that’s where 3-D printing is heading,” he said.
The Quest To Solve The Organ Shortage
The field of 3-D printing organs is still in its beginning stages, but there’s an urgency to get this technology off the ground.
Demand for organs far outweighs supply, and more than 100,000 Americans are currently wait-listed.
The majority are waiting for kidneys.
Researchers are looking to many avenues to alleviate the dire situation, and 3-D printing may be one part of a solution.
Carol Buckley, co-coordinator of the Kidney Support Group in The Villages, knows the challenges of getting a donated organ. Buckley’s son was diagnosed with polycystic kidney disease, a disorder that can cause kidney failure. He has received one kidney from a living donor he knew, then another from someone else he knew after that one failed. Otherwise, he’d have likely waited much longer, Buckley said.
Using 3-D printers to create living organs “would give so many people a new lease on life,” Buckley said.
It’s not just people waiting for a kidney who could benefit. Printed hearts have shown early potential.
In April, scientists at Tel Aviv University in Israel announced they had printed the first 3-D-printed heart with blood vessels.
“At this stage, our 3D heart is small, the size of a rabbit’s heart,” said professor Tal Dvir in a release.
The heart also does not have the ability to pump. Dvir said they are working toward addressing that and hoping to then test the hearts in animal models.
But the technology won’t benefit patients like Donald Hamel yet. Hamel has had two valves replaced in his heart. A third replacement, however, is not an option.
“He needs a new heart,” said Pam Bloom-Hamel, his wife of 16 years.
About 15 days ago, after extensive testing, the 62-year-old Village of Rio Grande resident landed on a transplant wait list at the AdventHealth Transplant Institute in Orlando.
The couple keeps a suitcase packed and doesn’t leave The Villages in hopes of getting the call that a heart is available.
“It’s tough,” Bloom-Hamel said. “We’re not letting it stop us, that’s for sure.”
Progress, But Not There Yet
A fully 3-D printed organ is a long way off, said Thomas Angelini, associate professor in the Department of Mechanical & Aerospace Engineering at the University of Florida.
“Right now, you still can’t just go out and buy a 3-D printer that will print a good piece of tissue that will function and survive when implanted into an animal,” he said.
But Angelini and his colleagues in the Soft Matter Research Lab are among researchers nationwide making progress toward printing tissues from living cells.
The 3-D printers, Angelini explained, hold a syringe filled with living cells. The printer moves the syringe to create a trail of cells, which are trapped in space by a hand-sanitizer like material.
“The structures that we print are like as if you took a razor blade and shaved a little, teeny disc across a grain of rice. That’s how small these things are,” he said. “But they’re made out of all the cells that the human liver is made out of. Our goal is to get those little teeny tissues to function the same way the human liver does.”
The biggest challenge to tissue engineering and the key to printing fully functioning tissues, and organs, has yet to be solved, Angelini said.
The body functions with a system of circulatory systems that carry blood through it, transporting oxygen, nutrients and waste.
Those systems work and grow with the organism as it develops from an embryo to be fully functioning independently.
“The piping that’s needed to support everything, they have it growing along with them,” Angelini said. “We haven’t learned to mimic nature in that way.”
Solutions Beyond The Stars
Meanwhile, an Orlando-based company is looking beyond Earth for answers.
Last summer, nScrypt partnered with another company to bring a 3-D bioprinter to the International Space Station.
It’s there now printing heart cells.
The thinking is that, when printed on Earth, tissues collapse under their own weight because of gravity. In space, the 3-D-printed structures maintain their shapes.
“We’ll see where that goes, but the hope is that we can learn from that,” said Ken Church, CEO of nScrypt.
The eventual goal is to return functional tissues to Earth. It’s a personal mission for Church, whose daughter has one lung.
“I was sort of set on growing her a lung,” he said. “Ultimately, the holy grail is to print a heart, print a lung.”
That’s at least a decade away, though, Church said. Angelini thinks it’s likely longer.
Angelini sees a more immediate use for the small, 3-D printed tissues he’s helped develop: testing drugs.
“The research and regulatory pathway to proving a compound isn’t harmful to humans is extremely extensive and extremely slow,” he said.
Even with that process, drugs are pulled from the market due to unanticipated toxicity to humans.
Angelini said they want to have a tissue model available that can test drug compounds to better predict if they’ll harm humans within the next year and a half.
Their hope is to accelerate approvals, getting safer drugs into the hands of patients who need them faster.
It’s another layer of potential for the technology within reach.
Senior writer Ciara Varone can be reached at 352-753-1119, ext. 5395, or firstname.lastname@example.org.