3D Bioprinting Skin Equivalents: A Methodological Perspective on Human Keratinocyte and Fibroblast Models for Wound Repair and Regeneration
Juliana Amorim dos Santos
Laboratory of Oral Histopathology, School of Health Sciences, University of Brasilia, Brasília, Brazil
Department of Periodontics and Oral Medicine, Epithelial Biology Laboratory, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorMylene Martins Monteiro
Laboratory of Oral Histopathology, School of Health Sciences, University of Brasilia, Brasília, Brazil
Search for more papers by this authorCaio C. Silva da Barros
Department of Periodontics and Oral Medicine, Epithelial Biology Laboratory, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorLarissa Di Carvalho Melo
Laboratory of Oral Histopathology, School of Health Sciences, University of Brasilia, Brasília, Brazil
Search for more papers by this authorRicardo D. Coletta
Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, Brazil
Search for more papers by this authorRogerio M. Castilho
Department of Periodontics and Oral Medicine, Epithelial Biology Laboratory, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorCristiane H. Squarize
Department of Periodontics and Oral Medicine, Epithelial Biology Laboratory, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorCorresponding Author
Eliete Neves Silva Guerra
Laboratory of Oral Histopathology, School of Health Sciences, University of Brasilia, Brasília, Brazil
Correspondence:
Eliete Neves Silva Guerra ([email protected])
Search for more papers by this authorJuliana Amorim dos Santos
Laboratory of Oral Histopathology, School of Health Sciences, University of Brasilia, Brasília, Brazil
Department of Periodontics and Oral Medicine, Epithelial Biology Laboratory, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorMylene Martins Monteiro
Laboratory of Oral Histopathology, School of Health Sciences, University of Brasilia, Brasília, Brazil
Search for more papers by this authorCaio C. Silva da Barros
Department of Periodontics and Oral Medicine, Epithelial Biology Laboratory, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorLarissa Di Carvalho Melo
Laboratory of Oral Histopathology, School of Health Sciences, University of Brasilia, Brasília, Brazil
Search for more papers by this authorRicardo D. Coletta
Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, Brazil
Search for more papers by this authorRogerio M. Castilho
Department of Periodontics and Oral Medicine, Epithelial Biology Laboratory, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorCristiane H. Squarize
Department of Periodontics and Oral Medicine, Epithelial Biology Laboratory, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorCorresponding Author
Eliete Neves Silva Guerra
Laboratory of Oral Histopathology, School of Health Sciences, University of Brasilia, Brasília, Brazil
Correspondence:
Eliete Neves Silva Guerra ([email protected])
Search for more papers by this authorFunding: Amorim dos Santos was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior/Coordination for the Improvement of Higher Education Personnel—Brazil (CAPES), CAPES/PRINT (Edital N 41/2017, File #88887.694581/2022-00). C. Squarize and R. Castilho's work was funded by the National Institute of General Medical Sciences (R01GM143938).
ABSTRACT
Three-dimensional (3D) bioprinting is a promising approach to developing reliable tissue substitutes for translational research. The great interest in creating skin substitutes still faces challenges considering its structural and cellular complexity. Despite significant advancements, the lack of reproducible protocols and different translational barriers limit the clinical applicability of current methods. This review aims to provide guidance for future studies and improve methodological replication on wound repair and regeneration. Following the PRISMA 2020 guidelines, a search was conducted on MEDLINE/PubMed, EMBASE, and Web of Science. Inclusion criteria focused on 3D bioprinter constructs with human keratinocytes and fibroblasts for wound healing. Authors screened titles and abstracts, followed by full-text documents. Data extraction was conducted and cross-checked by two others using customised table sheets. Eighteen studies met the inclusion criteria, primarily focusing on skin substitutes, with no studies found on oral mucosal models. Geographic distribution was predominantly China (44.4%) and the United States (27.7%), with notable international collaborations. Most studies used extrusion-based bioprinting, with gelatin-based hydrogels as the most frequent components in the bioinks (61.6%). Other common materials included fibrinogen (38.8%) and alginate (33.3%), while some studies incorporated human serum and silk to enhance functionality. Constructed skin substitutes included epidermal layers with keratinocytes and dermal layers with fibroblasts, with some incorporating endothelial and follicle papilla cells for added complexity. Analyses included morphology, cell viability, histology, proliferation, protein and gene expression, and transepidermal electrical resistance. Many studies (61.1%) validated results through animal model implantation, primarily in mice. This review underscores the global interest and collaborative efforts in 3D bioprinting for skin wound healing and regeneration. However, we also emphasise the need for standardised protocols to improve replicability and enhance translational potential for clinical applications. Belike, future studies using computational modelling or machine learning should refine these technologies.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that supports the findings of this study are available in the supplementary material of this article.
Supporting Information
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Data S1: Supporting Information. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1P. P. Adhikary, Q. Ul Ain, A. C. Hocke, and S. Hedtrich, “COVID-19 Highlights the Model Dilemma in Biomedical Research,” Nature Reviews Materials 6, no. 5 (2021): 374–376, https://doi.org/10.1038/s41578-021-00305-z.
- 2A. Loewa, J. J. Feng, and S. Hedtrich, “Human Disease Models in Drug Development,” Nature Reviews Bioengineering 1, no. 8 (2023): 545–559, https://doi.org/10.1038/s44222-023-00063-3.
- 3O. Urzì, R. Gasparro, E. Costanzo, et al., “Three-Dimensional Cell Cultures: The Bridge Between In Vitro and In Vivo Models,” International Journal of Molecular Sciences 24, no. 15 (2023): 12046, https://doi.org/10.3390/ijms241512046.
- 4S. V. Murphy and A. Atala, “3D Bioprinting of Tissues and Organs,” Nature Biotechnology 32, no. 8 (2014): 773–785, https://doi.org/10.1038/nbt.2958.
- 5X. Ma, J. Liu, W. Zhu, et al., “3D Bioprinting of Functional Tissue Models for Personalized Drug Screening and In Vitro Disease Modeling,” Advanced Drug Delivery Reviews 132 (2018): 235–251, https://doi.org/10.1016/j.addr.2018.06.011.
- 6E. S. Bishop, S. Mostafa, M. Pakvasa, et al., “3-D Bioprinting Technologies in Tissue Engineering and Regenerative Medicine: Current and Future Trends,” Genes and Diseases 4, no. 4 (2017): 185–195, https://doi.org/10.1016/j.gendis.2017.10.002.
- 7H. Ravanbakhsh, V. Karamzadeh, G. Bao, L. Mongeau, D. Juncker, and Y. S. Zhang, “Emerging Technologies in Multi-Material Bioprinting,” Advanced Materials 33, no. 49 (2021): e2104730, https://doi.org/10.1002/adma.202104730.
- 8A. I. Toma, J. M. Fuller, N. J. Willett, and S. L. Goudy, “Oral Wound Healing Models and Emerging Regenerative Therapies,” Translational Research 236 (2021): 17–34, https://doi.org/10.1016/j.trsl.2021.06.003.
- 9D. Díaz- García, A. Filipová, I. Garza- Veloz, and M. L. Martinez- Fierro, “A Beginner's Introduction to Skin Stem Cells and Wound Healing,” International Journal of Molecular Sciences 22, no. 20 (2021): 11030, https://doi.org/10.3390/ijms222011030.
- 10D. N. Stanton, G. Ganguli-Indra, A. K. Indra, and P. Karande, “Bioengineered Efficacy Models of Skin Disease: Advances in the Last 10 Years,” Pharmaceutics 14, no. 2 (2022): 319, https://doi.org/10.3390/pharmaceutics14020319.
- 11M. J. Randall, A. Jüngel, M. Rimann, and K. Wuertz-Kozak, “Advances in the Biofabrication of 3D Skin In Vitro: Healthy and Pathological Models,” Frontiers in Bioengineering and Biotechnology 6 (2018): 154, https://doi.org/10.3389/fbioe.2018.00154.
- 12J. M. Faupel-Badger, A. L. Vogel, C. P. Austin, and J. L. Rutter, “Advancing Translational Science Education,” Clinical and Translational Science 15, no. 11 (2022): 2555–2566, https://doi.org/10.1111/cts.13390.
- 13M. J. Page, D. Moher, P. M. Bossuyt, et al., “PRISMA 2020 Explanation and Elaboration: Updated Guidance and Exemplars for Reporting Systematic Reviews,” BMJ (Clinical Research Ed.) 372 (2021): n160, https://doi.org/10.1136/bmj.n160.
- 14Z. Munn, C. Stern, E. Aromataris, C. Lockwood, and Z. Jordan, “What Kind of Systematic Review Should i Conduct? A Proposed Typology and Guidance for Systematic Reviewers in the Medical and Health Sciences,” BMC Medical Research Methodology 18, no. 1 (2018): 1–9, https://doi.org/10.1186/s12874-017-0468-4.
- 15M. Ouzzani, H. Hammady, Z. Fedorowicz, and A. Elmagarmid, “Rayyan—A Web and Mobile App for Systematic Reviews,” Systematic Reviews 5, no. 1 (2016): 210, https://doi.org/10.1186/s13643-016-0384-4.
- 16M. Albanna, K. W. Binder, S. V. Murphy, et al., “In Situ Bioprinting of Autologous Skin Cells Accelerates Wound Healing of Extensive Excisional Full-Thickness Wounds,” Scientific Reports 9, no. 1 (2019): 1856, https://doi.org/10.1038/s41598-018-38366-w.
- 17T. Baltazar, B. Jiang, A. Moncayo, et al., “3D Bioprinting of an Implantable Xeno-Free Vascularized Human Skin Graft,” Bioengineering & Translational Medicine 8, no. 1 (2022): e10324, https://doi.org/10.1002/btm2.10324.
- 18A. Cavallo, T. Al Kayal, A. Mero, et al., “Fibrinogen-Based Bioink for Application in Skin Equivalent 3D Bioprinting,” Journal of Functional Biomaterials 14, no. 9 (2023): 459, https://doi.org/10.3390/jfb14090459.
- 19K. Y. Choi, O. Ajiteru, H. Hong, et al., “A Digital Light Processing 3D-Printed Artificial Skin Model and Full-Thickness Wound Models Using Silk Fibroin Bioink,” Acta Biomaterialia 164 (2023): 159–174, https://doi.org/10.1016/j.actbio.2023.04.034.
- 20L. G. Dai, N. T. Dai, T. Y. Chen, L. Y. Kang, and S. Hsu, “A Bioprinted Vascularized Skin Substitute With Fibroblasts, Keratinocytes, and Endothelial Progenitor Cells for Skin Wound Healing,” Bioprinting 28 (2022): e00237.
- 21A. Desanlis, M. Albouy, P. Rousselle, et al., “Validation of an Implantable Bioink Using Mechanical Extraction of Human Skin Cells: First Steps to a 3D Bioprinting Treatment of Deep Second Degree Burn,” Journal of Tissue Engineering and Regenerative Medicine 15, no. 1 (2021): 37–48, https://doi.org/10.1002/term.3148.
- 22F. Hafezi, S. Shorter, A. G. Tabriz, et al., “Bioprinting and Preliminary Testing of Highly Reproducible Novel Bioink for Potential Skin Regeneration,” Pharmaceutics 12, no. 6 (2020): 550, https://doi.org/10.3390/pharmaceutics12060550.
- 23Y. Huyan, Q. Lian, T. Zhao, D. Li, and J. He, “Pilot Study of the Biological Properties and Vascularization of 3D Printed Bilayer Skin Grafts,” International Journal of Bioprinting 6, no. 1 (2020): 246, https://doi.org/10.18063/ijb.v6i1.246.
- 24T. Jiao, Q. Lian, W. Lian, et al., “Properties of Collagen/Sodium Alginate Hydrogels for Bioprinting of Skin Models,” Journal of Bionic Engineering 20 (2023): 105–118, https://doi.org/10.1007/s42235-022-00251-8.
- 25R. Jin, Y. Cui, H. Chen, et al., “Three-Dimensional Bioprinting of a Full-Thickness Functional Skin Model Using Acellular Dermal Matrix and Gelatin Methacrylamide Bioink,” Acta Biomaterialia 131 (2021): 248–261.
- 26A. M. Jorgensen, M. Varkey, A. Gorkun, et al., “Bioprinted Skin Recapitulates Normal Collagen Remodeling in Full-Thickness Wounds,” Tissue Engineering, Part A 26, no. 9–10 (2020): 512–526, https://doi.org/10.1089/ten.TEA.2019.0319.
- 27A. M. Jorgensen, A. Gorkun, N. Mahajan, et al., “Multicellular Bioprinted Skin Facilitates Human-Like Skin Architecture In Vivo,” Science Translational Medicine 15, no. 716 (2023): eadf7547, https://doi.org/10.1126/scitranslmed.adf7547.
- 28H. R. Lee, J. A. Park, S. Kim, Y. Jo, D. Kang, and S. Jung, “3D Microextrusion-Inkjet Hybrid Printing of Structured Human Skin Equivalents,” Bioprinting 22 (2021): e00143.
10.1016/j.bprint.2021.e00143 Google Scholar
- 29M. Li, L. Sun, Z. Liu, et al., “3D Bioprinting of Heterogeneous Tissue-Engineered Skin Containing Human Dermal Fibroblasts and Keratinocytes,” Biomaterials Science 11 (2023): 2461–2477.
- 30J. Liu, Z. Zhou, M. Zhang, F. Song, C. Feng, and H. Liu, “Simple and Robust 3D Bioprinting of Full-Thickness Human Skin Tissue,” Bioengineered 13, no. 4 (2022): 10087–10097, https://doi.org/10.1080/21655979.2022.2063651.
- 31Y. J. Seol, H. Lee, J. S. Copus, et al., “3D Bioprinted BioMask for Facial Skin Reconstruction,” Bioprinting 10 (2018): e00028, https://doi.org/10.1016/j.bprint.2018.e00028.
- 32L. T. Somasekharan, R. Raju, S. Kumar, et al., “Biofabrication of Skin Tissue Constructs Using Alginate, Gelatin and Diethylaminoethyl Cellulose Bioink,” International Journal of Biological Macromolecules 189 (2021): 398–409, https://doi.org/10.1016/j.ijbiomac.2021.08.114.
- 33D. Zhang, L. Lai, H. Fu, Q. Fu, and M. Chen, “3D-Bioprinted Biomimetic Multilayer Implants Comprising Microfragmented Adipose Extracellular Matrix and Cells Improve Wound Healing in a Murine Model of Full-Thickness Skin Defects,” ACS Applied Materials & Interfaces 15, no. 25 (2023): 29713–29728, https://doi.org/10.1021/acsami.2c21629.
- 34D. Sivaraj, K. Chen, A. Chattopadhyay, et al., “Hydrogel Scaffolds to Deliver Cell Therapies for Wound Healing,” Frontiers in Bioengineering and Biotechnology 9 (2021): 660145, https://doi.org/10.3389/fbioe.2021.660145.
- 35M. Mirhaj, S. Labbaf, M. Tavakoli, and A. M. Seifalian, “Emerging Treatment Strategies in Wound Care,” International Wound Journal 19, no. 7 (2022): 1934–1954, https://doi.org/10.1111/iwj.13786.
- 36R. Yadav, R. Kumar, M. Kathpalia, et al., “Innovative Approaches to Wound Healing: Insights Into Interactive Dressings and Future Directions,” Journal of Materials Chemistry B 12 (2024): 7977–8006, https://doi.org/10.1039/D3TB02912C.
- 37C. A. Wu, Y. Zhu, and Y. J. Woo, “Advances in 3D Bioprinting: Techniques, Applications, and Future Directions for Cardiac Tissue Engineering,” Bioengineering (Basel) 10, no. 7 (2023): 842, https://doi.org/10.3390/bioengineering10070842.
- 38A. Mazzocchi, S. Soker, and A. Skardal, “3D Bioprinting for High-Throughput Screening: Drug Screening, Disease Modeling, and Precision Medicine Applications,” Applied Physics Reviews 6, no. 1 (2019): 011302, https://doi.org/10.1063/1.5056188.
- 39P. Arumugam, G. Kaarthikeyan, and R. Eswaramoorthy, “Three-Dimensional Bioprinting: The Ultimate Pinnacle of Tissue Engineering,” Cureus 16, no. 4 (2024): e58029, https://doi.org/10.7759/cureus.58029.
- 40Y. Nishiyama, M. Nakamura, C. Henmi, et al., “Development of a Three-Dimensional Bioprinter: Construction of Cell Supporting Structures Using Hydrogel and State-Of-The-Art Inkjet Technology,” Journal of Biomechanical Engineering 131, no. 3 (2009): 035001, https://doi.org/10.1115/1.3002759.
- 41X. Li, B. Liu, B. Pei, et al., “Inkjet Bioprinting of Biomaterials,” Chemical Reviews 120, no. 19 (2020): 10793–10833, https://doi.org/10.1021/acs.chemrev.0c00008.
- 42J. Gong, Y. Qian, K. Lu, et al., “Digital Light Processing (DLP) in Tissue Engineering: From Promise to Reality, and Perspectives,” Biomedical Materials 17, no. 6 (2022): 062004, https://doi.org/10.1088/1748-605X/ac96ba.
- 43A. Summerfield, F. Meurens, and M. E. Ricklin, “The Immunology of the Porcine Skin and Its Value as a Model for Human Skin,” Molecular Immunology 66, no. 1 (2015): 14–21, https://doi.org/10.1016/j.molimm.2014.10.023.
- 44T. P. Sullivan, W. H. Eaglstein, S. C. Davis, and P. Mertz, “The Pig as a Model for Human Wound Healing,” Wound Repair and Regeneration 9, no. 2 (2001): 66–76, https://doi.org/10.1046/j.1524-475X.2001.00066.x.
- 45A. Kantaros, T. Ganetsos, F. I. T. Petrescu, and E. Alysandratou, “Bioprinting and Intellectual Property: Challenges, Opportunities, and the Road Ahead,” Bioengineering (Basel) 12, no. 1 (2025): 76, https://doi.org/10.3390/bioengineering12010076.
- 46J. Malda, J. Visser, F. P. Melchels, et al., “25th Anniversary Article: Engineering Hydrogels for Biofabrication,” Advanced Materials 25, no. 36 (2013): 5011–5028, https://doi.org/10.1002/adma.201302042.
- 47M. Zhu, Y. Wang, G. Ferracci, J. Zheng, N. J. Cho, and B. H. Lee, “Gelatin Methacryloyl and Its Hydrogels With an Exceptional Degree of Controllability and Batch-To-Batch Consistency,” Scientific Reports 9, no. 1 (2019): 6863, https://doi.org/10.1038/s41598-019-42186-x.
- 48C. A. Squier and M. J. Kremer, “Biology of Oral Mucosa and Esophagus,” Journal of the National Cancer Institute. Monographs 2001, no. 29 (2001): 7–15, https://doi.org/10.1093/oxfordjournals.jncimonographs.a003443.
10.1093/oxfordjournals.jncimonographs.a003443 Google Scholar
- 49F. G. Basso, J. Hebling, C. L. Marcelo, C. A. de Souza Costa, and S. E. Feinberg, “Development of an Oral Mucosa Equivalent Using a Porcine Dermal Matrix,” British Journal of Oral & Maxillofacial Surgery 55, no. 3 (2017): 308–311, https://doi.org/10.1016/j.bjoms.2016.09.019.
- 50F. G. Basso, T. N. Pansani, D. G. Soares, J. Hebling, and C. A. de Souza Costa, “LLLT Effects on Oral Keratinocytes in an Organotypic 3D Model,” Photochemistry and Photobiology 94, no. 1 (2018): 190–194, https://doi.org/10.1111/php.12845.
- 51L. M. Cardoso, T. N. Pansani, J. Hebling, C. A. de Souza Costa, and F. G. Basso, “Photobiomodulation of Inflammatory-Cytokine-Related Effects in a 3-D Culture Model With Gingival Fibroblasts,” Lasers in Medical Science 35, no. 5 (2020): 1205–1212, https://doi.org/10.1007/s10103-020-02974-8.
- 52R. Y. Lee, Y. Wu, D. Goh, et al., “Application of Artificial Intelligence to In Vitro Tumor Modeling and Characterization of the Tumor Microenvironment,” Advanced Healthcare Materials 12 (2023): e2202457, https://doi.org/10.1002/adhm.202202457.