ABOUT THE AUTHORS
Dr. Murugan Ramalingam is Professor at the Centre for Biomaterials, Cellular & Molecular Theranostics, Vellore Institute of Technology (VIT), India. His current research interests are focused on the development of multiphase biomedical materials; through conventional to nanotechnology to biomimetic approaches, microfabrication and bioprinting, cell patterning, stem cell differentiation, tissue engineering and drug delivery.
Rohin Shyam is a Ph.D scholar at Vellore Institute of Technology conducting his research in 3D bioprinting for vascularised cardiac tissue constructs, microfluidic studies for organ-on-chip COVID-19 disease models, and diagnostic methods to detect COVID-19.
3D Printing to Play Major Role in Mitigating Spread of COVID-19 Say Researchers from VIT
The Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2), commonly known as the novel Coronavirus disease (COVID-19) caused an outbreak in pneumonia spreading from the city of Wuhan, in Hubei province, China.  The virus can replicate rapidly and transmit from person-to-person via air droplets or close contact. Recent research has shown that this virus strain belongs to the same family of coronavirus as Severe Acute Respiratory Syndrome and Middle Eastern Respiratory Syndrome, which affected humans in 2002 and 2012 respectively.
The distinct feature of coronavirus is the presence of club-like protrusion called peplomers which give it a crown-like appearance under electron micrography. Furthermore, peplomers on SARS-CoV-2 have an affinity towards a receptor called angiotensin-converting enzyme 2 (ACE2), found on the surface of skin cells, lung cells, and mucous of nose, mouth and eye on which the virus can latch onto and enter the body. ACE2 is known to regulate blood pressure, inflammation, and cell reproduction within multiple organs, especially the lungs. Upon entry into the body, the virus reduces the availability of ACE2 receptor, blocking the reproduction of regenerative cells in organs causing respiratory, gastrointestinal, hepatic, and central nervous system diseases.
The virus has turned into a pandemic and has resulted in over two million infections and over 160,000 deaths globally. Hospitals, especially in countries like the United States of America (USA), Spain, and Italy where the virus has had its most severe outbreak, are facing an immediate problem of the lack of ventilation devices required to provide oxygen to patients infected with the disease who have difficulty in breathing. Global and local supply chain has been severely affected due to stringent lockdowns across the world resulting in the inability of medical equipment manufacturing industries to meet the demands under short notice in supplying critical medical products for lifesaving medical equipment such as ventilator and other reanimation devices when they break down.
Three-dimensional (3D) printing can come to the rescue in these circumstances to some extent. 3D printing is an additive manufacturing process that involves the layer-by-layer deposition of materials such as plastics, metals, and ceramics to create intricate objects in 3D space. Due to their versatile and compact nature, a 3D printer can be installed in a matter of minutes at points of care and be ready to meet the demands of the hospitals in a short span of time. Recently, 3D printing company FabLab based in Milan, Italy began printing ventilator valves for a hospital that was unable to get its usual supply from their contracted manufacturer. Another report from the United States of America where a 3D printing manufacturer, FormLabs, is 3D printing nasal swabs required for testing the virus. There is an ongoing demand for 3D CAD files of essential medical equipment that can be printed at any point of care with a 3D printer at their disposal.
Besides the manufacturing of spare parts for medical equipment and critical medical devices used in aiding critically ill patients infected with COVID-19, 3D Printing is capturing the imaginations of additive manufacturers worldwide in providing inventive solutions in an effort to combat this rapidly spreading contagion. Interesting examples include of a company based in The Czech Republic, Prusa3D, which is 3D printing the head mount of face shields, typically used as personal protective equipment for staff dealing with patients diagnosed with the virus and offering the CAD design files without charging a fee enabling printing anywhere in the world on any type of 3D Printer. Prusa3D is currently awaiting approval from the Czech Ministry of Health for verifications, which upon approval, will enable them to print approximately 800 shields per day at a cost of less than $1 per shield.
Transmission of the virus can occur through surfaces, especially hospital doors and handles which can be subjected to multiple physical contacts over the course of a day. Currently, hospitals overflowing with patients infected with the disease can aid in its transmission which led to a Belgian-based company, Materialise, to innovate a 3D printed hands-free door handle attachment. Along with other manufacturers, Materialise is providing CAD design files without charging a fee. There are several examples of inspiring innovations using 3D printing and include the printing of protective goggles, face masks and respirators, reanimation machine valves, converting a manual ventilator into an automatic one using 3D printed parts and microprocessors, and perhaps the most imaginative is the 3D printing of quarantine booths using urban construction waste as fabrication material by a Chinese 3D architectural company, Winsun, near hospitals in Wuhan, which faced the critical shortage of hospital beds to treat the patients in the early stages of virus transmission.
There is no doubt that with the current level of imagination capturing the attention of additive manufacturers across the world, it can be expected that in the coming weeks as global shutdown ensues, 3D printing will evolve to play a major role in mitigating the spread of coronavirus and the level of commitment from additive manufacturers is expected to increase as currently, most 3D printing companies are utilising the opportunity to not only promote their company’s product and innovation but that most of the designs are being offered for free, a gesture in harmony for a greater cause of valuing each life and beyond the corruption of monetary benefit in a time of crisis, something that has been observed in the past.
On the other hand, 3D bioprinting technology might play an important role in the aid of curtailing this pandemic. 3D bioprinting is a form of the additive manufacturing process that involves the printing of tissue-like structures that imitate natural tissues from a combination of cells and biomaterials, called bioinks.
Currently, there are no reports of 3D bioprinting technology being used in the fight against coronavirus. However, a potential future direction that employs 3D bioprinting can involve the replacement of defective organs due to viral infection. Additionally, the current challenge in the development of vaccines and novel therapeutic regimes is the time-intensive and high costs associated with human clinical testing of their safety and efficacy. Therefore, 3D bioprinting, combined with organ-on-a-chip or microfluidic systems, in some cases, can serve as a platform to develop organ models that can be used to test the efficacy and safety of novel vaccines and drugs.
This will not only reduce the high costs associated with human clinical trials but also greatly reduce the time factor involved. 3D bioprinting can be used to print human tissue-like structures and study the effect and efficacy of any novel vaccines and drugs on the human-like system without causing harm to either individuals enrolled in clinical trials or the developers of the novel vaccine. Researchers from the University of Toronto, Canada, are in the process of developing a miniaturised version of the lung, nose, and mouth using human cells and placing them on such an organ-on-chip model to study how the virus interacts with human cells. These models can aid in the development of drugs and therapeutic regimes to combat the virus.
As the outbreak continues to expand in the coming weeks and global lockdown ensues, there is a dire need for the confluence of digital manufacturers, tissue engineers, and virologists to expeditiously design systems that will not only resolve present issues and challenges but also improve preparedness for any future pandemic scale events.