Review Article
Biomedical Graft Technologies: An Overview
Luciana Pastena Giorno, Leonardo Ribeiro Rodrigues and Arnaldo R. Santos Jr*
Corresponding Author: Arnaldo R Santos, Federal University of ABC, Center for Natural and Human Sciences, Delta Block, room 204, Rua Arcturus 03, Jardim Antares, São Bernardo do Campo, 09606-070, SP, Brazil
Received: March 12, 2019; Accepted: March 18, 2019; Published: November 12, 2019;
Citation: Giorno LP, Rodrigues LR & Santos AR. (2019) Biomedical Graft Technologies: An Overview. Stem Cell Res Th, 4(1): 135-141.
Copyrights: ©2019 Giorno LP & Santos AR. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 

Introduction: Search for alternatives in the health area, new technologies and concepts help to set up dimensions of the clinical situation, and priorities for investigation. The field of tissue engineering substitutes aims to mimic the extracellular matrix structurally and physiologically to replace or improve functions of the failing organ.

Objective: Provide a brief summary of the current achievements of technology in organ transplantation.

Method: This is a narrative review based on sources of primary and secondary evidence from a bibliographic survey.

Results: In clinical practice, various strategies are available or developed from advantages and disadvantages techniques.

Conclusion: Similar to native tissues, sophisticated biomaterial designs are making compliance simpler in a dynamic system, aiming a personalized way.

 

Keywords: Prostheses and implants, Biomedical technology, Bioartificial organs, Biocompatible materials

INTRODUCTION

According to the World Health Organization (WHO)’s definition, “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [1]. It emphasizes the need for governmental agencies to elaborate on public health policies that responsibility to care about the welfare aspects [1,2]. Based on the foregoing analysis, the worldwide confronted with a shift resulting from globalization and challenges of a new knowledge-driven economy; cultural and community life; religion; morbidity and mortality due to the high prevalence of co-morbidities in a permanently evolving process of society [1-3].
In 2016 the average life expectancy at birth of the global population was 72.0 years [4,5]. Currently, quality of life is an important concern and it will dictate how these people will achieve the ‘elderly’ [6,7]. Reiterating that the organism has a limit to regenerate itself, loss of functionality through pathological changes or trauma reflects upon high-cost therapy and the population dependence on health services [8-10]. An example is organ transplantation, indicated to diseases sometimes refractory to treatment, which impacts the patients’ routine and requires constant changes in their daily life. Nevertheless, the shortage of donors for transplantation therapy is a serious worldwide issue and the number of patients on waiting lists increases [11-14].
The Brazilian Association of Organ Transplants (ABTO), a civil non-profit entity, shows that donation's rate practically stagnated (decrease of 0.6%) compared to the first semester in 2018 [12]. Moreover, some situations that are characterized by key limitations like cold ischemia time and pre-existing physical conditions may affect the survival of the transplanted organ [15].
Considering the biochemical and cellular phenomena to restore the body integrity in a dynamic system [8,16,17]; inter and multidisciplinary intervention correlates the scientific and technological environment by bioengineers supplying cell products that should face a personalized medicine [18-20].
One might hope by several strategies now available to be used for replacing or improve failing organs function (biodegradable or bioresorbable substrate) with specific physical characteristics according to clinical demand [18,20-26]. Attachment cells, growth, proliferation and differentiation in modifiable surface materials by functional reactions establish the bioactivity [22-24,26].
Others biotechnological tools to fabricate donor tissue or organs are being developed or tested for approval (e.g. tissue-engineered      substitutes;       molecular      diagnosis; genomics, etc.) [21,27-31]. Once, mechanical properties closer to those of natural, as well as attractive cost-effectiveness, safer products, restriction of animal experiments and effective drugs for research are desired [20,24,29,32-34].
Motivated by these considerations, in this narrative review we will provide a brief summary of current achievements in the field of organ transplantation technology, establishing the dimension and priorities for investigation.

METHOD
This is a narrative review that was based on primary and secondary evidence sources from bibliographic surveys. As Cochrane Library; Web of Science; MEDLINE from the National Library of Medicine of the United States of America via PubMed; databases of Latin American and Caribbean Literature in Health Sciences (Lilacs); SciVerse Scopus and Scientific Electronic Library Online (Scielo) by the Portal of Bases in Health Sciences (VHL).
The Health Sciences Descriptors (DeCS) used in English were: Prostheses and Implants; Biomedical Technology; Bioartificial Organs; Biocompatible Materials. The Boolean Operator “AND” was used. Articles with relevant and current rationale available in full were established as inclusion criteria. Duplicated articles (more than one database searched) and those that did not contemplate the subject matters were excluded.

RESULTS/DISCUSSION
Importance of the microenvironment
Difficulty in technical skill, ethical questions, and financing constraints still needed to be overcome [21,31,35,36]. To identify ways to simplify clinical practice through, effective and resolute care, has motivating scientists to achieve functionality model in a highly dynamic entity over the years [9].
The extracellular matrix (ECM) composed by multi-component structural elements (e.g. collagens, laminins, entactin, glycoproteins, elastic fibers, etc.), provide mechanical support to the resident cells, stability, a shape of tissues besides participating in their performance (tissue development, turnover and regeneration) [8].
Herewith, the homeostasis requires constant physical and chemical adaptations from cells residing in living systems [8]. And understanding human physiology as the components, structures and their interactions influence the environment’s manufacture [8,26,32,37].
To advance knowledge of sophisticated laboratory-grown, three-dimensional (3D) cultures with specific micro architectural features become a viable alternative to improve the interaction of adhered cells from different transplant techniques [20,27,32,38-41].
The scaffold constitutes in controlled morphologies of interconnected pore networks construction at various scales (nano, micro and macro) and different distribution, which affects the final application at post-injury to physical integrity [32].
Aiming to functional performance to handle the tackle of practical failures such as inadequate vascularization, it is important to select the most suitable material for the guide’s supporting substructure. If so, those variables need to be identified in the scaffold because they impact on mechanical properties during cell invasion and remodeling expressed in vitro [42-45].

Tissue engineered
There are valuable tools in tissue restoration for patient survival: I) allografts, also known as allogenic, homologous grafts or homografts; II) xenografts, heterografts or xenogenic grafts; and III) alloplastic grafts or synthetic grafts [20]. Regardless of the case, immunosuppressant medications are needed, even with their side effects [46].
Concerning item III, biomaterials have their compositions explored to act cooperatively or synergistically to the organism [19,20,26]. Confirming the growth of some products in the public and private health care organizations, which were approved by Food and Drug Administration (FDA) [10,23,47-49].
These biomaterials are defined as “a substance that is able, or has been engineered, to take a form which, alone or as part of a complex system, is used to direct, by control of interactions with components of living systems, the course of any therapeutic or diagnostic procedure, in human or veterinary medicine” [19]. However, thus with biological evaluation through material-tissue tests interaction in risk management established by the International Organization for Standardization of the Manufacture of Medical Devices [23], the immune response is one of the determinants of rejection [46].
Research endeavors make worldwide progress with an ingenious structural project that can include many substances and applications in different forms (foams, fibers, membranes, hydrocolloids, and hydrogels) for better settings [27]. Several biomaterials are used with a concept of organotypic models to acquire bottom-up or top-down approaches [30,50,51]. Some of them are discussed below.
Cells: The mergers of omics technologies in vitro engineered substitutes establish models for research and applications around the world [52,53]. Understanding the multipotent stem cell and its biology behavior, allow us to evolve a noninvasive and accurate method of diagnosis or therapy [54].
Furthermore, the stem cells can proliferate themselves for many generations and differentiating into multi-lineage cells. Readily being used, induced pluripotent stem cells (iPS cells or iPSCs) are reprogrammed from adult cells to create living neo-tissues in vitro as a strategy to reproduce biological function [55-57].
Another possibility is mesenchymal stem cells (MSCs) that can differentiate into a variety of cell types. Moreover, the multilineage potential, immunomodulation by express cell surface markers, and anti-inflammatory molecules make it an interesting tool in chronic diseases and clinical trials [54,56,57].
In addition, soft-tissue grafts have shown improvement in clinical outcomes. Abundant adipose tissue-derived stem cells (ADSCs) sources as a form of cell-based therapy are still discussed in regenerative medicine and became a topic of growing interesting [58,59].
Scaffold: Temporary to permanent substitutes materials with different characteristics allow for a diversified design [20]. It may consist of natural microstructures (e.g. polysaccharides: chitosan, alginate, cellulose and others; proteins: collagen, gelatin, fibrin and others), polymers (e.g. Polyglycolide (PGA) and its compounds, Polycaprolactone (PCL), Polylactide (PLA) and others) or hybrid approaches [29,43,55,60,61].
The Amniotic Membrane (AM) is a great potential for grafting material [20]. Either directly or following decellularized ECM scaffolds [62], they are used for the treatment of corneal defects, diabetic foot ulcers, severe skin burns and specialties of periodontics and implant surgery [20,63,64].
Another therapeutic possibility is porcine small intestinal submucosa (SIS). This material consists of about 90% collagen, exhibits growth factors and adhesion peptide sequences. Considering an important component of the epithelial basement membrane that facilitates integration with tissue [20,65,66].
Techniques: Structuring an integrated and functional graft by association materials, tailored surface, predictable performance for optimizing properties in their final applications makes futuristic technologies even closer to reality [21,32,67,68].
The bioreactor provides strategies for cell seeding of scaffolds [67,69,70] and based on the advantages and disadvantages of the various techniques applied, we have some examples:
·         Fiber-Assisted Molding (FAM): It establishes a method to fabricate microgrooves and study cells in complex helical and curved structures (e.g. intestine, esophagus, and heart), creating unconventional geometric volumes, which are assembled and remodeled during growth [71].
·         Rotary Jet-Spinning: By building anisotropic arrays, presenting as advantages reduced commercial cost, high rate of production, and uniaxially aligned nanofiber structures for polymers allow a contributor to fiber formation and its application in tissue engineering [72,73].
·         Bioprinting: Recently, ‘time’ is integrated at the evolution of 3D to 4D for complex bioconstructs. One of the possibilities is through ‘smart materials’ in a dynamic system whereas the external stimuli can change their reshape and function. And others by improving the bio-ink that is manufactured layer-by-layer in a static and inanimate situation, limited by the diameter of the syringe needle and by some polymers of liquid character. Some biomedical applications are transplantation and drug screening [74-77].
Nanotechnology: With nano and micro particles, multiple functions became possible [78].
·         Prevention: To understand the patient-specific basis of disease, the varied practical applications stimulate access to before inaccessible areas. Some characteristics have been observed at the nanoscale like anisotropic properties, concentration polarization, charge exclusion, and streaming current phenomena which are exploring and can contribute in a positive form [78,79].
·         Diagnosis: Some nanoparticles can serve as imaging agents due to their features contrast. Such as nanoparticles with metallic components used as a biosensor, assisting in image diagnosis and improving the clinical practices [78,79].
·         Treat diseases: Through targeted drug delivery systems (TTDS) make compliance simpler and can considerably improve therapeutic efficacy with more controlled side effects by harnessing various routes of administration. For example, nanorobots that have the ability to manipulate environments and biological matter [39]. Enable a treatment for cancer, the performance of vitreoretinal microsurgery at ocular sites or on-demand release of specific chemokines at sites of injury [78,79]. Moreover, a nano-fluidic system like biochip is capable of replicating functions of organs from biomarkers with a combination of bioactive agents carrying microparticles [51,80]. And nano-membranes in a sustained delivery system (e.g. alkaloids, flavonoids, essential oils and so on), incorporation of nanosizing with the medicinal plants or into nanostructures that can optimize wound management [78,79,81].
In tissue engineering, nanomaterials are able to enhance cell growth and function. A nanocomposite polymer can include bioactive properties for better results in transplant therapies [30,79].
 
TRENDS IN MODERN BIOLOGY
Exceeding the requirements of biocompatibility issues and highlights regenerative and restorative concept of compositional and functional structure, biomimicry, a term in biomaterials science that recently gained traction, can be defined as “new science that studies nature’s models and then imitates or takes inspiration from these designs and processes to solve human problems” [82,83].
In an artificial niche inspired by tissue-specific niches, it attempts to provide a high-performance material [51,83,84]. Based on the fact that requires complex design, a multi-layer scaffold bioinspired approach is the alternative most promising guided regeneration [27,85].

CONCLUSION
The aim of maintaining, enhance or restore tissues and organs into the dynamic landscape – that represents tissue physiology – through advances in synthetic technology and biological science by structural, chemical and physical insights, will yield functional biomaterial designs in the near future upon medical application.

1.       World Health Organization (2017) Constitution of WHO: Principles. Available from: https://www.who.int/about/mission/en/

2.       Ministry of Health. Unified Health System (SUS): structure, principles and how it works [Internet]. Available from: http://portalms.saude.gov.br/sistema-unico-de-saude

3.       Mercer AJ (2018) Updating the epidemiological transition model. Epidemiol Infect 146: 680-687.

4.       World Health Organization (2019) Global Health Observatory (GHO) data. Life expectancy. [Internet]. 2019. Available from: https://www.who.int/gho/mortality_burden_disease/life_tables/en/

5.       Brazilian Institute of Geography and Statistics (2017) IBGE news agency. In 2017, life expectancy was 76 years [Internet]. Available from: https://www.agenciadenoticias.ibge.gov.br/agencia-sala-de-imprensa/2013-agencia-de-noticias/releases/23200-em-2017-expectativa-de-vida-era-de-76-anos 

6.       Millá-Perseguer M, Guadalajara-Olmeda N, Vivas-Consuelo D, Usó-Talamantes R (2019) Measurement of health-related quality by multimorbidity groups in primary health care. Health Qual Life Outcomes 17:1-10.

7.       The World Health Organization Quality of Life assessment (WHOQOL) (1995) Position paper from the World Health Organization. Soc Sci Med 41: 1403-1409.

8.       Guyton AC, Hall JE (2011) Tratado de Fisiologia Médica. 12a ed. Rio de Janeiro: Elsevier, p: 1151.

9.       Alibardi L (2018) Limb regeneration in humans: Dream or reality? Ann Anat 217: 1-6.

10.    Brasil Ministério da Saúde (2015) Grupo de Trabalho Interinstitucional sobre Órteses, Próteses e Materiais Especiais (GTIOPME), instituído pela Portaria Interministerial nº 38, de 8 de janeiro de 2015. Available from: http://portalarquivos.saude.gov.br/images/pdf/2015/julho/07/Relatorio-Final-versao-final-6-7-2015.pdf

11.    Israni AK, Zaun D, Rosendale JD, Schaffhausen C, Snyder JJ, et al. (2019) OPTN/SRTR 2017 Annual Data Report: Deceased Organ Donation. Am J Transplant 19: 485-516.

12.    Registro Brasileiro de Transplantes (RBT). Ano XXIV Nº 3. Dados Númericos da doação de órgãos e transplantes realizados por estado e instituição no período: JANEIRO / SETEMBRO - 2018 [Internet]. 2018. Available from: http://www.abto.org.br/abtov03/Upload/file/RBT/2018/rbt2018-let-3t.pdf.

13.    Brasil Ministério da saúde (2009) Portaria nº 2.600, de 21 de outubro de 2009. Aprova o Regulamento Técnico do Sistema Nacional de Transplantes. Diário Oficial da República Federativa do Brasil, [Internet]. Available from: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2009/prt2600_21_10_2009.html

14.    Ministério da saúde. Saúde de A a Z. Doação de Órgãos: transplantes, lista de espera e como ser doador [Internet]. Available from: http://portalms.saude.gov.br/saude-de-a-z/doacao-de-orgaos

15.    Westphal G, Filho M, Vieira K, Zaclikevis V, Bartz M, et al. (2011) Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido. Parte II. Ventilação mecânica, controle endócrino metabólico e aspectos hematológicos e infecciosos. Rev Bras Ter Intensiva 23: 269-282.

16.    Reinke JM, Sorg H (2012) Wound repair and regeneration. Eur Surg Res 49: 35-43.

17.    Eming SA, Martin P, Tomic-canic M (2014) Wound repair and regeneration: Mechanisms, signaling and translation. Sci Transl Med 6: 265-266.

18.    Langer R, Vacanti JP (1993) Tissue Engineering. Science 260: 920-926.

19.    Williams DF (2009) On the nature of biomaterials. Biomaterials 30: 5897-5909.

20.    Chen FM, Liu X (2016) Advancing biomaterials of human origin for tissue engineering. Prog Polym Sci 53: 86-168.

21.    Asghari F, Samiei M, Adibkia K, Akbarzadeh A, Davaran S (2017) Biodegradable and biocompatible polymers for tissue engineering application: A review. Artif Cells Nanomedicine Biotechnol 45: 185-192.

22.    Liu C, Xia Z, Czernuszka JT (2007) Design and development of three-dimensional scaffolds for tissue engineering. Chem Eng Res Des 85: 1051-1064.

23.    ISO10993 (2016) Use of International Standard ISO 10993-1 “biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management process.” Dep Heal Hum Serv Food Drug Adm.

24.    ISO/EN10993-5 (2009) Biological evaluation of medical devices - Part 5: Tests for cytotoxicity: In vitro methods. International Standards Organization: Genève, Switzerland.

25.    Kirkpatrick CJ, Bittinger F, Wagner M, Kohler H, Van Kooten TG, et al. (1998) Current trends in biocompatibility testing. Proc Inst Mech Eng H 212: 75-84.

26.    Hench LL (1998) Biomaterials: A forecast for the future. Biomaterials 19: 1419-1423.

27.    Chaudhari AA, Vig K, Baganizi DR, Sahu R, Dixit S, et al. (2016) Future prospects for scaffolding methods and biomaterials in skin tissue engineering: A review. Int J Mol Sci 17: 1974.

28.    Goodarzi P, Falahzadeh K, Nematizadeh M, Farazandeh P, Payab M (2018) Tissue engineered skin substitutes. Adv Exp Med Biol 1107: 143-188.

29.    Holzapfel BM, Reichert JC, Schantz JT, Gbureck U, Rackwitz L (2013) How smart do biomaterials need to be? A translational science and clinical point of view. Adv Drug Deliv Rev 65: 581-603.

30.    Yildirimer L, Thanh NTK, Seifalian AM (2012) Skin regeneration scaffolds: A multimodal bottom-up approach. Trends Biotechnol 30: 638-648.

31.    Groeber F, Holeiter M, Hampel M, Hinderer S, Schenke-Layland K (2012) Skin tissue engineering - In vivo and in vitro applications. Clin Plast Surg 39: 33-58.

32.    Jiang S, Li SC, Huang C, Chan BP, Du Y (2018) Physical properties of implanted porous bioscaffolds regulate skin repair: Focusing on mechanical and structural features. Adv Healthc Mater 7: e1700894.

33.    Guimarães MV, Freire JE da C, Menezes LMB de (2016). Utilização de animais em pesquisas: Breve revisão da legislação no Brasil. Rev Bioética 24: 217-224.

34.    Xue M, Zhao R, Lin H, Jackson C (2018) Delivery systems of current biological for the treatment of chronic cutaneous wounds and severe burns. Adv Drug Deliv Rev 129: 219-241.

35.    World Health Organization (2004) Ethics, access and safety in tissue and organ transplantation : Issues of global concern. Madrid, Spain, 6-9 October 2003: Report.

36.    Steffens D, Braghirolli DI, Maurmann N, Pranke P (2018) Update on the main use of biomaterials and techniques associated with tissue engineering. Drug Discov Today 23: 1474-1488.

37.    Rahmani Del Bakhshayesh A, Annabi N, Khalilov R, Akbarzadeh A (2018). Recent advances on biomedical applications of scaffolds in wound healing and dermal tissue engineering. Artif Cells Nanomed Biotechnol 46: 691-705.

38.    Fu L, Xie J, Carlson MA, Reilly DA (2017) Three-dimensional nanofiber scaffolds with arrayed holes for engineering skin tissue constructs. MRS Commun 7: 361-366.

39.    Online engineering programs. Features. TECH 2020: WHAT’S COMING IN BIOMEDICAL ENGINEERING [Internet]. Available from: https://www.onlineengineeringprograms.com/features/tech-2020-biomedical

40.    Wood FM, Kolybaba ML (2006) The use of cultured epithelial autograft in the treatment of major burn injuries: A critical review of the literature. Burns 32: 395-401.

41.    Sun BK, Siprashvili Z, Khavari PA (2014) Advances in skin grafting and treatment of cutaneous wounds. Science 346: 941-945.

42.    Sekiya S, Morikawa S, Ezaki T, Shimizu T (2018) Pathological process of prompt connection between host and donor tissue vasculature causing rapid perfusion of the engineered donor tissue after transplantation. Int J Mol Sci 19: E4102.

43.    Kim B, Park I, Hoshiba T, Jiang H, Choi Y, et al. (2011) Design of artificial extracellular matrices for tissue engineering. Prog Polym Sci 36: 238-268.

44.    Shokrgozar MA, Fattahi M, Bonakdar S, Kashani IR, Majidi M, et al. (2012) Healing potential of mesenchymal stem cells cultured on a collagen-based scaffold for skin regeneration. Iran Biomed J 16: 68-76.

45.    Bacakova L, Filova E, Parizek M, Ruml T, Svorcik V (2011) Modulation of cell adhesion, proliferation and differentiation on materials designed for body implants. Biotechnol Adv 29: 739-767.

46.    Romano M, Fanelli G, Albany CJ, Giganti G, Lombardi G (2019) Past, present and future of regulatory T-cell therapy in transplantation and autoimmunity. Front Immunol 31: 43.

47.    Brohem CA, Da Silva Cardeal LB, Tiago M, Soengas MS, De Moraes Barros SB, et al. (2011) Artificial skin in perspective: Concepts and applications. Pigment Cell Melanoma Res 24: 35-50.

48.    Transparency Market Research. Global tissue engineered skin substitutes market to register 17.20 CAGR between 2015 and 2023 [Internet]. Available from: https://www.transparencymarketresearch.com/pressrelease/tissue-engineered-skin-substitute.htm

49.    Reifschneider A (2018) The new U.S. FDA regulations on biocompatibility and reprocessing for medical devices. SocArXiv.

50.    Pereira RF, Barrias CC, Granja PL, Bartolo PJ (2013) Advanced biofabrication strategies for skin regeneration and repair. Nanomedicine (Lond) 8: 603-621.

51.    Sriram G, Alberti M, Dancik Y, Wu B, Wu R, et al. (2018) Full-thickness human skin-on-chip with enhanced epidermal morphogenesis and barrier function. Mater Today 21: 326-340.

52.    Barh D, Kenneth B, Madigan MA (2016) OMICS: Biomedical perspectives and applications. CRC Press.

53.    Bredenoord AL, Clevers H, Knoblich JA (2017) Human tissues in a dish: The research and ethical implications of organoid technology. Science 355: eaaf9414.

54.    Ullah I, Subbarao RB, Rho GJ (2005) Human mesenchymal stem cells - Current trends and future prospective. Biosci Rep 35: e00191.

55.    Girard D, Laverdet B, Buhé V, Trouillas M, Ghazi K, et al. (2017) biotechnological management of skin burn injuries: Challenges and perspectives in wound healing and sensory recovery. Tissue Eng Part B Rev 23: 59-82.

56.    Platt JL, Cascalho M (2013) New and old technologies for organ replacement. Curr Opin Organ Transplant 18: 179-185.

57.    Madl CM, Heilshorn SC, Blau HM (2018) Bioengineering strategies to accelerate stem cell therapeutics. Nature 557: 335-342.

58.    Klar AS, Zimoch J, Biedermann T (2017) Skin tissue engineering: Application of adipose-derived stem cells. Biomed Res Int 2017: 9747010.

59.    Brett E, Chung N, Leavitt WT, Momeni A (2017) A review of cell-based strategies for soft tissue reconstruction. Tissue Eng Part B Rev 23: 336-346.

60.    Thanusha AV, Dinda AK, Koul V (2018) Evaluation of nano hydrogel composite based on gelatin/HA/CS suffused with Asiatic acid/ZnO and CuO nanoparticles for second degree burns. Mater Sci Eng C Mater Biol Appl 89: 378-386.

61.    Gomes S, Rodrigues G, Martins G, Henriques C, Silva JC (2017) Evaluation of nanofibrous scaffolds obtained from blends of chitosan, gelatin and polycaprolactone for skin tissue engineering. Int J Biol Macromol 102: 1174-1185.

62.    Debels H, Hamdi M, Abberton K, Morrison W (2015) Dermal matrices and bioengineered skin substitutes: A critical review of current options. Plast Reconstr Surg Glob Open 3: e284.

63.    Salehi SH, As'adi K, Mousavi SJ, Shoar S (2015) Evaluation of amniotic membrane effectiveness in skin graft donor site dressing in burn patients. Indian J Surg 77: 427-431.

64.    Wilshaw SP, Kearney J, Fisher J, Ingham E (2008) Biocompatibility and potential of acellular human amniotic membrane to support the attachment and proliferation of allogeneic cells. Tissue Eng Part A 14: 463-472.

65.    Lindberg K, Badylak SF (2001) Porcine small intestinal submucosa (SIS): A bioscaffold supporting in vitro primary human epidermal cell differentiation and synthesis of basement membrane proteins. Burns 27: 254-266.

66.    Shevchenko RV, James SL, James SE (2010) A review of tissue-engineered skin bioconstructs available for skin reconstruction. J R Soc Interface 7: 229-258.

67.    Santos Jr AR, Wada MLF (2007) Polímeros biorreabsorvíveis como substrato para cultura de células e engenharia tecidual. Polímeros Ciência e Tecnol 17: 308-317.

68.    Shamirzaei Jeshvaghani E, Ghasemi-Mobarakeh L, Mansurnezhad R, Ajalloueian F, Kharaziha M, et al. (2018) Fabrication, characterization and biocompatibility assessment of a novel elastomeric nanofibrous scaffold: A potential scaffold for soft tissue engineering. J Biomed Mater Res B Appl Biomater 106: 2371-2383.

69.    Partap S, Plunkett NA, O’Brien FJ (2010) Bioreactors in tissue engineering. Intech Open.

70.    Zhao J, Griffin M, Cai J, Li S, Bulter PEM, Kalaskar DM (2016) Bioreactors for tissue engineering: An update. Biochem Eng J 109: 268-281.

71.    Hosseini V, Kollmannsberger P, Ahadian S, Ostrovidov S, Kaji H, et al. (2014) Fiber-assisted molding (FAM) of surfaces with tunable curvature to guide cell alignment and complex tissue architecture. Small 10: 4851-4857.

72.    Rogalski JJ, Bastiaansen CWM, Peijs T (2017) Rotary jet spinning review - A potential high yield future for polymer nanofibers. Nanocomposites 3: 97-121.

73.    Badrossamay MR, McIlwee HA, Goss JA, Parker KK (2010) Nanofiber assembly by rotary jet-spinning. Nano Lett 10: 2257-2261.

74.    Gao B, Yang Q, Zhao X, Jin G, Ma Y, et al. (2016) 4D bioprinting for biomedical applications. Trends Biotechnol 34: 746-756.

75.    Shafiee A, Atala A (2016) Printing technologies for medical applications. Trends Mol Med 22: 254-265.

76.    Souza TV, Malmonge SM, Santos Jr AR (2018) Bioprinting and stem cells: The new frontier of tissue engineering and regenerative medicine. J Stem Cell Res Ther 4: 49-51.

77.    Pedde RD, Mirani B, Navaei A, Styan T, Wong S, et al. (2017) Emerging biofabrication strategies for engineering complex tissue constructs. Adv Mater 29.

78.    Hajialyani M, Tewari D, Sobarzo-Sánchez E, Nabavi SM, Farzaei MH, et al. (2018) Natural product-based nanomedicines for wound healing purposes: Therapeutic targets and drug delivery systems. Int J Nanomed 13: 5023-5043.

79.    Tasciotti E, Cabrera FJ, Evangelopoulos M, Martinez JO, Thekkedath UR, et al. (2016) The emerging role of nanotechnology in cell and organ transplantation. Transplantation 100: 1629-1638.

80.    van den Broek LJ, Bergers LIJC, Reijnders CMA, Gibbs S (2017) Progress and future prospective in skin-on-chip development with emphasis on the use of different cell types and technical challenges. Stem Cell Rev 13: 418-429.

81.    Mohammadi MH, Heidary Araghi B, Beydaghi V, Geraili A (2016) Skin diseases modeling using combined tissue engineering and microfluidic technologies. Adv Healthc Mater 5: 2459-2480.

82.    Benyus JM (2002) Echoing nature. In: Biomimicry: Innovation Inspired by Nature. New York: Harper Perennial Publication, pp: 1-11.

83.    Aziz MS, El Sherif AY (2016) Biomimicry as an approach for bio-inspired structure with the aid of computation. Alexandria Eng J 55: 707-714.

84.    Huebsch N, Mooney DJ (2009) Inspiration and application in the evolution of biomaterials. Nature 462: 426-432.

85.    Goins A, Webb AR, Allen JB (2019) Multi-layer approaches to scaffold-based small diameter vessel engineering: A review. Mater Sci Eng C Mater Biol Appl 97: 896-912.