In 2018 Spain’s health care system ranked third in the world, behind Hong Kong and Singapore, and first in Europe according to a Bloomberg study, so it’s no wonder that research and development of bioprinting technologies are heavily pushing to make the country a haven for its patients. In 2011, industrial engineer José Manuel Baena funded BRECA, a Granada-based healthcare company with its sights set on helping medicine solve some of the most complex pathologies out there. BRECA is a pioneer in Europe, specializing in the design, manufacture and marketing of customized implants. It is also one of the first companies in the world to manufacture a 3D printed implant using a combination of 3D printed made-to-measure synthetic medical devices and bioprinted structures to regenerate a lesion. It’s all about solving the greatest number of pathologies for Baena.

“There are many diseases in the world and most of us are going to be users of these medical solutions some day, so investing time in creating the necessary equipment to help the medical community is essential,” Baena told 3DPrint.com during an interview.

The founder of BRECA Health Care is also founder and CEO of REGEMAT 3D, a startup focusing on regenerative medicine, developing custom hardware and software required and demanded by some of the mayor hospitals and research universities in the region, as well as creating bioinks for bioprinting -from commercial to bioinks developed with university labs made of cellulose, colagen paste and with thermoplastic properties ideal for cellular therapy. They develop their own bioprinting systems, the BIO V1 machines, and customize them for their users’ applications according to the requirements of each investigation. It was back in 2011 when Baena met Juan Antonio Marchal, a professor at the Biomedical Research Centre (CIBM) of the Universidad de Granada, in Spain, working with cells and looking to make scaffolds and 3D matrices, that his interest in regenerative medicine peaked, so he began creating technology and synthetic materials to make cells that would help doctors repair and regenerate injuries.

REGEMAT 3D’s BIO V1 printer

“I see an exciting future ahead, with 3D printing offering many opportunities and applications in regenerative and therapy medicine. The next stage of bioprinting is to combine several tissues and build in vitro organs, but that could take decades. To get to a point where we can create functional complex solid organs, we need more developments, research, more people interested in using this technology, which is a fascinating tool for in-depth knowledge on the future creation of organs. It is also important to understand how bioreactors and decellularization will help us to develop functional tissues and organs. Which is why we have groups of researchers currently working on these applications, both in the short-term and looking way ahead into the future,” suggested Baena, one of the many enthusiasts who are trying to bridge 3D printing technology with medicine.

There are a lot of opportunities right now for companies like BRECA, like the combination of 3D printed custom made synthetic medical devices and bioprinted structures to regenerate an injury. According to Baena, in the past, if you wanted to do a reconstruction using biomaterials that biodegrade, you were restricted by the geometry and performance of sized medical devices. But now with 3D printing they offer customized solutions even using autologous cells of the patient to enhance the regeneration. REGEMAT 3D’s bioprinting platform is ideal for developing this type of customized options and along with BRECA they are very successful in bringing 3D printed implants and prosthesis to the clinical application with optimum results.

BRECA makes custom made plates, ATM implants, and bone reconstructions

BRECA was one of the pioneer companies in bioprinting, introducing the first bioprinter in the country. Today, they are the only Spanish company that designs and manufactures them on site. They also create bioreactors and in 2018 attempted to engineer cartilage tissue, one of the most promising treatments for articular cartilage defects, thanks to a bioreactor designed to implement a non-invasive real-time monitoring of the neo-cartilage tissue formation processes through ultrasonic signal analysis. Polylactic acid (PLA) scaffolds were printed and seeded with human chondrocytes and then, they were cultured in an ultrasound-integrated bioreactor. The team used a bioreactor system to validate ultrasound data against proliferation, gene expression and quantitative biochemistry of in vitro 3D chondrocytes.

With a total of 200 clinical cases all over the world, BRECA is helping doctors transition to a more customized solution that will improve patients’ lives. Through more personalized treatments, reducing complex surgical times and costs, the company is using 3D printing technologies for reconstruction of injuries in cranioplasty, maxillofacial, bone and cartilage, pediatric and thoracic surgery, neurosurgery, as well as other reconstructions with tailor-made surgical guides. Various reconstruction surgeries were performed at the University Hospital of La Paz, one of BRECA’s research partners, and where Ramón Cantero and Baena coordinate the 3D Tissue Engineering and Printing Platform (PITI3D), which provides ingredients and processes to generate functional tissues. 

REGEMAT 3D printer at work

“Last year we started working with PITI 3D, a fantastic 3D printing platform for tissue engineering at one of the most innovative hospitals in Spain. We offer solutions for patients, medical doctors and scientists in regenerative medicine applications. Our current projects include skin regeneration, specifically for a pediatric pathology known as butterfly skin (a genetic mutation that results in skin blistering); Kit Lab on a chip for antitumor treatments, and manufacturing custom-made medical devices for complex surgeries at the University Hospital of La Paz (which we do through BRECA),” suggested Baena, who recently graduated with his PhD in Biomedicine.

REGEMAT 3D printer at University of Iowa lab

Among the top 10 bioprinting companies in the world, BRECA has over 50 active projects in 25 countries, including the University of Sydney, Australia, the University of Iowa, in the U.S., the Paper and Fibre Research Institute of Sweden, Virgen del Rocio Hospital in Seville and Colombia´s National Institute of Rehabilitation. They have participated in many neurosurgery processes by developing the made-to-order medical devices for cranioplasty in patients with injuries or cranial defects, as well as jaw reconstructions and other types of bone prosthesis. The custom contoured grafts are made from materials such as titanium or synthetic bone substitutes.

“Many of the other bioprinting companies are selling mass-produced 3D printers but we chose to offer a one-of-a-kind machine for the researcher who wants to create unique bioprints, and this is working quite well for us, because we don’t just want to have our printers in every bioprinting lab, instead we like to be involved in the research being done, get to know the projects and help in any way we can. The BRECA-REGEMAT model is strongly invetsting on the future of clinical applications of additive manufacturing. There has been a continuous growth in bioprinting advances in the last thre years, but I consider that the next five years will see a strong increase in bioprinting discoveries,” says Baena.

With so many applications for bioprinting in the horizon, Baena believes that once we can engineer any human fully functional tissue, the next frontier will lie in uploading our memories, knowledge and consciousness for storage and to eventually regenerate encephalitic mass. He explains that we have the regeneration part down, but we need technologies and processes that will allow us to copy the existing information in the brain so that we can regenerate it too. “Like a backup of our brain”, he calls it. And although the scientist and engineer know that the idea is far fetched and could take years before it actually happens, he believes that “continuous investigation is the key to making the impossible possible.” After all, regenerating tissues was something that sounded quite futuristic some 50 years ago.

The Spanish company believes in the advantages and potential of technology, as well as in its innumerable applications, but there is still a lot of investigation on the way and decades before some of the more daring ventures, like creating fully functional organs, become realities. According to Baena, Spanish legislation is not an impediment for using the 3D printing machines, but yes when it comes to the clinical phase, so it might be a few years before some of the research gets to patient clinical trials and lawmakers catch up to some of the technological advances tacking place today.

Baena and the REGEMAT team