Tissue Engineered Elastic Cartilage-Mimetic Auricular Grafts for Ear Reconstruction

Patients born with microtia, the congenital malformation of the external ear, face substantial psychosocial strain. Current reconstruction relies on harvesting rib cartilage, an invasive procedure associated with donor site morbidity and unnaturally stiff ears due to the use of hyaline cartilage. Tissue engineered auricles could overcome these drawbacks by providing patient-specific elastic cartilage without the need for rib harvest. Yet, key challenges such as fibrocartilage formation, inhomogeneous extracellular matrix formation and mechanical inferiority during ex vivo maturation remain, often leading to graft deformation and degradation in vivo. To address this gap, we integrated approaches maintaining the chondrogenic potential with growth factors, promoting elastic cartilage formation through stress-relaxing materials, and achieving homogeneous maturation by culturing grafts on an elevated bioreactor platform that enables uniform nutrient diffusion, using primary human auricular chondrocytes. Together these approaches resulted in the maturation of bioprinted auricular grafts that closely resemble native human auricular cartilage, demonstrated by the uniform distribution of elastin, glycosaminoglycans, and collagen II, and lack of collagen I. RNA sequencing revealed gene expression patterns consistent with the transition from fibrocartilage towards elastic cartilage. On a functional level, grafts achieved a compressive modulus of 1.1{+/-}0.03 MPa, matching that of native human auricular cartilage (1.0{+/-}0.1 MPa) and maintained their structural integrity for 6 weeks in a subcutaneous rat model, where they transitioned towards mature elastic fibers. These grafts represent the closest approximation of native elastic cartilage achieved ex vivo to date, bringing the field closer to a clinically viable, long-term therapy for children affected by microtia. One-sentence summaryBioprinted auricular grafts develop native-like elastic cartilage and advance towards a durable therapy for children with microtia.