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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Bioeng. Biotechnol.</journal-id>
<journal-title>Frontiers in Bioengineering and Biotechnology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Bioeng. Biotechnol.</abbrev-journal-title>
<issn pub-type="epub">2296-4185</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">764212</article-id>
<article-id pub-id-type="doi">10.3389/fbioe.2021.764212</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Bioengineering and Biotechnology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>A Three-Dimensional Co-Culture Model for Rheumatoid Arthritis Pannus Tissue</article-title>
<alt-title alt-title-type="left-running-head">Lin et&#x20;al.</alt-title>
<alt-title alt-title-type="right-running-head">3D Printing of Pannus Mimic</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Lin</surname>
<given-names>Jietao</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1452411/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Sun</surname>
<given-names>Antonia RuJia</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1188260/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Li</surname>
<given-names>Jian</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1255293/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Yuan</surname>
<given-names>Tianying</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Cheng</surname>
<given-names>Wenxiang</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1439573/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ke</surname>
<given-names>Liqing</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chen</surname>
<given-names>Jianhai</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1476118/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Sun</surname>
<given-names>Wei</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Mi</surname>
<given-names>Shengli</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/338586/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Zhang</surname>
<given-names>Peng</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="corresp" rid="c001">&#x2a;</xref>
<uri xlink:href="https://loop.frontiersin.org/people/692005/overview"/>
</contrib>
</contrib-group>
<aff id="aff1">
<label>
<sup>1</sup>
</label>Center for Translational Medicine Research and Development, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, <addr-line>Shenzhen</addr-line>, <country>China</country>
</aff>
<aff id="aff2">
<label>
<sup>2</sup>
</label>University of Chinese Academy of Sciences, <addr-line>Beijing</addr-line>, <country>China</country>
</aff>
<aff id="aff3">
<label>
<sup>3</sup>
</label>Shenzhen Engineering Research Center for Medical Bioactive Materials, <addr-line>Shenzhen</addr-line>, <country>China</country>
</aff>
<aff id="aff4">
<label>
<sup>4</sup>
</label>Biomanufacturing Center, Department of Mechanical Engineering, Tsinghua University, <addr-line>Beijing</addr-line>, <country>China</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>
<bold>Edited by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/126674/overview">Feng-Huei Lin</ext-link>, National Taiwan University, Taiwan</p>
</fn>
<fn fn-type="edited-by">
<p>
<bold>Reviewed by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/461794/overview">Xin Zhao</ext-link>, Hong Kong Polytechnic University, Hong Kong SAR, China</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/852454/overview">Menekse Ermis Sen</ext-link>, Terasaki Institute for Biomedical Innovation, United&#x20;States</p>
</fn>
<corresp id="c001">&#x2a;Correspondence: Peng Zhang, <email>peng.zhang@siat.ac.cn</email>
</corresp>
<fn fn-type="other">
<p>This article was submitted to Tissue Engineering and Regenerative Medicine, a section of the journal Frontiers in Bioengineering and Biotechnology</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>12</day>
<month>11</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="collection">
<year>2021</year>
</pub-date>
<volume>9</volume>
<elocation-id>764212</elocation-id>
<history>
<date date-type="received">
<day>25</day>
<month>08</month>
<year>2021</year>
</date>
<date date-type="accepted">
<day>27</day>
<month>10</month>
<year>2021</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2021 Lin, Sun, Li, Yuan, Cheng, Ke, Chen, Sun, Mi and Zhang.</copyright-statement>
<copyright-year>2021</copyright-year>
<copyright-holder>Lin, Sun, Li, Yuan, Cheng, Ke, Chen, Sun, Mi and Zhang</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these&#x20;terms.</p>
</license>
</permissions>
<abstract>
<p>Three-dimensional (3D) co-culture models have closer physiological cell composition and behavior than traditional 2D culture. They exhibit pharmacological effects like <italic>in vivo</italic> responses, and therefore serve as a high-throughput drug screening model to evaluate drug efficacy and safety <italic>in&#x20;vitro</italic>. In this study, we created a 3D co-culture environment to mimic pathological characteristics of rheumatoid arthritis (RA) pannus tissue. 3D scaffold was constructed by bioprinting technology with synovial fibroblasts (MH7A), vascular endothelial cells (EA.hy 926) and gelatin/alginate hydrogels. Cell viability was observed during 7-day culture and the proliferation rate of co-culture cells showed a stable increase stage. Cell-cell interactions were evaluated in the 3D printed scaffold and we found that spheroid size increased with time. TNF-&#x3b1; stimulated MH7A and EA.hy 926 in 3D pannus model showed higher vascular endothelial growth factor (VEGF) and angiopoietin (ANG) protein expression over time. For drug validation, methotrexate (MTX) was used to examine inhibition effects of angiogenesis in 3D pannus co-culture model. In conclusion, this 3D co-culture pannus model with biological characteristics may help the development of anti-RA drug research.</p>
</abstract>
<kwd-group>
<kwd>rheumatoid arthritis</kwd>
<kwd>3D bioprinting</kwd>
<kwd>tissue engineering</kwd>
<kwd>pannus tissue model</kwd>
<kwd>drug screening</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec id="s1">
<title>Introduction</title>
<p>Joint is a dynamic tissue that supports us to move, but it may suffer destruction of bone and cartilage because of arthritis like RA. Due to the genetic factor or immune system disorder, synovial membrane in RA patients presents abnormal proliferation of synovial cells and migration of inflammatory cells (<xref ref-type="bibr" rid="B11">Deane et&#x20;al., 2017</xref>). Synovial joint is usually rich in blood vessels, which is a unique manifestation of RA. New vessels and hyperplastic fibrous tissue contribute to angiogenic disorders and form a complex vascular tissue called pannus (<xref ref-type="bibr" rid="B42">Veale et&#x20;al., 2017</xref>). Angiogenesis not only provides more means for the spread of inflammatory cytokines and the infiltration of leukocyte but aggravate the formation of pannus (<xref ref-type="bibr" rid="B29">Maruotti et&#x20;al., 2006</xref>; <xref ref-type="bibr" rid="B13">Elshabrawy et&#x20;al., 2015</xref>). RA pannus is an aggressive and invasive tissue with massive leukocyte infiltration, proliferative synovial membranes and neovascularization, which is directly responsible for cartilage destruction and bone erosion (<xref ref-type="bibr" rid="B20">Lee and Weinblatt, 2001</xref>). The development of pannus is highly relevant to the growth factors, pro-inflammatory cytokines and chemokines. Growth factors, such as vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) are described as the key regulators in proliferation, migration and vascular formation. Pro-inflammatory cytokines like tumor necrosis factor (TNF)-&#x3b1;, interleukin (IL)-6, which provide inflammatory conditions in RA synovium, have direct and indirect effects on other cell types to produce pro-angiogenic factors (<xref ref-type="bibr" rid="B35">Semerano et&#x20;al., 2011</xref>).</p>
<p>In recent years, RA have become the most common form of inflammatory arthritis. Patients need to rely on drugs for control as it is an incurable disease (<xref ref-type="bibr" rid="B12">Doan and Massarotti, 2005</xref>; <xref ref-type="bibr" rid="B45">Yu et&#x20;al., 2018</xref>). Inhibition of angiogenesis can be a helpful strategy for early prevention and treatment of RA (<xref ref-type="bibr" rid="B41">Veale and Fearon, 2006</xref>; <xref ref-type="bibr" rid="B26">MacDonald et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B3">Balogh et&#x20;al., 2019</xref>). However, RA drug testing has low accuracy and drug development cycle is long. Although animal model is the most effective way to study RA drugs before clinical trials, ethics and experimental accuracy limits rapid and efficient evaluation of drug safety and efficacy (<xref ref-type="bibr" rid="B21">Li and Izpisua Belmonte, 2019</xref>). To overcome these difficulties, co-culture models are often used to mimic physiological environment of pannus for RA study and anti-RA drug screening (<xref ref-type="bibr" rid="B10">D&#x2019;andrea et&#x20;al., 1998</xref>; <xref ref-type="bibr" rid="B16">Kasama et&#x20;al., 2001</xref>; <xref ref-type="bibr" rid="B30">Nozaki et&#x20;al., 2007</xref>; <xref ref-type="bibr" rid="B7">Chu et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B14">Gou et&#x20;al., 2018</xref>). IBOLD et&#x20;al. developed a 3D pannus model <italic>in&#x20;vitro</italic> as a high-throughput screening assay. Chondrocytes from porcine donors were isolated and seeded them into wells to form extracellular matrix (ECM). After 14&#xa0;days, it would be coated with human synovial fibroblasts. They found that intercellular communication between these 2&#xa0;cell types occurs both through gap junctions and ATP-mediated paracrine stimulation. (<xref ref-type="bibr" rid="B10">D&#x2019;andrea et&#x20;al., 1998</xref>). In the co-culture model of chondrocytes and synovial cells, D&#x2019;ANDREA et&#x20;al. found that the Ca &#x2b; signal between these 2&#xa0;cell types can be affected by 18&#x3b1;-glycyrrhetinic acid, suggesting they have communication in pannus tissue (<xref ref-type="bibr" rid="B30">Nozaki et&#x20;al., 2007</xref>). Monocytes or polymorphonuclear neutrophils (PMNs) were seeded onto fibroblasts and Kasama et&#x20;al. found that the expression of VEGF in co-culture groups are higher than synovial fibroblasts, monocytes or PMNs alone groups, which means VEGF expression in pannus can be also regulated by the interaction of synovial fibroblasts and activated leukocytes (<xref ref-type="bibr" rid="B7">Chu et&#x20;al., 2018</xref>). Nozaki et&#x20;al. isolated pannus tissue from RA patients and the inflammatory cells including macrophages, T&#x20;cells and fibroblasts. They collected these cell types without enzyme digestion and found that inflammatory cells could develop into pannus-like tissue spontaneously <italic>in&#x20;vitro</italic>. This pannus model continuously secreted MMP-9 and TNF-&#x3b1;, IL-8 and M-CSF, which related with osteoclastogenesis (<xref ref-type="bibr" rid="B14">Gou et&#x20;al., 2018</xref>). Although these studies revealed useful characteristics of 3D pannus models <italic>in&#x20;vitro</italic>, it is still difficult to construct a long lasting and strong repeatability pannus model to test anti-RA drugs due to the limitations of fabrication techniques.</p>
<p>Recent advances in 3D fabrication technology have allowed direct assembly of cells and biocompatible materials to form <italic>in&#x20;vitro</italic> cellular models for artificial organ regenerations, the study of disease mechanisms and drug screening. This promising technique has the advantages of accurate control of cell distribution, high simulation of physiological microenvironments and cost-effectiveness, which is suitable for constructing complex 3D <italic>in&#x20;vitro</italic> models (<xref ref-type="bibr" rid="B27">Mandrycky et&#x20;al., 2016</xref>; <xref ref-type="bibr" rid="B25">Ma et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B31">Ong et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B50">Zhu et&#x20;al., 2020</xref>). Therefore, 3D printing has been applied in the establishments of disease pathogenesis and drug screening model in hepatocellular carcinoma (<xref ref-type="bibr" rid="B36">Sun et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B43">Xie et&#x20;al., 2021</xref>), breast cancer (<xref ref-type="bibr" rid="B38">Swaminathan et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B24">Lv et&#x20;al., 2021</xref>), cervical tumor (<xref ref-type="bibr" rid="B49">Zhao et&#x20;al., 2014</xref>; <xref ref-type="bibr" rid="B32">Pang et&#x20;al., 2018</xref>), bladder cancer (<xref ref-type="bibr" rid="B17">Kim et&#x20;al., 2019</xref>), and neurodegenerative diseases (<xref ref-type="bibr" rid="B40">Thomas and Willerth, 2017</xref>). To apply the potential value of 3D printing on anti-RA drug research, in this paper we constructed the <italic>in&#x20;vitro</italic> pannus model by 3D printing of endothelial cells (EA.hy 926)/Synovial fibroblasts (MH7A) and gelatin/alginate and characterized its biological function. To our knowledge, RA synovial tissue fibroblasts produce pro-angiogenic growth factors, cytokines under the induction of inflammatory mediators or hypoxia. Under the condition of pro-angiogenic and inflammatory factors, endothelial cells therefore promote cell proliferation, migration and tube formation (<xref ref-type="bibr" rid="B39">Szekanecz et&#x20;al., 2005</xref>; <xref ref-type="bibr" rid="B13">Elshabrawy et&#x20;al., 2015</xref>; <xref ref-type="bibr" rid="B2">Alam et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B9">Croft et&#x20;al., 2019</xref>). Both MH7A cell line (synovial fibroblasts) and EA.hy 926 cell line (endothelial cells) are widely used to be the cell model in RA research as they are considered valuable in preclinical trials (<xref ref-type="bibr" rid="B18">Komorowski et&#x20;al., 2006</xref>; <xref ref-type="bibr" rid="B6">Cheng et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B34">Qu et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B19">Kong et&#x20;al., 2020</xref>). In addition, we used gelatin/alginate as they can mimics ECM to provide the cells a better natural microenvironment. They show good biocompatibility and good molding effect when building 3D biological scaffolds, and these structures could have long retention time (<xref ref-type="bibr" rid="B36">Sun et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B24">Lv et&#x20;al., 2021</xref>). The schematic of 3D pannus scaffold printing process has been showed in <xref ref-type="fig" rid="F1">Figure&#x20;1</xref>. Biological characterization of 3D printed pannus models on calcium cross-linking toxicity, cell proliferation, cell survival, cell morphology and VEGF and Angiopoietin (ANG) protein expression will be evaluated. Our findings may offer a basic view of 3D printed pannus model in drug screening application.</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption>
<p>Schematic of the 3D scaffold printing process. Fabrication of pannus mimic with gelatin /alginate and EA.hy 926/MH7A cells.</p>
</caption>
<graphic xlink:href="fbioe-09-764212-g001.tif"/>
</fig>
</sec>
<sec sec-type="materials|methods" id="s2">
<title>Materials and Methods</title>
<sec id="s2-1">
<title>Cell Culture</title>
<p>Human endothelial cells (EA.hy 926) were generously given by professor Qin&#x2019;s Laboratory and the cells were cultured in Dulbecco Modified Eagle Medium (DMEM) with 4.5&#xa0;g/L glucose, supplemented with 10% fetal bovine serum (Gibco, Thermo Fisher Scientific) and 1% penicillin/streptomycin (Sigma-Aldrich, MO, United&#x20;States). Human synovial fibroblasts (MH7A) were purchased from the Riken Cell Bank (Tsukuba, Japan). The cells were maintained in Roswell Park Memorial Institute (RPMI) cultivation medium (Hyclone, Thermo Fisher Scientific, Wilmington, DE, United&#x20;States) plus 10% fetal bovine serum (Gibco, Thermo Fisher Scientific) and 1% penicillin/streptomycin (Sigma-Aldrich). For TNF-&#x3b1; co-culture model, EA.hy 926 and MH7A were pretreated with 20&#xa0;ng/ml TNF-&#x3b1; for 6&#xa0;h before printing. All culture experiments are under the condition of humidified air with 5% CO<sub>2</sub> in 37&#xb0;C.</p>
</sec>
<sec id="s2-2">
<title>Bioink Preparation</title>
<p>Gelatin/alginate was purchased from Sunp Biotech (Beijing, China). The lyophilized powder was dissolved in DMEM medium at 56&#xb0;C. The mixed ink should be pasteurized by 70&#xb0;C for 30&#xa0;min and 4&#xb0;C for 10&#xa0;min three times at constant temperature water bath and stored at 4&#xb0;C until use. Before the experiment, the ink was kept at 37&#xb0;C for 2&#xa0;h. For co-culture bioink, 2.5&#xd7;10<sup>6</sup> cells of each EA.hy 926 and MH7A were resuspended in DMEM medium and homogeneously mixed with gelatin/alginate ink at a volume ratio at 1:4, resulting in a final cells density of 10<sup>6</sup> cells/ml.</p>
</sec>
<sec id="s2-3">
<title>3D Scaffold Formation and Culture</title>
<p>3D Cell Printer (SPP1603, SUNP, China) were used to fabricate all the 3D scaffold models. The temperature of the nozzle and printing bed were 23 and 15&#xb0;C, respectively. 25G needle was chosen and the scanning speed was controlled at 3&#xa0;mm/s. The models were printed in an eight-layered square grid pattern with the size of 10&#x20;&#xd7; 10&#xa0;mm cross sectional area and 2.4&#xa0;mm thickness. The inks were loaded into 3&#xa0;ml printing syringe and precooled at the printing chamber for 10&#xa0;min. Preprinted on the 35&#xa0;mm petri dishes and ensured that the bioink was smoothly extruded. After printing, hydrogel scaffolds were immersed in CaCl<sub>2</sub> solution for 5&#xa0;min for crosslinking with alginate, providing better strength to the scaffolds. All scaffolds were gently blown with a pipette to remove bubbles. Then the scaffolds were washed with sterile physiologic saline once and finally cultured in DMEM medium. The scaffolds were crosslinked and the medium was changed every 3&#xa0;days.</p>
</sec>
<sec id="s2-4">
<title>Calcium Cross-Linking Toxicity</title>
<p>EA.hy 926, MH7A and co-culture mixed cells were seeded into 96-well culture plates (3,000 cells/well) for 24&#xa0;h. The cells were stimulated by 3% CaCl<sub>2</sub> solution for 5&#xa0;min and washed by physiologic saline, and then they were cultured in DMEM medium for another 24 or 48&#xa0;h. To evaluate cellular metabolic activity, Cell counting kit-8 (CCK-8, Dojindo, Japan) were added into each well at the volume of 10% of the total, protected against exposure to light. After 3&#xa0;h incubation at 37&#xb0;C, fluorescence of the culture medium was detected by microplate reader (PerkinElmer, Waltham, MA) at 450&#xa0;nm. The data was then normalized to the standard and calculated cell viability.</p>
</sec>
<sec id="s2-5">
<title>Cell Proliferation Analysis</title>
<p>Cell proliferation in printed scaffolds was studied using CCK-8 on cultured days 1, 3, 5 and 7. Cells were incubated in a mixture of culture medium and CCK-8 for 2&#xa0;h. The values of fluorescence at 450&#xa0;nm were compared among different printed groups.</p>
</sec>
<sec id="s2-6">
<title>Cell Survival</title>
<p>Cell survival test in 3D scaffolds was carried out on day 1, 3, 5, 7 after printing. Fluorescent Live/Dead assay (C2015M, Beyotime, China) was used according to the instruction manual. Briefly, medium was removed and the scaffolds were then washed twice with phosphate buffer solution (PBS). Subsequently, Calcein-AM and propidium iodide (PI) was mixed with detection buffer at the dilution ratio of 1:1,000 and 1.5:1,000, respectively. The cell laden scaffolds were incubated at 37&#xb0;C for 30&#xa0;min in dark, then washed three times with PBS. Calcein-AM marks viable cells green and propidium iodide (PI) shows dead cells red. Images were obtained from fluorescence microscopy (Leica, Germany).</p>
</sec>
<sec id="s2-7">
<title>Cell Morphology Imaging and Analysis</title>
<p>The scaffold shapes were taken with camera (<xref ref-type="sec" rid="s11">Supplementary Figure S1</xref>). Two dimensional cell morphology of EA.hy 926 and MH7A was captured using inverted optical microscope (Carl Zeiss, Germany) at cell density of 80%. Three-dimensional scaffold was examined by using fluorescence microscope (Leica, Germany) on cultured days 1, 3, 5 and 7. The images were taken in three random fields at 100&#xd7; magnification. Cell diameters were measured by Image J (NIH, United&#x20;States) software and analyzed by Origin (Originlab, United&#x20;States).</p>
</sec>
<sec id="s2-8">
<title>Enzyme-Linked Immunosorbent Assay</title>
<p>The experiment was divided into four groups: blank (no cell) group, co-culture group, TNF-&#x3b1; pannus model group and TNF-&#x3b1; pannus treated by 100&#xa0;nM MTX for 24&#xa0;h group. The concentrations of VEGF and ANG protein in the culture medium of 3D scaffold were detected on day 1, 3, 5, 7. Secretory cytokines were examined using corresponding commercial ELISA kits (R&#x26;D Systems, United&#x20;States). A standard curve was constructed for each assay according to the manufacturer&#x2019;s instructions. The cytokine concentrations of each sample were calculated on the basis of the standard&#x20;curve.</p>
</sec>
<sec id="s2-9">
<title>Statistical Analysis</title>
<p>All the data were presented as mean&#x20;&#xb1; SD. Statistical significance was evaluated by Students T Test. Differences were considered to be significant for <italic>p</italic>&#x20;&#x3c; 0.05. &#x2a;<italic>p</italic>&#x20;&#x3c; 0.05; &#x2a;&#x2a;<italic>p</italic>&#x20;&#x3c; 0.01; &#x2a;&#x2a;&#x2a;<italic>p</italic>&#x20;&#x3c; 0.001. Each experiment was performed in triplicate (<italic>n</italic>&#x20;&#x3d; 3) on at least independent three samples (<italic>N</italic>&#x20;&#x2265;&#x20;3).</p>
</sec>
</sec>
<sec sec-type="results" id="s3">
<title>Results</title>
<sec id="s3-1">
<title>Calcium Toxicity on Cells in 2D Planar Culture</title>
<p>To test the cytotoxic effect of calcium on EA.hy 926 and MH7A and 1:1&#x20;co-culture mixture, CCK-8 was used to determine the cell viability. As is shown in <xref ref-type="fig" rid="F2">Figure&#x20;2</xref>, after stimulating by calcium for 5&#xa0;min and cultured in DMEM for 24&#xa0;h, The percentage of EA.hy 926 cell viability decreased to 26.53&#x20;&#xb1; 4.34, but it rose to 54.49&#x20;&#xb1; 6.17&#xa0;at 48&#xa0;h MH7A cells also had the same trend, 21.05&#x20;&#xb1; 3.30 percent at 24&#xa0;h and 43.01&#x20;&#xb1; 4.24 percent at 48&#xa0;h, respectively. In terms of 1:1&#x20;co-culture mixture, they performed 38.29&#x20;&#xb1; 3.71&#xa0;at 24&#xa0;h and 55.62&#x20;&#xb1; 4.17&#xa0;at 48&#xa0;h.</p>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption>
<p>Cytotoxicity of calcium on EA.hy 926 and MH7A and 1:1 co-culture mixture in 2D planar. Cells were treated with CaCl2 solution for 5 min and washed with physiologic saline once. After 24 and 48 h, their viability was determined using CCK-8 assay (mean &#x00B1; SD, <sup>&#x002A;</sup>
<italic>p</italic> &#x003C; 0.05; <sup>&#x002A;&#x002A;</sup>
<italic>p</italic> &#x003C; 0.01; <sup>&#x002A;&#x002A;&#x002A;</sup>
<italic>p</italic> &#x003C; 0.001, t-test). Con &#x003D; no calcium stimulation; SD &#x003D; standard deviation.</p>
</caption>
<graphic xlink:href="fbioe-09-764212-g002.tif"/>
</fig>
</sec>
<sec id="s3-2">
<title>Cell Distribution and Viability in 3D Scaffolds</title>
<p>To determine cell distribution and survival in 3D gelatin/alginate/EA.hy 926/MH7A model, we used calcein-AM/PI staining assay to analyze live/dead cells on day 1, 3, 5 and 7. As we can see, the cells were evenly distributed in gelatin/alginate scaffold. Cell viability was stable about 80% during the <italic>in&#x20;vitro</italic> culture of EA.hy 926/MH7A in 3D scaffold (<xref ref-type="fig" rid="F3">Figure&#x20;3A</xref>). The cellular proliferation in 3D scaffolds was detected using CCK-8 kit on the same time. <xref ref-type="fig" rid="F3">Figure&#x20;3B</xref> demonstrates that compared with day 1, cells had 1.36-fold proliferation on day 3, 1.75-fold proliferation on day 5, and 2.03-fold proliferation on day 7. There were significant differences between day 1 (0.39&#x20;&#xb1; 0.12) and day 5 (0.68&#x20;&#xb1; 0.05) and 7 (0.79&#x20;&#xb1; 0.05). Overall, the proliferation rate of co-culture cells had a stable increase stage from day 1 to day&#x20;7.</p>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption>
<p>Cell survival and proliferation in the 3D cell laden pannus tissue model. <bold>(A)</bold> Cell survival at different time points after printing. Live and dead cells were labelled with calcein-AM (green) and PI (red), respectively. Scale bar, 750 &#x03BC;m. <bold>(B)</bold> Proliferation rates of cells in 3D co-culture cell laden scaffolds at day 1, 3, 5, and 7.</p>
</caption>
<graphic xlink:href="fbioe-09-764212-g003.tif"/>
</fig>
</sec>
<sec id="s3-3">
<title>Development of Co-Culture Spheroids Within Cell Laden Scaffold</title>
<p>Inverted optical microscope was used to observe the cell morphology in 2D planar culture. EA.hy 926 shows epithelioid morphology and MH7A shows epithelioid and polygonal morphology (<xref ref-type="fig" rid="F4">Figure&#x20;4A</xref>). The cells and cellular distribution pattern in printed scaffolds were characterized using fluorescence microscope on day 1, 3, 5, 7. Compared with 2D planar culture, cells turned to be spheroids within 3D scaffolds, and they were observed to form larger spheroids after 3&#xa0;days of bioprinting. The spheroid size increased over time. <xref ref-type="fig" rid="F4">Figure&#x20;4B</xref> shows spheroid distribution in the 3D co-culture cell laden scaffold. At day 1, 7.09% of the spheroids were at the diameter range of 20&#x2013;30&#xa0;&#x3bc;m. At day 3, the size between 20&#x2013;30&#xa0;&#x3bc;m was up to 28%. The percentages of over 30&#xa0;&#x3bc;m at day 5 and day 7 were 10.65 and 14.73%, respectively (<xref ref-type="fig" rid="F4">Figure&#x20;4C</xref>).</p>
<fig id="F4" position="float">
<label>FIGURE 4</label>
<caption>
<p>Cellular morphological differences between 2D planar culture and 3D scaffolds. <bold>(A)</bold> EA.hy 926 and MH7A cells morphology in 2D planar culture. EA.hy 926 cells look epithelioid and MH7A cells are epithelioid and polygonal. Scale bar, 100 &#x03BC;m. <bold>(B)</bold> 3D Gelatin /alginate/EA.hy 926/MH7A scaffolds observed by a fluorescence microscope on culture days 1, 3, 5, and 7. Scale bar, 100 &#x03BC;m. Black arrows indicate cells and cellular spheroids in 3D scaffolds. <bold>(C)</bold> Distribution of spheroid diameter in 3D cell laden scaffolds on day 1, 3, 5, and 7.</p>
</caption>
<graphic xlink:href="fbioe-09-764212-g004.tif"/>
</fig>
</sec>
<sec id="s3-4">
<title>Effect of 3D Engineered Scaffold on VEGF and ANG Expression</title>
<p>The experiment was divided into four groups: blank (no cell) group, co-culture group, TNF-&#x3b1; pannus model group and TNF-&#x3b1; pannus treated by MTX group. The culture medium of the three-dimensional scaffold was collected on day 1, 3, 5, 7. <xref ref-type="fig" rid="F5">Figure&#x20;5A</xref> shows that the cell co-culture scaffold and pannus scaffold secreted more VEGF protein on day 5 and 7 compared with that on the first day, but there was no significant difference compared with the no cell group on the same day (<italic>p</italic>&#x20;&#x3e; 0.05). <xref ref-type="fig" rid="F5">Figure&#x20;5B</xref> illustrates the content of ANG secreted protein in the co-culture scaffold on day 1 was different from that of the no cell group (<italic>p</italic>&#x20;&#x3c; 0.05), and there was a significant difference from day 3 to day 7 (<italic>p</italic>&#x20;&#x3c; 0.001). On the day 7, the ANG protein concentration of the TNF-&#x3b1; pannus model group was different from that of the blank group (<italic>p</italic>&#x20;&#x3c; 0.05). Although the ANG concentration decreased in the pannus MTX group, there was no significant difference when compared with that in TNF-&#x3b1; pannus&#x20;group.</p>
<fig id="F5" position="float">
<label>FIGURE 5</label>
<caption>
<p>Concentration of VEGF and ANG secreted protein in the supernatant of the three-dimensional scaffold on Day 1, 3, 5, and 7. <bold>(A)</bold> A. VEGF secreted protein concentration (pg/ml); <bold>(B)</bold> ANG secreted protein concentration (pg/ml).</p>
</caption>
<graphic xlink:href="fbioe-09-764212-g005.tif"/>
</fig>
</sec>
</sec>
<sec sec-type="discussion" id="s4">
<title>Discussion</title>
<p>RA is a chronic and systemic autoimmune disease, and immune dysregulation occurs earlier than joint inflammation. Current medications for RA are glucocorticoids (GCs), nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs) and biological therapies, which provide clinically meaningful pain relief and control inflammation in patients. However, several side effects, including cytopenia, psoriasis, lung disease and liver damage, have been proved in treatments with these drugs (<xref ref-type="bibr" rid="B4">Burmester and Pope, 2017</xref>; <xref ref-type="bibr" rid="B1">Abbasi et&#x20;al., 2019</xref>). Thus, the discovery of a safe and effective drug for RA treatment remains a crucial challenge.</p>
<p>Over the last 2&#xa0;decades, angiogenesis has been reported to play an important role in the deterioration of RA. RA pannus is an aggressive and invasive tissue with rich proinflammatory cytokines like TNF-&#x3b1;, IL-1&#x3b2; and IL-6, which is directly responsible for cartilage destruction and bone erosion (<xref ref-type="bibr" rid="B20">Lee and Weinblatt, 2001</xref>; <xref ref-type="bibr" rid="B26">MacDonald et&#x20;al., 2018</xref>). Numerous researchers have studied on inhibition of angiogenesis in RA (<xref ref-type="bibr" rid="B47">Zhang et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B44">Yang et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B22">Li et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B46">Zhai et&#x20;al., 2019</xref>). In order to screen anti-RA drugs in a more accurate and efficient way, here we developed a 3D printed model to mimic the microenvironment of RA pannus. In terms of cell composition, we chose vascular endothelial cells and synovial fibroblast. Since EA.hy 926 and MH7A cells are widely used in drug discovery in RA and they are cell lines, we chose them to ensure the effectiveness and repeatability of our model. However, single cell model failed to offer a complex microenvironment to evaluate cellular response to drugs accurately (<xref ref-type="bibr" rid="B37">Sun et&#x20;al., 2019</xref>). In the microenvironment, we added inflammatory factors (TNF-&#x3b1;) to simulate the inflammatory microenvironment. Compared to monolayer cell culture, 3D printing model is close to the space environment of the actual RA pannus tissue, enhancing the communication between cells and thereby improving the accuracy and efficiency of drug detection. For example, Kim et&#x20;al. showed that cells grown in 2D culture conditions exhibit different gene and protein expression from those observed <italic>in vivo</italic>. And it was confirmed that cell proliferation rates in 3D culture was higher than that in the 2D cell culture because they mimic cell-to-cell interaction. They also found that there was a different anticancer effect between these two models. The drug effect in the 2D cell culture model is exaggerated, which explains why immunotherapies have shown excellent efficacy in research studies but not in clinical studies and patients (<xref ref-type="bibr" rid="B17">Kim et&#x20;al., 2019</xref>). Thus, in this study we constructed the 3D pannus model based on the co-culture system of MH7A and EA.hy 926 cells. Alginate and gelatin are natural biomaterials. Both of them have high printability and good biocompatibility with cells. In addition, micro-extrusion printing has been shown that they can print cell laden scaffold in a controllable way with high cell viability. Despite cells experience stress condition during printing, they still have good cell viability with hydrogel (<xref ref-type="bibr" rid="B27">Mandrycky et&#x20;al., 2016</xref>; <xref ref-type="bibr" rid="B33">Panwar and Tan, 2016</xref>). To maintain sufficient mechanical strength, printed scaffold needs to crosslink with CaCl<sub>2</sub> solution every 3&#xa0;days. Our result showed that CaCl<sub>2</sub> solution had a cytotoxic effect among EA.hy 926 cells, MH7A&#xa0;cells, and 1:1&#x20;co-culture mixture groups in 2D planar. Cell viability decreased to around 30% after calcium stimulation for 5&#xa0;min at 24&#xa0;h, but cell viability regulated to around half at 48&#xa0;h. According to the manufacturer&#x2019;s instruction, the recommendation time for crosslinking is 4&#x2013;8&#xa0;min, and we chose 5&#xa0;min in order to hold the shape of the scaffold. As the concentration and ratio of gelatin and sodium alginate are confidential and there would be difference between 2D culture and 3D hydrogel scaffold, we further tested cell survival using calcein-AM/PI staining assay and measured cell proliferation using CCK-8 assay in 3D cell laden scaffold. The survival result showed that the viability of the co-culture mixture was around 80%. The proliferation rate of co-culture cells increased steadily from day 1 to day 7, which illustrates the gelatin/alginate bioink is biocompatible with cell growth. Earlier studies have demonstrated that cell viability and behavior in the scaffold is influenced by biomaterial type, material viscosity, printing speed, printing temperature and extrusion pressure (<xref ref-type="bibr" rid="B48">Zhao et&#x20;al., 2015</xref>; <xref ref-type="bibr" rid="B23">Li et&#x20;al., 2018</xref>). During our exploration on printing process, we noticed that too low temperature would lead to over coagulation of bioink. The bioink was so difficult to extrude that shear forces increased, resulting in cellular injury and&#x20;death.</p>
<p>Compared with the morphology of MH7A cells and EA.hy 926 in 2D planar culture and 3D printed scaffold, we found that MH7A showed epithelioid and polygonal morphology and EA.hy 926 presented epithelioid morphology while they looked spheroids from day 1 to day 7. What&#x2019;s more, after we measured the diameter of cellular spheroids on day 1, 3, 5 and 7, we observed that cells were assembled to be larger spheroid with&#x20;time.</p>
<p>VEGF and ANG are considered fundamental in the formation of pannus. VEGF is one of the key regulators of angiogenesis as they are related to proliferation, migration and vascular tube formation (<xref ref-type="bibr" rid="B28">Marrelli et&#x20;al., 2011</xref>). ANG acts later in the pathogenesis of pannus compared to VEGF. ANG is increased to form and increase blood vessel stability (<xref ref-type="bibr" rid="B8">Clavel et&#x20;al., 2003</xref>). In order to verify the biological function of our 3D printed scaffold, we conducted ELISA assay to detect concentrations of VEGF and ANG protein. The results showed that the expression of VEGF and ANG in the co-culture and pannus group increased with days, but the co-culture group showed a more obvious effect. This may be because the cells in pannus group was induced by TNF-&#x3b1; before the model was constructed, but we did not provide an external inflammatory environment afterwards, resulting in the incomplete performance of the pannus characteristics. MTX has been showed that it could reduce VEGF content in CIA rat model to relieve angiogenesis (<xref ref-type="bibr" rid="B5">Chen et&#x20;al., 2021</xref>). Hirata S also illustrated that MTX inhibited both basal and vascular endothelial cell growth factor-stimulated tritiated deoxyuridine (3H-UdR) incorporation into vascular endothelial cell in a dose-dependent manner (<xref ref-type="bibr" rid="B15">Hirata et&#x20;al., 1989</xref>). So MTX was added after the model was printed, and the concentration of pro-angiogenic factors decreased compared with the pannus group for 7&#xa0;days.</p>
<p>However, there are some differences between our 3D pannus scaffold and the actual pannus tissue. Here we only chose vascular endothelial cells and synovial fibroblast to mimic the cell composition of RA pathological pannus tissue instead of using all cell types. The pro-angiogenic factors <italic>in vivo</italic>, such as growth factors, hypoxia inducible factors, cytokines, chemokines, matrix metalloproteinase and adhesion molecules are also complex in deterioration of pannus. In this study, we constructed a 3D co-culture model for RA pannus tissue and provided a basic view of its biological characteristics. Further work on the comparison of pathological characteristics between pannus model of RA <italic>in&#x20;vitro</italic> and clinical pannus specimens is needed, and improvements of this scaffold should be processed in the future.</p>
</sec>
<sec sec-type="conclusion" id="s5">
<title>Conclusion</title>
<p>We report the construction of <italic>in&#x20;vitro</italic> RA pannus co-culture model by applying 3D printing technique with EA.hy 926/MH7A and gelatin/alginate. The 3D pannus model showed a good cell viability and interaction to mimic the microenvironment of pannus <italic>in vivo</italic>. The concentration of VEGF and ANG protein in the supernatant of the 3D pannus model increased over time. In addition, adding MTX to the 3D pannus model can down-regulate the expression of pro-angiogenic factors. Further studies are required to develop more details to construct the platform for drug screening, but this study may offer a basic view of 3D printed pannus model in drug screening application.</p>
</sec>
</body>
<back>
<sec id="s6">
<title>Data Availability Statement</title>
<p>The raw data supporting the conclusion of this article will be made available by the authors, without undue reservation.</p>
</sec>
<sec id="s7">
<title>Author Contributions</title>
<p>JtL, AS, JnL, WC, and PZ contributed to the conception of the study. JnL, TY, LK, and JC conducted the experiment. SM and WS provided the 3D printing machine. JtL, JnL, and JC performed the data analyses and wrote the manuscript. PZ supervised and trained JtL and he has been the corresponding author for the manuscript.</p>
</sec>
<sec id="s8">
<title>Funding</title>
<p>This research was supported by the National Key R&#x26;D Program of China, China: 2018YFC1705205; Foreign cooperation project of Chinese Academy of Sciences, China: 172644KYSB20190032; National Natural Science Foundation of China, China: 92068117 and 81871809; Guangdong Basic and Applied Basic Research Fund, China: 2020B1515120052; Sanming Project of Medicine in Shenzhen, China: SZSM201808072; Development and Reform Commission of Shenzhen Municipality, China: XMHT20190106001. Shenzhen Double Chain Project for Innovation and Development Industry supported by Bureau of Industry and Information Technology of Shenzhen, China: 201908141541. The flow chart of 3D scaffold printing process was made on <ext-link ext-link-type="uri" xlink:href="http://Biorender.com">Biorender.com</ext-link>.</p>
</sec>
<sec sec-type="COI-statement" id="s9">
<title>Conflict of Interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="disclaimer" id="s10">
<title>Publisher&#x2019;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<ack>
<p>Authors also wish to acknowledge the great help from Prof. Mi and Prof. Sun of Tsinghua University.</p>
</ack>
<sec id="s11">
<title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fbioe.2021.764212/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fbioe.2021.764212/full&#x23;supplementary-material</ext-link>
</p>
<supplementary-material xlink:href="DataSheet1.docx" id="SM1" mimetype="application/docx" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
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