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3D Cell Culture in Alginate Hydrogels Abstract This review compiles information regarding the use of alginate, and in particular alginate hydrogels, in culturing cells in 3D. Knowledge of alginate chemical structure and functionality are shown to be important parameters in design of alginate-based matrices for cell culture. Gel elasticity as well as hydrogel stability can be impacted by the type of alginate used, its concentration, the choice of gelation technique (ionic or covalent), and divalent cation chosen as the gel inducing ion. The use of peptide-coupled alginate can control cell–matrix interactions. Gelation of alginate with concomitant immobilization of cells can take various forms. Droplets or beads have been utilized since the 1980s for immobilizing cells. Newer matrices such as macroporous scaffolds are now entering the 3D cell culture product market. Finally, delayed gelling, injectable, alginate systems show utility in the translation of in vitro cell culture to in vivo tissue engineering applications. Alginate has a history and a future in 3D cell culture. Historically, cells were encapsulated in alginate droplets cross-linked with calcium for the development of artificial organs. Now, several commercial products based on alginate are being used as 3D cell culture systems that also demonstrate the possibility of replacing or regenerating tissue. 1. Introduction The world around us, including the human body, is constructed in three dimensions. Since the 1940s, cells have been cultured, often attached to glass or plastic surfaces, essentially in two dimensions. Today, there is a need for more realistic and controllable culture systems that support cell growth, organization and differentiation essentially as found in tissues and organs. Growing cells in 3D adds a variety of aspects more physiologically significant than would be possible in 2D. A few of these are: cell culture and tumor formation of malignant cells; more relevant drug development and testing; in vitro culture of multi-cellular tissue for later implantation. Despite the major differences compared to the naturally occurring 3D cell environments found in tissue, most cell culture studies in vitro are performed using cells cultured as monolayers (2D) on hard plastic or glass surfaces because of the ease, convenience and high cell viability associated with this culture method. However, forcing cells to adapt to an artificial flat and a rigid surface can alter cell metabolism and change or reduce functionality, thereby providing results that may not be similar to expected behavior in vivo [1,2]. A powerful and reliable tool for evaluation of cell behavior is gene expression data. Significant changes comparing cells cultured in 2D compared to 3D can be found associated with key biological processes such as immune system activation, defense response, cell adhesion and tissue development [3,4]. There is no doubt that 3D systems are biologically more relevant and 3D cell culture is therefore expected to also provide cellular responses that will be of higher biological relevance. The significance and potential of in vitro cell culture studies are great considering the need for more cost efficient development of new drugs, time efficient treatment of cancer patients, and an understanding of developmental biology and mechanisms of stem cell differentiation. One example relates to drug development where, currently, only 12% of drugs that enter clinical trials are eventually approved for use in humans [5]. Most drugs fail due to efficacy, which likely could have been revealed at an earlier time point with more reliable cell culture models. Consequently, appropriate cell models would also reduce the need for animal trials, especially for toxicity assays [6]. Reducing the number of animal trials would also be in alignment with the principles of the 3Rs [7] (Replacement, Reduction, Refinement) which are considered an ethical framework for conducting scientific experiments using animals humanely. To better predict the clinical outcome of medical treatments such as chemotherapy, the selection of drugs can be optimized based on the response from isolated cancer cells from the patient. There are several formats and materials available that enable 3D cell culture. We will focus on the “physical” differently shaped hydrogel formats like beads, moldable gels, injectable gels and macroporous structures. However, other technologies such as hanging drop, low-binding plastic, pyramid plates, etc., are also available for culturing cells in 3D. Some macroporous scaffolds such as meshes, fibrous patches or foams, enable cell seeding throughout the thickness of the matrix and cells may be spatially organized. Such systems are, however, considered semi-3D or 2.5D [1,8] as the initial cell–matrix interaction will be more similar to what is found in 2D with cells spreading on the surface of fibers or pore walls. This is especially true for polystyrene-based 3D cell culture materials. Nearly all cells that make up tissue reside in an extracellular matrix (ECM). The ECM consists of a complex three-dimensional (3D) fibrous meshwork of collagen and elastic fibers embedded in a highly hydrated gel-like material of glycosaminoglycans, proteoglycans and glycoproteins [1]. All together they provide complex biochemical and physical signals to the cells. A wide range of biomaterials have demonstrated applicability as matrices providing a biologically more relevant environment for cells mimicking several characteristics of the ECM such as physical, mechanical and biological properties. 3D cell culture can be defined as when cells are embedded in a scaffold or matrix and signals from the scaffold and surrounding cells can be received from all directions [1,8]. Cell to cell communication can occur in three dimensions as well. This requires that cells are first suspended in a hydrogel precursor solution and next entrapped by a gel initiation reaction forming covalently or non-covalently linked molecules [9,10]. Polymer hydrogels are considered well suited for 3D cell culture as they have similarities to natural extracellular matrix. Examples of synthetic materials with the capability of forming hydrogels are polyethylene glycol (PEG), poly(hydroxyethyl methacrylate) (polyHEMA), polyvinyl alcohol (PVA) and polycaprolactone (PCL). Natural polymers (and proteins) able to form hydrogels are alginate, chitosan, hyaluronan, dextran, collagen and fibrin where alginate hyaluronan (as a product of bacterial fermentation) and dextran represent non-animal derived materials. Despite the homogeneous nature of synthetic polymers, their use as cell-entrapping materials has to some extent been avoided due to harsh polymerization conditions [1]. However, some initiator systems for photopolymerization of, for example, PEG-diacrylates are suitable for cell based hydrogel formation considering cytotoxicity, crosslinking efficiency and crosslinking kinetics [11]. Components of animal tissue are naturally recognized by cells due to the presence of cell binding ligands [12] and have been considered as good materials for scaffolds. However, these materials are less attractive because of a reduced degree of experimental control due to batch-to-batch variations as a result of their inherent diversity in material composition. Animal-derived materials may also have limited availability, and for use in the clinic, there are potential risks of immunogenicity and pathogen transmission; hence, obtaining regulatory approval for such applications may be challenging [8]. Natural hydrogels of non‑animal origin are of great interest because of their outstanding biocompatibility and mild gelation conditions, although limited control of gelation kinetics, inherent variations in material composition, and limited control over mechanical properties have been reported [1]. Alginate hydrogels have demonstrated high applicability as a structure for cell immobilization. Different soft and elastic hydrogels with typically 98%–99% aqueous media can be formulated at physiological conditions with preservation of cell viability and function. Since alginate microbeads were used for the first time in humans as an artificial pancreas in the 1980s [13], the polymer has been used with different cell types both in vivo and in vitro. Alginate is recognized for properties and characteristics such as its ability to make hydrogels at physiological conditions, gentle dissolution of gels for cell retrieval, transparency for microscopic evaluation, gel pore network that allows diffusion of nutrients and waste materials in addition to its non-animal origin. Culture of cells in alginate beads is well known [14], and a standard guide describing cell encapsulation in alginate is available from ASTM International [15]. Well-characterized alginates with high purity should be used to prepare hydrogels with consistent mechanical properties for cell encapsulation. In this review, we will give an introduction to physicochemical and biological properties of alginates and the interaction of alginate hydrogels with cells. In addition, we will focus on 3D cell culture techniques and present aspects of immobilization of cells in alginate beads and new alginate‑based 3D cell culture kits commercially available for use with standard cell culture well plates. 2. Alginate Commercially available alginates are extracted from harvested brown seaweeds. Significant amounts can also be produced by fermentation of bacteria, but this technology is not yet commercialized and will not be presented herein. The annual production of algal alginates is estimated to be approximately 38,000 tons worldwide and the largest volumes go to the food and pharmaceutical industry [16]. Alginates are also used as biomaterials in biomedical products for human use which are already on the market or in clinical trials. Such applications include wound healing, a bone graft substitute for spine fusion, cell therapy, and augmentation of the left ventricle wall for patients with dilated cardiomyopathy [17]. 2.1. Alginate Structure, Chemistry and Purity Alginates are polysaccharides which consist of linear (unbranched) 1,4 linked residues of β-d-mannuronic acid (M) and its C5-epimer α-l-guluronic acid (G) (Figure 1). The alginate molecular structure contains blocks of consecutive G or M monomers (-GGG- or -MMM-) or blocks of alternating monomers (-MGMG-). The G content of most algal alginates varies between 30% and 70%. The blocks vary considerably in length and distribution depending on from what species and part of the seaweed the alginate is extracted. The chemical composition and distribution of blocks in the alginate molecule play a major role in their capability of forming ionic gels. Figure 1 The structure of alginate shown as the segment of ..MMGG.. residues [18]. Epimerisation of the M residues changes the conformation of the sugar from 4C1 to 1C4 [19,20]. At neutral pH alginate has a polyanionic character due to the pKa values d-mannuronic and l‑gulronic acid of 3.38 and 3.65, respectively [21]. Hence, acidification below pKa leads to insoluble alginic acid, whereas alginate molecules in solution have an extended random coil conformation due to intramolecular electrostatic repulsion between neighboring negative charges. This results in highly viscous solutions of alginate even at low concentrations where the viscosity is influenced by the ionic strength, temperature and molecular weight [21]. Commodity alginates, while having similar physicochemical properties, may contain contaminants inducing adverse cell reactions or undesired and uncontrolled cell to matrix interactions. Cells do not have receptors that recognize alginates and regular commercially available alginates can be considered as inert if they are of ultrapure quality. Impurities that should be considered and controlled in alginates for biomedical applications are presented in ASTM F 2067 and relate to the level of endotoxins, protein contaminants, elemental impurities and microbial bioburden [22]. The presence of residual endotoxins will, for example, interact with the liposolysaccharide (LPS) receptor CD14 [23]. CD14 is involved in different cell signaling pathways related to management of sepsis and can induce secretion of cytokines and upregulation of adhesion molecules. To ensure consistent cellular behavior in the presence of alginate biomaterials, the use of well-characterized and highly purified alginates is essential. 2.2. Alginate Hydrogels 2.2.1. Ionic Gelation Alginates have high affinity for alkaline earth metals and ionic hydrogels can be formed in the presence of divalent cations (except Mg2+) [21,24,25,26,27]. Chelation of the gel-forming ion occurs between two consecutive residues (Figure 2A) and an intermolecular gel network is formed as a result of a cooperative binding of consecutive residues in different alginate chains (Figure 2B). The G-blocks are the key structural elements in alginate hydrogels, but also alternating blocks may contribute to gel formation [27]. The different junction zones in an alginate gel are presented in Figure 2C. Alginates have different affinity for divalent cations in an increasing manner as Ca2+80%) cell viability following bioprinting. These reports also show two different approaches in the design of alginate as a bioink. Khalil and Sun [117] use a multinozzle system that prints alginate + cells and overlays with calcium chloride in order to induce gelation. The addition of a low-melting gelatin together with an alginate solution forms a gel when the solution printed at 37 °C cools. Moreover, addition of a calcium poly phosphate salt or bioglass to the cell‑containing hydrogel led to enhanced biomineralization by SaOS-2 cells [118,119]. Using 3D printing technology and alginate as a bioink, Zhao et al. show the advantage of printing Hela cells to form an in vitro cervical tumor model in order to study disease pathogenesis and enable new anti-cancer drug discovery with a more relevant physiological disease model [120]. This report used gelatin together with alginate to initiate gelation prior to printing. The printed construct was further strengthened after printing by subsequent addition of a calcium salt solution. The authors included fibrinogen in the gelatin/alginate formulation to mimic ECM components. Printed HeLa cells formed spheroids which were shown to be more resistant to paclitaxel treatment than HeLa cells grown as a 2D cell culture. By oxidizing alginate, a known technique to “build in” biodegradability [121], Jia et al. demonstrate the interaction of alginate viscosity and density on printability while biodegradability of printed scaffolds containing human adipose-derived stem cells was also described [122]. Optimization of alginate for use in different printing technologies is, however, necessary. For inc-jet types of printing, droplet formation is impacted by alginate molecular weight, solution viscosity, monomer composition (if ionic cross-linking is to be used to form a gel), and purity which impacts on biocompatibility. Xu et al. studied the characteristics of the droplet formation process using alginate viscosity and shear rate [123]. Furthermore, Gasperini et al. present a bioprinting techniques based on electrohydrodynamic processes to jet droplets of alginate containing cells [124]. 3.5. Cryopreservation Simple cell and tissue preservation techniques have disadvantages including limited shelf-life, high cost, risk of contamination or generic drift [125]. A more tangable option is cryopreservation where cells are preserved by cooling them to low temperatures typically in liquid nitrogen (−196 °C). At such low temperatures, biological activities of the cells are effectivly stopped. These includes the biochemical reactions that would lead to cell death under normal conditions and damage caused by the formation of ice crystals. Cryopreservation provides a valuable means for storing cells and tissues for future use. However, certain drawbacks exist, including damage that occurs to the cells during the freezing and/or thawing processes and the need to culture the cells after thawing to ensure that they have recovered properly. Such drawbacks limit the value of cryopreserved cells, particularly in situations where it is desirable to use the cryopreserved cells immediately or shortly after they have been thawed. There exist several methods to deal which such problems. One alternative is to suspend the cells in an alginate solution prior to cryopreservation. The cells can then be encapsulated (see Section 3.2) after thawing and used for their desired purpose without the need to culture the cryopreserved cells. Alternatively, cells are entrapped in hydrogels before they are cryopreserved [126,127]. This method is based on the discovery that cryopreserved cells that have been thawed, immediately suspended in alginate, and after encapsulation remain viable and are ready to be used [128]. To obtain off-the-shelf availability, distribution and storage of constructs, sterility testing and quality control, preservation of cells and tissues is vital [129]. 4. Future Developing 3D cell culture technology will lead to more physiologically relevant and likely more predictive approaches to organogenesis, tissue morphology, the importance of hypoxia, drug discovery, cell-based assays, and reduced animal use. The ability of 3D cell culture systems to mimic tissue structures, either from single cells or co-cultures, is a great advance from 2D monolayer cultures. Cell–cell communication and differentiated cellular function are more relevant in 3D and the impact of 3D cultures on predicting efficacy of drug treatments to actual in vivo response is great. 4.1. Drug Discovery Allowing cells to acquire a more natural phenotype when grown in 3D as opposed to 2D is a great advantage. This is especially true for the field of drug discovery where countless examples have been shown of the mismatch between in vitro drug effect and in vivo drug efficacy. 4.1.1. Cancer Already in 1990 an alginate culture method was used to test the effects of vincristine and 5‑fluorouracil on HT-29 human colon carcinoma cells [130]. Creating a more clinically relevant model of tumor biology has been a prime impetus for developing 3D culture systems. Burdett et al. [131] described the superiority of 3D over 2D cell culture where mimicking tumor behavior and drug resistance often seen in vivo is important. AlgiMatrix® is a commercial alginate-based product for 3D cell culture. Godugu et al. [110] demonstrate the possibility of using this culture system as an in vitro tumor model for anticancer drug screening. They treated several human non-small cell lung cancer cell lines (A549, H460, and H1650) with several anticancer drugs used in the clinic. 4.1.2. Safety and Toxicology HepG2 liver cells have been encapsulated in sterile alginate hydrogels and used to demonstrate their capability to metabolize a coumarin pro-drug in a manner similar to in vivo hepatic metabolic activity [132]. Another hepatic cell line, Huh-7, cultured in an alginate hydrogel showed cellular organization and hepatocyte architecture with respect to cell polarity, cell junctions and the appearance of bile canaliculi. The alginate-encapsulated Huh-7 cells also expressed specific hepatitis C virus receptors indicating that this 3D culture system may be useful in viral studied and liver tissue engineering [133]. Alginate encapsulation of hepatocytes provides protection from shear stress for hepatocyte aggregates in a 3D bioreactor cultures system [134]. In addition, the alginate hydrogel seems to provide the cells with a good support for extracellular matrix deposition. 4.2. Tissue Engineering and Regenerative Medicine 4.2.1. Skin Establishing normal physiology and function in a traditional 2D in vitro cell culture of skin is almost impossible. The advent of organotypic culture systems does allow approximation of skin complexity. 3D culture of skin allows dermatological studies which would otherwise be unsafe for animals and humans such as validating the mechanisms of skin diseases and testing the therapeutic potential of experimental drugs [135]. Developing a 3D in vitro human skin co-culture model has shown promise for detecting skin irritants as an alternative to in vivo animal testing [136]. 4.2.2. Cartilage Specific signature gene cluster regulation was seen during in vitro chondrogenic differentiation of human bone marrow-derived mesenchymal stem cells which were immobilized in a self-gelling alginate hydrogel. Upregulation of transcription factor genes as well as a signature cluster of extracellular matrix genes occurred during chondrogenesis while gene clusters involved in immune response, blood vessel development, and cell adhesion were downregulated [95]. Marker genes identified in this study show that stem cells can be directed to produce hyaline cartilage when immobilized in 3D alginate hydrogels. Immobilizing cells with chondrogenic potential in an alginate hydrogel has shown that neocartilage can be formed by mesenchymal stem cells [137]. Here, production of not only type II collagen but also assembled fibrils was dependent on cell seeding density. When cells were seeded at a high density, fibril assembly and procollagen processing occurred at a distance from the cell surface. 4.2.3. Cardiac Cardiac tissue engineering may involve the regeneration of myocardial tissue by first immobilizing stem cells in a scaffold or matrix in vitro and then placing such a scaffold on, or within, the damaged cardiac tissue. Immobilizing myocardial stem cells within a scaffold ensures that they will remain within the cardiac tissue after implantation. Ceccaldi et al. [138] has studied the influence of alginate composition on mesenchymal stem cells in alginate scaffolds. Their conclusion was the G-rich alginate hydrogels provided the most appropriate milieu for MSCs intended for cardiac therapy. Levit et al. [139] have shown similar results where alginate-encapsulated human mesenchymal stem cells were placed onto a rat heart as a hydrogel patch. The alginate hydrogel retained the MSCs and led to an improvement of cardiac function following induced myocardial infarct. 5. Conclusions Culturing cells in three dimensions will soon be the preferred way to investigate cell–cell interactions, growth into tissue, mechanisms of stem cell differentiation, and improved drug efficacy, to name a few areas. Various materials are available to enable 3D cell culture among which is the polysaccharide alginate. Immobilizing cells in alginate hydrogels is a mild process that occurs under physiological conditions. In addition, cells can be retrieved from alginate hydrogels by a simple de‑gelling process that does not require disaggregation of multi-cellular structures. Alginate can be modified by the attachment of peptides that mimic extracellular matrix proteins, such as RGD, thereby allowing immobilized cells to seemingly interact with the alginate hydrogel. We have shown here that some cells actually require the presence of RGD in order to proliferate and form 3D structures. Encapsulating cells in alginate hydrogel droplets was first described in the 1980s and various formulations are still under investigation for constructing artificial organs for, for example, treatment of Type I diabetes. Recently, two commercial alginate-based 3D cell culture systems have made their appearance. Cells are immobilized in an alginate foam-like scaffold and can then proceed to grow in three dimensions. Publications describing these 3D cell culture systems have begun to appear demonstrating their utility in several areas. Especially important for the use of alginate in 3D cell culture is the ability to change the physical characteristics of the hydrogel by changing the amount or type of gelling ions and/or alginate. One can now tailor-make an environment to which cells can adapt or differentiate. In fields as diverse as tissue engineering and drug discovery, alginate-based 3D cell culture systems show a significant advantage over classical 2D culture techniques. In addition, automation of 3D culture techniques, especially for high throughput screening will greatly increase the use of culturing cells in this manner. Although most in vitro cell-based assays were originally designed using 2D cell cultures, it will be important to validate assays using a 3D culture system. New or adjusted detection chemistries may need to be developed in order to optimize the 3D cell model. This should not be detrimental to the use of 3D culture systems but rather an opportunity to improve and customize assay systems for multi-cellular structures. The future promises ingenuity in adapting 3D culture systems into the fields of regenerative medicine. Supporting and improving cardiac function after infarct, correcting osteoarthritic cartilage degradation, and providing artificial skin for in vitro safety studies are among the fields 3D culture can bring new products and ideas. Finally, the adaptation of 3D bioprinting using an alginate-based bio-ink shows great promise. Patient-specific printed constructs can soon be made using alginate and a patient’s own cells. The availability of a commercial ultrapure, low endotoxin sodium alginate as well as peptide‑coupled alginate allows discrete cell signaling to be applied during 3D cell growth.

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