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CombiCTx: screening diffusion gradients of anti-cancer drug combinations
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.ORCID iD: 0000-0002-3957-9190
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.ORCID iD: 0000-0001-9039-8187
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab. Department of Health Science and Technology, ETH Zurich, Zurich, Switzerland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
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2026 (English)In: Lab on a Chip, ISSN 1473-0197, E-ISSN 1473-0189, Vol. 26, no 3, p. 695-710Article in journal (Refereed) Published
Abstract [en]

The reduced effectiveness of chemotherapy in many patients undergoing treatment highlights the need for novel drug combinations that target drug resistance mechanisms contributing to tumor survival. Dynamic conditions within the tumor microenvironment influence the response to anti-cancer drugs. Accordingly, identifying effective drug concentrations and interactions (additive, synergistic, or antagonistic) in relevant tumor tissue models will inform new treatment combinations. To address this need for combinatorial chemotherapeutic (CTx) screening assays, we have developed a new assay called CombiCTx, which uses a device with three reservoirs containing gels loaded with anti-cancer drugs. The drug-loaded device is inverted and placed in a standard culture dish above cancer cells, and both are then enclosed in gel. Drugs diffuse from the reservoirs and expose cancer cells to overlapping dynamic drug gradients. We imaged diffusion of the anti-cancer drug doxorubicin in the assay using time-lapse microscopy, and established an imaging protocol for quantifying MDA-MB-231 breast cancer cell survival responses along drug gradients. Finally, evaluating combination effects of navitoclax and gemcitabine with CombiCTx revealed localized effects of navitoclax, attributed to limited diffusion, while gemcitabine seemed to diffuse readily throughout the assay and revealed a mild synergy in navitoclax affected regions. These data demonstrate the capacity of CombiCTx to evaluate the cytotoxic effects of anti-cancer drug combinations while accounting for drug diffusion differences, which is relevant in the context of the 3D tumor environment and may thereby help inform clinical treatment strategies.

Place, publisher, year, edition, pages
Royal Society of Chemistry, 2026. Vol. 26, no 3, p. 695-710
National Category
Basic Cancer Research
Identifiers
URN: urn:nbn:se:uu:diva-581630DOI: 10.1039/d5lc00686dISI: 001662214100001Scopus ID: 2-s2.0-105027324592OAI: oai:DiVA.org:uu-581630DiVA, id: diva2:2043925
Part of project
Novel treatment strategies for intestinal injury: the combination of peptides and non-peptide drugs at the dynamic intestinal barrier. , Swedish Research CouncilCancer drug-induceed gastrointestinal toxicity: Pathogenesis and future management, Swedish Research CouncilAdditive Manufacturing for the Life Sciences, VinnovaThe role of endoplasmic reticulum stress in mediating drug resistance in hepatocellular carcinoma, Swedish Research Council
Funder
Vinnova, 2019-00029Swedish Cancer Society, 20 1285 PjFSwedish Cancer Society, 23 2692 Pj 01 HSwedish Cancer Society, 23 2776 PSwedish Cancer Society, CAN 24 3519 Pj 01 HSwedish Society for Medical Research (SSMF), S17-0092Swedish Research Council, 2020-02367Swedish Research Council, 2024-03166Swedish Research Council, 2021-01628Available from: 2026-03-06 Created: 2026-03-06 Last updated: 2026-03-30Bibliographically approved
In thesis
1. Applications of Additive Manufacturing for Advancing Cell Models from 2D to 3D
Open this publication in new window or tab >>Applications of Additive Manufacturing for Advancing Cell Models from 2D to 3D
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Two-dimensional (2D) cell culture systems are widely used in preclinical research due to their ease of handling and standardisation, but do not adequately reflect key aspects of the complex three-dimensional (3D) physiological microenvironment. This limits the predictive value of in vitro studies for both drug development and biomaterials research. The overall aim of this thesis was to explore how additive manufacturing supports the transition from 2D to more advanced 3D cell culture models.

In Study I, CombiCTx, a cell culture device for combinatorial anti-cancer drug testing, was developed. The system enables the formation of overlapping drug gradients through diffusion in a hydrogel matrix, and an assay and imaging analysis protocol was established. Using breast cancer cells, it was demonstrated that the assay can identify synergistic drug effects and that, for the drugs tested, these effects were spatially confined to specific regions of the assay space, highlighting the importance of diffusion processes not captured in standard 2D assays.

In Study II, an open source extrusion-based bioprinter based on the E3D motion system was established to increase accessibility to bioprinting technologies. The system supports multimaterial printing and FRESH bioprinting. Collagen scaffolds and cell-laden laminin-containing constructs were printed, and high cell viability was maintained, demonstrating the suitability of the platform for generating 3D cell culture environments.

Studies III and IV focused on biomaterials for bone regeneration. In Study III, the biosafety of a phosphoserine (pSER)-modified calcium phosphate bone adhesive was evaluated. Both in vitro and in vivo results indicated good biocompatibility, with no evidence of adverse immune reactions or ectopic bone formation.

In Study IV, 3D bioprinted collagen-silica hybrid scaffolds modified with pSER were investigated. In vitro experiments showed a dose-dependent effect of pSER in combination with calcium phosphate on cell viability. In vivo, mineralised scaffolds promoted bone formation, suggesting an osteogenic potential of these materials.

In conclusion, the studies presented in this thesis demonstrate that additive manufacturing can be used to develop more advanced in vitro models and to investigate biomaterials in controlled 3D environments. These approaches will contribute to improving the translation of preclinical findings into clinical applications.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2026. p. 73
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2248
Keywords
3D printing, additive manufacturing, 3D bioprinting, in vitro, biomaterials, combinatorial drug screening, bioink
National Category
Medical Biotechnology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-582589 (URN)978-91-513-2779-2 (ISBN)
Public defence
2026-05-08, A1:107a, Biomedical Center (BMC), Husargatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2026-04-16 Created: 2026-03-18 Last updated: 2026-04-16

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Stelzl, ChristinaClavero, Ada LermaEriksson, OlleDegerstedt, OliverLennernäs, HansHeindryckx, FemkeKreuger, JohanO'Callaghan, Paul

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Stelzl, ChristinaClavero, Ada LermaEriksson, OlleDegerstedt, OliverLennernäs, HansHeindryckx, FemkeKreuger, JohanO'Callaghan, Paul
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Department of Medical Cell BiologyScience for Life Laboratory, SciLifeLabDepartment of Pharmaceutical Biosciences
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