An overall comparison of different culture methods clearly shows the advantages of 3D tissue constructs for drug screening. Bioreactors can provide a better process control by taking into account the different demands of cells during cultivation. Furthermore, they can provide the technical means of performing controlled studies aimed at understanding specific biological, chemical, or physical effects, or for drug screening. Moreover, bioreactors enable a safe and reproducible production of tissue constructs, and can also be used to study effects such as shear flow and/or hydrostatic pressure on the generation of tissues.

With regard to future clinical applications, the bioreactor system should be an advantageous method in terms of low contamination risk, ease of handling, and scalability. With regard to drug screening, it is important that bioreactor systems are designed which allow for the cultivation of a magnitude ofsmall tissue samples or constructs in parallel (HTS), under controlled conditions. These devices should consist of disposable, inexpensive cultivation units implemented with hardware to control temperature and gas and medium supplies. Moreover, such devices should be capable of operating automatically and continuously, with minimal manipulation steps.

To date, the goals and expectations of bioreactor development have been fulfilled only to a limited extent, notably because bioreactor design in tissue engineering is not only very complex but is also at an early stage of development. In the future, an intimate collaboration between engineers and biologists should lead to an increased fundamental understanding of the complex issues that will impact on tissue formation in bioreactors. These advances should help to ensure that, in time, tissue engineering fulfils the expectations for revolutionizing drug screening tools and medical care.

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