Injectable antibacterial conductive nanocomposite cryogels with rapid shape recovery for noncompressible hemorrhage and wound healing

Shape-adaptable biodevices for wearable and implantable applications

Emerging wearable and implantable biodevices have been significantly revolutionizing the diagnosis and treatment of disease. However, the geometrical mismatch between tissues and biodevices remains a great challenge for achieving optimal performances and functionalities for biodevices. Shape-adaptable biodevices enabling active compliance with human body tissues offer promising opportunities for addressing the challenge through programming their geometries on demand. This article reviews the design principles and control strategies for shape-adaptable biodevices with programmable shapes and actively compliant capabilities, which have offered innovative diagnostic/therapeutic tools and facilitated a variety of wearable and implantable applications. The state-of-the-art progress in applications of shape-adaptable biodevices in the fields of smart textiles, wound care, healthcare monitoring, drug and cell delivery, tissue repair and regeneration, nerve stimulation and recording, and biopsy and surgery, is highlighted. Despite the remarkable advances already made, shape-adaptable biodevices still confront many challenges on the road toward the clinic, such as enhanced intelligence for actively sensing and operating in response to physiological environments. Next-generation paradigms will shed light on future directions for extending the breadth and performance of shape-adaptable biodevices for wearable and implantable applications.

Antioxidant and antibacterial polyelectrolyte wound dressing based on chitosan/hyaluronan/phosphatidylcholine dihydroquercetin

Antioxidant and antimicrobial wound dressings are the most favorable for acute and chronic wounds treatment. Herein, we formulated a multifunctional polyelectrolyte wound dressing membrane on the basis of chitosan (Ch) and hyaluronan (HA) enhanced by phosphatidylcholine dihydroquercetin (PCDQ). Physicochemical properties and microstructures of fabricated films were investigated adopting Fourier transform infrared (FT-IR) spectroscopy, thermogravimetric analysis (TGA) and scanning electron microscope (SEM). Furthermore, water uptakes, wettability profiles, surface roughness, and mechanical characteristics of the developed membranes were studied. The developed wound dressing revealed free radical scavenging potency, hemocompatibility with a tendency to enhance blood clotting. Furthermore, incorporation of PCDQ significantly promoted the antibacterial and anti-inflammatory activities of Ch/HA/PCDQ. Moreover, Ch/HA/PCDQ films exhibited cellular compatibility towards mouse fibroblast cells. The capability of Ch/HA/PCDQ to promote wound healing was evaluated using adult Wistar albino female rats. The in vivo findings demonstrated that Ch/HA/PCDQ films significantly ameliorated mouse full-thickness wounds as evidenced by a reduction in the wound area. Moreover, histological examinations of wounds dressed with Ch/HA/PCDQ illustrated a prominent re-epithelialization compared with wounds handled with the cotton gauze and Ch/HA dressings, exposing the efficiency of PCDQ. These findings emphasized that a Ch/HA/PCDQ membrane has outstanding potential for wound healing and skin regeneration.

Reinforcement of hydrogel scaffold using oxidized-guar gum incorporated with curcumin-loaded zein nanoparticles to improve biological performance

Newly, the use of biocompatible injectable hydrogel with appropriate features for application in the tissue engineering area as a perfect wound dressing has been more attracted. For this purpose, the curcumin loaded Zein nanoparticles/aldehyde-modified guar gum/silk fibroin (Cur-NPs/OGG/SF) hydrogel networks were successfully developed to increase the Cur bioavailability during the wound treatment procedure. Fabricated hydrogels were assessed for their morphological, thermal stability, degradation, and mechanical features. By varying the OGG/SF weight ratios, the physicochemical features of hydrogels without or with Cur-loaded Zein NPs were studied. The results showed that with enhancing the OGG content, the degradation behavior of hydrogels were improved. Besides, Cur-NPs/OGG/SF hydrogels increased the cell proliferation without any cytotoxic effect on mouse embryonic fibroblast (NIH-3T3) cells. The Cur-NPs/OGG/SF hydrogel exposed inhibition activity against Bacillus (15.26 ± 1.09 mm) and E. coli (11.54± 1.36 mm) bacteria. These achieved results recommended that the novel developed hydrogel could be suitable for wound healing application.

Bacterial Nanocellulose-Enhanced Alginate Double-Network Hydrogels Cross-Linked with Six Metal Cations for Antibacterial Wound Dressing

Alginate (Alg) and bacterial nanocellulose (BNC) have exhibited great potential in biomedical applications, especially wound dressing. Non-toxicity and a moisture-maintaining nature are common features making them favorable for functional dressing fabrication. BNC is a natural biopolymer that promotes major advances to the current and future biomedical materials, especially in a flat or tubular membrane form with excellent mechanical strength at hydrated state. The main drawback limiting wide applications of both BNC and Alg is the lack of antibacterial activity, furthermore, the inherent poor mechanical property of Alg leads to the requirement of a secondary dressing in clinical treatment. To fabricate composite dressings with antibacterial activity and better mechanical properties, sodium alginate was efficiently incorporated into the BNC matrix using a time-saving vacuum suction method followed by cross-linking through immersion in separate solutions of six cations (manganese, cobalt, copper, zinc, silver, and cerium). The results showed the fabricated composites had not only pH-responsive antibacterial activities but also improved mechanical properties, which are capable of acting as smart dressings. All composites showed non-toxicity toward fibroblast cells. Rat model evaluation showed the skin wounds covered by the dressings healed faster than by BNC.

Biomass-Derived Multilayer-Structured Microparticles for Accelerated Hemostasis and Bone Repair

It is very desirable to develop advanced sustainable biomedical materials with superior biosafety and bioactivity for clinical applications. Herein, biomass-derived multilayer-structured absorbable microparticles (MQ x T y ) composed of starches and plant polyphenols are readily constructed for the safe and effective treatment of bone defects with intractable bleeding by coating multiple layers of quaternized starch (Q+) and tannic acid onto microporous starch microparticles via facile layer-by-layer assembly. MQ x T y microparticles exhibit efficient degradability, low cytotoxicity, and good blood compatibility. Among various MQ x T y microparticles with distinct Q+/T- double layers, MQ2T2 with outmost polyphenol layer possess the unique properties of platelet adhesion/activation and red blood cell aggregation, resulting in the best hemostatic performance. In a mouse cancellous-bone-defect model, MQ2T2 exhibits the favorable hemostatic effect, low inflammation/immune responses, high biodegradability, and promoted bone repair. A proof-of-concept study of beagles further confirms the good performance of MQ2T2 in controlling intractable bleeding of bone defects. The present work demonstrates that such biomass-based multilayer-structured microparticles are very promising biomedical materials for clinical use.

Antimicrobial effects of positively charged, conductive electrospun polymer fibers

In recent years, electrospun polymer fibers have gained attention for various antibacterial applications. In this work, the effect of positively charged polymer fiber mats as antibacterial gauze is studied using electrospun poly(caprolactone) and polyaniline nanofibers. Chloroxylenol, an established anti-microbial agent is used for the first time as a secondary dopant to polyaniline during the electrospinning process to make the surface of the polyaniline fiber positively charged. Both Gram-positive Staphylococcus aureus and Gram-negative Escherichia coli are used to investigate the antibacterial activity of the positively charged and uncharged polymer surfaces. The results surprisingly show that the polyaniline surface can inhibit the growth of both bacteria even when chloroxylenol is used below its minimum inhibitory concentration. This study provides new insights allowing the better understanding of dopant-based, intrinsically conducting polymer surfaces for use as antibacterial fiber mats.

Needle-injectable microcomposite cryogel scaffolds with antimicrobial properties

Porous three-dimensional hydrogel scaffolds have an exquisite ability to promote tissue repair. However, because of their high water content and invasive nature during surgical implantation, hydrogels are at an increased risk of bacterial infection. Recently, we have developed elastic biomimetic cryogels, an advanced type of polymeric hydrogel, that are syringe-deliverable through hypodermic needles. These needle-injectable cryogels have unique properties, including large and interconnected pores, mechanical robustness, and shape-memory. Like hydrogels, cryogels are also susceptible to colonization by microbial pathogens. To that end, our minimally invasive cryogels have been engineered to address this challenge. Specifically, we hybridized the cryogels with calcium peroxide microparticles to controllably produce bactericidal hydrogen peroxide. Our novel microcomposite cryogels exhibit antimicrobial properties and inhibit antibiotic-resistant bacteria (MRSA and Pseudomonas aeruginosa), the most common cause of biomaterial implant failure in modern medicine. Moreover, the cryogels showed negligible cytotoxicity toward murine fibroblasts and prevented activation of primary bone marrow-derived dendritic cells ex vivo. Finally, in vivo data suggested tissue integration, biodegradation, and minimal host inflammatory responses when the antimicrobial cryogels, even when purposely contaminated with bacteria, were subcutaneously injected in mice. Collectively, these needle-injectable microcomposite cryogels show great promise for biomedical applications, especially in tissue engineering and regenerative medicine.

Preparation of lysozyme loaded gelatin microcryogels and investigation of their antibacterial properties

Antibacterial micron-sized cryogels, so-called microcryogels, were prepared by cryogelation of gelatin and integration of lysozyme. Gelation yield, specific surface area, macro-porosity and swelling degree of the microcryogels were examined in order to characterize their physical properties. MTT method was utilized to measure cell viability of the gelatin microcryogels with a period of 24, 48, and 72 h and no significant decrease was observed at 72 h. Apoptotic staining assay also showed high viability at 24, 48, 72 h in parallel with the control group. The antibacterial performances of the gelatin microcryogels against Bacillus subtilis, Staphylococcus aureus, and Escherichia coli were examined. The results showed that the incorporation of lysozyme into gelatin microcryogels exhibited the antibacterial activity against S. aureus, B. subtilis, and E. coli, that may provide great potential for various applications in the biomedical industry.

"Hard" ceramics for "Soft" tissue engineering: Paradox or opportunity?

Tissue engineering provides great possibilities to manage tissue damages and injuries in modern medicine. The involvement of hard biocompatible materials in tissue engineering-based therapies for the healing of soft tissue defects has impressively increased over the last few years: in this regard, different types of bioceramics were developed, examined and applied either alone or in combination with polymers to produce composites. Bioactive glasses, carbon nanostructures, and hydroxyapatite nanoparticles are among the most widely-proposed hard materials for treating a broad range of soft tissue damages, from acute and chronic skin wounds to complex injuries of nervous and cardiopulmonary systems. Although being originally developed for use in contact with bone, these substances were also shown to offer excellent key features for repair and regeneration of wounds and "delicate" structures of the body, including improved cell proliferation and differentiation, enhanced angiogenesis, and antibacterial/anti-inflammatory activities. Furthermore, when embedded in a soft matrix, these hard materials can improve the mechanical properties of the implant. They could be applied in various forms and formulations such as fine powders, granules, and micro- or nanofibers. There are some pre-clinical trials in which bioceramics are being utilized for skin wounds; however, some crucial questions should still be addressed before the extensive and safe use of bioceramics in soft tissue healing. For example, defining optimal formulations, dosages, and administration routes remain to be fixed and summarized as standard guidelines in the clinic. This review paper aims at providing a comprehensive picture of the use and potential of bioceramics in treatment, reconstruction, and preservation of soft tissues (skin, cardiovascular and pulmonary systems, peripheral nervous system, gastrointestinal tract, skeletal muscles, and ophthalmic tissues) and critically discusses their pros and cons (e.g., the risk of calcification and ectopic bone formation as well as the local and systemic toxicity) in this regard. STATEMENT OF SIGNIFICANCE: Soft tissues form a big part of the human body and play vital roles in maintaining both structure and function of various organs; however, optimal repair and regeneration of injured soft tissues (e.g., skin, peripheral nerve) still remain a grand challenge in biomedicine. Although polymers were extensively applied to restore the lost or injured soft tissues, the use of bioceramics has the potential to provides new opportunities which are still partially unexplored or at the very beginning. This reviews summarizes the state of the art of bioceramics in this field, highlighting the latest evolutions and the new horizons that can be opened by their use in the context of soft tissue engineering. Existing results and future challenges are discussed in order to provide an up-to-date contribution that is useful to both experienced scientists and early-stage researchers of the biomaterials community.

Polymeric Hydrogel Systems as Emerging Biomaterial Platforms to Enable Hemostasis and Wound Healing

Broad interest in developing new hemostatic technologies arises from unmet needs in mitigating uncontrolled hemorrhage in emergency, surgical, and battlefield settings. Although a variety of hemostats, sealants, and adhesives are available, development of ideal hemostatic compositions that offer a range of remarkable properties including capability to effectively and immediately manage bleeding, excellent mechanical properties, biocompatibility, biodegradability, antibacterial effect, and strong tissue adhesion properties, under wet and dynamic conditions, still remains a challenge. Benefiting from tunable mechanical properties, high porosity, biocompatibility, injectability and ease of handling, polymeric hydrogels with outstanding hemostatic properties have been receiving increasing attention over the past several years. In this review, after shedding light on hemostasis and wound healing processes, the most recent progresses in hydrogel systems engineered from natural and synthetic polymers for hemostatic applications are discussed based on a comprehensive literature review. Most studies described used in vivo models with accessible and compressible wounds to assess the hemostatic performance of hydrogels. The challenges that need to be tackled to accelerate the translation of these novel hemostatic hydrogel systems to clinical practice are emphasized and future directions for research in the field are presented.

An 'on-demand' photothermal antibiotic release cryogel patch: evaluation of efficacy on an ex vivo model for skin wound infection

A myriad of topical therapies and dressings are available to the clinicians for wound healing skin, but only a very few have shown their effectiveness in promoting wound repair due to challenges in controlling drug release. To address this issue, in this work, a near infrared (NIR)-light activable cryogel based on butyl methacrylate (BuMA) and poly(ethylene glycol) methyl ether methacrylate (PEGMEMA) incorporated with reduced graphene oxide (rGO) was fabricated. The obtained cryogel provides the required hydrophilicity beneficial for wound treatment. The excellent photo-thermal properties of rGO allow for heating the cryogel, which results in subsequent swelling of the cryogel (CG) followed by release of the encapsulated drug load, cefepime in our case. Without photothermal activation, no release of payload was observed. The potential of this bandage for wound healing was examined using an ex vivo human skin model infected with Staphylococcus aureus (S. aureus). Apart from the efficacy of the cryogel based wound healing system, our results also suggest that the ex vivo wound model evaluated here provides a rapid and valuable tool to study superficial skin infections in humans and test the efficacy of antimicrobial agents.

A natural polymer-based porous sponge with capillary-mimicking microchannels for rapid hemostasis

Natural polymer materials have attracted great attention in the field of hemostasis because of their wide range of source, nontoxicity, hydrophilicity, and air permeability. In the present study, two natural polymers composed of carboxymethyl chitosan (CMCS) and sodium carboxymethylcellulose (CMCNa) plus γ-(2,3-epoxypropoxy) propytrimethoxysilane (KH560) that serves as a crosslinking agent were selected to synthesize a capillary-mimicking composite hemostatic (CCK) sponge with a low density, interconnected microchannel architecture, suitable mechanical strength, high resilience, and ultrastrong liquid absorption capacity. The introduction of a large number of hydrophilic carboxymethyl functional groups and the design of capillary-mimicking structures formed by the ice segregation-induced self-assembly (ISISA) process endowed the CCK sponges with an ultrastrong liquid absorption capacity, which significantly enhanced the hemostatic ability of the materials. Both in vivo and in vitro hemostatic experiments confirmed the potential of the CCK sponges to achieve rapid hemostasis. Additionally, cytotoxicity and hemolysis assays showed that the CCK sponges exhibited good biocompatibility and hemocompatibility. The possible hemostatic mechanism was also discussed in this study. In conclusion, the capillary-mimicking hemostatic sponge exhibits a high potential to induce rapid hemostasis in prehospital emergency and clinical settings. STATEMENT OF SIGNIFICANCE: In the present study, an oriented composite hemostatic (CCK) sponge with a capillary-mimicking structure formed by the ice segregation-induced self-assembly (ISISA) process was designed and used to achieve rapid hemostasis. The unique aligned microchannel structure of the sponge exhibited an ultrastrong capillary-mimicking action and endowed the prepared CCK hemostatic sponge with a strong liquid absorption capacity. By changing the proportion of raw materials, we could modify the unique capillary-mimicking structure with aligned microchannels. Two natural polymer-based materials with abundant hydrophilic groups were chosen to prepare the CCK sponge to fully utilize the characteristics of this structure. The oriented natural polymer-based porous sponge with capillary-mimicking microchannels exhibited a strong hemostatic ability in both in vivo and in vitro tests. The results showed that the CCK sponge with the capillary-mimicking structure has a high potential to achieve rapid hemostasis.

Fabricating Tough Interpenetrating Network Cryogels with DNA as the Primary Network for Biomedical Applications

This work investigates a sequential strategy to develop DNA-based hydrogel scaffolds with interpenetrating polymeric network. The scaffolds were formed via a two-step procedure. First, a covalently cross-linked DNA-based cryogel was formed by the chemical reaction between DNA strands and a bifunctional cross-linker, polyethylene glycol diepoxide at subzero temperatures. In the second step, alginate chains were absorbed into the preformed macroporous DNA cryogel network, followed by ionic cross-linking with divalent calcium ions. The individual and synergistic effects of covalent and ionic cross-linkings on mechanical and physical properties of the IPN cryogel were tested. The IPN cryogels were able to sustain large deformations higher than 95% of strain under compressive forces without exhibiting any failure. Addition of a physically cross-linked alginate network to the covalently linked DNA cryogel significantly enhanced its toughness and energy dissipation compared to the covalent network alone. The formulated hydrogels also exhibited excellent biocompatibility with human stem cells. Overall, this DNA-based IPN cryogel has the potential to be used as a biomaterial scaffold for a diverse range of tissue engineering applications.

Fabrication of Chitosan-Reinforced Multifunctional Graphene Nanocomposite as Antibacterial Scaffolds for Hemorrhage Control and Wound-Healing Application

Accidents on battlefields and roads often lead to hemorrhage and uncontrolled bleeding. Hence, immediate hemorrhage control remains of great importance to reduce mortality and socioeconomic loss. Herein, nanobiocomposite scaffolds (film and sponge) have been fabricated for the first time through the incorporation of a graphene-silver-polycationic peptide (GAP) nanocomposite into chitosan (Cs). Ten different scaffolds viz. Cs, Cs-GAP25, Cs-GAP50, Cs-GAP75, and Cs-GAP100 were prepared in the form of films and sponges. Cs-GAP100 nanobiocomposite sponge exhibited excellent porosity, fluid absorption, and blood clotting capacity, whereas Cs-GAP100 nanobiocomposite film showed excellent mechanical strength and poor degradation property. The presence of graphene in GAP provided a unique mechanical property and prevented the natural degradation, whereas silver nanoparticles and polycationic peptide provided an efficient antimicrobial property to the scaffolds. The high surface area of graphene and the hydrophilic nature of the polycationic peptide also imparted high fluid and blood absorption capacity to Cs-GAP nanobiocomposite scaffolds. The in vitro whole blood clotting assay demonstrated that clotting efficacy improved with the concentration of GAP nanocomposite and Cs-GAP100 nanobiocomposite sponge significantly (p value <0.003) reduced the clotting time to 60 s, as compared to the pristine chitosan dressings. On the other side, the Cs-GAP100 nanobiocomposite film showed an excellent wound-healing property. The Cs-GAP100 nanobiocomposite demonstrated profound antibacterial activity against Escherichia coli and Staphylococcus aureus. The intracellular reactive oxygen species (ROS) assay explained the interfacial interaction of Cs-GAP100 nanobiocomposite and bacterial cells, resulting in cell damage and finally cell death. The obtained information thus provided a novel safe-by-design concept for fabrication of Cs-GAP100 nanobiocomposite scaffolds and demonstrated potential development of antibacterial hemostatic and wound dressing in traumacare management.

Antibacterial Hybrid Hydrogels

Bacterial infectious diseases and bacterial-infected environments have been threatening the health of human beings all over the world. In view of the increased bacteria resistance caused by overuse or improper use of antibiotics, antibacterial biomaterials are developed as the substitutes for antibiotics in some cases. Among them, antibacterial hydrogels are attracting more and more attention due to easy preparation process and diversity of structures by changing their chemical cross-linkers via covalent bonds or noncovalent physical interactions, which can endow them with various specific functions such as high toughness and stretchability, injectability, self-healing, tissue adhesiveness and rapid hemostasis, easy loading and controlled drug release, superior biocompatibility and antioxidation as well as good conductivity. In this review, the recent progress of antibacterial hydrogel including the fabrication methodologies, interior structures, performances, antibacterial mechanisms, and applications of various antibacterial hydrogels is summarized. According to the bacteria-killing modes of hydrogels, several representative hydrogels such as silver nanoparticles-based hydrogel, photoresponsive hydrogel including photothermal and photocatalytic, self-bacteria-killing hydrogel such as inherent antibacterial peptides and cationic polymers, and antibiotics-loading hydrogel are focused on. Furthermore, current challenges of antibacterial hydrogels are discussed and future perspectives in this field are also proposed.

Thermo-responsive chitosan hydrogel for healing of full-thickness wounds infected with XDR bacteria isolated from burn patients: In vitro and in vivo animal model

Treatment of non-healing skin wounds infected with extensively drug-resistant (XDR) bacteria remains as a big challenge. To date, different biomaterials have been applied for treatment of post-wound infections, nevertheless their efficacy for treatment of the wounds infected with XDR isolates has not been determined yet. In this study, the potential of the thermo-responsive chitosan (TCTS) hydrogel for protection of full-thickness wounds XDR bacteria isolated from burn patients was evaluated both in vitro and in vivo in a rat model. Antibacterial activity of the TCTS hydrogel against standard strain and clinical isolates of Acinetobacter baumannii, cytobiocompatibility for Hu02 fibroblast cells, degradation rate and swelling ratio were determined in vitro. MTT assay and disk diffusion test indicated no detectable cytotoxicity and antibacterial activity in vitro, respectively. In vivo study showed significant acceleration of wound healing, re-epithelialization, wound closure, and decreased colony count in the TCTS hydrogel group compared with control. This study suggests TCTS hydrogel as an excellent wound dressing for management of the wounds infected with XDR bacteria, and now promises to proceed with clinical investigations.

3D printed intelligent scaffold prevents recurrence and distal metastasis of breast cancer

Rationale: Tumors are commonly treated by resection, which usually leads to massive hemorrhage and tumor cell residues, thereby increasing the risk of local recurrence and distant metastasis.

Methods: Herein, an intelligent 3D-printed poly(lactic-co-glycolic acid), gelatin, and chitosan scaffold loaded with anti-cancer drugs was prepared that showed hemostatic function and good pH sensitivity.

Results: Following in situ implantation in wounds, the scaffolds absorbed hemorrhage and cell residues after surgery, and promoted wound healing. In an in vivo environment, the scaffold responded to the slightly acidic environment of the tumor to undergo sustained drug release to significantly inhibit the recurrence and growth of the tumor, and reduced drug toxicity, all without causing damage to healthy tissues and with good biocompatibility.

Conclusions: The multifunctional intelligent scaffold represents an excellent treatment modality for breast cancer following resection, and provides great potential for efficient cancer therapy.

Morphology-controllable cellulose/chitosan sponge for deep wound hemostasis with surfactant and pore-foaming agent

Developing a facile and scalable synthetic route is important to explore the potential application of functional cellulose sponges. Here, a simple and efficient strategy to produce porous and hydrophilic cellulose sponges using surfactant and pore-foaming agent is demonstrated. The obtained cellulose sponges exhibit high water absorption capacity and rapid shape recoverability. The introduction of chitosan endows the chitosan/cellulose composite sponge with good mechanical properties. Inhibitory effects on Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa are particularly proved. Besides, the result of the dynamic whole blood clotting time indicated that the chitosan/cellulose composite sponge has better coagulation ability than those of traditional gauze and gelatin sponge. Animal experiment further showed that rapid hemostasis within 105 s could be reached with the composite sponge. Good biocompatibility of the composite sponge is proved by the results of hemocompatibility and cytotoxicity, indicating an excellent candidate as a rapid hemostatic material.

Intrinsically Bioactive Cryogels Based on Platelet Lysate Nanocomposites for Hemostasis Applications

The currently used hemostatic agents are highly effective in stopping hemorrhages but have a limited role in the modulation of the wound-healing environment. Herein, we propose an intrinsically bioactive hemostatic cryogel based on platelet lysate (PL) and aldehyde-functionalized cellulose nanocrystals (a-CNCs). PL has attracted great attention as an inexpensive milieu of therapeutically relevant proteins; however, its application as a hemostatic agent exhibits serious constraints (e.g., structural integrity and short shelf-life). The incorporation of a-CNCs reinforced the low-strength PL matrix by covalent cross-linking its amine groups that exhibit an elastic interconnected porous network after full cryogelation. Upon blood immersion, the PL-CNC cryogels absorbed higher volumes of blood at a faster rate than commercial hemostatic porcine gelatin sponges. Simultaneously, the cryogels released biomolecules that increased stem cell proliferation, metabolic activity, and migration as well as downregulated the expression of markers of the fibrinolytic process. In an in vivo liver defect model, PL-CNC cryogels showed similar hemostatic performance in comparison with gelatin sponges and normal material-induced tissue response upon subcutaneous implantation. Overall, owing to their structure and bioactive composition, the proposed PL-CNC cryogels provide an alternative off-the-shelf hemostatic and antibacterial biomaterial with the potential to deliver therapeutically relevant proteins in situ.

Manufacture of pH- and HAase-responsive hydrogels with on-demand and continuous antibacterial activity for full-thickness wound healing

A kind of "intelligent" antibacterial dressing-A-HA/HA-ADH/SS hydrogel was in situ formed quickly via dynamic covalent bonds cross-linking between aldehyde hyaluronic acid (A-HA), adipic acid dihydrazide graft hyaluronic acid (HA-ADH) and sisomicin sulfate (SS). FT-IR, SEM and rheological results displayed that the hydrogels were successfully prepared. The hydrogels had good optical transmittance, injectability, self-healing ability, cytocompatibility, antioxidant activity and hemostatic performance which were beneficial to observe the wound healing condition and provide a good healing environment for wounds. In addition, the hydrogels showed a pH- and HAase- dependent degradability, which allowed them to release more SS at infected wound and then exert on-demand and sustained antibacterial effect against S. aureus and E. coli. The results of wound healing and histological examination revealed that these hydrogels have a good therapeutic effect in the full-thickness mouse skin defect wound. Thus, the hydrogels are expected to be used as potential wound dressings to improve wound healing.

Multifunctional Tissue-Adhesive Cryogel Wound Dressing for Rapid Nonpressing Surface Hemorrhage and Wound Repair

Cryogels with tissue adhesion have great potential as wound dressings for rapid hemostasis for uncontrollable nonpressing surface hemorrhage and wound healing, but their use has not been reported previously. Herein, we designed a series of antibacterial and antioxidant tissue-adhesive cryogels based on quaternized chitosan (QCS) and polydopamine (PDA). These cryogels had good blood cell and platelet adhesion, enrichment, and activation properties for rapid nonpressing surface hemostasis and wound healing. The cryogels exhibited outstanding mechanical strength and easy removability, antioxidant activity, and NIR photothermal-enhanced antibacterial performance. The cryogels showed much better hemostasis than gauze and gelatin sponge in a standardized strip rat liver injury model, a standardized circular rabbit liver section model, and a pig skin laceration model. Furthermore, the excellent hemostatic performance of the QCS/PDA2.0 cryogel (containing 20 mg/mL QCS and 2.0 mg/mL PDA) for coagulopathic hemorrhages was confirmed in a standardized coagulation disorder rabbit circular liver section model. In addition, the QCS/PDA2.0 cryogel promoted rapid hemostasis in a deep noncompressible wound and a much better wound healing effect than a chitosan sponge and Tegaderm film in a full-thickness skin defect model. Overall, these multifunctional tissue-adhesive cryogels with excellent hemostatic performance and enhanced wound healing properties are suitable candidates for tissue-adhesive hemostat and wound healing dressings.

Rapid hemostatic chitosan/cellulose composite sponge by alkali/urea method for massive haemorrhage

Here, a simple and efficient strategy to produce porous and hydrophilic chitosan/cellulose sponge using surfactant and pore-forming agent is demonstrated. The preparation of composite sponge by LiOH/KOH/urea solvent system effectively solve the problems of uneven distribution of chitosan, poor softness and acid residue caused by soaking in chitosan acid solution. The obtained chitosan/cellulose sponges exhibit high water absorption capacity and rapid shape recoverability, as well as good mechanical properties. Effective inhibitory on Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa are particularly proved. Besides, the result of the dynamic whole blood clotting time indicated that the chitosan/cellulose composite sponge has better coagulation ability than those of traditional gauze and gelatin sponge. Animal experiment further showed that rapid hemostasis within 34 s can be reached with the composite sponge. Better biocompatibility of the composite sponge is proved by the results of hemocompatibility and cytotoxicity, indicating an excellent candidate for rapid hemostasis in massive haemorrhage.

Natural Polymer-Based Antimicrobial Hydrogels without Synthetic Antibiotics as Wound Dressings

Wound healing is usually accompanied by bacterial infection. The excessive use of synthetic antibiotics leads to drug resistance, posing a significant threat to human health. Hydrogel-based wound dressings aimed at mitigating bacterial infections have emerged as an effective wound treatment. The review presented herein particularly focuses on the hydrogels originating from natural polymers. To further enhance the performance of wound dressings, various strategies and approaches have been developed to endow the hydrogels with excellent broad-spectrum antibacterial activity. Those that are summarized in the current review are the hydrogels with intrinsic or stimuli-triggered bactericidal properties and others that serve as vehicles for loading antibacterial agents without synthetic antibiotics. Specific attention is paid to antimicrobial mechanisms and the antibacterial performance of hydrogels. Practical antibacterial applications to accelerate the wound healing employing these antibiotic-free hydrogels are also introduced along with the discussion on the current challenges and perspectives leading to new technologies.

Multifunctional Supramolecular Hydrogel for Prevention of Epidural Adhesion after Laminectomy

Postoperative epidural adhesion remains a clinically challenging problem in spine surgery. Currently there are no effective and safe antifibrotic and antiadhesion biomaterials that have been specifically developed for this complication in clinical practice. Herein we designed and engineered an advanced antiadhesion hydrogel with multiple functionalities, including temperature-responsive gelation, self-healing, tissue adhesiveness, antioxidation, anti-inflammation, and antifibrosis. This multifunctional supramolecular hydrogel can be facilely constructed by integrating three functional modules, i.e., a thermosensitive triblock copolymer, poloxamer 407 (PX); a reactive oxygen species-eliminating and anti-inflammatory nanoparticle (TPCD NP); and an adhesion-enhancing compound, tannic acid (TA). The optimal formulation (PXNT) was hierarchically screened based on in vitro properties and in vivo activities. Therapeutically, local treatment with PXNT hydrogel effectively prevented epidural fibrosis and adhesion after laminectomy in both rats and rabbits. Of note, PXNT hydrogel showed more beneficial efficacy than different control thermosensitive hydrogels and a commercially available barrier product, Interceed. Mechanistically, PXNT hydrogel significantly attenuated local oxidative stress, inhibited inflammatory responses, and reduced fibrotic tissue formation. Moreover, treatment with PXNT hydrogel did not cause systemic adverse effects and neurological symptoms. Consequently, PXNT hydrogel is a highly promising biomaterial for preventing postlaminectomy epidural adhesion and adhesions after other surgeries.

Particulate-Aggregated Adhesives with Exudate-Sensitive Properties and Sustained Bacteria Disinfection to Facilitate Wound Healing

Wound-associated infections create additional suffering and come at a high cost for patients and their families, which urgently require wound disinfection biomaterials with improved healing efficacy. Here, we report an adhesive with sustained bacteria disinfection ability, which is aggregated from hydrogen-bonded polymer particulates. The particulate-aggregated adhesive shows strong binding ability on different surfaces from rigid substrates to soft skins. Moreover, water-sensitive mechanical properties are shown in wound exudates, resulting from the dissociation of hydrogen bonds under the competition of water and thus the sustained release of particulates. Synergizing with the strong binding ability, exudate-sensitive behaviors, and sustained release of antibacterial particulates, the adhesive achieves sustained bactericidal activity and can facilitate the healing process in bacteria-infected skin wounds.

Hybrid Freeze-Dried Dressings Composed of Epidermal Growth Factor and Recombinant Human-Like Collagen Enhance Cutaneous Wound Healing in Rats

Epidermal growth factor (EGF) is important for promoting skin repair and remodeling. Native collagen is also widely used as a scaffold for skin tissue engineering. The limitations of EGF include easy decomposition or inactivation, whereas native collagen is immunogenic and has poor solubility. Therefore, we constructed a freeze-dried dressing based on the recombinant human-like collagen (RHC) to act as a carrier for EGF (RHC/EGF freeze-dried dressing) and promote skin wound closure. Here, the freeze-dried dressing that combined EGF and RHC significantly enhanced the proliferation, adhesion, and spreading of NIH/3T3 fibroblasts and migration of HaCaT keratinocytes at the wound site. The physicochemical characteristics of the RHC/EGF freeze-dried dressing investigated using scanning electron microscopy, Fourier transform infrared (FTIR) spectroscopy, and differential scanning calorimetry revealed that it was a loose and porous cake that redissolved quickly. The molecular mechanisms involved in cell proliferation and angiogenesis were also assessed. The expression levels of the markers Ki-67, proliferating cell nuclear antigen, vascular endothelial growth factor, and cluster of differentiation 31 were significantly increased after treatment with the RHC/EGF freeze-dried dressing (P < 0.01, vs. RHC or EGF alone). This increase indicated that the RHC/EGF freeze-dried dressing significantly accelerated wound closure, re-epithelialization, and the orderly arrangement and deposition of collagen in the Sprague–Dawley rats with full-thickness skin defects. This work describes a significant step toward the development of wound environments conducive to healing, and the RHC/EGF freeze-dried dressing is a potential therapeutic strategy in wound management.

Hemostatic nanotechnologies for external and internal hemorrhage management

An uncontrolled hemorrhage can easily lead to death during surgery and military operations. Despite the significant advances in hemostatic research, there is still an urgent and increasing need for safer and more effective hemostatic materials. Recently, nanotechnologies have been receiving increasing interest owing to their unique advantages and have been propelling the developement of hemostatic materials. This review summarizes the fundamentals of hemostasis and emphasizes the recent developments regarding hemorrhage-related hemostatic nanotechnologies. In terms of external accessible hemorrhage management, natural and synthetic polymers and inorganic components that have been used in traditional hemostats provide novel nanoscale solutions. Regarding internal noncompressible hemorrhage management, current research endeavors are dedicated to the development of substitutes for blood components, and nanoformulated hemostatic drugs. This review also briefly discusses the main and persistent problems of hemostatic nanomaterials, including safety concerns and clinical translation challenges. This review is hoped to provide critical insight into hemostatic nanomaterial development.

Stereocomplexed electrospun nanofibers containing poly (lactic acid) modified quaternized chitosan for wound healing

Skin damage, especially the extensive full-thickness wound, is seriously affecting people's daily life and health. Meanwhile, wound healing is always challenged by bacterial infection. In this study, for the purpose of developing a disinfectant wound dressing, we designed a novel multi-functional nanofiber mats via electrospinning combining chitosan derivations and stereocomplex crystallite (SC). The SC membrane of poly (lactic acid)/chitosan derivatives were prepared via warming at 80 °C for 1 h. The thermal and mechanical properties of the heated mats were strengthened owing to the formation of SC, which restricted the lactide chains mobility. In vivo wound healing test revealed that the SC mats have better wound repair ability than the control group with a wound healing rate of 100 % within 15 days. In a word, the biomass-based mats with enhanced thermal and mechanical properties, antibacterial effect and antioxidant activity, providing a potential multi-functional platform for designing of disinfectant wound dressings.

Preparation of aminated fish scale collagen and oxidized sodium alginate hybrid hydrogel for enhanced full-thickness wound healing

Acute full-thickness wounds require a more extended healing period, thus increasing the risk of infection. Severe infection frequently resulted in wound ulceration, necrosis, and even life-threatening complications. Here, a hybrid hydrogel comprising aminated collagen (AC), oxidized sodium alginate (OSA), and antimicrobial peptides (polymyxin B sulfate and bacitracin) was developed to enhance full-thickness wound healing. The AC with low immunogenicity and high biocompatibility was made from marine fish scales, which are eco-friendly, low-cost, and sustainable. The cross-linked hydrogel was formed by a Schiff base reaction without any catalysts and additional procedures. As expected, the presented hybrid hydrogel can effectively against E. coli and S. aureus, as well as promote cell growth and angiogenesis in vitro. In addition, the hydrogel can promote full-thickness wound healing in a rat model through accelerating reepithelialization, collagen deposition, and angiogenesis. Our work demonstrated that the hybrid hydrogel has promising applications in the field of wound healing, which would prompt the utilization of marine fish resources during food processing.

Nanoenzyme-Reinforced Injectable Hydrogel for Healing Diabetic Wounds Infected with Multidrug Resistant Bacteria

Diabetic wound healing remains a critical challenge due to its vulnerability to multidrug-resistant (MDR) bacterial infection, as well as the hyperglycemic and oxidative wound microenvironment. Herein, an injectable multifunctional hydrogel (FEMI) was developed to simultaneously overcome these hurdles. The FEMI hydrogel was fabricated through a Schiff-based reaction between ε-polylysine (EPL)-coated MnO₂ nanosheets (EM) and insulin-loaded self-assembled aldehyde Pluronic F127 (FCHO) micelles. Through a synergistic combination of EPL and "nanoknife-like" MnO₂ nanosheets, the FEMI hydrogel exhibited extraordinary antimicrobial capacities against MDR bacteria. The MnO₂ nanoenzyme reshaped the hostile oxidative wound microenvironment by decomposing the endogenous H₂O₂ into O₂. Meanwhile, the pH/redox dual-responsive FEMI hydrogel achieved a sustained and spatiotemporal controlled release of insulin to regulate the blood glucose. Our FEMI hydrogel demonstrated an accelerated MDR bacteria-infected diabetic wound healing in vivo and represents a versatile strategy for healing a broad range of tissue damages caused by diabetes.

A Solvent Co-cross-linked Organogel with Fast Self-Healing Capability and Reversible Adhesiveness at Extreme Temperatures

Antifreezing gels are promising in diverse engineering applications such as structural soft matters, sensors, and wearable devices. However, the capability of fast self-healing and reversible adhesiveness still remain a huge challenge for gels at extreme temperatures. Here, we proposed a solvent-involved cross-linking system composed of polyacrylic acid, polyvinyl alcohol, borax, ethylene glycol, and water, capable of antifreezing below -90 °C. It was not only antifreezing, anticrystalline, and abundant in dynamic bonds but also highly transparent, stretchable (over 800%), and conductive over the scope of temperature from -60 to 60 °C. Moreover, this gel could self-heal within 1 min and repeatedly adhere to multiple substrates including glass, metal, and rubber with an adhesive strength greater than 18 kPa. These key functions of the gel could be mostly preserved after 5 days of storage at 70% relative humidity. It is anticipated that our research opens a new scope for high-performance extreme environment-tolerant adhesives or wearable devices.

Fabrication and In-Vivo Study of Micro-Colloidal Zanthoxylum acanthopodium-Loaded Bacterial Cellulose as a Burn Wound Dressing

Bacterial cellulose (BC) is a biopolymer commonly used for wound dressing due to its high biocompatible properties either in-vitro or in-vivo. The three-dimensional fiber structure of BC becomes an advantage because it provides a template for the impregnation of materials in order to improve BC's properties as a wound dressing, since BC has not displayed any bioactivity properties. In this study, micro-colloidal Zanthoxylum acanthopodium (MZA) fruit was loaded into BC fibers via an in-situ method. Z. acanthopodium is known to have anti-inflammatory, antioxidant and antimicrobial activities that can support BC to accelerate the wound healing process. The FTIR, XRD and SEM analysis results showed that the loading process of MZA and the composite fabrication were successfully carried out. The TGA test also showed that the presence of MZA in BC fibers decreased Tmax composite from BC, from 357.8 to 334.5 °C for BC-MZA3. Other aspects, i.e., water content, porosity, hemocompatibility and histology studies, also showed that the composite could potentially be used as a wound dressing.

Composite Hydrogels in Three-Dimensional in vitro Models

3-dimensional (3D) in vitro models were developed in order to mimic the complexity of real organ/tissue in a dish. They offer new possibilities to model biological processes in more physiologically relevant ways which can be applied to a myriad of applications including drug development, toxicity screening and regenerative medicine. Hydrogels are the most relevant tissue-like matrices to support the development of 3D in vitro models since they are in many ways akin to the native extracellular matrix (ECM). For the purpose of further improving matrix relevance or to impart specific functionalities, composite hydrogels have attracted increasing attention. These could incorporate drugs to control cell fates, additional ECM elements to improve mechanical properties, biomolecules to improve biological activities or any combinations of the above. In this Review, recent developments in using composite hydrogels laden with cells as biomimetic tissue- or organ-like constructs, and as matrices for multi-cell type organoid cultures are highlighted. The latest composite hydrogel systems that contain nanomaterials, biological factors, and combinations of biopolymers (e.g., proteins and polysaccharide), such as Interpenetrating Networks (IPNs) and Soft Network Composites (SNCs) are also presented. While promising, challenges remain. These will be discussed in light of future perspectives toward encompassing diverse composite hydrogel platforms for an improved organ environment in vitro.

Poly(selenoviologen)-Assembled Upconversion Nanoparticles for Low-Power Single-NIR Light-Triggered Synergistic Photodynamic and Photothermal Antibacterial Therapy

The development of a highly effective photosensitizer (PS) that can be activated with a low-power single light is a pressing issue. Herein, we report a PS for synergistic photodynamic and photothermal therapy constructed through self-assembly of poly(selenoviologen) on the surface of core-shell NaYF₄:Yb/Tm@NaYF₄ upconversion nanoparticles. The hybrid UCNPs/PSeV PS showed strong ROS generation ability and high photothermal conversion efficiency (∼52.5%) under the mildest reported-to-date irradiation conditions (λ = 980 nm, 150 mW/cm², 4 min), leading to a high efficiency in killing methicillin-resistant Staphylococcus aureus (MRSA) both in vitro and in vivo. Remarkably, after intravenous injection, the reported PS accumulated preferentially in deep MRSA-infected tissues and achieved an excellent therapeutic index. This PS design realizes a low-power single-NIR light-triggered synergistic phototherapy and provides a simple and versatile strategy to develop safe clinically translatable agents for efficient treatment of deep tissue bacterial inflammations.

Recent Advances in Nanomaterial-Based Wound-Healing Therapeutics

Nanomaterial-based wound healing has tremendous potential for treating and preventing wound infections with its multiple benefits compared with traditional treatment approaches. In this regard, the physiochemical properties of nanomaterials enable researchers to conduct extensive studies on wound-healing applications. Nonetheless, issues concerning the use of nanomaterials in accelerating the efficacy of existing medical treatments remain unresolved. The present review highlights novel approaches focusing on the recent innovative strategies for wound healing and infection controls based on nanomaterials, including nanoparticles, nanocomposites, and scaffolds, which are elucidated in detail. In addition, the efficacy of nanomaterials as carriers for therapeutic agents associated with wound-healing applications has been addressed. Finally, nanomaterial-based scaffolds and their premise for future studies have been described. We believe that the in-depth analytical review, future insights, and potential challenges described herein will provide researchers an up-to-date reference on the use of nanomedicine and its innovative approaches that can enhance wound-healing applications.

Surface modification of carbon nanotube with gelatin via mussel inspired method

Carbon nanotube (CNT) has aroused much attention in biomedical field. However, the cytotoxicity and aggregation are critical factors that affect the application of carbon nanotube (CNT). Herein, gelatin was grafted on the surface of CNT via mussel-inspired method. The gelatin modified CNT can disperse homogeneously in water. The in vitro test showed that gelatin modified CNT showed much better biocompatibility than the native CNT, which may improve its potential application in biomedical field.

Antibacterial and Hemostatic Thiol-Modified Chitosan-Immobilized AgNPs Composite Sponges

Wound bleeding and infection are two of the major threats to patients' lives, but developing safe materials with high hemostasis efficiency and antibacterial activity remains a major challenge. Silver nanoparticles (AgNPs) are suitable as antibacterial agents in the hemostatic process, but the application is hampered because of easy accumulation of toxicity. Herein, thiol-modified chitosan (TMC) was prepared by modifying with mercaptosuccinic acid and then was used to immobilize AgNPs to obtain composite sponges (TMC/AgNPs) for stemming the bleeding and preventing infection. TMC/AgNPs sponges had complex interlaced tubular porous structure with high porosity (99.42%), indicating high absorption. TMC had high immobilization efficiency for AgNPs-the release rate of AgNPs was 14.35% after 14 days-but the TMC/AgNPs sponge still had excellent antibacterial activity against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. In vitro and in vivo experiments confirm that the TMC/AgNPs sponge had fast and efficient hemostatic performance in comparison with the PVF sponge, and its possible mechanism was the synergistic effect of high blood absorption capacity and the interaction between amino, sulfydryl, and blood cells. Furthermore, the TMC/AgNPs sponge can promote wound healing by preventing wound infection, while the PVF sponge cannot. More importantly, the sponges had good safety due to the immobilization of TMC for AgNPs.

Ultralong Organic Phosphorescent Nanocrystals with Long-Lived Triplet Excited States for Afterglow Imaging and Photodynamic Therapy

The development of novel applications of ultralong organic phosphorescent (UOP) materials is highly desired. Herein, a series of UOP materials (EDCz, E = O, S, Se, and Te) for bacterial afterglow imaging and photodynamic therapy (PDT) is reported. By structurally bonding with the chalcogen atoms with π-conjugated scaffolds, EDCz not only absorbs visible light but also emits UOP with an efficiency of ca. 0.01-6.8% and a long lifetime of 0.08-0.318 s under ambient conditions. Benefiting from the long-lived triplet excited states, the SeDCz nanocrystals (NCs) possessed the best optical properties in the series, generating ¹O₂ under white light irradiation and performing as an agent for Staphylococcus aureus afterglow imaging and PDT at a low concentration (98 ng mL^-1). The SeDCz NCs are also utilized as real-time UOP imaging agents and promoted healing of infected wounds in living mice. To the best of our knowledge, this study presents the first example of UOP-based bacterial photodynamic theranostic agents and creates a platform for the next-generation efficient UOP-based photosensitizers for bioimaging and skin regeneration.