In vitro cytotoxity of silver: implication for clinical wound care

Nanomedicine in Healing Chronic Wounds: Opportunities and Challenges

The poor healing associated with chronic wounds affects millions of people worldwide through high mortality rates and associated costs. Chronic wounds present three main problems: First, the absence of a suitable environment to facilitate cell migration, proliferation, and angiogenesis; second, bacterial infection; and third, unbalanced and prolonged inflammation. Unfortunately, current therapeutic approaches have not been able to overcome these main issues and, therefore, have limited clinical success. Over the past decade, incorporating the unique advantages of nanomedicine into wound healing approaches has yielded promising outcomes. Nanomedicine is capable of stimulating various cellular and molecular mechanisms involved in the wound microenvironment via antibacterial, anti-inflammatory, and angiogenetic effects, potentially reversing the wound microenvironment from nonhealing to healing. This review briefly discusses wound healing mechanisms and pathophysiology and then highlights recent findings regarding the opportunities and challenges of using nanomedicine in chronic wound management.

Silver Sulfadiazine's Effect on Keratin-19 Expression as Stem Cell Marker in Burn Wound Healing

BACKGROUND

Burn wounds are one of the causes of cutaneous injury that involve both epidermal and dermal layers of skin. Silver sulfadiazine (SSD) has been widely used to treat burn wounds, however recent studies have found the treatment to have some drawbacks, such as cellular toxicity effects. Cutaneous wound regeneration is known to start from the basal layer of the epidermal epithelial cells, which are enriched with highly proliferative cells. Keratin-19 (K19) is one of the epidermal stem cell biomarkers found in the skin. This study aims to explore the expression of K19 in burn wound tissue and to investigate the effect of SSD on its expression.

METHODS

We created a burn wound model in Sprague Dawley rats and randomly divided them into control and SSD groups. Wound closure was evaluated (visitrak) overtime series followed by histological evaluation of K19 expression in the wound tissue (immunohistochemistry staining).

RESULTS

Our model successfully represents full-thickness damage caused by a burn wound. The SSD group showed a faster reduction of wound surface area (wound closure) compared to the control group with the peak at day 18 post wounding (p < 0.05). K19 expression was found in both groups and was distributed on epidermal layers, hair follicles and dermis of granulation tissue showing similar patterns.

CONCLUSION

Topical application of SSD on burn wounds showed superiority in wound closure and is likely to have no harmful effect on epidermal stem cells. However, further study is required to investigate the effect of silver species on cell viability and toxicity effects during long term treatment.

Alginate Affects Bioactivity of Chimeric Collagen-Binding LL37 Antimicrobial Peptides Adsorbed to Collagen-Alginate Wound Dressings

Chronic infected wounds cause more than 23,000 deaths annually. Antibiotics and antiseptics are conventionally used to treat infected wounds; however, they can be toxic to mammalian cells, and their use can contribute to antimicrobial resistance. Antimicrobial peptides (AMPs) have been utilized to address the limitations of antiseptics and antibiotics. In previous work, we modified the human AMP LL37 with collagen-binding domains from collagenase (cCBD) or fibronectin (fCBD) to facilitate peptide tethering and delivery from collagen-based wound dressings. We found that cCBD-LL37 and fCBD-LL37 were retained and active when bound to 100% collagen scaffolds. Collagen wound dressings are commonly made as composites with other materials, such as alginate. The goal of this study was to investigate how the presence of alginate affects the tethering, release, and antimicrobial activity of LL37 and CBD-LL37 peptides adsorbed to commercially available collagen-alginate wound dressings (FIBRACOL Plus-a 90% collagen and 10% alginate wound dressing). We found that over 85% of the LL37, cCBD-LL37, and fCBD-LL37 was retained on FIBRACOL Plus over a 14-day release study (90.3, 85.8, and 98.6%, respectively). Additionally, FIBRACOL Plus samples loaded with peptides were bactericidal toward Pseudomonas aeruginosa, even after 14 days in release buffer but demonstrated no antimicrobial activity against Escherichia coli, Staphylococcus aureus, and Staphylococcus epidermidis. The presence of alginate in solution induced conformational changes in the cCBD-LL37 and LL37 peptides, resulting in increased peptide helicity, and reduced antimicrobial activity against P. aeruginosa. Peptide-loaded FIBRACOL Plus scaffolds were not cytotoxic to human dermal fibroblasts. This study demonstrates that CBD-mediated LL37 tethering is a viable strategy to reduce LL37 toxicity, and how substrate composition plays a crucial role in modulating the antimicrobial activity of tethered AMPs.

Toxicity of silver nanoparticles on wound healing: A case study of zebrafish fin regeneration model

Dressings coated with silver nanoparticle (AgNP) are widely used in the management of acute and chronic wounds. However, whether AgNP exerts toxicity on wound healing remains ambiguous. To demonstrate the effects of AgNP on wound healing, we precisely quantified the recovery speed of wound by taking advantage of the fin regeneration of zebrafish. This method also enabled assessment of the adverse effect of AgNP on various steps of wound healing in vivo. We revealed that AgNP treatment at the concentration of 2 μg/ml impaired fin regeneration when exposure was performed at the phases of epithelialization and the beginning of blastema formation. Cell proliferation of regenerative blastema was significantly decreased after AgNP exposure. But the canonical signals including Wingless/Integrated (Wnt), Notch and Fibroblast growth factor (Fgf) which play important roles in cell proliferation during fin regeneration were not modulated at 36 hours post amputation (hpa). Further study showed that AgNP impaired fin regeneration through declining amputation-induced ROS as early as epithelialized phase at 18 hpa, rather than inducing ROS generation. AgNP exposure also promoted recruitment of neutrophils in the early phase of wound healing, which suggests that this event dampened amputation-induced ROS. Overall, this study suggested that application of AgNP-coated dressings should be carefully considered at the beginning stage of wound healing.

Nine-Residue Peptide Self-Assembles in the Presence of Silver to Produce a Self-Healing, Cytocompatible, Antimicrobial Hydrogel

Silver compounds have been used extensively for wound healing because of their antimicrobial properties, but high concentrations of silver are toxic to mammalian cells. We designed a peptide that binds silver and releases only small amounts of this ion over time, therefore overcoming the problem of silver toxicity. Silver binding was achieved through incorporation of an unnatural amino acid, 3'-pyridyl alanine (3'-PyA), into the peptide sequence. Upon the addition of silver ions, the peptide adopts a beta-sheet secondary structure and self-assembles into a strong hydrogel as characterized by rheology, circular dichroism, and transmission electron microscopy. We show that the resulting hydrogel kills Escherichia coli and Staphylococcus aureus but is not toxic to fibroblasts and could be used for wound healing. The amount of Ag(I) released by hydrogels into the solution is less than 4% and this low amount of Ag(I) does not change in the pH range 6-8. These studies provide an initial indication for use of the designed hydrogel as injectable, antimicrobial wound dressing.

Investigation of antibacterial effect of copper introduced titanium surface by electrochemical treatment against facultative anaerobic bacteria

This study investigated the efficacy of copper (Cu) as an antibacterial element incorporated on titanium (Ti) surface by electrochemical treatment. Cu was incorporated onto Ti surface by micro-arc oxidation (MAO). A small amount of Cu was incorporated into the oxide layer and was found to be in oxidized states. Cu-incorporated samples exhibited no-harmful effect on the proliferation of osteoblastlike cells. Moreover, the difference in antibacterial property between fresh and incubated samples was evaluated using gram-positive and gram-negative facultative anaerobic bacteria. The specific antibacterial property of Cu incorporated into the Ti surface were confirmed. The antibacterial property prolonged upon immersion in physiological saline for 28 days. In other words, MAO-treated Ti containing Cu in this study is expected to achieve long-term antibacterial property in practical usage.

Comparison of silver nanoparticle-induced inflammatory responses between healthy and metabolic syndrome mouse models

Silver nanoparticles (AgNPs) are utilized in surgical implants and medical textiles, thus providing access to the circulation. While research has been conducted primarily in healthy models, AgNP-induced toxicity evaluations in disease conditions are critical, as many individuals have preexisting conditions. Specifically, over 20% of United States adults suffer from metabolic syndrome (MetS). It was hypothesized that MetS may increase susceptibility to AgNP-mediated toxicity due to induction of differential inflammation and altered biodistribution. Mice were injected with 2 mg/kg AgNPs, and organs assessed for inflammatory gene expression (TNF-α, CXCL1, CXCL2, CCL2, TGF-β, HO-1, IL-4, IL-13), and Ag content. AgNPs were determined to induce differential inflammation in healthy and MetS mice. While AgNP exposure increased TNF-α, CXCL1, TGF-β, HO-1, and IL-4 expression within healthy mouse spleens, MetS-treated animals demonstrated decreased CXCL1, IL-4, and IL-13 expression. Healthy and MetS mice livers exhibited similar inflammatory responses to one another. AgNPs localized primarily to the liver and spleen, although Ag was present in all examined organs. In organs of minor AgNP deposition, such as kidney, gene expression was variable. Induction of inflammatory genes did not correspond with biodistribution, suggesting disease-related variations in AgNP-mediated adverse responses. These findings indicate that disease may influence inflammation and biodistribution, impacting AgNP clinical applications.

Cellulose nanocrystals/nanofibrils loaded astaxanthin nanoemulsion for the induction of apoptosis via ROS-dependent mitochondrial dysfunction in cancer cells under photobiomodulation

The present study investigated effects of low-level laser therapy with cellulose nanocrystals/cellulose nanofibrils loaded in nanoemulsion (NE) against skin cancer cells on apoptosis. The nanoemulsion was fabricated and characterized by the standard methods. The toxicity level by cytotoxicity assays, generation of reactive singlet oxygen (ROS) and antioxidant potential, cell proliferation and migration were confirmed by using standard assays. The cellular uptake efficacy was evaluated by differential staining. The protein levels of EGFR, PI3K, AKT, ERK, GAPDH, and β-actin were detected by western blot. The samples showed a spherical shaped structure with the average size confirmed strong and stable hydrogen bonding forces with high degradation temperature and endothermic transition peaks. The fabricated samples showed no toxicity and high cell proliferation by generating more singlet oxygen levels and antioxidants. The intracellular signaling pathways was regulated with high protein expression levels, which was stimulated by specific molecules for cell proliferation, migration, and differentiation in cancer cells. The results proved that combined treatment regulated the intracellular signaling pathways in cancer cells. The current study showed a novel strategy for improving therapeutic efficacy of nanoemulsion by using low-level laser therapy. Further, the current favorable outcomes will be evaluated in in vivo animal models.

New Antibacterial Paper Made of Silver Phosphate Cellulose Fibers: A Preliminary Study on the Elimination of Staphylococcus aureus Involved in Diabetic Foot Ulceration

AIM

To evaluate in vitro the antibacterial effect of a paper made of silver phosphate cellulose fibers (SPCF) on Staphylococcus aureus, the most common diabetic foot ulceration (DFU) pathogen when compared with other common commercial products.

METHODS

The antibacterial activity of SPCF samples was evaluated through time with cell counting on agar plates. SPCF samples were then compared with commercial wound care products currently in use in DFU treatments (Silvercel™, Acticoat 7, and Aquacel Ag ExtraTM) through time on agar plates (growth inhibition zones).

RESULTS

After 6 hours, there was no viable bacterial cell detected on either plate (p < 0.05). There was a net growth inhibition zone for SPCF samples but no significant difference between the two silver concentrations. Compared with common commercial products, SPCF paper provides results equal to Acticoat 7 (p < 0.05). There was a net growth inhibition zone for SPCF samples but no significant difference between the two silver concentrations. Compared with common commercial products, SPCF paper provides results equal to Acticoat 7 (p < 0.05). There was a net growth inhibition zone for SPCF samples but no significant difference between the two silver concentrations. Compared with common commercial products, SPCF paper provides results equal to Acticoat 7 (.

CONCLUSIONS

These results have shown the efficiency of SPCF paper to eliminate Staphylococcus aureus in these conditions. SPCF papers are effective when compared with other common commercial products and could have an industrial potential in wound care. Infected DFU could benefit from the antibacterial effectiveness of SPCF, but more relevant experimentations related to foot ulcers are needed.Staphylococcus aureus, the most common diabetic foot ulceration (DFU) pathogen when compared with other common commercial products.

Is using nanosilver mattresses/pillows safe? A review of potential health implications of silver nanoparticles on human health

Human exposure to engineered nanoparticles has become inevitable in today's extensive commercial use and large-scale production of engineered nanoparticles. Even though several studies have characterised the exposure to nanomaterials during wakeful state (related to occupational exposures and exposures from commercially available particles), very few studies on human exposure during sleep exist. As the study of exposure to all possible nanomaterials during sleep is extensive, this study focuses on exposure to specifically silver nanoparticles which are present in beddings and mattresses. The reasoning behind the use of silver nanoparticles in bedding and related materials, possible routes of entry to various population groups in several sleep positions, exposure characterisation and toxicity potential of such silver nanoparticles are reviewed in this study. The toxicity potential of silver nanoparticles in vivo tests with relation to mammals and in vitro tests on human cells has been tabulated to understand the risks associated during oral, dermal and inhalation exposure to silver nanoparticles. The exposure to humans with regard to dermal absorption and oral intake has been summarised. Although potential inhalation exposure to silver nanoparticles is increasing, only a few studies address the possible toxic effect of inhaled silver particles. Determination of exposure to silver nanoparticles in beddings is a topic that has been less researched, and this review aims to provide background information for future research and help establish a comprehensive risk assessment during sleep in the times of increasing usage of nanoparticles in our daily activities. Despite the current limitations of our understanding, risk assessments must utilise the available data and apply extrapolation procedures in the face of uncertainty, in order to address the needs of regulatory programs. This would enable safe use of the antimicrobial properties of silver nanoparticles without negatively impacting human health. Until then, it would be better to adopt a conservative approach on the usage of silver nanoparticles in daily used commercial items.

Silver in Wound Care-Friend or Foe?: A Comprehensive Review

Due to its strong antimicrobial activity, silver is a commonly used adjunct in wound care. However, it also has the potential to impair healing by exerting toxic effects on keratinocytes and fibroblasts. The published literature on the use of silver in wound care is very heterogeneous, making it difficult to generate useful treatment guidelines.

Antibiofilm Potential of Silver Sulfadiazine-Loaded Nanoparticle Formulations: A Study on the Effect of DNase-I on Microbial Biofilm and Wound Healing Activity

Biofilm resistance is one of the severe complications associated with chronic wound infections, which impose extreme microbial tolerance against antibiotic therapy. Interestingly, deoxyribonuclease-I (DNase-I) has been empirically proved to be efficacious in improving the antibiotic susceptibility against biofilm-associated infections. DNase-I hydrolyzes the extracellular DNA, a key component of the biofilm responsible for the cell adhesion and strength. Moreover, silver sulfadiazine, a frontline therapy in burn wound infections, exhibits delayed wound healing due to fibroblast toxicity. In this study, a chitosan gel loaded with solid lipid nanoparticles of silver sulfadiazine (SSD-SLNs) and supplemented with DNase-I has been developed to reduce the fibroblast cytotoxicity and overcome the biofilm-imposed resistance. The extensive optimization using the Box-Behnken design (BBD) resulted in the formation of SSD-SLNs with a smooth surface as confirmed by scanning electron microscopy and controlled release (83%) for up to 24 h. The compatibility between the SSD and other formulation excipients was confirmed by Fourier transform infrared, differential scanning calorimetry, and powder X-ray diffraction studies. Developed SSD-SLNs in combination with DNase-I inhibited around 96.8% of biofilm of Pseudomonas aeruginosa as compared to SSD with DNase-I (82.9%). In line with our hypothesis, SSD-SLNs were found to be less toxic (cell viability 90.3 ± 3.8% at 100 μg/mL) in comparison with SSD (Cell viability 76.9 ± 4.2%) against human dermal fibroblast cell line. Eventually, the results of the in vivo wound healing study showed complete wound healing after 21 days' treatment with SSD-SLNs along with DNase-I, whereas marketed formulations SSD and SSD-LSNs showed incomplete healing after 21 days. Data in hand suggest that the combination of SSD-SLNs with DNase-I is an effective treatment strategy against the biofilm-associated wound infections and accelerates wound healing.

Colloidal Silver Induces Cytoskeleton Reorganization and E-Cadherin Recruitment at Cell-Cell Contacts in HaCaT Cells

Up until the first half of the 20th century, silver found significant employment in medical applications, particularly in the healing of open wounds, thanks to its antibacterial and antifungal properties. Wound repair is a complex and dynamic biological process regulated by several pathways that cooperate to restore tissue integrity and homeostasis. To facilitate healing, injuries need to be promptly treated. Recently, the interest in alternatives to antibiotics has been raised given the widespread phenomenon of antibiotic resistance. Among these alternatives, the use of silver appears to be a valid option, so a resurgence in its use has been recently observed. In particular, in contrast to ionic silver, colloidal silver, a suspension of metallic silver particles, shows antibacterial activity displaying less or no toxicity. However, the human health risks associated with exposure to silver nanoparticles (NP) appear to be conflicted, and some studies have suggested that it could be toxic in different cellular contexts. These potentially harmful effects of silver NP depend on various parameters including NP size, which commonly range from 1 to 100 nm. In this study, we analyzed the effect of a colloidal silver preparation composed of very small and homogeneous nanoparticles of 0.62 nm size, smaller than those previously tested. We found no adverse effect on the cell proliferation of HaCaT cells, even at high NP concentration. Time-lapse microscopy and indirect immunofluorescence experiments demonstrated that this preparation of colloidal silver strongly increased cell migration, re-modeled the cytoskeleton, and caused recruitment of E-cadherin at cell-cell junctions of human cultured keratinocytes.

Silver triethanolamine-loaded PVB/CO films for a potential liquid bandage application

Many studies have reported that silver has excellent antibacterial properties. However, silver ions can easily react with oxygen to form Ag2O, thus leading to a color change and a reduction in its anti-microbial characteristics. In this study, silver triethanolamine- (ST) loaded PVB/CO solution was prepared as a potential candidate liquid bandage. PVB/CO/ST retained high transparency after exposure to light for 12 months, which allowed convenient inspection of the wound bed without removal of the dressing. The PVB/CO/ST film exhibited favorable properties, such as speed of drying, excellent tensile strength and elongation characteristics and water vapor transmission rate (WVTR). It was comfortable and waterproof, and therefore effective at preventing bacterial invasion, providing effective biosafety. PVB/CO/ST solution-treated wounds exhibited accelerated healing and reduced inflammation in a nude mouse mode. Our data suggested that PVB/CO/ST solution could serve as a promising liquid bandage for treatment of minor trauma.

Toxicity assessment of wearable wound sensor constituents on keratinocytes

This research reports on the cytotoxicity of materials present in a wound biosensor on human keratinocytes (HaCaT) to evaluate the biocompatibility of the sensor for continuous wound monitoring applications. Individual and collective effects of the sensor materials, gold (Au) and silver (Ag) nanoparticles (NPs), uricase enzyme (UOx), ferrocene carboxylic acid (FCA), multi-walled carbon nanotubes (MWCNTs) and poly vinyl alcohol-based polymer (PVA-SbQ) on HaCaT were studied. The toxicology profiles of these materials were derived from cell viability, mitochondrial activity retention and apoptotic behavior studies. At the concentrations present in the sensor, the cell viability studies showed minimal toxicity for Au and Ag NPs, UOx and FCA (cell viability >75%), while MWCNTs and PVA-SbQ exhibited excellent biocompatibility towards keratinocytes (cell viability >90%). Resazurin assay confirmed minimal impairment of mitochondrial activity at lower concentrations for all the materials (mitochondrial activity >0.7). The caspase-3/7 apoptotic assay showed no pronounced apoptotic behavior caused by the materials. The material mixtures studied were Au/UOx/FCA/PVA-SbQ, Ag/UOx/FCA/PVA-SbQ, and MWCNTs/UOx/FCA/PVA-SbQ. A higher toxicity profile was observed for the heterogeneous material mixtures as a result of the cumulative effect of the individual materials. However, the biosensor itself was seen to exhibit lower toxicity (~5%) compared to the material mixtures, due to the protective PVA-SbQ capping over the biosensor. This work establishes the biocompatibility of the reported wound sensor for human measurements with minimal toxic effects on human keratinocytes.

Investigation of Realizing Both Antibacterial Property and Osteogenic Cell Compatibility on Titanium Surface by Simple Electrochemical Treatment

Recently, the problem of infection on implanted devices caused by the formation of biofilms has been recognized. Surface treatment to prevent the initial stages of bacterial adhesion and subsequent bacterial growth is the only possible solution against such infection. In this study, simple electrochemical treatment was used for introducing silver, an antibiotic agent, on the titanium surface. A porous oxide layer containing small amounts of silver was formed on the metal of the substrate. This was done by microarc oxidation using the electrolyte with silver nitrate. The porous oxide layer was almost amorphous with a small fraction of anatase phase. The samples prepared using the electrolyte containing 0.04 mM or a higher concentration of silver nitrate showed an excellent antibacterial effect against both E. coli and S. aureus. However, the proliferation of osteoblast-like cells in the samples was not affected when a concentration of 0.5 mM or lower was used. Moreover, samples containing silver showed no harmful effects on the process of bone differentiation. Furthermore, the calcification process of the cells on the samples treated with and without silver were more promoted than that on untreated Ti. Thus, we found that it is possible to use this optimum concentration of silver to realize the conflicting biofunctions: its antibacterial property and osteogenic cell compatibility.

Application of micellar electrokinetic chromatography for detection of silver nanoparticles released from wound dressing

The recent emergence of nanotechnology has provided a new therapeutic modality in case of silver nanoparticles. Dressings containing silver form the basis for the treatment of burns and wounds, either acute or chronic ones. The aim of the study was to examine silver release from the different wound dressings: commercially available (Atrauman Ag, Aquacel Ag) and experimental (FKDP-AgNPs) using MEKC. In order to characterize prepared keratin based wound dressing before and after its modification with AgNPs, a compositional analysis was conducted using energy dispersive X-ray spectroscopy. Nanosilver toxicity was evaluated with the 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4 sulfophenyl)-2H-tetrazolium test. Silver release from wound dressings was assessed using MEKC. The best separation was observed for MEKC in 20 mM borate buffer at pH 9 with 20 mM SDS addition. In vitro studies showed silver at higher concentration than 10 ppm exerted a toxic effect on fibroblasts isolated from diabetic mice versus. NIH/3T3 and BJ cell lines (p < 0.05). We observed silver was released more gradually from experimental FKDP-AgNPs wound dressing, in compare to commercially available wound dressings. The fast and low-cost method utilizing MEKC can be used in clinical practice to detect silver release from the wound dressings.

A Sensitive Fluorescence Biosensor for Silver Ions (Ag+) Detection Based on C-Ag+-C Structure and Exonuclease III-Assisted Dual-Recycling Amplification

A C-Ag⁺-C structure-based fluorescence biosensor with novel combination design of exonuclease III (Exo III) dual-recycling amplification is proposed for the application of silver ions (Ag⁺) detection. Since oligo-1 involves C-C mismatches, the presence of Ag⁺ can be captured to form C-Ag⁺-C base pairs, which results in a double-helix structure with a blunt terminus. The double-helix structure can be cleaved by EXO III to release short mononucleotide fragments (trigger DNA) and Ag⁺. Released Ag⁺ can form new bindings with oligo-1, and other trigger DNA can be produced in the digestion cycles. Hybridization with the signal DNA (oligo-2) transforms a trigger DNA into double-stranded DNA with blunt terminus which can be cleaved by Exo III to reproduce the trigger DNA and form guanine- (G-) quadruplex DNA. The trigger DNA returns free to the solution and hybridizes with another signal DNA, which realizes the dual-recycling amplification. The G-quadruplex DNA can be reported by N-methylmesoporphyrin IX (NMM), a specific G-quadruplex DNA fluorochrome. This method allows Ag⁺ to be determined in the 5 to 1500 pmol/L concentration range, with a 2 pmol/L detection limit, and it has been successfully applied to the detection of Ag⁺ in real samples.

Ionic silver functionalized ovine forestomach matrix - a non-cytotoxic antimicrobial biomaterial for tissue regeneration applications

BACKGROUND

Antimicrobial technologies, including silver-containing medical devices, are increasingly utilized in clinical regimens to mitigate risks of microbial colonization. Silver-functionalized resorbable biomaterials for use in wound management and tissue regeneration applications have a narrow therapeutic index where antimicrobial effectiveness may be outweighed by adverse cytotoxicity. We examined the effects of ionic silver functionalization of an extracellular matrix (ECM) biomaterial derived from ovine forestomach (OFM-Ag) in terms of material properties, antimicrobial effectiveness and cytotoxicity profile.

METHODS

Material properties of OFM-Ag were assessed by via biochemical analysis, microscopy, atomic absorption spectroscopy (AAS) and differential scanning calorimetry. The silver release profile of OFM-Ag was profiled by AAS and antimicrobial effectiveness testing utilized to determine the minimum effective concentration of silver in OFM-Ag in addition to the antimicrobial spectrum and wear time. Biofilm prevention properties of OFM-Ag in comparison to silver containing collagen dressing materials was quantified via in vitro crystal violet assay using a polymicrobial model. Toxicity of ionic silver, OFM-Ag and silver containing collagen dressing materials was assessed toward mammalian fibroblasts using elution cytoxicity testing.

RESULTS

OFM-Ag retained the native ECM compositional and structural characteristic of non-silver functionalized ECM material while imparting broad spectrum antimicrobial effectiveness toward 11 clinically relevant microbial species including fungi and drug resistant strains, maintaining effectiveness over a wear time duration of 7-days. OFM-Ag demonstrated significant prevention of polymicrobial biofilm formation compared to non-antimicrobial and silver-containing collagen dressing materials. Where silver-containing collagen dressing materials exhibited cytotoxic effects toward mammalian fibroblasts, OFM-Ag was determined to be non-cytotoxic, silver elution studies indicated sustained retention of silver in OFM-Ag as a possible mechanism for the attenuated cytotoxicity.

CONCLUSIONS

This work demonstrates ECM biomaterials may be functionalized with silver to favourably shift the balance between detrimental cytotoxic potential and beneficial antimicrobial effects, while preserving the ECM structure and function of utility in tissue regeneration applications.

Flaminal® versus Flamazine® in the treatment of partial thickness burns: A randomized controlled trial on clinical effectiveness and scar quality (FLAM study)

Although partial thickness burns are the most frequently reported burn injuries, there is no consensus on the optimal treatment. The objective of this study was to compare the clinical effectiveness and scar quality of Flaminal® Forte to silver sulfadiazine (Flamazine®) in the treatment of partial thickness burns. In this two‐arm open label multicenter randomized controlled trial, adult patients with acute partial thickness burns and an affected total body surface area of less than 30% were randomized between Flaminal® Forte and Flamazine® and followed for 12 months. Dressing changes in the Flamazine® group were performed daily, and in the Flaminal® group during the first 3 days post burn and thereafter every other day until complete wound healing or surgery. Forty‐one patients were randomly allocated to Flaminal® Forte and 48 patients to Flamazine®. The primary outcome was time to wound healing, which did not differ between the groups: median 18 days with Flaminal® Forte (range 8–49 days) versus 16 days with Flamazine® (range 7–48 days; p = 0.24). Regarding the secondary outcomes during hospital admission, there were no statistically significant differences between the groups concerning need for surgery, pain scores, pruritus, or pain‐related and anticipatory anxiety. More patients in the Flaminal® group developed wound colonization (78% versus 32%, p < 0.001), but the treatment groups did not differ regarding the incidence of local infections and use of systemic antibiotics. In terms of scar quality, no statistically significant differences between both treatment groups were found regarding subjective scar assessment (Patient and Observer Scar Assessment Scale (POSAS)), scar melanin and pigmentation (DermaSpectrometer®), and scar elasticity and maximal extension (Cutometer®) during 12 month postburn. In conclusion, time to wound healing did not differ, but the use of Flaminal® Forte seemed favorable because less dressing changes are needed which lowers the burden of wound care.

Sputtering of Electrospun Polymer-Based Nanofibers for Biomedical Applications: A Perspective

Electrospinning has gained wide attention recently in biomedical applications. Electrospun biocompatible scaffolds are well-known for biomedical applications such as drug delivery, wound dressing, and tissue engineering applications. In this review, the synthesis of polymer-based fiber composites using an electrospinning technique is discussed. Formerly, metal particles were then deposited on the surface of electrospun fibers using sputtering technology. Key nanometals for biomedical applications including silver and copper nanoparticles are discussed throughout this review. The formulated scaffolds were found to be suitable candidates for biomedical uses such as antibacterial coatings, surface modification for improving biocompatibility, and tissue engineering. This review briefly mentions the characteristics of the nanostructures while focusing on how nanostructures hold potential for a wide range of biomedical applications.

Rapid antibacterial effect of sunlight-exposed silicon nanowire arrays modified with Au/Ag alloy nanoparticles

Au/Ag alloy nanoparticles modified silicon nanowire arrays can kill bacterial cells in several minutes under sunlight due to their photothermal and photocatalytic activities.

ZIF nano-dagger coated gauze for antibiotic-free wound dressing

ZIF nano-dagger coated gauze was used for antibiotic-free and biocompatible wound dressing with a lower haemolytic activity, less cytotoxicity and improved wound healing performance.

Healing kinetics of diabetic wounds controlled with charge-biased hydrogel dressings

This study investigates the properties and use as wound-dressings of hydrogels made of anionic 3-sulfopropyl methacrylate (SA) and cationic [2-(methacryloyloxy)ethyl]trimethylammonium (TMA) to form poly(SA-co-TMA) gels with varying charge bias.

Pentavalent Antimonials Combined with Other Therapeutic Alternatives for the Treatment of Cutaneous and Mucocutaneous Leishmaniasis: A Systematic Review

The first choice drugs for the treatment of cutaneous and mucocutaneous leishmaniasis are pentavalent antimonials, sodium stibogluconate, or meglumine antimoniate. However, the treatment with these drugs is expensive, can cause serious adverse effects, and is not always effective. The combination of two drugs by different routes or the combination of an alternative therapy with systemic therapy can increase the efficacy and decrease the collateral effects caused by the reference drugs. In this systematic review we investigated publications that described a combination of nonconventional treatment for cutaneous and mucocutaneous with pentavalent antimonials. A literature review was performed in the databases Web of Knowledge and PubMed in the period from 01st of December 2004 to 01st of June 2017, according to Prisma statement. Only clinical trials involving the treatment for cutaneous or mucocutaneous leishmaniasis, in English, and with available abstract were added. Other types of publications, such as reviews, case reports, comments to the editor, letters, interviews, guidelines, and errata, were excluded. Sixteen articles were selected and the pentavalent antimonials were administered in combination with pentoxifylline, granulocyte macrophage colony-stimulating factor, imiquimod, intralesional sodium stibogluconate, ketoconazole, silver-containing polyester dressing, lyophilized LEISH-F1 protein, cryotherapy, topical honey, and omeprazole. In general, the combined therapy resulted in high rates of clinical cure and when relapse or recurrence was reported, it was higher in the groups treated with pentavalent antimonials alone. The majority of the articles included in this review showed that cure rate ranged from 70 to 100% in patients treated with the combinations. Serious adverse effects were not observed in patients treated with drugs combination. The combination of other drugs or treatment modalities with pentavalent antimonials has proved to be effective for cutaneous and mucocutaneous leishmaniasis and for most seemed to be safe. However, new randomized, controlled, and multicentric clinical trials with more robust samples should be performed, especially the combination with immunomodulators.

In vitro evaluation of drug release and antibacterial activity of a silver-loaded wound dressing coated with a multilayer system

The goal of the study was to elaborate an antibacterial silver wound dressing covered by a protective coating that would prevent silver diffusion toward skin without losing its biocide properties. Therefore, non woven polyethyleneterephtalate (PET) textiles were pre-treated by two types of polysaccharides - chitosan and cyclodextrin - both crosslinked with citric acid by a pad/dry/cure process. Both types of resulting thermofixed textiles carrying the citrate crosslinks were then impregnated in silver solution followed by a thermal treatment and were finally coated by Layer-by-Layer (L-b-L) deposition of a polyelectrolyte multilayer (PEM) film consisting of anionic water-soluble poly-cyclodextrin and cationic chitosan. The influence of the process parameters was investigated in terms of silver adsorption capacity, PEM system build-up, silver kinetics of release and antibacterial activity. We demonstrate i) the utility of the intermediate thermal treatment step in the reduction of silver leakage in the polyelectrolyte solutions used in the L-b-L process, ii) that silver adsorption on the preliminary thermofixed layers did not affect the PEM system build-up, iii) the slowing down of silver release kinetic thanks to the PEM coating, iv) the preservation of the antibacterial activity despite the PEM coating.

Silver nanoparticles in situ synthesized by polysaccharides from Sanghuangporus sanghuang and composites with chitosan to prepare scaffolds for the regeneration of infected full-thickness skin defects

In recent years, silver nanoparticles have widely been used in antibacterial dressings to solve antibiotic resistance problems. However, traditional methods for reducing silver nanoparticles are usually toxic. To overcome this problem, Sanghuangporus sanghuang polysaccharides (FSHPs) were used as a green reducing agent to prepare silver nanoparticles (AgNPs) with a size of 3-35 nm. The FSHPs‑silver nanoparticles (FSHPs-Ag) composite with chitosan solution were then freeze-dried to obtain a porous sponge dressing of chitosan-FSHPs-Ag (CS-FSHPs-Ag). The internal pores of CS-FSHPs-Ag were between 50 and 100 μm and had good swelling and water retention properties, which could provide a moist environment for wounds. Based on the experimental results, the appropriate concentration of AgNPs required for CS-FSHPs-Ag to inhibit Escherichia coli and Staphylococcus aureus was determined. Moreover, there was no statistically significant difference between the material treatment and the blank control group, indicating that the material almost showed no toxicity to L929 cells. Finally, this material was used for dressing animal wounds. The results showed that the CS-FSHPs-Ag promoted wound contraction and internal tissue growth better than the wounds treated with Aquacel® Ag, which indicated that the CS-FSHPs-Ag has a great potential as an ideal wound dressing material.

Fabrication and in vitro behavior of dual-function chitosan/silver nanocomposites for potential wound dressing applications

We report the synthesis and in vitro evaluation of dual-function chitosan-silver nanoparticles (CTS-AgNPs) films with potential applications as wound dressings. We attempted to formulate nanocomposite films with appropriate AgNPs concentrations to simultaneously display antibacterial activity and suitability for cell culture. Nanocomposites were obtained by CTS-mediated in situ chemical reduction of AgNO₃. Circular-shape AgNPs (sizes ca. 7-50 nm) well distributed within the CTS matrices were obtained in concentrations from 0.018 to 0.573 wt%. Efficacy (bacteriostatic and bactericidal properties) of CTS-AgNPs films to decrease planktonic and biofilm bacterial growth was AgNPs concentration- and bacteria strain-dependent. Films showed significant antibacterial activity against Gram-negative E. coli and P. aeruginosa and Gram-positive S. aureus. Antibacterial activity against S. epidermidis was moderated. Films suitability for cell culture was characterized using primary human fibroblasts (HF). HF displayed cell viability higher than 90% and the characteristic fusiform morphology of adhered fibroblast upon culture on films with AgNPs concentration ≤ 0.036 wt%. HF cultured on these films also showed positive expression of tropoelastin, procollagen type I and Ki-67, characteristic proteins of extracellular matrix and proliferative cells, respectively. In vitro assays demonstrated that cytocompatibility/antibacterial properties decreased/increased as silver concentration increased, suggesting that CTS-AgNPS nanocomposite films with ≈0.04-0.20 wt% might be considered as potential temporary dual-function wound dressings.

Characterisation of impaired wound healing in a preclinical model of induced diabetes using wide-field imaging and conventional immunohistochemistry assays

Major complications of diabetes lead to inflammation and oxidative stress, delayed wound healing, and persistent ulcers. The high morbidity, mortality rate, and associated costs of management suggest a need for non-invasive methods that will enable the early detection of at-risk tissue. We have compared the wound-healing process that occurs in streptozotocin (STZ)-treated diabetic rats with non-diabetic controls using contrast changes in colour photography (ie, Weber Contrast) and the non-invasive optical method Spatial Frequency Domain Imaging (SFDI). This technology can be used to quantify the structural and metabolic properties of in-vivo tissue by measuring oxyhaemoglobin concentration (HbO₂ ), deoxyhaemoglobin concentration (Hb), and oxygen saturation (StO₂ ) within the visible boundaries of each wound. We also evaluated the changes in inducible nitric oxide synthase (iNOS) in the dermis using immunohistochemistry. Contrast changes in colour photographs showed that diabetic rats healed at a slower rate in comparison with non-diabetic control, with the most significant change occurring at 7 days after the punch biopsy. We observed lower HbO₂ , StO₂ , and elevated Hb concentrations in the diabetic wounds. The iNOS level was higher in the dermis of the diabetic rats compared with the non-diabetic rats. Our results showed that, in diabetes, there is higher level of iNOS that can lead to an observed reduction in HbO₂ levels. iNOS is linked to increased inflammation, leading to prolonged wound healing. Our results suggest that SFDI has potential as a non-invasive assessment of markers of wound-healing impairment.

Metallic Nanoparticles: General Research Approaches to Immunological Characterization

Our immunity is guaranteed by a complex system that includes specialized cells and active molecules working in a spatially and temporally coordinated manner. Interaction of nanomaterials with the immune system and their potential immunotoxicity are key aspects for an exhaustive biological characterization. Several assays can be used to unravel the immunological features of nanoparticles, each one giving information on specific pathways leading to immune activation or immune suppression. Size, shape, and surface chemistry determine the surrounding corona, mainly formed by soluble proteins, hence, the biological identity of nanoparticles released in cell culture conditions or in a living organism. Here, we review the main laboratory characterization steps and immunological approaches that can be used to understand and predict the responses of the immune system to frequently utilized metallic or metal-containing nanoparticles, in view of their potential uses in diagnostics and selected therapeutic treatments.

Formulation Optimization of Chitosan-Stabilized Silver Nanoparticles Using In Vitro Antimicrobial Assay

Antimicrobial resistance at the infected site is a serious medical issue that increases patient morbidity and mortality. Silver has antibacterial activity associated with some dose-dependent toxicity. Silver nanoparticles, due to larger surface area, have antibacterial properties, which make them useful in the treatment of infections. Chitosan-stabilized silver nanoparticles (CH-AgNP) were formulated and evaluated for minimal inhibitory concentration and minimal bactericidal concentration testing against Staphylococcus aureus ATCC 29213, S aureus ATCC 25923, Pseudomonas aeruginosa ATCC 27853, Escherichia coli ATCC 25922, and 20 methicillin-resistant S aureus isolates. Minimum biofilm eradication concentration study was used to evaluate the biofilm reduction, and in vitro antimicrobial checkerboard assays were performed. The effective optimum ratio of AgNP:chitosan solution was 1:4. Minimal inhibitory concentration and minimal bactericidal concentration ranges of CH-AgNP were 4 to 14 times lower compared to AgNP alone against methicillin-resistant S aureus isolates. Minimum biofilm eradication concentration values of CH-AgNP for ATCC PA-01, P aeruginosa isolate 1, and P aeruginosa isolate 2 were found to be >84.59 μg/mL, 42.29 μg/mL, and 21.15 μg/mL, respectively. Thus, CH-AgNP is a potential formulation for wound treatment and management of infected sites associated with antimicrobial resistance.

Application of nanoparticles in percutaneous delivery of active ingredients in cosmetic preparations

Developments in nanotechnology have expanded novel nanoparticles for several applications, including cosmetic topical preparation. The aim of this article was to review recent literature on percutaneous delivery of cosmetics active ingredient by nanoparticles. The main focus here, is on lipid based nanoparticles since they are of great importance in skin cargo delivery and have vast application in current cosmetic formulations. Data were collected via electronic databases using MeSH keywords, including nanoparticles, lipid particles, cosmetic, dermal delivery and combinations of these words. According to literature nanoparticles play a major role in improving the usefulness of cosmetics. They are able to improve the physiochemical stability of the skin based cosmetic products. Based on data, lipid nanostructures can be added to current cosmetic formulations without any significant problem due to their physical stability and compatibility with other ingredients. However, due to their basically risky nature of nanoparticles, their risk assessment should be taken into consideration.

Red emission nitrogen, boron, sulfur co-doped carbon dots for "on-off-on" fluorescent mode detection of Ag+ ions and l-cysteine in complex biological fluids and living cells

Herein, a simple and efficient fluorescent assay for Ag⁺ ions and l-cysteine (L-Cys) in complex biological fluids and living cells was first developed based on the fluorescent "on-off-on" mode of red emission nitrogen, boron, sulfur co-doped carbon dots (NBS-CDs). Red emission NBS-CDs were prepared via one-step hydrothermal synthesis by using 3-aminobenzeneboronic acid and 2,5-diaminobenzenesulfonic acid as precursors. Such NBS-CDs exhibited excellent optical properties and relatively high absolute fluorescent quantum yield compared with some reported NBS-CDs. Due to the strong quenching ability of Ag⁺ ions on the fluorescence of NBS-CDs, red emission NBS-CDs were used for the determination of Ag⁺ ions with high sensitivity and excellent selectivity. The fluorescence of NBS-CDs was recovered after the interaction between Ag⁺ ions and L-Cys, which realized the specific determination of L-Cys in human urine samples and human plasma samples. The established NBS-CDs-based fluorescent "on-off-on" sensor offered a relatively low detection limits of 0.35 μM for Ag⁺ ions and 0.045 μM for L-Cys based on three times signal-to-noise criteria. Notably, this strategy was applied for the visual detections of Ag⁺ ions and L-Cys in living human cancer cells (HeLa cells and MCF-7 cells). This method is simple, high sensitive, and excellent selectivity, which provided a new insight on the potential applications of NBS-CDs to develop the biosensor in clinical diagnosis and other biologically related areas.

Delayed Healing Associated with Silver Sulfadiazine Use for Partial Thickness Scald Burns in Children

Burns are a leading cause of injury in children. Management principles vary widely, with no consensus about the best treatment. The purpose of this study was to compare outcomes of three different dressings for pediatric partial-thickness scald burns. A retrospective, single-center study was conducted for patients 0–16 years old with a diagnosis of acute partial-thickness scald burn between July 2007 and December 2012. Data regarding prehospital, inpatient, and outpatient course were collected. Cohort was stratified into topical antimicrobial (TA) ointment, silver sulfadiazine (SS), and biosynthetic dressing (BD) groups for analysis. The primary outcome of interest was time to full healing. One hundred and seventy-seven patients met all study criteria. Overall, mean total body surface area burned was 8.3 per cent. TAwas used in 24 per cent cases, SS in 32 per cent, and BD in 44 per cent. The groups were comparable in terms of presenting burn characteristics and hospital course with the exception of the BD group being associated with greater extent of injury. Patients treated with SS had a significantly longer time to full healing and increased requirement of compression garments for scar therapy. Based on these data, the authors have amended their practice and presently use BD or TA dressings to improve healing.

Novel fibrous collagen-based cream accelerates fibroblast growth for wound healing applications: in vitro and in vivo evaluation

The present study reports the development of a novel film-forming bovine collagenous cream (BCC) based on bovine collagen (BC). In this study, collagen was isolated from bovine forestomach tissue, a novel source, and a cream formulation was prepared using some other bioactive ingredients. The electrophoretic pattern of the BC was found to be similar to type I collagen. The purity of BC was examined by amino acid analysis, which confirmed the presence of atelocollagen. The physicochemical properties of BCC such as rheology, spreadability, and temperature stability were characterized. The antimicrobial activity was examined against Bacillus subtilis, Staphylococcus aureus, and Escherichia coli, and BCC displayed excellent inhibitory effect. In vitro biocompatibility studies using NIH 3T3 fibroblast cells showed enhanced cell viability. FACS analysis revealed the non-toxic nature of BCC toward cells. The cell morphology and proliferation on the BCC matrix was studied using SEM and fluorescence microscopy. The in vivo wound healing efficacy of the BCC as a topical wound dressing was demonstrated on full thickness excision wounds in rat models. The healing profile showed that the BCC significantly enhanced re-epithelialization, collagen deposition, and contraction in the wound healing process. The findings of this study provide a new opportunity for the utilization of the untapped byproducts of the meat industry for valorization. We expect that this kind of topical healing cream could be a potential candidate in wound management and future clinical needs.

Role of Nanotechnology in Cosmeceuticals: A Review of Recent Advances

Nanotechnology manifests the progression in the arena of research and development, by increasing the efficacy of the product through delivery of innovative solutions. To overcome certain drawbacks associated with the traditional products, application of nanotechnology is escalating in the area of cosmeceuticals. Cosmeceuticals are regarded as the fastest growing segment of the personal care industry and the use has risen drastically over the years. Nanocosmeceuticals used for skin, hair, nail, and lip care, for conditions like wrinkles, photoaging, hyperpigmentation, dandruff, and hair damage, have come into widespread use. Novel nanocarriers like liposomes, niosomes, nanoemulsions, microemulsion, solid lipid nanoparticles, nanostructured lipid carrier, and nanospheres have replaced the usage of conventional delivery system. These novel nanocarriers have advantages of enhanced skin penetration, controlled and sustained drug release, higher stability, site specific targeting, and high entrapment efficiency. However, nanotoxicological researches have indicated concern regarding the impact of increased use of nanoparticles in cosmeceuticals as there are possibilities of nanoparticles to penetrate through skin and cause health hazards. This review on nanotechnology used in cosmeceuticals highlights the various novel carriers used for the delivery of cosmeceuticals, their positive and negative aspects, marketed formulations, toxicity, and regulations of nanocosmeceuticals.

Silver Sulfadiazine Retards Wound Healing and Increases Hypertrophic Scarring in a Rabbit Ear Excisional Wound Model

This study evaluated the effects of topical use of silver sulfadiazine cream (SSD) on wound healing and subsequent scarring in a rabbit ear wound model. Seven millimeter full-thickness excisional wounds were created in rabbit ears. Twenty-four rabbits were randomized into four groups in which each group received base cream, 0.01% SSD, 0.1% SSD, or 1% SSD, respectively. Each treatment was applied at 2-day intervals from postoperative days (PODs) 2 to 14. At POD 7, half of the rabbits from each group were killed and tissues were harvested to measure wound healing parameters that included epithelial gap and granulation area. At POD 28, the remaining rabbits from each group were assessed for hypertrophic scarring. Epithelial gaps in SSD-treated groups at concentrations of 0.1 and 1% were significantly larger than those of base cream-treated controls. In contrast, analysis of granulation areas that represent volume of granulation tissue formed during healing did not show any statistical differences between the base cream-treated group and all three SSD-treated groups. At POD 28, when compared to the base cream-treated group (1.44 ± 0.03), SSD-treated-groups (0.1 and 1%) had more (P < .05) hypertrophic scar formation (scar elevation index = 1.65 ± 0.04, 0.1%; 1.63 ± 0.06, 1%). The results of this study demonstrate that SSD treatment contributes not only to impaired reepithelialization but also to a greater hypertrophic scar formation. These results also indicate that caution should be exercised when using SSD clinically to prevent or treat wound infections.