Advanced Therapeutic Dressings for Effective Wound Healing--A Review

EHO-85: A Multifunctional Amorphous Hydrogel for Wound Healing Containing Olea europaea Leaf Extract: Effects on Wound Microenvironment and Preclinical Evaluation

The prevalence of chronic wounds is increasing due to the population aging and associated pathologies, such as diabetes. These ulcers have an important socio-economic impact. Thus, it is necessary to design new products for their treatment with an adequate cost/effectiveness ratio. Among these products are amorphous hydrogels. Their composition can be manipulated to provide a favorable environment for ulcer healing. The aim of this study was to evaluate a novel multifunctional amorphous hydrogel (EHO-85), containing Olea europaea leaf extract, designed to enhance the wound healing process. For this purpose, its moistening ability, antioxidant capacity, effect on pH in the wound bed of experimental rats, and the effect on wound healing in a murine model of impaired wound healing were assessed. EHO-85 proved to be a remarkable moisturizer and its application in a rat skin wound model showed a significant antioxidant effect, decreasing lipid peroxidation in the wound bed. EHO-85 also decreased the pH of the ulcer bed from day 1. In addition, in mice (BKS. Cg-m +/+ Leprdb) EHO-85 treatment showed superior wound healing rates compared to hydrocolloid dressing. In conclusion, EHO-85 can speed up the closure of hard-to-heal wounds due to its multifunctional properties that are able to modulate the wound microenvironment, mainly through its remarkable effect on reactive oxygen species, pH, and moistening regulation.

Versatile Bilayer Hydrogel for Wound Dressing through PET-RAFT Polymerization

Multifunctional hydrogel-based wound dressings have been explored for decades due to their huge potential in multifaceted medical intervention to wound healing. However, it is usually not easy to fabricate a single hydrogel with all of the desirable functions at one time. Herein, a bilayer model with an outer layer for hydrogel wound dressing was proposed. The inner layer (H_m-PN_n) was a hybrid hydrogel prepared by N-isopropylacrylamide and chitosan-N-2-hydroxypropyl trimethylammonium chloride (HACC), and the outer layer (PVA_o-PAm_p) was prepared by polyvinyl alcohols and acrylamide. The two hydrogel layers of the bilayer model were covalently connected with excellent interfacial strength by photoinduced electron/energy transfer-reversible addition-fragmentation chain transfer (PET-RAFT) polymerization. The outer layer exposed to the ambient environment exhibited good stretchability and toughness, while the inner-layer hydrogel adhered to the skin exhibited excellent softness, antibacterial activity, thermoresponsivity, and biocompatibility. In particular, the inner layer of a hydrogel demonstrated excellent antibacterial capability toward both Staphylococcus aureus as Gram-positive bacteria and Escherichia coli as Gram-negative bacteria. Cell cytotoxicity showed that the cell viability of all H_m-PN_n layer hydrogels exceeds 80%, confirming that the hydrogels bear excellent biocompatibility. In vivo experimental results indicated that the H_m-PN_n/PVA_o-PAm_p bilayer hydrogel has a significant effect on the acceleration of wound healing, which was demonstrated in a full-thickness skin defect model showing improved collagen disposition and granulation tissue thickness. With these results, the established multifunctional bilayer hydrogel exhibits potential as an excellent wound dressing for wound healing applications, especially for open and infected traumas.

Dextran and peptide-based pH-sensitive hydrogel boosts healing process in multidrug-resistant bacteria-infected wounds

Traumatic multidrug-resistant (MDR) bacterial infections are deadly threat to the public. To combat MDR bacteria, we developed a dual functional pH-sensitive hydrogel based on peptide DP7 (VQWRIRVAVIRK) and oxidized dextran (DP7-ODEX hydrogel). As an antimicrobial peptide, DP7 can synergize with many antibiotics; thus, we loaded ceftazidime into DP7-ODEX hydrogel, which showed an obvious advantage in MDR P. aeruginosa inhibition. Additionally, due to the interaction between aldehyde groups in oxidized dextran and amine groups from wound tissue, the hydrogel could extend on the irregular surface of skin defects and promote epithelial cells adhesion. DP7 could also be used as a wound-healing peptide and accelerate the healing process. We confirmed that the DP7-ODEX hydrogel exerted formidable therapeutic effects in normal or diabetic wound infection model. According to histomorphology analysis we found that DP7 hydrogel also have a scarless wound healing ability. In summary, we developed a hydrogel fabricated by the dual functional peptide DP7 that can kill multidrug-resistant bacteria colonizing the wound bed and boost scarless wound healing.

Effect of Alginate Gelatin Hydrogel Composited with Nano-Zinc on Cesarean Section Wound Healing

The Surgical procedure of cesarean section (CS) causes a large wound that any delay in its healing could increase the rate of stress, inconvenience, and dissatisfaction among the women who underwent CS procedure about six weeks after childbirth. The present study is trying to evaluate the effect of alginate and gelatin hydrogel composited with nanozinc effective extensibility and compressibility as a wound dressing nursing care after CS. The number of participants was 700 individuals enrolled all who underwent C-sections at Medical College in the Second Affiliated Hospital of Xi'an Jiaotong University (from September 2017 until September 2020). Patients were divided into two groups of case and control consist of 350 cases. The case group was treated with alginate gelatin hydrogel-nZnO+antibacterial wound dress and the control group was treated with wound healing ordinary creams+antibacterial. Three and four weeks following CS, the healing process of the wound was evaluated using REEDA wound scale. In the current study, there was not any significant difference between the studied case and control group in respect to individual's demographical characteristics such as economic status, educational level, BMI, and age. (P > 0.05). Also, we observed that patients treated with alginate gelatin hydrogel-nZnO would experience a significantly lower score for redness, ecchymosis, edema, and approximation of CS wound in comparison to the control group (P < 0.05). Also, slope analysis showed that the healing process was significantly quicker in patients treated with alginate gelatin hydrogel-nZnO in comparison to the control group. Finally, it was observed that more than 80% of patients did not represent any major sign of CS after three weeks, however, in the control case this issue was estimated at 50.6%. No allergic reaction has been observed. Our results showed that using alginate gelatin hydrogel-nZnO wound dress could be a novel treatment in a nursing care setting to decrease the CS wound complication and increase the healing process without any allergic reaction.

Spatiotemporally dynamic therapy with shape-adaptive drug-gel for the improvement of tissue regeneration with ordered structure

A spatiotemporally dynamic therapy (SDT) is proposed as a powerful therapeutic modality that provides spatially dynamic responses of drug-carriers for adapting to the wound microenvironment. Herein, dynamic chitosan-poly (ethylene glycol) (CP) Schiff-base linkages are employed to perform SDT by directly converting a liquid drug Kangfuxin (KFX) into a gel formation. The obtained KFX-CP drug-gel with shape-adaptive property is used to treat a representative oral mucositis (OM) model in a spatiotemporally dynamic manner. The KFX-CP drug-gel creates an instructive microenvironment to regulate signaling biomolecules and endogenous cells behavior, thereby promoting OM healing by the rule of dynamically adjusting shape to fit the irregular OM regions first, and then provides space for tissue regeneration, over KFX potion control and the general hydrogel group of CP hydrogel and KFX-F127. Most interestingly, the regenerated tissue has ordered structure like healthy tissue. Therefore, the SDT provides a new approach for the design of next generation of wound dressing and tissue engineering materials.

Fabrication and characterization of biaxially electrospun collagen/alginate nanofibers, improved with Rhodotorula mucilaginosa sp. GUMS16 produced exopolysaccharides for wound healing applications

Fabrication of scaffolds with enhanced mechanical properties and desirable cellular compatibility is critical for numerous tissue engineering applications. This study was aimed at fabrication and characterization of a nanofiber skin substitute composed of collagen (Col)/sodium alginate (SA)/ polyethylene oxide (PEO)/Rhodotorula mucilaginosa sp. GUMS16 produced exopolysaccharides (EPS) were prepared using the biaxial electrospinning technique. This study used collagen extracted from the bovine tendon as a natural scaffold, sodium alginate as an absorber of excess wound fluids, and GUMS16 produced exopolysaccharides as an antioxidant. Collagen was characterized using FTIR and EDS analyses. The cross-linked nanofibers were characterized by SEM, FTIR, tensile, contact-angle, swelling test, MTT, and cell attachment techniques. The average diameter of Col nanofiber was 910 ± 89 nm. The Col and Col-SA/PEO non-woven mats' water contact angle measurement was 41.6o and 56.4o, Col/EPS1%, Col/EPS2%, Col-SA/PEO + EPS1%, and Col-SA/PEO + EPS2% were 61.4o, 58.3o, 38.5o, and 50.6o, respectively. Cell viability of more than 100% was shown in Col-SA/PEO + EPS nanofibers. Also, SEM images of cells on nanofiber scaffolds demonstrated that all nanofibers incorporated with GUMS16-produced EPS have good cell growth and proliferation. The acquired results expressed that the GUMS16-produced EPS can be considered a novel biomacromolecule in electrospun fibers that increase cell viability and proliferation.

Development and Evaluation of Hydrogel Wound Dressings Loaded with Herbal Extracts

The current study aimed to develop carbomer based hydrogel dressings, incorporating ethanolic extracts of Rosmarinus officinalis aerial parts, Achillea millefolium and Calendula officinalis flowers. The pharmaceutical properties of the obtained hydrogels, as well as their texture and antimicrobial activity, were further evaluated. Five wound dressing formulations based on carbopol were prepared. The addition of the ethanolic extracts to the formulation slightly lowered the pH of the hydrogels, as expected. The Rosmarinus officinalis aerial parts extract loaded hydrogel proved to be the firmest one. In terms of consistency and viscosity, the behavior of the five hydrogels was relatively similar. Based on the texture analysis, the texture of the hydrogels has been affected to some extent by the addition of the ethanolic extracts, decreasing their consistency, firmness, and adhesiveness. The hydrogel loaded with Rosmarinus officinalis aerial parts extract and the one incorporating the blend of extracts (mixture of the three above-mentioned extracts) proved to have a good antimicrobial activity. The studied hydrogel formulations could serve as a basis for the development of novel wound dressing materials, although more extended in vivo studies would be needed in order to support current results.

An Up-to-Date Review of Biomaterials Application in Wound Management

Whether they are caused by trauma, illness, or surgery, wounds may occur throughout anyone's life. Some injuries' complexity and healing difficulty pose important challenges in the medical field, demanding novel approaches in wound management. A highly researched possibility is applying biomaterials in various forms, ranging from thin protective films, foams, and hydrogels to scaffolds and textiles enriched with drugs and nanoparticles. The synergy of biocompatibility and cell proliferative effects of these materials is reflected in a more rapid wound healing rate and improved structural and functional properties of the newly grown tissue. This paper aims to present the biomaterial dressings and scaffolds suitable for wound management application, reviewing the most recent studies in the field.

The Regenerative Potential of Substance P

Wound healing is a highly coordinated process which leads to the repair and regeneration of damaged tissue. Still, numerous diseases such as diabetes, venous insufficiencies or autoimmune diseases could disturb proper wound healing and lead to chronic and non-healing wounds, which are still a great challenge for medicine. For many years, research has been carried out on finding new therapeutics which improve the healing of chronic wounds. One of the most extensively studied active substances that has been widely tested in the treatment of different types of wounds was Substance P (SP). SP is one of the main neuropeptides released by nervous fibers in responses to injury. This review provides a thorough overview of the application of SP in different types of wound models and assesses its efficacy in wound healing.

A review on Biopolymer-derived Electrospun Nanofibers for Biomedical and Antiviral Applications

Unique aspects of polymer-derived nanofibers provide significant potential in the area of biomedical and health care applications. Much research has demonstrated several plausible nanofibers to overcome the modern-day challenges in...

Recent Advances in Nanozymes for Bacteria-Infected Wound Therapy

Bacterial-infected wounds are a serious threat to public health. Bacterial invasion can easily delay the wound healing process and even cause more serious damage. Therefore, effective new methods or drugs are needed to treat wounds. Nanozyme is an artificial enzyme that mimics the activity of a natural enzyme, and a substitute for natural enzymes by mimicking the coordination environment of the catalytic site. Due to the numerous excellent properties of nanozymes, the generation of drug-resistant bacteria can be avoided while treating bacterial infection wounds by catalyzing the sterilization mechanism of generating reactive oxygen species (ROS). Notably, there are still some defects in the nanozyme antibacterial agents, and the design direction is to realize the multifunctionalization and intelligence of a single system. In this review, we first discuss the pathophysiology of bacteria infected wound healing, the formation of bacterial infection wounds, and the strategies for treating bacterially infected wounds. In addition, the antibacterial advantages and mechanism of nanozymes for bacteria-infected wounds are also described. Importantly, a series of nanomaterials based on nanozyme synthesis for the treatment of infected wounds are emphasized. Finally, the challenges and prospects of nanozymes for treating bacterial infection wounds are proposed for future research in this field.

Photothermal-enhanced antibacterial and antioxidant hydrogels dressings based on catechol-modified chitosan derived carbonized polymer dots for effective treatment of wound infection

Bacterial infection and excess reactive oxygen species (ROS) remain challenging factors contributing for the delayed healing of chronic wounds. Although various antibacterial and antioxidant hydrogel dressings have been developed to...

Mesoporous Bioactive Glasses in Cancer Diagnosis and Therapy: Stimuli-Responsive, Toxicity, Immunogenicity, and Clinical Translation

Cancer is one of the top life-threatening dangers to the human survival, accounting for over 10 million deaths per year. Bioactive glasses have developed dramatically since their discovery 50 years ago, with applications that include therapeutics as well as diagnostics. A new system within the bioactive glass family, mesoporous bioactive glasses (MBGs), has evolved into a multifunctional platform, thanks to MBGs easy-to-functionalize nature and tailorable textural properties-surface area, pore size, and pore volume. Although MBGs have yet to meet their potential in tumor treatment and imaging in practice, recently research has shed light on the distinguished MBGs capabilities as promising theranostic systems for cancer imaging and therapy. This review presents research progress in the field of MBG applications in cancer diagnosis and therapy, including synthesis of MBGs, mechanistic overview of MBGs application in tumor diagnosis and drug monitoring, applications of MBGs in cancer therapy ( particularly, targeted delivery and stimuli-responsive nanoplatforms), and immunological profile of MBG-based nanodevices in reference to the development of novel cancer therapeutics.

Foraging for the Optimal Dressing Scaffold to Carry Adipose-Derived Stromal/Progenitor Cells for Cell Therapy

In our daily plastic surgery practice, we have seen many chronic wounds that need new biotechnology to help and improve wound healing. Stem cells play a crucial role in regenerative medicine. Many pre-clinical researches had reported the beneficial paracrine effects of stem cell therapy for chronic wounds. Cell-friendly scaffolds may provide the protection and three-dimensional space required for adherence of stem cells, thus allowing these stem cells to proliferate and differentiate for treatment purpose. A successful scaffold may enhance the effects of stem cell therapy. In this presented series, the authors attempted to identify the most suitable scaffolds from several commercially available wound dressings that could sustain adipose-derived stromal/progenitor cells (ADSCs) survival. Therefore, we isolated ADSCs containing the green fluorescent protein (GFP) from GFP transgenic rats. The GFP (+) ADSCs and their progenies could be easily observed using a fluorescence microscope. Moreover, we analyzed the cytokines secreted in condition medium (CM) to understand the activities of ADSCs in various dressings. Our results showed that the foam dressings, hydrofiber, chitosan, and alginate plus carboxymethylcellulose were identified as the most suitable dressing materials. Higher concentrations of transforming growth factor beta (TGF-β) and vascular endothelial growth factor (VEGF) were observed 48 h after loading them with GFP (+) ADSCs. Therefore, multiple topical cell therapy using ADSCs can be performed by applying suitable dressing scaffolds without repeated needle injections to deliver the stem cells into the wound bed. Based on their fluorescence property, the GFP (+) ADSCs can also possibly be used for testing biocompatibility of medical materials in the future.

Nano-silver functionalized polysaccharides as a platform for wound dressings: A review

The healing of defected skin tissue is a complex process, especially for chronic wounds. Poor healing of these wounds may cause extensive suffering and high cost for patients. Traditional wound dressings are typically designed for a single function and they cannot satisfy all requirements for the whole process of wound healing. Therefore, it is necessary to develop new types of wound dressings with multiple functions for wound healing. In particular, adding an antibacterial function has been shown to be of great benefit during tissue repair. Nano‑silver is widely used in wound treatment because of various advantages, such as its wide antibacterial spectrum and lower drug resistance. Therefore, wound dressings loaded with nano‑silver have attracted widespread attention in wound healing. Naturally derived polysaccharides hold great potential as wound dressings, because of their abundant availability, low prices and good biocompatibility. In this review, nano‑silver functionalized polysaccharide-based wound dressings are systematically reviewed, including their preparation methods, antibacterial performances and classification of nano‑silver wound dressings. Moreover, the toxicity of nano‑silver based wound dressings is discussed and the prospective research direction is elaborated. This review aims to provide readers with an overview of the latest developments in silver nanotechnology, and to provide a little guidance for the research of nano‑silver functionalized polysaccharide-based wound dressings.

Design, preparation and in vitro characterization of biomimetic and bioactive chitosan/polyethylene oxide based nanofibers as wound dressings

Chitosan-based nanofibers (CS-NFs) are excellent artificial extracellular matrices (ECMs) due to the resemblance of CS with the glycosaminoglycans of the natural ECMs. Despite this excellent feature, the poor electrospinnability and mechanical properties of CS are responsible for important limitations in respect to its biomedical applications. To improve the CS's physico-chemical properties, new bioactive and biomimetic CS-NFs were formulated with polyethylene oxide (PEO), having incorporated different active components (ACs) with important beneficial effects for healing. Manuka honey (trophic and antimicrobial effects), propolis (antimicrobial effects), Calendula officinalis infusion (antioxidant effect, reepithelialization stimulating agent), insulin (trophic effect), and L-arginine (angiogenic effect) were selected as ACs. SEM morphology analysis revealed well-alignment, unidirectional arrays, with small diameters, no beads, and smooth surfaces for developed CS_PEO-ACs NFs. The developed NFs showed good biodegradability (NFs mats lost up to 60% of their initial weight in PBS), increased hemocompatibility (hemolytic index less than 4%), and a reduced cytotoxicity degree (cell viability degree more than 90%). In addition, significant antioxidant and antimicrobial effects were noted for the developed NFs which make them suitable for chronic wounds, due to the role of oxidative stress and infection risk in delaying normal wound healing. The most suitable for wound healing applications seems to be CS_PEO@P_C which showed an improved hemolysis index (2.92 ± 0.16%), is non-toxic (cell viability degree more than 97%), and has also significant radical scavenging effect (DPPH inhibition more than 65%). In addition, CS_PEO@P_C presents increased antimicrobial effects, more noticeably for Staphylococcus aureus strain, which is a key feature in preventing wound infection and delaying the healing process. It can be concluded that the developed CS/PEO-ACs NFs are very promising biomaterials for wound care, especially CS_PEO@P_C.

Green and efficient in-situ biosynthesis of antioxidant and antibacterial bacterial cellulose using wine pomace

Biologically active bacterial cellulose (BC) was efficiently synthesized in situ using wine pomace and its hydrolysate. The structural and biomechanical properties together with the biological functions of the BC were investigated. Functional BC from wine pomace and its enzymatic hydrolysate were of high purity and had higher crystallinity indexes (90.61% and 89.88%, respectively) than that from HS medium (82.26%). FTIR results proved the in-situ bindings of polyphenols to the functionalized BC. Compared to BC from HS medium, wine pomace-based BC had more densely packed ultrafine fibrils, higher diameter range distributions of fiber ribbon, but lower thermal decomposition temperatures, as revealed by the SEM micrographs and DSC data. Meanwhile, wine pomace-based BC exhibited higher loads in tensile strength and higher hardness (4.95 ± 0.31 N and 5.13 ± 0.63 N, respectively) than BC in HS medium (3.43 ± 0.14 N). Furthermore, BC synthesized from wine pomace hydrolysate exhibited a slower release rate of phenolic compounds, and possessed more antioxidant activities and better bacteriostatic effects than BC from wine pomace. These results demonstrate that BC synthesized in situ from wine pomace (especially from enzymatic hydrolysate) is a promising biomolecule with a potential application in wound dressing, tissue engineering, and other biomedical fields.

Facile Preparation of Tunicate-Inspired Chitosan Hydrogel Adhesive with Self-Healing and Antibacterial Properties

In order to replace traditional wound treatments such as sutures, tissue adhesives with strong wet tissue adhesion and biocompatibility have attracted more attention to the applications of non-invasive wound closure. Herein, inspired by tunicate adhesive protein, a series of 2,3,4-trihydroxybenzaldehyde (TBA)-modified chitosan hydrogels (CS-TBA-Fe) were prepared by easily mixing the solutions of chitosan-FeCl₃ and TBA via the Schiff-base reaction and the coordination between Fe³⁺ and pyrogallol groups. The gelation time was greatly shortened to only several seconds after induced even trace Fe³⁺. The hydrogel (CS-TBA-Fe) exhibited ~12-fold enhanced wet tissue adhesion strength (60.3 kPa) over the commercial fibrin glue. Meanwhile, the hydrogel also showed robust adhesion to various substrates such as wood, PMMA, and aluminum. The swelling ratio and rheological property can be simply controlled by changing the concentrations of chitosan, TBA, and Fe³⁺. Moreover, the hydrogel displayed a rapid and highly efficient self-healing ability and an excellent antibacterial activity against E. coli. The overall results show that the CS-TBA-Fe hydrogel with enhanced wet adhesiveness will be a promising tissue adhesive material.

Conductive Biomaterials as Bioactive Wound Dressing for Wound Healing and Skin Tissue Engineering

Conductive biomaterials based on conductive polymers, carbon nanomaterials, or conductive inorganic nanomaterials demonstrate great potential in wound healing and skin tissue engineering, owing to the similar conductivity to human skin, good antioxidant and antibacterial activities, electrically controlled drug delivery, and photothermal effect. However, a review highlights the design and application of conductive biomaterials for wound healing and skin tissue engineering is lacking. In this review, the design and fabrication methods of conductive biomaterials with various structural forms including film, nanofiber, membrane, hydrogel, sponge, foam, and acellular dermal matrix for applications in wound healing and skin tissue engineering and the corresponding mechanism in promoting the healing process were summarized. The approaches that conductive biomaterials realize their great value in healing wounds via three main strategies (electrotherapy, wound dressing, and wound assessment) were reviewed. The application of conductive biomaterials as wound dressing when facing different wounds including acute wound and chronic wound (infected wound and diabetic wound) and for wound monitoring is discussed in detail. The challenges and perspectives in designing and developing multifunctional conductive biomaterials are proposed as well.

Ficus carica extract impregnated amphiphilic polymer scaffold for diabetic wound tissue regenerations

Diabetes associated injury healing and other tissue irregularities are viewed as a significant concern. The purpose of the study is to design the wound regeneration activity of Ficus carica extract (FFE) loaded amphiphilic polymeric scaffold of poly(xylitol-g-adipate-co-glutamide) (PXAG)-polyhydroxybutyrate (PHB) for potential diabetic affected wound regeneration. The PXAG copolymer was prepared by the condensation method, and the polymeric scaffolds of PXAG-PHB, PXAG-PHB/FFE were developed through the ultra-sonication process and magnetic stirrer processes. The chemical structure, crystalline nature, thermal stability, size, surface charge and surface morphology of PXAG-PHB and PXAG-PHB/FFE polymeric scaffolds were investigated. The PXAG-PHB/FFE exhibits 99.0% free radical scavenging activity which was determined by the DPPH method. The inhibition zones by the PXAG-PHB/FFE indicate it had a higher antibacterial activity with the Escherichia coli (gram-negative) and Staphylococcus aureus (gram-positive) pathogens. The PXAG, PXAG-PHB and PXAG-PHB/FFE polymeric scaffolds exhibited good viability against diabetic induced wound cells (WS1) in 100 μg/mL concentrations up to 72 h incubation. Since the synthesized PXAG-PHB/FFE polymeric scaffolds possess excellent thermal stability, bioactivity, biocompatibility and antioxidant activity along with potent antimicrobial activity, they play a potential role in diabetic wound tissue regenerations.

N-carboxymethyl chitosan/sodium alginate composite hydrogel loading plasmid DNA as a promising gene activated matrix for in-situ burn wound treatment

Improving the degree of vascularization through the regulation of wound microenvironment is crucial for wound repair. Gene activated matrix (GAM) technology provides a new approach for skin regeneration. It is a local gene delivery system that can not only maintain a moist environment, but also increase the concentration of local active factors. For this purpose, we fabricated the mVEGF165/TGF-β₁ gene-loaded N-carboxymethyl chitosan/sodium alginate hydrogel and studied its effect on promoting deep second degree burn wound repair. The average diameter of the hydrogel pores was 100 μm and the porosity was calculated as 50.9%. SEM and CLSM images showed that the hydrogel was suitable for cell adhesion and growth. The NS-GAM could maintain continuous expression for at least 9 days in vitro, showing long-term gene release and expression effect. Deep second-degree burn wound model was made on the backs of Wistar rats to evaluate the healing effect. The wounds were healed by day 22 in NS-GAM group with the prolonged high expression of VEGF and TGF-β₁ protein. A high degree of neovascularization and high expression level of CD34 were observed in NS-GAM group in 21 days. The histological results showed that NS-GAM had good tissue safety and could effectively promote epithelialization and collagen regeneration. These results indicated that the NS-GAM could be applied as a promising local gene delivery system for the repair of deep second-degree burn wounds.

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The plasmids loaded in NS-GAM can achieve efficient gene delivery and expression in vitro and in vivo.

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The NS-GAM showed long-term controlled release function of the plasmids.

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The NS-GAM played a significant effect on neovascularization by means of gene delivery.

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The NS-GAM could achieve efficient in situ repair on deep second degree burn wounds.

Exosome-loaded hydrogels: a new cell-free therapeutic approach for skin regeneration

The treatment of unhealable and chronic cutaneous wounds is a significant challenge for the healthcare system. Hence, there has been heightened interest in the development of innovative therapeutic approaches for the acceleration of wound healing. Regenerative medicine based on mesenchymal stem cells (MSCs) has shown appropriate potential in skin repair. The regenerative properties of stem cells are mainly attributed to paracrine effects of secreted products, including exosomes. There are advantages to using exosomes as a cell-free approach instead of direct application of stem cells. Exosomes have nanoscale dimension and are immune-tolerant, Exosomes have the nanoscale dimension and are immune-tolerant. They can easily endocytose, and transfer the cargo content to recipient cells. They contribute to the regulation of the wound healing process by activating specific signaling pathways. To preserve exosome bioactivity and controlled release of effective concentration during prolonged wound care, the design of an optimized delivery system is necessary. Accordingly, hydrogels with their unique properties are promising candidates as exosome delivery and wound management products. This article investigates the characteristics of exosomes, their molecular mechanism in wound healing, and the advantages of the hydrogel delivery system. Also, published reports on the potential of exosome-loaded hydrogels in skin regeneration have been reviewed.

Preparation and Characterization of Curcumin Nanoemulgel Utilizing Ultrasonication Technique for Wound Healing: In Vitro, Ex Vivo, and In Vivo Evaluation

Hydrogels being a drug delivery system has great significance particularly for topical application in cutaneous open wound. Its specific physicochemical properties such as non-adhesiveness, moisture retention, exudate absorption, and gas permeability make them ideal as a drug delivery vehicle for wound healing application. Further, curcumin (a natural bioactive) was selected as a therapeutic agent to incorporate into the hydrogel system to design and develop nanogel pharmaceutical products for wound healing. Although, curcumin possesses remarkable anti-inflammatory, antioxidant, and anti-infective activity along with hastening the healing process by acting over the different stages of the wound healing process, but its poor biopharmaceutical (low aqueous solubility and skin penetrability) attributes hamper their therapeutic efficacy for skin applications. The current investigation aimed to develop the curcumin-loaded nanogel system and evaluated to check the improvement in the therapeutic efficacy of curcumin through a nanomedicine-based approach for wound healing activity in Wistar rats. The curcumin was enclosed inside the nanoemulsion system prepared through a high-energy ultrasonic emulsification technique at a minimum concentration of surfactant required to nanoemulsify the curcumin-loaded oil system (Labrafac PG) having droplet size 56.25 ± 0.69 nm with polydispersity index 0.05 ± 0.01 and negatively surface charge with zeta potential −20.26 ± 0.65 mV. It was observed that the impact of Smix (surfactant/co-surfactant mixture) ratio on droplet size of generated nanoemulsion is more pronounced at lower Smix concentration (25%) compared to the higher Smix concentration (30%). The optimized curcumin-loaded nanoemulsion was incorporated into a 0.5% Carbopol^® 940 hydrogel system for topical application. The developed curcumin nanoemulgel exhibited thixotropic rheological behavior and a significant (p < 0.05) increase in skin penetrability characteristics compared to curcumin dispersed in conventional hydrogel system. The in vivo wound healing efficacy study and histological examination of healed tissue specimen further signify the role of the nanomedicine-based approach to improve the biopharmaceutical attributes of curcumin.

Management of invasive ductal carcinoma in hypermobile Ehlers-Danlos syndrome: a case report

Literature is sparse regarding the management and long-term outcomes of breast cancer in patients with Ehlers-Danlos syndrome (EDS). Of the EDS subtypes, hypermobile Ehlers-Danlos Syndrome (hEDS) is associated with cardiovascular dysautonomia which manifests as spontaneous episodes of tachycardia and hypotension. Given this clinical autonomic system impact, hEDS is known to have significant intraoperative risk and postoperative complications. However, outcomes of hEDS patients have not been specifically studied in the field of breast cancer surgery. Here we present a case of a 62-year-old female with hEDS and node-positive invasive ductal breast carcinoma. Given the patient's medical history of hEDS, close attention was given to the patient's intraoperative vital signs and predisposition for poor wound healing. The patient underwent left Goldilocks mastectomy with left axillary lymph node dissection. Due to cardiac comorbidities, she was not a candidate for neoadjuvant or adjuvant chemotherapy. The patient tolerated adjuvant radiation and endocrine therapy without side effects, and has remained free of local, regional, and distant cancer recurrence following treatment. This case report highlights a literature gap in the surgical and radiation therapy management of breast cancer in patients with hEDS. Although breast surgery and radiation therapy in patients with invasive breast cancer and hEDS can be a safe management option, we discuss how perioperative complications must be cautiously navigated and how treatment must be tailored to individuals' specific hEDS variant to ensure optimal patient safety and positive long-term outcomes.

Wound-aided semi-solid poly(vinyl alcohol) hydrogels incorporating essential oil-loaded chitosan nanoparticles

The potential of chitosan nanoparticles (CSNPs) loaded with essential oil (EO) incorporated into semi-solid PVA hydrogels for use in wound management was studied. Two types of essential oil were compared including clove essential oil (CEO) and turmeric essential oil (TEO). The EO-loaded CSNPs were prepared by a two-step method; oil-in-water (o/w) emulsification followed by ionic gelation using different ratios of chitosan:EO (i.e., 1:0.25, 1:0.50, 1:0.75, and 1:1.00 w/w). The increasing amount of EO caused more aggregate structure as observed from SEM images. The TEO-loaded CSNPs showed a higher extent of aggregation than the CEO-loaded CSNPs. The adhesiveness of the semi-solid PVA hydrogels containing TEO-loaded CSNPs was the highest. The use of EO-loaded CSNPs in the semi-solid PVA hydrogel helped to sustain and prolong the release rate of EO from the hydrogels as compared to just the EO alone. The studied semi-solid PVA hydrogels were non-toxic to both NCTC clone 929 and NHDF cells. Overall results suggested that these semi-solid hydrogels are good candidates for use in wound management.

Development of a novel beta-glucan supplemented hydrogel spray formulation and wound healing efficacy in a db/db diabetic mouse model

To relief the severe economic and social burdens and patient suffering caused by the increasing incidence of chronic wounds, more effective treatments are urgently needed. In this study, we focused on developing a novel sprayable wound dressing with the active ingredient β-1,3/1,6-glucan (βG). Since βG is already available as the active ingredient in a commercial wound healing product provided as a hydrogel in a tube (βG-Gel), the sprayable format should bring clinical benefit by being easily sprayed onto wounds; whilst retaining βG-Gel's physical stability, biological safety and wound healing efficacy. Potentially sprayable βG hydrogels were therefore formulated, based on an experimental design setup. One spray formulation, named βG-Spray, was selected for further investigation, as it showed favorable rheological and spraying properties. The βG-Spray was furthermore found to be stable at room temperature for more than a year, retaining its rheological properties and sprayability. The cytotoxicity of βG-Spray in keratinocytes in vitro, was shown to be promising even at the highest tested concentration of 100 μg/ml. The βG-Spray also displayed favorable fluid affinity characteristics, with a capacity to both donate and absorb close to 10% fluid relative to its own weight. Finally, the βG-Spray was proven comparably effective to the commercial product, βG-Gel, and superior to both the water and the carrier controls (NoβG-Spray), in terms of its ability to promote wound healing in healing-impaired animals. Contraction was found to be the main wound closure mechanism responsible for the improvement seen in the βG-treatment groups (βG-Spray and βG-Gel). In conclusion, the novel sprayable βG formulation, confirmed its potential to expand the clinical use of βG as wound dressing.

Highly Crosslinked Agar/Acrylic Acid Hydrogels with Antimicrobial Properties

Hydrogels are three-dimensional soft polymeric materials that can entrap huge amounts of water. They are widely attractive in the biomedicine area because of their outstanding applications such as biosensors, drug delivery vectors, or matrices for cell scaffolds. Generally, the low mechanical strength and fragile structure of the hydrogels limit their feasibility, but this is not the case. In this work, acrylic acid-agar hydrogels with excellent mechanical properties were synthesized using gamma radiation as a crosslinking promoter. The obtained hydrogels exhibited a water absorption capacity up to 6000% in weight without breaking and keeping their shape; additionally, they showed a noticeable adhesion to the skin. The synthesized materials were characterized by infrared spectroscopy (FTIR-ATR), thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), scanning electron microscopy (SEM), and mechanical testing. Additionally, their water uptake capacity and critical pH were studied. Net(Agar/AAc) hydrogel exhibited a noticeable capacity to load silver nanoparticles (AgNPs), which endowed it with antimicrobial activity that was demonstrated when challenged against Escherichia coli and methicillin-resistant Staphylococcus aureus (MRSA) on in vitro conditions.

Decellularised extracellular matrix decorated PCL PolyHIPE scaffolds for enhanced cellular activity, integration and angiogenesis

Wound healing involves a complex series of events where cell–cell and cell-extracellular matrix (ECM) interactions play a key role. Wounding can be simple, such as the loss of the epithelial integrity, or deeper and more complex, reaching to subcutaneous tissues, including blood vessels, muscles and nerves. Rapid neovascularisation of the wounded area is crucial for wound healing as it has a key role in supplying oxygen and nutrients during the highly demanding proliferative phase and transmigration of inflammatory cells to the wound area. One approach to circumvent delayed neovascularisation is the exogenous use of pro-angiogenic factors, which is expensive, highly dose-dependent, and the delivery of them requires a very well-controlled system to avoid leaky, highly permeable and haemorrhagic blood vessel formation. In this study, we decorated polycaprolactone (PCL)-based polymerised high internal phase emulsion (PolyHIPE) scaffolds with fibroblast-derived ECM to assess fibroblast, endothelial cell and keratinocyte activity in vitro and angiogenesis in ex ovo chick chorioallantoic membrane (CAM) assays. Our results showed that the inclusion of ECM in the scaffolds increased the metabolic activity of three types of cells that play a key role in wound healing and stimulated angiogenesis in ex ovo CAM assays over 7 days. Herein, we demonstrated that fibroblast-ECM functionalised PCL PolyHIPE scaffolds appear to have great potential to be used as an active wound dressing to promote angiogenesis and wound healing.

Decellularisation of in vitro generated extracellular matrix (ECM) provides an effective way to stimulate angiogenesis and wound healing.

Three-dimensional printed personalized drug devices with anatomical fit: a review

OBJECTIVES

Three-dimensional printing (3DP) has opened the era of drug personalization, promising to revolutionize the pharmaceutical field with improvements in efficacy, safety and compliance of the treatments. As a result of these investigations, a vast therapeutic field has opened for 3DP-loaded drug devices with an anatomical fit. Along these lines, innovative dosage forms, unimaginable until recently, can be obtained. This review explores 3DP-engineered drug devices described in recent research articles, as well as in patented inventions, and even devices already produced by 3DP with drug-loading potential.

KEY FINDINGS

3D drug-loaded stents, implants and prostheses are reviewed, along with devices produced to fit hard-to-attach body parts such as nasal masks, vaginal rings or mouthguards. The most promising 3DP techniques for such devices and the complementary technologies surrounding these inventions are also discussed, particularly the scanners useful for mapping body parts. Health regulatory concerns regarding the new use of such technology are also analysed.

SUMMARY

The scenario discussed in this review shows that for wearable 3DP drug devices to become a tangible reality to users, it will be necessary to overcome the existing regulatory barriers, create new interfaces with electronic systems and improve the mapping mechanisms of body surfaces.

Anticandidal Potential of Two Cyanobacteria-Synthesized Silver Nanoparticles: Effects on Growth, Cell Morphology, and Key Virulence Attributes of Candida albicans

Candida albicans is an opportunistic human fungal pathogen responsible for 90-100% of mucosal and nosocomial infections worldwide. The emergence of drug-resistant strains has resulted in adverse consequences for human health, including numerous deaths. Consequently, there is an urgent need to identify and develop new antimicrobial drugs to counter these effects. Antimicrobial nanoagents have shown potent inhibitory activity against a number of pathogens through targeting their defense systems, such as biofilm formation. Here, we investigated the anticandidal activity of silver nanoparticles biosynthesized by the cyanobacterial strains Desertifilum sp. IPPAS B-1220 and Nostoc Bahar_M (D-SNPs and N-SNPs, respectively), along with that of silver nitrate (AgNO3), and examined the mechanisms underlying their lethal effects. For this, we performed agar well diffusion and enzyme activity assays (lactate dehydrogenase, adenosine triphosphatase, glutathione peroxidase, and catalase) and undertook morphological examinations using transmission electron microscopy. The effects of the three treatments on Hwp1 and CDR1 gene expression and protein patterns were assessed using qRT-PCR and SDS-PAGE assays, respectively. All of the three treatments inhibited C. albicans growth; disrupted membrane integrity, metabolic function, and antioxidant activity; induced ultrastructural changes in the cell envelope; and disrupted cytoplasmic and nuclear contents. Of the three agents, D-SNPs showed the greatest biocidal activity against C. albicans. Additionally, the D-SNP treatment significantly reduced the gene expression of Hwp1 and CDR1, suggestive of negative effects on biofilm formation ability and resistance potential of C. albicans, and promoted protein degradation. The mechanism involved in the biocidal effects of both D-SNPs and N-SNPs against C. albicans could be attributed to their ability to interfere with fungal cell structures and/or stimulate oxidative stress, enabling them to be used as a robust antimycotic agent.

A Novel Three-Polysaccharide Blend In Situ Gelling Powder for Wound Healing Applications

In this paper, alginate/pectin and alginate/pectin/chitosan blend particles, in the form of an in situ forming hydrogel, intended for wound repair applications, have been successfully developed. Particles have been used to encapsulate doxycycline in order to control the delivery of the drug, enhance its antimicrobial properties, and the ability to inhibit host matrix metalloproteinases. The presence of chitosan in the particles strongly influenced their size, morphology, and fluid uptake properties, as well as drug encapsulation efficiency and release, due to both chemical interactions between the polymers in the blend and interactions with the drug demonstrated by FTIR studies. In vitro antimicrobial studies highlighted an increase in antibacterial activity related to the chitosan amount in the powders. Moreover, in situ gelling powders are able to induce a higher release of IL-8 from the human keratinocytes that could stimulate the wound healing process in difficult-healing. Interestingly, doxycycline-loaded particles are able to increase drug activity against MMPs, with good activity against MMP-9 even at 0.5 μg/mL over 72 h. Such results suggest that such powders rich in chitosan could be a promising dressing for exudating wounds.

Recent advancements in cellulose-based biomaterials for management of infected wounds

INTRODUCTION

Chronic wounds are a substantial burden on the healthcare system. Their treatment requires advanced dressings, which can provide a moist wound environment, prevent bacterial infiltration, and act as a drug carrier. Cellulose is biocompatible, biodegradable, and can be functionalized according to specific requirements, which makes it a highly versatile biomaterial. Antimicrobial cellulose dressings are proving to be highly effective against infected wounds.

AREAS COVERED

This review briefly addresses the mechanism of wound healing and its pathophysiology. It also discusses wound infections, biofilm formation, and progressive emergence of drug-resistant bacteria in chronic wounds and the treatment strategies for such types of infected wounds. It also summarizes the general properties, method of production, and types of cellulose wound dressings. It explores recent studies and advancements regarding the use of cellulose and its derivatives in wound management.

EXPERT OPINION

Cellulose and its various functionalized derivatives represent a promising choice of wound dressing material. Cellulose-based dressings loaded with antimicrobials are very useful in controlling infection in a chronic wound. Recent studies showing its efficacy against drug-resistant bacteria make it a favorable choice for chronic wound infections. Further research and large-scale clinical trials are required for better clinical evidence of its efficiency.

Rational Design of Immunomodulatory Hydrogels for Chronic Wound Healing

With all the advances in tissue engineering for construction of fully functional skin tissue, complete regeneration of chronic wounds is still challenging. Since immune reaction to the tissue damage is critical in regulating both the quality and duration of chronic wound healing cascade, strategies to modulate the immune system are of importance. Generally, in response to an injury, macrophages switch from pro-inflammatory to an anti-inflammatory phenotype. Therefore, controlling macrophages' polarization has become an appealing approach in regenerative medicine. Recently, hydrogels-based constructs, incorporated with various cellular and molecular signals, have been developed and utilized to adjust immune cell functions in various stages of wound healing. Here, the current state of knowledge on immune cell functions during skin tissue regeneration is first discussed. Recent advanced technologies used to design immunomodulatory hydrogels for controlling macrophages' polarization are then summarized. Rational design of hydrogels for providing controlled immune stimulation via hydrogel chemistry and surface modification, as well as incorporation of cell and molecules, are also dicussed. In addition, the effects of hydrogels' properties on immunogenic features and the wound healing process are summarized. Finally, future directions and upcoming research strategies to control immune responses during chronic wound healing are highlighted.

Multifunctional Nanofibrous Dressing with Antimicrobial and Anti-Inflammatory Properties Prepared by Needle-Free Electrospinning

An active wound dressing should address the main goals in wound treatment, which are improved wound healing and reduced infection rates. We developed novel multifunctional nanofibrous wound dressings with three active ingredients: chloramphenicol (CAM), beta-glucan (βG) and chitosan (CHI), of which βG and CHI are active nanofiber-forming biopolymers isolated from the cell walls of Saccharomyces cerevisiae and from shrimp shells, respectively. To evaluate the effect of each active ingredient on the nanofibers' morphological features and bioactivity, nanofibers with both βG and CHI, only βG, only CHI and only copolymers, polyethylene oxide (PEO) and hydroxypropylmethylcellulose (HPMC) were fabricated. All four nanofiber formulations were also prepared with 1% CAM. The needle-free NanospiderTM technique allowed for the successful production of defect-free nanofibers containing all three active ingredients. The CAM-containing nanofibers had a burst CAM-release and a high absorption capacity. Nanofibers with all active ingredients (βG, CHI and CAM) showed a concentration-dependent anti-inflammatory activity, while maintaining the antimicrobial activity of CAM. The promising anti-inflammatory properties, together with the high absorption capacity and antimicrobial effect, make these multifunctional nanofibers promising as dressings in local treatment of infected and exuding wounds, such as burn wounds.

Polyurethane-Nanolignin Composite Foam Coated with Propolis as a Platform for Wound Dressing: Synthesis and Characterization

This piece of research explores porous nanocomposite polyurethane (PU) foam synthesis, containing nanolignin (NL), coated with natural antimicrobial propolis for wound dressing. PU foam was synthesized using polyethylene glycol, glycerol, NL, and 1, 6-diisocyanato-hexane (NCO/OH ratio: 1.2) and water as blowing agent. The resultant foam was immersed in ethanolic extract of propolis (EEP). PU, NL-PU, and PU-NL/EEP foams were characterized from mechanical, morphological, and chemical perspectives. NL Incorporation into PU increased mechanical strength, while EEP coating showed lower strength than PU-NL/EEP. Morphological investigations confirmed an open-celled structure with a pore diameter of 150-200 μm, a density of nearly 0.2 g/cm3,, and porosity greater than 85%, which led to significantly high water absorption (267% for PU-NL/EEP). The hydrophilic nature of foams, measured by the contact angle, proved to be increased by NL addition and EEP coating. PU and PU-NL did not show important antibacterial features, while EEP coating resulted in a significant antibacterial efficiency. All foams revealed high biocompatibility toward L929 fibroblasts, with the highest cell viability and cell attachment for PU-NL/EEP. In vivo wound healing using Wistar rats' full-thickness skin wound model confirmed that PU-NL/EEP exhibited an essentially higher wound healing efficacy compared with other foams. Hence, PU-NL/EEP foam could be a promising wound dressing candidate.

Current Trends in Advanced Alginate-Based Wound Dressings for Chronic Wounds

Chronic wounds represent a major public health issue, with an extremely high cost worldwide. In healthy individuals, the wound healing process takes place in different stages: inflammation, cell proliferation (fibroblasts and keratinocytes of the dermis), and finally remodeling of the extracellular matrix (equilibrium between metalloproteinases and their inhibitors). In chronic wounds, the chronic inflammation favors exudate persistence and bacterial film has a special importance in the dynamics of chronic inflammation in wounds that do not heal. Recent advances in biopolymer-based materials for wound healing highlight the performance of specific alginate forms. An ideal wound dressing should be adherent to the wound surface and not to the wound bed, it should also be non-antigenic, biocompatible, semi-permeable, biodegradable, elastic but resistant, and cost-effective. It has to give protection against bacterial, infectious, mechanical, and thermal agents, to modulate the level of wound moisture, and to entrap and deliver drugs or other molecules This paper explores the roles of alginates in advanced wound-dressing forms with a particular emphasis on hydrogels, nanofibers networks, 3D-scaffolds or sponges entrapping fibroblasts, keratinocytes, or drugs to be released on the wound-bed. The latest research reports are presented and supported with in vitro and in vivo studies from the current literature.

A freeze-thaw PVA hydrogel loaded with guava leaf extract: physical and antibacterial properties

A polyvinyl alcohol (PVA) hydrogel loaded with guava leaf extract (GLE) has potential applications as a wound dressing with good antibacterial activity. This study succeeded in fabricating a PVA hydrogel containing GLE using the freeze-thaw (FT) method. By varying the GLE concentration, we can adjust the physical properties of the hydrogel. The addition of GLE results in a decrease in cross-linking during gelation and an increase in the pore size of the hydrogels. The increase of the pore size made the swelling increase and the mechanical strength decrease. The weight loss of the hydrogel also increases because the phosphate buffer saline (PBS) dissolves the GLE. Increasing the GLE concentration caused the Fourier-transform infrared (FTIR) absorbance peaks to widen due to hydrogen bonds formed during the FT process. The crystalline phase was transformed into an amorphous phase in the PVA/GLE hydrogel based on the X-ray diffraction (XRD) spectra. The differential scanning calorimetry (DSC) characterization showed a significant decrease in the hydrogel weight over temperatures of 30-150 °C due to the evaporation of water from the hydrogel matrix. The zone of inhibition of the PVA/GLE hydrogel increased with antibacterial activity against Staphylococcus aureus of 17.93% per gram and 15.79% per gram against Pseudomonas aeruginosa.

Preclinical efficacy study of a porous biopolymeric scaffold based on gelatin-hyaluronic acid-chondroitin sulfate in a porcine burn injury model: role of critical molecular markers (VEGFA, N-cadherin, COX-2), gamma sterilization efficacy and a comparison of healing potential to Integra™

Development of scaffold from biopolymers can ease the requirements for donor skin autograft and plays an effective role in the treatment of burn wounds. In the current study, a porous foam based, bilayered hydrogel scaffold was developed using gelatin, hyaluronic acid and chondroitin sulfate (G-HA-CS). The fabricated scaffold was characterized physicochemically for pre- and post-sterilization efficacy by scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, differential scanning calorimetry (DSC) and thermal gravimetric analysis (TGA).In-vitrostudies proved that the scaffold promoted cellular proliferation. The efficacy of G-HA-CS scaffold was compared with Integra™ at different time points (7, 14, 21 and 42 days), in a swine second degree burn wound model. Remarkable healing potential of the scaffold was evident from the wound contraction rate, reduction of IL-6, TNF-αand C3. The expression of healing markers TGF-β1 and collagen 1 revealed significant skin regeneration with regulated fibroblast activation towards the late phase of healing (p< 0.001 at day 21 and 42 vs. control). Expression of Vascular Endothelial Growth Factor A (VEGFA), vimentin and N-cadherin were found to favor angiogenesis and skin regeneration. Mechanistically, scaffold promoted wound healing by modulation of CD-45, cyclooxygenase-2 and MMP-2. Thus, the promising results with foam based scaffold, comparable to Integra™ in swine burn injury model offer an innovative lead for clinical translation for effective management of burn wound.

Functional hydrogels for diabetic wound management

Diabetic wounds often have a slow healing process and become easily infected owing to hyperglycemia in wound beds. Once planktonic bacterial cells develop into biofilms, the diabetic wound becomes more resistant to treatment. Although it remains challenging to accelerate healing in a diabetic wound due to complex pathology, including bacterial infection, high reactive oxygen species, chronic inflammation, and impaired angiogenesis, the development of multifunctional hydrogels is a promising strategy. Multiple functions, including antibacterial, pro-angiogenesis, and overall pro-healing, are high priorities. Here, design strategies, mechanisms of action, performance, and application of functional hydrogels are systematically discussed. The unique properties of hydrogels, including bactericidal and wound healing promotive effects, are reviewed. Considering the clinical need, stimuli-responsive and multifunctional hydrogels that can accelerate diabetic wound healing are likely to form an important part of future diabetic wound management.

Nile tilapia skin (Oreochromis niloticus) for burn treatment: ultrastructural analysis and quantitative assessment of collagen

Nile tilapia (Oreochromis niloticus) skin is a well-known biomaterial used as an occlusive dressing for burn treatment. It is also an inexpensive and important source of collagen. This study aims to describe the ultrastructural aspects of Nile tilapia skin, assess its collagen amount and organization, and compare quantitative methods of histochemical and immunohistochemical analysis (in all sterilization steps for use in burn dressings). One sample (0.5 × 0.5 cm) of ten different fish skins was divided in four groups: in natura skin (IN), chemical sterilization (CH), additional irradiation (30 kGy) (IR), and skins used in burn treatment (BT) to compare histochemical and immunohistochemical findings of collagen amount and describe ultrastructural aspects through scanning electron microscopy. The amount of type I collagen decreased during sterilization and clinical use owing to gradual reduction of immunostaining (anti-collagen-I) and decreasing fiber thickness of the collagen, when compared to type III (Picrosirius-red-polarized light). The collagen fibers were rearranged at each sterilization step, with a low collagen percentage and large structural disorganization in BT. The amount of type-I collagen was further reduced after BT (p < 0.05). Both the methods did not exhibit a quantified value difference (p = 0.247), and a positive correlation (r = 0.927; 95 % CI = 0.720-0.983) was observed between them, with concordance for collagen quantification in similar samples, presenting a low systematic error rate (Dalberg coefficient: 6.70). A significant amount of type-I collagen is still observed despite sterilization, although clinical application further reduces type I collagen. Its quantification can be performed both by immunohistochemistry and/or Picrosirius Red reliably.

Bupivacaine-eluting soy protein structures for controlled release and localized pain relief: An in vitro and in vivo study

Burn pain is known to be excruciating, and while burn care has greatly advanced, treatment for burn-related pain is lacking. Current pain relief methods include systemic administration of analgesics, which does not provide high drug concentration at the wound site. In the present study, soy protein was used as the base material for bupivacaine-loaded hybrid wound dressings. The effect of the formulation on the drug release profile was studied using high performance liquid chromatography, and the cytotoxicity was tested on human fibroblasts. A second-degree burn model in rats was used to quantify the efficacy of the wound dressings in vivo, using the Rat Grimace Scale. All tested films exhibited high biocompatibility, and the drug release profiles showed rapid release during the initial 5 hr and a continuous slower release for another 24 hr. Significant pain relief was achieved in the animal trials, proving a decrease of 51-68% in pain levels during days 1-3 post-burn. Hence, the results indicate a safe and controlled bupivacaine release for a period of more than 24 hr, effectively treating pain caused by second-degree burns. The understanding of the formulation-properties effects, together with our in vivo study, enables to advance this field toward tailorable systems with high therapeutic potential.

Three-dimensional bioprinting of a full-thickness functional skin model using acellular dermal matrix and gelatin methacrylamide bioink

Treatment of full-thickness skin defects still presents a significant challenge in clinical practice. Three-dimensional (3D) bioprinting technique offers a promising approach for fabricating skin substitutes. However, it is necessary to identify bioinks that have both sufficient mechanical properties and desirable biocompatibilities. In this study, we successfully fabricated acellular dermal matrix (ADM) and gelatin methacrylamide (GelMA) bioinks. The results demonstrated that ADM preserved the main extracellular matrix (ECM) components of the skin and GelMA had tunable mechanical properties. Both bioinks with shear-thinning properties were suitable for 3D bioprinting and GelMA bioink exhibited high printability. Additionally, the results revealed that 20% GelMA with sufficient mechanical properties was suitable to engineer epidermis, 1.5% ADM and 10% GelMA displayed relatively good cytocompatibilities. Here, we proposed a new 3D structure to simulate natural full-thickness skin, which included 20% GelMA with HaCaTs as an epidermal layer, 1.5% ADM with fibroblasts as the dermis, and 10% GelMA mesh with human umbilical vein endothelial cells (HUVECs) as the vascular network and framework. We demonstrated that this 3D bioprinting functional skin model (FSM) could not only promote cell viability and proliferation, but also support epidermis reconstruction in vitro. When transplanted in vivo, the FSM could maintain cell viability for at least 1 week. Furthermore, the FSM promoted wound healing and re-epithelization, stimulated dermal ECM secretion and angiogenesis, and improved wound healing quality. The FSM may provide viable functional skin substitutes for future clinical applications. STATEMENT OF SIGNIFICANCE: We propose a new 3D structure to simulate natural full-thickness skin, which included 20% GelMA with HaCaTs as an epidermal layer, 1.5% ADM with fibroblasts as the dermis, and 10% GelMA mesh with HUVECs as the vascular network. It could not only maintain a moist microenvironment and barrier function, but also recreate the natural skin microenvironment to promote cell viability and proliferation. This may provide viable functional skin substitutes for future clinical applications.

Physically crosslinked PVA/graphene-based materials/aloe vera hydrogel with antibacterial activity

Burn is a major skin injury that occurs worldwide. For second-degree burns, special treatment should be given for creating a suitable wound healing environment. Hydrogel wound dressing as the primary care should possess extra properties that include antibacterial activity and cytocompatibility to enhance the treatment effectiveness. Additional therapy such as electrical stimulation can be applied as well promote wound healing. Herein, we used the tissue engineering concept to create a novel antibacterial and cytocompatible hydrogel made of polyvinyl alcohol (PVA), graphene-based material (GBM), and aloe vera extract (Av) through the freeze-thaw process. We prepared the PVA/GBM/Av hydrogel and examined its potential as a wound dressing. We found that it exhibited excellent hydrophilicity with a contact angle between 15 and 31 degrees and electrical conductivity within the range of 0.0102-0.0154 S m-1, which is comparable to that of the human skin tissue and possesses tensile strength up to 1.5 MPa with elongation of 405%. It also demonstrated good stability in phosphate buffer saline with a weight ratio of 73-80% after 14 days of immersion. We presented that the addition of graphene and graphene oxide (GO) inhibited the growth of Gram-positive Staphylococcus aureus ATCC 6538 with the lowest bacterial population observed in PVA/GO, which is 1.74 × 107 cfu mL-1 after 1 day incubation and 99.94% bacterial reduction. Furthermore, our PVA/GBM/Av showed no toxicity to 3T3 fibroblast cells after 48 h with viability up to 295% for PVA/GO/Av. In summary, our fabricated hydrogels have shown their potential as wound dressing with antibacterial and non-cytotoxic properties.

In vitro and in vivo advancement of multifunctional electrospun nanofiber scaffolds in wound healing applications: Innovative nanofiber designs, stem cell approaches, and future perspectives

The skin is one of the most essential tissues in the human body, interacting with the outside environment and shielding the body from diseases and excessive water loss. Hydrogels, decellularized porcine dermal matrix, and lyophilized polymer scaffolds have all been used in studies of skin wound repair, wound dressing, and skin tissue engineering, however, these materials cannot replicate the nanofibrous architecture of the skin's native extracellular matrix (ECM). Electrospun nanofibers are a fascinating new form of nanomaterials with tremendous potential across a broad spectrum of applications in the biomedical field, including wound dressings, wound healing scaffolds, regenerative medicine, bioengineering of skin tissue, and multifaceted drug delivery. This article reviews recent in vitro and in vivo developments in multifunctional electrospun nanofibers (MENs) for wound healing. This review begins with an introduction to the electrospinning process, its principle, and the processing parameters which have a significant impact on the nanofiber properties. It then discusses the various geometries and advantages of MEN scaffolds produced by different innovative electrospinning techniques for wound healing applications when used in combination with stem cells. This review also discusses some of the possible future nanofiber-based models that could be used. Finally, we conclude with potential perspectives and conclusions in this area.

Chitosan-Coated Poly(lactic acid) Nanofibres Loaded with Essential Oils for Wound Healing

Chronic skin wounds are characterised by a non-healing process that makes necessary the application of wound dressings on the damaged area to promote and facilitate the recovery of skin’s physiological integrity. The aim of the present work is to develop a bioactive dressing that, once applied on the injured tissue, would exert antibacterial activity and promote adhesion and proliferation of fibroblasts. Nanofibres consisting of poly(lactic acid) (PLA) and essential oils (EOs) were electrospun and coated with a medium molecular weight chitosan (CS). Black pepper essential oil (BP-EO) or limonene (L), well-known for their antibacterial properties, were added to the PLA/acetone solution before electrospinning; phase separation phenomena occurred due to the poor solubility of the EOs in the PLA solution and led to fibres having surface nano-pores. The porous electrospun fibres were coated with CS to produce hydrophilic membranes that were easy to handle, biocompatible, and suited to promote cellular proliferation. The fibrous scaffolds were tested in terms of mechanical resistance, wettability, antibacterial activity, in-vitro cytotoxicity, and ability to promote fibroblasts’ adhesion and proliferation. The results obtained proved that the CS coating improved the hydrophilicity of the fibrous mats, enhanced EO’s antibacterial potential, and promoted cell adhesion and proliferation.

Development of Spanish Broom and Flax Dressings with Glycyrrhetinic Acid-Loaded Films for Wound Healing: Characterization and Evaluation of Biological Properties

The selection of an appropriate dressing for each type of wound is a very important procedure for a faster and more accurate healing process. So, the aim of this study was to develop innovative Spanish Broom and flax wound dressings, as alternatives to cotton used as control, with polymeric films containing glycyrrhetinic acid (GA) to promote wound-exudate absorption and the healing process. The different wound dressings were prepared by a solvent casting method, and characterized in terms of drug loading, water uptake, and in vitro release. Moreover, biological studies were performed to evaluate their biocompatibility and wound-healing efficacy. Comparing the developed wound dressings, Spanish Broom dressings with GA-loaded sodium hyaluronate film had the best functional properties, in terms of hydration ability and GA release. Moreover, they showed a good biocompatibility, determining a moderate induction of cell proliferation and no cytotoxicity. In addition, the wound-healing test revealed that the Spanish Broom dressings promoted cell migration, further facilitating the closure of the wound.

Research Advances in the Application of Adipose-Derived Stem Cells Derived Exosomes in Cutaneous Wound Healing

Cutaneous wound healing has always been an intractable medical problem for both clinicians and researchers, with an urgent need for more efficacious methods to achieve optimal outcomes morphologically and functionally. Stem cells, the body's rapid response 'road repair crew,' being on standby to combat tissue injuries, are an essential part of regenerative medicine. Currently, the use of adipose-derived stem cells (ADSCs), a kind of mesenchymal stem cells with multipotent differentiation and self-renewal capacity, is surging in the field of cutaneous wound healing. ADSCs may exert influences either by releasing paracrine signalling factors or differentiating into mature adipose cells to provide the 'building blocks' for engineered tissue. As an important paracrine substance released from ADSCs, exosomes are a kind of extracellular vesicles and carrying various bioactive molecules mediating adjacent or distant intercellular communication. Previous studies have indicated that ADSCs derived exosomes (ADSCs-Exos) promoted skin wound healing by affecting all stages of wound healing, including regulating inflammatory response, promoting proliferation and migration of fibroblasts or keratinocytes, facilitating angiogenesis, and regulating remodeling of extracellular matrix, which have provided new opportunities for understanding how ADSCs-Exos mediate intercellular communication in pathological processes of the skin and therapeutic strategies for cutaneous wound repair. In this review, we focus on elucidating the role of ADSCs-Exos at various stages of cutaneous wound healing, detailing the latest developments, and presenting some challenges necessary to be addressed in this field, with the expectation of providing a new perspective on how to best utilize this powerful cell-free therapy in the future.

Nanocellulose-based wound dressing for conservative wound management in children with second-degree burns

The initial care of burn wounds and choice of dressing are pivotal to optimally support the healing process. To ensure fast re-epithelialisation within 10-14 days and prevent complications, an optimal healing environment is essential. An innovative dressing based on nanocellulose was used for the treatment of burns in children. Children (0-16 years) with clean, partial-thickness burn wounds, 1 to 10% of the total body surface area were included. Complete re-epithelialisation was achieved within 7-17 days, with 13 patients showing re-epithelialised >95% by day 10. Satisfying results concerning time to re-epithelialisation and material handling were obtained. The possibility to leave the dressing on the wounds for 7 days showed a positive effect in the treatment of children, for whom every hospital visit may cause massive stress reactions. The nanocellulose-based dressing is a promising tool in conservative treatment of burns. Reducing the frequency of dressing changes supports a fast and undisturbed recovery; moreover, the dressing provides an optimal moist healing environment. The time to re-epithelialisation is comparable to frequently used materials, and cost reduction effect can be achieved without loss of quality. Possible pain and distress levels are kept to a minimum; therefore, flexibility and compliance of the patients and their parents are enhanced.