Nanomedicine and advanced technologies for burns: Preventing infection and facilitating wound healing

Pullulan film incorporated with nanocapsules improves pomegranate seed oil anti-inflammatory and antioxidant effects in the treatment of atopic dermatitis in mice

This study aimed to prepare pullulan films containing pomegranate seeds oil (PSO) based nanocapsules, and evaluate the formulation efficacy in the treatment of atopic dermatitis (AD)-like lesions induced by 2,4-dinitrochlorobenzene (DNCB). The Eudragit RS 100® nanocapsules (PSONC) were prepared by the interfacial precipitation of preformed polymer, whereas the films were produced by the solvent casting method. Pomegranate seed oil nanoemulsions (PSONE) were prepared by the spontaneous emulsification method for comparative reasons. Both nanosystems presented adequate mean diameter (248 ± 16 nm for PSONE and 181 ± 6 nm for PSONC), polydispersity index (below 0.2), zeta potential (-25.63 ± 1.1 mV for PSONE and + 43.13 ± 0.7 mV for PSONC) and pH in the acid range (6.77 ± 0.27 and 5.31 ± 0.17, PSONE and PSONC). By a pre-formulation study, sorbitol (6.5%) and PEG 400 (1.5%) were considered the most suitable plasticizers for developing pullulan films (6%) intending topical application. In general, pullulan films were classified as flexible and hydrophilic, with high occlusive properties, 57.6 ± 0.8%, 64.6 ± 0.8% for vehicle, PSONCF (pullulan film containing PSONC), respectively. All formulations (films and nanocarriers) presented no irritant potential in the chorioallantoic membrane test. In the in vivo model, the treatments with free PSO and PSONCF attenuated the skin injury as well as the mechanical hypernociceptive behavioral induced by DNCB exposure to mice. Importantly, the biochemical analyses provided evidence that only the treatment with PSONCF modulated the inflammatory and the oxidative stress parameters evaluated in this study. In conclusion, these data lead us to believe that PSONC incorporation into a pullulan film matrix improved the biological properties of the PSO in this AD-model.

Hybrid Molecularly Imprinted Polymers: The Future of Nanomedicine?

Molecularly imprinted polymers (MIPs) have been widely used in nanomedicine in the last few years. However, their potential is limited by their intrinsic properties resulting, for instance, in lack of control in drug release processes or complex detection for in vivo imaging. Recent attempts in creating hybrid nanomaterials combining MIPs with inorganic nanomaterials succeeded in providing a wide range of new interesting properties suitable for nanomedicine. Through this review, we aim to illustrate how hybrid molecularly imprinted polymers may improve patient care with enhanced imaging, treatments, and a combination of both.

Fabricating scalable, personalized wound dressings with customizable drug loadings via 3D printing

In recent times, 3D printing has been gaining traction as a fabrication platform for customizable drug dosages as a form of personalized medicine. While this has been recently demonstrated as oral dosages, there is potential to provide the same customizability and personalization as topical applications for wound healing. In this paper, the application of 3D printing to fabricate hydrogel wound dressings with customizable architectures and drug dosages was investigated. Chitosan methacrylate was synthesized and mixed with Lidocaine Hydrochloride and Levofloxacin respectively along with a photoinitiator before being used to print wound dressings of various designs. These designs were then investigated for their effect on drug release rates and profiles. Our results show the ability of 3D printing to customize drug dosages and drug release rates through co-loading different drugs at various positions and varying the thickness of drug-free layers over drug-loaded layers in the wound dressing respectively. Two scale-up approaches were also investigated for their effects on drug release rates from the wound dressing. The influence that each wound dressing design has on the release profile of drugs was also shown by fitting them with drug release kinetic models. This study thus shows the feasibility of utilizing 3D printing to fabricate wound dressings with customizable shapes, drug dosage and drug release rates that can be tuned according to the patient's requirements.

Phytochemical-Based Nano-Pharmacotherapeutics for Management of Burn Wound Healing

Medicinal plants have been used since ancient times for their various therapeutic activities and are safer compared to modern medicines, especially when properly identifying and preparing them and choosing an adequate dose administration. The phytochemical compounds present in plants are progressively yielding evidence in modern drug delivery systems by treating various diseases like cancers, coronary heart disease, diabetes, high blood pressure, inflammation, microbial, viral and parasitic infections, psychotic diseases, spasmodic conditions, ulcers, etc. The phytochemical requires a rational approach to deliver the compounds to enhance the efficacy and to improve patients’ compatibility. Nanotechnology is emerging as one of the most promising strategies in disease control. Nano-formulations could target certain parts of the body and control drug release. Different studies report that phytochemical-loaded nano-formulations have been tested successfully both in vitro and in vivo for healing of skin wounds. The use of nano systems as drug carriers may reduce the toxicity and enhance the bioavailability of the incorporated drug. In this review, we focus on various nano-phytomedicines that have been used in treating skin burn wounds, and how both nanotechnology and phytochemicals are effective for treating skin burns.

Recent Strategies to Develop Innovative Photosensitizers for Enhanced Photodynamic Therapy

This review presents a robust strategy to design photosensitizers (PSs) for various species. Photodynamic therapy (PDT) is a photochemical-based treatment approach that involves the use of light combined with a light-activated chemical, referred to as a PS. Attractively, PDT is one of the alternatives to conventional cancer treatment due to its noninvasive nature, high cure rates, and low side effects. PSs play an important factor in photoinduced reactive oxygen species (ROS) generation. Although the concept of photosensitizer-based photodynamic therapy has been widely adopted for clinical trials and bioimaging, until now, to our surprise, there has been no relevant review article on rational designs of organic PSs for PDT. Furthermore, most of published review articles in PDT focused on nanomaterials and nanotechnology based on traditional PSs. Therefore, this review aimed at reporting recent strategies to develop innovative organic photosensitizers for enhanced photodynamic therapy, with each example described in detail instead of providing only a general overview, as is typically done in previous reviews of PDT, to provide intuitive, vivid, and specific insights to the readers.

Chitosan-poloxamer-based thermosensitive hydrogels containing zinc gluconate/recombinant human epidermal growth factor benefit for antibacterial and wound healing

Chitosan/poloxamer-based thermosensitive hydrogels containing zinc gluconate/recombinant human epidermal growth factor (ZnG/rhEGF@Chit/Polo) were developed as a convenient, safe and effective dressing for skin wound treatment. Their fabrication procedure and characterization were reported, and their morphology was examined by a scanning electron microscope. Antibacterial and biofilms activities were evaluated by in vitro tests to reveal the inhibitory effects and scavenging activity on the biofilms of Staphylococcus aureus and Pseudomonas aeruginosa. ZnG/rhEGF@Chit/Polo was also investigated as a potential therapeutic agent for wound healing therapy. In vivo wound healing studies on rats for 21 days proves that ZnG/rhEGF@Chit/Polo supplements the requisite Zn²⁺ and rhEGF for wound healing to promote the vascular remodeling and collagen deposition, facilitate fibrogenesis, and reduce the level of interleukin 6 for wound basement repair, and thus is a good wound therapy.

Phenylalanine-based poly(ester urea)s composite films with nitric oxide-releasing capability for anti-biofilm and infected wound healing applications

Infected wounds show delayed and incomplete healing processes and even render patients at a high risk of death due to the formed bacterial biofilms in the wound site, which protect bacteria against antimicrobial treatments and immune response. Nitric oxide based therapy is considered a promising strategy for eliminating biofilms and enhancing wound healing, which encounters a significant challenge of controlling the NO release behavior at the wound site. Herein, a kind of phenylalanine based poly(ester urea)s with high thermal stability are synthesized and fabricated to electrospun films as NO loading vehicle for infected wound treatment. The resultant films can continuously and stably release nitric oxide for 360 h with a total concentration of 1.15 μmol L^-1, which presents obvious advantages in killing the bacteria and removing biofilms. The results exhibit the films have no cytotoxicity and may accelerate the wound repair without causing inflammation, hemolysis, or cytotoxic reactions as well as stimulate the proliferation of fibroblasts and increase the synthesis of collagen. Therefore, the films may be a suitable NO releasing dressing for removing biofilms and repairing infected wounds.

Hollow polydopamine nanoparticles loading with peptide RL-QN15: a new pro-regenerative therapeutic agent for skin wounds

BACKGROUND

Although the treatments of skin wounds have greatly improved with the increase in therapeutic methods and agents, available interventions still cannot meet the current clinical needs. Therefore, the development of new pro-regenerative therapies remains urgent. Owing to their unique characteristics, both nanomaterials and peptides have provided novel clues for the development of pro-regenerative agents, however, more efforts were still be awaited and anticipated.

RESULTS

In the current research, Hollow polydopamine (HPDA) nanoparticles were synthesized and HPDA nanoparticles loading with RL-QN15 (HPDAlR) that was an amphibian-derived peptide with obvious prohealing activities were prepared successfully. The characterization, biodistribution and clearance of both HPDA nanoparticles and HPDAlR were evaluated, the loading efficiency of HPDA against RL-QN15 and the slow-releasing rate of RL-QN15 from HPDAlR were also determined. Our results showed that both HPDA nanoparticles and HPDAlR exerted no obvious toxicity against keratinocyte, macrophage and mice, and HPDA nanoparticles showed no prohealing potency in vivo and in vitro. Interestingly, HPDAlR significantly enhanced the ability of RL-QN15 to accelerate the healing of scratch of keratinocytes and selectively modulate the release of healing-involved cytokines from macrophages. More importantly, in comparison with RL-QN15, by evaluating on animal models of full-thickness injured skin wounds in mice and oral ulcers in rats, HPDAlR showed significant increasing in the pro-regenerative potency of 50 and 10 times, respectively. Moreover, HPDAlR also enhanced the prohealing efficiency of peptide RL-QN15 against skin scald in mice and full-thickness injured wounds in swine.

CONCLUSIONS

HPDA obviously enhanced the pro-regenerative potency of RL-QN15 in vitro and in vivo, hence HPDAlR exhibited great potential in the development of therapeutics for skin wound healing.

Transcorneal delivery of topically applied silver nanoparticles does not delay epithelial wound healing

Silver nanoparticles (AgNPs) are a common antimicrobial additive for a variety of applications, including wound care. However, AgNPs often undergo dissolution resulting in release of silver ions, with subsequent toxicity to mammalian cells. The cornea is a primary exposure site to topically administered AgNPs in and around the eye but their impact on corneal wound healing is understudied. Thus, the purpose of this study was to determine in vitro toxicity of AgNPs on corneal epithelial cells and fibroblasts as well as their effects on corneal epithelial wound healing utilizing an in vivo rabbit model. Non-coated 20 nm sized AgNP (AgNP-20) as well as 1% and 10% silver silica NPs (AgSiO₂NPs) were tested at concentrations ranging from 0.05-250 μg/mL. Immortalized human corneal epithelial (hTCEpi) cells and primary rabbit corneal fibroblasts (RCFs) were incubated for 24 h with AgNPs and cell viability was tested. Additionally, a round wound healing assay was performed to determine hTCEpi cell migration. Quantitative real-time PCR and western blot analysis was performed to determine α-smooth muscle actin (α-SMA, a myofibroblast marker) mRNA and protein expression, respectively, in RCFs treated with 50 μg/mL of AgNPs. Corneal epithelial wound healing was evaluated with 1%-AgSiO₂NPs (10 and 250 μg/mL) using an in vivo rabbit model. Rabbits were subsequently euthanized, and histologic sections of the enucleated globes were used to determine corneal penetration of 1%-AgSiO₂NPs with autometallography and hyperspectral darkfield microscopy. Cell viability of both the hTCEpi cells and fibroblasts was significantly decreased by the three AgNPs in a dose dependent manner. Migration of hTCEpi cells was significantly inhibited by the three AgNPs. Alpha-SMA mRNA expression was significantly inhibited with three AgNPs, but only the 1%-AgSiO₂NPs inhibited protein expression of α-SMA. In vivo epithelial wound closure did not significantly differ between groups treated with 10 or 250 μg/mL of 1%-AgSiO₂NPs or vehicle control. The 1%-AgSiO₂NPs penetrated throughout all corneal layers and into the anterior chamber in all treated eyes with no histopathological changes observed. In conclusion, the 1%-AgSiO₂NPs are safe and have potential therapeutic applications through its efficacy of the corneal penetration and reduced scar formation during corneal wound healing.

Polymer-Based Nanotherapeutics for Burn Wounds

Burn wounds are complex and intricate injuries that have become a common cause of trauma leading to significant mortality and morbidity every year. Dressings are applied to burn wounds with the aim of promoting wound healing, preventing burn infection and restoring skin function. The dressing protects the injury and contributes to recovery of dermal and epidermal tissues. Polymer-based nanotherapeutics are increasingly being exploited as burn wound dressings. Natural polymers such as cellulose, chitin, alginate, collagen, gelatin and synthetic polymers like poly (lactic-co-glycolic acid), polycaprolactone, polyethylene glycol, and polyvinyl alcohol are being obtained as nanofibers by nanotechnological approaches like electrospinning and have shown wound healing and re-epithelialization properties. Their biocompatibility, biodegradability, sound mechanical properties and unique structures provide optimal microenvironment for cell proliferation, differentiation, and migration contributing to burn wound healing. The polymeric nanofibers mimic collagen fibers present in extracellular matrix and their high porosity and surface area to volume ratio enable increased interaction and sustained release of therapeutics at the site of thermal injury. This review is an attempt to compile all recent advances in the use of polymer-based nanotherapeutics for burn wounds. The various natural and synthetic polymers used have been discussed comprehensively and approaches being employed have been reported. With immense research effort that is currently being invested in this field and development of proper characterization and regulatory framework, future progress in burn treatment is expected to occur. Moreover, appropriate preclinical and clinical research will provide evidence for the great potential that polymer-based nanotherapeutics hold in the management of burn wounds.

Recent advances in nanotherapeutics for the treatment of burn wounds

Moderate or severe burns are potentially devastating injuries that can even cause death, and many of them occur every year. Infection prevention, anti-inflammation, pain management and administration of growth factors play key roles in the treatment of burn wounds. Novel therapeutic strategies under development, such as nanotherapeutics, are promising prospects for burn wound treatment. Nanotherapeutics, including metallic and polymeric nanoformulations, have been extensively developed to manage various types of burns. Both human and animal studies have demonstrated that nanotherapeutics are biocompatible and effective in this application. Herein, we provide comprehensive knowledge of and an update on the progress of various nanoformulations for the treatment of burn wounds.

Lipid-Based Drug Delivery Systems in Regenerative Medicine

The most important goal of regenerative medicine is to repair, restore, and regenerate tissues and organs that have been damaged as a result of an injury, congenital defect or disease, as well as reversing the aging process of the body by utilizing its natural healing potential. Regenerative medicine utilizes products of cell therapy, as well as biomedical or tissue engineering, and is a huge field for development. In regenerative medicine, stem cells and growth factor are mainly used; thus, innovative drug delivery technologies are being studied for improved delivery. Drug delivery systems offer the protection of therapeutic proteins and peptides against proteolytic degradation where controlled delivery is achievable. Similarly, the delivery systems in combination with stem cells offer improvement of cell survival, differentiation, and engraftment. The present review summarizes the significance of biomaterials in tissue engineering and the importance of colloidal drug delivery systems in providing cells with a local environment that enables them to proliferate and differentiate efficiently, resulting in successful tissue regeneration.

Modern Wound Dressings: Hydrogel Dressings

Chronic wounds do not progress through the wound healing process in a timely manner and are considered a burden for healthcare system; they are also the most common reason for decrease in patient quality of life. Traditional wound dressings e.g., bandages and gauzes, although highly absorbent and effective for dry to mild, exudating wounds, require regular application, which therefore can cause pain upon dressing change. In addition, they have poor adhesional properties and cannot provide enough drainage for the wound. In this regard, the normalization of the healing process in chronic wounds is an extremely urgent task of public health and requires the creation and implementation of affordable dressings for patients with chronic wounds. Modern wound dressings (WDs) are aimed to solve these issues. At the same time, hydrogels, unlike other types of modern WDs (foam, films, hydrocolloids), have positive degradation properties that makes them the perfect choice in applications where a targeted delivery of bioactive substances to the wound is required. This mini review is focused on different types of traditional and modern WDs with an emphasis on hydrogels. Advantages and disadvantages of traditional and modern WDs as well as their applicability to different chronic wounds are elucidated. Furthermore, an effectiveness comparison between hydrogel WDs and the some of the frequently used biotechnologies in the field of regenerative medicine (adipose-derived mesenchymal stem cells (ADMSCs), mesenchymal stem cells, conditioned media, platelet-rich plasma (PRP)) is provided.

A novel self-healing triple physical cross-linked hydrogel for antibacterial dressing

The poor mechanical properties of wound dressings have always been a challenge in their application as wound protective barriers. In particular, when the hydrogel dressing absorbs the tissue fluid, the mechanical properties of the hydrogel will decrease greatly due to the swelling effect. In this study, an original antibacterial hydrogel dressing was prepared by a one-step process with acrylic acid, 1-vinyl-3-butylimidazolium, COOH-modified gum arabic, and aluminium chloride. The mechanical properties of this hydrogel were improved after water absorption due to hydrophobic interactions, so the hydrogel dressing could maintain good mechanical properties after absorption of the tissue fluid. Furthermore, 1-vinyl-3-butylimidazolium as an ionic liquid was introduced into the polymer backbone of hydrogels via covalent bonds and could promote the self-healing of hydrogels by facilitating the migration of aluminum ions with charge. The obtained hydrogels showed good self-healing properties, with a strain self-healing rate of 98.2% and a stress self-healing rate of 92.3%. In addition, this hydrogel exhibited excellent antibacterial activity against E. coli, S. aureus, and C. albicans. The results of the study on rat wound closure indicated that this hydrogel effectively accelerated the healing of a full-thickness skin defect. Therefore, this novel hydrogel has a broad application prospect in the field of wound dressing.

Harnessing biocompatible nanofibers and silver nanoparticles for wound healing: Sandwich wound dressing versus commercial silver sulfadiazine dressing

Owing to the structural replication of native extracellular matrix, nonwoven mats of electrospun nanofibers have great potential for use in wound healing. Herein, we report the design and fabrication of a sandwich wound dressing to balance its antimicrobial activity and biocompatibility. This success mainly relies on the incorporation of silver nanoparticles (AgNPs) into electrospun nanofibers, together with the rational design of a sandwich structure for the dressing. The bottom layer was composed of hydrophilic nanofibers made from a blend of polycaprolactone (PCL) and gelatin (Gel). The top layer consisted of hydrophobic PCL nanofibers. AgNP-loaded PCL/Gel nanofibers were sandwiched between the two layers. When compared with a commercial silver sulfadiazine dressing, the designed wound dressing showed competitive antimicrobial properties, lower cell toxicity, and accelerated wound closure for mouse skin injury. By balancing the biocompatibility of electrospun nanofibers and the broad-spectrum antibacterial activity of AgNPs within a sandwich structure, the novel multifunctional wound dressing could be valuable for effective wound healing and related applications.

Hyaluronic acid nanofiber mats loaded with antimicrobial peptide towards wound dressing applications

Chronic wounds are highly susceptible to bacterial infections. Previously, we loaded a natural antimicrobial peptide of low cost and high safety, ε-polylysine (EPL), into the electrospun nanofiber mat of starch. The mat showed comparable antibacterial activity but markedly better biocompatibility than the commercial silver-containing dressing. To further optimize material property, in this paper, we use hyaluronic acid (HA) to replace starch. Results show that EPL-loaded HA nanofiber mats (OHA-EPL) have suitable water vapor permeability, good biocompatibility and broad-spectrum antibacterial property similar to that of EPL-loaded starch nanofiber mat (Starch-EPL). Differently, the content of EPL in OHA-EPL nanofiber mats increases from 19.2% to 27.9%, the tensile strength rises from 0.3 MPa to 0.6 MPa, the elongation grows from 62.0% to 130.0%, and the fiber degradation and EPL release accelerates. In addition, OHA-EPL can absorb up to 26.3-times exudate, which is much higher than Starch-EPL (15.1 times). Combined with the excellent biological activity of HA, OHA-EPL may produce better therapeutic effects than Starch-EPL.

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.

Antimicrobial Peptides: The Promising Therapeutics for Cutaneous Wound Healing

Chronic wound infections have caused an increasing number of deaths and economic burden, which necessitates wound treatment options. Hitherto, the development of functional wound dressings has achieved reasonable progress. Antibacterial agents, growth factors, and miRNAs are incorporated in different wound dressings to treat various types of wounds. As an effective antimicrobial agent and emerging wound healing therapeutic, antimicrobial peptides (AMPs) have attracted significant attention. The present study focuses on the application of AMPs in wound healing and discusses the types, properties and formulation strategies of AMPs used for wound healing. In addition, the clinical trial and the current status of studies on "antimicrobial peptides and wound healing" are elaborated through bibliometrics. Also, the challenges and opportunities for further development and utilization of AMP formulations in wound healing are discussed.

Nanotechnology against COVID-19: Immunization, diagnostic and therapeutic studies

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in early 2020 soon led to the global pandemic of Coronavirus Disease 2019 (COVID-19). Since then, the clinical and scientific communities have been closely collaborating to develop effective strategies for controlling the ongoing pandemic. The game-changing fields of recent years, nanotechnology and nanomedicine have the potential to not only design new approaches, but also to improve existing methods for the fight against COVID-19. Nanomaterials can be used in the development of highly efficient, reusable personal protective equipment, and antiviral nano-coatings in public settings could prevent the spread of SARS-CoV-2. Smart nanocarriers have accelerated the design of several therapeutic, prophylactic, or immune-mediated approaches against COVID-19. Some nanovaccines have even entered Phase IΙ/IIΙ clinical trials. Several rapid and cost-effective COVID-19 diagnostic techniques have also been devised based on nanobiosensors, lab-on-a-chip systems, or nanopore technology. Here, we provide an overview of the emerging role of nanotechnology in the prevention, diagnosis, and treatment of COVID-19.

A sandwich structure composite wound dressing with firmly anchored silver nanoparticles for severe burn wound healing in a porcine model

Wounds may remain open for a few weeks in severe burns, which provide an entry point for pathogens and microorganisms invading. Thus, wound dressings with long-term antimicrobial activity are crucial for severe burn wound healing. Here, a sandwich structure composite wound dressing anchored with silver nanoparticles (AgNPs) was developed for severe burn wound healing. AgNPs were in situ synthesized on the fibers of chitosan nonwoven fabric (CSNWF) as the interlayer of wound dressing for sustained release of silver ion. The firmly anchored AgNPs could prevent its entry into the body, thereby eliminating the toxicity of nanomaterials. The outer layer was a polyurethane membrane, which has a nanoporous structure that could maintain free transmission of water vapor. Chitosan/collagen sponge was selected as the inner layer because of its excellent biocompatibility and biodegradability. The presence of AgNPs in the CSNWF was fully characterized, and the high antibacterial activity of CSNWF/AgNPs was confirmed by against Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. The superior wound healing effect on deep dermal burns of presented composite wound dressing was demonstrated in a porcine model. Our finding suggested that the prepared AgNPs doped sandwich structure composite wound dressing has great potential application in severe wound care.

Stimuli-responsive nanocarriers for bacterial biofilm treatment

ABSTRACT

Bacterial biofilm infections have been threatening the human's life and health globally for a long time because they typically cause chronic and persistent infections. Traditional antibiotic therapies can hardly eradicate biofilms in many cases, as biofilms always form a robust fortress for pathogens inside, inhibiting the penetration of drugs. To address the issues, many novel drug carriers emerged as promising strategies for biofilm treatment. Among them, stimuli-responsive nanocarriers have attracted much attentions for their intriguing physicochemical properties, such as tunable size, shape and surface chemistry, especially smart drug release characteristic. Based on the microenvironmental difference between biofilm infection sites and normal tissue, many stimuli, such as bacterial products accumulating in biofilms (enzymes, glutathione, etc.), lower pH and higher H₂O₂ levels, have been employed and proved in favor of "on-demand" drug release for biofilm elimination. Additionally, external stimuli including light, heat, microwave and magnetic fields are also able to control the drug releasing behavior artificially. In this review, we summarized recent advances in stimuli-responsive nanocarriers for combating biofilm infections, and mainly, focusing on the different stimuli that trigger the drug release.

摘要

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Skin wounds, the healing process, and hydrogel-based wound dressings: a short review

Skin wounds are damage to the epithelial layer and the integrity of living tissue. The healing mechanism is dynamic and complex, and often treatments with wound dressings help in tissue regeneration, reducing the risk of infections. Polymeric hydrogels become good candidates for wet curing process. These materials prevent dehydration of the tissue and avoid discomfort to the patient when changing the dressing. In this short review, we demonstrate the importance of the healing process, the types of skin wounds, and the hydrogels that are potentially attractive as wound dressings.

Morphological features and mechanical properties of nanofibers scaffolds of polylactic acid modified with hydroxyapatite/CdSe for wound healing applications

Ternary nanocomposites, including graphene oxide (GO), hydroxyapatite (HAP), and cadmium selenite (CdSe) have been encapsulated into nanofibrous scaffolds of polylactic acid. These compositions were indexed as HAP@PLA (C1), CdSe@PLA (C2), HAP/CdSe@PLA (C3), HAP/GO@PLA (C4), and HAP/CdSe/GO@PLA (C5). Structural confirmation is executed by XRD and XPS techniques, while FESEM performs morphological characteristics. CdSe and GO dopants cause a significant increase in nanofiber diameter, HAP/GO@PLA (C4), showing thin surface fibers with fiber diameter up to 3.1 μm, followed by HAP/CdSe/GO@PLA (C4) composite that belongs to filament size up to 2.1 μm. On the other hand, the mechanical properties reveal that the dual dopant composites HAP/CdSe@PLA (C3) and HAP/GO@PLA (C4) hit the maximum tensile fracture values with 1.49 ± 0.3 and 0.99 ± 0.2 MPa. Further, the ternary C5 composite represents the lowest contact angle of 86.1 ± 3.7°. The antibacterial activity increased from 32.4 ± 9.7 and 28.4 ± 6.5% to be 85.3 ± 4.6 and 88.1 ± 5.6% for C1 and C5, respectively, against both E. coli and S. aureus in dark conditions. Moreover, the antibacterial potency enhanced from 75.4 ± 7.6 to be 83.5 ± 6.5 from dark to light conditions against E. coli for the composition of PLA containing the binary composition of HAP/CdSe.

Nanomaterials applied in wound healing: Mechanisms, limitations and perspectives

Internal and external factors cause various types of wounds on the skin. Infections, nonhealing chronic wounds, and aesthetic and functional recovery all cause challenges for clinicians. The development of nanotechnology in biomedicine has brought many new materials, methods and therapeutic targets for the treatment of wounds, which are believed to have great prospects. In this work, the nanomaterials applied in different stages to promote wound healing and systematically expounded their mechanisms were reviewed. Then, the difficulties and defects of the present research and suggested methods for improvement were pointed out. Moreover, based on the current application status of nanomaterials in wound treatment, some new ideas for subsequent studies were proposed and the feasibility of intelligent healing by real-time monitoring, precision regulation, and signal transmission between electronic signals and human nerve signals in the future were discussed. This review will provide valuable directions and spark new thoughts for researchers.

Recent perspectives of nanotechnology in burn wounds management: a review

OBJECTIVE

The burden of the management of problematic skin wounds characterised by a compromised skin barrier is growing rapidly. Almost six million patients are affected in the US alone, with an estimated market of $25 billion annually. There is an urgent requirement for efficient mechanism-based treatments and more efficacious drug delivery systems. Novel strategies are needed for faster healing by reducing infection, moisturising the wound, stimulating the healing mechanisms, speeding up wound closure and reducing scar formation.

METHODS

A systematic review of qualitative studies was conducted on the recent perspectives of nanotechnology in burn wounds management. Pubmed, Scopus, EMBASE, CINAHL and PsychINFO databases were all systematically searched. Authors independently rated the reporting of the qualitative studies included. A comprehensive literature search was conducted covering various resources up to 2018-2019. Traditional techniques aim to simply cover the wound without playing any active role in wound healing. However, nanotechnology-based solutions are being used to create multipurpose biomaterials, not only for regeneration and repair, but also for on-demand delivery of specific molecules. The chronic nature and associated complications of nonhealing wounds have led to the emergence of nanotechnology-based therapies that aim at facilitating the healing process and ultimately repairing the injured tissue.

CONCLUSION

Nanotechnology-based therapy is in the forefront of next-generation therapy that is able to advance wound healing of hard-to-heal wounds. In this review, we will highlight the developed nanotechnology-based therapeutic agents and assess the viability and efficacy of each treatment. Herein we will explore the unmet needs and future directions of current technologies, while discussing promising strategies that can advance the wound-healing field.

Comorbidities of scars in China: a national study based on hospitalized cases

Background

Scar comorbidities seriously affect the physical and mental health of patients, but few studies have reported the exact epidemiological characteristics of scar comorbidities in China. This study aimed to investigate the prevalence of scar comorbidities in China.

Methods

The data of 177,586 scar cases between 2013 and 2018 were obtained from the Hospital Quality Monitoring System based on the 10th edition of the International Classification of Diseases coding system. The total distribution of scar comorbidities and their relationship with age, aetiology and body regions were analysed.

Results

Six comorbidities (contracture, malformation, ocular complications, adhesion, infection and others) were the main focus. In general, male patients outnumbered females and urban areas outnumbered rural areas. The proportion of contractures was the highest at 59,028 (33.24%). Students, workers and farmers made up the majority of the occupation. Han Chinese accounted for the majority of the ethnic. The highest proportion of scar contracture occurred at 1-1.9 years of age (58.97%), after which a significant downward trend was observed. However, starting from 50 years of age, ocular complications increased gradually and significantly, eventually reaching a peak of 34.49% in those aged >80 years. Scar contracture was the most common comorbidity according to aetiology, and the highest proportion was observed in patients who were scalded (29.33%). Contractures were also the most frequent comorbidity in hands (10.30%), lower limbs (6.97%), feet (6.80%) and upper limbs (6.02%). The mean and median hospitalization durations were 12.85 and 8 days, respectively.

Conclusions

Contractures were the most common comorbidities, and different comorbidities tended to occur at different ages and with different causative factors.

Recent trends on burn wound care: hydrogel dressings and scaffolds

Acute and chronic wounds can cause severe physical trauma to patients and also result in an immense socio-economic burden. Thus, wound management has attracted increasing attention in recent years. However, burn wound management is still a major challenge in wound management. Autografts are often considered the gold-standard for burn care, but their application is limited by many factors. Hence, ideal burn dressings and skin substitute dressings are desirable. With the development of biomaterials and progress of tissue engineering technology, some innovative dressings and tissue engineering scaffolds, such as nanofibers, films, foams and hydrogels, have been widely used in the field of biomedicine, especially in wound management. Among them, hydrogels have attracted tremendous attention with their unique advantages. In this review, we discuss the challenges in burn wound management, several crucial design considerations with respect to hydrogels for burn wound healing, and available polymers for hydrogels in burn wound care. In addition, the potential application and plausible prospect of hydrogels are also highlighted.

Altered Genes and Biological Functions in Response to Severe Burns

Severe burns are acute wounds caused by local heat exposure, resulting in life-threatening systemic effects and poor survival. However, the specific molecular mechanisms remain unclear. First, we downloaded gene expression data related to severe burns from the GEO database (GSE19743, GSE37069, and GSE77791). Then, a gene expression analysis was performed to identify differentially expressed genes (DEGs) and construct protein-protein interaction (PPI) network. The molecular mechanism was identified by enrichment analysis and Gene Set Enrichment Analysis. In addition, STEM software was used to screen for genes persistently expressed during response to severe burns, and receiver operating characteristic (ROC) curve was used to identify key DEGs. A total of 2631 upregulated and 3451 downregulated DEGs were identified. PPI network analysis clustered these DEGs into 13 modules. Importantly, module genes mostly related with immune responses and metabolism. In addition, we identified genes persistently altered during the response to severe burns corresponding to survival and death status. Among the genes with high area under the ROC curve in the PPI network gene, CCL5 and LCK were identified as key DEGs, which may affect the prognosis of burn patients. Gene set variation analysis showed that the immune response was inhibited and several types of immune cells were decreased, while the metabolic response was enhanced. The results showed that persistent gene expression changes occur in response to severe burns, which may underlie chronic alterations in physiological pathways. Identifying the key altered genes may reveal potential therapeutic targets for mitigating the effects of severe burns.

Potential use of the Diels-Alder reaction in biomedical and nanomedicine applications

The Diels-Alder reaction and its retro breakdown has garnered increasing research focus due to several of its advantageous properties including, atomic conservation, reversibility, and substituent retention. This is especially true in biomedical application and nanomedicine development which display a preference for rapid, efficient, and clean "click" chemistry reactions allowing for delivery of active ingredients and subsequent release upon temperature elevation. There are multiple variations on the Diels-Alder reaction based around substitution position and materials being coupled which can affect the temperature threshold for and rate of the retro reaction reversal. Hence, the Diels-Alder reaction offers a simple coupling reaction for active ingredients with tailorable release. In this review the incorporation of the Diels-Alder chemistries and linkers within the biomedical and nanomedicine field will be discussed, as well as its use in future potential technologies.

Chitosomes-In-Chitosan Hydrogel for Acute Skin Injuries: Prevention and Infection Control

Burns and other skin injuries are growing concerns as well as challenges in an era of antimicrobial resistance. Novel treatment options to improve the prevention and eradication of infectious skin biofilm-producing pathogens, while enhancing wound healing, are urgently needed for the timely treatment of infection-prone injuries. Treatment of acute skin injuries requires tailoring of formulation to assure both proper skin retention and the appropriate release of incorporated antimicrobials. The challenge remains to formulate antimicrobials with low water solubility, which often requires carriers as the primary vehicle, followed by a secondary skin-friendly vehicle. We focused on widely used chlorhexidine formulated in the chitosan-infused nanocarriers, chitosomes, incorporated into chitosan hydrogel for improved treatment of skin injuries. To prove our hypothesis, lipid nanocarriers and chitosan-comprising nanocarriers (≈250 nm) with membrane-active antimicrobial chlorhexidine were optimized and incorporated into chitosan hydrogel. The biological and antibacterial effects of both vesicles and a vesicles-in-hydrogel system were evaluated. The chitosomes-in-chitosan hydrogel formulation demonstrated promising physical properties and were proven safe. Additionally, the chitosan-based systems, both chitosomes and chitosan hydrogel, showed an improved antimicrobial effect against S. aureus and S. epidermidis compared to the formulations without chitosan. The novel formulation could serve as a foundation for infection prevention and bacterial eradication in acute wounds.

Electrospun chitosan oligosaccharide/polycaprolactone nanofibers loaded with wound-healing compounds of Rutin and Quercetin as antibacterial dressings

Burn injury has posed devastating burdens on the public health due to its inevitable damage to the skin structure resulting in the increased risk of infection. Therefore, it is highly demanding to develop efficacious antibacterial wound-healing dressing. Despite the favourable wound-healing activities, the curative efficacy of phytochemical compounds of quercetin (Qe) and its derivatives is limited by their poor water solubility. Here, we have fabricated a novel electrospun nanofiber membrane (ENM) consisting of polycaprolactone (PCL), chitosan oligosaccharides (COS), and Qe/Rutin (Ru) as the potential bioactive dressing for wound healing. The incorporation of chitosan oligosaccharides (COSs) in the PCL scaffold at the optimized molar ratio not only contributed to the improved hydrophilicity and water absorption performance of the ENM but effectively increased the specific surface area of the formed nanofibers. In particular, the antioxidant and antibacterial activities of the Qe/rutin-loaded nanofiber membranes were tested, which revealed that the PCL-COS-Qe membrane exhibited superior performance among all nanofiber membranes. Therefore, the developed PCL-COS-Qe/Ru nanofiber membranes hold enormous potential as healthcare products, such as wound dressings for burn injuries.

Nanomaterials in Wound Healing and Infection Control

Wounds continue to be a serious medical concern due to their increasing incidence from injuries, surgery, burns and chronic diseases such as diabetes. Delays in the healing process are influenced by infectious microbes, especially when they are in the biofilm form, which leads to a persistent infection. Biofilms are well known for their increased antibiotic resistance. Therefore, the development of novel wound dressing drug formulations and materials with combined antibacterial, antibiofilm and wound healing properties are required. Nanomaterials (NM) have unique properties due to their size and very large surface area that leads to a wide range of applications. Several NMs have antimicrobial activity combined with wound regeneration features thus give them promising applicability to a variety of wound types. The idea of NM-based antibiotics has been around for a decade at least and there are many recent reviews of the use of nanomaterials as antimicrobials. However, far less attention has been given to exploring if these NMs actually improve wound healing outcomes. In this review, we present an overview of different types of nanomaterials explored specifically for wound healing properties combined with infection control.

Antibacterial and wound healing-promoting effect of sponge-like chitosan-loaded silver nanoparticles biosynthesized by iturin

Silver nanoparticles (AgNPs) are widely used in wound dressing, but are limited in the application due to its high toxicity at effective concentrations. iturin-AgNPs was previously found to have much higher antibacterial activity at lower AgNPs content than the commercial AgNPs. To verify its potential application in the promotion of wound healing, a chitosan (CS) composite sponge dressing-loaded iturin-AgNPs was developed and evaluated for their antibacterial activity in vitro and used for wound healing in vivo. As results, the synthesized CS dressing had high porosity and water absorption. As expected, the antibacterial activity of CS dressing was significantly promoted by the incorporation of iturin-AgNPs. The CS dressing-loaded iturin-AgNPs showed more effective inhibition of bacterial infection and promotion of wound healing processing and quality than the commercial wound dressing loaded AgNPs in vivo. The mechanisms for the promotion of wound healing by the CS dressing-loaded iturin-AgNPs were found as the enhancement of re-epithelialization and collagen formation, as well as the increased antibacerial activity. No toxicity was found to all organs of mice. The study developed an efficient way to enhance the antibacterial activity of CS dressing loaded AgNPs at low toxicity, which has great potential in wound care application.

Pressure-driven spreadable deferoxamine-laden hydrogels for vascularized skin flaps

The development of hydrogels that support vascularization to improve the survival of skin flaps, yet establishing homogeneous angiogenic niches without compromising the ease of use in surgical settings remains a challenge. Here, pressure-driven spreadable hydrogels were developed utilizing beta-sheet rich silk nanofiber materials. These silk nanofiber-based hydrogels exhibited excellent spreading under mild pressure to form a thin coating to cover all the regions of the skin flaps. Deferoxamine (DFO) was loaded onto the silk nanofibers to support vascularization and these DFO-laden hydrogels were implanted under skin flaps in rats to fill the interface between the wound bed and the flap using the applied pressure. The thickness of the spread hydrogels was below 200 μm, minimizing the physical barrier effects from the hydrogels. The distribution of the hydrogels provided homogeneous angiogenic stimulation, accelerating rapid blood vessel network formation and significantly improving the survival of the skin flaps. The hydrogels also modulated the immune reactions, further facilitating the regeneration of the skin flaps. Considering the homogeneous distribution at the wound sites, improved vascularization, reduced barrier effects and low inflammation, these hydrogels appear to be promising candidates for use in tissue repair where a high blood supply is in demand. The pressure-driven spreading properties should simplify the use of the hydrogels in surgical settings to facilitate clinical translation.

The Role of Porphyrinoid Photosensitizers for Skin Wound Healing

Microorganisms, usually bacteria and fungi, grow and spread in skin wounds, causing infections. These infections trigger the immune system and cause inflammation and tissue damage within the skin or wound, slowing down the healing process. The use of photodynamic therapy (PDT) to eradicate microorganisms has been regarded as a promising alternative to anti-infective therapies, such as those based on antibiotics, and more recently, is being considered for skin wound-healing, namely for infected wounds. Among the several molecules exploited as photosensitizers (PS), porphyrinoids exhibit suitable features for achieving those goals efficiently. The capability that these macrocycles display to generate reactive oxygen species (ROS) gives a significant contribution to the regenerative process. ROS are responsible for avoiding the development of infections by inactivating microorganisms such as bacteria but also by promoting cell proliferation through the activation of stem cells which regulates inflammatory factors and collagen remodeling. The PS can act solo or combined with several materials, such as polymers, hydrogels, nanotubes, or metal-organic frameworks (MOF), keeping both the microbial photoinactivation and healing/regenerative processes' effectiveness. This review highlights the developments on the combination of PDT approach and skin wound healing using natural and synthetic porphyrinoids, such as porphyrins, chlorins and phthalocyanines, as PS, as well as the prodrug 5-aminolevulinic acid (5-ALA), the natural precursor of protoporphyrin-IX (PP-IX).

Synergistic and On-Demand Release of Ag-AMPs Loaded on Porous Silicon Nanocarriers for Antibacteria and Wound Healing

Due to the abuse of antibiotics, antimicrobial resistance is rapidly emerging and becoming a major global risk for public health. Thus, there is an urgent need for reducing the use of antibiotics, finding novel treatment approaches, and developing controllable release systems. In this work, a dual synergistic antibacterial platform with on-demand release ability based on silver nanoparticles (AgNPs) and antimicrobial peptide (AMP) coloaded porous silicon (PSi) was developed. The combination of AgNPs and AMPs (Tet-213, KRWWKWWRRC) exhibited an excellent synergistic antibacterial effect. As a carrier, porous silicon can efficiently load AgNPs and AMP under mild conditions and give the platform an on-demand release ability and a synergistic release effect. The AgNPs and AMP coloaded porous silicon microparticles (AgNPs-AMP@PSiMPs) exhibited an acid pH and reactive oxygen species (ROS)-stimulated release of silver ions (Ag⁺) and AMPs under bacterial infection conditions because of oxidation and desorption effects. Moreover, the release of the bactericide could be promoted by each other due to the interplay between AgNPs and Tet-213. In vitro antibacterial tests demonstrated that AgNPs-AMP@PSiMPs inherited the intrinsic properties and synergistic antibacterial efficiency of both bactericides. In addition, wound dressing loaded with AgNPs-AMP@PSiMPs showed outstanding in vivo bacteria-killing activity, accelerating wound-healing, and low biotoxicity in aStaphylococcus aureus-infected rat wound model. The present work demonstrated that PSiMPS might be an efficient platform for loading the antibiotic-free bactericide, which could synergistically and on-demand release to fight wound infection and promote wound healing.

A composite hydrogel with co-delivery of antimicrobial peptides and platelet-rich plasma to enhance healing of infected wounds in diabetes

Diabetic wound healing remains a major challenge due to its vulnerability to bacterial infection, as well as the less vascularization and prolonged inflammatory phase. In this study, we developed a hydrogel system for the treatment of chronic infected wounds, which can regulate inflammatory (through the use of antimicrobial peptides) and enhance collagen deposition and angiogenesis (through the addition of platelet-rich plasma (PRP)). Based on the formation of Schiff base linkage, the ODEX/HA-AMP/PRP hydrogel was prepared by mixing oxidized dextran (ODEX), antimicrobial peptide-modified hyaluronic acid (HA-AMP) and PRP under physiological conditions, which exhibited obvious inhibition zones against three pathogenic bacterial strains (E. coli, S. aureus and P. aeruginosa) and slow release ability of antimicrobials and growth factors. Moreover, CCK-8, live/dead fluorescent staining and scratch test confirmed that ODEX/HA-AMP/PRP hydrogel could facilitate the proliferation and migration of L929 fibroblast cells. More importantly, in vivo experiments further demonstrated that the prepared hydrogels could significantly improve wound healing in a diabetic mouse infection by regulating inflammation, accelerating collagen deposition and angiogenesis. In addition, prepared hydrogel showed a significant antibacterial activity against S. aureus and P. aeruginosa, inhibited pro-inflammatory factors (TNF-α, IL-1β and IL-6), enhanced anti-inflammatory factors (TGF-β1) and vascular endothelial growth factor (VEGF) production. The findings of this study suggested that the composite hydrogel with AMP and PRP controlled release ability could be used as a promising candidate for chronic wound healing and infection-related wound healing.

Plant oils: From chemical composition to encapsulated form use

The last decade has witnessed a burgeoning global movement towards essential and vegetable oils in the food, agriculture, pharmaceutical, cosmetic, and textile industries thanks to their natural and safe status, broad acceptance by consumers, and versatile functional properties. However, efforts to develop new therapy or functional agents based on plant oils have met with challenges of limited stability and/or reduced efficacy. As a result, there has been increased research interest in the encapsulation of plant oils, whereby the nanocarriers serve as barrier between plant oils and the environment and control oil release leading to improved efficacy, reduced toxicity and enhanced patient compliance and convenience. In this review, special concern has been addressed to the encapsulation of essential and vegetable oils in three types of nanocarriers: polymeric nanoparticles, liposomes and solid lipid nanoparticles. First, the chemical composition of essential and vegetable oils was handled. Moreover, we gather together the research findings reported by the literature regarding the different techniques used to generate these nanocarriers with their significant findings. Finally, differences and similarities between these nanocarriers are discussed, along with current and future applications that are warranted by their structures and properties.

A double-network polysaccharide-based composite hydrogel for skin wound healing

Effective wound dressings are of great significance in preventing infections and promoting wound healing. However, most existing hydrogel dressings have an inadequacy in either mechanical performance, biological activities, or versatilities. Here we presented a double-network cross-linked polysaccharide-based hydrogel composed of collagen peptide-functionalized carboxymethyl chitosan (CS) and oxidized methacrylate sodium alginate (SA). The hydrogel possessed interconnected porous morphologies, suitable swelling ratios, excellent mechanical properties, and favorable biocompatibility. Meanwhile, the in vivo studies using a mouse full-thickness skin defect model showed that the double-network CS/SA hydrogel significantly accelerated wound healing by regulating the inflammatory process, promoting collagen deposition, and improving vascularization. Therefore, the functionalized double-network hydrogel should be a potential candidate as wound dressings.

Conductive Antibacterial Hemostatic Multifunctional Scaffolds Based on Ti3C2Tx MXene Nanosheets for Promoting Multidrug-Resistant Bacteria-Infected Wound Healing

Chronic bacterial-infected wound healing/skin regeneration remains a challenge due to drug resistance and the poor quality of wound repair. The ideal strategy is combating bacterial infection, while facilitating satisfactory wound healing. However, the reported strategy hardly achieves these two goals simultaneously without the help of antibiotics or bioactive molecules. In this work, a two-dimensional (2D) Ti₃C₂T_x MXene with excellent conductivity, biocompatibility, and antibacterial ability was applied in developing multifunctional scaffolds (HPEM) for methicillin-resistant Staphylococcus aureus (MRSA)-infected wound healing. HPEM scaffolds were fabricated by the reaction between the poly(glycerol-ethylenimine), Ti₃C₂T_x MXene@polydopamine (MXene@PDA) nanosheets, and oxidized hyaluronic acid (HCHO). HPEM scaffolds presented multifunctional properties containing self-healing behavior, electrical conductivity, tissue-adhesive feature, antibacterial activity especially for MRSA resistant to many commonly used antibiotics (antibacterial efficiency was 99.03%), and rapid hemostatic capability. HPEM scaffolds enhanced the proliferation of normal skin cells with negligible toxicity. Additionally, HPEM scaffolds obviously accelerated the MRSA-infected wound healing (wound closure ratio was 96.31%) by efficient anti-inflammation effects, promoting cell proliferation, and the angiogenic process, stimulating granulation tissue formation, collagen deposition, vascular endothelial differentiation, and angiogenesis. This study indicates the important role of multifunctional 2D MXene@PDA nanosheets in infected wound healing. HPEM scaffolds with multifunctional properties provide a potential strategy for MRSA-infected wound healing/skin regeneration.

Cytotoxicity and Epidermal Barrier Function Evaluation of Common Antiseptics for Clinical Use in an Artificial Autologous Skin Model

Bioengineered artificial skin substitutes (BASS) are the main treatment used in addition to autografts when skin injuries involve a large body surface area. Antiseptic/antibiotic treatment is necessary to prevent infections in the BASS implant area. This study aims to evaluate the effect of antiseptics and antibiotics on cell viability, structural integrity, and epidermal barrier function in BASS based on hyaluronic acid during a 28 day follow-up period. Keratinocytes (KTs) and dermal fibroblasts (DFs) were isolated from skin samples and used to establish BASS. The following antibiotic/antiseptic treatment was applied every 48 h: colistin (1%), chlorhexidine digluconate (1%), sodium chloride (0.02%), and polyhexanide (0.1%). Cell viability (LIVE/DEAD® assay), structural integrity (histological evaluation), and epidermal barrier function (trans-epidermal water loss, (TEWL), Tewameter®) were also evaluated. Cell viability percentage of BASS treated with chlorhexidine digluconate was significantly lower (p ≤ 0.001) than the other antiseptics at day 28. Compared to other treatments, chlorhexidine digluconate and polyhexanide significantly affected the epithelium. No significant differences were found regarding epidermal barrier. These results may be useful for treatment protocols after implantation of BASS in patients and evaluating them in clinical practice. BASS represent a suitable model to test in vitro the impact of different treatments of other skin wounds.

Development of Bacterial Cellulose Biocomposites Combined with Starch and Collagen and Evaluation of Their Properties

One of the major benefits of biomedicine is the use of biocomposites as wound dressings to help improve the treatment of injuries. Therefore, the main objective of this study was to develop and characterize biocomposites based on bacterial cellulose (BC) with different concentrations of collagen and starch and characterize their thermal, morphological, mechanical, physical, and barrier properties. In total, nine samples were produced with fixed amounts of glycerol and BC and variations in the amount of collagen and starch. The water activity (0.400–0.480), water solubility (12.94–69.7%), moisture (10.75–20.60%), thickness (0.04–0.11 mm), water vapor permeability (5.59–14.06 × 10⁻⁸ g·mm/m²·h·Pa), grammage (8.91–39.58 g·cm⁻²), opacity (8.37–36.67 Abs 600 nm·mm⁻¹), elongation (4.81–169.54%), and tensile strength (0.99–16.32 MPa) were evaluated and defined. In addition, scanning electron microscopy showed that adding biopolymers in the cellulose matrix made the surface compact, which also influenced the visual appearance. Thus, the performance of the biocomposites was directly influenced by their composition. The performance of the different samples obtained resulted in them having different potentials for application considering the injury type. This provides a solution for the ineffectiveness of traditional dressings, which is one of the great problems of the biomedical sector.

Nanotheranostics: A Possible Solution for Drug-Resistant Staphylococcus aureus and their Biofilms?

Staphylococcus aureus is a notorious pathogen that colonizes implants (orthopedic and breast implants) and wounds with a vicious resistance to antibiotic therapy. Methicillin-resistant S. aureus (MRSA) is a catastrophe mainly restricted to hospitals and emerged to community reservoirs, acquiring resistance and forming biofilms. Treating biofilms is problematic except via implant removal or wound debridement. Nanoparticles (NPs) and nanofibers could combat superbugs and biofilms and rapidly diagnose MRSA. Nanotheranostics combine diagnostics and therapeutics into a single agent. This comprehensive review is interpretative, utilizing mainly recent literature (since 2016) besides the older remarkable studies sourced via Google Scholar and PubMed. We unravel the molecular S. aureus resistance and complex biofilm. The diagnostic properties and detailed antibacterial and antibiofilm NP mechanisms are elucidated in exciting stories. We highlight the challenges of bacterial infections nanotheranostics. Finally, we discuss the literature and provide "three action appraisals". (i) The first appraisal consists of preventive actions (two wings), avoiding unnecessary hospital visits, hand hygiene, and legislations against over-the-counter antibiotics as the general preventive wing. Our second recommended preventive wing includes preventing the adverse side effects of the NPs from resistance and toxicity by establishing standard testing procedures. These standard procedures should provide breakpoints of bacteria's susceptibility to NPs and a thorough toxicological examination of every single batch of synthesized NPs. (ii) The second appraisal includes theranostic actions, using nanotheranostics to diagnose and treat MRSA, such as what we call "multifunctional theranostic nanofibers. (iii) The third action appraisal consists of collaborative actions.

Releasable antimicrobial polymer-silk coatings for combating multidrug-resistant bacteria

Controlled release of synthetic cationic antimicrobial polymers from silk-based coating for preventing bacterial biofilm formation on the surface and for killing planktonic bacteria cells.

Nanoparticle-functionalized dressings for the treatment of third-degree skin burns - histopathological and immunohistochemical study

Skin burns are one of the most common injuries associated with increased morbidity and mortality, especially in the children and the elderlies. Severe burns, especially, result in a systemic immune and inflammatory response, which may reflect in multiple organ insufficiency, and a fast and effective local restorative process is essential for functionality recovering, as well as for interrupting the generalized systemic response. We have aimed here to assess the effect of different wound dressings in what it regards the morphology and clinical restoration after a skin burn. On a rat animal model, we have evaluated the macroscopic and histopathological features of controlled third degree skin burns in control animals versus treatments with local dressings of silver sulfadiazine (SDA) cream, simple gel (G), gel + silver nanoparticles (AgNPs) (G+NPS), gel + exosomes (G+EXO) and gel + AgNPs + exosomes (Gel+NPS+EXO), at 14 days and, respectively, 21 days after the lesion. Tissue fragments were harvested and processed for histopathology and immunohistochemistry. Immunofluorescence was utilized to evaluate the maturity of underlaying granulation tissue based on double stainings for smooth muscle actin (SMA) and cluster of differentiation 31 (CD31). Our study showed variability in what it regards the vessel density and immunoexpression of SMA between the treatments, and image analysis revealed that most SMA reduction and blood vessel density reduction in the maturing granulation tissue occurred for the G+NPS and G+NPS+EXO treatments. A complete re-epithelization was also observed for the G+NPS+EXO treatment. Overall, our results show that improved topic treatments promote faster re-epithelization and reparation of the dermis after skin burn lesions, providing thus an avenue for new treatments that aim both local recuperation and systemic infection prevention.