Synthetic polymeric biomaterials for wound healing: a review

Bio-extract amalgamated sodium alginate-cellulose nanofibres based 3D-sponges with interpenetrating BioPU coating as potential wound care scaffolds

In this work, sodium alginate (SA) based "all-natural" composite bio-sponges were designed for potential application as wound care scaffold. The composite bio-sponges were developed from the aqueous amalgamation of SA and cellulose nanofibres (CNFs) in bio-extracts like Rice water (Rw) and Giloy extract (Ge). These sponges were modified by employing a simple coating strategy using vegetable oil-based bio-polyurethane (BioPU) to tailor their physicochemical and biological properties so as to match the specific requirements of a wound care scaffold. Bio-sponges with shared interpenetrating polymeric network structures were attained at optimized BioPU coating formulation. The interpenetration of BioPU chains within the sponge construct resulted in the formation of numerous micro-networks in the interconnected microporous structure of sponges (porosity ≥75%). The coated sponge showed a superior mechanical strength (compressive strength ~3.8 MPa, compressive modulus ~35 MPa) with appreciable flexibility and recoverability under repeated compressive loading-unloading cycles. A tunable degradation behaviour was achieved by varying BioPU coating concentrations owing to the different degree of polymer chain entanglement within the sponge construct. The physical entanglement of BioPU chains with core structural components of sponge improved their structural stability by suppressing their full fragmentation in water-based medium without affecting its swelling behaviour (swelling ratio > 1000%). The coated sponge surface has provided a suitable moist-adherent physical environment to support the adhesion and growth of skin cells (HaCaT cells). The MTT (3-(4,5-dimethyl thiazolyl-2)-2,5-diphenyltetrazolium bromide) assay and hemolytic assay revealed the non-toxic and biocompatible nature of coated sponges in vitro. Moreover, no signs of skin erythema or edema were observed during in vivo dermal irritation and corrosion test performed on the skin of Sprague Dawley (SD) rats. Our initial observations revealed the credibility of these sponges as functional wound care scaffolds as well as its diverse potential as a suitable substrate for various tissue engineering applications.

Advanced Hydrogels as Wound Dressings

Skin is the largest organ of the human body, protecting it against the external environment. Despite high self-regeneration potential, severe skin defects will not heal spontaneously and need to be covered by skin substitutes. Tremendous progress has been made in the field of skin tissue engineering, in recent years, to develop new skin substitutes. Among them, hydrogels are one of the candidates with most potential to mimic the native skin microenvironment, due to their porous and hydrated molecular structure. They can be applied as a permanent or temporary dressing for different wounds to support the regeneration and healing of the injured epidermis, dermis, or both. Based on the material used for their fabrication, hydrogels can be subdivided into two main groups—natural and synthetic. Moreover, hydrogels can be reinforced by incorporating nanoparticles to obtain “in situ” hybrid hydrogels, showing superior properties and tailored functionality. In addition, different sensors can be embedded in hydrogel wound dressings to provide real-time information about the wound environment. This review focuses on the most recent developments in the field of hydrogel-based skin substitutes for skin replacement. In particular, we discuss the synthesis, fabrication, and biomedical application of novel “smart” hydrogels.

Cellulose Nanofibrils-based Hydrogels for Biomedical Applications: Progresses and Challenges

Background:

Cellulose Nanofibrils (CNFs) are natural nanomaterials with nanometer dimensions. Compared with ordinary cellulose, CNFs own good mechanical properties, large specific surface areas, high Young's modulus, strong hydrophilicity and other distinguishing characteristics, which make them widely used in many fields. This review aims to introduce the preparation of CNFs-based hydrogels and their recent biomedical application advances.

Methods:

By searching the recent literatures, we have summarized the preparation methods of CNFs, including mechanical methods and chemical mechanical methods, and also introduced the fabrication methods of CNFs-based hydrogels, including CNFs cross-linked with metal ion and with polymers. In addition, we have summarized the biomedical applications of CNFs-based hydrogels, including scaffold materials and wound dressings.

Results:

CNFs-based hydrogels are new types of materials that are non-toxic and display a certain mechanical strength. In the tissue scaffold application, they can provide a micro-environment for the damaged tissue to repair and regenerate it. In wound dressing applications, it can fit the wound surface and protect the wound from the external environment, thereby effectively promoting the healing of skin tissue.

Conclusion:

By summarizing the preparation and application of CNFs-based hydrogels, we have analyzed and forecasted their development trends. At present, the research of CNFs-based hydrogels is still in the laboratory stage. It needs further exploration to be applied in practice. The development of medical hydrogels with high mechanical properties and biocompatibility still poses significant challenges.

Investigating the skin penetration and wound healing properties of niosomal pentoxifylline cream

Wounds are defined as any injuries to the skin. Wounds can cause great inconvenience and health problems for the patients depending on the healing time and severity. This makes wound healing and the strategies to treat a wound or reduce their treatment time, an important concern in health care systems. Pentoxifylline (PTX) has been reported to facilitate the wound healing in systemic administration. Different cellular and immunological mechanisms have been reported and suggested regarding the promising effects of PTX. On the other hand, the topical application of PTX seems to improve its therapeutic efficiency by localizing the drug on the wound site. In this study, PTX-niosomes were prepared and characterized. Niosomes with Zavg of 150, 200, and 300 nm were incorporated into the base cold cream. In-vitro release of PTX from these formulations was obtained between 70 -100%. Ex-vivo penetration/retention studies showed that niosomal formulations (F₆ and F₇) increased penetration of PTX by 1.8 and 1.2 times, respectively in comparison with the PTX-conventional cream. Retention of PTX from both niosomal creams was about 2 times higher than the PTX-conventional cream. In -vivo studies on the full-thickness wound in BALB/c mice showed that PTX-niosomal creams shortened the duration of wound healing by two days compared to control groups (PTX-conventional cream, base cream, and no treatment). The final wound size in the niosomal cream-treated group was also significantly smaller than the control groups. Histological analysis of the wounds confirmed the results of in-vivo studies.

Innovations in Infection Prevention and Treatment

Background: Patients with large, acute burn injuries are a major challenge for clinicians. The loss of skin barrier protection against micro-organisms combined with the induced immunosuppression after burn injury makes this population especially vulnerable to infection. For burn-injured patients who survive immediate management considerations and burn resuscitation after acute injury, sepsis remains the primary cause of death. The purpose of this article is to describe current strategies and innovations in burn sepsis prevention and management. Methods: This work reviews the current understanding of the systemic inflammatory response to burn injury and burn sepsis as well as current strategies in insolation and infection prevention, newer burn unit design strategies in the context of infection prevention, and novel therapies being considered in topical antimicrobial wound care management. Results: A review of burn sepsis is key to understanding current paradigms and innovation in burn management and prevention. Key management principles begin from the time of injury and persist throughout the patient's hospital course. This includes use of personal protective equipment, burn unit design considerations, and knowledge of critical care principles such as central venous catheter management strategies. Innovations on wound dressing types, forms, and use have been key to better controlling burn wound sepsis and improving wound healing. Products incorporating nanotechnology, novel anions, oxygen, and even light have been key to introducing previously unconsidered methods to fight or prevent infection. Conclusion: Understanding the pathophysiology and source identification of sepsis from burn wounds has been a key contributor in developing innovative prevention and therapeutic strategies in burn management. The emergence of drug-resistant pathogens and the difficulty of systemic antibiotic agents to reach poorly vascularized wounds have further reinforced the need to anticipate management strategies moving forward. A proactive, multidisciplinary approach is necessary to minimize the morbidity and mortality associated with infection control.

Micro-Structured Patches for Dermal Regeneration Obtained via Electrophoretic Replica Deposition

Artificial substrates supporting the healing of skin wounds require specific structural and chemical architectures that promote a recapitulation of the complexity of the native organ. Bottom-up fabrication technologies are emerging as effective strategies to fine tune biochemical, morphological, and structural features intended for regenerative applications. Here, we proposed an electrophoretic replica deposition (EPrD) approach to realize chitosan three-dimensional structures specifically designed to treat patients with serious cutaneous damages or losses. The EPrD process has been optimized to consistently obtain random porosity vs. hierarchical lattice structures, showing mechanical properties in the range of skin tissue (E = 0.2–20 MPa). The obtained patches were tested in vivo via a one-stage grafting procedure in a full thickness skin wound rat model. Chitosan patches showed no adverse reactions throughout the experimental period (14 days). Hair follicles and sebaceous glands were observed in histological sections, indicating the regeneration of a thin epidermal layer with more skin appendages. Immunohistochemistry results demonstrated that keratin 10 was mostly expressed in basal and suprabasal layers, like normal skin, in structures with random porosity and with smaller lattice structures. The obtained results show the potential of EPrD to innovate the design of artificial substrates in skin healing therapies.

Recent Advances in the Controlled Release of Growth Factors and Cytokines for Improving Cutaneous Wound Healing

Bioengineered materials are widely utilized due to their biocompatibility and degradability, as well as their moisturizing and antibacterial properties. One field of their application in medicine is to treat wounds by promoting tissue regeneration and improving wound healing. In addition to creating a physical and chemical barrier against primary infection, the mechanical stability of the porous structure of biomaterials provides an extracellular matrix (ECM)-like niche for cells. Growth factors (GFs) and cytokines, which are secreted by the cells, are essential parts of the complex process of tissue regeneration and wound healing. There are several clinically approved GFs for topical administration and direct injections. However, the limited time of bioactivity at the wound site often requires repeated drug administration that increases cost and may cause adverse side effects. The tissue regeneration promoting factors incorporated into the materials have significantly enhanced wound healing in comparison to bolus drug treatment. Biomaterials protect the cargos from protease degradation and provide sustainable drug delivery for an extended period of time. This prolonged drug bioactivity lowered the dosage, eliminated the need for repeated administration, and decreased the potential of undesirable side effects. In the following mini-review, recent advances in the field of single and combinatorial delivery of GFs and cytokines for treating cutaneous wound healing will be discussed.

Novel ECM Patch Combines Poly(vinyl alcohol), Human Fibroblast-Derived Matrix, and Mesenchymal Stem Cells for Advanced Wound Healing

Decellularized extracellular matrix (ECM)-based scaffold has been a very useful resource for effective tissue regeneration. In this study, we report a novel ECM patch that physically combines human fibroblast-derived matrix (hFDM) and poly(vinyl alcohol) (PVA) hydrogel. hFDM was obtained after decellularization of in vitro cultured human fibroblasts. We investigated the basic characteristics of hFDM alone using immunofluorescence (fibronectin, collagen type I) and angiogenesis-related factor analysis. Successful incorporation of hFDM with PVA produced an hFDM/PVA patch, which showed excellent cytocompatibility with human mesenchymal stem cells (hMSCs), as assessed via cell adhesion, viability, and proliferation. Moreover, in vitro scratch assay using human dermal fibroblasts showed a significant improvement of cell migration when treated with the paracrine factors originated from the hMSC-incorporated hFDM. To evaluate the therapeutic effect on wound healing, hMSCs were seeded on the hFDM/PVA patch and they were then transplanted into a mouse full-thickness wound model. Among four experimental groups (control, PVA, hFDM/PVA, hMSC/hFDM/PVA), we found that hMSC/hFDM/PVA patch accelerated the wound closure with time. More notably, histology and immunofluorescence demonstrated that compared to the other interventions tested, hMSC/hFDM/PVA patch could lead to significantly advanced tissue regeneration, as confirmed via nearly normal epidermis thickness, skin adnexa regeneration (hair follicle), mature collagen deposition, and neovascularization. Additionally, cell tracking of prelabeled hMSCs suggests the in vivo retention of transplanted cells in the wound region after the transplantation of hMSC/hFDM/PVA patch. Taken together, our engineered ECM patch supports a strong regenerative potential toward advanced wound healing.

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

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

Hydrogel Dressings for the Treatment of Burn Wounds: An Up-To-Date Overview

Globally, the fourth most prevalent devastating form of trauma are burn injuries. Ideal burn wound dressings are fundamental to facilitate the wound healing process and decrease pain in lower time intervals. Conventional dry dressing treatments, such as those using absorbent gauze and/or absorbent cotton, possess limited therapeutic effects and require repeated dressing changes, which further aggravate patients' suffering. Contrariwise, hydrogels represent a promising alternative to improve healing by assuring a moisture balance at the burn site. Most studies consider hydrogels as ideal candidate materials for the synthesis of wound dressings because they exhibit a three-dimensional (3D) structure, which mimics the natural extracellular matrix (ECM) of skin in regard to the high-water amount, which assures a moist environment to the wound. There is a wide variety of polymers that have been used, either alone or blended, for the fabrication of hydrogels designed for biomedical applications focusing on treating burn injuries. The aim of this paper is to provide an up-to-date overview of hydrogels applied in burn wound dressings.

Nanomaterials for Wound Dressings: An Up-to-Date Overview

As wound healing continues to be a challenge for the medical field, wound management has become an essential factor for healthcare systems. Nanotechnology is a domain that could provide different new approaches concerning regenerative medicine. It is worth mentioning the importance of nanoparticles, which, when embedded in biomaterials, can induce specific properties that make them of interest in applications as materials for wound dressings. In the last years, nano research has taken steps to develop molecular engineering strategies for different self-assembling biocompatible nanoparticles. It is well-known that nanomaterials can improve burn treatment and also the delayed wound healing process. In this review, the first-line of bioactive nanomaterials-based dressing categories frequently applied in clinical practice, including semi-permeable films, semipermeable foam dressings, hydrogel dressings, hydrocolloid dressings, alginate dressings, non-adherent contact layer dressings, and multilayer dressings will be discussed. Additionally, this review will highlight the lack of high-quality evidence and the necessity for future advanced trials because current wound healing therapies generally fail to provide an excellent clinical outcome, either structurally or functionally. The use of nanomaterials in wound management represents a unique tool that can be specifically designed to closely reflect the underlying physiological processes in tissue repair.

Coaxial electrospinning of PEEU/gelatin to fiber meshes with enhanced mesenchymal stem cell attachment and proliferation

Microfibers with a core-shell structure can be produced by co-axial electrospinning, allowing for the functionalization of the outer layer with bioactive molecules. In this study, a thermoplastic, degradable polyesteretherurethane (PEEU), consisting of poly(p-dioxanone) (PPDO) and poly(ɛ-caprolactone) (PCL) segments with different PPDO to PCL weight ratios, were processed into fiber meshes by co-axial electrospinning with gelatin. The prepared PEEU fibers have a diameter of 1.3±0.5 μm and an elastic modulus of around 5.1±1.0 MPa as measured by tensile testing in a dry state at 37°C, while the PEEU/Gelatin core-shell fibers with a gelatin content of 12±6 wt% and a diameter of 1.5±0.5 μm possess an elastic modulus of 15.0±1.1 MPa in a dry state at 37 °C but as low as 0.7±0.7 MPa when hydrated at 37 °C. Co-axial electrospinning allowed for the homogeneous distribution of the gelatin shell along the whole microfiber. Gelatin with conjugated Fluorescein (FITC) remained stable on the PEEU fibers after 7 days incubation in Phosphate-buffered saline (PBS) at 37 °C. The gelatin coating on PEEU fibers lead to enhanced human adipose tissue derived mesenchymal stem cell (hADSC) attachment and a proliferation rate 81.7±34.1 % higher in cell number in PEEU50/Gelatin fibers after 7 days of cell culture when compared to PEEU fibers without coating. In this work, we demonstrate that water-soluble gelatin can be incorporated as the outer shell of a polymer fiber via molecular entanglement, with a sustained presence and role in enhancing stem cell attachment and proliferation.

Development and Evaluation of a Polyvinylalcohol -Cellulose Derivative-Based Film with Povidone-Iodine Predicted for Wound Treatment

The aim of this study was to develop and assess a polyvinyl alcohol-cellulose derivatives-based film with incorporated povidone-iodine (PVP-I) predicted for applications in the treatment of periodontitis. Films were fabricated by solvent-casting, and their physical characteristics, such as their surface and structure morphology, mechanical properties, and disintegrating time, were evaluated. For in vitro iodine release studies and evaluation, the antimicrobial activity was tested using a modified disc diffusion method against five microbial strains. For further use, we selected the film with polyvinyl alcohol-hydroxypropyl methylcellulose (PVA/HPMC_B) based on acceptable physicochemical properties. To assess the subacute toxicity of the film composition, the tissue regeneration process was tested in rats and compared to a conventional dressing commonly used in wound healing (Spongostan). Seven days after implantation, dorsal skin sections and blood samples (n = 10, in total n = 30) were examined. The wound area, epithelium, and dermis were evaluated microscopically, while the blood collected from the rats underwent biochemical analysis. The blood biochemistry results were comparable in all three groups. No significant histological differences between the Spongostan and the placebo film developed after subcutaneous implantation were observed. In contrast, the inflammation stage was reduced and the “scar” in the dermis was smaller when PVP-I and PVA/HPMC_B films were used. A smaller local inflammatory response inflicted less tissue damage, leading to the activation of subsequent regeneration phases and restoration of the area to its original state. The results obtained confirmed that PVP-I incorporated into PVA-hydroxypropyl methylcellulose film is a promising drug carrier, working faster and more effectively than the other two dressing materials evaluated. These developments provide a promising alternative in tissue regeneration and the wound healing process.

Recent Advances in Nanomaterial-Based Wound-Healing Therapeutics

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

Highly Elastic and Water Stable Zein Microfibers as a Potential Drug Delivery System for Wound Healing

The development of biomaterials for wound healing applications requires providing a number of properties, such as antimicrobial action, facilitation of cell proliferation, biocompatibility and biodegradability. The aim of the present study was to investigate morphological and mechanical properties of zein-based microfibers, ultimately aimed at creating an environment suitable for wound healing. This was achieved through co-axial electrospinning of core-shell microfibers, with zein protein in the core and polyethylene oxide (PEO) in the shell. Small amounts of PEO or stearic acid were additionally incorporated into the fiber core to modify the morphology and mechanical properties of zein fibers. The presence of PEO in the core was found to be essential for the formation of tubular fibers, whereas PEO in the shell enhanced the stability of the microfibers in water and ensured high elasticity of the microfiber mats. Tetracycline hydrochloride was present in an amorphous form within the fibers, and displayed a burst release as a result of pore-formation in the fibers. The developed systems exhibited antimicrobial activity against Staphylococcus aureus and Escherichia coli, and showed no cytotoxic effect on fibroblasts. Biocompatibility, antimicrobial activity and favorable morphological and mechanical properties make the developed zein-based microfibers a potential biomaterial for wound healing purposes.

Modulating neutrophil extracellular traps for wound healing

A diabetic microenvironment primes neutrophils for NETosis, a process of formation of neutrophil extracellular traps (NETs) that further degrades the neutrophils and makes them unavailable for the early-stage inflammatory processes. Mechanistically, simple modification of arginine residues of histones to citrulline by peptidylarginine deiminase (PAD4) enzyme is considered to be a prerequisite for NETosis. In fact, under diabetic conditions, an increase in PAD4-mediated NET formation is considered as one of the reasons for impaired wound healing. Therefore, in the present work, an alginate-GelMa (generally recognized as safe category by FDA, USA) based hydrogel scaffold containing a tripeptide (Thr-Asp-F-amidine) that inhibits PAD4 is developed, based on the hypothesis that inhibiting PAD4 enzyme might offer a way to enhance wound healing under diabetic conditions. The scaffolds are thoroughly characterized for their physicochemical and biological properties. Furthermore, neutrophil-scaffold interactions in terms of NETosis ability and release of other related biomarkers are studied. The wound healing ability is evaluated by a cell migration assay. In vivo wound healing efficacy of the developed scaffolds is demonstrated using a diabetic rat model. The results suggest a reduction in NETosis in the presence of a PAD4 inhibitor. Thus, the study demonstrates a novel scaffold system to deliver the PAD4 inhibitor that can be used to modulate NETosis and improve wound healing.

Hydrogel membranes: A review

Hydrogel membranes (HMs) are defined and applied as hydrated porous media constructed of hydrophilic polymers for a broad range of applications. Fascinating physiochemical properties, unique porous architecture, water-swollen features, biocompatibility, and special water content dependent transport phenomena in semi-permeable HMs make them appealing constructs for various applications from wastewater treatment to biomedical fields. Water absorption, mechanical properties, and viscoelastic features of three-dimensional (3D) HM networks evoke the extracellular matrix (ECM). On the other hand, the porous structure with controlled/uniform pore-size distribution, permeability/selectivity features, and structural/chemical tunability of HMs recall membrane separation processes such as desalination, wastewater treatment, and gas separation. Furthermore, supreme physiochemical stability and high ion conductivity make them promising to be utilised in the structure of accumulators such as batteries and supercapacitors. In this review, after summarising the general concepts and production processes for HMs, a comprehensive overview of their applications in medicine, environmental engineering, sensing usage, and energy storage/conservation is well-featured. The present review concludes with existing restrictions, possible potentials, and future directions of HMs.

Electrospun Fibers and Sorbents as a Possible Basis for Effective Composite Wound Dressings

Skin burns and ulcers are considered hard-to-heal wounds due to their high infection risk. For this reason, designing new options for wound dressings is a growing need. The objective of this work is to investigate the properties of poly (ε-caprolactone)/poly (vinyl-pyrrolidone) (PCL/PVP) microfibers produced via electrospinning along with sorbents loaded with Argovit™ silver nanoparticles (Ag-Si/Al2O3) as constituent components for composite wound dressings. The physicochemical properties of the fibers and sorbents were characterized using scanning electron microscopy (SEM), differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR) and inductively coupled plasma optical emission spectroscopy (ICP-OES). The mechanical properties of the fibers were also evaluated. The results of this work showed that the tested fibrous scaffolds have melting temperatures suitable for wound dressings design (58-60 °C). In addition, they demonstrated to be stable even after seven days in physiological solution, showing no macroscopic damage due to PVP release at the microscopic scale. Pelletized sorbents with the higher particle size demonstrated to have the best water uptake capabilities. Both, fibers and sorbents showed antimicrobial activity against Gram-negative bacteria Pseudomona aeruginosa and Escherichia coli, Gram-positive Staphylococcus aureus and the fungus Candida albicans. The best physicochemical properties were obtained with a scaffold produced with a PCL/PVP ratio of 85:15, this polymeric scaffold demonstrated the most antimicrobial activity without affecting the cell viability of human fibroblast. Pelletized Ag/Si-Al2O3-3 sorbent possessed the best water uptake capability and the higher antimicrobial activity, over time between all the sorbents tested. The combination of PCL/PVP 85:15 microfibers with the chosen Ag/Si-Al2O3-3 sorbent will be used in the following work for creation of wound dressings possessing exudate retention, biocompatibility and antimicrobial activity.

Bioactive antibacterial silica-based nanocomposites hydrogel scaffolds with high angiogenesis for promoting diabetic wound healing and skin repair

Diabetic wound repair and skin regeneration remains a worldwide challenge due to the impaired functionality of re-vascularization. Methods: This study reports a bioactive self-healing antibacterial injectable dual-network silica-based nanocomposite hydrogel scaffolds that can significantly enhance the diabetic wound healing/skin tissue formation through promoting early angiogenesis without adding any bioactive factors. The nanocomposite scaffold comprises a main network of polyethylene glycol diacrylate (PEGDA) forming scaffolds, with an auxiliary dynamic network formed between bioactive glass nanoparticles containing copper (BGNC) and sodium alginate (ALG) (PABC scaffolds). Results: PABC scaffolds exhibit the biomimetic elastomeric mechanical properties, excellent injectabilities, self-healing behavior, as well as the robust broad-spectrum antibacterial activity. Importantly, PABC hydrogel significantly promoted the viability, proliferation and angiogenic ability of endothelial progenitor cells (EPCs) in vitro. In vivo, PABC hydrogel could efficiently restore blood vessels networks through enhancing HIF-1α/VEGF expression and collagen matrix deposition in the full-thickness diabetic wound, and significantly accelerate wound healing and skin tissue regeneration. Conclusion: The prominent multifunctional properties and angiogenic capacity of PABC hydrogel scaffolds enable their promising applications in angiogenesis-related regenerative medicine.

A promising wound dressing based on alginate hydrogels containing vitamin D3 cross-linked by calcium carbonate/d-glucono-δ-lactone

In the present study, we fabricated vitamin D₃-loaded alginate hydrogel and assessed its wound healing capability in the animal model. The various concentrations of vitamin D3 were added to the pre-dissolved sodium alginate in deionized water and cross-linked by calcium carbonate in combination with d-glucono-δ-lactone. The microstructure, swelling behavior, weight loss, hemo- and cytocompatibility of the fabricated hydrogels were evaluated. In the last stage, the therapeutic efficacy of the prepared hydrogels was evaluated in the full-thickness dermal wound model. The scanning electron microscopy images showed that the prepared hydrogel was highly porous with the porosity of 89.2 ± 12.5% and contained the interconnected pores. Weight loss assessment showed that the prepared hydrogel is biodegradable with the weight loss percentage of about 89% in 14 days. The results showed that the prepared hydrogels were hemo- and cytocompatible. The animal study results implied that alginate hydrogel/3000 IU vitamin D₃ group exhibited the highest wound closure present which was statistically significant than the control group (p < 0.05). Moreover, the histological examinations revealed that hydrogel containing 3000 IU vitamin D3 had the best performance and induced the highest re-epithelialization and granular tissue formation. All in all, this study suggests that alginate hydrogels with 3000 IU vitamin D₃ can be exploited as a potential wound dressing in skin tissue engineering.

Therapeutic advances in wound healing

Wound healing is a complex physiological process that occurs in the human body involving the sequential activation of multiple cell types and signaling pathways in a coordinated manner. Chronic wounds and burns clearly decrease quality of life of the patients since they are associated with an increase in physical pain and socio-economical complications. Furthermore, incidence and prevalence of chronic wounds (unlike burns) have been increasing mainly due to population aging resulting in increased costs for national health systems. Thus, the development of new and more cost-effective technologies/therapies is not only of huge interest but also necessary to improve the long-term sustainability of national health systems. This review covers the current knowledge on recent technologies/therapies for skin regeneration, such as: wound dressings; skin substitutes; exogenous growth factor based therapy and systemic therapy; external tissue expanders; negative pressure; oxygen; shock wave, and photobiomodulation wound therapies. Associated benefits and risks as well as the clinical use and availability are all addressed for each therapy. Moreover, future trends in wound care including novel formulations using metallic nanoparticles and topical insulin are herein presented. These novel formulations have shown to be promising therapeutic options in the near future that may change the wound care paradigm.

Transparent chitosan based nanobiocomposite hydrogel: Synthesis, thermophysical characterization, cell adhesion and viability assay

This study designed to explore the characteristic features of the novel prepared hydrogel. This transparent nanocomposite hydrogel was formulated with employing environmental friendly biopolymer, "chitosan". To increase the hydrophilicity of chitosan, it was quaternized with triethyl amine. Also by incorporating click protocol, the triazole rings were inserted in the structure. After decoration with appropriate chemicals using efficient methods, functionalized chitosan and the corresponding hydrogel were investigated by Fourier transform infrared (FT-IR), thermal gravimetric analysis (TGA), differential scanning calorimetric (DSC) and dynamic-mechanical thermal analysis (DMTA). Swelling behavior of the synthesized hydrogel was assayed in both room temperature and 37 °C. Moreover, swelling kinetics were appraised and found that the experimental data fit the Schott's equation. To study the cell adhesion and proliferation, MTT assay was performed and the SEM images of 24, 48 and 72 h of direct cell culture on the surface of the scaffold were obtained. Morphological features of cultured cells were confirmed with Giemsa staining. The results displayed the potential capability of the synthesized scaffold for being used in bioapplications.

Tunable hydrogels for mesenchymal stem cell delivery: Integrin-induced transcriptome alterations and hydrogel optimization for human wound healing

Therapeutic applications for mesenchymal stem/stromal cells (MSCs) are growing; however, the successful implementation of these therapies requires the development of appropriate MSC delivery systems. Hydrogels are ideally suited to cultivate MSCs but tuning hydrogel properties to match their specific in vivo applications remains a challenge. Thus, further characterization of how hydrogel-based delivery vehicles broadly influence MSC function and fate will help lead to the next generation of more intelligently designed delivery vehicles. To date, few attempts have been made to comprehensively characterize hydrogel impact on the MSC transcriptome. Herein, we have synthesized cell-degradable hydrogels based on bio-inert poly(ethylene glycol) tethered with specific integrin-binding small molecules and have characterized their resulting effect on the MSC transcriptome when compared with 2D cultured and untethered 3D hydrogel cultured MSCs. The 3D culture systems resulted in alterations in the MSC transcriptome, as is evident by the differential expression of genes related to extracellular matrix production, glycosylation, metabolism, signal transduction, gene epigenetic regulation, and development. For example, genes important for osteogenic differentiation were upregulated in 3D hydrogel cultures, and the expression of these genes could be partially suppressed by tethering an integrin-binding RGD peptide within the hydrogel. Highlighting the utility of tunable hydrogels, when applied to ex vivo human wounds the RGD-tethered hydrogel was able to support wound re-epithelialization, possibly due to its ability to increase PDGF expression and decrease IL-6 expression. These results will aid in future hydrogel design for a broad range of applications.

Fabrication of pH-responsive TA-keratin bio-composited hydrogels encapsulated with photoluminescent GO quantum dots for improved bacterial inhibition and healing efficacy in wound care management: In vivo wound evaluations

Wounds origins serious complications of lives of human beings which may leads to death. The important issue for the problem is infection during wound care management which delays wound healing process. These kinds of infections may be caused by the overuse or misuse of antibiotics, antidotes, usage of new drugs, not properly sterilized surgical instruments, not appropriate for pH level and imperfect wound dressing etc. during or after surgery. Hence in this report, antimicrobial action of pH responsive TA/KA composited hydrogel crosslinked with GO-QDs (TA/KA-GOQDs) using citric acid as cross-linker has been reported by demonstrating in-vitro and in-vivo studies for wound care management. The prepared samples of GOQDs, TA/KA hydrogel and TA/KA-GOQDs were characterized using FT-IR, XRD, SEM and TEM techniques. pH responsive hydrogel property of TA/KA was evaluated by swelling studies. In-vitro antibacterial studies was carried out by direct contact test method. Further, the prepared samples were tested in a wound healing model of rate with the wound of size 1.5 cm² for in-vivo studies. After 16 days of treatment, the prepared samples for wound healing causes 100% wound areas closure. Histological observations were made by MT and HE staining process which proves keratinocytes proliferation by biocompatible and biocomposited TA/KA-GOQDs. The pH responsive TA/KA-GOQDs proved as efficient wound healing agent by faster keratinocytes proliferation within a compact period.

Methods of extraction, physicochemical properties of alginates and their applications in biomedical field – a review

In this paper, the current state-of-art of extraction of alginates and the determination of their physico-chemical properties as well as their overall applications focussing on biomedical purposes has been presented. The quality and quantity of the alginate obtained with a variable yield prepared from brown seaweeds as a result of many factors, such as type of algae, extraction methods, chemical modification and others. Alginates are mainly extracted by using conventional alkaline extraction. However, novel extraction techniques such as microwave and ultrasound assisted extractions have gained a lot of interest. The extraction parameters (e.g., temperature and time of extraction) have critical impact on the alginate physiochemical and mechanical properties and thus, their potential applications. By controlling a chemical process makes it possible get various forms of alginates, such as fibres, films, hydrogels or foams. It is important to characterise the obtained alginates in order to their proper applications. This article presents several techniques used for the analysis of alginate properties. These natural polysaccharides are widely used in the commercial production, as a food ingredient, in the pharmaceutical industry due to their antibacterial, anticancer and probiotic properties. Their gelling characteristic and absorbable properties enable using alginates as a wound management material. Moreover, they are also biocompatible, non-toxic and biodegradable, therefore adequate in other biomedical applications.

Preparation and Characterization of Agar Based Magnetic Nanocomposite for Potential Biomedical Applications

PURPOSE

The purpose of the present study was to make a biocompatible agar based composite material via incorporation of appropriate additives within the agar matrix for potential applications in drug delivery and biomedical fields.

METHODOLOGY

Agar based composites were prepared by the incorporation of magnetic iron oxide nano particles, graphite and sodium aluminum as additives in different proportions within the agar matrix by a simple thermophysico- mechanical method. The as prepared agar based composites were then characterized by different techniques i.e. FTIR, SEM, TGA, XRD and EDX analyses. The FTIR peaks confirmed the presence of each component in the agar composite. SEM images showed the uniform distribution of each component in the agar composite. TGA study showed the thermal stability range of different composite sheets. XRD pattern revealed the crystallinity and EDX analysis confirmed the elemental composition of the prepared composites. The prepared agar based composites were evaluated for antimicrobial activities against three pathogenic bacterial strains Escherichia coli, Staphylococcus aureus and Klebsiella pneumonia and the result indicated efficient antimicrobial activities for all composites.

CONCLUSION

From the overall study, it was concluded that due to the non-toxic nature, thermal stability and excellent antibacterial properties, the prepared agar based composites can receive potential biomedical applications.

Drug therapies and delivery mechanisms to treat perturbed skin wound healing

Acute wound healing is an orderly process of four overlapping events: haemostasis, inflammation, proliferation and remodelling. A drug delivery system with a temporal control of release could promote each of these events sequentially. However, acute wound healing normally proceeds very well in healthy individuals and there is little need to promote it. In the elderly and diabetics however, healing is often slow and wounds can become chronic and we need to promote their healing. Targeting the events of acute wound healing would not be appropriate for a chronic wound, which have stalled in the proinflammatory phase. They also have many additional problems such as poor circulation, low oxygen, high levels of leukocytes, high reactive oxygen species, high levels of proteolytic enzymes, high levels of proinflammatory cytokines, bacterial infection and high pH. The future challenge will be to tackle each of these negative factors to create a wound environment conducive to healing.

Natural composite dressings based on collagen, gelatin and plant bioactive compounds for wound healing: A review

Skin wound dressings are commonly used to stimulate and enhance skin tissue repair. Even if wounds seem easy to repair for clinicians and to replicate in an in vitro set-up for scientists, chronic wounds remain currently an open challenge in skin tissue engineering for patients with complementary diseases. The seemingly simple process of skin healing hides a heterogenous sequence of events, specific timing, and high level of organization and coordination among the involved cell types. Taken together, all these aspects make wound healing a unique process, but we are not yet able to completely repair the chronic wounds or to reproduce them in vitro with high fidelity. This review highlights the main characteristics and properties of a natural polymer, which is widely used as biomaterial, namely collagen and of its denatured form, gelatin. Available wound dressings based on collagen/gelatin and proposed variants loaded with bioactive compounds derived from plants are presented. Applications of these composite biomaterials are discussed with emphasis on skin wound healing. A perspective on current issues is given in the light of future research. The emerging technologies support the development of innovative dressings based exclusively on natural constituents, either polymeric or bioactive compounds.

Therapeutic compression materials and wound dressings for chronic venous insufficiency: A comprehensive review

Chronic venous insufficiency (CVI) is a common disorder worldwide. Related pathophysiological mechanisms reportedly involve venous pooling and reduced venous return, leading to heaviness, aching, itchiness, tiredness, varicosities, pigmentation, and even lower limb ulceration. Approaches adopted to manage CVI at various stages of clinical-etiology-anatomy-pathophysiology include compression therapy, pharmacological treatment, ultrasound treatment, surgery, electrical or wireless microcurrent stimulation, and pulsed electromagnetic treatment. Among these, polymer-based therapeutic compression materials and wound dressings play increasingly key roles in treating all stages of CVI because of their unique physical, mechanical, chemical, and biological functions. However, the characteristics, working mechanisms, and effectiveness of these CVI treatment materials are not comprehensively understood. The present systematic review examines the structures, properties, types, and applications of various polymer-based compression materials and wound dressings used in prophylaxis and treatment of CVI. Existing problems, limitations, and future trends of CVI treatment materials are also discussed. This review could contribute to the design and application of new functional polymer materials and dressings to enhance the efficiency of CVI treatments, thereby facilitating patients' self-care ability and long-term health improvement.

Non-Propellant Foams of Green Nano-Silver and Sulfadiazine: Development and In Vivo Evaluation for Burn Wounds

PURPOSE

A non-propellant based foam (NPF) system was developed incorporating the antibiotics, pectin capped green nano-silver and sulfadiazine (SD) for the topical treatment of burn wounds as a convenient alternative to the existing therapies.

METHODS

NPF were prepared using various surfactants and oils forming a nanoemulsion. Anti-microbial studies by resazurin microtitre assay, ex vivo diffusion, in vivo skin permeation and deposition studies, and acute irritation studies were carried out. NPF was applied onto secondary thermal wounds manifested on mice models followed by macroscopic and histological examinations.

RESULTS

NPF had an average globule size of <75 nm. The viscosity was ~10 cP indicating the feasibility of expulsion from the container upon actuation. With no skin irritation, the foams showed a higher skin deposition of SD. A high contraction and an evident regeneration of the skin tissue upon treatment with NPF indicated a good recovery from the thermal injury was apparent from the histology studies.

CONCLUSION

NPF represents an alternative topical formulation that can be employed as a safe and effective treatment modality for superficial second degree (partial thickness) burn wounds. With a minimal requirement of mechanical force, the no-touch application of NPF makes it suitable for sensitive and irritant skin surfaces.

The Benefits Of Occlusive Dressings In Wound Healing

There are several types of wounds with their own healing properties. The latest innovation in wound management by using occlusive dressings can prevent infections, improve healing time and patient’s comfort. Occlusive dressings are often used as an immediate wound hygiene control and also prevent blood loss until debridement is performed. They are used to protect wounds and surrounding tissue from pathogens and other harmful materials. A good cover depends on the condition around the wound, the person's skills, and the injury's nature. In this article, we provide an insight into the types of polymer materials used clinically in wound dressing and underlying mechanisms between the biomaterial dressings and the body tissue.

Low-intensity current (LIC) stimulation of subcutaneous adipose derived stem cells (ADSCs) - A missing link in the course of LIC based wound healing

Millions of people die as a result of fatal injuries accounting for 9% of the total global annual deaths. Non fatal injuries generally result in variety of wounds. The normal wound healing process is slow and takes weeks to months, depending on the type of wound. In last two decades, electrotherapy called low-intensity currents (LIC) for the treatment became popular for faster wound healing, as well as in management of nonresponding and ulcerative wounds. It was reported that LIC mimics 'the current of injury' which is generated by body on wounding and helps in faster wound healing. Researchers have also studied the migration of localized cell and other bio-molecules under the influence of LIC helping the wound to heal faster. Literature review has also suggested that, electrical stimulation of isolated adipose tissue derived stem cells (ADSCs) releases growth factors and differentiates in to specialized cells like fibroblasts and keratinocytes in laboratory conditions. These research areas are well explored and emerged as independent state-of-the-arts therapies and technologies. Considering the fact, that adipose tissue (along with ADSCs) is present subcutaneously, a new hypothesis is proposed which states that 'low intensity current (LIC) stimulation of wound stimulates subcutaneous adipose tissue containing ADSCs which releases different growth factors and also differentiates into certain cells like fibroblasts, neurons and keratinocytes. These cells easily migrate to wound site due to lipolysis and loosening of fat tissue, resulting in faster wound healing'. Thus this hypothesis provides a missing link between two state of the art technologies; first one is 'LIC based electrotherapy' and second one is 'in-vitro LIC stimulation of ADCSs' where role and significance of in-situ ADCSs were never studied.

Culturing melanocytes and fibroblasts within three-dimensional macroporous PDMS scaffolds: towards skin dressing material

In the present study, we propose a platform for topical wound dressing material using a polydimethylsiloxane (PDMS) scaffold in order to enhance the skin healing process. In vitro co-culture assessment of epidermal-origin mouse B16-F10 melanocyte cells and mouse L929 fibroblast cells in three-dimensional polymeric scaffolds has been carried out towards developing bio-stable, interconnected, highly macroporous, PDMS based tissue-engineered scaffolds, using the salt leaching method. To determine a suitable ratio of salt to PDMS pre-polymer in the scaffold, two different samples with ratios 2:1 and 3:1 [w/w], were fabricated. Effective pore sizes of both scaffolds were observed to lie in the desirable range of 152-165 μm. In addition, scaffolds were pre-coated with collagen and investigated as a podium for culturing the chosen cells (fibroblast and melanocyte cells). Experimental results demonstrate not only a high proliferative potential of the skin tissue-specific cells within the fabricated PDMS based scaffolds but also confirm the presence of several other essential attributes such as high interconnectivity, optimum porosity, excellent mechanical strength, gaseous permeability, promising cell compatibility, water absorption capability and desired surface wettability. Therefore, scaffolds facilitate a high degree of cellular adhesion while providing a microenvironment necessary for optimal cellular infiltration and viability. Thus, the outcomes suggest that PDMS based macroporous scaffold can be used as a potential candidate for skin dressing material. In addition, the fabricated PDMS scaffolds may also be exploited for a plethora of other applications in tissue engineering and drug delivery.

Fibrin Nanoparticles Coupled with Keratinocyte Growth Factor Enhance the Dermal Wound-Healing Rate

Expediting the wound-healing process is critical for patients chronically ill from nonhealing wounds and diseases such as hemophilia or diabetes or who have suffered trauma including easily infected open wounds. FDA-approved external tissue sealants include the topical application of fibrin gels, which can be 500 times denser than natural fibrin clots. With lower clot porosity and higher polymerization rates than physiologically formed fibrin clots, the commercial gels quickly stop blood loss but impede the later clot degradation kinetics and thus retard tissue-healing rates. The fibrin nanoparticles (FBNs) described here are constructed from physiologically relevant fibrin concentrations that support new tissue and dermal wound scaffold formation when coupled with growth factors. The FBNs, synthesized in a microfluidic droplet generator, support cell adhesion and traction generation, and when coupled to keratinocyte growth factor (KGF), support cell migration and in vivo wound healing. The FBN-KGF particles enhance cell migration in vitro greater than FBN alone or free KGF and also improve healing outcomes in a murine full thickness injury model compared to saline, bulk fibrin sealant, free KGF, or bulk fibrin mixed with KGF treatments. Furthermore, FBN can be potentially administered with other tissue-healing factors and inflammatory mediators to improve wound-healing outcomes.