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

High efficiency of in-situ cross-linking and acid triggered drug delivery by introducing tobramycin into injectable and biodegradable hydrogels

High efficiency of in-situ cross-linking and acid triggered drug delivery is realized by introducing tobramycin into the hydrogels. Injectable and biodegradable hydrogels are prepared through two steps: First generation of reactive aldehyde groups in the sodium alginate (A-Alg) and then introduction of antibiotic tobramycin as cross-linker. Due to the formation of dynamic Schiff base bonds between the amino groups in tobramycin and aldehyde groups in A-Alg, the gelation of hydrogels can be realized immediately. Thus, tobramycin acts well as the first role cross-linker and the hydrogels containing tobramycin can be injected into the wound during the treatment. In addition, the acid from the decomposition of organic compounds by the bacteria can break the cross-linking points previously formed by tobramycin in the hydrogels. Therefore, tobramycin can be released and act as the second role model drug to kill the bacteria. Because the hydrogels network is broken, the release of tobramycin is more efficient than the traditional drug delivery from hydrogels by diffusion. Based on these unique properties, the present hydrogels containing tobramycin exhibit a good injectable and biodegradable capability. In addition, due to the existence of the reversible acid-labile linkages in the hydrogels, the hydrogels containing tobramycin are also self-healing, which additionally is favorable for the application of wound dressing. More importantly, the antibacterial hydrogels also demonstrate good biocompatibility in vitro and significantly therapeutic effects on an infected mice model in vivo. Based on the above special properties, the hydrogels cross-linked by tobramycin indicate a new approach to prepare hydrogel dressings with low-cost, non-toxicity and good anti-bacterial performance in the treatment of infectious wounds.

Tough Wet Adhesion of Hydrogen-Bond-Based Hydrogel with On-Demand Debonding and Efficient Hemostasis

Hydrogels have been widely used in wet tissues. However, the insufficient adhesion of hydrogels for wound hemostasis remains a grand challenge. Herein, a facile yet effective strategy is developed to fabricate tough wet adhesion of hydrogen-bond-based hydrogel (PAAcVI hydrogel) using copolymerization of acrylic acid and 1-vinylimidazole in dimethyl sulfoxide followed by solvent exchange with water. The PAAcVI hydrogel shows equally robust adhesion (>400 J m^-2) to both wet and dry tissues. Moreover, the PAAcVI hydrogel also exhibits strong long-term stable adhesion underwater and in various wet environments. Meanwhile, the adhesion of PAAcVI hydrogel can be adjusted through Zn²⁺-ion-mediated on-demand debonding, which makes it easy to peel off from the tissue reducing pain during dressing removal and avoiding secondary injury. The PAAcVI hydrogel displays efficient hemostasis in the mice-tail docking model and mice-liver bleeding model. This hydrogen-bond-based hydrogel shows tough wet adhesion, and its adhesion is controllable, demonstrating its promising application in moisture-resistant adhesives, medical adhesives, and hemostatic materials.

Cellulose-Based Cryogel Microspheres with Nanoporous and Controllable Wrinkled Morphologies for Rapid Hemostasis

First-aid hemostatic agents for acute bleeding can save lives in emergency situations. However, rapid hemostasis remains challenging when uncontrolled hemorrhage occurs on lethal noncompressible and irregular wounds. Herein, cellulose-based cryogel microspheres with deliberately customized micromorphologies for ultrafast water transportation and diffusion, including the shark skin riblet-inspired wrinkled surface with low fluid drag and the hydrophilic nanoporous 3D networks, are developed to deal with the acute noncompressible bleeding within seconds. These cryogel microspheres can rapidly absorb a large amount of blood over 6 times their own weight in 10 s and form a robust barrier to seal a bleeding wound without applying pressure. Remarkably, massive bleeding from a cardiac penetrating hole is effectively stopped using the microspheres within 20 s and no blood leakage is observed after 30 min. Additionally, these microspheres could be readily removed without rebleeding and capillary thrombus, which is highly favorable to rapid hemostasis in emergency rescue.

Self-healing hydrogel based on polyphosphate-conjugated pectin with hemostatic property for wound healing applications

Self-healing hydrogels have important application in hemostasis and wound repairing. In this research, pectin based self-healing hydrogel was fabricated with conjugated polyphosphate for hemostatic and wound healing applications. The hydrogel formed without any stimulus and hydrogel kept its biocompatibility; at the same time, the hydrogel degraded completely by enzyme and in vivo. The polyphosphate conjugated hydrogel also showed self-healing property and sustained release performance with strong coagulation characteristic. More importantly, the in vivo experiment revealed that the polyphosphate conjugated hydrogel reduced the blood loss and hemostasis time in hemorrhage model; meanwhile, the hydrogel accelerated the wound repairing rate of the open wound by preventing bacterial invasion. Altogether, the PolyP conjugated hemostatic pectin-based hydrogel is a good candidate as wound dressing material applied in clinic or open wound repairing.

Hydrogel Combined with Phototherapy in Wound Healing

Wound healing is a complex biological process that involves tissue regeneration. Traditional wound dressings are dry, cannot provide a moist environment for wound healing, and do not have high antibacterial properties. Hydrogels, which are capable of retaining large amounts of water, can create a moist healing environment. Currently, phototherapies have exhibited a high potential for the treatment of bacterial infections. Therefore, combining hydrogels with phototherapy can adequately overcome the shortcomings of traditional wound treatment methods and show great potential for wound healing owing to their high efficiency, low irritation, and good antibacterial performance. In this review, the application of hydrogels combined with phototherapy in wound healing is summarized. First, the basic principles of photodynamic therapy and photothermal therapy are briefly introduced. In addition, the progress of the application of hydrogel combined with phototherapy in wound healing is systematically investigated. Finally, the challenges and prospects of combining hydrogel with phototherapy in wound healing are discussed.

Electrospun kaolin-loaded chitosan/PEO nanofibers for rapid hemostasis and accelerated wound healing

Development of chitosan-based hemostatic products and their application in wound healing has always been a research hotspot in the field of emergency treatment and biomedicine. In this study, the classic hemostatic chitosan and the most well-known inorganic hemostatic agent-kaolin were tried to combine to form a more excellent dressing. Together with the aid of non-toxic, harmless and good hydrophilic polyethylene oxide, chitosan/polyethylene oxide (PEO)/kaolin nanofiber membranes (CPKs) were prepared by electrospinning technology. Such membranes exhibited adjustable mechanical properties and good biocompatibility. Furthermore, a series of in vitro coagulation experiments proved that CPKs with 10 % ratio of kaolin (CPK10) has excellent hemostatic ability. Especially, in the whole blood coagulation time (WBCT) assay, the hemostatic time of CPK10 (43 ± 1.4 s) was significantly lower than that of chitosan/polyethylene oxide (CPK0) nanofiber membrane (61 ± 2.2 s) and QuikClot® Combat Gauze (55.7 ± 1.2 s). The further rat liver injury test reconfirmed that CPK10 can stop bleeding better and faster compared to other groups. In addition, CPKs could promote back wound healing in rats within 14 days without significant inflammatory response. This safe and effective hemostatic CPKs is expected to be a promising candidate hemostat in pre-hospital medical care.

Mussel-inspired multifunctional hydrogel dressing with hemostasis, hypoglycemic, photothermal antibacterial properties on diabetic wounds

To meticulously establish an efficient photothermal multifunctional hydrogel dressing is a prospective strategy for the treatment of diabetic chronic wounds. Herein, glucose oxidase (GOx) was added to polydopamine/acrylamide (PDA/AM) hydrogels to reduce hyperglycemia to a normal level (3.9-6.1 mmol L^-1) and enhance compressive properties (55 kPa) and adhesive properties (32.69 kPa), which are capable of hemostasis in the wound. Then, MnO₂ nanoparticles were encapsulated into a polydopamine/acrylamide (PDA/AM) hydrogel, endowing it with excellent antibacterial properties (E. coli and S. aureus were 97.87% and 99.99%) under the irradiation of 808 nm NIR; meanwhile, the biofilm was eliminated completely. Besides, O₂ was generated (18 mg mL^-1) by the decomposition of H₂O₂ under the catalysis of MnO₂, which could accelerate the formation of angiogenesis and promote the crawling and proliferation of cells. Furthermore, the diabetic wound in vivo treated with the PDA/AM/GOx/MnO₂ hydrogel had a less inflammatory response and faster healing speed, which was completely healed in 14 days. Therefore, the multifunctional hydrogels with the capability of high compressible, hemostasis, antibacterial, hyperglycemia manipulation, and O₂ generation, demonstrate promise in diabetic chronic wound dressing.

Injectable shape memory hydroxyethyl cellulose/soy protein isolate based composite sponge with antibacterial property for rapid noncompressible hemorrhage and prevention of wound infection

Uncontrollable hemorrhage and subsequent wound infection are severe threats to life, especially for the deep noncompressible massive bleeding. However, traditional hemostatic materials are ineffective for extreme bleeding and subsequent wound infection. Here, we prepared an injectable shape memory hydroxyethyl cellulose/soy protein isolate based composite sponge (EHSS) for rapid noncompressible hemorrhage and prevention of wound infection. The nano silver (AgNPs)-loaded shape memory sponge (EHP@Ag) was fabricated by mussel-inspired polydopamine coating EHSS sponge, then reducing and immobilizing AgNPs in situ. The EHP@Ag sponges showed rapid blood-triggered shape recovery speed, which is beneficial for administering noncompressible hemorrhage. The results of the hemostatic experiment in vivo demonstrated that EHP@Ag sponge exhibited a desirable hemostasis effect (hemostasis time: 22.75 ± 3.86 s, blood loss: 285.25 ± 24.93 mg) compared to the commercial gelatin sponge (hemostasis time: 49.25 ± 3.30 s, blood loss: 755.50 ± 24.45 mg). Meanwhile, the EHP@Ag sponge has an efficient antibacterial property. Furthermore, the antibacterial experiment in vivo showed that the EHP@Ag sponges could kill bacteria effectively and reduce the bacteria-induced inflammatory response. In summary, the shape memory sponges can quickly control bleeding and avoid bacterial infection, which shows great potential for clinical application as a multifunctional hemostatic agent.

Magnetic nanostructure and biomolecule synergistically promoted Suaeda-inspired self-healing hydrogel composite for seawater evaporation

Multifunctional hydrogels with excellent comprehensive performance are essential prerequisite for the implementation of effective water resources technology with high efficiency and low energy consumption. Inspired by the water purification and self-healing properties of natural plants, and based on the synergy of photothermal and biological effects, high photothermal Fe₃O₄ nanoparticles and natural polyhydroxy oligomeric proanthocyanidin (OPC) are introduced into a water-active polyvinyl alcohol (PVA) hydrogel. Two new bio-hydrogels of PVA/Fe₃O₄/graphite and PVA/OPC with self-healing and stretchable properties are proposed and designed. The obtained hydrogels exhibit reversible covalent cross-linked water-promoted healing (chemically) and photothermal melting/recrystallization healing (physically). The double-layered hydrogel composite demonstrates a dual response function (sunlight and near-infrared light), along with water purification properties. It is prepared through a water spray triggered self-healing process. The ultimate fracture strain of the photothermal layer and purification layer hydrogel was more than 1000% and 400% respectively after self-healing.After 48 h of hydrogel composite adsorption, the color of a methylene blue solution faded, and the absorption peak at 664 nm decreased. In addition, this research adopts a phased evaporation method to concentrate local energy and provide power for seawater evaporation. The evaporation efficiency of seawater induced by near-infrared (NIR) light was up to 3.15 kg m^-2 h^-1, whereas that under sunlight was 1.25 kg m^-2 h^-1. Selection of the evaporation excitation light source allowed control of the evaporation efficiency. The proposed technology is expected to be widely applicable to the staged evaporation of seawater as well as water purification.

Janus mucosal dressing with a tough and adhesive hydrogel based on synergistic effects of gelatin, polydopamine, and nano-clay

There are many problems and challenges related to the treatment of highly prevalent oral mucosal diseases and oral drug delivery because of a large amount of saliva present in the oral cavity, the accompanying oral movements, and unconscious swallowing in the mouth. Therefore, an ideal oral dressing should possess stable adhesion and superior tough strength in the oral cavity. However, this fundamental requirement greatly limits the use of synthetic adhesive dressings for oral dressings. Here, we developed a mussel-inspired Janus gelatin-polydopamine-nano-clay (GPC) hydrogel with controlled adhesion and toughness through the synergistic physical and chemical interaction of gelatin (Gel), nano-clay, and dopamine (DA). The hydrogel not only exhibits strong wet adhesion force (63 kPa) but also has high toughness (1026 ± 100 J m^-3). Interfacial adhesion of hydrogels is achieved by modulating the interaction of catechol groups of the hydrogel with specific functional groups (e.g., NH₂, SH, OH, and COOH) on the tissue surface. The matrix dissipation of the hydrogel is regulated by physical crosslinking of gelatin, chemical crosslinking of gelatin with polydopamine (Michael addition and Schiff base formation), and nano-clay-induced constraint of the molecular chain. In addition, the GPC hydrogel shows high cell affinity and favors cell adhesion and proliferation. The hydrogel's instant and strong mucoadhesive properties provide a long-lasting therapeutic effect of the drug, thereby enhancing the healing of oral ulcers. Therefore, mussel-inspired wet-adhesion Janus GPC hydrogels can be used as a platform for mucosal dressing and drug delivery systems. STATEMENT OF SIGNIFICANCE: It is a great challenge to treat oral mucosal diseases due to the large amount of saliva present in the oral cavity, the accompanying oral movements, unconscious swallowing, and flushing of drugs in the mouth. To overcome the significant limitations of clinical bioadhesives, such as weakness, toxicity, and poor usage, in the present study, we developed a simple method through the synergistic effects of gelatin, polydopamine, and nano-clay to prepare an optimal mucosal dressing (Janus GPC) that integrates Janus, adhesion, toughness, and drug release property. It fits effectively in the mouth, resists saliva flushing and oral movements, provides oral drug delivery, and reduces patient discomfort. The Janus GPC adhesive hydrogels have great commercial potential to support further the development of innovative therapies for oral mucosal diseases.

Biocompatible Hemostatic Sponge Exhibiting Broad-Spectrum Antibacterial Activity

Hemorrhage during accidents or surgery is a significant challenge that can contribute to mortality. This is further aggravated due to bacterial infections at the injured site. Therefore, rapid application of a hemostatic and antibacterial material is highly necessary as a pretreatment for patients' survival. Herein, we have developed a hemostatic sponge (Hemobac) through amide crosslinking of gelatin and an N-(2-hydroxy) propyl-3-trimethylammonium chitosan (HTCC)-silver chloride nanocomposite (QAm₁-Ag_0.1) to mitigate bacterial infections, while aiding hemostasis. This Hemobac sponge completely eradicated (∼4-5 log) a wide range of Gram-positive and Gram-negative bacteria encompassing various clinical isolates within 6 h. The antihemorrhagic ability of Hemobac was ascertained through SEM images, which exhibited the presence of agglomerated blood cells onto the sponge with a significantly low blood-clotting index value (∼23 ± 1). Notably, Hemobac reduced the blood loss by ∼70-80% in the liver puncture model and femoral vein injury model in mice, displaying its improved hemostatic ability over a marketed gelatin-based sponge. Negligible hemolytic activity (∼6%) and retained healthy morphology of mammalian cells were observed upon exposure to the Hemobac sponge. Minimal immune response was noticed at the Hemobac-treated wound in mice through histopathology analysis. Collectively, these findings indicate that this biocompatible Hemobac sponge can stop the bleeding instantaneously and combat bacterial infections.

Leveraging the advancements in functional biomaterials and scaffold fabrication technologies for chronic wound healing applications

Exploring new avenues for clinical management of chronic wounds holds the key to eliminating socioeconomic burdens and health-related concerns associated with this silent killer. Engineered biomaterials offer great promise for repair and regeneration of chronic wounds because of their ability to deliver therapeutics, protect the wound environment, and support the skin matrices to facilitate tissue growth. This mini review presents recent advances in biomaterial functionalities for enhancing wound healing and demonstrates a move from sub-optimal methods to multi-functionalized treatment approaches. In this context, we discuss the recently reported biomaterial characteristics such as bioadhesiveness, antimicrobial properties, proangiogenic attributes, and anti-inflammatory properties that promote chronic wound healing. In addition, we highlight the necessary mechanical and mass transport properties of such biomaterials. Then, we discuss the characteristic properties of various biomaterial templates, including hydrogels, cryogels, nanomaterials, and biomolecule-functionalized materials. These biomaterials can be microfabricated into various structures, including smart patches, microneedles, electrospun scaffolds, and 3D-bioprinted structures, to advance the field of biomaterial scaffolds for effective wound healing. Finally, we provide an outlook on the future while emphasizing the need for their detailed functional behaviour and inflammatory response studies in a complex in vivo environment for superior clinical outcomes and reduced regulatory hurdles.

Temperature-triggered fluorocopolymer aggregate coating switching from antibacterial to antifouling and superhydrophobic hemostasis

The multifunction antibacterial hemostatic materials can reduce blood loss, infection and wound complications, which probably decrease morbidity and health care costs. However, the contradictory relationship between antibacterial ability and biocompatibility, and the unnecessary blood loss restricts the practical application of hydrophilic cationic antibacterial hemostatic materials. Herein, a multifunctional temperature-triggered antibacterial hemostatic fluorocopolymer aggregate coating was developed. After self-assembly and quaternization process, the quaternized poly(N,N-dimethylaminoethylmethacrylate)-b-poly(1H,1H,2H,2H-heptadecafluorodecyl acrylate) block copolymers (PDMA-b-PFOEMA) aggregate coating consisting of fluoropolymer and quaternary ammonium salt were built. The synergistic effect on fluorinated block with low surface energy and quaternary ammonium salt block with bactericide activity severs the way of initial bacterial attachment and proliferation, while the migration of fluorinated block greatly promotes the biocompatibility and anti-adhesion performance in response to the switch from room temperature to physiological temperature. Furthermore, the fluorocopolymer aggregate coating with hydrophobic properties possessed the property of rapid coagulation, low blood loss, minor secondary bleeding and least bacteria infiltration. The multifunctional temperature-triggered fluorocopolymer aggregate coating with antifouling, antibacterial and hemostatic properties may have a great potential in the biomedical application.

Oxidized dextran crosslinked polysaccharide/protein/polydopamine composite cryogels with multiple hemostatic efficacies for noncompressible hemorrhage and wound healing

Noncompressible hemorrhage caused by gunshots and sharp objects leads to higher trauma mortality, and cryogels have great potential in controlling noncompressible hemorrhage applications owing to their shape-memory properties. However, the use of non-toxic crosslinkers to prepare cryogels for noncompressible hemorrhage remains a challenge. In this study, a series of cryogels were prepared using oxidized dextran (ODex) as a biocompatible crosslinker, combined with the good hemostatic properties of chitosan (CS) and human-like collagen (HLC), and polydopamine nanoparticles (PDA-NPs) were also introduced to strengthen the shape recovery speed of the cryogels and further enhance their hemostatic performance. The CS/HLC/ODex/PDA-NPs (CHOP) cryogels presented a highly interconnected macroporous structure, powerful water/blood absorption capacity, robust mechanical performance, and rapid water/blood-triggered shape recovery. In vitro coagulation and coagulation mechanism tests showed that CHOP exhibited strong procoagulant ability, high adhesion to blood cells and fibrinogen, and the capacity to activate platelets and intrinsic pathways. In vivo hemostatic tests indicated that CHOP could effectively shorten the bleeding time and reduce the bleeding volume of liver incision bleeding and liver noncompressible hemorrhage. Meanwhile, CHOP exhibited good biocompatibility and biodegradability, and could promote wound healing. These results suggest that CHOP cryogels will be a promising hemostatic dressing.

Novel biohybrid spongy scaffolds for fabrication of suturable intraoral graft substitutes

Despite the fact that classic autograft is the gold standard material for periodontal plastic surgery, it has some drawbacks, including the need for a second surgical site and the scarcity of palatal donor tissue. However, only a few research works on the manufacturing of bioengineered intraoral connective tissue grafts have been conducted. In this work, porous bovine serum albumin methacryloyl/gelatin methacryloyl (BG) biohybrid scaffolds were developed for super-elasticity, shape recovery, suturability for persistent stability, sufficient scaffolding function, and convenient manipulating characteristics to fabricate an intraoral graft substitute with superb stability to resist frequent dynamic forces caused by functional movement (speaking, masticating, and swallowing). Furthermore, in a 3D cell culture assay, BG scaffolds demonstrated excellent cell adhesion and proliferation of L929 cells. In addition, the BG scaffolds were able to release Ibuprofen in a controlled manner for postoperative recovery. The use of a low-cost, optimized cryogelation technique for functional biomacromolecules offers up new possibilities to develop promising scaffolds for dental clinical settings.

Chitosan-based composites reinforced with antibacterial flexible wood membrane for rapid hemostasis

Irregular hemorrhagic traumas always threaten the health of patients due to uncontrollable bleeding and wound infections. The traditional hemostatic materials show dissatisfactory hemostatic efficiency and antibacterial activity in solving these potential bleeding dangers. Herein, we proposed a kind of composites based on flexible wood membrane (FWM) loaded with chitosan/alginate derivative for accelerating rapid hemostasis and preventing infection. FWM was removed part of hemicellulose and lignin by using NaOH/Na₂SO₃ mixture to obtain excellent flexibility while retaining the original porous structure, followed by loading silver nanoparticles on the FWM surface to prepare AgNPs-FWM as an antibacterial bio-carrier. Then, AgNPs-FWM was coated with polyoxyethylene stearate-modified chitosan and multi-aldehyde sodium alginate to fabricate the composites of chitosan/alginate/AgNPs-FWM (CSA/AgNPs-FWM) using in-situ Schiff base reaction. Furthermore, in vitro and in vivo experiments showed that the CSA/AgNPs-FWM composites exhibited lower BCI value (2.6 ± 1.3 %), more rapid hemostasis (26 s) and lower blood loss (67.8 mg) than that of the traditional materials. The possible mechanism for the hemostasis process was not only the high blood absorption capacity, but also the synergistic interaction between hydrophobic alkane chains, amino groups, aldehydes, hydroxyl groups and blood cells. Moreover, CSA/AgNPs-FWM showed exceptional superiorities in mechanical properties and antibacterial activity, which endowed composites high potential in hemostasis application for irregular external wound.

Nanocomposite conductive tough hydrogel based on metal coordination reinforced covalent Pluronic F-127 micelle network for human motion sensing

The design of conductive hydrogels integrating anti-fatigue, high sensitivity, strong mechanical property and good sterilization performance remains a challenge. We innovatively introduced metal coordination in covalently crosslinked Pluronic F-127 micelle network and synthesized nanocomposite conductive tough hydrogel through the combination of covalent crosslinking, metal coordination and silver nanowire reinforcement. Compared with pure diacylated PF127 hydrogel (PF127), the tensile strength of PF-AA-AM-Al³⁺/Ag0.25 hydrogel reaching 1.4 MPa was about 10 times than that of PF127. The toughness of PF-AA-AM-Al³⁺/Ag0.25 reaches 1.88 MJ/m³. Compared with PF-AA-AM-Al³⁺, the introduction of silver nanowires increased the fatigue life of PF-AA-AM-Al³⁺/Ag0.25 by 200% (31837 cycles), 170% (12804 cycles) and 1022% (511 cycles) under 100%, 120% and 150% ultimate tensile strains, respectively. Besides, the PF-AA-AM-Al³⁺/Ag0.25 showed strain sensitivity to small deformation (Gauge factor = 2.42) in wearable tests on hands and knees. In addition, the PF-AA-AM-Al³⁺/Ag0.25 had good cytocompatibility and antibacterial performance that bacteria killing ratio of 98% to S. aureus and 99% to E. coli. Finally, a viscoelastic numerical constitutive model was established based on finite element method to study the damage failure history of the material. Comparative analysis showed that local stress concentration was the main factor leading to the failure of hydrogel.

Antibacterial Sericin Cryogels Promote Hemostasis by Facilitating the Activation of Coagulation Pathway and Platelets

Cryogels, with high water/blood absorption, have great potential for rapid hemostasis. In this study, a hemostatic and antibacterial sericin-methacryloyl/Ag cryogel (SMC@Ag) based on freeze polymerization of methacryloyl-modified sericin and in situ reduction of silver ions is developed. The combination of interconnected micropores and Ag NPs endows the cryogel with high water/blood absorption, and outstanding hemostatic and antibacterial performance. SMC@Ag shows much better hemostatic performance than the commercial gelatin sponge in rat liver injury, tail amputation, and femoral artery injury models. Furthermore, the excellent hemostatic activity of SMC@Ag is due to facilitating the coagulation pathway activation and enhancing the platelets adhesion during coagulation process. Overall, SMC@Ag cryogel with excellent hemostatic and antibacterial performance is a suitable candidate for traumatic hemorrhage and wound healing.

Polyhexamethylene guanidine hydrochloride modified sodium alginate nonwoven with potent antibacterial and hemostatic properties for infected full-thickness wound healing

The development of multifunctional wound dressings has always been considered as a promising strategy to promote blood coagulation, inhibit bacterial infection, and accelerate wound healing. Herein, an antibacterial and hemostatic dressing (SA-PHMG) was developed based on sodium alginate (SA) nonwoven and polyhexamethylene guanidine hydrochloride (PHMG) through a completely green industrial route, including dipping, padding, and drying. According to studies, SA-PHMG dressings exhibited excellent liquid absorption capacity and water vapor permeability. Moreover, bactericidal assays have demonstrated that SA-PHMG dressings have ideal antibacterial activity against Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and mixed bacteria, maintaining potent antibacterial activity even after 10 cycles of antibacterial trials or 50 times of washing or soaping. The in vitro evaluation of the hemostatic effect indicated that the SA-PHMG could significantly promote blood clotting by activating platelets, and in vitro and in vivo hemolysis, cytotoxicity and skin irritation studies demonstrated the ideal biocompatibility of the dressings. In addition, better wound closure and tissue regeneration were recorded using SA-PHMG nonwoven as the dressing based on an infected full-thickness wound model. In conclusion, this antibacterial, hemostatic, biocompatible, and environmentally friendly SA-PHMG nonwoven exhibit the potential for infected wound healing.

Development of tannin-bridged cerium oxide microcubes-chitosan cryogel as a multifunctional wound dressing

Efficient resolution of oxidative stress, inflammation, and bacterial infections is crucial for wound healing. To surmount these problems, tannic acid (TA)-bridged CeO₂ microcubes and chitosan (CS) (CS-TA@CeO₂) cryogel was fabricated through hydrogen bonding interactions as a multifunctional wound dressing. Successful introduction and uniform incorporation TA@CeO₂ microtubules enter the CS network. Thus-obtained CS-TA@CeO₂ cryogels displayed a suitable porous structure and swelling rate. Cryogels has excellent tissue adhesion, blood cell coagulation and hemostasis, anti-infection, and cell recruitment functions. In addition, the cryogel also showed good antibacterial activity against gram-positive bacteria and gram-negative bacteria. Based on the in vivo study of the multifunctional mixed cryogels, it promotes fibroblasts' adhesion and proliferation and significantly improves cell proliferation and tissue remodelling in wound beds. Furthermore, the chronic wound healing process in infected full-thickness skin defect models showed that cryogels significantly enhanced angiogenesis, collagen deposition and granulation tissue formation by providing a large amount of antioxidant activity. Therefore, this multifunctional mixed cryogels has potential clinical application value.

Iota-carrageenan/xyloglucan/serine powders loaded with tranexamic acid for simultaneously hemostatic, antibacterial, and antioxidant performance

This study sought to prepare powder hemostats based on iota-carrageenan (ιC), xyloglucan (XYL), l-serine (SER), and tranexamic acid (TA). The powder form was chosen because it enables the hemostat to be used in wounds of any shape and depth. The powder hemostats showed irregular shapes and specific surface areas ranging from 34 to 46 m²/g. Increasing TA amount decreases the specific surface area, bulk density, water and blood absorption, and the antibacterial activities of the powder hemostats, but not the water retention ability. Conversely, in vitro biodegradation was positively impacted by increasing the TA content in the powder hemostats. In both the in vitro and in vivo tests, powder hemostats showed reduced bleeding time, significant adhesion of red blood cells, great hemocompatibility, moderate antioxidant activity, and high biocompatibility. These findings shed new light on designing powder hemostats with intrinsic antibacterial and antioxidant activity and excellent hemostatic performance.

Microfluidics-assisted optimization of highly adhesive haemostatic hydrogel coating for arterial puncture

Although common in clinical practice, bleeding after tissue puncture may cause serious outcomes, especially in arterial puncture. Herein, gelatin-tannic acid composite hydrogels with varying compositions are prepared, and their adhesive properties are further optimized in microfluidic channel-based simulated vessels for haemostasis in arterial puncture. It is revealed that the composite hydrogels on the syringe needles used for arterial puncture should possess underwater adhesion higher than 4.9 kPa and mechanical strength higher than 86.0 kPa. The needles coated with the gelatin-tannic acid composite hydrogel completely prevent blood loss after both vein and arterial puncture in different animal models. This study holds great significance for the preparation of haemostatic needles for vessel puncture, and gelatin-tannic acid hydrogel coated needles may help to prevent complications associated with arterial puncture.

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Haemostatic needles were prepared with coating of gelatin-tannic acid hydrogel.

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Microfluidic system was employed to optimize the underwater adhesion of gelatin-tannic acid hydrogel coating.

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Needles coated with the gelatin-tannic acid hydrogel exhibited complete haemostasis after arterial puncture.

Dual-Driven Hemostats Featured with Puncturing Erythrocytes for Severe Bleeding in Complex Wounds

Achieving rapid hemostasis in complex and deep wounds with secluded hemorrhagic sites is still a challenge because of the difficulty in delivering hemostats to these sites. In this study, a Janus particle, SEC-Fe@CaT with dual-driven forces, bubble-driving, and magnetic field– (MF–) mediated driving, was prepared via in situ loading of Fe₃O₄ on a sunflower sporopollenin exine capsule (SEC), and followed by growth of flower-shaped CaCO₃ clusters. The bubble-driving forces enabled SEC-Fe@CaT to self-diffuse in the blood to eliminate agglomeration, and the MF-mediated driving force facilitated the SEC-Fe@CaT countercurrent against blood to access deep bleeding sites in the wounds. During the movement in blood flow, the meteor hammer-like SEC from SEC-Fe@CaT can puncture red blood cells (RBCs) to release procoagulants, thus promoting activation of platelet and rapid hemostasis. Animal tests suggested that SEC-Fe@CaT stopped bleeding in as short as 30 and 45 s in femoral artery and liver hemorrhage models, respectively. In contrast, the similar commercial product Celox™ required approximately 70 s to stop the bleeding in both bleeding modes. This study demonstrates a new hemostat platform for rapid hemostasis in deep and complex wounds. It was the first attempt integrating geometric structure of sunflower pollen with dual-driven movement in hemostasis.

Multifunctional chitosan/silver/tannic acid cryogels for hemostasis and wound healing

Wound dressing is a kind of significant artificial materials for protecting injured tissues and promoting wound healing. However, fabrication of antibacterial wound dressing usually involves tedious procedures and toxic components. Herein, we demonstrate a multifunctional chitosan/silver/tannic acid (CS/Ag/TA) cryogel based on an economic method to block acute hemorrhage and promote wound healing. The prepared CS/Ag/TA cryogel not only performs steady stability and compressibility, but also shows good antibacterial ability for both S. aureus and E. coli. Attributing to TA molecules, the CS/Ag/TA cryogel can effectively scavenge more than 95% of free radicals, showing effective oxidation resistance. Due to the porous structure and positive charge of CS, the prepared cryogel exhibits good hemostatic capability with a hemostasis time less than 20 s. Benefitting from the good biocompatibility and cell proliferation, the CS/Ag/TA cryogel can significantly promote wound repair in the skin incision model. All the results indicated that the greenly fabricated cryogel can be widely applied in clinic for hemostasis and wound healing.

Rational Design of High-Performance Keratin-Based Hemostatic Agents

Keratins are considered ideal candidates as hemostatic agents, but the development lags far behind their potentials due to the poorly understood hemostatic mechanism and structure-function relations, owing to the composition complexity in protein extracts. Here, it is shown that by using a recombinant synthesis approach, individual types of keratins can be expressed and used for mechanism investigation and further high-performance keratin hemostatic agent design. In the comparative evaluation of full-length, rod-domain, and helical segment keratins, the α-helical contents in the sequences are identified to be directly proportional to keratins' hemostatic activities, and Tyr, Phe, and Gln residues at the N-termini of α-helices in keratins are crucial in fibrinopeptide release and fibrin polymerization. A feasible route to significantly enhance the hemostatic efficiency of helical keratins by mutating Cys to Ser in the sequences for enhanced water wettability through soluble expression is then further presented. These results provide a rational strategy to design high-efficiency keratin hemostatic agents with superior performance over clinically used gelatin sponge in multiple animal models.

A Bio-Inorganic Hybrid Hemostatic Gauze for Effective Control of Fatal Emergency Hemorrhage in "Platinum Ten Minutes"

Death from massive hemorrhage represents a global problem. It is a challenging task to design hemostatic materials with significant efficacy, good biocompatibility, reliable safety, and high stability. In this study, we demonstrate an effective bio-inorganic hybrid hemostat fabricated by stepwise procedures of on-site growth of zeolite gauze and immobilization of trypsin on the zeolite gauze. The as-synthesized hybrid hemostat catalyzes the transition of prothrombin-to-thrombin and exhibits excellent procoagulant performance in the both normal plasma and FX-deficient plasma. The hemostatic treatment of junctional femoral artery rupture in the porcine model confirms that this hybrid hemostat manifests itself with superior hemostatic performance over commercial hemostatic dressings, in terms of a reduced time to hemostasis and blood loss. The stability of the hybrid hemostat is validated through high temperature and violent shaking evaluation. This bio-inorganic hybrid hemostat displays high procoagulant activity, low cytotoxicity, and extended shelf life which may achieve the "Platinum Ten Minutes" rescue in battlefield and traffic accident medicine.

Shape-Recoverable Macroporous Nanocomposite Hydrogels Created via Ice Templating Polymerization for Noncompressible Wound Hemorrhage

Uncontrolled hemorrhage resulting from severe trauma or surgical operations remains a challenge. It is highly important to develop functional materials to treat noncompressible wound bleeding. In this work, a shape-recoverable macroporous nanocomposite hydrogel was facilely created through ice templating polymerization. The covalently cross-linked gelatin networks provide a robust framework, while the Laponite nanoclay disperses into the three-dimensional matrix, enabling mechanical reinforcement and hemostatic functions. The resultant macroporous nanocomposite hydrogel possesses an inherent interconnected macroporous structure and rapid deformation recovery. In vitro assessments indicate that the hydrogel displays good cytocompatibility and a low hemolysis ratio. The hydrogel shows a higher coagulation potential and more erythrocyte adhesion compared to the commercial gauze and gelatin sponge. The noncompressible liver hemorrhage models also confirm its promising hemostasis performance. This strategy of combining a nano-enabled solution with ice templating polymerization displays great potential to develop appealing absorbable macroporous biomaterials for rapid hemostasis.

Expandable, biodegradable, bioactive quaternized gelatin sponges for rapidly controlling incompressible hemorrhage and promoting wound healing

Designing expandable sponges with biodegradability and effective antibacterial properties are the urgent challenge for incompressible hemorrhage and wound healing. In the present investigation, based on quaternized gelatin (QG) and oxidized dextran (OD), a series of expandable sponges (ODQG) with high-water absorption capacity and robust mechanical properties were prepared. ODQG had good biodegradability in vitro and in vivo, and had inherent antibacterial activity (90% for E. coli and 99.74% for S. aureus). Due to the synergy effect of electrostatic interaction and blood concentration, ODQG could effectively attract and activate red blood cells/platelets and accelerate the coagulation process. Therefore, ODQG showed better hemostatic performance than Kuaikang® gelatin sponges and gauzes in incompressible hemorrhage model. Furthermore, ODQG could regulate inflammatory factor (TNF-α) and cytokines (TGF-β, VEGF), and greatly promote wound healing process. The biodegradable sponges with excellent antibacterial properties might have potential application prospect for incompressible hemostasis and wound healing in the future.

Poly(N-isopropylacrylamide) Based Electrically Conductive Hydrogels and Their Applications

Poly(N-isopropylacrylamide) (PNIPAM) based electrically conductive hydrogels (PNIPAM-ECHs) have been extensively studied in recent decades due to their thermal-responsive (leading to the volume change of hydrogels) and electrically conductive performance. The incorporation of conductive components into the PNIPAM hydrogel network makes it become conductive hydrogel, and as a result, the PNIPAM hydrogel could become sensitive to an electrical signal, greatly expanding its application. In addition, conductive components usually bring new stimuli-responsive properties of PNIPAM-based hydrogels, such as near-infrared light and stress/strain responsive properties. PNIPAM-ECHs display a wide range of applications in human motion detection, actuators, controlled drug release, wound dressings, etc. To summarize recent research advances and achievements related to PNIPAM-ECHs, this manuscript first reviews the design and structure of representative PNIPAM-ECHs according to their conductive components. Then, the applications of PNIPAM-ECHs have been classified and discussed. Finally, the remaining problems related to PNIPAM-ECHs have been summarized and a future research direction is proposed which is to fabricate PNIPAM-ECHs with integrated multifunctionality.

In Situ Growth of Zeolitic Imidazolate Framework-L in Macroporous PVA/CMC/PEG Composite Hydrogels with Synergistic Antibacterial and Rapid Hemostatic Functions for Wound Dressing

Although many advances have been made in medicine, traumatic bleeding and wound infection are two of the most serious threats to human health. To achieve rapid hemostasis and prevent infection by pathogenic microbes, the development of new hemostatic and antibacterial materials has recently gained significant attention. In this paper, safe, non-toxic, and biocompatible polyvinyl alcohol (PVA); carboxymethyl cellulose (CMC), which contains several carboxyl and hydroxyl groups; and polyethylene glycol (PEG), which functions as a pore-forming agent, were used to prepare a novel PVA/CMC/PEG-based composite hydrogel with a macroporous structure by the freeze-thaw method and the phase separation technique. In addition, a PVA/CMC/PEG@ZIF-L composite hydrogel was prepared by the in situ growth of zeolitic imidazolate framework-L (ZIF-L). ZIF-L grown in situ on hydrogels released Zn²⁺ and imidazolyl groups. They elicited a synergistic antibacterial effect in hemostasis with PVA and CMC, rendering the PVA/CMC/PEG@ZIF-L hydrogel with a good antibacterial effect against Staphylococcus aureus. At the same time, the macroporous structure enabled the rapid release of Zn²⁺ and imidazolyl groups in ZIF-L and promoted cell proliferation at an early stage, enhancing the coagulation efficiency. A rat liver injury model was used to confirm its rapid hemostasis capacity.

Hemostatic Performance of ɑ-Chitin/gelatin Composite Sponges with Directional Pore Structure

Biomedical materials with effective hemostatic properties are in great demand in clinical and battlefield application for severe hemorrhage control. In this study, nearly amorphous chitin is obtained by treating α-chitin with superfine grinding, and the solubility of chitin in hexafluoro-2-propanol (HFIP) is significantly increased. Chitin and gelatin mixtures are prepared by adding different amount of gelatin to the 8mg ml^-1 chitin solution. In the presence water (non-solvent), the mixtures are gelled as HFIP is replaced by water, and chitin/gelatin composite sponges with directional pore structure are prepared by directional freeze drying of the hydrogel. The structure, porosity, liquid absorbing capacity, biodegradability, and hemostatic properties of the sponges with different ratios of gelatin are investigated. The results show that the sponge with the mass ratio of chitin/gelatin of 1:1 is potential hemostatic material with high absorbing capacity, hemocompatibility, and the best hemostatic performance. The in vivo study demonstrates that hemostatic time of the composite sponge (73 s) is much shorter than of that of gauze (193 s), chitin sponge (132s) as well as gelatin sponge (116 s) in rat femoral artery injury model. This article is protected by copyright. All rights reserved.

Recent Development of Conductive Hydrogels for Tissue Engineering: Review and Perspective

In recent years, tissue engineering techniques have been rapidly developed and offer a new therapeutic approach to organ or tissue damage repair. However, most of tissue engineering scaffolds are nonconductive and cannot establish effective electrical coupling with tissue for the electroactive tissues. Electroconductive hydrogels (ECHs) have received increasing attention in tissue engineering owing to their electroconductivity, biocompatibility and high water content. In vitro, ECHs can not only promote the communication of electrical signals between cells, but also mediate the adhesion, proliferation, migration, and differentiation of different kinds of cells. In vivo, ECHs can transmit the electric signal to electroactive tissues and activate bioelectrical signaling pathways to promote tissue repair. As a result, implanting ECHs into damaged tissues can effectively reconstruct physiological functions related to electrical conduction. In this review, we first present an overview about the classifications and the fabrication methods of ECHs. And then, the applications of ECHs in tissue engineering, including cardiac, nerve, skin and skeletal muscle tissue, are highlighted. At last, we provide some rational guidelines for designing ECHs towards clinical applications. This article is protected by copyright. All rights reserved.

Development of a Microenvironment-Responsive Hydrogel Promoting Chronically Infected Diabetic Wound Healing through Sequential Hemostatic, Antibacterial, and Angiogenic Activities

Microenvironment-responsive hydrogels present high potential in treating refractory wounds due to their capability of on-demand drug release. In this study, a specially designed hydrogel with smart targeting of refractory wound characteristics was designed to treat chronically infected diabetic wounds. Aminated gelatin reacted with oxidized dextran, forming a hydrogel cross-linked with a dynamic Schiff base, which is sensitive to the low-pH environment in refractory wounds. Nano-ZnO was loaded into the hydrogel for killing microbes. A Paeoniflorin-encapsulated micelle with a ROS-responsive property was fixed to the skeleton of the hydrogel via a Schiff base bond for low-pH- and ROS-stimulated angiogenic activity. The sequential responsiveness of the novel hydrogel enabled smart rescue of the deleterious microenvironment in refractory wounds. This highly biocompatible hydrogel demonstrated antibacterial and angiogenic abilities in vitro and significantly promoted healing of chronically infected diabetic wounds via sequential hemostatic, microbe killing, and angiogenic activities. This microenvironment-responsive hydrogel loaded with nZnO and Pf-encapsulated micelles holds great potential as a location-specific dual-response delivery platform for curing refractory, chronically infected diabetic wounds.

Macroporous Silk Nanofiber Cryogels with Tunable Properties

Cryogels are widely used in tissue regeneration due to their porous structures and friendly hydrogel performance. Silk-based cryogels were developed but failed to exhibit desirable tunable properties to adapt various biomedical applications. Here, amorphous short silk nanofibers (SSFs) were introduced to fabricate silk cryogels with versatile cues. Compared to previous silk cryogels, the SSF cryogels prepared under same conditions showed significantly enhanced mechanical properties. The microporous cryogels were achieved under lower silk concentrations, confirming better tunability. Versatile cryogels with the modulus in the range of 0.5-283.7 kPa were developed through adjusting silk concentration and crosslinking conditions, superior to previous silk cryogel systems. Besides better cytocompatibility, the SSF cryogels were endowed with effective mechanical cues to control osteogenetic differentiation behaviors of BMSCs. The mechanical properties could be further regulated finely through the introduction of β-sheet-rich silk nanofibers (SNFs), which suggested possible optimization of mechanical niches. Bioactive cargo-laden SNFs were introduced to the SSF cryogel systems, bringing biochemical signals without the compromise of mechanical properties. Versatile SNF-based cryogels with different physical and biological cues were developed here to facilitate the applications in various tissue engineering.

Shape-Recoverable Hyaluronic Acid-Waterborne Polyurethane Hybrid Cryogel Accelerates Hemostasis and Wound Healing

Wound dressings that promote quick hemostasis and are highly efficient in healing wounds are urgently needed to meet the increase in clinical demands worldwide. Herein, a dihydrazide-modified waterborne biodegradable polyurethane emulsion (PU-ADH) and oxidized hyaluronic acid (OHA) were autonomously cross-linked to form a hybrid hyaluronic acid-polyurethane (HA-PU) cryogel by hydrazone bonding at -20 °C. Through its specific macroporous structure (which is approximately 220 μm) constructed by aggregated PU-ADH particles and long-chain OHA, a dried cryogel can have a dramatically compressed volume (1/7 of its original volume) with stable fixation, and it can swell rapidly by absorbing water or blood to approximately 22 and 16 times its dried weight, respectively, in a few minutes. This instantaneous shape-recovering ability favors fast hemostasis in minimally invasive surgery. Moreover, this cryogel is superior to gauze, has excellent biocompatibility, and quickly coagulates blood (in approximately 2 min) by activating the endogenous coagulation system. Comparably, an injectable HA-PU hydrogel with the same components as the HA-PU cryogel was prepared at room temperature, and it exhibited good self-healing properties. An in vivo evaluation of a rat liver hemostasis model and rat skin defect model revealed that the cryogel in fast hemostasis has great potential and superior wound-healing abilities, decreases immune inflammation, and promotes the regeneration of angiogenesis and hair follicles. Consequently, this work proposes a versatile method for constructing biodegradable hybrid cryogels via autonomous cross-linking between synthesized polymer emulsions and natural polymers. The hybrid cryogels demonstrated great potential for applications as high-performance wound dressings.

Copper-Hydrazide Coordinated Multifunctional Hyaluronan Hydrogels for Infected Wound Healing

Bacterial infection and delayed healing are two major obstacles in cutaneous wound management, and developing multifunctional hydrogels with antibacterial and prohealing capabilities presents a promising strategy to dress wounds. However, the simple and facile fabrication of such hydrogel dressings remains challenging. Herein, we report the first observation on hydrazide-metal coordination crosslinking that is utilized to successfully construct a series of hyaluronan (HA)-metal hydrogels by mixing hydrazided HA and metal ion solutions. Considering the antibacterial, prohealing, and proangiogenic properties of HA and Cu(II), as a proof of principle, a HA-Cu hydrogel was systematically investigated as a wound dressing. Surprisingly, the hydrazide-Cu(II) coordination was dynamic in nature and imparted the HA-Cu hydrogel with physicochemical multifunctions, including spontaneous self-healing, shear-thinning injectability, reversible pH/redox/ion pair triple responsiveness, etc. Moreover, the HA-Cu hydrogel exhibited a robust broad-spectrum antibacterial activity and could significantly accelerate infectious wound healing. Impressively, glutathione-triggered hydroxyl radical generation further potentiated wound healing, providing a paradigm for on-demand antibacterial activity enhancement. Hence, the HA-Cu hydrogel is a clinically applicable "smart" dressing for multi-scenario wound healing. We envision that the simple and versatile coordination approach opens up a new avenue to develop multifunctional hydrogels and shows great potential in frontier fields, such as biomedicine, wearable devices, and soft robots.

Carboxymethyl chitosan-based multifunctional hydrogels incorporated with photothermal therapy against drug-resistant bacterial wound infection

Wound infection especially that induced by drug resistant bacteria has been considered an increasing medical crisis. Herein a biocompatible wound dressing is conveniently constructed by incorporating (Sr_0.6Bi_0.305)₂Bi₂O₇ (denoted as SBO) with excellent photothermal performance into a facile antibacterial hydrogel (gel) obtained from multiple physical crosslinks among Ag⁺, carboxymethyl chitosan and polyacrylic acid. The prepared SBO gel features excellent bactericidal activities, hemostasis, adequate mechanical properties, adhesiveness and adsorption capacities to bacterial cells and toxin. The gel can disperse SBO homogeneously in the network and SBO effectively convert visible light energy into localized heat for synergistic sterilization. In vitro assays confirm the potent broad-spectrum bactericidal activities of SBO gel to some common pathogens and drug resistant strains such as MRSA and CAPA. Mice model of MRSA-induced wound infections verified the practical efficacy of SBO gel in combating bacterial infections and accelerating wound healing. Moreover, this is the first report of SBO as a photothermal agent applied in anti-infection treatment. All of these results highlight the potential application of SBO gel in drug-resistant bacteria associated wound management.

Histatin-1 loaded multifunctional, adhesive and conductive biomolecular hydrogel to treat diabetic wound

Micro-/macroangiopathy, neuropathy and prolonged inflammation are common in diabetic wound, however, traditional wound dressing cannot treat these problems in the same time. Herein, we developed a multifunctional hydrogel with promoted angiogenesis, cell proliferation and anti-inflammation ability to treat diabetic wound. The hydrogel was composed of natural polymers, including gelatin and chitosan, which have excellent biocompatibility. Histatin-1 (His-1) was added into the hydrogel to improve the cell adhesion, proliferation and angiogenesis. Besides, polypyrrole based conductive nanoparticles (G-Ppy) were introduced in the hydrogel to enhance the electrical signal conduction between skin and promote the mechanical strength of the hydrogel. The polypyrrole nanoparticles were growth in the chain of methacryloyl grafted gelatin (Gel-MA), leading to a better biocompatibility and water dispersibility. In vivo wound healing experiment proved that the hydrogel accelerated the wound healing rate, down regulation the expression of pro-inflammation factor TNF-α and upregulation the expression of CD31 and α-SMA, indicating the prospects in the application of diabetic wound healing.