Mechanically robust, negative-swelling, mussel-inspired tissue adhesives

Reversibly Adhesive, Anti-Swelling, and Antibacterial Hydrogels for Tooth-Extraction Wound Healing

Oral wound treatment faces challenges due to the complex oral environment, thus, sealing the wound quickly becomes necessary. Although some materials have achieved adhesion and sterilization, how to effectively solve the contradiction between strong adhesion and on-demand removal remains a challenge. Herein, a reversibly adhesive hydrogel is designed by free radical copolymerization of cationic monomer [2-(acryloyloxy) ethyl] trimethylammonium chloride (ATAC), hydrophobic monomer ethylene glycol phenyl ether acrylate (PEA) and N-isopropylacrylamide (NIPAAm). The cationic quaternary ammonium salts provide electrostatic interactions, the hydrophobic groups provide hydrophobic interactions, and the PNIPAAm chain segments provide hydrogen bonding, leading to strong adhesion. Therefore, the hydrogel obtains an adhesion strength of 18.67 KPa to oral mucosa and can seal wounds fast within 10 s. Furthermore, unlike pure PNIPAAm, the hydrogel has a lower critical solution temperature of 40.3 °C due to the contribution of ATAC and PEA, enabling rapid removal with 40 °C water after treatment. In addition, the hydrogel realizes excellent anti-swelling ratio (≈80%) and antibacterial efficiency (over 90%). Animal experiments prove that the hydrogel effectively reduces inflammation infiltration, promotes collagen deposition and vascular regeneration. Thus, hydrogel as a multi-functional dressing has great application prospects in oral wound management.

Swift Covalent Gelation Coupled with Robust Wet Adhesive Powder: A Novel Approach for Acute Massive Hemorrhage Control in Dynamic and High-Pressure Wound Environments

The quest for efficient hemostatic agents in emergency medicine is critical, particularly for managing massive hemorrhages in dynamic and high-pressure wound environments. Traditional self-gelling powders, while beneficial due to their ease of application and rapid action, fall short in such challenging conditions. To bridge this gap, the research introduces a novel self-gelling powder that combines ultrafast covalent gelation and robust wet adhesion, presenting a significant advancement in acute hemorrhage control. This ternary system comprises ε-polylysine (ε-PLL) and 4-arm polyethylene glycol succinyl succinate (4-arm-PEG-NHS) forming the hydrogel framework. Na2HPO4 functions as the "H+ sucker" to expedite the amidation reaction, slashing gelation time to under 10 s, crucial for immediate blood loss restriction. Moreover, PEG chains' hydrophilicity facilitates efficient absorption of interfacial blood, increasing the generated hydrogel's cross-linking density and strengthens its tissue bonding, thereby resulting in excellent mechanical and wet adhesion properties. In vitro experiments reveal the optimized formulation's exceptional tissue compliance, procoagulant activity, biocompatibility and antibacterial efficacy. In porcine models of heart injuries and arterial punctures, it outperforms commercial hemostatic agent Celox, confirming its rapid and effective hemostasis. Conclusively, this study presents a transformative approach to hemostasis, offering a reliable and potent solution for the emergency management of massive hemorrhage.

Photocurable extracellular matrix sealant for cessation of venous hemorrhage

Hemorrhage is the second leading cause of death in patients under 46 years of age in the United States. Cessation of hemorrhage prevents hemorrhagic shock and tissue hypoxia. Controlling the bleed via direct pressure or tourniquet is often the first line of defense, but long-term care requires staples, hemostatic agents, or sealants that seal the vessel and restore blood flow. Here, we compare a new photocurable extracellular matrix sealant (pcECM) with low, medium, and high crosslink density formulations to a commercially available fibrin-based sealant, TISSEEL®. pcECM has potential uses in surgical and remote settings due to room temperature storage conditions and fast preparation time. Here, we determine if pcECM sealant can stop venous hemorrhage in a murine model, adhere to the wound site in vivo throughout the wound-healing process, and has the mechanical properties necessary for stopping hemorrhage. Adjusting pcECM crosslinking density significantly affected viscosity, swelling, burst strength, tensile strength, and elasticity of the sealant. 3-Dimensional ultrasound volume segmentations showed pcECM degrades to 17 ± 8% of its initial implant volume by day 28. Initially, local hemodynamic changes were observed, but returned close to baseline levels by day 28. Acute inflammation was observed near the puncture site in pcECM implanted mice, and we observed inflammatory markers at the 14-day explant for both sealants. pcECM and fibrin sealant successfully sealed the vessel in all cases, and consistently degraded over 14-28 days. pcECM is a durable sealant with tunable mechanical properties and possible uses in hemorrhage control and other surgical procedures.

Nature-Inspired Wet Drug Delivery Platforms

Nature has created various organisms with unique chemical components and multi-scale structures (e.g., foot proteins, toe pads, suckers, setose gill lamellae) to achieve wet adhesion functions to adapt to their complex living environments. These organisms can provide inspirations for designing wet adhesives with mediated drug release behaviors in target locations of biological surfaces. They exhibit conformal and enhanced wet adhesion, addressing the bottleneck of weaker tissue interface adhesion in the presence of body fluids. Herein, it is focused on the research progress of different wet adhesion and bioinspired fabrications, including adhesive protein-based adhesion and inspired adhesives (e.g., mussel adhesion); capillarity and Stefan adhesion and inspired adhesive surfaces (e.g., tree frog adhesion); suction-based adhesion and inspired suckers (e.g., octopus' adhesion); interlocking and friction-based adhesion and potential inspirations (e.g., mayfly larva and teleost adhesion). Other secreted protein-induced wet adhesion is also reviewed and various suckers for other organisms and their inspirations. Notably, one representative application scenario of these bioinspired wet adhesives is highlighted, where they function as efficient drug delivery platforms on target tissues and/or organs with requirements of both controllable wet adhesion and optimized drug release. Finally, the challenges of these bioinspired wet drug delivery platforms in the future is presented.

Bioadhesive Technology Platforms

Bioadhesives have emerged as transformative and versatile tools in healthcare, offering the ability to attach tissues with ease and minimal damage. These materials present numerous opportunities for tissue repair and biomedical device integration, creating a broad landscape of applications that have captivated clinical and scientific interest alike. However, fully unlocking their potential requires multifaceted design strategies involving optimal adhesion, suitable biological interactions, and efficient signal communication. In this Review, we delve into these pivotal aspects of bioadhesive design, highlight the latest advances in their biomedical applications, and identify potential opportunities that lie ahead for bioadhesives as multifunctional technology platforms.

Tailoring the Swelling-Shrinkable Behavior of Hydrogels for Biomedical Applications

Hydrogels with tailor-made swelling-shrinkable properties have aroused considerable interest in numerous biomedical domains. For example, as swelling is a key issue for blood and wound extrudates absorption, the transference of nutrients and metabolites, as well as drug diffusion and release, hydrogels with high swelling capacity have been widely applicated in full-thickness skin wound healing and tissue regeneration, and drug delivery. Nevertheless, in the fields of tissue adhesives and internal soft-tissue wound healing, and bioelectronics, non-swelling hydrogels play very important functions owing to their stable macroscopic dimension and physical performance in physiological environment. Moreover, the negative swelling behavior (i.e., shrinkage) of hydrogels can be exploited to drive noninvasive wound closure, and achieve resolution enhancement of hydrogel scaffolds. In addition, it can help push out the entrapped drugs, thus promote drug release. However, there still has not been a general review of the constructions and biomedical applications of hydrogels from the viewpoint of swelling-shrinkable properties. Therefore, this review summarizes the tactics employed so far in tailoring the swelling-shrinkable properties of hydrogels and their biomedical applications. And a relatively comprehensive understanding of the current progress and future challenge of the hydrogels with different swelling-shrinkable features is provided for potential clinical translations.

Adhesive cryogel particles for bridging confined and irregular tissue defects

BACKGROUND

Reconstruction of damaged tissues requires both surface hemostasis and tissue bridging. Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies, making tissue bridging challenging.

METHODS

This study proposes a tissue adhesive in the form of adhesive cryogel particles (ACPs) made from chitosan, acrylic acid, 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) and N-hydroxysuccinimide (NHS). The adhesion performance was examined by the 180-degree peel test to a collection of tissues including porcine heart, intestine, liver, muscle, and stomach. Cytotoxicity of ACPs was evaluated by cell proliferation of human normal liver cells (LO2) and human intestinal epithelial cells (Caco-2). The degree of inflammation and biodegradability were examined in dorsal subcutaneous rat models. The ability of ACPs to bridge irregular tissue defects was assessed using porcine heart, liver, and kidney as the ex vivo models. Furthermore, a model of repairing liver rupture in rats and an intestinal anastomosis in rabbits were established to verify the effectiveness, biocompatibility, and applicability in clinical surgery.

RESULTS

ACPs are applicable to confined and irregular tissue defects, such as deep herringbone grooves in the parenchyma organs and annular sections in the cavernous organs. ACPs formed tough adhesion between tissues [(670.9 ± 50.1) J/m² for the heart, (607.6 ± 30.0) J/m² for the intestine, (473.7 ± 37.0) J/m² for the liver, (186.1 ± 13.3) J/m² for muscle, and (579.3 ± 32.3) J/m² for the stomach]. ACPs showed considerable cytocompatibility in vitro study, with a high level of cell viability for 3 d [(98.8 ± 1.2) % for LO2 and (98.3 ± 1.6) % for Caco-2]. It has comparable inflammation repair in a ruptured rat liver (P = 0.58 compared with suture closure), the same with intestinal anastomosis in rabbits (P = 0.40 compared with suture anastomosis). Additionally, ACPs-based intestinal anastomosis (less than 30 s) was remarkably faster than the conventional suturing process (more than 10 min). When ACPs degrade after surgery, the tissues heal across the adhesion interface.

CONCLUSIONS

ACPs are promising as the adhesive for clinical operations and battlefield rescue, with the capability to bridge irregular tissue defects rapidly.

Metamaterial with Tunable Positive and Negative Hygrothermal Expansion Inspired by a Four-Fold Symmetrical Islamic Motif

A metamaterial with controllable positive and negative thermal and hygroscopic expansions is investigated herein by inspiration from a range of Islamic geometric patterns. Constructing from eight pairs of pin-jointed Y-elements, each unit cell manifests eight rhombi that are arranged circumferentially, thereby manifesting four axes of symmetry. By attachment of bimaterial spiral springs of contrasting expansion coefficients to the far arms of the paired Y-elements, a change in the environment’s thermal or hygroscopic condition alters the offset angle of the paired Y-elements such that the unit cell of the metamaterial ranges from the eight-pointed star to the regular octagon. The effective coefficient of thermal expansion (CTE) and the coefficient of moisture expansion (CME) of this metamaterial were developed for small and large changes in environmental fluctuations using infinitesimal and finite models, respectively. Generated data indicates that the sign and magnitude of the effective thermal and hygroscopic expansion coefficients can be controlled by geometrical descriptors of the bimaterial spiral spring—such as its coil number and the ratio of its mean radius to its thickness—as well as the properties of the bimaterial’s layers such as their expansion coefficients, Young’s moduli and, in the case of effective hygroscopic expansion, their relative absorptivity. The obtained results suggest that the proposed metamaterial can be designed to perform as highly sensitive thermal and/or moisture sensors, as well as other functional materials or devices that take advantage of environmental changes as stimuli.

Multifunctional Dual Cross-Linked Bioadhesive Patch with Low Immunogenic Response and Wet Tissues Adhesion

The development of bioadhesives is an important, yet challenging task as seemingly mutually exclusive properties need to be combined in one material, that is, strong adhesion, water resistance, and high biocompatibility. Here, a biocompatible and biodegradable protein-based bioadhesive patch (PBP) with high adhesion strength and low immunogenic response is reported. PBP exists as a strong adhesion for biological surfaces, which is higher than some conventional bioadhesives (i.e., polyethylene glycol and fibrin). Robust adhesion and strength are realized through the removal of interfacial water and fast formation of multiple supramolecular interactions induced by metal ions. The PBP's high biocompatibility is evaluated and immunogenic response in vitro and in vivo is neglected. The strong adhesion on soft biological tissues qualifies the PBP as biomedical glue outperforming some commercial products for applications in hemostasis performance, accelerated wound healing, and sealing of defected organs, anticipating to be useful as a tissue adhesive and sealant.

In vivo Sealing of Fetoscopy-Induced Fetal Membrane Defects by Mussel Glue

INTRODUCTION

The benefits of fetal surgery are impaired by the high incidence of iatrogenic preterm prelabor rupture of the fetal membranes (iPPROM), for which chorioamniotic separation has been suggested as a potential initiator. Despite the urgent need to prevent iPPROM by sealing the fetoscopic puncture site after intervention, no approach has been clinically translated.

METHODS

A mussel-inspired biomimetic glue was tested in an ovine fetal membrane (FM) defect model. The gelation time of mussel glue (MG) was first optimized to make it technically compatible with fetal surgery. Then, the biomaterial was loaded in polytetrafluoroethylene-coated nitinol umbrella-shaped receptors and applied on ovine FM defects (N = 10) created with a 10 French trocar. Its sealing performance and tissue response were analyzed 10 days after implantation by amniotic fluid (AF) leakage and histological methods.

RESULTS

All ewes and fetuses recovered well after the surgery, and 100% ewe survival and 91% fetal survival were observed at explantation. All implants were tight at explantation, and no AF leakage was observed in any of them. Histological analysis revealed a mild tissue response to the implanted glue.

CONCLUSION

MG showed promising properties for the sealing of FM defects and thereby the prevention of preterm birth. Studies to analyze the long-term tissue response to the sealant should be performed.

Injectable, stretchable, toughened, bioadhesive composite hydrogel for bladder injury repair†

The bladder is exposed to constant internal and external mechanical forces due to its deformation and the dynamic environment in which it is placed, which can hamper its repair after an injury. Traditional hydrogel materials have limitations regarding their use in the bladder owing to their poor mechanical and tissue adhesion properties. In this study, a composite hydrogel composed of methacrylate gelatine, methacrylated silk fibroin, and Pluronic F127 diacrylate was developed, which combines the characteristics of natural and synthetic polymers. The mechanical properties of the novel hydrogel, such as stretchability, viscoelasticity, and toughness, were improved by virtue of a particular molecular design strategy whereby covalent and non-covalent bond interactions create a cross-linking effect. In addition, the composite hydrogel has important usability properties; it can be injected in liquid format and rapidly transformed into a gel via photo-initiated crosslinking. This was demonstrated on an isolated porcine bladder where the hydrogel closed arbitrarily-shaped tissue defects within 90 s of its application, verifying its effective bioadhesive and sealing properties. This composite hydrogel has great potential for application in bladder injury repair as a tissue-engineering scaffold.

An injectable, stretchable, toughened, bioadhesive composite hydrogel offers a new application strategy for sutureless repair and tissue regeneration of injured bladders.

Bone-Adhesive Anisotropic Tough Hydrogel Mimicking Tendon Enthesis

Tendon consists of soft collagen, yet it is mechanically strong and firmly adhered to the bone owing to its hierarchically anisotropic structure and unique tendon-to-bone integration (enthesis), respectively. Despite the recent advances in biomaterials, hydrogels simultaneously providing tendon-like high mechanical properties and strong adhesion to bone-mimicking enthesis is still challenging. Here, a strong, stiff, and adhesive triple-network (TN) anisotropic hydrogel that mimics a bone-adhering tendon is shown. The tough adhesive TN hydrogel is developed by combining imidazole-containing polyaspartamide (providing multiple hydrogen bonds to the bone surface) and energy-dissipative alginate-polyacrylamide double-network. To mimic the anisotropic structure and high mechanical properties of tendons, the bone-adhered TN hydrogel is linearly stretched and subsequently fixed via secondary cross-linking. The resulting hydrogel exhibits high tensile modulus and strength while maintaining a high bone adhesion without chemical modification of the bone surface. Furthermore, a bone-ligament-bone structure with strong bone adhesion reminiscent of the natural ligament is realized.

A bio-inspired, ultra-tough, high-sensitivity, and anti-swelling conductive hydrogel strain sensor for motion detection and information transmission

Conductive hydrogels are excellent candidates for the next-generation wearable materials and are being extensively investigated for their potential use in health monitoring devices, human-machine interfaces, and other fields. However, their relatively low mechanical strength and performance degradation due to swelling have presented challenges in their practical application. Inspired by the multiscale heterogeneous architecture of biological tissue, a dynamic cross-linked, ultra-tough, and high-sensitivity hydrogel with a swelling resistance characteristic was fabricated by the principle of multiple non-covalent interaction matching and a step-by-step construction strategy. A heterogeneous structure was constructed by the combination of a 'soft' hydrophobic-conjugated micro-region structural domain with inter/intra-molecular hydrogen bonding and π-π stacking along with 'rigid' cross-linking via strong ionic coordination interactions. Reversible cross-linking synergies and variations in the content of rigid and flexible components guaranteed the hydrogel to undergo flexible and efficient modulation of the structures and gain excellent mechanics, including elongation at break (>2000%), toughness (∼60 MJ m^-3), and recovery (>88%). Notably, hydrogels displayed good anti-swelling properties even in solutions with different pH (pH 2-11) and solvents. Moreover, the hydrogel further exhibited fast response (47.4 ms) and high sensitivity due to the presence of dynamic ions (Fe³⁺, Na⁺, and Cl^-); therefore, it was assembled into a sensor to detect various human motions and used as a signal transmitter for the encryption and decryption of information according to Morse code. This study provides basis for the development of a variety of robust and flexible conductive hydrogels with multifunctional sensing applications in next-generation wearable devices.

Bridging wounds: tissue adhesives' essential mechanisms, synthesis and characterization, bioinspired adhesives and future perspectives

Bioadhesives act as a bridge in wound closure by forming an effective interface to protect against liquid and gas leakage and aid the stoppage of bleeding. To their credit, tissue adhesives have made an indelible impact on almost all wound-related surgeries. Their unique properties include minimal damage to tissues, low chance of infection, ease of use and short wound-closure time. In contrast, classic closures, like suturing and stapling, exhibit potential additional complications with long operation times and undesirable inflammatory responses. Although tremendous progress has been made in the development of tissue adhesives, they are not yet ideal. Therefore, highlighting and summarizing existing adhesive designs and synthesis, and comparing the different products will contribute to future development. This review first provides a summary of current commercial traditional tissue adhesives. Then, based on adhesion interaction mechanisms, the tissue adhesives are categorized into three main types: adhesive patches that bind molecularly with tissue, tissue-stitching adhesives based on pre-polymer or precursor solutions, and bioinspired or biomimetic tissue adhesives. Their specific adhesion mechanisms, properties and related applications are discussed. The adhesion mechanisms of commercial traditional adhesives as well as their limitations and shortcomings are also reviewed. Finally, we also discuss the future perspectives of tissue adhesives.

A double-network strategy for the tough tissue adhesion of hydrogels with long-term stability under physiological environment

Achieving tough and stable tissue adhesion under a physiological environment is of great significance for the clinical applications of hydrogel adhesives. The current tough hydrogel adhesives face challenges in the preservation of the maximal adhesion for a long time due to swelling. Here, we propose a double-network strategy for tough tissue adhesion by a hydrogel with long-term stability under a physiological environment. A double-network hydrogel consisting of a covalently crosslinked primary network with tunable hydrophilicity and a non-covalently crosslinked secondary network with functional groups is designed. The primary network exhibited hydrophobicity in the physiological environment, which could constrict the secondary network and limit the swelling of the entire hydrogel. The secondary network could form strong interlinks with tissue and provide large energy dissipation through the unzipping of its noncovalent crosslinks when separated by a force. The combination of the two networks resulted in a tough and stable tissue adhesion. A poly(N-isopropylacrylamide)/calcium alginate hydrogel synthesized based on this strategy realized an adhesion energy of 300-500 J m^-2 with porcine tissues, and the maximal adhesion could be maintained for over 1000 min after submerging in a PBS solution at 37 °C. The swelling behavior of the hydrogel and changes in mechanical properties under the physiological environment are studied, and its application in repairing the aorta wound is demonstrated.

Infant Skin Friendly Adhesive Hydrogel Patch Activated at Body Temperature for Bioelectronics Securing and Diabetic Wound Healing

Adhesive-caused injury is a great threat for infants with premature skin or diabetic patients with fragile skin because extra-strong adhesion might incur pain, inflammation, and exacerbate trauma upon removal. Herein, we present a skin-friendly adhesive hydrogel patch based on protein-polyphenol complexation strategy, which leads to a thermoresponsive network sensitive to body temperature. The adhesion of the hydrogel is smartly activated after contacting with warm skin, whereas the painless detachment is easily realized by placing an ice bag on the surface of the hydrogel. The hydrogel exhibits an immunomodulatory performance that prevents irritation and allergic reactions during long-period contact with the skin. Thus, the hydrogel patch works as a conformable and nonirritating interface to guarantee nondestructively securing bioelectronics on infant skin for healthcare. Furthermore, the hydrogel patch provides gentle adhesion to wounded skin and provides a favorable environment to speed up the healing process for managing diabetic wounds.

Glucose-sensitive delivery of tannic acid by a photo-crosslinked chitosan hydrogel film for antibacterial and anti-inflammatory therapy

A glucose-sensitive antibacterial and anti-inflammatory hydrogel film with controlled release of tannic acid (TA) was synthesized using chitosan (CS). Specifically, the photo-crosslinked CS hydrogel was first obtained and then immersed in TA solution to generate composite hydrogel film with enhanced mechanical properties. Subsequently, N-hydroxysuccinimide/1-ethyl-3-(3-dimethylaminopropyl) carbodiimide based coupling chemistry was used to covalently crosslink glucose oxidase (GOx) to CS to obtain glucose sensitivity. The physicochemical properties, including chemical composition, enzyme-related characteristics, glucose responsiveness, and mechanical strength, were thoroughly investigated, followed by the cytotoxicity, antibacterial and anti-inflammatory tests. The results showed that the GOx immobilized on the film surface by covalent bonding gave better stability than those that were physically adsorbed. In addition, it could quickly and correspondingly modify its inner pore structure in response to the glucose stimulus and then control the loaded TA release. Meanwhile, the TA addition could enhance the film's mechanical properties. The composite hydrogel film demonstrated adequate biocompatibility and can inhibit NO, IL-6, and TNF-α production in stimulated macrophages, as well as Porphyromonas gingivalis growth, demonstrating effective antibacterial and anti-inflammatory activity.

Mussel Inspired Trigger-Detachable Adhesive Hydrogel

Adhesion to many kinds of surfaces, including biological tissues, is important in many fields but has been proved to be extremely challenging. Furthermore, peeling from strong adhesion is needed in many conditions, but is sometimes painful. Herein, a mussel inspired hydrogel is developed to achieve both strong adhesion and trigger-detachment. The former is actualized by electrostatic interactions, covalent bonds, and physical interpenetration, while the latter is triggered, on-demand, through combining a thixotropic supramolecular network and polymer double network. The results of the experiments show that the hydrogel can adhere to various material surfaces and tissues. Moreover, triggered by shear force, non-covalent interactions of the supramolecular network are destroyed. This adhesion can be peeled easily. The possible mechanism involved is discussed and proved. This work will bring new insight into electronic engineering and tissue repair like skin care for premature infants and burn victims.

A low-swelling and toughened adhesive hydrogel with anti-microbial and hemostatic capacities for wound healing

Hydrogel-based wound dressings with tissue adhesion abilities are widely used for wound closure. However, currently developed hydrogel adhesives are still poor at continuing to seal wounds while bleeding is ongoing. Herein, we demonstrate an antibacterial and hemostatic hydrogel adhesive with low-swelling properties and toughness for wound healing. The hydrogel was composed of Pluronic F127 diacrylate, quaternized chitosan diacrylate, silk fibroin, and tannic acid, and it was not only able to maintain good tissue adhesion abilities in a moist environment but it also showed guaranteed tissue adhesion and mechanical strength after absorbing water due to its low-swelling and toughness properties. Furthermore, in vitro and in vivo tests demonstrated that the hydrogel also had antibacterial, antioxidant, and hemostatic properties, which could promote tissue regeneration. All these findings demonstrate that this hydrogel with multifunctional properties is a promising material for clinical wound healing applications.

Biomaterial-based treatments for the prevention of preterm birth after iatrogenic rupture of the fetal membranes

Minimally invasive interventions to ameliorate or correct fetal abnormalities are becoming a clinical reality. However, the iatrogenic premature preterm rupture of the fetal membranes (FMs) (iPPROM), which may result in...

Genetically Engineered Polypeptide Adhesive Coacervates for Surgical Applications

Adhesive hydrogels have been developed for wound healing applications. However, their adhesive performance is impaired dramatically due to their high swelling on wet tissues. To tackle this challenge, we fabricated a new type of non-swelling protein adhesive for underwater and in vivo applications. In this soft material, the electrostatic complexation between supercharged polypeptides with oppositely charged surfactants containing 3,4-dihydroxylphenylalanine or azobenzene moieties plays an important role for the formation of ultra-strong adhesive coacervates. Remarkably, the adhesion capability is superior to commercial cyanoacrylate when tested in ambient conditions. Moreover, the adhesion is stronger than other reported protein-based adhesives in underwater environment. The ex vivo and in vivo experiments demonstrate the persistent adhesive performance and outstanding behaviors for wound sealing and healing.

Mussel-inspired hydrogels as tough, self-adhesive and conductive bioelectronics: a review

To overcome the wearable sensor's defects and achieve the goal of robust mechanical properties, long-term adhesion, sensitive electrical conductivity, the multifunctional hydrogels were inspired by various mussels on the base of catechol and its analogues. In this review, we review the strategies for improving the mechanical strength, adhesion, conductivity and antibacterial properties of mussel-inspired hydrogels as bioelectronics. Double network structures, nanocomposites, supramolecular block polymers and other strategies were utilized for achieving tough hydrogels to prevent tensile fractures under high deformation. Many mussel-inspired chemistries were incorporated for constructing skin-attachable hydrogel strain sensors and some strategies for controlling the oxidation of catechol were employed to achieve long-term adhesion. In addition, electrolytes, conductive fillers, conductive polymers and their relevant hydrophilic modifications were introduced for fabricating the conductive hydrogel bioelectronics to enhance the conductivity properties. Finally, the challenges and outlooks in this promising field are featured from the perspective of materials chemistry.

High-Strength Hydrogel Adhesive Formed via Multiple Interactions for Persistent Adhesion under Saline

Hydrogel adhesives have been widely used in wet environments. Nonetheless, strong and stable persistent adhesion remains a challenge. Here, we report a facile yet powerful strategy to construct high-strength hydrogel adhesives for durable adhesion in a saline environment. Such a hydrogel consists of two polymer networks: a hydrophobic-associated polyacrylamide network of covalent and noncovalent cross-links and an alginate network cross-linked by divalent cations in saline. Meanwhile, polydopamine nanoparticles formed through in-situ self-polymerization are distributed evenly throughout the system to provide underwater adhesion. A low and controllable swelling rate and high compressive strength of hydrogels can be achieved via this multiple interaction strategy. Ultimately, this strategy contributes to the persistent underwater adhesion of hydrogels, and the decreasing rate of lap-shear adhesion strength of hydrogels is only 24.79 ± 8.01% after saline immersion for up to 21 days. Moreover, good cytocompatibility of hydrogels is helpful for their application in the biomedical field.

Multifaceted Design and Emerging Applications of Tissue Adhesives

Tissue adhesives can form appreciable adhesion with tissues and have found clinical use in a variety of medical settings such as wound closure, surgical sealants, regenerative medicine, and device attachment. The advantages of tissue adhesives include ease of implementation, rapid application, mitigation of tissue damage, and compatibility with minimally invasive procedures. The field of tissue adhesives is rapidly evolving, leading to tissue adhesives with superior mechanical properties and advanced functionality. Such adhesives enable new applications ranging from mobile health to cancer treatment. To provide guidelines for the rational design of tissue adhesives, here, existing strategies for tissue adhesives are synthesized into a multifaceted design, which comprises three design elements: the tissue, the adhesive surface, and the adhesive matrix. The mechanical, chemical, and biological considerations associated with each design element are reviewed. Throughout the report, the limitations of existing tissue adhesives and immediate opportunities for improvement are discussed. The recent progress of tissue adhesives in topical and implantable applications is highlighted, and then future directions toward next-generation tissue adhesives are outlined. The development of tissue adhesives will fuse disciplines and make broad impacts in engineering and medicine.

Advances in versatile anti-swelling polymer hydrogels

Swelling is ubiquitous for traditional as-prepared hydrogels, but is unfavorable in many situations, especially biomedical applications, such as tissue engineering, internal wound closure, soft actuating and bioelectronics, and so forth. As the swelling of a hydrogel usually leads to a volume expansion, which not only deteriorates the mechanical property of the hydrogel but can bring about undesirable oppression on the surrounding tissues when applied in vivo. In contrast, anti-swelling hydrogels hardly alter their volume when applied in aqueous environment, therefore reserving the original mechanical performance and size-stability and facilitating their potential application. In the past decade, with the development of advanced hydrogels, quite a number of anti-swelling hydrogels with versatile functions have been developed by researchers to meet the practical applications well, through integrating anti-swelling property with certain performance or functionality, such as high strength, self-healing, injectability, adhesiveness, antiseptics, etc. However, there has not been a general summary with regard to these hydrogels. To promote the construction of anti-swelling hydrogels with desirable functionalities in the future, this review generalizes and analyzes the tactics employed so far in the design and manufacture of anti-swelling hydrogels, starting from the viewpoint of classical swelling theories. The review will provide a relatively comprehensive understanding of anti-swelling hydrogels and clues to researchers interested in this kind of materials to develop more advanced ones suitable for practical application.

Robust Hydrogel Adhesive with Dual Hydrogen Bond Networks

Hydrogel adhesives are attractive for applications in intelligent soft materials and tissue engineering, but conventional hydrogels usually have poor adhesion. In this study, we designed a strategy to synthesize a novel adhesive with a thin hydrogel adhesive layer integrated on a tough substrate hydrogel. The adhesive layer with positive charges of ammonium groups on the polymer backbones strongly bonds to a wide range of nonporous materials’ surfaces. The substrate layer with a dual hydrogen bond system consists of (i) weak hydrogen bonds between N,N-dimethyl acrylamide (DMAA) and acrylic acid (AAc) units and (ii) strong multiple hydrogen bonds between 2-ureido-4[1H]-pyrimidinone (UPy) units. The dual hydrogen-bond network endowed the hydrogel adhesives with unique mechanical properties, e.g., toughness, highly stretchability, and insensitivity to notches. The hydrogel adhesion to four types of materials like glass, 316L stainless steel, aluminum, Al₂O₃ ceramic, and two biological tissues including pig skin and pig kidney was investigated. The hydrogel bonds strongly to dry solid surfaces and wet tissue, which is promising for biomedical applications.

Engineering Hydrogel Adhesion for Biomedical Applications via Chemical Design of the Junction

Hydrogel adhesion inherently relies on engineering the contact surface at soft and hydrated interfaces. Upon contact, adhesion normally occurs through the formation of chemical or physical interactions between the disparate surfaces. The ability to form these adhesion junctions is challenging for hydrogels as the interfaces are wet and deformable and often contain low densities of functional groups. In this Review, we link the design of the binding chemistries or adhesion junctions, whether covalent, dynamic covalent, supramolecular, or physical, to the emergent adhesive properties of soft and hydrated interfaces. Wet adhesion is useful for bonding to or between tissues and implants for a range of biomedical applications. We highlight several recent and emerging adhesive hydrogels for use in biomedicine in the context of efficient junction design. The main focus is on engineering hydrogel adhesion through molecular design of the junctions to tailor the adhesion strength, reversibility, stability, and response to environmental stimuli.

A Multifunctional, Self-Healing, Self-Adhesive, and Conductive Sodium Alginate/Poly(vinyl alcohol) Composite Hydrogel as a Flexible Strain Sensor

Hydrogel-based wearable devices have attracted tremendous interest due to their potential applications in electronic skins, soft robotics, and sensors. However, it is still a challenge for hydrogel-based wearable devices to be integrated with high conductivity, a self-healing ability, remoldability, self-adhesiveness, good mechanical strength and high stretchability, good biocompatibility, and stimulus-responsiveness. Herein, multifunctional conductive composite hydrogels were fabricated by a simple one-pot method based on poly(vinyl alcohol) (PVA), sodium alginate (SA), and tannic acid (TA) using borax as a cross-linker. The composite hydrogel network was built by borate ester bonds and hydrogen bonds. The obtained hydrogel exhibited pH- and sugar-responsiveness, high stretchability (780% strain), and fast self-healing performance with healing efficiency (HE) as high as 93.56% without any external stimulus. Additionally, the hydrogel displayed considerable conductive behavior and stable changes of resistance with high sensitivity (gauge factor (GF) = 15.98 at a strain of 780%). The hydrogel was further applied as a strain sensor for monitoring large and tiny human motions with durable stability. Significantly, the healed hydrogel also showed good sensing behavior. This work broadens the avenue for the design and preparation of biocompatible polymer-based hydrogels to promote the application of hydrogel sensors with comfortable wearing feel and high sensitivity.

Mussel foot protein inspired tough tissue-selective underwater adhesive hydrogel

Mussel foot proteins (Mfps) show strong adhesion to underwater substrates, making mussels tightly cling to reefs to withstand the sea current. Therefore, Mfps-inspired tissue adhesives have aroused much research interest, but tough underwater biological tissue adhesion is still a great challenge. Herein, we report a tough and reversible wet tissue-selective adhesive hydrogel made of poly(acrylic acid-co-catechol) and chitosan (CS). It provides negatively charged -COO^-, positively charged -NH₃⁺, catechol group and hydrophobic alkyl chain, resemble amino acids, catechol and hydrophobic units in Mfps. Due to the covalent/electrostatic attraction/π-π/cationic-π/hydrogen bonding, in addition to the hydrophobic interaction from the long hydrophobic alkyl chain of the catechol derivative, the hydrogel has a high cohesion strength and toughness, i.e., tensile stress, fracture strain and fracture toughness of ∼0.57 MPa, 2510% and 6620 J m^-2, respectively. As a tissue adhesive, its adhesion bonding to the porcine skin surface is so strong that its adhesion strength is almost equal to the tearing strength of the hydrogel. The 180-degree peeling adhesion energy of the hydrogel to blood-wetted porcine skin is notably ∼1010 J m^-2. It can tightly and seamlessly adhere to the porcine small intestine, and has a bursting pressure of up to 520 mmHg. The hydrogel can be handily debonded from the porcine skin surface in the presence of aqueous solution at pH 8.0, and its adhesiveness is reversible for at least 20 cycles. It is supposed that the synergistic interactions of the adhesive catechol group, displacement of water on the wet skin surface by the positively charged -NH₃⁺ groups of CS and the water-repelling potential of the hydrophobic unit of the catechol derivative, the protection of the catechol group from oxidation into a less adhesive quinone group, and the energy dissipation capacity of the mechanically tough hydrogel contribute to the strong and repeatable wet tissue adhesion.

Mussel-inspired adhesive and polypeptide-based antibacterial thermo-sensitive hydroxybutyl chitosan hydrogel as BMSCs 3D culture matrix for wound healing

Hydrogels have gained great attentions as wound dressing. Binding to the tissue and preventing wound infection were the basic requirements for an "ideal dressing". We employed l-DOPA and ε-Poly-l-lysine to modify thermo-sensitive hydroxybutyl chitosan (HBC) to obtain (l-DOPA) - (ε-Poly-l-lysine)-HBC hydrogels (eLHBC). The eLHBC exhibited an almost 1.5 fold (P < 0.01) increase in wet adhesion strength compared to HBC. Upon the introduction of ε-Poly-l-lysine, eLHBC presented inherent antimicrobial property and prevented wound infection and inflammation response. Bone marrow mesenchymal stem cells (BMSCs) encapsulated in the eLHBC (BMSCs ⊂ eLHBC) could secret cytokins and growth factors via paracrine and promote the migration of fibroblast cells. BMSCs ⊂ eLHBC enhanced the complete skin-thickness wound healing via promoting collagen deposition and inhibiting infection and inflammation in vivo with wound closure rate being above 99 % after 15 days. The bioinspired, tissue-adhesive eLHBC could serve as advanced wound dressings for facilitating tissue repair and regeneration.

Changing polymer catechol content to generate adhesives for high versus low energy surfaces

Adhesive bonding is commonly used to replace mechanical fasteners in many applications. However, the surface chemistry of different substrates varies, making adhesion to a variety of materials difficult. Many biological adhesives are adept at sticking to multiple surfaces with a range of surface chemistries. Marine mussels utilize a catechol moiety within their adhesive proteins to bring about surface binding as well as cohesive cross-linking. Mimicking this functionality in synthetic polymers has yielded high strength adhesives that can attach to both high and low surface energy materials, although not equally well. Here, the amount of catechol within a copolymer system was varied for potential tailoring to specific surfaces. Structure-function studies revealed differing trends of optimal catechol content for high energy aluminum versus low energy polytetrafluoroethylene (Teflon^TM) surfaces. Adhesion strengths were optimized with ∼10 mol% catechol for aluminum and ∼41 mol% for Teflon^TM. Varying the catechol incorporation also resulted in changes to wettability, failure modes, and mechanics on these substrates. When considering performance of the entire bulk material, the different surfaces required an altered adhesive-cohesive balance. Tailoring the composition of polymeric adhesives for different surfaces may aid future manufacturing in cases where joining a variety of materials is required.

Fast-Curing Mussel-Inspired Adhesive Derived from Vegetable Oil

The development of functional materials based on renewable resources is of great significance in today's resource shortage. Here, we present an effective way to synthesize a mussel-inspired adhesive from acrylated epoxidized soybean oil (AESO), a renewable and commercially available small molecular material with a molecular weight around 1200 Da, by a one-step esterification reaction with the affordable 3,4-dihydroxybenzoic acid (DHA). By taking advantages of both the double bond and the catechol moiety presented in this small molecular adhesive, a short curing time was achieved with UV irradiation. An average bonding strength around 1.4 MPa at a curing time of only around 10 min on a glass substrate was observed, which reached 3.1 MPa (average 2.8 MPa) at a curing time of 2 h under ambient conditions. The curing time is much shorter, and the bonding strength is obviously stronger than the conditions where conventional oxidation agents such as IO₄^- or oxidation/coordination agents such as Fe³⁺ are used as the curing agent. Furthermore, the AESO-g-DHA can be used as an underwater adhesive, and an appreciable bonding strength up to 0.64 MPa was observed, which is superior than most of currently known commercialized glues. Given that the adhesive could be synthesized from low-cost renewable resources in one step, it might be a potential candidate for large-scale practical application.

Tissue Adhesives: From Research to Clinical Translation

Sutures, staples, clips and skin closure strips are used as the gold standard to close wounds after an injury. In spite of being the present standard of care, the utilization of these conventional methods is precarious amid complicated and sensitive surgeries such as vascular anastomosis, ocular surgeries, nerve repair, or due to the high-risk components included. Tissue adhesives function as an interface to connect the surfaces of wound edges and prevent them from separation. They are fluid or semi-fluid mixtures that can be easily used to seal any wound of any morphology - uniform or irregular. As such, they provide alternatives to new and novel platforms for wound closure methods. In this review, we offer a background on the improvement of distinctive tissue adhesives focusing on the chemistry of some of these products that have been a commercial success from the clinical application perspective. This review is aimed to provide a guide toward innovation of tissue bioadhesive materials and their associated biomedical applications.

Polymeric Tissue Adhesives

Polymeric tissue adhesives provide versatile materials for wound management and are widely used in a variety of medical settings ranging from minor to life-threatening tissue injuries. Compared to the traditional methods of wound closure (i.e., suturing and stapling), they are relatively easy to use, enable rapid application, and introduce minimal tissue damage. Furthermore, they can act as hemostats to control bleeding and provide a tissue-healing environment at the wound site. Despite their numerous current applications, tissue adhesives still face several limitations and unresolved challenges (e.g., weak adhesion strength and poor mechanical properties) that limit their use, leaving ample room for future improvements. Successful development of next-generation adhesives will likely require a holistic understanding of the chemical and physical properties of the tissue-adhesive interface, fundamental mechanisms of tissue adhesion, and requirements for specific clinical applications. In this review, we discuss a set of rational guidelines for design of adhesives, recent progress in the field along with examples of commercially available adhesives and those under development, tissue-specific considerations, and finally potential functions for future adhesives. Advances in tissue adhesives will open new avenues for wound care and potentially provide potent therapeutics for various medical applications.

Supramolecular Cross-Links in Mussel-Inspired Tissue Adhesives

Here we introduce a tissue-adhesive patch with orthogonal cohesive and adhesive chemistries; supramolecular ureido-4-pyrimidinone (UPy) cross-links provide cohesive strength, and catechols provide mussel-inspired tissue adhesion. In the development of tissue-adhesive biomaterials, prior research has focused on forming strong adhesive interfaces in wet conditions, leaving the use of supramolecular cross-links for cohesive strength underexplored. In developing this adhesive patch, the influence of the comonomers' composition and amphiphilicity on adhesion was investigated by lap shear adhesion to wet tissue. We determined failed lap joints' failure mechanism using catechol-specific Arnow's stain and identified formulations with improved cohesive strength. The adhesive materials were cytocompatible in mammalian cell conditioned media viability studies. We found that using orthogonal motifs to independently control adhesives' cohesive and adhesive strengths resulted in stronger tissue adhesion. The design principles presented here advance the development of wet tissue adhesives and could allow for the future design of biomaterials with desirable stimuli-responsive properties.

Pressure-Sensitive Tissue Adhesion and Biodegradation of Viscoelastic Polymer Blends

Viscoelastic blends of biodegradable polyesters with low and high molecular weight distributions have remarkably strong adhesion (significantly greater than 1 N/cm2) to soft, wet tissue. Those that transition from viscous flow to elastic, solidlike behavior at approximately 1 Hz demonstrate pressure-sensitivity yet also have sufficient elasticity for durable bonding to soft, wet tissue. The pressure-sensitive tissue adhesive (PSTA) blends produce increasingly stronger pull-apart adhesion in response to compressive pressure application, from 10 to 300 s. By incorporating a stiffer high molecular weight component, the PSTA exhibits dramatically improved burst pressure (greater than 100 kPa) when used as a tissue sealant. The PSTA's biodegradation mechanism can be switched from erosion (occurring primarily over the first 10 days) to bulk chemical degradation (and minimal erosion) depending on the chemistry of the high molecular weight component. Interestingly, fibrosis toward the PSTA is reduced when fast-occurring erosion is the dominant biodegradation mechanism.

Correlating the mass and mechanical property changes during the degradation of PEG-based adhesive

Change in mechanical property of a degrading adhesive is critical to its performance. However, characterization of degradation behavior is often limited to tracking its mass loss. 4-armed PEG end modified with dopamine (PEG-DA) was used as a model bioadhesive to correlate its change in mass with change in mechanical property. Shear modulus (G) was calculated based on the mass and average molecular weight between crosslinks( M ¯ c ) of PEG-DA, while the storage modulus (G') was determined by oscillatory rheometry. G decreased slowly within the first week of degradation (10% reduction by week 2), while G' decreased by 60% during the same period. This large discrepancy is due to the partially disconnected and elastically ineffective PEG polymer, which is trapped within the adhesive network. This resulted in minimal mass change and higher calculated G value during the earlier time points. Therefore, tracking mass loss profile alone is inadequate to completely describe the degradation behavior of an adhesive. Additionally, PEG-DA was coated onto magnetoelastic (ME) sensors, and the change in the resonance amplitude of the sensor corresponded well with dry mass loss of PEG-DA. ME sensing provide a non-destructive method to track the mass loss of the coated adhesive.

Mussel-inspired bioadhesives in healthcare: design parameters, current trends, and future perspectives

Mussels are well-known for their extraordinary capacity to adhere onto different surfaces in various hydrophillic conditions. Their unique adhesion ability under water or in wet conditions has generated considerable interest towards developing mussel inspired polymeric systems that can mimic the chemical mechanisms used by mussels for their adhesive properties. Catechols like 3,4-dihydroxy phenylalanine (DOPA) and their biochemical interactions have been largely implicated in mussels' strong adhesion to various substrates and have been the centerpoint of research and development efforts towards creating superior tissue adhesives for surgical and tissue engineering applications. In this article, we review bioadhesion and adhesives from an engineering standpoint, specifically the requirements of a good tissue glue, the relevance that DOPA and other catechols have in tissue adhesion, current trends in mussel-inspired bioadhesives, strategies to develop mussel-inspired tissue glues, and perspectives for future development of these materials.

In vivo safety assessment of a bio-inspired bone adhesive

A new class of materials, bone adhesives, could revolutionise the treatment of highly fragmented fractures. We present the first biological safety investigation of a bio-inspired bone adhesive. The formulation was based upon a modified calcium phosphate cement that included the amino acid phosphoserine. This material has recently been described as substantially stronger than other bioresorbable calcium phosphate cements. Four adhesive groups with the active substance (phosphoserine) and two control groups without phosphoserine were selected for in vitro and in vivo biocompatibility testing. The test groups were subject for cell viability assay and subcutaneous implantation in rats that was followed by gene expression analysis and histology assessment after 6 and 12 weeks. All adhesive groups supported the same rate of cell proliferation compared to the α-TCP control and had viability between 45-64% when compared to cell control. There was no evidence of an increased immune response or ectopic bone formation in vivo. To conclude, this bio-inspired bone adhesive has been proven to be safe, in the present study, without any harmful effects on the surrounding soft tissue.