Enhanced Bacterial-Infected Wound Healing by Nitric Oxide-Releasing Topological Supramolecular Nanocarriers with Self-Optimized Cooperative Multi-Point Anchoring

High-affinity uric acid clearance based on motile β-CD/F-127 polyrotaxane microspheres for enhanced diabetic wound repair

Hyperuricemia-related diabetic wounds are notoriously difficult to treat due to elevated uric acid (UA) levels, excessive reactive oxygen species (ROS), and chronic inflammation. Current therapies often fail to address these underlying causes, underscoring the need for innovative approaches that not only clear UA but also mitigate inflammation and promote tissue regeneration. In this study, we developed a polyrotaxane-based microsphere (HPR MS) system conjugated with 4,5-diamino-2-thiouracil (DT) to achieve high-affinity UA clearance without increasing cytotoxicity. By leveraging the molecular motility of the polyrotaxane structure, featuring β-cyclodextrin (β-CD) shuttles along the F-127 axis, we significantly improved the molecular recognition between DT and UA for enhanced UA absorption efficiency. In vitro experiments confirmed that HPR/DT MS rapidly reduced UA levels compared to control groups. Using a type 2 diabetic wound model, HPR/DT MS treatment effectively reduced UA levels, suppressed COX-2 expression, and transformed the immune microenvironment from a pro-inflammatory to a regenerative state in vivo. This was accompanied by enhanced M2 macrophage polarization, angiogenesis, and improved blood perfusion, resulting in accelerated wound healing. Overall, these findings highlight HPR/DT MS as a promising therapeutic strategy for hyperuricemia-related diabetic wounds, targeting the core pathological factors to improve wound repair.

Near-infrared light-triggered nitric oxide-releasing hyaluronic acid hydrogel for precision transdermal therapy of androgenic alopecia

Progressive follicle and vascular atrophy, insufficient nutrient supply, and hormonal imbalance are direct causes of androgenic alopecia (AGA), limiting treatment options. Nitric oxide (NO) has demonstrated significant advantages in cell proliferation, vascular repair, and inflammation regulation. However, precise control of NO concentration and efficient utilization limit its clinical application for AGA treatment. To address this, we developed a near-infrared (NIR) light-triggered NO-releasing delivery system (Gel@L-Arg). The system uses Chlorin e6 (Ce6) grafted onto oxidized hyaluronic acid, reacting with L-Arg-loaded polyethyleneimine via Schiff base to form hyaluronic acid hydrogel. Under NIR light, Ce6 generates ROS, oxidizing L-Arg to release NO, after 5 min of irradiation, the NO concentration in Gel@L-Arg (1 %) is >1.5 times that in Gel@L-Arg (0.5 %), enabling on-demand release of NO. Gel@L-Arg (0.5 %) effectively promotes angiogenesis while significantly repairing damaged human dermal papilla cells (HDPCs), with cell viability reaching 131.6 ± 4.6 %. In animal models, the system reduced inflammation (IL-6, TNF-α), enhanced nutrient supply (VEGF, CD31), regulated androgens, and improved the follicular microenvironment, effectively treating AGA. This hyaluronic acid hydrogel, combining NIR light-triggered release with gas therapy, offers a new strategy for the treatment of AGA with good biocompatibility, providing insight into controlled gas release therapies for disease treatment.

Multifunctional Microneedle Patches Loaded With Engineered Nitric Oxide-Releasing Nanocarriers for Targeted and Synergistic Chronic Wound Therapy

Chronic wounds impose significant physical and mental burdens on patients. Nano-based formulations offer a promising strategy for chronic wound healing due to their non-invasive nature and enhanced biofilms penetration, but they often lack targeting capability or fail to achieve long-term and synergistic effects. In this work, a multifunctional microneedle (MN) patch loaded with engineered nitric oxide (NO)-releasing nanocarriers are presented that encapsulate an antibacterial agent and are immobilized with Concanavalin A (Con A) and NO molecules for targeted and synergistic treatment of chronic wounds. With the assistance of MNs, the nanoparticles (NPs) can directly cross bacterial biofilms and be efficiently delivered to wound tissues, where they target harmful bacteria through the specific recognition between Con A and polysaccharides on bacterial surfaces, followed by the release of the encapsulated antimicrobial agent, thereby achieving effective antibacterial effect. Moreover, the NPs generate NO in a sustained manner as they dissociate in the wound tissue, which exerts potent anti-inflammatory action and benefits tissue regeneration, further promoting chronic wounds closure. Consequently, this work provides a novel MN patch loaded with engineered NPs designed for accelerating chronic wound healing through targeted and synergistic therapy.

Glucose oxidase: An emerging multidimensional treatment option for diabetic wound healing

The healing of diabetic skin wounds is a complex process significantly affected by the hyperglycemic environment. In this context, glucose oxidase (GOx), by catalyzing glucose to produce gluconic acid and hydrogen peroxide, not only modulates the hyperglycemic microenvironment but also possesses antibacterial and oxygen-supplying functions, thereby demonstrating immense potential in the treatment of diabetic wounds. Despite the growing interest in GOx-based therapeutic strategies in recent years, a systematic summary and review of these efforts have been lacking. To address this gap, this review article outlines the advancements in the application of GOx and GOx-like nanozymes in the treatment of diabetic wounds, including reaction mechanisms, the selection of carrier materials, and synergistic therapeutic strategies such as multi-enzyme combinations, microneedle structures, and gas therapy. Finally, the article looks forward to the application prospects of GOx in aiding the healing of diabetic wounds and the challenges faced in translating these innovations to clinical practice. We sincerely hope that this review can provide readers with a comprehensive understanding of GOx-based diabetic treatment strategies, facilitate the rigorous construction of more robust multifunctional therapeutic systems, and ultimately benefit patients with diabetic wounds.

Three-arm polyrotaxanes with multidirectional molecular motions as the nanocarrier for nitric oxide-enhanced photodynamic therapy against bacterial biofilms in septic arthritis

Bacterial biofilms are one of the major contributors to the refractoriness of septic arthritis. Although nitric oxide (NO)-enhanced photodynamic (PDT) therapy has been involved in biofilm eradication, the anti-biofilm efficacy is usually hindered by the short half-life and limited diffusion distance of active molecules. Herein, we report a three-arm structure using the photosensitive core chlorin e6 to integrate three α-cyclodextrin (α-CD) polyrotaxane chains as the supramolecular nanocarrier of NO-enhanced PDT therapy, in which NO was loaded on the cationic rings (α-CDs). Beneficial from the enhanced permeability of the nanocarrier due to the collective act on biofilms by the molecular motions (slide and rotation of rings) of three chains in different directions, NO capable of inducing biofilm dispersal and reactive oxygen species were efficiently delivered deep inside biofilms under 660 nm laser irradiation, and reactive nitrogen species with stronger bactericidal ability was produced in-situ, further accomplishing bacteria elimination inside biofilms. In-vivo therapeutic performance of this platform was demonstrated in a rat septic arthritis model by eliminating the methicillin-resistant Staphylococcus aureus infection, and potentiating the immune microenvironment regulation and bone loss inhibition, also providing a promising strategy to numerous obstinate clinical infections caused by biofilms.

Nanocomposite system with photoactive phloxine B eradicates resistant Staphylococcus aureus

Nanomaterials modified with hybrid films functionalized with photoactive compounds can be an effective system to prevent and eradicate biofilms on medical devices. The aim of this research was to extend current knowledge on nanomaterial comprised of polyurethane (PU) modified with a nanocomposite film of organoclay with the functionalized photosensitizer (PS) phloxine B (PhB). Particles of the clay mineral saponite were, at first modified by octadecyltrimethylammonium cations to activate the surface for PhB adsorption. The colloids were filtered to get silicate films on polytetrafluoroethylene membrane filters, which were layered with a liquid mixture of PU precursors. The penetration of PU into the silicate formed a thin nanocomposite film. This nanomaterial demonstrated excellent effectiveness against methicillin-resistant S. aureus (MRSA) resistant to fluoroquinolones (L12 and S61, respectively). It showed more than 1000- and 10 000-fold inhibition of biofilm growth after irradiation with green laser compared to the unmodified PU material. Principal component analysis and multiple linear regression showed that the effectiveness of the nanomaterial was not influenced by virulence factors such as the expression of efflux pumps of the Nor family, the adhesin PIA encoded by the icaADBC operon or the robustness of the biofilms. However, the presence of organoclay, PhB and irradiation had a significant effect on the anti-biofilm properties of the nanocomposite. The anti-microbial properties of the material were strengthened after irradiation, because of high reactive oxygen species release (more than 14-fold compared to non-irradiated sample). Materials based on photoactive molecules can represent a worthwhile pathway towards the development of more complex nanomaterials applicable in various fields of medicine.

An Antibiotic Nanobomb Constructed from pH-Responsive Chemical Bonds in Metal-Phenolic Network Nanoparticles for Biofilm Eradication and Corneal Ulcer Healing

In the treatment of refractory corneal ulcers caused by Pseudomonas aeruginosa, antibacterial drugs delivery faces the drawbacks of low permeability and short ocular surface retention time. Hence, novel positively-charged modular nanoparticles (NPs) are developed to load tobramycin (TOB) through a one-step self-assembly method based on metal-phenolic network and Schiff base reaction using 3,4,5-trihydroxybenzaldehyde (THBA), ε-poly-ʟ-lysine (EPL), and Cu2+ as matrix components. In vitro antibacterial test demonstrates that THBA-Cu-TOB NPs exhibit efficient instantaneous sterilization owing to the rapid pH responsiveness to bacterial infections. Notably, only 2.6 µg mL-1 TOP is needed to eradicate P. aeruginosa biofilm in the nano-formed THBA-Cu-TOB owing to the greatly enhanced penetration, which is only 1.6% the concentration of free TOB (160 µg mL-1). In animal experiments, THBA-Cu-TOB NPs show significant advantages in ocular surface retention, corneal permeability, rapid sterilization, and inflammation elimination. Based on molecular biology analysis, the toll-like receptor 4 and nuclear factor kappa B signaling pathways are greatly downregulated as well as the reduction of inflammatory cytokines secretions. Such a simple and modular strategy in constructing nano-drug delivery platform offers a new idea for toxicity reduction, physiological barrier penetration, and intelligent drug delivery.

Enhanced Chemoradiotherapy for MRSA-Infected Osteomyelitis Using Immunomodulatory Polymer-Reinforced Nanotherapeutics

The eradication of osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA) poses a significant challenge due to its development of biofilm-induced antibiotic resistance and impaired innate immunity, which often leads to frequent surgical failure. Here, the design, synthesis, and performance of X-ray-activated polymer-reinforced nanotherapeutics that modulate the immunological properties of infectious microenvironments to enhance chemoradiotherapy against multidrug-resistant bacterial deep-tissue infections are reported. Upon X-ray radiation, the proposed polymer-reinforced nanotherapeutic generates reactive oxygen species and reactive nitrogen species. To robustly eradicate MRSA biofilms at deep infection sites, these species can specifically bind to MRSA and penetrate biofilms for enhanced chemoradiotherapy treatment. X-ray-activated nanotherapeutics modulate the innate immunity of macrophages to prevent the recurrence of osteomyelitis. The remarkable anti-infection effects of these nanotherapeutics are validated using a rat osteomyelitis model. This study demonstrates the significant potential of a synergistic chemoradiotherapy and immunotherapy method for treating MRSA biofilm-infected osteomyelitis.

Cellulose nanofibers embedded chitosan/tannin hydrogel with high antibacterial activity and hemostatic ability for drug-resistant bacterial infected wound healing

Millions of patients annually suffer life-threatening illnesses caused by bacterial infections of skin wounds. However, the treatment of wounds infected with bacteria is a thorny issue in clinical medicine, especially with drug-resistant bacteria infections. Therefore, there is an increasing interest in developing wound dressings that can efficiently fight against drug-resistant bacterial infections and promote wound healing. In this work, an anti-drug-resistant bacterial chitosan/cellulose nanofiber/tannic acid (CS/CNF/TA) hydrogel with excellent wound management ability was developed by electrospinning and fiber breakage-recombination. The hydrogel exhibited an outstanding antibacterial property exceeding 99.9 %, even for drug-resistant bacteria. This hydrogel could adhere to the tissue surface due to its abundant catechol groups, which avoided the shedding of hydrogel during the movement. Besides, it exhibited extraordinary hemostatic ability during the bleeding phase of the wound and then regulated the wound microenvironment by absorbing water and moisturizing. Moreover, the CS/CNF/TA also promoted the regrowth of vessels and follicles, accelerating the healing of infected wound tissue, with a healing rate exceeding 95 % within a 14-day timeframe. Therefore, the CS/CNF/TA hydrogel opens a new approach for the healing of drug-resistant bacterial infected wounds.

A nanocomposite hydrogel for co-delivery of multiple anti-biofilm therapeutics to enhance the treatment of bacterial biofilm-related infections

The characteristics of biofilms have exacerbated the issue of clinical antibiotic resistance, rendering it a pressing challenge in need of resolution. The combination of biofilm-dispersing agents and antibiotics can eliminate biofilms and promote healing synergistically in infected wounds. In this study, we developed a novel nanocomposite hydrogel (NC gel) comprised of the poly(lactic acid)-hyperbranched polyglycerol (PLA-HPG) based bioadhesive nanoparticles (BNPs) and a hydrophilic carboxymethyl chitosan (CS) network. The NC gel was designed to co-deliver two biofilm-dispersing agents (an NO-donor SNO, and an α-amylase Am) and an antibiotic, cefepime (Cef), utilizing a synergistic anti-biofilm mechanism in which Am loosens the matrix structure and NO promotes the release of biofilm bacteria via quorum sensing, and Cef kills bacteria. The drug-loaded NC gel (SNO/BNP/CS@Am-Cef) demonstrated sustained drug release, minimal cytotoxicity, and increased drug-bacterial interactions at the site of infection. When applied to mice infected with methicillin-resistant Staphylococcus aureus (MRSA) biofilms in vivo, SNO/BNP/CS@Am-Cef enhanced biofilm elimination and promoted wound healing compared to traditional antibiotic treatments. Our work demonstrates the feasibility of the co-delivery of biofilm-dispersing agents and antibiotics using the NC gel and presents a promising approach for the polytherapy of bacterial biofilm-related infections.

Overview of the effects and mechanisms of NO and its donors on biofilms

Microbial biofilm is undoubtedly a challenging problem in the food industry. It is closely associated with human health and life, being difficult to remove and antibiotic resistance. Therefore, an alternate method to solve these problems is needed. Nitric oxide (NO) as an antimicrobial agent, has shown great potential to disrupt biofilms. However, the extremely short half-life of NO in vivo (2 s) has facilitated the development of relatively more stable NO donors. Recent studies reported that NO could permeate biofilms, causing damage to cellular biomacromolecules, inducing biofilm dispersion by quorum sensing (QS) pathway and reducing intracellular bis-(3'-5')-cyclic dimeric guanosine monophosphate (c-di-GMP) levels, and significantly improving the bactericidal effect without drug resistance. In this review, biofilm hazards and formation processes are presented, and the characteristics and inhibitory effects of NO donors are carefully discussed, with an emphasis on the possible mechanisms of NO resistance to biofilms and some advanced approaches concerning the remediation of NO donor deficiencies. Moreover, the future perspectives, challenges, and limitations of NO donors were summarized comprehensively. On the whole, this review aims to provide the application prospects of NO and its donors in the food industry and to make reliable choices based on these available research results.

Bacteria-Targeted Combined with Photothermal/NO Nanoparticles for the Treatment and Diagnosis of MRSA Infection In Vivo

Currently, undeveloped diagnosis and delayed treatment of bacteria-infected sites in vivo not only expand the risk of tissue infection but are also a major clinical cause of multiple drug-resistant bacterial infections. Herein, an efficient nanoplatform for near-infrared (NIR)-light-controlled release and bacteria-targeted delivery of nitric oxide (NO) combined with photothermal therapy (PTT) is presented. Using maltotriose-decorated mesoporous polydopamine (MPDA-Mal) and BNN6, a smart antibacterial (B@MPDA-Mal) is developed to combine bacterial targeting, gas-controlled release, and PTT. Utilizing bacteria's unique maltodextrin transport system, B@MPDA-Mal can accurately distinguish bacterial infection from sterile inflammation and target the bacteria-infected sites for efficient drug enrichment. Moreover, NIR-light causes MPDA to generate heat, which not only effectively induces BNN6 to produce NO, but also raises the temperature to harm the bacteria further. NO/photothermal combination therapy effectively eliminates biofilm and drug-resistant bacteria. The myositis model of methicillin-resistant Staphylococcus aureus infection is established and indicates that B@MPDA-Mal can successfully eradicate inflammation and abscesses in mice. Meanwhile, magnetic resonance imaging technology is used to monitor the treatment procedure and healing outcomes. Given the aforementioned advantages, the smart antibacterial nanoplatform B@MPDA-Mal can be used as a potential therapeutic tool in the biomedical field against drug-resistant bacterial infections.