Chitosan-collagen scaffolds with nano/microfibrous architecture for skin tissue engineering

3D-bioprinted GelMA/gelatin/amniotic membrane extract (AME) scaffold loaded with keratinocytes, fibroblasts, and endothelial cells for skin tissue engineering

Gelatin-methacryloyl (GelMA) is a highly adaptable biomaterial extensively utilized in skin regeneration applications. However, it is frequently imperative to enhance its physical and biological qualities by including supplementary substances in its composition. The purpose of this study was to fabricate and characterize a bi-layered GelMA-gelatin scaffold using 3D bioprinting. The upper section of the scaffold was encompassed with keratinocytes to simulate the epidermis, while the lower section included fibroblasts and HUVEC cells to mimic the dermis. A further step involved the addition of amniotic membrane extract (AME) to the scaffold in order to promote angiogenesis. The incorporation of gelatin into GelMA was found to enhance its stability and mechanical qualities. While the Alamar blue test demonstrated that a high concentration of GelMA (20%) resulted in a decrease in cell viability, the live/dead cell staining revealed that incorporation of AME increased the quantity of viable HUVECs. Further, gelatin upregulated the expression of KRT10 in keratinocytes and VIM in fibroblasts. Additionally, the histological staining results demonstrated the formation of well-defined skin layers and the creation of extracellular matrix (ECM) in GelMA/gelatin hydrogels during a 14-day culture period. Our study showed that a 3D-bioprinted composite scaffold comprising GelMA, gelatin, and AME can be used to regenerate skin tissues.

Applications of drug delivery systems, organic, and inorganic nanomaterials in wound healing

The skin is known to be the largest organ in the human body, while also being exposed to environmental elements. This indicates that skin is highly susceptible to physical infliction, as well as damage resulting from medical conditions such as obesity and diabetes. The wound management costs in hospitals and clinics are expected to rise globally over the coming years, which provides pressure for more wound healing aids readily available in the market. Recently, nanomaterials have been gaining traction for their potential applications in various fields, including wound healing. Here, we discuss various inorganic nanoparticles such as silver, titanium dioxide, copper oxide, cerium oxide, MXenes, PLGA, PEG, and silica nanoparticles with their respective roles in improving wound healing progression. In addition, organic nanomaterials for wound healing such as collagen, chitosan, curcumin, dendrimers, graphene and its derivative graphene oxide were also further discussed. Various forms of nanoparticle drug delivery systems like nanohydrogels, nanoliposomes, nanofilms, and nanoemulsions were discussed in their function to deliver therapeutic agents to wound sites in a controlled manner.

Bioactive bacterial cellulose wound dressings for burns with collagen in-situ and chitosan ex-situ impregnation

Bacterial cellulose (BC) is a biopolymer that commonly used for wound dressings regarding to its high in-vitro and in-vivo biocompatibility. Moreover, the three-dimensional fibers in BC become an advantageous for bioactive wound dressing application as they serve as templates for impregnation other supportive materials. Chitosan and collagen are two of the materials that can be impregnated to optimize the BC properties for serve as wound dressing material. Collagen can help skin cells grow on the wound sites, where chitosan has anti-bacterial properties and can bind red blood cells. BC-based wound dressings were made by impregnating collagen via in-situ method followed by immersing chitosan via ex-situ method into BC fibers for 24 h. The intermolecular interactions of amine groups in the wound dressing were confirmed by FTIR. The XRD diffractogram showed wider peaks at 14.2°, 16.6°, and 22.4° due to the presence of collagen and chitosan molecules in the BC fibers. SEM images confirmed that chitosan and collagen could penetrate BC fibers well. Other tests, such as water content, porosity, antibacterial properties, and haemocompatibility, indicated that the wound dressing was non-hemolytic. In-vivo test indicated that BC/collagen/chitosan wound dressing supported the wound healing process on second degree burn.

Single unit functionally graded bioresorbable electrospun scaffold for scar-free full-thickness skin wound healing

Full-thickness wounds are difficult to heal spontaneously. Scaffolds, meant for treating full-thickness wounds, should ensure proper tissue regeneration, both structurally and functionally. An ideal scaffold should mimic the physical, mechanical and biochemical properties of natural skin. However, available mono- or bi-layer skin scaffolds lack in the precise architecture and functionality, thus, failing to provide scar-free regeneration of full-thickness skin wounds. These unmet challenges of scar-free skin regeneration have been addressed in the present study for the first time. This research deals with the synthesis of a low-cost, structurally and functionally graded single unit biodegradable polymeric scaffold. The functional gradient in this scaffold was achieved by varying polymer concentration and electrospinning parameters. This gradient in the scaffold provided the required microenvironment for proper functional and structural reconstruction of all the layers of natural skin. The mechanical property of the scaffold matched that of the natural skin. Besides, the degradation kinetics of the scaffold was in coordination with the regeneration time for the full-thickness wound. The porosity and hydrophilicity gradients of the scaffold helped it mimic the in vivo hypodermal, dermal and epidermal microenvironments of the skin, simultaneously. Co-culturing PCS-201 (dermal fibroblasts) and HaCaT (keratinocytes) on the scaffold resulted in successful regeneration through cellular proliferation, differentiation and organization of the skin tissue. The scaffold also displayed better wound healing in vivo, in terms of speedy wound closure and proper tissue regeneration, in comparison to the standard treatment. Altogether, this study successfully established a simple, one-step synthesis process of a functionally graded, bioresorbable scaffold for scar-free, native-like, structural and functional regeneration of full-thickness skin wounds. Due to cost-effectiveness, easy synthesis process and microarchitectural features, the designed scaffold possesses a potential of translation to a good commercial wound healing product.

Stem Cell-Based Tissue Engineering for the Treatment of Burn Wounds: A Systematic Review of Preclinical Studies

Burn wounds are a devastating type of skin injury leading to severe impacts on both patients and the healthcare system. Current treatment methods are far from ideal, driving the need for tissue engineered solutions. Among various approaches, stem cell-based strategies are promising candidates for improving the treatment of burn wounds. A thorough search of the Embase, Medline, Scopus, and Web of Science databases was conducted to retrieve original research studies on stem cell-based tissue engineering treatments tested in preclinical models of burn wounds, published between January 2009 and June 2021. Of the 347 articles retrieved from the initial database search, 33 were eligible for inclusion in this review. The majority of studies used murine models with a xenogeneic graft, while a few used the porcine model. Thermal burn was the most commonly induced injury type, followed by surgical wound, and less commonly radiation burn. Most studies applied stem cell treatment immediately post-burn, with final endpoints ranging from 7 to 90 days. Mesenchymal stromal cells (MSCs) were the most common stem cell type used in the included studies. Stem cells from a variety of sources were used, most commonly from adipose tissue, bone marrow or umbilical cord, in conjunction with an extensive range of biomaterial scaffolds to treat the skin wounds. Overall, the studies showed favourable results of skin wound repair in animal models when stem cell-based tissue engineering treatments were applied, suggesting that such strategies hold promise as an improved therapy for burn wounds.

A Biomimetic Composite Bilayer Dressing Composed of Alginate and Fibroin for Enhancing Full-Thickness Wound Healing

Full-thickness skin wound dressings are critically important for acute cutaneous wound healing. In this study, we developed a bilayer sheet originating from biological macromolecules, mimicking skin hierarchy structure. This sheet was composed of a steady silk fibroin (SF)/sodium alginate (SA) composite scaffold as the bottom regenerative layer and a SA film as the protective top layer. SEM analysis revealed the thickness of the top layer was ∼25 μm and was tightly adhered to the composite scaffold layer with interconnected pores (∼150 μm). The bilayer sheets displayed suitable water uptake capacity and high stability in water. The mass retention percentage of the bilayer sheets was approximately 50% during three weeks of PBS degradation in vitro. The tensile strength of the bilayer sheets significantly increased from 13.41 ± 3.75 kPa (single scaffold) to 59.81 ± 5.98 kPa. The composite scaffolds were more conducive to the growth and proliferation of human dermal microvascular endothelial cells. The experiment results in vivo demonstrated superior and faster epithelialisation and dermal regeneration in the wound treated with bilayer sheets because the sheets accelerated wound closure, reduced the inflammatory response, and promoted protein synthesis in the extracellular matrix and blood vessel ingrowth. This article is protected by copyright. All rights reserved.

What affects the biocompatibility of polymers?

In recent decades synthetic polymers have gained increasing popularity, and nowadays they are an integral part of people's daily lives. In addition, owing to their competitive advantage and being susceptible to modification, polymers have stimulated the fast development of innovative technologies in many areas of science. Biopolymers are of particular interest in various branches of medicine, such as implantology of bones, cartilage and skin tissues as well as blood vessels. Biomaterials with such specific applications must have appropriate mechanical and strength characteristics and above all they must be compatible with the surrounding tissues, human blood and its components, i.e. exhibit high hemo- and biocompatibility, low or no thrombo- and carcinogenicity, foreign body response (host response), appropriate osteoconduction, osteoinduction and mineralization. For biocompatibility improvement many surface treatment techniques have been utilized leading to fabricate the polymer biomaterials of required properties, also at nanoscale. This review paper discusses the most important physicochemical and biological factors that affect the biocompatibility, thus the reaction of the living organism after insertion of the polymer-based biomaterials, i.e. surface modification and/or degradation, surface composition (functional groups and charge), size and shapes, hydrophilic-hydrophobic character, wettability and surface free energy, topography (roughness, stiffness), crystalline and amorphous structure, nanostructure, cell adhesion and proliferation, cellular uptake. Particularly, the application of polysaccharides (chitosan, cellulose, starch) in the tissue engineering is emphasized.

Tissue Engineering 3D Porous Scaffolds Prepared from Electrospun Recombinant Human Collagen (RHC) Polypeptides/Chitosan Nanofibers

Electrospinning, the only method that can continuously produce nanofibers, has been widely used to prepare nanofibers for tissue engineering applications. However, electrospinning is not suitable for preparing clinically relevant three-dimensional (3D) nanofibrous scaffolds with hierarchical pore structures. In this study, recombinant human collagen (RHC)/chitosan nanofibers prepared by electrospinning were combined with porous scaffolds produced by freeze drying to fabricate 3D nanofibrous scaffolds. These scaffolds exhibited high porosity (over 80%) and an interconnected porous structure (ranging from sub-micrometers to 200 μm) covered with nanofibers. As confirmed by the characterization results, these scaffolds showed good swelling ability, stability, and adequate mechanical strength, making it possible to use the 3D nanofibrous scaffolds in various tissue engineering applications. In addition, after seven days of cell culturing, NIH 3T3 was infiltrated into the scaffolds while maintaining its morphology and with superior proliferation and viability. These results indicated that the 3D nanofibrous scaffolds hold great promise for tissue engineering applications.

Recent Developments in Chitosan-Based Micro/Nanofibers for Sustainable Food Packaging, Smart Textiles, Cosmeceuticals, and Biomedical Applications

Chitosan has many useful intrinsic properties (e.g., non-toxicity, antibacterial properties, and biodegradability) and can be processed into high-surface-area nanofiber constructs for a broad range of sustainable research and commercial applications. These nanofibers can be further functionalized with bioactive agents. In the food industry, for example, edible films can be formed from chitosan-based composite fibers filled with nanoparticles, exhibiting excellent antioxidant and antimicrobial properties for a variety of products. Processing 'pure' chitosan into nanofibers can be challenging due to its cationic nature and high crystallinity; therefore, chitosan is often modified or blended with other materials to improve its processability and tailor its performance to specific needs. Chitosan can be blended with a variety of natural and synthetic polymers and processed into fibers while maintaining many of its intrinsic properties that are important for textile, cosmeceutical, and biomedical applications. The abundance of amine groups in the chemical structure of chitosan allows for facile modification (e.g., into soluble derivatives) and the binding of negatively charged domains. In particular, high-surface-area chitosan nanofibers are effective in binding negatively charged biomolecules. Recent developments of chitosan-based nanofibers with biological activities for various applications in biomedical, food packaging, and textiles are discussed herein.

Recent Advancement of Molecular Structure and Biomaterial Function of Chitosan from Marine Organisms for Pharmaceutical and Nutraceutical Application

Chitosan is an innate cationic biological polysaccharide polymer, naturally obtained from chitin deacetylation, that possesses broad-spectrum properties such as antibacterial, biodegradability, biocompatibility, non-toxic, non-immunogenicity, and so on. Chitosan can be easily modified owing to its molecular chain that contains abundant active amino and hydroxyl groups, through various modifications. Not only does it possess excellent properties but it also greatly accelerates its solubility and endows it with additional special properties. It can be developed into bioactive materials with innovative properties, functions, and multiple uses, especially in the biomedical fields. In this paper, the unique properties and the relationship between the molecular structure of chitosan and its derivatives are emphasized, an overview of various excellent biomedical properties of chitosan and its current progress in the pharmaceutical and nutraceutical field have prospected, to provide the theoretical basis for better development and utilization of new biomedical materials of chitosan and its derivatives.

Chitosan based bioactive materials in tissue engineering applications-A review

In recent years, there have been increasingly rapid advances of using bioactive materials in tissue engineering applications. Bioactive materials constitute many different structures based upon ceramic, metallic or polymeric materials, and can elicit specific tissue responses. However, most of them are relatively brittle, stiff, and difficult to form into complex shapes. Hence, there has been a growing demand for preparing materials with tailored physical, biological, and mechanical properties, as well as predictable degradation behavior. Chitosan-based materials have been shown to be ideal bioactive materials due to their outstanding properties such as formability into different structures, and fabricability with a wide range of bioactive materials, in addition to their biocompatibility and biodegradability. This review highlights scientific findings concerning the use of innovative chitosan-based bioactive materials in the fields of tissue engineering, with an outlook into their future applications. It also covers latest developments in terms of constituents, fabrication technologies, structural, and bioactive properties of these materials that may represent an effective solution for tissue engineering materials, making them a realistic clinical alternative in the near future.

Bioengineered smart trilayer skin tissue substitute for efficient deep wound healing

Skin substitutes for deep wound healing require meticulous designing and fabrication to ensure proper structural and functional regeneration of the tissue. Range of physical and mechanical properties conducive for regeneration of different layers of skin is a prerequisite of an ideal scaffold. However, single or bilayer substitutes, lacking this feature, fail to heal full thickness wound. Complete scar free regeneration of skin is still a big challenge. This study reports fabrication of a trilayer scaffold, from biodegradable polymers that can provide the right ambience for simultaneous regeneration of all the three layers of skin. The scaffold was developed through optimization of different fabrication techniques, namely, casting, electrospinning and lyophilisation, for obtaining a tailored trilayer structure. It has mechanical strength similar to skin layers, can maintain a porosity-gradient and provides microenvironments suitable for simultaneous regeneration of epidermis, dermis and hypodermis. A co-culture model, of keratinocytes and dermal fibroblasts, confirms the efficiency of the scaffold in supporting proliferation and differentiation of different types of cells, into organized tissue. The scaffold showed improved and expedited wound healing in-vivo. Taken together, these compelling evidences successfully established the engineered trilayer scaffold as a promising template for skin tissue regeneration in case of deep wound.

Regeneration and Repair of Skin Wounds: Various Strategies for Treatment

Skin as a mechanical barrier between the inner and outer environment of our body protects us against infection and electrolyte loss. This organ consists of 3 layers: the epidermis, dermis, and hypodermis. Any disruption in the integrity of skin leads to the formation of wounds, which are divided into 2 main categories: acute wounds and chronic wounds. Generally, acute wounds heal relatively faster. In contrast to acute wounds, closure of chronic wounds is delayed by 3 months after the initial insult. Treatment of chronic wounds has been one of the most challenging issues in the field of regenerative medicine, promoting scientists to develop various therapeutic strategies for a fast, qualified, and most cost-effective treatment modality. Here, we reviewed more recent approaches, including the development of stem cell therapy, tissue-engineered skin substitutes, and skin equivalents, for the healing of complex wounds.

Chitosan-Chondroitin sulfate based polyelectrolyte complex for effective management of chronic wounds

Acute and chronic wound remain an unresolved clinical problem among various demographic groups. Traditional marketed products focus mainly on inhibition of bacterial growth at the wound site neglecting the tissue repair, which significantly affect the healing rate. It would be highly beneficial if a wound healing material can be developed which has both antibacterial as well as tissue regenerating potential. We have prepared a polyelectrolyte complex (PEC) using chitosan (CH) and chondroitin sulfate (CS) which can form an in-situ scaffold by spontaneous mixing. The fabrication of CH-CS PEC was optimized using Quality-By-Design (QbD) approach. The prepared PEC showed very high swelling and porosity property. It was found to be non-hemolytic with good blood compatibility and low blood clotting index. It also exhibited good antibacterial activity against both gram-positive and gram-negative bacteria. The cell proliferation study exhibited good cytocompatibility and almost four-fold increase in cell density when treated with CH-CS PEC compared to control. In summary, we demonstrated that the prepared CH-CS PEC showed good blood compatibility, high antibacterial effect, and promoted wound healing potentially by stimulating fibroblast growth, making it an ideal wound dressing material.

Effect of copper nanoparticles on physico-chemical properties of chitosan and gelatin-based scaffold developed for skin tissue engineering application

Development of new and effective scaffold continues to be an area of intense research in skin tissue engineering. The objective of this study was to study the effect of copper nanoparticles over physico-chemical properties of the chitosan and gelatin composite scaffolds for skin tissue engineering. The copper-doped scaffolds were prepared using freeze-drying method. Chitosan and gelatin were taken in varied composition with 0.01%, 0.02%, and 0.03% Cu nanoparticles. The physico-chemical properties of the copper nanoparticles and the scaffolds were analyzed using Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM), and transmission electron microscopy. Porosity of the scaffolds was measured by liquid displacement method and hemocompatibility was tested using goat blood. SEM micrographs of the scaffolds displayed the interconnected pores which ranged between 25 and 40 µm. This average pore size was later enhanced to 95 µm after the addition of copper nanoparticles. Cell viability assay was performed to ensure the growth and proliferation of the skin cells over the scaffolds. FTIR, EDS, and XRD analysis of scaffolds confirmed the presence of copper in the chitosan-based scaffolds. Porosity measurement showed the interconnectivity between pores which ranged between 65 and 88% as required for skin tissue engineering application. The degradation study of the scaffolds was done which depicted that, after the addition of copper nanoparticles with 0.03%, degradation rate was decreased. SEM and cytocompatibility assay on all scaffolds showed the cell adhesion and proliferation on the scaffolds which was not affected after addition of copper nanoparticles. Oxidative stress evaluation was done to study the effect of copper nanoparticles on the cells which showed that there was no such production of ROS in the scaffolds. Hence, scaffolds prepared after doping of copper nanoparticles show suitable physico-chemical and biological properties for skin tissue engineering application.

Current and Future Perspectives on Skin Tissue Engineering: Key Features of Biomedical Research, Translational Assessment, and Clinical Application

The skin is responsible for several important physiological functions and has enormous clinical significance in wound healing. Tissue engineered substitutes may be used in patients suffering from skin injuries to support regeneration of the epidermis, dermis, or both. Skin substitutes are also gaining traction in the cosmetics and pharmaceutical industries as alternatives to animal models for product testing. Recent biomedical advances, ranging from cellular-level therapies such as mesenchymal stem cell or growth factor delivery, to large-scale biofabrication techniques including 3D printing, have enabled the implementation of unique strategies and novel biomaterials to recapitulate the biological, architectural, and functional complexity of native skin. This progress report highlights some of the latest approaches to skin regeneration and biofabrication using tissue engineering techniques. Current challenges in fabricating multilayered skin are addressed, and perspectives on efforts and strategies to meet those limitations are provided. Commercially available skin substitute technologies are also examined, and strategies to recapitulate native physiology, the role of regulatory agencies in supporting translation, as well as current clinical needs, are reviewed. By considering each of these perspectives while moving from bench to bedside, tissue engineering may be leveraged to create improved skin substitutes for both in vitro testing and clinical applications.

Chitosan based-asymmetric membranes for wound healing: A review

The wound healing process involves highly complex and dynamic events that allow the re-establishment of skin's structural integrity. To further improve or to overcome the drawbacks associated with this process, researchers have been focused on the development of new therapeutics. Among them, asymmetric membranes are currently one of the most promising approaches to be used in wound healing due to its structural similarities with the epidermal and dermal layers of the native skin. The outer layer of asymmetric membranes provides a barrier that protects the wound from external damages (e.g. microorganisms and chemical agents), whereas the interior porous layer acts as template for supporting cell adhesion, migration and proliferation. Among the different materials used to produce these distinct layers, the chitosan arises as one of the preeminent materials due to its inherent biocompatibility, antibacterial, hemostatic, and healing properties. Therefore, in this review, it is provided an overview of the different chitosan-based asymmetric membranes developed for wound dressing applications. Further, the chitosan modifications to enhance its bioactivity as well as the asymmetric membranes general properties and production techniques are also described.

Electrospinning of in situ crosslinked recombinant human collagen peptide/chitosan nanofibers for wound healing

Electrospun collagen nanofibers are effective for wound healing; however, many problems, such as the tedious preparation process, weak strength and poor structure integration, limit further applications. In this study, recombinant human collagen (RHC) peptides and a simple one-step crosslinking strategy were used to prepare RHC/chitosan nanofibers. With the nonpathogenic, water-soluble RHC and a mild electrospinning solvent, in situ crosslinked nanofibers (S-CN) not only simplified the preparation procedure but also maintained a more integrated morphology. Compared with the immersed crosslinked nanofibers (I-CN), S-CN showed better performance in moisture retention, degradation and mechanical strength tests. In vitro cell proliferation, morphology and RT-PCR studies confirmed that fibroblasts presented better activities on nanofibers crosslinked in situ. Importantly, after treating with the nanofibers, rapid epidermidalization and angiogenesis were observed in an SD rat scalding model. All these data suggest that electrospun RHC/chitosan nanofibers crosslinked in situ are an ideal candidate that can be used for wound healing applications.

Fluorinated methacrylamide chitosan hydrogel dressings enhance healing in an acute porcine wound model

Wound healing involves multiple interrelated processes required to lead to successful healing outcomes. Phagocytosis, inflammation, cell proliferation, angiogenesis, energy production, and collagen synthesis are all directly or indirectly dependent on oxygen. Along with other critical factors, such as nutrition and comorbidities, availability of oxygen is a key determinant of healing success. Previously, we have presented a novel oxygenated hydrogel material that can be made into dressings for continuous localized oxygen delivery to wounds. In this study, an acute porcine wound model was used to test the healing benefits of these oxygenated MACF (MACF + O₂) hydrogel dressings compared to controls, which included commercial Derma-Gel^TM hydrogel dressings. Wound closure and histological analyses were performed to assess re-epithelialization, collagen synthesis, angiogenesis, and keratinocyte maturation. Results from these assays revealed that wounds treated with MACF + O₂ hydrogel dressings closed faster as compared to Derma-Gel (p<0.05). Targeted metabolomics via liquid chromatography separation and mass spectrometric detection (LC-MS/MS) and a biochemical assay determined the concentration of hydroxyproline in wound samples at days 14 and 21, showing that MACF + O₂ hydrogel dressings improved wound healing via an upregulated collagen synthesis pathway as compared to Derma-Gel (p<0.05). Histological evidence showed that MACF + O₂ hydrogel dressings improve new blood vessel formation and keratinocyte maturation over all other treatments.

Bilayered nanofibrous 3D hierarchy as skin rudiment by emulsion electrospinning for burn wound management

Mimicking skin extracellular matrix hierarchy, the present work aims to develop a bilayer skin graft comprising a porous cotton-wool-like 3D layer with membranous structure of PCL-chitosan nanofibers. Emulsion electrospinning with differential stirring periods of PCL-chitosan emulsion results in development of a bilayer 3D structure with varied morphology. The electrospun membrane has fiber diameter ∼274 nm and pore size ∼1.16 μm while fluffy 3D layer has fiber diameter ∼1.62 μm and pore size ∼62 μm. The 3D layer was further coated with collagen I isolated from Cirrhinus cirrhosus fish scales to improve biofunctionality. Surface coating with collagen I resulted in bundling the fibers together, thereby increasing their average diameter to 2.80 μm and decreasing pore size to ∼45 μm. The architecture and composition of the scaffold promotes efficient cellular activity where interconnected porosity with ECM resembling collagen I coating assists cellular adhesion, infiltration, and proliferation from initial days of fibroblast seeding, while keratinocytes migrate on the surface only without infiltrating in the membranous nanofiber layer. Anatomy of the scaffold arising due to variation in pore size distribution at different layers thereby facilitates compartmentalization and prevents initial cellular transmigration. The scaffold also assists in extracellular matrix protein synthesis and keratinocyte stratification in vitro. Further, the scaffold effectively integrates and attaches with third-degree burn wound margins created in rat models and accelerates healing in comparison to standard Tegaderm dressing™. The bilayer scaffold is thus a promising, readily available, cost-effective, off-the-shelf matrix as a skin substitute.

Biomaterials for Skin Substitutes

Patients with extensive burns rely on the use of tissue engineered skin due to a lack of sufficient donor tissue, but it is a challenge to identify reliable and economical scaffold materials and donor cell sources for the generation of a functional skin substitute. The current review attempts to evaluate the performance of the wide range of biomaterials available for generating skin substitutes, including both natural biopolymers and synthetic polymers, in terms of tissue response and potential for use in the operating room. Natural biopolymers display an improved cell response, while synthetic polymers provide better control over chemical composition and mechanical properties. It is suggested that not one material meets all the requirements for a skin substitute. Rather, a composite scaffold fabricated from both natural and synthetic biomaterials may allow for the generation of skin substitutes that meet all clinical requirements including a tailored wound size and type, the degree of burn, the patient age, and the available preparation technique. This review aims to be a valuable directory for researchers in the field to find the optimal material or combination of materials based on their specific application.

Tissue Engineered Skin Substitutes

The fundamental skin role is to supply a supportive barrier to protect body against harmful agents and injuries. Three layers of skin including epidermis, dermis and hypodermis form a sophisticated tissue composed of extracellular matrix (ECM) mainly made of collagens and glycosaminoglycans (GAGs) as a scaffold, different cell types such as keratinocytes, fibroblasts and functional cells embedded in the ECM. When the skin is injured, depends on its severity, the majority of mentioned components are recruited to wound regeneration. Additionally, different growth factors like fibroblast growth factor (FGF), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF) are needed to orchestrated wound healing process. In case of large surface area wounds, natural wound repair seems inefficient. Inspired by nature, scientists in tissue engineering field attempt to engineered constructs mimicking natural healing process to promote skin restoration in untreatable injuries. There are three main types of commercially available engineered skin substitutes including epidermal, dermal, and dermoepidermal. Each of them could be composed of scaffold, desired cell types or growth factors. These substitutes could have autologous, allogeneic, or xenogeneic origin. Moreover, they may be cellular or acellular. They are used to accelerate wound healing and recover normal skin functions with pain relief. Although there are a wide variety of commercially available skin substitutes, almost none of them considered as an ideal equivalents required for proper wound healing.

Fabrication of bi-layer scaffold of keratin nanofiber and gelatin-methacrylate hydrogel: Implications for skin graft

Bi-layer scaffold composed of human hair keratin/chitosan nanofiber mat and gelatin methacrylate (GelMA) hydrogel was fabricated by using electrospinning and photopolymerization techniques. To prepare the nanofiber layer, the blend solution of human hair keratin and chitosan (mixture ratio: 5/5) was electrospun using formic acid as a solvent in the presence of poly(ethylene glycol), followed by cross-linking with glutaraldehyde. The tensile strength of the human hair keratin/chitosan nanofiber mat was much higher than that of pure human hair keratin nanofiber mat. Meanwhile, the blend nanofiber mat was relatively more compatible with HaCaT cell proliferation and keratinocyte differentiation than the pure chitosan nanofiber mat. The bi-layer scaffold was prepared by photopolymerization of GelMA under the cross-linked nanofiber mat. To evaluate the feasibility as a skin graft, human fibroblast was encapsulated in the hydrogel layer and HaCaT cells were cultured on the nanofiber layer and they were co-cultured for 10days. As a result, the encapsulated fibroblasts proliferated in the hydrogel matrix and HaCaT cells formed a cell layer on the top of scaffold, mimicking dermis and epidermis of skin tissue.

Functional electrospun fibers for the treatment of human skin wounds

Wounds are trauma induced defects of the human skin involving a multitude of endogenous biochemical events and cellular reactions of the immune system. The healing process is extremely complex and affected by the patient's physiological conditions, potential implications like infectious pathogens and inflammation as well as external factors. Due to increasing incidence of chronic wounds and proceeding resistance of infection pathogens, there is a strong need for effective therapeutic wound care. In this context, electrospun fibers with diameters in the nano- to micrometer range gain increasing interest. While resembling the structure of the native human extracellular matrix, such fiber mats provide physical and mechanical protection (including protection against bacterial invasion). At the same time, the fibers allow for gas exchange and prevent occlusion of the wound bed, thus facilitating wound healing. In addition, drugs can be incorporated within such fiber mats and their release can be adjusted by the material and dimensions of the individual fibers. The review gives a comprehensive overview about the current state of electrospun fibers for therapeutic application on skin wounds. Different materials as well as fabrication techniques are introduced including approaches for incorporation of drugs into or drug attachment onto the fiber surface. Against the background of wound pathophysiology and established therapy approaches, the therapeutic potential of electrospun fiber systems is discussed. A specific focus is set on interactions of fibers with skin cells/tissues as well as wound pathogens and strategies to modify and control them as key aspects for developing effective wound therapeutics. Further, advantages and limitations of controlled drug delivery from fiber mats to skin wounds are discussed and a future perspective is provided.

Versatility of Chitosan-Based Biomaterials and Their Use as Scaffolds for Tissue Regeneration

Chitosan is a naturally occurring polysaccharide obtained from chitin, present in abundance in the exoskeletons of crustaceans and insects. It has aroused great interest as a biomaterial for tissue engineering on account of its biocompatibility and biodegradation and its affinity for biomolecules. A significant number of research groups have investigated the application of chitosan as scaffolds for tissue regeneration. However, there is a wide variability in terms of physicochemical characteristics of chitosan used in some studies and its combinations with other biomaterials, making it difficult to compare results and standardize its properties. The current systematic review of literature on the use of chitosan for tissue regeneration consisted of a study of 478 articles in the PubMed database, which resulted, after applying inclusion criteria, in the selection of 61 catalogued, critically analysed works. The results demonstrated the effectiveness of chitosan-based biomaterials in 93.4% of the studies reviewed, whether or not combined with cells and growth factors, in the regeneration of various types of tissues in animals. However, the absence of clinical studies in humans, the inadequate experimental designs, and the lack of information concerning chitosan's characteristics limit the reproducibility and relevance of studies and the clinical applicability of chitosan.

Protein nanocoatings on synthetic polymeric nanofibrous membranes designed as carriers for skin cells

Protein-coated resorbable synthetic polymeric nanofibrous membranes are promising for the fabrication of advanced skin substitutes. We fabricated electrospun polylactic acid and poly(lactide-co-glycolic acid) nanofibrous membranes and coated them with fibrin or collagen I. Fibronectin was attached to a fibrin or collagen nanocoating, in order further to enhance the cell adhesion and spreading. Fibrin regularly formed a coating around individual nanofibers in the membranes, and also formed a thin noncontinuous nanofibrous mesh on top of the membranes. Collagen also coated most of the fibers of the membrane and randomly created a soft gel on the membrane surface. Fibronectin predominantly adsorbed onto a thin fibrin mesh or a collagen gel, and formed a thin nanofibrous structure. Fibrin nanocoating greatly improved the attachment, spreading, and proliferation of human dermal fibroblasts, whereas collagen nanocoating had a positive influence on the behavior of human HaCaT keratinocytes. In addition, fibrin stimulated the fibroblasts to synthesize fibronectin and to deposit it as an extracellular matrix. Fibrin coating also showed a tendency to improve the ultimate tensile strength of the nanofibrous membranes. Fibronectin attached to fibrin or to a collagen coating further enhanced the adhesion, spreading, and proliferation of both cell types.

Methodologies in creating skin substitutes

The creation of skin substitutes has significantly decreased morbidity and mortality of skin wounds. Although there are still a number of disadvantages of currently available skin substitutes, there has been a significant decline in research advances over the past several years in improving these skin substitutes. Clinically most skin substitutes used are acellular and do not use growth factors to assist wound healing, key areas of potential in this field of research. This article discusses the five necessary attributes of an ideal skin substitute. It comprehensively discusses the three major basic components of currently available skin substitutes: scaffold materials, growth factors, and cells, comparing and contrasting what has been used so far. It then examines a variety of techniques in how to incorporate these basic components together to act as a guide for further research in the field to create cellular skin substitutes with better clinical results.

Collagen-chitosan 3-D nano-scaffolds effects on macrophage phagocytosis and pro-inflammatory cytokine release

Macrophages are effector cells in the innate and adaptive immune systems and in situ exist within three-dimensional (3-D) microenvironments. As there has been an increase in interest in the use of 3-D scaffolds to mimic natural microenvironments in vitro, this study examined the impact on cultured mice peritoneal macrophages using standard 2-D plates as compared to 3-D collagen-chitosan scaffolds. Here, 2-D and 3-D cultured macrophages were evaluated for responses to lipopolysaccharide (LPS), dexamethasone (Dex), BSA (bovine serum albumin), safranal (herbal component isolated from safranal [Saf]) and Alyssum homolocarpum mucilage (A. muc: mixed herbal components). After treatments, cultured macrophages were evaluated for viability, phagocytic activity and release of tumor necrosis factor (TNF)-α and interleukin (IL)-1β pro-inflammatory cytokines. Comparison of 2-D vs 3-D cultures showed that use of either system - with or without any exogenous agent - had no effect on cell viability. In the case of cell function, macrophages cultured on scaffolds had increases in phagocytic activity relative to that by cells on 2-D plates. In general, the test herbal components Saf and A. muc. had more impact than any of the other exogenous agents on nanoparticle uptake. With respect to production of TNFα and IL-1β, compared to the 2-D cells, scaffold cells tended to have significantly different levels of production of each cytokine, with the effect varying (higher or lower) depending on the test agent used. However, unlike with particle uptake, here, while Saf and A. muc. led to significantly greater levels of cytokine formation by the 3-D culture cells vs that by the 2-D plate cells, there was no net effect (stimulatory) vs control cultures. These results illustrated that collagen-chitosan scaffolds could provide a suitable 3-D microenvironment for macrophage phagocytosis and could also impact on the formation of pro-inflammatory cytokines.

Electrospinning of natural polymers for advanced wound care: towards responsive and adaptive dressings

Nanofibrous dressings produced by electrospinning proteins and polysaccharides are highly promising candidates in promoting wound healing and skin regeneration.

Chitosan-Coated Collagen Membranes Promote Chondrocyte Adhesion, Growth, and Interleukin-6 Secretion

Designing scaffolds made from natural polymers may be highly attractive for tissue engineering strategies. We sought to produce and characterize chitosan-coated collagen membranes and to assess their efficacy in promoting chondrocyte adhesion, growth, and cytokine secretion. Porous collagen membranes were placed in chitosan solutions then crosslinked with glutaraldehyde vapor. Fourier transform infrared (FTIR) analyses showed elevated absorption at 1655 cm-1 of the carbon-nitrogen (N=C) bonds formed by the reaction between the (NH₂) of the chitosan and the (C=O) of the glutaraldehyde. A significant peak in the amide II region revealed a significant deacetylation of the chitosan. Scanning electron microscopy (SEM) images of the chitosan-coated membranes exhibited surface variations, with pore size ranging from 20 to 50 µm. X-ray photoelectron spectroscopy (XPS) revealed a decreased C-C groups and an increased C-N/C-O groups due to the reaction between the carbon from the collagen and the NH2 from the chitosan. Increased rigidity of these membranes was also observed when comparing the chitosan-coated and uncoated membranes at dried conditions. However, under wet conditions, the chitosan coated collagen membranes showed lower rigidity as compared to dried conditions. Of great interest, the glutaraldehyde-crosslinked chitosan-coated collagen membranes promoted chondrocyte adhesion, growth, and interleukin (IL)-6 secretion. Overall results confirm the feasibility of using designed chitosan-coated collagen membranes in future applications, such as cartilage repair.

Advances in skin regeneration: application of electrospun scaffolds

The paucity of cellular and molecular signals essential for normal wound healing makes severe dermatological ulcers stubborn to heal. The novel strategies of skin regenerative treatments are focused on the development of biologically responsive scaffolds accompanied by cells and multiple biomolecules resembling structural and biochemical cues of the natural extracellular matrix (ECM). Electrospun nanofibrous scaffolds provide similar architecture to the ECM leading to enhancement of cell adhesion, proliferation, migration and neo tissue formation. This Review surveys the application of biocompatible natural, synthetic and composite polymers to fabricate electrospun scaffolds as skin substitutes and wound dressings. Furthermore, the application of biomolecules and therapeutic agents in the nanofibrous scaffolds viz growth factors, genes, antibiotics, silver nanoparticles, and natural medicines with the aim of ameliorating cellular behavior, wound healing, and skin regeneration are discussed.

Effects of 3-dimensional culture conditions (collagen-chitosan nano-scaffolds) on maturation of dendritic cells and their capacity to interact with T-lymphocytes

In the body, there is a natural three-dimensional (3D) microenvironment in which immune cells, including dendritic cells (DC), play their functions. This study evaluated the impact of using collagen-chitosan 3D nano-scaffolds in comparisons to routine 2D culture plates on DC phenotype and functions. Bone marrow-derived DC were cultured on scaffolds and plates and then stimulated with lipopolysaccharide (LPS) or chitosan-based nanoparticles (NP) for 24 h. Thereafter, DC viability, expression of maturation markers and levels of cytokines secretion were evaluated. In another set of studies, the DC were co-cultured with allogenic T-lymphocytes in both the 2D and 3D systems and effects on DC-induction of T-lymphocyte proliferation and cytokine release were analyzed. The results indicated that CD40, CD86 and MHC II marker expression and interleukin (IL)-12, IL-6 and tumor necrosis factor (TNF)-α secretion by DC were enhanced in 3D cultures in comparison to by cells maintained in the 2D states. The data also showed that DNA/chitosan NP activated DC more than LPS in the 3D system. T-Lymphocyte proliferation was induced to a greater extent by DNA/NP-treated DC when both cell types were maintained on the scaffolds. Interestingly, while DC induction of T-lymphocyte interferon (IFN)-γ and IL-4 release was enhanced in the 3D system (relative to controls), there was a suppression of transforming growth factor (TGF)-β production; effects on IL-10 secretion were variable. The results here suggested that collagen-chitosan scaffolds could provide a pro-inflammatory and activator environment to perform studies to analyze effects of exogenous agents on the induction of DC maturation, NP uptake and/or cytokines release, as well as for the ability of these cells to potentially interact with other immune system cells in vitro.

An update on clinical applications of electrospun nanofibers for skin bioengineering

Mimicking morphological similarities of the natural extra cellular matrix (ECM), described by ultrafine continuous fibers, high surface to volume ratio, and high porosity is valuable for effective regeneration of injured skin tissue. Electrospun nanofibers, being one of the most favorable and fast developing products of technology today, display a tremendous potential in wound healing and skin tissue engineering. Under the remarkable attention being given to electrospun nanofibrous scaffolds in promoting wound healing and skin regeneration, this review focuses on the potential of the electrospinning technique as a promising tool for constructing polymeric nanofibrous scaffolds with the favorable physicochemical properties needed for skin bioengineering. In addition, current applications of electrospun nanofibrous matrices for skin bioengineering are detailed in this review.