Therapeutic efficacy of antibiotic-loaded gelatin microsphere/silk fibroin scaffolds in infected full-thickness burns

Biomedical Applications of Electro-Initiated Polymerisation on Ti6Al4 V Titanium Alloy using Silk Fibroin Coatings for Antibiotic Delivery and Improved Cell Metabolism

Silk fibroin interactions with metallic surfaces can provide utility for medical materials and devices. Toward this goal, titanium alloy (Ti6Al4 V) was covalently grafted with polyacrylamide via electrochemically reducing 4-nitrobenzene diazonium salt in the presence of acrylamide. Analysis of the modified surfaces with FT-IR spectra, SEM and AFM were consistent with surface grafting. Functionalised titanium samples with a silk fibroin membrane, with and without impregnated therapeutics, were used to assess cytocompatibility and drug delivery. Initial cytocompatibility experiments using fibroblasts showed that the functionalised samples, both with and without silk fibroin coatings, supported significant increases between 72-136 % in cell metabolism, compared to the controls after 7 days. A 7-days release profiling showed consistent bacterial inhibition through gentamicin release with average inhibition zones of 239 mm2. Over a 5-week period, silk fibroin coated samples, both with and without growth factors, supported better human mesenchymal stem cell metabolism with increases reaching 1031 % and 388 %, respectively, compared to samples without the silk fibroin coating with.

Silk fibroin-based dressings with antibacterial and anti-inflammatory properties

Silk fibroin is a fibrillar protein obtained from arthropods such as mulberry and non-mulberry silkworms. Silk fibroin has been used as a dressing in wound treatment for its physical, chemical, mechanical, and biological properties. This systematic review analyzed studies from PubMed, Web of Science, and Scopus databases to identify the molecules preferred for functionalizing silk fibroin-based dressings and to describe their mechanisms of exhibiting anti-inflammatory and antibacterial properties. The analysis of the selected articles allowed us to classify the dressings into different conformations, such as membranes, films, hydrogels, sponges, and bioadhesives. The incorporation of various molecules, including antibiotics, natural products, peptides, nanocomposites, nanoparticles, secondary metabolites, growth factors, and cytokines, has allowed the development of dressings that promote wound healing with antibacterial and immunomodulatory properties. In addition, silk fibroin-based dressings have been established to have the potential to regenerate wounds such as venous ulcers, arterial ulcers, diabetic foot, third-degree burns, and neoplastic ulcers. Evaluation of the efficacy of silk fibroin-based dressings in tissue engineering is an area of great activity that has shown significant advances in recent years.

Antibacterial functionalization of calfskin bioremediation film

Decellularized calfskins are a well-established skin substitute that retains the dermal tissue's spatial structure, facilitating skin regeneration, and is already available in the market. However, their mechanical properties can change with degradation, leading to tearing at the suture. Moreover, decellularized calfskins do not possess inherent antimicrobial abilities, which can lead to wound infection and further injury during the healing process. With the objectives of supporting the clinical use of decellularized calfskins, minimizing the probability of decellularized calfskin fracture and damage during usage, and improving their anti-infective properties, this study utilized a post-loading method to load gentamicin sulfate onto the decellularized calfskin to functionalize it for antimicrobial purposes. In addition, the mechanical and physicochemical properties of the drug-carrying film were investigated to see if they could meet the clinical requirements. The results revealed that vancomycin sulfate could be loaded onto the decellularized calfskin without affecting collagen. The tensile strength of the drug-loaded membrane was determined to be in the range of 5.53-29.25 MPa, meeting the clinical requirements. Thermal analysis and pH analysis experiments demonstrated that the drug-loaded membrane did not undergo thermal denaturation or decomposition during skin repair and remained within the normal pH range of the skin, avoiding significant fluctuations in wound pH.

Preparation and Properties of Antibacterial Silk Fibroin Scaffolds

The development of a wound dressing with both antibacterial and healing-guiding functions is a major concern in the treatment of open and infected wounds. In this study, poly(hexamethylene biguanide) hydrochloride (PHMB) was loaded into a 3D silk fibroin (SF) scaffold based on electrostatic interactions between PHMB and SF, and PHMB/SF hybrid scaffolds were prepared via freeze-drying. The effects of the PHMB/SF ratio on the antibacterial activity and cytocompatibility of the hybrid scaffold were investigated. The results of an agar disc diffusion test and a bacteriostasis rate examination showed that when the mass ratio of PHMB/SF was greater than 1/100, the scaffold exhibited obvious antibacterial activity against E. coli and S. aureus. L-929 cells were encapsulated in the PHMB/SF scaffolds and cultured in vitro. SEM, laser scanning confocal microscopy, and CCK-8 assay results demonstrated that hybrid scaffolds with a PHMB/SF ratio of less than 2/100 significantly promoted cell adhesion, spreading, and proliferation. In conclusion, a hybrid scaffold with a PHMB/SF ratio of approximately 2/100 not only effectively inhibited bacterial reproduction but also showed good cytocompatibility and is expected to be usable as a functional antibacterial dressing for wound repair.

An Overview of Recent Developments in the Management of Burn Injuries

According to the World Health Organization (WHO), around 11 million people suffer from burns every year, and 180,000 die from them. A burn is a condition in which heat, chemical substances, an electrical current or other factors cause tissue damage. Burns mainly affect the skin, but can also affect deeper tissues such as bones or muscles. When burned, the skin loses its main functions, such as protection from the external environment, pathogens, evaporation and heat loss. Depending on the stage of the burn, the patient's condition and the cause of the burn, we need to choose the most appropriate treatment. Personalization and multidisciplinary collaboration are key to the successful management of burn patients. In this comprehensive review, we have collected and discussed the available treatment options, focusing on recent advances in topical treatments, wound cleansing, dressings, skin grafting, nutrition, pain and scar tissue management.

Aldehyde-mediated adaptive membranes with self-healing and antimicrobial properties for endometrial repair

Traditional treatment methods for irreversible endometrial damage face a number of challenges in clinical practice, the most important of which are bacterial infection and the inability to restore endometrial function. By modifying glucan, oxidized dextran (OD) with multifunctional aldehyde groups was obtained in this study. Based on the dynamic Schiff base reaction between gelatin (GA) and OD, a GA-OD adaptive membrane with good biocompatibility, self-healing, biodegradability, and antimicrobial properties was created. In vitro studies revealed that GA and OD cross-linking overcame GA's low gel temperature, accelerated gelling, and improved mechanical properties, hydrophilicity, and degradability. The dynamic bond formed by the reaction between GA and OD caused the GA-OD film to self-heal. Meanwhile, the GA-OD membrane had antibacterial properties. To assess the repair effect of GA-OD film, an in vivo rat endometrial injury model filled with GA-OD adaptive membrane was created. According to the results of the study, the GA-OD membrane was biocompatible, and the uterine tissue did not have edema and inflammation. Further study on the postoperative endometrial regeneration effect of GA-OD material showed that it had an excellent ability for epithelial reconstruction and cell proliferation. As a result, the use of GA-OD composite film in endometrial repair has promising therapeutic implications.

Designing Silk-Based Cryogels for Biomedical Applications

There is a need to develop the next generation of medical products that require biomaterials with improved properties. The versatility of various gels has pushed them to the forefront of biomaterials research. Cryogels, a type of gel scaffold made by controlled crosslinking under subzero or freezing temperatures, have great potential to address many current challenges. Unlike their hydrogel counterparts, which are also able to hold large amounts of biologically relevant fluids such as water, cryogels are often characterized by highly dense and crosslinked polymer walls, macroporous structures, and often improved properties. Recently, one biomaterial that has garnered a lot of interest for cryogel fabrication is silk and its derivatives. In this review, we provide a brief overview of silk-based biomaterials and how cryogelation can be used for novel scaffold design. We discuss how various parameters and fabrication strategies can be used to tune the properties of silk-based biomaterials. Finally, we discuss specific biomedical applications of silk-based biomaterials. Ultimately, we aim to demonstrate how the latest advances in silk-based cryogel scaffolds can be used to address challenges in numerous bioengineering disciplines.

Recent advancements and perspective of ciprofloxacin-based antimicrobial polymers

In recent years, microbial pathogens, which are major sources of infections, have become a widespread concern across the world. The number of deaths caused by infectious diseases is continually rising, according to World Health Organization records. Antimicrobial resistance, particularly resistance to several drugs, is steadily growing in percentages of organisms. Ciprofloxacin is a second-generation fluoroquinolone with significant antimicrobial activity and pharmacokinetic characteristics. According to studies, many bacteria are resistant to the antibiotic ciprofloxacin. In this article, we look into polymers as ciprofloxacin macromolecular carriers with a wide range of antibacterial activity. We also discuss the latter form of coupling, in which ciprofloxacin and polymers are covalently bonded. This article also discusses the use of antimicrobial polymers in combination with ciprofloxacin in a various sectors. The current review article provides an overview of publications in the last five years on polymer loaded or modified with ciprofloxacin having applications in numerous sectors.

Preparation and evaluation of antibacterial wound dressing based on vancomycin-loaded silk/dialdehyde starch nanoparticles

One of the main reasons infected wounds go untreated is that antibiotic-resistant bacteria mainly cause infection. Vancomycin is an antibiotic used against Gram-positive bacteria, such as MRSA, but it has limited intravenous use due to its toxicity. This study describes using a local drug delivery approach at the wound site. The aim is to prepare a silk dressing containing dialdehyde starch nanoparticles loaded with vancomycin that can cure infection through the controlled release of antibiotics. First, the starch was oxidized by sodium periodate solution and converted to dialdehyde starch. Dialdehyde starch was converted into nanoparticles by the microemulsion method. Simultaneously, with nanoparticle formation, the antibiotic vancomycin (VAN), added to the solution, was loaded into the dialdehyde starch nanoparticles (DASNP). The wound dressing (SF/DASNP/VAN) was prepared by adding nanoparticles containing antibiotics to the silk fibroin (SF) solution, and then, the solution containing the nanoparticles was freeze-dried, and the nanoparticles were placed inside the silk matrix. Drug release of dressings was performed by immersion in phosphate-buffered saline, and cytotoxicity by MTT assay and antibacterial properties of dressings were investigated by the inhibition zone method. The morphology of the SF/DASNP/VAN dressing, its biocompatibility, antibacterial efficiency, and antibiotic release kinetics were assessed. The synthesized dressing has the desired biocompatibility with 69% cell viability and shows antibacterial properties against MRSA with a growth inhibition zone diameter of 12 mm. Also, VAN was successfully incorporated into the dressing, resulting in a 144-h continuous release profile. It may be concluded that the fabricated dressing based on silk and dialdehyde starch nanoparticles opens up a new option for topical administration of antibiotics. We believe its properties can be considered a new dressing for infectious wounds by reducing infection associated with controlled drug delivery.

Design of polysaccharidicAloe veragel incorporated PVA/tetracycline electrospun cell culture scaffolds for biomedical applications

In this study, hybrid nanofibrous 3D scaffolds containingAloe vera(AV), polyvinyl alcohol (PVA) and tetracycline hydrochloride (TCH) are fabricated by electrospinning for cell culture applications. The role of polysaccharides present in AV gel is found to enhance the biocompatibility of the nanofibrous scaffolds. Different combinations of the polymers were selected to produce homogenous nanofibers with favorable mean fiber diameter and tensile strength. The surface morphology of the products was studied by SEM and it is found that the mean fiber diameter is decreased to about 188 nm upon addition of the AV component. The electrospun scaffolds were investigated by FT-IR spectroscopy to reveal the chemical structure of the samples and their crystallinity was studied by XRD. The hydrophilicity of the scaffolds was tested by optical contact angle measurements and their mechanical strength was examined by tensile strength tests. It is found that PVA is the main component contributing the mechanical stability of the scaffold structure. The fabricated scaffolds presented a more pronounced inhibitory effect against Gram-positive bacterial strains ofS. aureusandB. cereus. Cell culture experiments using fibroblast L929 murine cells reveals that the AV/PVA/TCH scaffolds are promising for cell growth and the cells are capable of achieving a proper cell adhesion and proliferation. The cell viability experiment by MTT assay exhibits the contributing role of AV gel to L929 cell viability on the AV/PVA/TCH scaffolds.

Preparation of Codonopsis pilosula polysaccharide microcapsules and its effect and mechanism on skin wound healing in rats

In this study, after optimizing the extraction process of CPP (Codonopsis pilosula polysaccharides), CPPM (CPP microcapsules) were prepared. Subsequently, the structural characteristics and physicochemical properties were studied. The results showed that CPPM is a hollow sac-like structure with rough folds and protuberances and comes in spherical or ellipsoidal shapes with uniform particle size. CPPM has certain swelling degree, low hardness, good adhesion, and stability. Then, the effect of CPPM on wounds repair was investigated by a rat model. The results showed that CPPM could improve the wound healing rate. Histological evaluation showed CPPM could promote neovascularization and fibroblast proliferation. By investigating the healing mechanism, it was found that CPPM increased the hydroxyproline content in granulation tissue and had an excellent antioxidant ability, and then inhibited lipid peroxidation, in addition, it significantly increased the transcript levels of VEGF and miRNA-21 genes, indicating that CPPM play an influential role in vascular remodeling during wound healing by up-regulating the expression of VEGF and miRNA-21 genes.

A Review on Antibacterial Silk Fibroin-based Biomaterials: Current State and Prospects

Bacterial contamination of biomaterials is a common problem and a serious threat to human health worldwide. Therefore, the development of multifunctional biomaterials that possess antibacterial properties and can resist infection is a continual goal for biomedical applications. Silk fibroin (SF), approved by U.S. Food and Drug Administration (FDA) as a biomaterial, is one of the most widely studied natural polymers for biomedical applications due to its unique mechanical properties, biocompatibility, tunable biodegradation, and versatile material formats. In the last decade, many methods have been employed for the development of antibacterial SF-based biomaterials (SFBs) such as physical loading or chemical functionalization of SFBs with different antibacterial agents and bio-inspired surface modifications. In this review, we first describe the current understanding of the composition and structure-properties relationship of SF as a leading-edge biomaterial. Then we demonstrate the different antibacterial agents and methods implemented for the development of bactericidal SFBs, their mechanisms of action, and different applications. We briefly address their fabrication methods, advantages, and limitations, and finally discuss the emerging technologies and future trends in this research area.

Nerve Decellularized Matrix Composite Scaffold With High Antibacterial Activity for Nerve Regeneration

Nerve decellularized matrix (NDM) has received much attention due to its natural composition and structural advantages that had proven to be an excellent candidate for peripheral nerve regeneration. However, NDM with simultaneous biocompatibility, promoting nerve regeneration, as well as resistant to infection was rarely reporter. In this study, a porous NDM-CS scaffold with high antimicrobial activity and high biocompatibility was prepared by combining the advantages of both NDM and chitosan (CS) in a one-step method. The NDM-CS scaffold possessed high porosity and hydrophilicity, exhibited excellent biocompatibility which was suitable for cell growth and nutrient exchange. Meanwhile, NDM-CS scaffold had a significant antibacterial effect on both Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), which could avoid wound infection during the repair process. In addition, the NDM-CS scaffold could support the growth and viability of Schwann cells effectively. Among them, the E2C1 group had the strongest ability to enhance proliferation, polarization and migration of Schwann cells among the three groups. The positive effect on Schwann cells indicated their ability in the process of nerve injury repair. Therefore, this NDM-CS scaffold may have potential prospects for application in neural tissue engineering.

Porous gelatin microspheres for controlled drug delivery with high hemostatic efficacy

Effective hemostasis and antibacterial efficacy for extensive trauma in a warzone and civilian accidents are important for reducing mortalities and serious complications. Gelatin has been widely used as a hemostatic agent and has the potential for use in drug delivery systems. To enhance its hemostatic efficiency and create conducive conditions for sustained drug release, we developed Vancomycin-impregnated porous gelatin microspheres (Van-MS) by introducing the porous structure into gelatin. Results showed that Van-MS can be successfully developed via the ice crystal pore-making method combined with hydration maintaining its stability. We also explored the use of biodegradable porous materials for treatment of infections and bleeding in soft tissue, and analyzed Van-MS via scanning electron microscopy (SEM), scanning electron microscopy and energy dispersive X-ray spectrometry (SEM-EDS), Fourier Transform infrared spectroscopy (FTIR) and High-Performance Liquid Chromatography (HPLC). Results from Van-MS showed high hemostatic both efficacies in vivo and in vitro. Moreover, muscle lesions treated by Van-MS showed formation of fibrous connective tissue and were nearly sealed after 10 days in a rabbit traumatic infection model. This antibacterial performance was attributed to absorption of exudates and sustained drug release. Hemostatic effects were due to: (1) particles water swelling form a physical barrier that led to physical hemostasis; (2) activation of the endogenous coagulation pathway which resulted in physiological hemostasis; (3) aggregation of platelets and erythrocytes after absorbing water; and (4) stronger hemostatic properties owing to their porous structure with high specific surface area.

Design and Development of Antibacterial/Anti-inflammatory Dual Drug-Loaded Nanofibrous Inserts for Ophthalmic Sustained Delivery of Gentamicin and Methylprednisolone: In Vitro Bioassay, Solvent, and Method Effects’ Evaluation

Purpose: To overcome the challenges caused by the use of conventional ophthalmic dosage forms such as the fast elimination of the drug from the surface of the eye, in this study, dual drug-loaded nanofibers were developed for sustained ophthalmic delivery of gentamicin (GNT) and methylprednisolone (MP). Moreover, the solvent effects, polymer mixtures, and method of preparation on the release profile of the prepared nanofibers, were evaluated.

Methods: The nanofibers were prepared using polycaprolactone (PCL), poly (lactic-co-glycolic acid) (PLGA), and polyvinyl alcohol (PVA) using electrospinning technique. Thereafter, seven optimized formulations were developed with different solvent mixtures and polymer concentrations using various electrospinning methods. The physicochemical and mechanical properties of nanofibers were also evaluated, and the morphology of formulations was observed. The antibacterial efficacy was investigated and the in vitro release amounts of GNT and MP from nanofibers were estimated using the bioassay and ultraviolet-visible (UV-Vis) spectroscopy.

Results: The developed G1, G4, G5, G6, and G7 had suitable mechanical properties and morphologies with diameter ranging between 70-350 nm. The 1:1 v/v ratio of DMF/DCM in the solvent mixture and using core-shell technique for the preparation, formed nanofibers with more favorable release profiles. The optimized formulations indicated sustained-release manner for both drugs during 3-9 days and the antibacterial efficacy against Staphylococcus aureus.

Conclusion: Among all the prepared formulations, the nanofiber with core-shell structure possessed the best sustained-release profiles of GNT and MP. The obtained results suggest that these nanofibers have a potential to be used as an insert in the eye for long-term release of the drug.

Gold, Silver, and Iron Oxide Nanoparticle Incorporation into Silk Hydrogels for Biomedical Applications: Elaboration, Structure, and Properties

Silk fibroin (SF) is a versatile material with biodegradable and biocompatible properties, which make it fit for broad biomedical applications. In this context, the incorporation of nanosized objects into SF allows the development of a variety of bionanocomposites with tailored properties and functions. Herein, we report a thorough investigation on the design, characterization, and biological evaluation of SF hydrogels incorporating gold, silver, or iron oxide nanoparticles. The latter are synthesized in aqueous media using a biocompatible ligand allowing their utilization in various biomedical applications. This ligand seems to play a pivotal role in nanoparticle dispersion within the hydrogel. Results show that the incorporation of nanoparticles does not greatly influence the mechanism of SF gelation and has a minor impact on the mechanical properties of the so-obtained bionanocomposites. By contrast, significant changes are observed in the swelling behavior of these materials, depending on the nanoparticle used. Interestingly, the main characteristics of these bionanocomposites, related to their potential use for biomedical purposes, show the successful input of nanoparticles, including antibacterial properties for gold and silver nanoparticles and magnetic properties for iron oxide ones.

Tailoring the cationic lipid composition of lipo-DVDMS augments the phototherapy efficiency of burn infection

Increase in infections with Gram-negative Pseudomonas aeruginosa (P. aeruginosa) is a serious global challenge in healthcare. Sinoporphyrin sodium (DVDMS) combined with photodynamic antimicrobial chemotherapy (PACT) can effectively eradicate Gram-positive organisms. However, the poor penetration of DVDMS into the Gram-negative bacterial cell membrane and bacterial biofilm greatly limits the photo-inspired antimicrobial activity. This study optimized the cationic lipid-mediated nano-DVDMS delivery to improve the cellular uptake, and evaluated the antimicrobial efficacy of cationic DVDMS-liposome (CDL)-provoked PACT in both P. aeruginosa and its multidrug resistant strain. The results showed that the positively charged liposome modification promoted the enrichment of DVDMS in Gram-negative bacteria. CDL-PACT-produced ROS and caused bacterial death, accompanied by the decreased expression levels of virulence factor-related genes. The P. aeruginosa-infected burn model indicated satisfactory bacterial eradication and accelerated wound healing after CDL-PACT, in addition to gradually increasing bFGF, VEGF, TGF-β₁ and Hyp levels and reducing TNF-α and IL-6, with no detectable side-effects. Overall, these findings provide fundamental knowledge that enables the design of feasible and efficient PACT treatments, including biophysical membrane permeabilization and photodynamic eradication, which are promising to overcome the infection and resistance of highly opportunistic Gram-negative bacteria.

Exploration of Bioengineered Scaffolds Composed of Thermo-Responsive Polymers for Drug Delivery in Wound Healing

Innate and adaptive immune responses lead to wound healing by regulating a complex series of events promoting cellular cross-talk. An inflammatory response is presented with its characteristic clinical symptoms: heat, pain, redness, and swelling. Some smart thermo-responsive polymers like chitosan, polyvinylpyrrolidone, alginate, and poly(ε-caprolactone) can be used to create biocompatible and biodegradable scaffolds. These processed thermo-responsive biomaterials possess 3D architectures similar to human structures, providing physical support for cell growth and tissue regeneration. Furthermore, these structures are used as novel drug delivery systems. Locally heated tumors above the polymer lower the critical solution temperature and can induce its conversion into a hydrophobic form by an entropy-driven process, enhancing drug release. When the thermal stimulus is gone, drug release is reduced due to the swelling of the material. As a result, these systems can contribute to the wound healing process in accelerating tissue healing, avoiding large scar tissue, regulating the inflammatory response, and protecting from bacterial infections. This paper integrates the relevant reported contributions of bioengineered scaffolds composed of smart thermo-responsive polymers for drug delivery applications in wound healing. Therefore, we present a comprehensive review that aims to demonstrate these systems' capacity to provide spatially and temporally controlled release strategies for one or more drugs used in wound healing. In this sense, the novel manufacturing techniques of 3D printing and electrospinning are explored for the tuning of their physicochemical properties to adjust therapies according to patient convenience and reduce drug toxicity and side effects.

Silk Polymers and Nanoparticles: A Powerful Combination for the Design of Versatile Biomaterials

Silk fibroin (SF) is a natural protein largely used in the textile industry but also in biomedicine, catalysis, and other materials applications. SF is biocompatible, biodegradable, and possesses high tensile strength. Moreover, it is a versatile compound that can be formed into different materials at the macro, micro- and nano-scales, such as nanofibers, nanoparticles, hydrogels, microspheres, and other formats. Silk can be further integrated into emerging and promising additive manufacturing techniques like bioprinting, stereolithography or digital light processing 3D printing. As such, the development of methodologies for the functionalization of silk materials provide added value. Inorganic nanoparticles (INPs) have interesting and unexpected properties differing from bulk materials. These properties include better catalysis efficiency (better surface/volume ratio and consequently decreased quantify of catalyst), antibacterial activity, fluorescence properties, and UV-radiation protection or superparamagnetic behavior depending on the metal used. Given the promising results and performance of INPs, their use in many different procedures has been growing. Therefore, combining the useful properties of silk fibroin materials with those from INPs is increasingly relevant in many applications. Two main methodologies have been used in the literature to form silk-based bionanocomposites: in situ synthesis of INPs in silk materials, or the addition of preformed INPs to silk materials. This work presents an overview of current silk nanocomposites developed by these two main methodologies. An evaluation of overall INP characteristics and their distribution within the material is presented for each approach. Finally, an outlook is provided about the potential applications of these resultant nanocomposite materials.

Thermo-responsive chitosan hydrogel for healing of full-thickness wounds infected with XDR bacteria isolated from burn patients: In vitro and in vivo animal model

Treatment of non-healing skin wounds infected with extensively drug-resistant (XDR) bacteria remains as a big challenge. To date, different biomaterials have been applied for treatment of post-wound infections, nevertheless their efficacy for treatment of the wounds infected with XDR isolates has not been determined yet. In this study, the potential of the thermo-responsive chitosan (TCTS) hydrogel for protection of full-thickness wounds XDR bacteria isolated from burn patients was evaluated both in vitro and in vivo in a rat model. Antibacterial activity of the TCTS hydrogel against standard strain and clinical isolates of Acinetobacter baumannii, cytobiocompatibility for Hu02 fibroblast cells, degradation rate and swelling ratio were determined in vitro. MTT assay and disk diffusion test indicated no detectable cytotoxicity and antibacterial activity in vitro, respectively. In vivo study showed significant acceleration of wound healing, re-epithelialization, wound closure, and decreased colony count in the TCTS hydrogel group compared with control. This study suggests TCTS hydrogel as an excellent wound dressing for management of the wounds infected with XDR bacteria, and now promises to proceed with clinical investigations.

Evaluating the antimicrobial resistance patterns and molecular frequency of bla oxa-48 and bla GES-2 genes in Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from burn wound infection in Tehran, Iran

The aim of this study is to evaluate the antimicrobial resistance patterns and molecular frequency of bla_GES-2 and bla_oxa-48 genes in Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from burn wound infection in Tehran, Iran. In this study, 50 isolates of A. baumannii and 48 isolates of P. aeruginosa were collected from the Burn Unit of Shahid Motahari Hospital at Tehran, Iran. Antibiotic susceptibility tests of all isolates were carried out using the disc diffusion method, and the production of extended-spectrum β-lactamases (ESBLs) in isolates was surveyed by the double disc synergy method and based on CLSI (2019 AST M100) criteria. Finally, the frequency of bla_GES-2 and bla_oxa-48 genes was surveyed by PCR. Antibiotic susceptibility tests showed that 48/48 (100%) of P. aeruginosa isolates and 49/50 (98%) of A. baumannii isolates were resistant to ceftriaxone and cefotaxime, respectively. Ceftazidime exhibited the lowest (26/48; 54.1%) resistance rates against P. aeruginosa isolates. The production of ESBLs was seen in 8/48 (16.6%) and 3/50 (6%) of P. aeruginosa and A. baumannii isolates, respectively. On the basis of conventional PCR and sequencing, the frequencies of the bla_GES-2 gene among P. aeruginosa and A. baumannii was 87.5% and 58%, respectively. Moreover, bla_oxa-48 gene was detected in 70.83% and 92% of P. aeruginosa and A. baumannii isolates, respectively. Results suggest that antibiotic-resistant A. baumannii and P. aeruginosa strains isolated from burn patients are frequently found; therefore, it is absolutely necessary to implement continuous screening and follow-up programmes for detecting antimicrobial resistance.

Biocompatibility enhancement of graphene oxide-silver nanocomposite by functionalisation with polyvinylpyrrolidone

Several materials such as silver are used to enhance graphene oxide (GO) sheets antimicrobial activity. However, these toxic materials decrease its biocompatibility and hinder its usage in many biological applications. Therefore, there is an urgent need to develop nanocomposites that can preserve both the antimicrobial activity and biocompatibility simultaneously. This work highlights the importance of functionalisation of GO sheets using Polyvinylpyrrolidone (PVP) and decorating them with silver nanoparticles (AgNPs) in order to enhance their antimicrobial activity and biocompatibility at the same time. The structural and morphological characterisations were performed by UV-Visible, Fourier transform infrared (FTIR), and Raman spectroscopic techniques, X-ray diffraction (XRD), and high-resolution transmission electron microscopy (HR-TEM). The antimicrobial activities of the prepared samples against Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans were studied. The cytotoxicity of prepared materials was tested against BJ1 normal skin fibroblasts. The results indicated that the decoration with AgNPs showed a significant increase in the antimicrobial activity of GO and FGO sheets, and functionalisation of GO sheets and GO-Ag nanocomposite with PVP improved the cell viability about 40 and 35%, respectively.

Smart Hydrogel-Based DVDMS/bFGF Nanohybrids for Antibacterial Phototherapy with Multiple Damaging Sites and Accelerated Wound Healing

Burn infection is one of the commonest causes of death in severely burned patients. Developing multifunctional biological nanomaterials has a great significance for the comprehensive treatment of burn infection. In this paper, we developed a hydrogel-based nanodelivery system with antibacterial activity and skin regeneration function, which was used for photodynamic antimicrobial chemotherapy (PACT) in the treatment of burns. The treatment system is mainly composed of porphyrin photosensitizer sinoporphyrin sodium (DVDMS) and poly(lactic-co-glycolic acid) (PLGA)-encapsulated basic fibroblast growth factor (bFGF) nanospheres that are embedded in carboxymethyl chitosan (CMCS)-sodium alginate to form CSDP hybrid hydrogel. We systematically evaluated the inherent antibacterial performance, rheological properties, fluorescence imaging, and biocompatibility of the CSDP nanosystem. Under mild photoirradiation (30 J/cm², 5 min), 10 μg/mL CSDP showed excellent antibacterial and anti-biofilm activities, which eradicated almost 99.99% of Staphylococcus aureus and multidrug-resistant (MDR) S. aureus in vitro. KEGG analysis identified that multiple signaling pathways were changed in MDR S. aureus after PACT. In the burn-infection model, CSDP-PACT successfully inhibited bacteria growth and concurrently promoted wound healing. Moreover, several regenerative factors were increased and some proinflammatory factors were reduced in the burn wounds of CSDP hydrogel treatment. These results suggest that the multifunctional CSDP hydrogel is a portable, light-triggered, antibacterial theranostic-platform and CSDP-PACT provides a promising strategy or the mechanically based synergistic treatment of burn infections.

Silk biomaterials in wound healing and skin regeneration therapeutics: From bench to bedside

Silk biomaterials are known for biomedical and tissue engineering applications including drug delivery and implantable devices owing to their biocompatible and a wide range of ideal physico-chemical properties. Herein, we present a critical overview of the progress of silk-based matrices in skin regeneration therapeutics with an emphasis on recent innovations and scientific findings. Beginning with a brief description of numerous varieties of silks, the review summarizes our current understanding of the biological properties of silk that help in the wound healing process. Various silk varieties such as silkworm silk fibroin, silk sericin, native spider silk and recombinant silk materials have been explored for cutaneous wound healing applications from the past few decades. With an aim to harness the regenerative properties of silk, numerous strategies have been applied to develop functional bioactive wound dressings and viable bio-artificial skin grafts in recent times. The review examines multiple inherent properties of silk that aid in the critical events of the healing process such as cell migration, cell proliferation, angiogenesis, and re-epithelialization. A detailed insight into the progress of silk-based cellular skin grafts is also provided that discusses various co-culture strategies and development of bilayer and tri-layer human skin equivalent under in vitro conditions. In addition, functionalized silk matrices loaded with bioactive molecules and antibacterial compounds are discussed, which have shown great potential in treating hard-to-heal wounds. Finally, clinical studies performed using silk-based translational products are reviewed that validate their regenerative properties and future applications in this area. STATEMENT OF SIGNIFICANCE: The review article discusses the recent advances in silk-based technologies for wound healing applications, covering various types of silk biomaterials and their properties suitable for wound repair and regeneration. The article demonstrates the progress of silk-based matrices with an update on the patented technologies and clinical advancements over the years. The rationale behind this review is to highlight numerous properties of silk biomaterials that aid in all the critical events of the wound healing process towards skin regeneration. Functionalization strategies to fabricate silk dressings containing bioactive molecules and antimicrobial compounds for drug delivery to the wound bed are discussed. In addition, a separate section describes the approaches taken to generate living human skin equivalent that have recently contributed in the field of skin tissue engineering.

Cloning, Expression and Effects of P. americana Thymosin on Wound Healing

The American cockroach (Periplaneta americana) is a medicinal insect. Its extract is used clinically to promote wound healing and tissue regeneration, but the effective medicinal components and mechanisms are not yet clear. It has been reported that human thymosin beta 4 (Tβ4) may accelerate skin wound healing, however, the role of P. americana thymosin (Pa-THYs) is still poorly understood. In the present study, we identify and analyze the DNA sequences of Pa-THYs by bioinformatics analysis. Then we clone, express, and purify the Pa-THYs proteins and evaluate the activity of recombinant Pa-THYs proteins by cell migration and proliferation assays in NIH/3T3 cells. To elucidate the role of Pa-THYs in wound healing, a mouse model is established, and we evaluate wound contraction, histopathological parameters, and the expressions of several key growth factors after Pa-THYs treatment. Our results showed that three THY variants were formed by skipping splicing of exons. Pa-THYs could promote fibroblast migration, but have no effect on fibroblast proliferation. In wound repair, Pa-THYs proteins could effectively promote wound healing through stimulating dermal tissue regeneration, angiogenesis, and collagen deposition. On the molecular mechanism, Pa-THYs also stimulated the expression of several key growth factors to promote wound healing. The data suggest that Pa-THYs could be a potential drug for promoting wound repair.

Advanced drug delivery systems and artificial skin grafts for skin wound healing

Cutaneous injuries, especially chronic wounds, burns, and skin wound infection, require painstakingly long-term treatment with an immense financial burden to healthcare systems worldwide. However, clinical management of chronic wounds remains unsatisfactory in many cases. Various strategies including growth factor and gene delivery as well as cell therapy have been used to enhance the healing of non-healing wounds. Drug delivery systems across the nano, micro, and macroscales can extend half-life, improve bioavailability, optimize pharmacokinetics, and decrease dosing frequency of drugs and genes. Replacement of the damaged skin tissue with substitutes comprising cell-laden scaffold can also restore the barrier and regulatory functions of skin at the wound site. This review covers comprehensively the advanced treatment strategies to improve the quality of wound healing.

Controlled-release neurotensin-loaded silk fibroin dressings improve wound healing in diabetic rat model

Diabetic foot ulcers (DFU), which may lead to lower extremity amputation, is one of the severe and chronic complications of diabetic mellitus. This study aims to develop, and use dressings based on Silk fibroin (SF) as the scaffold material, gelatin microspheres (GMs) as the carrier for the neurotensin (NT), a neuropeptide that acts as an inflammatory modulator in wound healing and NT as accelerate wound healing drug to treat DFU. We evaluated the wound healing processes and neo-tissue formation in rat diabetic model by macroscopic observation, histological observation (H&E staining and Masson's trichrome staining) and immunofluorescence analysis at 3, 7, 14, 21 and 28 post-operation days. Our results show that the NT/GMs/SF group performance the best not only in macroscopic healing and less scars in 28 post-operation days, but also in fibroblast accumulation in tissue granulation, collagen expression and deposition at the wound site. From release profiles, we can know the GMs are a good carrier for control release drugs. The SEM results shows that the NT/GMs/SF dressings have an average pore size are 40–80 μm and a porosity of ∼85%, this pore size is suit for wound healing regeneration. These results suggest that the NT/GMs/SF dressings may work as an effective support for control release NT to promote DFU wound healing.

•

This study aims to develop, and use dressings based on Silk fibroin (SF) as the scaffold material, gelatin microspheres (GMs) as the carrier for the Neurotensin (NT), a neuropeptide that acts as an inflammatory modulator in wound healing and NT as accelerate wound healing drug to treat DFU.

•

The NT/GMs/SF dressings stimulated fibroblast accumulation in tissue granulation, collagen expression and deposition at the wound site, which lead to the production of a more organized collagen matrix.

•

This treatment effectively accelerating wound regeneration and re-epithelialization.

Comparative analysis and properties evaluation of gelatin microspheres crosslinked with glutaraldehyde and 3-glycidoxypropyltrimethoxysilane as drug delivery systems for the antibiotic vancomycin

In the present comparative study, gelatin microspheres (GMs) were prepared by emulsification-solvent-extraction method using well-known crosslinker: glutaraldehyde (GA) and biocompatible silane-coupling agent: glycidoxypropyltrimethoxysilane (GPTMS). Crosslinking with GA was done by a definite and common procedure, while GPTMS crosslinking potency was investigated after 5, 10, 24, and 48 h synthesis periods and the fabrication method was adjusted in order for preparation of GMs with optimized morphological and compositional characteristics. The prepared GMs were then evaluated and compared as drug delivery systems for the antibiotic vancomycin (Vm). Morphological observations, FTIR, ninhydrin assay, swelling behavior evaluation and Hydrolytic degradation analysis proved successful modification of GMs and revealed that increasing synthesis time from 5 h to 24 h and 48 h, when using GPTMS as crosslinker, led to formation of morphologically-optimized GMs with highest crosslinking degree (∼50%) and the slowest hydrolytic degradation rate. Such GMs also exhibited most sustained release period of Vm. The antibacterial test results against gram-positive bacterium Staphylococcus aureus, were in accordance with the release profiles of Vm, as well. Together, GPTMS-crosslinked GMs with their preferable characteristics and known as biocompatible gelatin-siloxane hybrids, could act as proper drug delivery systems for the sustained release of the antibiotic vancomycin.

Enhanced healing activity of burn wound infection by a dextran-HA hydrogel enriched with sanguinarine

Burn wounds are associated with a series of risks, such as infection and pathologic scar tissue formation, which significantly delay wound healing and lead to complications. In this study, we successfully fabricated a dextran-hyaluronic acid (Dex-HA) hydrogel enriched with sanguinarine (SA) incorporated into gelatin microspheres (GMs), which had high porosity, good swelling ratio, enhanced NIH-3T3 fibroblast cell proliferation, and sustained SA release profile. The in vitro degradation results indicate that the SA/GMs/Dex-HA hydrogel can be degraded. The in vitro antibacterial tests showed that the SA/GMs/Dex-HA hydrogel can inhibit methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli (E. coli). We evaluated the wound-healing effects and antibacterial properties of SA/GMs/Dex-HA hydrogels in a rat full-thickness burn infection model. The hematoxylin-eosin (H&E) and Masson's trichrome staining results of the SA/GMs/Dex-HA hydrogel showed that it improved re-epithelialization and enhanced extracellular matrix remodeling, and immunohistochemistry results showed that the expression of TGF-β1 and TNF-α was decreased, while the TGF-β3 expression was increased. Our findings suggest that the SA/GMs/Dex-HA hydrogel provides a potential way for infected burn treatment with high-quality and efficient scar inhibition.

Preparation of biocompatible wound dressings with long-term antimicrobial activity through covalent bonding of antibiotic agents to natural polymers

Wound dressings with long-term antimicrobial activity are highly desired for treatment of chronic wound infections. Herein, the sustained antimicrobial wound dressings were developed by using antibiotic agents, ciprofloxacin HCL (CIP) and gentamicin sulfate (GS), covalent bonding to natural polymer matrix composites, carboxymethyl chitosan (CMC) and collagen (COL). By amide bond formation between antibiotic agents and polymer chains, two antimicrobial wound dressings CMC-COL-CIP and CMC-COL-GS were prepared. The presented wound dressings exhibited high water absorption capacity, excellent water vapor transmission rate (WVTR), appropriate mechanical properties, and impressive stability. Cytocompatibility of the dressings was demonstrated by in vitro human skin fibroblast (HSF) cells culture study. The results of in vitro and in vivo studies indicated that the two antimicrobial wound dressings have effective antimicrobial activity and prolonged antimicrobial period. Furthermore, the antimicrobial dressings could promote the wound healing, reepithelialization, collagen deposition, and angiogenesis. It also displays superiority wound healing effects compared to commercially available silver-based dressings (Aguacel Ag). This work indicates that the prepared antimicrobial wound dressings have great potential application in chronic wound healing, such as severe wound cure and diabetic foot ulcers.

Overview of Silk Fibroin Use in Wound Dressings

Recently, biomimetic wound dressings were introduced as potential replacements for treating skin injuries. Although there are some clinically available skin replacements, the range of wound types and locations necessitates a broader range of options for the clinic. Natural polymeric-based dressings are of central interest in this area due to their outstanding biocompatibility, biodegradability, low toxicity, and non-allergenic nature. Among them, silk fibroin (SF) has exceptional characteristics as a wound dressing. SF-based dressings can also be used as carriers for delivering drugs, growth factors, and bioactive agents to the wound area, while providing appropriate support for complete healing. In this review, we describe recent advances in the development of SF-based wound dressings for skin regeneration.

3D Protein-Based Bilayer Artificial Skin for the Guided Scarless Healing of Third-Degree Burn Wounds in Vivo

Severe burn injuries can lead to delays in healing and devastating scar formation. Attempts have been made to develop a suitable skin substitute for the scarless healing of such skin wounds. Currently, there is no effective strategy for completely scarless healing after the thermal injuries. In our recent work, we fabricated and evaluated a 3D protein-based artificial skin made from decellularized human amniotic membrane (AM) and electrospun nanofibrous silk fibroin (ESF) in vitro. We also characterized both biophysical and cell culture investigation to establish in vitro performance of the developed bilayer scaffolds. In this report, we evaluate the appropriate utility of this fabricated bilayered artificial skin in vivo with particular emphasis on healing and scar formation due to the biochemical and biomechanical complexity of the skin. For this work, AM and AM/ESF membranes alone or seeded with adipose-tissue-derived mesenchymal stem cells (AT-MSCs) are implanted on full-thickness burn wounds in mice. The healing efficacy and scar formation are evaluated at 7, 14, and 28 days post-implantation in vivo. Our data reveal that ESF accelerates the wound-healing process through the early recruitment of inflammatory cells such as macrophages into the defective site as well as the up-regulation of angiogenic factors from the AT-MSCs and the facilitation of the remodeling phase. In vivo application of the prepared AM/ESF membrane seeded with the AT-MSCs reduces significantly the post-burn scars. The in vivo data suggest that the potential applications of the AM/ESF bilayered artificial skin may be considered a clinical translational product with stem cells to guide the scarless healing of severe burn injuries.

Yeasts from skin colonization are able to cross the acellular dermal matrix

In recent decades, the prognosis for burn patients has improved considerably with the development of specialized care. The acellular dermal matrix (ADM) is a totally artificial acellular device that functions to control water loss, prevent penetration by bacteria and allow migration of endothelial cells and fibroblasts from patient tissues. However, little is known about its effectiveness against yeasts. The present study evaluated the capacity of colonization and migration of some human commensal yeasts. Three clinical isolates from skin scales, identified as Candida parapsilosis, Candida glabrata and Rhodotorula mucilaginosa, were used. Their ability to cross the ADM was evaluated. After three days, all isolates had crossed the ADM. C. parapsilosis showed the lowest growth, while R. mucilaginosa showed intermediate and C. glabrata the highest growth. In the plates incubated for seven days, the growth of C. parapsilosis and C. glabrata increased by 1 log over the third day. All isolates have the capacity to colonize and migrate through the matrix, increasing the potential risk to burn patients, who can develop severe and even fatal infections by invasive fungi.

A gene-activating skin substitute comprising PLLA/POSS nanofibers and plasmid DNA encoding ANG and bFGF promotes in vivo revascularization and epidermalization

A gene-activated porous nanofibrous scaffold for effectively promoting vascularization, epidermalization and dermal wound healing by sustained release of dual plasmid DNAs.

A Gelatin-sulfonated Silk Composite Scaffold based on 3D Printing Technology Enhances Skin Regeneration by Stimulating Epidermal Growth and Dermal Neovascularization

One of the key problems hindering skin repair is the deficiency of dermal vascularization and difficulty of epidermis regeneration, which makes it challenging to fabricate scaffolds that can biologically fulfill the requirements for skin regeneration. To overcome this problem, three-dimensional printing was used to fabricate a gelatin-sulfonated silk composite scaffold that was incorporated with basic fibroblast growth factor 2 (FGF-2) through binding with a sulfonic acid group (SO₃) (3DG-SF-SO₃-FGF). The efficacy and mechanism by which the 3DG-SF-SO₃-FGF scaffolds promote skin regeneration were investigated both within in vitro cell culture and in vivo with a full-thickness skin defect model. The histological results showed that the gelatin-sulfonated silk composite scaffolds promoted granulation, and that incorporation of FGF-2 significantly enhanced the regeneration of skin-like tissues after implantation in rat skin defects for 14 and 28 days. Further investigations demonstrated that 3DG-SF-SO₃-FGF scaffolds might stimulate dermal vascularization. These findings thus suggest that incorporation of FGF-2 into the 3D printed scaffolds is a viable strategy for enhancing skin regeneration.

A bridging SF/Alg composite scaffold loaded NGF for spinal cord injury repair

Neurons loss and axons degeneration after spinal cord injury (SCI) gradually give rise to result in functional motor and sensory impairment. A bridging biomaterial scaffold that allows the axons to grow through has been investigated for the repair of injured spinal cord. In this study, we introduced a silk fibroin (SF)-based neurobridge as scaffold enriched with/without nerve growth factor (NGF) that can be utilized as a therapeutic approach for spinal cord repair. NGF released from alginate (Alg) microspheres on SF scaffold (SF/Alg composites scaffolds) to the central lesion site of SCI significantly enhanced the sparing of spinal cord tissue and increased the number of surviving neurons. This optimal multi-disciplinary approach of combining biomaterials, controlled-release microspheres and neurotrophic factors offers a promising treatment for the injured spinal cord.