Hybrid wound dressings with controlled release of antibiotics: Structure-release profile effects and in vivo study in a guinea pig burn model

Development of a cationic bacterial cellulose film loaded with anionic liposomes for prolonged release of oxacillin in wound dressing applications

Dressings should protect wounds, promote healing, absorb fluids, and maintain moisture. Bacterial cellulose is a biopolymer that stands out in biomaterials due to its high biocompatibility in several applications. In the area of dressings, it is already marketed as an alternative to traditional dressings. However, it lacks any intrinsic activity; among these, the need for antimicrobial activity in infected wounds stands out. We developed a cationic cellulose film by modifying cellulose with 1-(5-carboxypentyl)pyridin-1-ium bromide, enhancing its wettability (contact angle: 26.6°) and water retention capacity (2714.37 %). This modified film effectively retained oxacillin compared to the unmodified control. Liposomal encapsulation further prolonged oxacillin release up to 11 days. Both oxacillin-loaded films and liposomal formulations demonstrated antimicrobial activity against Staphylococcus aureus. Our findings demonstrate the potential of chemically modified cellulose as a platform for controlled anionic antibiotics and/or their formulations delivery in wound care.

An antibacterial nanoclay- and chitosan-based quad composite with controlled drug release for infected skin wound healing

Microbial infections of surgical sites and other wounds represent a major impediment for patients. Multifunctional low-cost dressings promoting tissue reparation while preventing infections are of great interest to medical professionals. Here, clay-based laponite nanodiscs (LAP) were loaded with the antibacterial drug kanamycin (KANA) before being embedded into a poly(lactic-co-glycolic acid) (PLGA) membrane and coated with the biopolymer chitosan (CS). Results indicated that these biocompatible materials combined the excellent capacity of LAP for controlled drug release with the mechanical robustness of PLGA and the antibacterial properties of CS as well as its hydrophilicity to form a composite highly suitable as an infection-preventing wound dressing. In vitro, PLGA/LAP/KANA/CS released drugs in a sustainable manner over 30 d, completely inhibited the growth of infectious bacteria, prompted the adhesion fibroblasts, and accelerated their proliferation 1.3 times. In vivo, the composite enabled the fast healing of infected full-thickness skin wounds with a 96.19 % contraction after 14 d. During the healing process, PLGA/LAP/KANA/CS stimulated re-epithelization, reduced inflammation, and promoted both angiogenesis and the formation of dense collagen fibers with an excellent final collagen volume ratio of 89.27 %. Thus, multifunctional PLGA/LAP/KANA/CS made of low-cost components demonstrated its potential for the treatment of infected skin wounds.

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.

Antimicrobial Natural Hydrogels in Biomedicine: Properties, Applications, and Challenges-A Concise Review

Natural hydrogels are widely used as biomedical materials in many areas, including drug delivery, tissue scaffolds, and particularly wound dressings, where they can act as an antimicrobial factor lowering the risk of microbial infections, which are serious health problems, especially with respect to wound healing. In this review article, a number of promising strategies in the development of hydrogels with biocidal properties, particularly those originating from natural polymers, are briefly summarized and concisely discussed. Common strategies to design and fabricate hydrogels with intrinsic or stimuli-triggered antibacterial activity are exemplified, and the mechanisms lying behind these properties are also discussed. Finally, practical antibacterial applications are also considered while discussing the current challenges and perspectives.

Biomimetic multifunctional hybrid sponge via enzymatic cross-linking to accelerate infected burn wound healing

Preparing sponge dressings with stable wet adhesion remains difficult in wound repair, especially in burn wounds with bleeding and large amounts of exudate. In this work, a multifunctional hybrid sponge dressing (DHGT+PHMB+TiO₂NPs) with good wet adhesion was developed by combining biomimetic and enzymatic cross-linking reactions. The sponge dressing matrix (DHGT) was prepared by tyrosinase-catalyzed cross-linking of dopamine-modified hyaluronic acid (DOPA-HA) and gelatin. The multifunctional hybrid sponge dressing was obtained by loading polyhexamethylene biguanide (PHMB) and titanium dioxide nanoparticles (TiO₂NPs) onto the DHGT matrix. The newly developed sponge dressing exhibited high mechanical properties, good wet adhesion, antibacterial activity, reactive oxygen species (ROS) scavenging, biocompatibility, and excellent hemostasis ability. In vivo studies showed that the multifunctional hybrid sponge dressing could significantly accelerate the healing of infected full-thickness burn wounds by inhibiting bacterial growth, accelerating skin tissue reepithelialization, collagen deposition, and angiogenesis, as well as regulating the expression of inflammatory factors and cytokines.

Hybrid-Based Wound Dressings: Combination of Synthetic and Biopolymers

Most commercialized wound dressings are polymer-based. Synthetic and natural polymers have been utilized widely for the development of wound dressings. However, the use of natural polymers is limited by their poor mechanical properties, resulting in their combination with synthetic polymers and other materials to enhance their mechanical properties. Natural polymers are mostly affordable, biocompatible, and biodegradable with promising antimicrobial activity. They have been further tailored into unique hybrid wound dressings when combined with synthetic polymers and selected biomaterials. Some important features required in an ideal wound dressing include the capability to prevent bacteria invasion, reduce odor, absorb exudates, be comfortable, facilitate easy application and removal as well as frequent changing, prevent further skin tear and irritation when applied or removed, and provide a moist environment and soothing effect, be permeable to gases, etc. The efficacy of polymers in the design of wound dressings cannot be overemphasized. This review article reports the efficacy of wound dressings prepared from a combination of synthetic and natural polymers.

Plant-inspired conductive adhesive organohydrogel with extreme environmental tolerance as a wearable dressing for multifunctional sensors

Conductive hydrogels have attracted significant attention as a promising material in electrical and biomedical fields. However, the simultaneous realization of good conductivity, toughness, high tissue adhesiveness, excellent biocompatibility, and extreme environmental tolerance remains a challenge. Inspired by the antifreezing/antiheating behavior of natural plants, a calcium chloride/TEMPO-oxidized cellulose nanofiber-dopamine/ polyacrylamide (CaCl₂/TOCNF-DOPA/PAM) glycerol/water organohydrogel with antifreezing and antiheating properties, good transparency, conductivity, stability, excellent biocompatibility, mechanical properties, and tissue adhesiveness was fabricated. The organohydrogel has about 700% stretchability, with about 90% transparency. The organohydrogel exhibits good conductivity of 4.9 × 10^-4 S/cm and high tissue adhesiveness of 50 kPa, which can monitor various human activities. The organohydrogel displays excellent extreme environmental tolerance to maintain the conductivity and mechanical properties under an extremely wide temperature range (-24 to 50 °C) for a long period due to its water-locking effect between glycerol and water molecules. The biocompatible organohydrogel is able to protect the skin from frostbite or burns in harsh environments. The plant-inspired stable and durable organohydrogel is used as a wearable dressing for multifunctional sensors.

A mechanical, electrical dual autonomous self-healing multifunctional composite hydrogel

The versatile properties make hydrogels a potential multipurpose material that finds wide applications. However, the preparation of multipurpose hydrogels is very challenging. Here, we report a method based on free radical reaction and composite mechanisms to prepare mechanical and electrical self-healing multifunctional hydrogels. In this study, the introduction of imidazolium salt ionic liquids and glycerol in the hydrogel system endows the gels with good antibacterial, conductive, and adhesive properties and excellent antifreeze properties. The testing results show that the as-prepared hydrogel has stable mechanical and electrical properties even under the extremely cold condition of -50°C after self-healing. Moreover, the active esters formed in the dynamic radical reaction have better reducibility, thus further investing the as-prepared hydrogel with high antioxidant activity. The application results show that these comprehensive properties make such hydrogel system very useful in wound repair and wearable strain sensors.

Polylactide/Polyvinylalcohol-Based Porous Bioscaffold Loaded with Gentamicin for Wound Dressing Applications

This study explores the feasibility of modifying the surface liquid spraying method to prepare porous bioscaffolds intended for wound dressing applications. For this purpose, gentamicin sulfate was loaded into polylactide-polyvinyl alcohol bioscaffolds as a highly soluble (hygroscopic) model drug for in vitro release study. Moreover, the influence of inorganic salts including NaCl (10 g/L) and KMnO4 (0.4 mg/L), and post-thermal treatment (T) (80 °C for 2 min) on the properties of the bioscaffolds were studied. The bioscaffolds were characterized by scanning electron microscopy, Fourier Transform infrared spectroscopy, and differential scanning calorimetry. In addition, other properties including porosity, swelling degree, water vapor transmission rate, entrapment efficiency, and the release of gentamicin sulfate were investigated. Results showed that high concentrations of NaCl (10 g/L) in the aqueous phase led to an increase of around 68% in the initial burst release due to the increase in porosity. In fact, porosity increased from 68.1 ± 1.2 to 94.1 ± 1.5. Moreover, the thermal treatment of the Polylactide-polyvinyl alcohol/NaCl (PLA-PVA/NaCl) bioscaffolds above glass transition temperature (Tg) reduced the initial burst release by approximately 11% and prolonged the release of the drug. These results suggest that thermal treatment of polymer above Tg can be an efficient approach for a sustained release.

Investigation of propellant-free aqueous foams as pharmaceutical carrier systems

Due to their light consistency and good spreadability, aqueous foams are considered as convenient and highly accepted drug carrier systems that are of great importance in the field of topical drug delivery. The production of a stable, easy to dose, preferably environmentally harmless foam formulation is challenging. Therefore, foam characterisation requires a complex approach: several tests are to be performed throughout the formulation. Our study primarily aims to investigate the quality attributes of propellant-free foam-forming additives. Throughout the research, we focused on acquiring knowledge about the properties of pharmaceutical excipients suitable for foam formulations and their effect on foam characteristics. Not only were the relative foam density, actuated foam weight and the foam collapse tendencies studied, but also the initial liquid properties. Along with surface tension determination, bubble-forming experiments were carried out. The bubble size and rate of formation, standardised by using a texture analyser, were followed by image analysis. Analysing the bubble-forming properties of dilute surfactant solutions allows assumptions on the properties of foam formed from the more concentrated solutions. The size and number of bubbles in the produced foams are related to the kinetics of single bubble formation. For comparison, commercially available medicated foams were studied.

Preparation and evaluation of heparinized sponge based on collagen and chitosan for wound healing

The wound dressing can temporarily replace the skin and play a protective role in the process of wound healing, preventing wound infection and inflammation, and providing a favorable environment for wound healing. In this study, a mixture of collagen and chitosan was lyophilized to be the host material of the sponge. This sponge was soaked into 1-ethyl-(dimethylaminopropyl) carbodiimide/N-hydroxy sulfosuccinimide cross-linking solution containing heparin and experienced secondary lyophilization to prepare the heparinized sponge (CT-CL/Hp). The surface morphology and structural characterization of the sponge was characterized by scanning electron microscope and Fourier transform infrared spectrometer, respectively. Relatively favorable water absorption capability were observed by measuring the physical properties. Satisfactory antibacterial properties against various bacteria and microbial isolation performance were observed by the antibacterial effect analysis in vitro. The sustained-release property of heparin from the sponges was measured using Alcian Blue assay. Experiments in vitro and in vivo showed that the sponges had satisfactory biocompatibility and lower sensitization. Moreover, the effect of sponge on early stages of wound healing was evaluated by guinea pigs wound healing models. Analysis of wound healing rates and histological examination showed satisfactory results. CT-CL/Hp enhanced expression of growth factors, particularly VEGF and EGF at day 7. These results demonstrated that CT-CL/Hp–treated sponges benefit to wound skin healing and regeneration.

Improvement in mechanical properties and biodegradability of PLA using poly(ethylene glycol) and triacetin for antibacterial wound dressing applications

Wound is among the most common injuries. A suitable wound dressing has a significant effect on the healing process. In this study, a porous wound dressing was prepared using poly (lactic acid) (PLA) and two plasticizers, polyethylene glycol (PEG) and triacetin (TA), through solvent casting method. For antibacterial activities, metronidazole was incorporated in the structure. The morphology was investigated by scanning electron microscopy (SEM). In addition, the effect of plasticizers ratio on porosity growth was evaluated. It was also observed that each had a unique effect on the structure's porosity. The mechanical properties confirmed the effect of both plasticizers on increasing polymer softness and flexibility, and the most similar formulations to human skin in terms of mechanical properties were introduced. According to the results, TA had stronger effect on mechanical properties. The differential scanning calorimetry (DSC) showed the effect of increasing plasticizer concentration on crystalline structure and Tm reduction of PLA. The water contact angle measurement showed that both plasticizers enhanced hydrophilic characteristics of PLA, and this effect was weaker in PEG-containing formulations. The in vitro degradation study showed biodegradability, as a desirable property in wound dressing. Results suggested that higher degradation can be obtained by both plasticizers at the same time. The results also showed that PEG was more effective in enhancing water absorbency. In vitro drug release study indicated an explosive release and the highest amount was 85% over 186 h. The antibacterial activity test confirmed the effectiveness of the drug in preventing bacterial growth in the drug-containing formulations, while it showed the antibacterial property of TA. MTT assay was performed and the cellular toxicity of the formulations was checked and those that revealed the least toxicity were introduced.

Ciprofloxacin-intercalated layered double hydroxide-in-hybrid films as composite dressings for controlled antimicrobial topical delivery

Films based on biopolymers and loaded with antimicrobial agents are convenient pharmaceutical dosage forms for topical application. Inorganic carriers loaded with these agents lead to composite materials, which combined with polymers produce further functionality. Here, hybrid composite films based on layered double hydroxide (LDH) and hyaluronan (HS) as ciprofloxacin (Cip) delivery systems were studied as an alternative for prophylaxis and treatment of opportunistic infections in wounds. Cip-intercalated Zn-Al LDH (LDH-Cip), with high drug loading and crystallinity, were obtained by a precipitation at variable pH method, and then included in a HS dispersion for obtaining the hybrid composite films by solvent casting. Physicochemical characterization of films showed that a composite material where the HS acted as matrix and LDH-Cip aggregates acted as filler were obtained. LDH-Cip were uniformly dispersed along the (LDH-Cip)/HS films, which exhibited roughness in their surface, increasing their swelling capacity in PBS pH = 5.8. Controlled releases of Cip toward PBS at pH = 5.8 and 7.4 were obtained, and the best fits for the release profiles were found with Higuchi and Korsmeyer-Peppas models, respectively. (LDH-Cip)/HS films exhibited antimicrobial activity against S. aureus. These films would then provide sustained release of Cip after topical administration, maintaining a suitable level of antibacterial activity, combined with the wound healing properties of the HS. The interesting properties shown by the (LDH-Cip)/HS films make them a promising alternative for application in skin wounds.

Development of Bioinspired Gelatin and Gelatin/Chitosan Bilayer Hydrofilms for Wound Healing

In the current study, we developed a novel gelatin-based bilayer wound dressing. We used different crosslinking agents to confer unique properties to each layer, obtaining a bioinspired multifunctional hydrofilm suitable for wound healing. First, we produced a resistant and non-degradable upper layer by lactose-mediated crosslinking of gelatin, which provided mechanical support and protection to overall design. For the lower layer, we crosslinked gelatin with citric acid, resulting in a porous matrix with a great swelling ability. In addition, we incorporated chitosan into the lower layer to harness its wound healing ability. FTIR and SEM analyses showed that lactose addition changed the secondary structure of gelatin, leading to a more compact and smoother structure than that obtained with citric acid. The hydrofilm was able to swell 384.2 ± 57.2% of its dry weight while maintaining mechanical integrity. Besides, its water vapour transmission rate was in the range of commercial dressings (1381.5 ± 108.6 g/m2·day). In vitro, cytotoxicity assays revealed excellent biocompatibility. Finally, the hydrofilm was analysed through an ex vivo wound healing assay in human skin. It achieved similar results to the control in terms of biocompatibility and wound healing, showing suitable characteristics to be used as a wound dressing.

Novel skin patch combining human fibroblast-derived matrix and ciprofloxacin for infected wound healing

Skin injuries are frequently encountered in daily life, but deep wounds often poorly self-heal and do not recover completely. In this study, we propose a novel skin patch that combines antibiotic, cell-derived extracellular matrix (ECM) and biocompatible polyvinyl alcohol (PVA) hydrogel.

Methods: Decellularized human lung fibroblast-derived matrix (hFDM) was prepared on tissue culture plate (TCP) and PVA solution was then poured onto it. After a freeze-thaw process, PVA was peeled off from TCP along with hFDM tightly anchored to PVA. Subsequently, ciprofloxacin (Cipro)-incorporated PVA/hFDM (PVA/Cipro/hFDM) was fabricated via diffusion-based drug loading.

Results: In vitro analyses of PVA/Cipro/hFDM show little cytotoxicity of ciprofloxacin, stability of hFDM, rich fibronectin in hFDM, and good cell attachment, respectively. In addition, hFDM proved to be beneficial in promoting cell migration of dermal fibroblasts and human umbilical vein endothelial cells (HUVECs) using transwell inserts. The antibacterial drug Cipro was very effective in suppressing colony growth of gram-negative and -positive bacteria as identified via an inhibition zone assay. For animal study, infected wound models in BALB/c mice were prepared and four test groups (control, PVA, PVA/Cipro, PVA/Cipro/hFDM) were administered separately and their effect on wound healing was examined for up to 21 days. The results support that Cipro successfully reduced bacterial infection and thus encouraged faster wound closure. Further analysis using histology and immunofluorescence revealed that the most advanced skin regeneration was achieved with PVA/Cipro/hFDM, as assessed via re-epithelialization, collagen texture and distribution in the epidermis, and skin adnexa (i.e., glands and hair follicles) regeneration in the dermis.

Conclusion: This work demonstrates that our skin patch successfully consolidates the regenerative potential of ECM and the antibacterial activity of Cipro for advanced wound healing.

Nanofibrous peptide hydrogel elicits angiogenesis and neurogenesis without drugs, proteins, or cells

The design of materials for regenerative medicine has focused on delivery of small molecule drugs, proteins, and cells to help accelerate healing. Additionally, biomaterials have been designed with covalently attached mimics of growth factors, cytokines, or key extracellular matrix components allowing the biomaterial itself to drive biological response. While the approach may vary, the goal of biomaterial design has often centered on promoting either cellular infiltration, degradation, vascularization, or innervation of the scaffold. Numerous successful studies have utilized this complex, multicomponent approach; however, we demonstrate here that a simple nanofibrous peptide hydrogel unexpectedly and innately promotes all of these regenerative responses when subcutaneously implanted into the dorsal tissue of healthy rats. Despite containing no small molecule drugs, cells, proteins or protein mimics, the innate response to this material results in rapid cellular infiltration, production of a wide range of cytokines and growth factors by the infiltrating cells, and remodeling of the synthetic material to a natural collagen-containing ECM. During the remodeling process, a strong angiogenic response and an unprecedented degree of innervation is observed. Collectively, this simple peptide-based material provides an ideal foundational system for a variety of bioregenerative approaches.

Bioadhesive and biocompatible films as wound dressing materials based on a novel dendronized chitosan loaded with ciprofloxacin

The bioadhesive polymeric films as topical drug delivery systems are interesting alternatives to improve the pharmacotherapy and patient compliances. New derivate biomaterials based on weisocyanate- dendronized PVP- crosslinked chitosan and loaded with ciprofloxacin (CIP), as model drug, were used to prepare bioadhesive films. Relevant in vitro/in vivo attributes to define main physicochemical and biopharmaceutical characteristics for topical wound-healing applications were evaluated. A high proportion of CIP, uniformly dispersed along throughout the film, was loaded. An extended release of CIP and different behaviors of release profiles, depending on the presence of dendron, were observed. The films loaded with CIP were effective in inhibiting the growth of both Gram positive and Gram negative bacteria. In addition, biocompatibility and bioadhesion into conjuntival-sacs of the rabbits suggests that these films have good properties to be applied over skin wounds for topical applications, allowing a reduction of the frequency of administration and improving the residence time of the films.

Silica core-shell particles for the dual delivery of gentamicin and rifamycin antibiotics

Increasing bacterial resistance calls for the simultaneous delivery of multiple antibiotics. One strategy is to design a unique pharmaceutical carrier that is able to incorporate several drugs with different physico-chemical properties. This is highly challenging as it may require the development of compartmentalization approaches. Here we have prepared core-shell silica particles allowing for the dual delivery of gentamicin and rifamycin. The effect of silica particle surface functionalization on antibiotic sorption was first studied, enlightening the role of electrostatic and hydrophobic interactions. This in turn dictates the chemical conditions for shell deposition and further sorption of these antibiotics. In particular, the silica shell deposition was favored by the positively charged layer of gentamicin coating on the core particle surface. Shell modification by thiol groups finally allowed for rifamycin sorption. The antibacterial activity of the core-shell particles against Staphylococcus aureus and Pseudomonas aeruginosa demonstrated the dual release and action of the two antibiotics.

Prilling and supercritical drying: A successful duo to produce core-shell polysaccharide aerogel beads for wound healing

Bacterial infections often affect the wound, delaying healing and causing areas of necrosis. In this work, an aerogel in form of core-shell particles, able to prolong drug activity on wounds and to be easily removed was developed. Aerogel microcapsules consisted of a core made by amidated pectin hosting doxycycline, an antibiotic drug with a broad spectrum of action, and a shell consisting of high mannuronic content alginate. Particles were obtained by prilling using a coaxial nozzle for drop production and an ethanolic solution of CaCl2 as gelling promoter. The alcogels where dried using supercritical CO2. The influence of polysaccharides and drug concentrations on aerogel properties was evaluated. Spherical particles with high drug encapsulation efficiency (87%) correlated to alginate concentration in the processed liquid feeds were obtained. The release of the drug, mainly concentrated into the pectin core, was prolonged till 48h, and dependent on both drug/pectin ratio and alginate concentration.

Exploiting a new glycerol-based copolymer as a route to wound healing: Synthesis, characterization and biocompatibility assessment

The use of biocompatible materials based on naturally derived monomers plays a key role in pharmaceutical and cosmetic industries. In this paper we describe the synthesis of a new low molecular weight copolymer, based on glycerol and l-tartaric acid, useful to develop biocompatible dermal patches with drug delivery properties. The copolymer's chemical composition was assessed by FT-IR (Fourier transform infrared spectroscopy), (1)H NMR ((1)H Nuclear Magnetic Resonance) and XPS (X-ray photoelectron spectroscopy), while its molecular weight distribution was estimated by SEC (size exclusion chromatography). Copolymer thermal properties were studied by TGA (thermogravimetric analysis). Biological evaluations by MTT assay and SEM (scanning electron microscopy) observations performed with murine fibroblasts and human keratinocytes (HaCaT) revealed a good compatibility of the proposed copolymer. Ciprofloxacin was selected as model drug and its release was evaluated by HPLC (high performance liquid chromatography), showing that the new copolymer supplied promising results as drug delivery system for wound healing applications. Furthermore, investigations on Skin-Mesenchymal stem cells (S-MSCs) behaviour and gene expression showed that the copolymer and its combination with ciprofloxacin did not affect their stemness. In this regard, the fabrication of dermal patches with new, low cost materials for local treatment of skin infections represents an attractive strategy in order to bypass the worrying side effects of systemic antibiotic therapy. Overall, the performed physico-chemical characterization, drug release test and biological evaluations showed that this new copolymer could be a promising tool for the in situ delivery of bioactive molecules during skin lesions treatment.