Electrospun nanofibers as a wound dressing for treating diabetic foot ulcer

Novel design and development of Centella Asiatica extract - loaded poloxamer/ZnO nanocomposite wound closure material to improve anti-bacterial action and enhanced wound healing efficacy in diabetic foot ulcer

Diabetic wounds can occur as a prevalent complication among people diagnosed with diabetes, frequently resulting in the necessity for amputation. The cause and effect of diabetic foot ulcer is complex, involving multiple factors. In the present study, wound healing strategies utilizing nanomaterials have proven to be effective in battling bacterial infections and improve wound regeneration. Poloxamers (PLX) exhibit extensive potential as a viable option for the development of nanomedicines owing to their inherent characteristics of self-assembly and encapsulation. This study aims to design and develop a PLX/ZnO nanocomposite incorporated with Centella Asiatica extract (CAE) for the multi-functional action in the diabetic wound healing treatment. Subsequently physico-chemical characterizations, such as XRD, FTIR, and TEM observations, demonstrated that the ZnO were evenly distributed through the PLX framework. The developed nanocomposite was biocompatible with mouse fibroblast cell line (L929), and it had multiple beneficial characteristics, such as a rapid self-healing process and effective antibacterial action against G+ and G- bacterial pathogens. After being treated with the developed formulation, skin fibroblast cell line and HUVECs demonstrated a substantial increase in their in vitro cell proliferation ability, migration, and tube-forming abilities. The utilization of a CAE@PLX/ZnO nanoformulation presents a viable strategy and a distinctive, encouraging composite for diabetic wound healing treatment.

Sodium alginate-based nanofibers loaded with Capparis Sepiaria plant extract for wound healing

Burn wounds are associated with infections, drug resistance, allergic reactions, odour, bleeding, excess exudates, and scars, requiring prolonged hospital stay. It is crucial to develop wound dressings that can effectively combat allergic reactions and drug resistance, inhibit infections, and absorb excess exudates to accelerate wound healing. To overcome the above-mentioned problems associated with burn wounds, SA/PVA/PLGA/Capparis sepiaria and SA/PVA/Capparis sepiaria nanofibers incorporated with Capparis sepiaria plant extract were prepared using an electrospinning technique. Fourier-transform infrared spectroscopy confirmed the successful incorporation of the extract into the nanofibers without any interaction between the extract and the polymers. The nanofibers displayed porous morphology and a rough surface suitable for cellular adhesion and proliferation. SA/PVA/PLGA/Capparis sepiaria and SA/PVA/Capparis sepiaria nanofibers demonstrated significant antibacterial effects against wound infection-associated bacterial strains: Pseudomonas aeruginosa, Enterococcus faecalis, Mycobaterium smegmatis, Escherichia coli, Enterobacter cloacae, Proteus vulgaris, and Staphylococcus aureus. Cytocompatibility studies using HaCaT cells revealed the non-toxicity of the nanofibers. SA/PVA/PLGA/Capparis sepiaria and SA/PVA/Capparis sepiaria nanofibers exhibited hemostatic properties, resulting from the synergistic effect of the plant extract and polymers. The in vitro scratch wound healing assay showed that the SA/PVA/Capparis sepiaria nanofiber wound-healing capability is more than the plant extract and a commercially available wound dressing. The wound-healing potential of SA/PVA/Capparis sepiaria nanofiber is attributed to the synergistic effect of the phytochemicals present in the extract, their porosity, and the ECM-mimicking structure of the nanofibers. The findings suggest that the electrospun nanofibers loaded with Capparis sepiaria extract are promising wound dressings that should be explored for burn wounds.

Effect of Tetrapropylammonium Chloride Quaternary Ammonium Salt on Characterization, Cytotoxicity, and Antibacterial Properties of PLA/PEG Electrospun Mat

In this study, poly(lactic acid) (PLA)-tetrapropylammonium chloride (TCL)-poly(ethylene glycol) (PEG) nonwoven networks were produced using PLA, PEG with different concentrations (3, 5, 7, and 9 wt%), and TCL. PEG is included as a plasticizer in PLA polymer, which has high biocompatibility but a brittle structure. The importance of this study is to investigate the effect of TCL salt on the characterization of PLA-PEG nanofibers. For this research, the cytotoxicity test system responsible for the fibroblast cell line (L929) was evaluated with the liquid absorption capacity (LAC) and drying time tests for its use in wound dressings. The addition of TCL salt reduced bead formation in PLA-PEG nanofibers and increased the homogeneity of fiber dispersion. The smoothest and most homogeneous nonwoven networks were obtained as PLA-5TCL-PEG. It was also reported that this nonwoven network exhibited liquid absorption behavior with a maximum increase of 150% compared to the PLA-PEG nonwoven network and had the highest Young's modulus value of 12.97 MPa. In addition to these tests, evaluations were made with Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), drying time test, differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), and mechanical tests. In addition, high cell viability was observed in L292 mouse fibroblast cells at the end of the 24th hour, again with the effect of TCL salt. In addition, antibacterial activity was tested against gram-negative E. coli and gram-positive S. aureus bacteria, and it was observed that there was no antibacterial activity. Since PLA-TCL-PEG nonwoven webs have a maximum cell viability of 133.27%, they are recommended as a potential dermal wound dressing.

Accelerating healing of infected wounds with G. glabra extract and curcumin Co-loaded electrospun nanofibrous dressing

This study aimed to construct a nanofibrous wound dressing composed of polyvinyl alcohol (PVA) and chitosan (CS) containing curcumin and Glycyrrhiza glabra root extract to inhibit infection and accelerate wound healing. Loading 10 wt% of G. glabra extract-curcumin (50:50) by electrospinng technique resulted in the formation of nanofibers (NFs) with diameter distribution 303 ± 38 and had a uniform and defect-free morphology. FTIR analysis confirmed the loading of the components without adverse interactions. Also, the results showed extremely high porosity, extraordinary liquid absorption capacity, and complete wettability. In addition, G. glabra extract-curcumin showed significant antioxidant activity and their release profile from NFs was continuous and sustained. Also, the prepared NF could inhibit the growth of both Gram-positive Saureus and Gram-negative E. coli strains. Wound healing evaluation in the infected animal model showed that the NFs caused full wound closure and accelerated skin regeneration. The studies on inhibiting the bacteria growth at the wound site also revealed complete inhibitory effects. Moreover, histopathology studies confirmed the complete regeneration of skin layers, formation of collagen fibers, and angiogenesis. Finally, PVA/CS NFs containing G. glabra extract-curcumin as a multifunctional bioactive wound dressing presented a promising approach for promoting the healing of infected wounds.

Electrospun nanofibrous wound dressings with enhanced efficiency through carbon quantum dots and citrate incorporation

Nanofibers show promise for wound healing by facilitating active agent delivery, moisture retention, and tissue regeneration. However, selecting suitable dressings for diverse wound types and managing varying exudate levels remains challenging. This study synthesized carbon quantum dots (CQDs) from citrate salt and thiourea using a hydrothermal method. The CQDs displayed antibacterial activity against Staphylococcus aureus and Escherichia coli. A nanoscaffold comprising gelatin, chitosan, and polycaprolactone (GCP) was synthesized and enhanced with silver nanoparticle-coated CQDs (Ag-CQDs) to form GCP-Q, while citrate addition yielded GCP-QC. Multiple analytical techniques, including electron microscopy, FT-IR spectroscopy, dynamic light scattering, UV-Vis, photoluminescence, X-ray diffraction, porosity, degradability, contact angle, and histopathology assessments characterized the CQDs and nanofibers. Integration of CQDs and citrate into the GCP nanofibers increased porosity, hydrophilicity, and degradability-properties favorable for wound healing. Hematoxylin and eosin staining showed accelerated wound closure with GCP-Q and GCP-QC compared to GCP alone. Overall, GCP-Q and GCP-QC nanofibers exhibit significant potential for skin tissue engineering applications.

Mechanism and application of fibrous proteins in diabetic wound healing: a literature review

Diabetic wounds are more complex than normal chronic wounds because of factors such as hypoxia, reduced local angiogenesis, and prolonged inflammation phase. Fibrous proteins, including collagen, fibrin, laminin, fibronectin, elastin etc., possess excellent inherent properties that make them highly advantageous in the area of wound healing. Accumulating evidence suggests that they contribute to the healing process of diabetic wounds by facilitating the repair and remodel of extracellular matrix, stimulating the development of vascular and granulation tissue, and so on. However, there is currently a lack of a comprehensive review of the application of these proteins in diabetes wounds. An overview of fibrous protein characteristics and the alterations linked to diabetic wounds is given in this article's initial section. Next is a summary of the advanced applications of fibrous proteins in the last five years, including acellular dermal matrix, hydrogel, foam, scaffold, and electrospun nanofibrous membrane. These dressings have the ability to actively promote healing in addition to just covering wounds compared to traditional wound dressings like gauze or bandage. Research on fibrous proteins and their role in diabetic wound healing may result in novel therapeutic modalities that lower the incidence of diabetic wounds and thereby enhance the health of diabetic patients.

Design and development of dual drug-loaded nanofibrous inserts for ophthalmic sustained delivery of AMK and VAN: Pharmacokinetic study in rabbit's eye

Bacterial corneal keratitis is a damage to the corneal tissue that if not treated, can cause various complications like severe vision loss or even blindness. Combination therapy with two antibiotics which are effective against Gram-positive and Gram-negative bacteria offers sufficient broad-spectrum antibiotic coverage for the treatment of keratitis. Nanofibers can be a potential carrier in dual drug delivery due to their structural characteristics, specific surface area and high porosity. In order to achieve a sustained delivery of amikacin (AMK) and vancomycin (VAN), the current study designed, assessed, and compared nanofibrous inserts utilizing polyvinyl alcohol (PVA) and polycaprolactone (PCL) as biocompatible polymers. Electrospinning method was utilized to prepare two different formulations, PVA-VAN/AMK and PCL/PVA-VAN/AMK, with 351.8 ± 53.59 nm and 383.85 ± 49 nm diameters, respectively. The nanofibers were simply inserted in the cul-de-sac as a noninvasive approach for in vivo studies. The data obtained from the physicochemical and mechanical properties studies confirmed the suitability of the formulations. Antimicrobial investigations showed the antibacterial properties of synthesized nanofibers against Staphylococcus aureus and Pseudomonas aeruginosa. Both in vitro and animal studies demonstrated sustained drug release of the prepared nanofibers for 120 h. Based on the in vivo findings, the prepared nanofibers' AUC0-120 was found to be 20 to 31 times greater than the VAN and AMK solutions. Considering the results, the nanofibrous inserts can be utilized as an effective and safe system in drug delivery.

Recent progress of electrospun nanofibers as burning dressings

Burns are a global public health problem, which brings great challenges to public health and the economy. Severe burns often lead to systemic infection, shock, multiple organ failure, and even death. With the increasing demand for the therapeutic effect of burn wounds, traditional dressings have been unable to meet people's needs due to their single function and many side effects. In this context, electrospinning shows a great prospect on the way to open up advanced wound dressings that promote wound repairing and prevent infection. With its large specific surface area, high porosity, and similar to natural extracellular matrix (ECM), electrospun nanofibers can load drugs and accelerate wound healing. It provides a promising solution for the treatment and management of burn wounds. This review article introduces the concept of burn and the types of electrospun nanofibers, then summarizes the polymers used in electrospun nanofiber dressings. Finally, the drugs (plant extracts, small molecule drugs and nanoparticles) loaded with electrospun burn dressings are summarized. Some promising aspects for developing commercial electrospun burn dressings are proposed.

Enhancing diabetic wound healing: advances in electrospun scaffolds from pathogenesis to therapeutic applications

Diabetic wounds are a significant subset of chronic wounds characterized by elevated levels of inflammatory cytokines, matrix metalloproteinases (MMPs), and reactive oxygen species (ROS). They are also associated with impaired angiogenesis, persistent infection, and a high likelihood of hospitalization, leading to a substantial economic burden for patients. In severe cases, amputation or even mortality may occur. Diabetic foot ulcers (DFUs) are a common complication of diabetes, with up to 25% of diabetic patients being at risk of developing foot ulcers over their lifetime, and more than 70% ultimately requiring amputation. Electrospun scaffolds exhibit a structural similarity to the extracellular matrix (ECM), promoting the adhesion, growth, and migration of fibroblasts, thereby facilitating the formation of new skin tissue at the wound site. The composition and size of electrospun scaffolds can be easily adjusted, enabling controlled drug release through fiber structure modifications. The porous nature of these scaffolds facilitates gas exchange and the absorption of wound exudate. Furthermore, the fiber surface can be readily modified to impart specific functionalities, making electrospinning nanofiber scaffolds highly promising for the treatment of diabetic wounds. This article provides a concise overview of the healing process in normal wounds and the pathological mechanisms underlying diabetic wounds, including complications such as diabetic foot ulcers. It also explores the advantages of electrospinning nanofiber scaffolds in diabetic wound treatment. Additionally, it summarizes findings from various studies on the use of different types of nanofiber scaffolds for diabetic wounds and reviews methods of drug loading onto nanofiber scaffolds. These advancements broaden the horizon for effectively treating diabetic wounds.

Integrating RNA-sequencing and network analysis to explore the mechanism of topical Pien Tze Huang treatment on diabetic wounds

Introduction: Diabetic ulcers have become one of the major complications of diabetes mellitus (DM) and are a leading cause of death and disabling disease. However, current therapies are not effective enough to meet clinical needs. A traditional Chinese medicine (TCM) formula, Pien Tze Huang (PZH), is known as a medicine that is used to treat diabetic ulcers. Methods: In this study, PZH (0.05 g/cm2 and 0.15 g/cm2) and the positive drug-rhEGF were topically administered in a high-fat diet (HFD) and streptozotocin (STZ)-induced diabetic full-thickness incisional wounds, respectively. Wound healing was assessed by wound closure rate, two-photon microscope (SHG), staining with Hematoxylin and eosin (H&E), and Masson's trichrome (MTC). Then, RNA sequencing (RNA-seq) analysis, Enzyme-linked immunosorbent assay (ELISA), western blotting, and immunofluorescence (IF), network analysis, were performed. Results and discussion: The results showed that PZH significantly accelerated wound healing, as well as enhanced the expression of collagen. RNA-seq analysis showed that PZH has functions on various biological processes, one of the key biological processes is inflammatory response. Tlr9, Klrk1, Nod2, Tlr2, and Ifng were identified as vital targets and the NF-κB signaling pathway was identified as the vital pathway. Additionally, PZH profoundly reduced the levels of Cleaved caspase-3 and promoted the expression of CD31 and TGF-β1. Mechanically, PZH significantly decreased expression of NKG2-D, NOD2, and TLR2, and further inhibited the activation of downstream NF-κB signaling pathway and inhibited expression of inflammatory factors (IFN-γ and IL-1β). Importantly, we found that several active ingredients may play a significant role in diabetic wound healing, including Notoginsenoside R1, Deoxycorticosterone, Ursolic acid, and 4-Methoxyphenol. In summary, our study sheds light on the complicated mechanisms underlying the promising anti-diabetic wounds of PZH and provides the discovery of agents treating diabetic ulcers.

Zingiber officinale and thymus vulgaris extracts co-loaded polyvinyl alcohol and chitosan electrospun nanofibers for tackling infection and wound healing promotion

Infections are severe complications associated with chronic wounds and tardy healing that should be timely treated to achieve rapid and proper tissue repair. To hinder such difficulties, a nanofibrous mat composed of polyvinyl alcohol and chitosan (PVA/CS) was developed by electrospinning method, containing thyme (Thymus vulgaris) and ginger (Zingiber officinale) extracts. The mat containing 10 wt% of the extracts (at the ratio of 50:50) exposed the nanofibers (NFs) with the nanoscale diameter (average 382 ± 60 nm), smooth surface, and defect-free morphology. Likewise, the relevant analyses of the loaded mat displayed high wettability, porosity, and liquid absorption capacity without any adverse interaction. The obtained mat also provided a high antioxidant activity, and its release profile was continuous and sustained for nearly 72 h. Besides, it inhibited the growth of both Gram-positive S. aureus and Gram-negative E. coli strains. Furthermore, the proposed mat significantly accelerated cutaneous wound healing in bacterial-infected rats by preventing bacteria growth at the wound site. At last, histopathology analysis confirmed the ample regeneration of skin structures, forming collagen fibers and appendages. Overall, the proposed mat containing ginger-thyme extracts provides multiple therapeutic capabilities with promising solutions for inhibiting wound infection and accelerating the healing process.

Development of 5-fluorouracil/etoposide co-loaded electrospun nanofibrous scaffold for localized anti-melanoma therapy

Nanofibrous scaffolds have emerged as promising candidates for localized drug delivery systems in the treatment of cutaneous cancers. In this study, we prepared an electrospun nanofibrous scaffold incorporating 5-fluorouracil (5-FU) and etoposide (ETP) for chemotherapy targeting melanoma cutaneous cancer. The scaffold was composed of polyvinyl alcohol (PVA) and chitosan (CS), prepared via the electrospinning process and loaded with the chemotherapeutic agents. We conducted relevant physicochemical characterizations, assessed cytotoxicity, and evaluated apoptosis against melanoma A375 cells. The prepared 5-FU/ETP co-loaded PVA/CS scaffold exhibited nanofibers (NFs) with an average diameter of 321 ± 61 nm, defect-free and homogenous morphology. FTIR spectroscopy confirmed successful incorporation of chemotherapeutics into the scaffold. Additionally, the scaffold demonstrated a hydrophilic surface, proper mechanical strength, high porosity, and efficient liquid absorption capacity. Notably, sustained and controlled drug release was observed from the nanofibrous scaffold. Furthermore, the scaffold significantly increased cytotoxicity (95%) and apoptosis (74%) in A375 melanoma cells. Consequently, the prepared 5-FU/ETP co-loaded PVA/CS nanofibrous scaffold holds promise as a valuable system for localized eradication of cutaneous melanoma tumors and mitigation of adverse drug reactions associated with chemotherapy.

Essential Oils Infused Poly-ε-Caprolactone/Gelatin Electrospun Nanofibrous Mats: Biocompatibility and Antibacterial Study

Infections caused by antibiotic-resistant pathogens result in a delayed wound-healing process. As an approach to prevent infections, alternatives in the form of natural antimicrobial products have become public interest. Essential oils derived from plants are used as antimicrobials owing to their broad-spectrum activity against pathogenic organisms. In this study, essential oil from seeds of watermelon, jackfruit, and papaya was incorporated into poly-ε-caprolactone/gelatin nanofibers using an electrospinning technique. The synthesized nanofibers were smooth, continuous, and bead-free. The nanofibers were found to be mechanically competent as confirmed by the universal tensile tester. The antibacterial activity of the various essential oil-loaded nanofibrous mats was determined by disc diffusion assay. Furthermore, they were found to be non-toxic and biocompatible by MTT and CMFDA assays on fibroblast cells. The obtained results have demonstrated that essential oil-loaded nanofiber mats are promising alternatives to conventional antibacterial wound dressings.

Enhancing angiogenesis: Innovative drug delivery systems to facilitate diabetic wound healing

Diabetic wounds (DW) constitute a substantial burden on global healthcare owing to their widespread occurrence as a complication of diabetes. Angiogenesis, a crucial process, plays a pivotal role in tissue recovery by supplying essential oxygen and nutrients to the injury site. Unfortunately, in diabetes mellitus, various factors disrupt angiogenesis, hindering wound healing. While biomaterials designed to enhance angiogenesis hold promise for the treatment of DWs, there is an urgent need for more in-depth investigations to fully unlock their potential in clinical management. In this review, we explore the intricate mechanisms of angiogenesis that are crucial for DW recovery. We introduce a rational design for angiogenesis-enhancing drug delivery systems (DDS) and provide a comprehensive summary and discussion of diverse biomaterials that enhance angiogenesis for facilitating DW healing. Lastly, we address emerging challenges and prospects in angiogenesis-enhancing DDS for facilitating DW healing, aiming to offer a comprehensive understanding of this critical healthcare issue and potential solutions.

"Sandwich-like" structure electrostatic spun micro/nanofiber polylactic acid-polyvinyl alcohol-polylactic acid film dressing with metformin hydrochloride and puerarin for enhanced diabetic wound healing

A diabetic wound is a typical chronic wound with a long repair process and poor healing effects. It is an effective way to promote diabetic wound healing to design electrospinning nanofiber films with drug-assisted therapy, good air permeability and, a multilayer functional structure. In this paper, a diabetic wound dressing with a "sandwich-like" structure was designed. Metformin hydrochloride, loaded in the hydrophilic PVA inner layer, could effectively promote diabetic wound healing. The drug release was slowed down by osmosis. The laminate film dressing had good mechanical properties, with tensile strength and elongation at break reaching 5.91 MPa and 90.47 %, respectively, which was close to human skin. The laminate film loaded with erythromycin and puerarin in the hydrophobic PLA outer layer had good antibacterial properties. In addition, due to the high specific surface of the electrostatic spun film, it exhibited high water vapor permeability. It facilitates the gas exchange between the wound and the outside world. The cell experiments proved that the laminate film dressing had good biocompatibility. There was no toxic side effect on cell proliferation. In the diabetic animal wound model, it was shown that the closure rate of diabetic wound repair by laminate film reached 91.11 % in the second week. Our results suggest that the "sandwich-like" nanofiber film dressing could effectively promote the healing process and meet the various requirements of diabetic wound dressing as a promising candidate for future clinical application of chronic wound dressings.

Wound healing performance of electrospun PVA/70S30C bioactive glass/Ag nanoparticles mats decorated with curcumin: In vitro and in vivo investigations

Biocompatible fibrous scaffold containing polyvinyl alcohol (PVA), 70S30C bioactive glass (BG), silver (Ag) nanoparticles and curcumin (Cur) was fabricated through electrospinning method. Scanning electron microscope (SEM) and Field emission scanning electron microscopy (FESEM) were employed to investigate the morphological characteristics of the scaffolds. In addition, biodegradability, hydrophilicity, and contact angle were studied as criteria for evaluating physical properties of the scaffolds. Tensile strength was reported to be 0.971 ± 0.093 MPa. Also, the viability of fibroblasts after 7 days of cell culture was 93.58 ± 1.36 %. The antibacterial activity against Escherichia coli and Staphylococcus aureus bacteria was illustrated using inhibition zones of 13.12 ± 0.69 and 14.21 ± 1.37 mm, respectively. Histological results revealed that tissue regeneration after 14 days of surgery was much higher for the dressing group compared to the blank group. According to the obtained results, the authors introduce the PVA-BG-Ag-Cur scaffold as a promising candidate for skin tissue engineering applications.

Creation of Chitosan-Based Nanocapsule-in-Nanofiber Structures for Hydrophobic/Hydrophilic Drug Co-Delivery and Their Dressing Applications in Diabetic Wounds

Nanofiber meshes (NFMs) loaded with therapeutic agents are very often employed to treat hard-to-heal wounds such as diabetic wounds. However, most of the NFMs have limited capability to load multiple or hydrophilicity distinctive-therapeutic agents. The therapy strategy is therefore significantly hampered. To tackle the innate drawback associated with the drug loading versatility, a chitosan-based nanocapsule-in-nanofiber (NC-in-NF) structural NFM system is developed for simultaneous loading of hydrophobic and hydrophilic drugs. Oleic acid-modified chitosan is first converted into NCs by the developed mini-emulsion interfacial cross-linking procedure, followed by loading a hydrophobic anti-inflammatory agent Curcumin (Cur) into the NCs. Sequentially, the Cur-loaded NCs are successfully introduced into reductant-responsive maleoyl functional chitosan/polyvinyl alcohol NFMs containing a hydrophilic antibiotic Tetracycline hydrochloride. Having a co-loading capability for hydrophilicity distinctive agents, biocompatibility, and a controlled release property, the resulting NFMs have demonstrated the efficacy on promoting wound healing either in normal or diabetic rats.

Transforming Wound Management: Nanomaterials and Their Clinical Impact

Wound healing is a complex process that can be further complicated in chronic wounds, leading to prolonged healing times, high healthcare costs, and potential patient morbidity. Nanotechnology has shown great promise in developing advanced wound dressings that promote wound healing and prevent infection. The review article presents a comprehensive search strategy that was applied to four databases, namely Scopus, Web of Science, PubMed, and Google Scholar, using specific keywords and inclusion/exclusion criteria to select a representative sample of 164 research articles published between 2001 and 2023. This review article provides an updated overview of the different types of nanomaterials used in wound dressings, including nanofibers, nanocomposites, silver-based nanoparticles, lipid nanoparticles, and polymeric nanoparticles. Several recent studies have shown the potential benefits of using nanomaterials in wound care, including the use of hydrogel/nano silver-based dressings in treating diabetic foot wounds, the use of copper oxide-infused dressings in difficult-to-treat wounds, and the use of chitosan nanofiber mats in burn dressings. Overall, developing nanomaterials in wound care has complemented nanotechnology in drug delivery systems, providing biocompatible and biodegradable nanomaterials that enhance wound healing and provide sustained drug release. Wound dressings are an effective and convenient method of wound care that can prevent wound contamination, support the injured area, control hemorrhaging, and reduce pain and inflammation. This review article provides valuable insights into the potential role of individual nanoformulations used in wound dressings in promoting wound healing and preventing infections, and serves as an excellent resource for clinicians, researchers, and patients seeking improved healing outcomes.

Antibacterial Surgical Sutures Developed Using Electrostatic Yarn Wrapping Technology

A significant amount of research has been conducted on applying functional materials as surgical sutures. Therefore, research on how to solve the shortcomings of surgical sutures through available materials has been given increasing attention. In this study, hydroxypropyl cellulose (HPC)/PVP/zinc acetate nanofibers were coated on absorbable collagen sutures using an electrostatic yarn winding technique. The metal disk of an electrostatic yarn spinning machine gathers nanofibers between two needles with positive and negative charges. By adjusting the positive and negative voltage, the liquid in the spinneret is stretched into fibers. The selected materials are toxicity free and have high biocompatibility. Test results indicate that the nanofiber membrane comprises evenly formed nanofibers despite the presence of zinc acetate. In addition, zinc acetate can effectively kill 99.9% of E. coli and S. aureus. Cell assay results indicate that HPC/PVP/Zn nanofiber membranes are not toxic; moreover, they improve cell adhesion, suggesting that the absorbable collagen surgical suture is profoundly wrapped in a nanofiber membrane that exerts antibacterial efficacy and reduces inflammation, thus providing a suitable environment for cell growth. The employment of electrostatic yarn wrapping technology is proven effective in providing surgical sutures with antibacterial efficacy and a more flexible range of functions.

Emulsion Electrospinning of PLLA/PVA/Chitosan with Hypericum perforatum L. as an Antibacterial Nanofibrous Wound Dressing

Chronic wounds are one of the most severe health problems that affect millions of people worldwide. These types of injuries impair healing and lead to life-threatening complications. Therefore, suitable wound dressing materials are essential to prevent the risk of infection and to provide an excellent healing environment. The present research reports the development of an electrospun Poly (L-lactic acid) (PLLA)/Poly (vinyl alcohol) (PVA)/Chitosan (CS) wound dressing material, produced via emulsion electrospinning in a single step using homogeneous gel-like suspensions of two different and incompatible polymer solutions. The electrospun PLLA/PVA/CS fiber mats were loaded with two different amounts of Hypericum perforatum L. (HP) (2.5% and 5.0% owf). The results revealed that the produced electrospun PLLA/PVA/CS fiber mats displayed ideal properties as a wound dressing due to a total porosity, wettability, water vapor transmission rate (WVTR), and swelling properties similar to those reported for the extracellular matrix (ECM) of the skin, mainly when 2.5% owf HP was incorporated. Moreover, the electrospun PLLA/PVA/CS fiber mats containing HP were able to prevent the growth of gram-positive bacterium Staphylococcus aureus (S. aureus) without causing cytotoxicity to normal human dermal fibroblasts (NHDF). These findings suggest that these electrospun dressing mats are helpful for preventing wound infections as well as an appropriate support and microenvironment for wound healing.

Electrospinning Nanofibers as a Dressing to Treat Diabetic Wounds

Globally, diabetic mellitus (DM) is a common metabolic disease that effectively inhibits insulin production, destroys pancreatic β cells, and consequently, promotes hyperglycemia. This disease causes complications, including slowed wound healing, risk of infection in wound areas, and development of chronic wounds all of which are significant sources of mortality. With an increasing number of people diagnosed with DM, the current method of wound healing does not meet the needs of patients with diabetes. The lack of antibacterial ability and the inability to sustainably deliver necessary factors to wound areas limit its use. To overcome this, a new method of creating wound dressings for diabetic patients was developed using an electrospinning methodology. The nanofiber membrane mimics the extracellular matrix with its unique structure and functionality, owing to which it can store and deliver active substances that greatly aid in diabetic wound healing. In this review, we discuss several polymers used to create nanofiber membranes and their effectiveness in the treatment of diabetic wounds.

Nanofibrous Scaffolds for Diabetic Wound Healing

Chronic wounds are one of the secondary health complications that develop in individuals who have poorly managed diabetes mellitus. This is often associated with delays in the wound healing process, resulting from long-term uncontrolled blood glucose levels. As such, an appropriate therapeutic approach would be maintaining blood glucose concentration within normal ranges, but this can be quite challenging to achieve. Consequently, diabetic ulcers usually require special medical care to prevent complications such as sepsis, amputation, and deformities, which often develop in these patients. Although several conventional wound dressings, such as hydrogels, gauze, films, and foams, are employed in the treatment of such chronic wounds, nanofibrous scaffolds have gained the attention of researchers because of their flexibility, ability to load a variety of bioactive compounds as single entities or combinations, and large surface area to volume ratio, which provides a biomimetic environment for cell proliferation relative to conventional dressings. Here, we present the current trends on the versatility of nanofibrous scaffolds as novel platforms for the incorporation of bioactive agents suitable for the enhancement of diabetic wound healing.

Fabrication and characterization of anti-rosacea 3D nanofibrous customized sheet masks as a novel scaffold for repurposed use of spironolactone with pre-clinical studies

The repurposed oral use of spironolactone (SP) as an anti-rosacea drug faces many challenges that hinder its efficacy and compliance. In this study, a topically applied nanofibers (NFs) scaffold was evaluated as a promising nanocarrier that enhances SP activity and avoids the friction routine that exaggerates rosacea patients' inflamed, sensitive skin. SP-loaded poly-vinylpyrrolidone (40% PVP) nanofibers (SP-PVP NFs) were electrospun. Scanning electron microscopy showed that SP-PVP NFs have a smooth homogenous surface with a diameter of about 426.60 nm. Wettability, solid state, and mechanical properties of NFs were evaluated. Encapsulation efficiency and drug loading were 96.34% ± 1.20 and 11.89% ± 0.15, respectively. The in vitro release study showed a higher amount of SP released over pure SP with a controlled release pattern. Ex vivo results showed that the permeated amount of SP from SP-PVP NFs sheets was 4.1 times greater than that of pure SP gel. A higher percentage of SP was retained in different skin layers. Moreover, the in vivo anti-rosacea efficacy of SP-PVP NFs using croton oil challenge showed a significant reduction in erythema score compared to the pure SP. The stability and safety of NFs mats were proved, indicating that SP-PVP NFs are promising carriers of SP.

Extracellular Vesicle-Based Hydrogels for Wound Healing Applications

Hydrogels and extracellular vesicle-based therapies have been proposed as emerging therapeutic assets in wound closure. The combination of these elements has given good results in managing chronic and acute wounds. The intrinsic characteristics of the hydrogels in which the extracellular vesicles (EVs) are loaded allow for overcoming barriers, such as the sustained and controlled release of EVs and the maintenance of the pH for their conservation. In addition, EVs can be obtained from different sources and through several isolation methods. However, some barriers must be overcome to transfer this type of therapy to the clinic, for example, the production of hydrogels containing functional EVs and identifying long-term storage conditions for EVs. The aim of this review is to describe the reported EV-based hydrogel combinations, along with the obtained results, and analyze future perspectives.

Wound healing promotion by flaxseed extract-loaded polyvinyl alcohol/chitosan nanofibrous scaffolds

Impaired wound healing is a severe complication of sufferers, related to prolonged wound closure, a high infection rate, and eventually disabilities of organs. To aid resolve this issue, we developed the electrospun polyvinyl alcohol and chitosan (PVA/CS) nanofibrous scaffold-loaded flaxseed extract. The scaffold containing 10 wt% of the extract indicated a three-dimensional cross-network with a nano-scale diameter (257 ± 37 nm) and smooth surface. Also, the relevant analyses confirmed high water absorption, porosity, and wettability of the scaffold. Fourier-transform infrared (FTIR), degradation, and mechanical studies revealed the intact presence and loading of the extract into the scaffold, the complete degradation over 48 h, and a high tensile elastic modulus. Besides, the advanced scaffold displayed remarkable anti-oxidant and could inhibit the growth of both Gram-positive and negative bacteria compared to the free PVA/CS scaffold. Desired fibroblast viability and blood compatibility of flaxseed-loaded scaffold endorsed the biocompatibility for wound zones. The in vitro studies showed that the flaxseed-loaded scaffold resulted in an accelerated wound healing process and 100 % closure of the scratched area within 48 h. The results obtained reveal that the flaxseed-loaded PVA/CS electrospun scaffold could be effectively applied for wound healing promotion.

Emerging Antimicrobial and Immunomodulatory Fiber-Based Scaffolding Systems for Treating Diabetic Foot Ulcers

Diabetic foot ulcers (DFUs) are one of the main complications of diabetes and are characterized by their complexity and severity, which are frequently aggravated by overexpressed inflammatory factors and polymicrobial infections. Most dressing systems offer a passive action in the treatment of DFUs, being frequently combined with antibiotic or immunomodulatory therapies. However, in many instances due to these combined therapies' inability to properly fight microbial presence, and provide a suitable, breathable and moist environment that is also capable of protecting the site from secondary microbial invasions or further harm, aggravation of the wound state is unavoidable and lower limb amputations are necessary. Considering these limitations and knowing of the urgent demand for new and more effective therapeutic systems for DFU care that will guarantee the quality of life for patients, research in this field has boomed in the last few years. In this review, the emerging innovations in DFU dressing systems via fiber-based scaffolds modified with bioactive compounds have been compiled; data focused on the innovations introduced in the last five years (2017-2022). A generalized overview of the classifications and constraints associated with DFUs healing and the bioactive agents, both antimicrobial and immunomodulatory, that can contribute actively to surpass such issues, has also been provided.

Chitosan-based electrospun nanofibers for diabetic foot ulcer management; recent advances

Diabetic foot ulcer (DFU) healing has long been a major medical challenge. The type of dressing is an essential factor in wound healing, prevention of local infection, and scar formation. Today, smart wound dressings or wound healing patches can precisely control drug delivery to the target tissue and prevent this significant complication. Nanofiber (NF) wound dressings are effective in reducing wound scarring and helping to speed up the healing process for DFU. The electrospun NFs have a suitable surface topography, density, and three-dimensional structure, which can be considered an efficient method to produce a substrate for tissue engineering and wound healing. Chitosan (CS) is one of the most well-known biopolymers in wound healing tissue engineering and drug delivery systems. The unique properties of CS make it suitable for biomedical applications. Based on new studies in the field of hemostatic and antimicrobial effects of CS in controlling bleeding and wound healing and application of NF wound dressings, the purpose of this study is a review relevant works on CS-based NFs to improve the DFU.

Nanofibrous Vildagliptin/PLGA Membranes Accelerate Diabetic Wound Healing by Angiogenesis

The inhibition of dipeptidyl peptidase-4 (DPP4) significantly enhances the wound closure rate in diabetic patients with chronic foot ulcers. DPP4 inhibitors are only prescribed for enteral, but topical administration, if feasible, to a wound would have more encouraging outcomes. Nanofibrous drug-eluting poly-D-L-lactide-glycolide (PLGA) membranes that sustainably release a high concentration of vildagliptin were prepared to accelerate wound healing in diabetes. Solutions of vildagliptin and PLGA in hexafluoroisopropanol were electrospun into nanofibrous biodegradable membranes. The concentration of the drug released in vitro from the vildagliptin-eluting PLGA membranes was evaluated, and it was found that effective bioactivity of vildagliptin can be discharged from the nanofibrous vildagliptin-eluting membranes for 30 days. Additionally, the electrospun nanofibrous PLGA membranes modified by blending with vildagliptin had smaller fiber diameters (336.0 ± 69.1 nm vs. 743.6 ± 334.3 nm, p < 0.001) and pore areas (3405 ± 1437 nm2 vs. 8826 ± 4906 nm2, p < 0.001), as well as a higher hydrophilicity value (95.2 ± 2.2° vs. 113.9 ± 4.9°, p = 0.004), and showed a better water-retention ability within 24 h compared with PLGA membranes. The vildagliptin-eluting PLGA membrane also enhanced the diabetic wound closure rate for two weeks (11.4 ± 3.0 vs. 18.7 ± 2.6 %, p < 0.001) and the level of the angiogenesis using CD31 expression (1.73 ± 0.39 vs. 0.45 ± 0.17 p = 0.006 for Western blot; 2.2 ± 0.5 vs. 0.7 ± 0.1, p < 0.001 for immunofluorescence). These results demonstrate that nanofibrous drug-eluting PLGA membranes loaded with vildagliptin are an effective agent for sustained drug release and, therefore, for accelerating cutaneous wound healing in the management of diabetic wounds.

Co-electrospun poly(vinyl alcohol)/poly(ɛ-caprolactone) nanofiber scaffolds containing coffee and Calendula officinalis extracts for wound healing applications

Fabrication of a biocompatible nanofibrous dressing with the advantage of the inclusion of bioactive herbal extracts is a promising approach in skin tissue engineering and wound healing applications. Herbal extracts possess many properties to promote the wound healing process, such as antioxidant properties, anti-inflammation activities as well as enhancing fibroblasts proliferation and migration.

In this study, Calendula officinalis ( C. officinalis) and coffee extracts were loaded into poly(vinyl alcohol)/poly(ɛ-caprolactone) (PVA/PCL) nanofibrous mats. The obtained scaffolds were then characterized using scanning electron microscopy (SEM), attenuated total reflection Fourier transform infrared (ATR-FTIR), contact angle, and mechanical measurements. Also, the antioxidant activity, scratch assay, and cell viability of fibroblast cells were also evaluated. The results showed PVA/PCL scaffold loaded with 10 wt% C. officinalis and coffee extracts displayed smooth homogenous morphology with 317 ± 106 nm average diameter. Moreover, the relevant analyses confirmed that the extracts were incorporated into the nanofibers with suitable hydrophilicity and higher mechanical strength (4 ± 0.4 MPa). The antioxidant assay showed that IC50 values of coffee and C. officinalis extracts were 46 ± 1 ppm and 101 ± 4 ppm, successively, which presented a high antioxidant activity. The combination of both extracts showed a higher rate of migration than individual extracts with not detected cytotoxic effects on the human dermal fibroblast cells. In conclusion, our results confirmed that the coffee and C. officinalis extracts loaded PVA/PCL nanofibrous scaffolds could provide an appropriate construct for wound healing applications.

Preparation and Properties of Asymmetric Polyvinyl Pyrroli-Done/Polycaprolactone Composite Nanofiber Loaded with Tea Tree Extract

To develop a novel asymmetric nanofiber membrane with antioxidant and antibacterial activities, biocompatible polyvinyl pyrrolidone (PVP) and polycaprolactone (PCL) were used as carriers to load water-soluble tea tree extract (TTE) and hydrophobic tea tree oil (TTO) via electrospinning and electrostatic spraying, respectively, which was named as TTE-PVP-3/TTO-PCL. The results show that uniform TTE-PVP nanofibers with an average diameter of 95 ± 27 nm could be obtained when the mass ratio of TTE to PVP was set as 1:3. Homogeneous TTO/PCL microspheres with an average size of 4.38 ± 0.79 µm could be obtained when the propulsion speed was 0.08 mm/min and the voltage was 10 KV. The activity study showed that TTE could only improve the antioxidant activity of TTE-PVP-3/TTO-PCL, while TTO could improve the antibacterial activity effectively. Under experimental conditions, the inhibition zones of TTE-PVP-3/TTO-PCL against Staphylococcus aureus and Escherichia coli were 7.50 ± 0.48 mm and 9.55 ± 0.45 mm, respectively, and its scavenging rates for 2,2-diphenylpicrylhydrazyl (DHPP) and hydroxyl radical were 59.79 ± 4.10% and 61.02 ± 4.95%, respectively. In conclusions, TTE-PVP-3/TTO PCL can be potentially used as a new kind of anti-oxidative and antibacterial wound dressings.

Recent development in nanoencapsulation and delivery of natural bioactives through chitosan scaffolds for various biological applications

Nowadays, nano/micro-encapsulation as a pioneering technique may significantly improve the bioavailability and durability of Natural bioactives. For this purpose, chitosan as a bioactive cationic natural polysaccharide has been frequently used as a carrier because of its distinct chemical and biological properties, including polycationic nature, biocompatibility, and biodegradability. Moreover, polysaccharide-based nano/micro-formulations are a new and extensive trend in scientific research and development in the disciplines of biomedicine, bioorganic/ medicinal chemistry, pharmaceutics, agrochemistry, and the food industry. It promises a new paradigm in drug delivery systems and nanocarrier formulations. This review aims to summarize current developments in approaches for designing innovative chitosan micro/nano-matrix, with an emphasis on the encapsulation of natural bioactives. The special emphasis led to a detailed integrative scientific achievement of the functionalities and abilities for encapsulating natural bioactives and mechanisms regulated in vitro/in vivo release in various biological/physiological environments.

Dissolvable wound dressing loaded with silver nanoparticles together with ampicillin and ciprofloxacin

Aim: The current study is focused on the development of water-soluble wound dressings, which are potential dressings for the treatment of burn wounds. Materials & methods: Sodium alginate-based dissolvable wound dressings were prepared and loaded with silver nanoparticles and various antibiotics (ampicillin and ciprofloxacin) followed by characterization and in vitro antibacterial studies. Results & conclusions: The prepared sodium alginate-based dissolvable wound dressing exhibited good porosity, water uptake and moisture content, promising antibacterial activity, high absorption capacity of simulated wound exudates, excellent water vapor transmission rate in the range of 2000 to 5000 g/m² day^-1, sustained drug-release profiles and water solubility. The wound dressings were active against Proteus mirabilis, Staphylococcus aureus, Proteus vulgaris, Escherichia coli and Klebsiella aeruginosa strains of bacteria. The results obtained revealed the wound dressing as potential wound dressings for burn wounds and sensitive skin.

Fabrication of Gelatin Nanofibers by Electrospinning-Mixture of Gelatin and Polyvinyl Alcohol

Gelatin, one of the most abundant, naturally derived biomacromolecules from collagen, is widely applicable in food additives, cosmetic ingredients, drug formulation, and wound dressing based on their non-toxicity and biodegradability. In parallel, polyvinyl alcohol (PVA), a synthetic polymer, has been commonly applied as a thickening agent for coating processes in aqueous systems and a major component in healthcare products for cartilage replacements, eye lubrication, and contact lenses. In this study, a new type of mixed hydrogel nanofiber was fabricated from gelatin and polyvinyl alcohol by electrospinning under a feasible range of polymer compositions. To determine the optimal composition of gelatin and polyvinyl alcohol in nanofiber fabrication, several key physicochemical properties of mixed polymer solutions such as viscosity, surface tension, pH, and electrical conductance were thoroughly characterized by a viscometer, surface tensiometer, water analyzer, and carbon electron probe. Moreover, the molecular structures of polymeric chains within mixed hydrogel nanofibers were investigated with Fourier-transform infrared spectroscopy. The morphologies and surface elemental compositions of the mixed hydrogel nanofibers were examined by the scanning electron microscope and energy-dispersive X-ray spectroscopy, respectively. The measurement of water contact angles was performed for measuring the hydrophilicity of nanofiber surfaces. Most importantly, the potential cytotoxicity of the electrospun nanofibers was evaluated by the in vitro culture of 3T3 fibroblasts. Through our extensive study, it was found that a PVA-rich solution (a volumetric ratio of gelatin/polyvinyl alcohol <1) would be superior for the efficient production of mixed hydrogel nanofibers by electrospinning techniques. This result is due to the appropriate balance between the higher viscosity (~420−~4300 10−2 poise) and slightly lower surface tension (~35.12−~32.68 mN/m2) of the mixed polymer solution. The regression on the viscosity data also found a good fit by the Lederer−Rougier’s model for a binary mixture. For the hydrophilicity of nanofibers, the numerical analysis estimates that the value of interfacial energy for the water contact on nanofibers is around ~−0.028 to ~−0.059 J/m2.

Astragalus Polysaccharides/PVA Nanofiber Membranes Containing Astragaloside IV-Loaded Liposomes and Their Potential Use for Wound Healing

Delayed wound healing is a common and serious complication in diabetic patients, especially the slow healing of foot ulcers, which seriously affects the quality of life of patients and is also the most important risk factor for lower limb amputation. The multifunctional novel dressing prepared by loading the polymer nanofibers with anti-inflammatory and prohealing plant extracts can promote the wound repair of these ulcers by electrospinning technology. Liposomes are nanoparticles prepared from phospholipids and have been widely used as drug delivery systems. Liposomes can be combined with electrospun nanofibrous webs to facilitate local and sustained delivery of loaded bioactive substances. In this study, liposomes were prepared with astragaloside IV (AS) by employing a modified ethanol injection method and conducting the physical and chemical characterization (e.g., the particle size, polydispersity index, zeta potential, and entrapment efficiency). Astragalus polysaccharides were extracted from Astragalus membranaceus. Subsequently, we prepared the electrospun polyvinyl alcohol (PVA)/astragalus polysaccharide (APS)/astragaloside IV (AS) nanofibers. The morphology of the produced ASL/APS/PVA, APS/PVA, and PVA nanofibers were analyzed by scanning electron microscopy (SEM), and it turns out that the addition of astragalus extract made the fiber diameter smaller and the fibers arranged neatly with no dripping. An induced diabetic rat model was built, and a diabetic ulcer model was built by total cortical resection to assess the prorepair ability of the prepared nanofibers. According to in vivo animal experiments, the nanofibrous membrane loaded with APS and ASL was reported to inhibit the occurrence of wound inflammation, enhance the deposition of collagen fibers (P < 0.05) and the repair of regenerated epithelium (P < 0.05), and effectively strengthen the wound healing of diabetic rats (P < 0.05). In brief, PVA-loaded APS/ASL nanofibrous membranes refer to a prominent wound healing dressing material, which can effectively facilitate the healing of diabetic wounds, and they are demonstrated to be highly promising for application in diabetic wound dressings and tissue engineering.

Electrospun Membrane Surface Modification by Sonocoating with HA and ZnO:Ag Nanoparticles—Characterization and Evaluation of Osteoblasts and Bacterial Cell Behavior In Vitro

Guided tissue regeneration and guided bone regeneration membranes are some of the most common products used for bone regeneration in periodontal dentistry. The main disadvantage of commercially available membranes is their lack of bone cell stimulation and easy bacterial colonization. The aim of this work was to design and fabricate a new membrane construct composed of electrospun poly (D,L-lactic acid)/poly (lactic-co-glycolic acid) fibers sonocoated with layers of nanoparticles with specific properties, i.e., hydroxyapatite and bimetallic nanocomposite of zinc oxide–silver. Thus, within this study, four different variants of biomaterials were evaluated, namely: poly (D,L-lactic acid)/poly (lactic-co-glycolic acid) biomaterial, poly(D,L-lactic acid)/poly (lactic-co-glycolic acid)/nano hydroxyapatite biomaterial, poly (D,L-lactic acid)/poly (lactic-co-glycolic acid)/nano zinc oxide–silver biomaterial, and poly (D,L-lactic acid)/poly (lactic-co-glycolic acid)/nano hydroxyapatite/nano zinc oxide–silver biomaterial. First, it was demonstrated that the wettability of biomaterials—a prerequisite property important for ensuring desired biological response—was highly increased after the sonocoating process. Moreover, it was indicated that biomaterials composed of poly (D,L-lactic acid)/poly (lactic-co-glycolic acid) with or without a nano hydroxyapatite layer allowed proper osteoblast growth and proliferation, but did not have antibacterial properties. Addition of a nano zinc oxide–silver layer to the biomaterial inhibited growth of bacterial cells around the membrane, but at the same time induced very high cytotoxicity towards osteoblasts. Most importantly, enrichment of this biomaterial with a supplementary underlayer of nano hydroxyapatite allowed for the preservation of antibacterial properties and also a decrease in the cytotoxicity towards bone cells, associated with the presence of a nano zinc oxide–silver layer. Thus, the final structure of the composite poly (D,L-lactic acid)/poly (lactic-co-glycolic acid)/nano hydroxyapatite/nano zinc oxide–silver seems to be a promising construct for tissue engineering products, especially guided tissue regeneration/guided bone regeneration membranes. Nevertheless, additional research is needed in order to improve the developed construct, which will simultaneously protect the biomaterial from bacterial colonization and enhance the bone regeneration properties.

Nitric oxide-releasing biomaterials for promoting wound healing in impaired diabetic wounds: State of the art and recent trends

Impaired diabetic wounds are serious pathophysiological complications associated with persistent microbial infections including failure in the closure of wounds, and the cause of a high frequency of lower limb amputations. The healing of diabetic wounds is attenuated due to the lack of secretion of growth factors, prolonged inflammation, and/or inhibition of angiogenic activity. Diabetic wound healing can be enhanced by supplying nitric oxide (NO) endogenously or exogenously. NO produced inside the cells by endothelial nitric oxide synthase (eNOS) naturally aids wound healing through its beneficial vasculogenic effects. However, during hyperglycemia, the activity of eNOS is affected, and thus there becomes an utmost need for the topical supply of NO from exogenous sources. Thus, NO-donors that can release NO are loaded into wound healing patches or wound coverage matrices to treat diabetic wounds. The burst release of NO from its donors is prevented by encapsulating them in polymeric hydrogels or nanoparticles for supplying NO for an extended duration of time to the diabetic wounds. In this article, we review the etiology of diabetic wounds, wound healing strategies, and the role of NO in the wound healing process. We further discuss the challenges faced in translating NO-donors as a clinically viable nanomedicine strategy for the treatment of diabetic wounds with a focus on the use of biomaterials for the encapsulation and in vivo controlled delivery of NO-donors.

Melittin from Bee Venom Encapsulating Electrospun Fibers as a Potential Antimicrobial Wound Dressing Patches for Skin Infections

Skin infection compromises the body’s natural defenses. Several antibiotics are no longer effective owing to the evolution of antimicrobial-resistant (AMR) bacteria, hence, the constant development of novel antibacterial agents. Naturally occurring antibacterial agents may be potential candidates for AMR bacterial infection treatments; however, caution should be taken when administering such agents due to the high incidence of toxicity. A fibrous material system from a biocompatible polymer that could be used as a skin patch for skin infections treatment caused by AMR bacteria is proposed in this study. Bee venom’s active ingredient, melittin, was fabricated using electrospinning technology. Scanning electron microscopy showed that melittin-loaded fibers had smooth surfaces with no signs of beads or pores. The average diameter of this fibrous system was measured to be 1030 ± 160 nm, indicating its successful preparation. The melittin fibers’ drug loading and entrapment efficiency (EE%) were 49 ± 3 µg/mg and 84 ± 5%, respectively. This high EE% can be another successful preparatory criterion. An in vitro release study demonstrated that 40% of melittin was released after 5 min and achieved complete release after 120 min owing to the hydrophilic nature of the PVP polymer. A concentration of ≤10 µg/mL was shown to be safe for use on human dermal fibroblasts HFF-1 after 24-h exposure, while an antibacterial MIC study found that 5 μg/mL was the effective antimicrobial concentration for S. aureus, A. baumannii, E. coli and Candida albicans yeast. A melittin-loaded fibrous system demonstrated an antibacterial zone of inhibition equivalent to the control (melittin discs), suggesting its potential use as a wound dressing patch for skin infections.

Leveraging Potential of Nanotherapeutics in Management of Diabetic Foot Ulcer

Diabetic foot ulcers (DFUs) are the most common complications associated with diabetes mellitus. DFUs are displayed as open sores or wounds located on the bottom of the foot as a secondary complication of diabetes mellitus (DM). DFUs are associated with significant morbidity and mortality and can subsequently lead to hospitalization and lower limb amputation if not recognized and treated on time. An immense challenge to conventional treatments is caused by the chronic nature of diabetic foot syndrome and it has led to the emergence of nanotechnology-based therapeutics. The greatest advantages of these nanotherapeutics are their unique biological, chemical, and physical properties. The present review highlights the augmentation of bacterial infections relating to delayed healing of DFUs and the potential of nanotherapeutics such as polymeric nanoparticles, metallic nanoparticles, siRNA-based nanoparticles, lipid nanoparticles, and nanofibers in accelerating wound healing in diabetic foot ulcers.

Polymer-Based Wound Dressing Materials Loaded with Bioactive Agents: Potential Materials for the Treatment of Diabetic Wounds

Diabetic wounds are severe injuries that are common in patients that suffer from diabetes. Most of the presently employed wound dressing scaffolds are inappropriate for treating diabetic wounds. Improper treatment of diabetic wounds usually results in amputations. The shortcomings that are related to the currently used wound dressings include poor antimicrobial properties, inability to provide moisture, weak mechanical features, poor biodegradability, and biocompatibility, etc. To overcome the poor mechanical properties, polymer-based wound dressings have been designed from the combination of biopolymers (natural polymers) (e.g., chitosan, alginate, cellulose, chitin, gelatin, etc.) and synthetic polymers (e.g., poly (vinyl alcohol), poly (lactic-co-glycolic acid), polylactide, poly-glycolic acid, polyurethanes, etc.) to produce effective hybrid scaffolds for wound management. The loading of bioactive agents or drugs into polymer-based wound dressings can result in improved therapeutic outcomes such as good antibacterial or antioxidant activity when used in the treatment of diabetic wounds. Based on the outstanding performance of polymer-based wound dressings on diabetic wounds in the pre-clinical experiments, the in vivo and in vitro therapeutic results of the wound dressing materials on the diabetic wound are hereby reviewed.

Notoginsenoside R1 Facilitated Wound Healing in High-Fat Diet/Streptozotocin-Induced Diabetic Rats

Diabetic ulcers bring about high morbidity and mortality in patients and cause a great economic burden to society as a whole. Since existing treatments cannot fulfil patient requirements, it is urgent to find effective therapies. In this study, the wound healing effect of topical notoginsenoside R1 (NR1) treatment on diabetic full-thickness wounds in type II diabetes mellitus (T2DM) was induced by the combination of a high-fat diet and streptozotocin (STZ) injection. NR1 significantly increased the wound closure rate, enhanced extracellular matrix (ECM) secretion, promoted collagen growth, increased platelet endothelial cell adhesion molecule-1 (CD31) expression, and decreased cleaved caspase-3 expression. RNA-Seq analysis identified ECM remodeling and inflammation as critical biological processes and Timp1 and Mmp3 as important targets in NR1-mediated wound healing. Further experiments showed that NR1-treated wounds demonstrated higher expression of tissue inhibitor of metalloproteinase 1 (TIMP1) and transforming growth factor-β1 (TGFβ1) and lower expression of matrix metallopeptidase 9 (MMP9), matrix metallopeptidase 3 (MMP3), interleukin-1β (IL-1β), and interleukin-6 (IL-6) than diabetic wounds. These investigations promote the understanding of the mechanism of NR1-mediated diabetic wound healing and provide a promising therapeutic drug to enhance diabetic wound healing.

Sandwich structure Aloin-PVP/Aloin-PVP-PLA/PLA as a wound dressing to accelerate wound healing

We have prepared a new type of Aloin/Polyvinylpyrrolidone (PVP)-Aloin/PVP/polylactic acid (PLA)-PLA sandwich nanofiber membrane (APP), to achieve a time-regulated biphasic drug release behavior, used for hemostasis, antibacterial activity and accelerated wound healing. We tested the water absorption capacity, water contact angle, tensile strength, thermogravimetric analysis, Fourier transform infrared spectroscopy and in vitro drug release of the prepared material, as well as analyzed the morphology of the nanofiber membrane with a scanning electron microscope. In the wound healing experiment, the wound healing rate of APP on the 15th day was 96.67%, and it demonstrated excellent antibacterial activity by the disc diffusion method, showing superior antibacterial activity against Gram-negative bacteria. The skin defect model on the back of mice showed that APP nanofibers significantly induced granulation tissue growth, collagen deposition and epithelial tissue remodeling. Current research shows that the prepared composite nanofibers can quickly stop bleeding and can effectively promote wound healing.

Flow chart for the preparation of “sandwich” nanofiber membranes.

Design, preparation and in vitro characterization of biomimetic and bioactive chitosan/polyethylene oxide based nanofibers as wound dressings

Chitosan-based nanofibers (CS-NFs) are excellent artificial extracellular matrices (ECMs) due to the resemblance of CS with the glycosaminoglycans of the natural ECMs. Despite this excellent feature, the poor electrospinnability and mechanical properties of CS are responsible for important limitations in respect to its biomedical applications. To improve the CS's physico-chemical properties, new bioactive and biomimetic CS-NFs were formulated with polyethylene oxide (PEO), having incorporated different active components (ACs) with important beneficial effects for healing. Manuka honey (trophic and antimicrobial effects), propolis (antimicrobial effects), Calendula officinalis infusion (antioxidant effect, reepithelialization stimulating agent), insulin (trophic effect), and L-arginine (angiogenic effect) were selected as ACs. SEM morphology analysis revealed well-alignment, unidirectional arrays, with small diameters, no beads, and smooth surfaces for developed CS_PEO-ACs NFs. The developed NFs showed good biodegradability (NFs mats lost up to 60% of their initial weight in PBS), increased hemocompatibility (hemolytic index less than 4%), and a reduced cytotoxicity degree (cell viability degree more than 90%). In addition, significant antioxidant and antimicrobial effects were noted for the developed NFs which make them suitable for chronic wounds, due to the role of oxidative stress and infection risk in delaying normal wound healing. The most suitable for wound healing applications seems to be CS_PEO@P_C which showed an improved hemolysis index (2.92 ± 0.16%), is non-toxic (cell viability degree more than 97%), and has also significant radical scavenging effect (DPPH inhibition more than 65%). In addition, CS_PEO@P_C presents increased antimicrobial effects, more noticeably for Staphylococcus aureus strain, which is a key feature in preventing wound infection and delaying the healing process. It can be concluded that the developed CS/PEO-ACs NFs are very promising biomaterials for wound care, especially CS_PEO@P_C.

Conductive Biomaterials as Bioactive Wound Dressing for Wound Healing and Skin Tissue Engineering

Conductive biomaterials based on conductive polymers, carbon nanomaterials, or conductive inorganic nanomaterials demonstrate great potential in wound healing and skin tissue engineering, owing to the similar conductivity to human skin, good antioxidant and antibacterial activities, electrically controlled drug delivery, and photothermal effect. However, a review highlights the design and application of conductive biomaterials for wound healing and skin tissue engineering is lacking. In this review, the design and fabrication methods of conductive biomaterials with various structural forms including film, nanofiber, membrane, hydrogel, sponge, foam, and acellular dermal matrix for applications in wound healing and skin tissue engineering and the corresponding mechanism in promoting the healing process were summarized. The approaches that conductive biomaterials realize their great value in healing wounds via three main strategies (electrotherapy, wound dressing, and wound assessment) were reviewed. The application of conductive biomaterials as wound dressing when facing different wounds including acute wound and chronic wound (infected wound and diabetic wound) and for wound monitoring is discussed in detail. The challenges and perspectives in designing and developing multifunctional conductive biomaterials are proposed as well.