An investigation on burn wound healing in rats with chitosan gel formulation containing epidermal growth factor

Pharmaceutical applications of chitosan in skin regeneration: A review

Skin regeneration is the process that restores damaged tissues. When the body experiences trauma or surgical incisions, the skin and tissues on the wound surface become damaged. The body repairs this damage through complex physiological processes to restore the original structural and functional states of the affected tissues. Chitosan, a degradable natural bioactive polysaccharide, has attracted widespread attention partly owing to its excellent biocompatibility and antimicrobial properties; additionally, a modified form of this compound has been shown to promote skin regeneration. This review evaluates the recent research progress in the application of chitosan to promote skin regeneration. First, we discuss the basic principles of the extraction and preparation processes of chitosan from its source. Subsequently, we describe the functional properties of chitosan and the optimization of these properties through modification. We then focus on the existing chitosan-based biomaterials developed for clinical applications and their corresponding effects on skin regeneration, particularly in cases of diabetic and burn wounds. Finally, we explore the challenges and prospects associated with the use of chitosan in skin regeneration. Overall, this review provides a reference for related research and contributes to the further development of chitosan-based products in cutaneous skin regeneration.

Fabrication of wound dressings: Herbal extract-loaded nanoliposomes embedded in fungal chitosan/polycaprolactone electrospun nanofibers for tissue regeneration

Wound healing is a complex process and one of the major therapeutic and economic subjects in the pharmaceutical area. In recent years, the fabrication of nano-sized wound dressing models has attracted great attention for tissue regeneration. Plant extracts loaded nanoparticles are environmentally friendly and non-toxic and the release of the bioactive substance will be controlled to the wound area. This study aims to fabricate wound dressing models that contain bioactive components for tissue regeneration. Fungal chitosan/polycaprolactone nanofiber was fabricated by electrospinning and it has been characterized. Plant extracts loaded nanoliposomes were prepared, characterized, and embedded in nanofiber structures. The effectiveness of wound dressing models for tissue regeneration was evaluated by in vitro and in vivo studies. It was observed that all wound dressing models positively affect the cell viability of human dermal fibroblast cells. It was determined that plant extracts loaded nanoparticles embedded in nanofibers increased in cell viability than nanoparticles that were non-embedded in nanofiber structures. Histological analysis showed that plant extract-loaded nanoliposomes embedded in chitosan/PCL nanofibers were used for tissue regeneration. The most effective nanofibers were determined as Wd-ClNL nanofibers. RESEARCH HIGHLIGHTS: Hypericum perforatum L. and Cistus laurifolius L. were prepared by modified ultrasonic extraction method. Fungal chitosan/polycaprolactone nanofiber was fabricated by electrospinning and it has been characterized. Plant extract-loaded nanoliposomes were prepared, and characterized. They were embedded in chitosan/polycaprolactone nanofiber. Effects of the wound dressing model were analyzed by in vitro and in vivo assays for tissue regeneration.

Burn Injury-related Growth Factor Expressions and Their Potential Roles in Burn-related Neuropathies

In the context of burn injury, growth factors (GFs) play a significant role in mediating the complex local and systematic processes that occur. Among the many systemic complications that arise following a burn injury, peripheral neuropathy remains one of the most common. Despite the broad understanding of the effects GFs have on multiple tissues, their potential implications in both wound healing and neuropathy remain largely unexplored. Therefore, this review aims to investigate the expression patterns of GFs prominent during the burn wound healing process and explore the potential contributions these GFs have on the development of burn-related peripheral neuropathy.

Vascular Endothelial Growth Factor Supplementation Enhance Skin Antioxidant Capacity in Hyperglycemic Rats

The fundamental reasons for delayed wound healing in diabetic animals include inadequate production of growth factors or their increased devastation. Vascular Growth Factor (VEGF) has a biological role in the healing process of mucosal and skin wounds, especially in the process of new vessel formation. We planned to examine the oxidant-antioxidant events that occur during healing with topical VEGF application in diabetic rats. Experiments were performed 36 adults female Wistar albino rat diabetes induced by streptozotocin. The incisional wounds were made on the dorsal region in the rats. Rats were separated to 3 groups: the untreated (negative control) group (n=12), the chitosan group (n=12), the chitosan + VEGF group (n=12). The treatments were continued for 3 and 7 days, excluding the control and negative control groups. Then, the animals were sacrificed on the 3rd and 7th days of wound healing. Antioxidant and oxidant parameters in skin tissue were measured using biochemical methods. Topical VEGF application was decreased the NOx levels on the 3rd day compared to other groups. Moreover, it increased wound tissue GSH and AA levels, subsequently contributing to the enhance tissue antioxidant capacity. In conclusion, VEGF application increases the antioxidant capacity of the tissue and simultaneously reduces the oxidative stress and thus gives a positive acceleration to the wound healing process.

Positive effect of acellular amniotic membrane dressing with immobilized growth factors in skin wound healing

The human amniotic membrane dressing has been shown to accelerate the wound healing process in the clinic. In this study, heparin was conjugated to a human Acellular Amniotic Membrane (hAAM) to provide affinity binding sites for immobilizing growth factors. To study the acceleration of the wound healing process, we bound epidermal growth factor and fibroblast growth factor 1 to heparinized hAAMs (GF-Hep-hAAMs). The heparinized hAAMs (Hep-hAAMs) were characterized by toluidine blue staining and infrared spectroscopy. The quality control of hAAM was performed by hematoxylin staining, swelling capacity test and biomechanical evaluation. The cytotoxicity, adhesion, and migration in vitro assays of GF-Hep-hAAMs on L-929 fibroblast cells were also studied by MTT assay, scanning electron microscopy, and scratch assay, respectively. Finally, in vivo skin wound healing study was performed to investigate the wound closure rate, re-epithelization, collagen deposition, and formation of new blood vessels. The results showed that GF-Hep-hAAMs enhance the rate of wound closure and epidermal regeneration in BALB/c mice. In conclusion, GF-Hep-hAAMs could accelerate the wound healing process, significantly in the first week.

A systematic review of natural products for skin applications: Targeting inflammation, wound healing, and photo-aging

BACKGROUND

Every day the skin is constantly exposed to several harmful factors that induce oxidative stress. When the cells are incapable to maintain the balance between antioxidant defenses and reactive oxygen species, the skin no longer can keep its integrity and homeostasis. Chronic inflammation, premature skin aging, tissue damage, and immunosuppression are possible consequences induced by sustained exposure to environmental and endogenous reactive oxygen species. Skin immune and non-immune cells together with the microbiome are essential to efficiently trigger skin immune responses to stress. For this reason, an ever-increasing demand for novel molecules capable of modulating immune functions in the skin has risen the level of their development, particularly in the field of natural product-derived molecules.

PURPOSE

In this review, we explore different classes of molecules that showed evidence in modulate skin immune responses, as well as their target receptors and signaling pathways. Moreover, we describe the role of polyphenols, polysaccharides, fatty acids, peptides, and probiotics as possible treatments for skin conditions, including wound healing, infection, inflammation, allergies, and premature skin aging.

METHODS

Literature was searched, analyzed, and collected using databases, including PubMed, Science Direct, and Google Scholar. The search terms used included "Skin", "wound healing", "natural products", "skin microbiome", "immunomodulation", "anti-inflammatory", "antioxidant", "infection", "UV radiation", "polyphenols", "polysaccharides", "fatty acids", "plant oils", "peptides", "antimicrobial peptides", "probiotics", "atopic dermatitis", "psoriasis", "auto-immunity", "dry skin", "aging", etc., and several combinations of these keywords.

RESULTS

Natural products offer different solutions as possible treatments for several skin conditions. Significant antioxidant and anti-inflammatory activities were reported, followed by the ability to modulate immune functions in the skin. Several membrane-bound immune receptors in the skin recognize diverse types of natural-derived molecules, promoting different immune responses that can improve skin conditions.

CONCLUSION

Despite the increasing progress in drug discovery, several limiting factors need future clarification. Understanding the safety, biological activities, and precise mechanisms of action is a priority as well as the characterization of the active compounds responsible for that. This review provides directions for future studies in the development of new molecules with important pharmaceutical and cosmeceutical value.

Therapeutic role of growth factors in treating diabetic wound

Wounds in diabetic patients, especially diabetic foot ulcers, are more difficult to heal compared with normal wounds and can easily deteriorate, leading to amputation. Common treatments cannot heal diabetic wounds or control their many complications. Growth factors are found to play important roles in regulating complex diabetic wound healing. Different growth factors such as transforming growth factor beta 1, insulin-like growth factor, and vascular endothelial growth factor play different roles in diabetic wound healing. This implies that a therapeutic modality modulating different growth factors to suit wound healing can significantly improve the treatment of diabetic wounds. Further, some current treatments have been shown to promote the healing of diabetic wounds by modulating specific growth factors. The purpose of this study was to discuss the role played by each growth factor in therapeutic approaches so as to stimulate further therapeutic thinking.

Cholecalciferol-load films for the treatment of nasal burns caused by cauterization of the hypertrophied inferior turbinate: formulation, in vivo study, and clinical assessment

Nasal turbinate hypertrophy is among the most common nasal obstruction disorders, affecting the patient's quality of life significantly. Endoscopic submucosal diathermy is a prevalent cauterization procedure for treating turbinate hypertrophy. Regrettably, the nasal burn associated with diathermy typically heals slowly causing facial pain and nasal bleeding and possibly resulting in synechiae formation. In the current study, we have developed, for the first time, a polymeric film loaded with cholecalciferol for local treatment of nasal burns. The casting method was used to prepare films of different compositions of polymers such as chitosan, polyvinyl alcohol (PVA), Carbopol 971p (CP971p), and hydroxypropyl methylcellulose (HPMC) as well as a plasticizer. Several characterizations were performed for the cholecalciferol-loaded films (e.g. weight, thickness, content uniformity, surface pH, folding endurance, disintegration time, and in vitro release) to select the optimal formulation. The optimal formulation (F4) displayed compatibility between the used polymers and the drug. In vivo animal study was carried out to assess the healing efficacy of the formulated cholecalciferol-loaded film. The rabbits treated with the cholecalciferol-loaded film demonstrated significantly higher mRNA expression of the growth factor TGF-β and significantly lower mRNA expression of the proinflammatory cytokine TNF-α and IL-1β compared to the plain film treated group and the untreated control group. A randomized, single-blinded, parallel, controlled clinical trial was conducted on 20 patients scheduled to undergo endoscopic submucous diathermy. The results of the clinical study demonstrated significant reductions in facial pain and nasal bleeding scores for the nostrils treated with cholecalciferol-loaded films in comparison to the nostrils treated with plain films. Furthermore, the endoscopic examination showed good healing for 95% of the cholecalciferol-loaded film-treated nostrils. In conclusion, the optimized film can be considered an opportune approach for enhancing the healing rate of nasal burns and thus reducing the downsides of the diathermy procedure.

Aloe vera and copaiba oleoresin-loaded chitosan films for wound dressings: microbial permeation, cytotoxicity, and in vivo proof of concept

Chitosan films are commonly used for wound dressing, provided that this polymer has healing, mucoadhesiveness and antimicrobial properties. These properties can be further reinforced by the combination of chitosan with polysaccharides and glycoproteins present in aloe vera, together with copaiba oleoresin's pharmacological activity attributed to sesquiterpenes. In this work, we developed chitosan films containing either aloe vera, copaiba oil or both, by casting technique, and evaluated their microbial permeation, antimicrobial activity, cytotoxicity, and in vivo healing potential in female adult rats. None of the developed chitosan films promoted microbial permeation, while the cytotoxicity in Balb/c 3 T3 clone A31 cell line revealed no toxicity of films produced with 2 % of chitosan and up to 1 % of aloe vera and copaiba oleoresin. Films obtained with either 0.5 % chitosan or 0.5 % copaiba oleoresin induced cell proliferation which anticipate their potential for closure of wound and for the healing process. The in vivo results confirmed that tested films (0.5 % copaiba-loaded chitosan film and 0.5 % aloe vera-loaded chitosan film) were superior to a commercial dressing film. For all tested groups, a fully formed epithelium was seen, while neoformation of vessels seemed to be greater in formulations-treated groups than those treated with the control. Our work confirms the added value of combining chitosan with aloe vera and copaiba oil in the healing process of wounds.

Efficacy of stromal vascular fraction and enzyme-free mechanical isolation therapy in experimental full thickness burn wounds

BACKGROUND

Autologous cell suspensions obtained by a stromal vascular fraction (SVF) and enzyme-free mechanical isolation (EMI) are an alternative in the treatment of burn wounds. In this study, we aimed to investigate the effect of autologous cell suspensions obtained by SVF and EMI on full-thickness skin burn wounds.

METHODS

A total of 45 male Sprague-Dawley rats were divided into three groups, SVF group, EMI group, and SVF + EMI group. The groups were also classified as the first, second, and third week of the burn to reveal the effect of the treatment on the burn in the early, middle, and late stages. For treatment, 0.2 ml SVF or 0.2 ml EMI was injected subcutaneously into the burn lesions of the subjects. Histopathological examination was performed on the burn wounds taken at the end of the experiment, and Ki67, CD44, CD73, CD90, and CK17 expressions were evaluated.

RESULTS

Histological examination revealed that there was no improvement in the control samples, but the skin was multicellular, vascularization was present. Histologic scores in all groups was significantly better than control, and SVF + EMI was the best group in terms of recovery (p < 0.05). Ki67, CK17, CD44, CD73, and CD90 expressions were significantly higher in the treatment groups compared to the control (p < 0.05).

CONCLUSION

We found in our study that both applications significantly increased the healing of the burn wound. Moreover, SVF + EMI application provided more improvement than SVF or EMI alone.

Controlled release of protein from gelatin/chitosan hydrogel containing platelet-rich fibrin encapsulated in chitosan nanoparticles for accelerated wound healing in an animal model

The physiological healing process is disrupted in many cases using the current wound healing procedures, resulting in delayed wound healing. Hydrogel wound dressings provide a moist environment to enhance granulation tissue and epithelium formation in the wound area. However, exudate accumulation, bacterial proliferation, and reduced levels of growth factors are difficulties of hydrogel dressings. Here, we loaded platelet-rich fibrin-chitosan (CH-PRF) nanoparticles into the gelatin-chitosan hydrogel (Gel-CH/CH-PRF) by solvent mixing method. Our goal was to evaluate the characteristics of hydrogel dressings, sustained release of proteins from the hydrogel dressing containing PRF, and reduction in the risk of infection by the bacteria in the wound area. The Gel-CH/CH-PRF hydrogel showed excellent swelling behavior, good porosity, proper specific surface area, high absorption of wound exudates, and proper vapor permeability rate (2023 g/m ².day), which provided requisite moisture without dehydration around the wound area. Thermal behavior and the protein release from the hydrogels were investigated using simultaneous thermal analysis and the Bradford test, respectively. Most importantly, an excellent ability to control the release of proteins from the hydrogel dressings was observed. The high antimicrobial activity of hydrogel was confirmed using Gram-positive and Gram-negative bacteria. Due to the presence of chitosan in the hydrogels, the lowest scavenging capacity-50 value (5.82 μgmL^-1) and the highest DPPH radical scavenging activity (83 %) at a concentration 25 μgmL^-1 for Gel-CH/CH-PRF hydrogel were observed. Also, the hydrogels revealed excellent cell viability and proliferation. The wound healing process was studied using an in vivo model of the full-thickness wound. The wound closure was significantly higher on Gel-CH/CH-PRF hydrogel compared to the control group, indicating the highest epidermis thickness, and enhancing the formation of new granulation tissue. Our findings demonstrated that Gel-CH/CH-PRF hydrogel can provide an ideal wound dressing for accelerated wound healing.

Healing Efficacy of Hesperetin-Containing Chitosan Gel in Burn Wound: Formulation Design and In Vivo Evaluation

More than 5 million people require medical attention due to burn-related injuries annually. Significant research has been carried out in recent decades to develop approaches to improve the healing of burn wounds. The focus has also been on the development of natural product-based therapeutic remedies for the treatment of burn wounds. This has been done primarily due to multimodal mechanisms exhibited by some promising bioactive molecules of natural origin. Hesperetin is one such molecule that possesses strong anti-inflammatory and antioxidant properties. It is mainly obtained from citrus species. The goal of the current study was to assess how well chitosan gel that contains hesperetin may cure burn wounds. The advantage of using chitosan gel is that it could form a depot at the site and provide a protective therapeutic covering over burn wounds. In the present study, hesperetin-containing chitosan gel was prepared and evaluated for percentage hesperetin content, extrudability, spreadability, and rheological behavior. The preclinical wound healing activity was evaluated using an experimental burn wound model in Wistar rats. The results of the animal experiment showed early and better healing of burn wounds in animals treated with hesperetin-containing chitosan gel. There was 92.79% healing after 14 days of application of hesperetin-containing chitosan gel compared to 69.49% healing observed in the control group. Further, the histopathological evaluation suggested no inflammatory cell infiltration, normal epidermal growth, and normal collagen bundle arrangement in these animals. Overall the results provide proof of concept to establish the wound healing potential of hesperetin-containing chitosan gel against burn wounds.

Amphiphilic Chitosan Porous Membranes as Potential Therapeutic Systems with Analgesic Effect for Burn Care

Eliminating or at least lessening the pain is a crucial aspect of burns management, as pain can negatively affect mental health and quality of life, and it can also induce a delay on wound healing. In this context, new amphiphilic chitosan 3D porous membranes were developed and investigated as burns therapeutic systems with analgesic effect for delivery of lidocaine as local anesthetic. The highly porous morphology of the membranes and the structural modifications were evidenced by scanning electron microscopy (SEM), energy dispersive X-ray (EDX) analysis and infrared spectroscopy (FTIR). Improved compression mechanical properties, long-term hydrolytic degradation (28 days) evaluation and high swelling capacities (ranging from 8 to 22.6 g/g) indicate an increased capacity of the prepared membranes to absorb physiological fluids (burns exudate). Lidocaine in vitro release efficiency was favored by the decreased content of cross-linking agent (reaching maximum value of 95.24%) and the kinetic data modeling, indicating that lidocaine release occurs by quasi-Fickian diffusion. In addition to the in vitro evaluation of analgesic effect, lidocaine-loaded chitosan membranes were successfully investigated and proved antibacterial activity against most common pathogens in burns infections: Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus.

Recent advances of chitosan-based polymers in biomedical applications and environmental protection

Interest in polymer-based biomaterials such as chitosan and its modifications and also the methods of their application in various fields of science is uninterruptedly growing. Owing to unique physicochemical, biological, ecological, physiological properties, such as biocompatibility, biodegradability, stability in the natural environment, non-toxicity, high biological activity, economic affordability, chelating of metal ions, high sorption properties, chitosan is used in various biomedical and industrial processes. The reactivity of the amino and hydroxyl groups in the structure makes it more interesting for diverse applications in drug delivery, tissue engineering, wound healing, regenerative medicine, blood anticoagulation and bone, tendon or blood vessel engineering, dentistry, biotechnology, biosensing, cosmetics, water treatment, agriculture. Taking into account the current situation in the world with COVID-19 and other viruses, chitosan is also active in the form of a vaccine system, it can deliver antibodies to the nasal mucosa and load gene drugs that prevent or disrupt the replication of viral DNA/RNA, and deliver them to infected cells. The presented article is an overview of the nowaday state of the application of chitosan, based on literature of recent years, showing importance of fundamental and applied studies aimed to expand application of chitosan-based polymers in many fields of science.

Chitosan: A review of molecular structure, bioactivities and interactions with the human body and micro-organisms

Chitosan has many desirable attributes e.g. antimicrobial properties and promoting wound healing, and is used in various applications. This article first discusses how degree of deacetylation (DD) and molecular weight (MW) impacts on what level of bioactivities chitosan manifests, then introduces the "molecular chain configuration" model to explain various possible mechanisms of antimicrobial interactions between chitosan with different MW and different types of bacteria. Similarly, the possible pathways of how chitosan reacts with cancer and the body's immune system to demonstrate immune and antitumor effects are also discussed by using this model. Moreover, the possible mechanisms of how chitosan enhances coagulation and wound healing are also discussed. With these beneficial bioactivities in mind, the application of chitosan in surgery, tissue engineering and oncology is outlined. This review concludes that as chitosan demonstrates many beneficial bioactivities via multiple mechanisms, it is an important polymer with a promising future in medicine.

Wound healing in second-degree burns in rats treated with silver sulfadiazine: a systematic review and meta-analysis

Objective:

This study aims to assess the wound healing efficacy in second-degree burns in rats treated with 1% silver sulfadiazine (SSD)—a sulfonamide antibiotic.

Method:

This is a systematic literature review and meta-analysis performed according to the PICO (Population, Intervention, Comparison and Outcomes) strategy.

Results:

The review found 100 studies in PubMed, Web of Science and other search engines. Of these, 70 studies were pre-selected after removing duplicates. After independent analysis by two reviewers, only seven studies met the inclusion criteria for meta-analysis. All studies except one showed faster wound closure by the application of silver sulfadiazine ointment. Using a random effects model, healing was faster in SSD-treated groups when compared to the control group on day 21, with a statistically significant mean difference of –2.72 days (95% confidence interval: –4.99, –0.45) between treatment and control groups (p<0.01).

Conclusion:

The results of this meta-analysis revealed that SSD aided in faster healing of second-degree burns.

Application of Chitosan and Hydroxyapatite in Periodontal Tissue Regeneration: A Review

Chronic periodontitis is an infection caused by bacteria in the gum tissue that supports the teeth. The current periodontal therapy manages or removes periodontal infections and repairs the periodontium destroyed due to periodontal disease. Due to its biodegradability and biocompatibility, chitosan (CH) and hydroxyapatite (HAP) are employed for bone tissue healing. The purpose of this study was to compare the utilization of CH and HAP in the regeneration of periodontal tissue. The presented study is a systematic review prepared from a collection of recent relevant published articles. This research was conducted by reviewing articles from 2016 to August 2021. The analysis found that CH/HAP is a therapeutic strategy for chronic periodontitis patients that allow low-cost bone regeneration, mHA/CH scaffolds may inhibit the growth of periodontal pathogens, and CH or HAP has the potential to be developed bone tissue engineering.

Novel Wound Dressing Based on Postbiotic/Chitosan Film Accelerates Cutaneous Wound Healing

Background: Wound healing is a complex and overlapping process involving immune cells, cytokines, and growth factors. Objectives: This study aimed to design and evaluate a novel wound dressing based on postbiotic/chitosan in accelerating wound healing. Methods: Lactobacillus reuteri PTCC1655 was cultured, and the cell-free supernatant (postbiotic) was obtained by medium centrifugation. The films were prepared using the solvent casting method and evaluated in terms of water absorption index, water vapor transmission rate, and antimicrobial properties. Forty-five male Wistar rats were subjected to a full-thickness excisional wound to assess the wound healing potential. The rats were randomly divided into ctrl-, chitosan, and postbiotic groups. The time-course histological and gene expression analysis was performed to compare the dressing efficacy. Results: The films showed proper water absorption and water vapor transmission rate and inhibited the pathogens commonly associated with wound infection. The postbiotic film improved wound healing by modulating the inflammatory phase, increasing collagen and elastin deposition, and enhancing angiogenesis based on the histological results. The gene expression assay showed that the postbiotic film accelerated wound healing by improving the expression of inflammatory mediators (IL-6 and TNF-α) and anti-inflammatory mediators (TGF-β and VEGF). Conclusions: The cell-free supernatant/chitosan/polyethylene glycol (CFS/CS/PEG) biodegradable film could be introduced as a novel dressing for cutaneous wound healing. This transparent film enhances cutaneous wound healing by modulating infiltrated immunity cells and expressing inflammatory/anti-inflammatory cytokines.

Angiogenic potential and wound healing efficacy of chitosan derived hydrogels at varied concentrations of APTES in chick and mouse models

Chitosan (Cs) based biomaterials seem to be indispensable for neovasculogenesis and angiogenesis that ensure accelerated wound healing. Cs/poly (vinyl alcohol) (PVA) bio-constructs were cross-linked and investigated with varying concentrations of aminopropyltriethoxysilane (APTES). This study comprised of three phases: fabrication of hydrogels, characterization, assessment of angiogenic potential along with toxico-pathological effects, wound healing efficacy in chick and mice, respectively. The hydrogels were characterized by FTIR, SEM and TGA and the swelling response was examined in different solvents. The hydrogels swelling ratio was decreased with increasing amount of APTES, showed the highest swelling at acidic and basic pH while low swelling at neutral pH. Chorioallantoic membranes (CAM) assay was performed to study in-vivo angiogenesis, toxicological, morphological, biochemical and histological analyses in developing chicks. The results showed remarkably improved angiogenesis with little deviations in morphological, histological features and liver enzymes of chick embryos at higher concentrations of APTES. Besides, full thickness wounds were excised on mice dorsolateral skin to assess the wound healing. The rate of wound size reduction was significantly higher after topical application of hydrogels with elevated levels of crosslinker. Hence, the hydrogels showed enhanced angiogenesis, accelerated wound healing with little or no observable in-vivo toxicity.

The use of chitosan as a skin-regeneration agent in burns injuries: A review

Chitosan is an amino-polysaccharide, traditionally obtained by the partial deacetylation of chitin from exoskeletons of crustaceans. Properties such as biocompatibility, hemostasis, and the ability to absorb physiological fluids are attributed to this biopolymer. Chitosan’s biological properties are regulated by its origin, polymerization degree, and molecular weight. In addition, it possesses antibacterial and antifungal activities. It also has been used to prepare films, hydrogels, coatings, nanofibers, and absorbent sponges, all utilized for the healing of skin wounds. In in vivo studies with second-degree burns, healing has been achieved in at least 80% of the cases between the ninth and twelfth day of treatment with chitosan coatings. The crucial steps in the treatment of severe burns are the early excision of damaged tissue and adequate coverage to minimize the risk of infection. So far, partial-thickness autografting is considered the gold standard for the treatment of full-thickness burns. However, the limitations of donor sites have led to the development of skin substitutes. Therefore, the need for an appropriate dermal equivalent that functions as a regeneration template for the growth and deposition of new skin tissue has been recognized. This review describes the properties of chitosan that validate its potential in the treatment of skin burns.

Cationic, anionic and neutral polysaccharides for skin tissue engineering and wound healing applications

Today, chronic wound care and management can be regarded as a clinically critical issue. However, the limitations of current approaches for wound healing have encouraged researchers and physicians to develop more efficient alternative approaches. Advances in tissue engineering and regenerative medicine have resulted in the development of promising approaches that can accelerate wound healing and improve the skin regeneration rate and quality. The design and fabrication of scaffolds that can address the multifactorial nature of chronic wound occurrence and provide support for the healing process can be considered an important area requiring improvement. In this regard, polysaccharide-based scaffolds have distinctive properties such as biocompatibility, biodegradability, high water retention capacity and nontoxicity, making them ideal for wound healing applications. Their tunable structure and networked morphology could facilitate a number of functions, such as controlling their diffusion, maintaining wound moisture, absorbing a large amount of exudates and facilitating gas exchange. In this review, the wound healing process and the influential factors, structure and properties of carbohydrate polymers, physical and chemical crosslinking of polysaccharides, scaffold fabrication techniques, and the use of polysaccharide-based scaffolds in skin tissue engineering and wound healing applications are discussed.

A bilayered skin substitute developed using an eggshell membrane crosslinked gelatin-chitosan cryogel

Commercially available allografts and xenografts pose problems such as high cost, risk of infection transmission and immune rejection of grafts. Thus, bioengineered skin substitutes fabricated from natural biomaterials or synthetic polymers are currently the focus of skin tissue engineering. In this study, eggshell membrane (ESM) powder was used to crosslink a gelatin-chitosan cryogel thereby replacing glutaraldehyde, a known cytotoxic chemical crosslinker. The resultant ESM-crosslinked macroporous cryogel with a pore size ranging between 10 and 350 μm has improved flexibility, biodegradability and biocompatibility compared to a glutaraldehyde-crosslinked cryogel. For healing of large and deep wounds, bilayered scaffolds which exhibit key aspects of skin physiology are being explored. Hence, we fabricated a bilayered substitute by coupling the ESM-crosslinked cryogel (dermal equivalent) to a non-porous, physically-crosslinked gelatin-chitosan film (epidermal equivalent). The epidermal layer provides the requisite barrier properties while the dermal layer facilitates cell attachment and migration for optimal wound healing. Further, chitosan confers antibacterial properties to the cryogel with almost 50% reduction in bacterial viability. Animal studies confirm that the developed bilayered skin substitute is non-allergic, aids wound healing by improving re-epithelialization within 14 days and supports the formation of skin appendages. This system presents a new and alternative treatment option for burn and chronic wounds.

Advancements in the Delivery of Growth Factors and Cytokines for the Treatment of Cutaneous Wound Indications

Significance: Wound healing involves the phasic production of growth factors (GFs) and cytokines to progress an acute wound to a resolved scar. Dysregulation of these proteins contributes to both wound chronicity and excessive scarring. Direct supplementation of GFs and cytokines for treatment of healing and scarring complications has, however, been disappointing. Failings likely relate to an inability to deliver recombinant proteins at physiologically relevant levels to an environment conducive to healing. Recent Advances: Inspired by the extracellular matrix, natural biomaterials have been developed that resemble human skin, and are capable of delivering bioactives. Hybrid biomaterials made using multiple polymers, fabrication methods, and proteins are proving efficacious in animal models of acute and impaired wound healing. Critical Issues: For clinical translation, these delivery systems must be tailored for specific wound indications and the correct phase of healing. GFs and cytokines must be delivered in a controlled manner that will target specific healing or scarring impairments. Preclinical assessment in clinically relevant animal models of impaired or excessive healing is critical. Future Directions: Clinical success will likely depend on the GF or cytokine selected, their compatibility with the chosen biomaterial(s), degradation rate of the fabricated system, and the degree of control over release kinetics. Further testing is essential to assess which wound indications are most suited to specific delivery systems and to prove whether they provide superior efficacy over direct protein therapies.

Engineering Bioactive Scaffolds for Skin Regeneration

Large skin wounds pose a major clinical challenge. Scarcity of donor site and postsurgical scarring contribute to the incomplete or partial loss of function and aesthetic concerns in skin wound patients. Currently, a wide variety of skin grafts are being applied in clinical settings. Scaffolds are used to overcome the issues related to the misaligned architecture of the repaired skin tissues. The current review summarizes the contribution of biomaterials to wound healing and skin regeneration and addresses the existing limitations in skin grafting. Then, the clinically approved biologic and synthetic skin substitutes are extensively reviewed. Next, the techniques for modification of skin grafts aiming for enhanced tissue regeneration are outlined, and a summary of different growth factor delivery systems using biomaterials is presented. Considering the significant progress in biomaterial science and manufacturing technologies, the idea of biomaterial-based skin grafts with the ability for scarless wound healing and reconstructing full skin organ is more achievable than ever.

Polymer-Based Nanotherapeutics for Burn Wounds

Burn wounds are complex and intricate injuries that have become a common cause of trauma leading to significant mortality and morbidity every year. Dressings are applied to burn wounds with the aim of promoting wound healing, preventing burn infection and restoring skin function. The dressing protects the injury and contributes to recovery of dermal and epidermal tissues. Polymer-based nanotherapeutics are increasingly being exploited as burn wound dressings. Natural polymers such as cellulose, chitin, alginate, collagen, gelatin and synthetic polymers like poly (lactic-co-glycolic acid), polycaprolactone, polyethylene glycol, and polyvinyl alcohol are being obtained as nanofibers by nanotechnological approaches like electrospinning and have shown wound healing and re-epithelialization properties. Their biocompatibility, biodegradability, sound mechanical properties and unique structures provide optimal microenvironment for cell proliferation, differentiation, and migration contributing to burn wound healing. The polymeric nanofibers mimic collagen fibers present in extracellular matrix and their high porosity and surface area to volume ratio enable increased interaction and sustained release of therapeutics at the site of thermal injury. This review is an attempt to compile all recent advances in the use of polymer-based nanotherapeutics for burn wounds. The various natural and synthetic polymers used have been discussed comprehensively and approaches being employed have been reported. With immense research effort that is currently being invested in this field and development of proper characterization and regulatory framework, future progress in burn treatment is expected to occur. Moreover, appropriate preclinical and clinical research will provide evidence for the great potential that polymer-based nanotherapeutics hold in the management of burn wounds.

Film-Forming Spray of Water-Soluble Chitosan Containing Liposome-Coated Human Epidermal Growth Factor for Wound Healing

Human epidermal growth factor (hEGF) has been known to have excellent wound-healing activity. However, direct application to the wound area can lead to low hEGF bioavailability due to protease enzymes or endocytosis. The use of liposomes as coatings and carriers can protect hEGF from degradation by enzymes, chemical reactions, and immune reactions. Sustained release using a matrix polymer can also keep the levels of hEGF in line with the treatment. Therefore, this study aimed to develop a film-forming spray of water-soluble chitosan (FFSWSC) containing hEGF-liposomes as a potential wound dressing. The hEGF-liposomes were prepared using the hydration film method, and the preparation of the FFSWSC was achieved by the ionic gelation method. The hydration film method produced hEGF-liposomes that were round and spread with a Z-average of 219.3 nm and encapsulation efficiency of 99.87%, whereas the film-forming solution, which provided good sprayability, had a formula containing 2% WSC and 3% propylene glycol with a viscosity, spray angle, droplet size, spray weight, and occlusion factor of 21.94 ± 0.05 mPa.s, 73.03 ± 1.28°, 54.25 ± 13.33 µm, 0.14 ± 0.00 g, and 14.57 ± 3.41%, respectively. The pH, viscosity, and particle size of the FFSWSC containing hEGF-liposomes were stable during storage for a month in a climatic chamber (40 ± 2 °C, RH 75 ± 5%). A wound healing activity test on mice revealed that hEGF-liposomes in FFSWSC accelerated wound closure significantly, with a complete wound closure on day 6. Based on the findings, we concluded that FFSWSC containing hEGF-liposomes has the potential to be used as a wound dressing.

Prospection of chitosan and its derivatives in wound healing: Proof of patent analysis (2010-2020)

Disruption in the normal anatomy and physiology of the skin often leads to wound formation. Its healing is a pretty complex and dynamic biological process with different phases. While there are many biopolymers (and their derivatives) for wound healing purposes. One of the most popular, promising, progressive and attention-grabbing biopolymers is 'chitosan'. It is a polysaccharide biopolymer that has tremendous potential in augmenting the process of wound healing. Most importantly, the derivatives of chitosan have heavily attracted the scientific community's attention to employing them in various formulations for wound healing applications. The prime focus of the present review is to provide scientific and technological prospection about chitosan and its derivatives for wound healing activity, starting from 2010 to 2020. Besides, the review also focuses about toxicity, different formulations and products of chitosan that are currently under clinical trials for wound healing purposes are described. Through this review, we present evidence that abundantly confirms that there is a growing interest in the domain of wound healing using novel, inventive, useful and patent protected chitosan derivatives. We speculate the possibility of more patent protected chitosan derivatives in the future for wound healing applications.

Effect of Chitosan and Aloe Vera Extract Concentrations on the Physicochemical Properties of Chitosan Biofilms

Chitosan films have been extensively studied as dressings in formulations for the treatment of chronic wounds. The incorporation of aloe vera (Aloe barbadensis Miller) into chitosan dressings could potentialize the healing process since aloe vera shows several pharmacological activities. This work aimed to evaluate the effect of aloe vera and chitosan concentrations on the physicochemical properties of the developed films. The films were obtained by casting technique and characterized with respect to their color parameters, morphology, barrier and mechanical properties, and thermal analysis. Results showed that the presence of aloe vera modified the films′ color parameters, changed barrier properties, increased fluid handling capacity (FHC), and decreased water-vapor permeability (WVP). The reduced elongation at break resulted in more rigid films. Aloe vera concentration did not significantly change film properties, but the presence of this gel increased the films’ stability at temperatures below 200 °C, showing similar behavior as chitosan films above 400 °C. The results suggest a crosslinking/complexation between chitosan and aloe vera, which combine appropriate physicochemical properties for application as wound dressing materials.

Peptide-Chitosan Engineered Scaffolds for Biomedical Applications

Peptides are signaling epitopes that control many vital biological events. Increased specificity, synthetic feasibility with concomitant lack of toxicity, and immunogenicity make this emerging class of biomolecules suitable for different applications including therapeutics, diagnostics, and biomedical engineering. Further, chitosan, a naturally occurring linear polymer composed of d-glucosamine and N-acetyl-d-glucosamine units, possesses anti-microbial, muco-adhesive, and hemostatic properties along with excellent biocompatibility. As a result, chitosan finds application in drug/gene delivery, tissue engineering, and bioimaging. Despite these applications, chitosan demonstrates limited cell adhesion and lacks biosignaling. Therefore, peptide-chitosan hybrids have emerged as a new class of biomaterial with improved biosignaling properties and cell adhesion properties. As a result, recent studies encompass increased application of peptide-chitosan hybrids as composites or conjugates in drug delivery, cell therapy, and tissue engineering and as anti-microbial material. This review discusses the recent investigations involving chitosan-peptide materials and uncovers various aspects of these interesting hybrid materials for biomedical applications.

bFGF and collagen matrix hydrogel attenuates burn wound inflammation through activation of ERK and TRK pathway

Burn injuries are most challenging to manage since it causes loss of the integrity of large portions of the skin leading to major disability or even death. Over the years, hydrogels are considered as a significant delivery system for wound treatment because of several advantages over other conventional formulations. We hypothesized that the bFGF-collagen-AgSD incorporated hydrogel formulation can accelerate the rate of burn healing in animal model and would promote fibroblast cell proliferation. Neovascularization and re-epithelialization is a hall mark of burn wound healing. In the present study, histopathological investigation and scanning electron microscopy of skin tissue of Wistar rats showed almost complete epithelialisation after 16 days in the treatment group. The developed hydrogel showed significantly accelerated wound closure compared with a standard and control group. The faster wound closure resulted from increased re-epithelialization and granulation tissue formation because of the presence of collagen and growth factor. Expressions of proteins such as TrkA, p- TrkA, ERK1/2, p-ERK1/2, NF-kβ, and p-NF-kβ involved in nerve growth factor (NGF) signalling pathway were analysed by western blot. All the findings obtained from this study indicated that the hydrogel can be considered as a promising delivery system against second degree burn by faster healing.

Challenges and effective routes for formulating and delivery of epidermal growth factors in skin care

Epidermal growth factors are important morphogenetic proteins that instruct cell behaviour. They have many inferred applications within regenerative medicine and have shown promising results in skincare treatments. Many growth factors are known to have skin anti-ageing benefits along with further potential in resolving scarring, acne and other skin disorders. Incorporation of these biologics into skincare formulations has been greatly hindered by low transdermal delivery efficacy, intricate material interactions and protein instability - especially within common cosmetic emulsions. This review explores the cosmeceutical capability of growth factors in skin care, current understandings of constituent interactions and advantageous delivery approaches for more effective topical delivery. The first section highlights the influences growth factor product formulation has on stability and synergy. Current understandings of growth factor formulating techniques in cosmetic products is limited, and the performance of other protein structures is an adequate point of reference. The second section examines emerging drug delivery systems to overcome the challenges of topical growth factor treatment. It is important to consider the coaction and durability of all components in a formulation simultaneously: active ingredients, product format and delivery vehicle, in order to engineer an optimal cosmeceutical product.

Formulation and In Vitro Penetration Study of Recombinant Human Epidermal Growth Factor-Loaded Transfersomal Emulgel

Purpose: Recombinant human epidermal growth factor (rhEGF) is a 6045-Da peptide that promotes the cell growth process, and it is also used for cosmetic purposes as an anti-aging compound. However, its penetration into skin is limited by its large molecular size. This study aimed to prepare rhEGF-loaded transfersomal emulgel with enhanced skin penetration compared with that of non-transfersomal rhEGF emulgel. Methods: Three transfersome formulations were prepared with different ratios between the lipid vesicle (phospholipid and surfactant) and rhEGF (200:1, 133:1, and 100:1) using a thin-film hydration-extrusion method. The physicochemical properties of these transfersomes and the percutaneous delivery of the transfersomal emulgel were evaluated. Long-term and accelerated stability studies were also conducted. Results: The 200:1 ratio of lipid to drug was optimal for rhEGF-loaded transfersomes, which had a particle size of 128.1 ± 0.66 nm, polydispersity index of 0.109 ± 0.004, zeta potential of -43.1 ± 1.07 mV, deformability index of 1.254 ± 0.02, and entrapment efficiency of 97.77% ± 0.09%. Transmission electron microscopy revealed that the transfersomes had spherical and unilamellar vesicles. The skin penetration of rhEGF was enhanced by as much as 5.56 fold by transfersomal emulgel compared with that of non-transfersomal emulgel. The stability study illustrated that the rhEGF levels after 3 months were 84.96-105.73 and 54.45%-66.13% at storage conditions of 2°C-8°C and 25°C ± 2°C/RH 60% ± 5%, respectively. Conclusion: The emulgel preparation containing transfersomes enhanced rhEGF penetration into the skin, and skin penetration was improved by increasing the lipid content.

Development of chitosan, gelatin and liposome film and analysis of its biocompatibility in vitro

A film of chitosan, gelatin and liposome has been designed for dermatological applications. Several adaptations were required throughout development to facilitate in vitro analysis, physicochemical characterization and biocompatibility evaluation. The final version of the film was characterized by differential scanning calorimetry, evaluation of swelling and scanning electron microscopy. The biocompatibility of the film was assessed by investigating cellular parameters of three types of human cells by direct contact or through films extracts: I) primary culture of adipose-derived mesenchymal stromal cells (ADCSs) and melanoma cell lines were used to test cell adhesion and morphology by direct cell culture on the material; II) ADSCs and immortalized keratinocytes were used in cell viability assay using different films extracts. The film showed physicochemical characteristics that favored cellular input, being suitable for in vitro analysis, which allowed its biocompatible characteristics such as the absence of toxicity to be verified without causing significant morphological changes in ADSCs and melanoma cell line. Altogether, these results suggest that the material has a potential application for drug delivery and promotion of skin tissue repair and is therefore worthwhile for further investigations using preclinical models to cover dermal lesions.

A novel multifaceted approach for wound healing: Optimization and in vivo evaluation of spray dried tadalafil loaded pro-nanoliposomal powder

The topical delivery of nanotherapeutics at the injury site for skin regeneration has received increasing attention as a strategy for wound treatment. This study aimed to investigate the preparation of spray dried tadalafil loaded pro-nanoliposomes powder as a novel system to accelerate wound healing process. The optimization was carried out employing 3² factorial design based on phospholipid and cholesterol concentrations. The physicochemical characterizations, in vitro cellular assessment and in vivo performance were evaluated. The results obtained pointed out that phospholipid concentration presented a positive effect on the entrapment efficacy and particle size, while cholesterol hindered the entrapment efficacy yet presented a prominent influence on particle size. Moreover, the optimized formulation showed a sustained release, high zeta potential and uniform spherical particles indicating entrapment of tadalafil in its amorphous state as demonstrated by FTIR and XPRD results. Cell viability and in vitro scratch assay demonstrated no cytotoxicity on human fibroblast cell lines and the ability of the drug and optimized formulation to promote cell migration. In vivo wound healing studies revealed significantly higher wound closure rates for areas treated with optimized loaded-formulation (65.95±6.47%) compared to unloaded formulation (29.78±9.65%), free drug (38.87±11.44%) and sham group (10.22±5.11%). In the in vivo study, histopathological specimens supported the previous results with presentation of cascade of healing elements via the angiogenetic activity of tadalafil. These outcomes provide an insight of a novel and emerging therapeutic drug system for wound treatment in clinical practice.

Asymmetric Membranes: A Potential Scaffold for Wound Healing Applications

Currently, due to uprising concerns about wound infections, healing agents have been regarded as one of the major solutions in the treatment of different skin lesions. The usage of temporary barriers can be an effective way to protect wounds or ulcers from dangerous agents and, using these carriers can not only improve the healing process but also they can minimize the scarring and the pain suffered by the human. To cope with this demand, researchers struggled to develop wound dressing agents that could mimic the structural and properties of native skin with the capability to inhibit bacterial growth. Hence, asymmetric membranes that can impair bacterial penetration and avoid exudate accumulation as well as wound dehydration have been introduced. In general, synthetic implants and tissue grafts are expensive, hard to handle (due to their fragile nature and poor mechanical properties) and their production process is very time consuming, while the asymmetric membranes are affordable and their production process is easier than previous epidermal substitutes. Motivated by this, here we will cover different topics, first, the comprehensive research developments of asymmetric membranes are reviewed and second, general properties and different preparation methods of asymmetric membranes are summarized. In the two last parts, the role of chitosan based-asymmetric membranes and electrospun asymmetric membranes in hastening the healing process are mentioned respectively. The aforementioned membranes are inexpensive and possess high antibacterial and satisfactory mechanical properties. It is concluded that, despite the promising current investigations, much effort is still required to be done in asymmetric membranes.

Chitosan hydrogels for sustained drug delivery

Sustainable and controlled delivery of drugs is at the centre of a huge amount of undertaken researches. The ability of hydrogels, high water content materials, to achieve a local and delayed-delivery has already been demonstrated for a wide variety of therapeutic agents and various polymer natures. In particular, chitosan, a natural polymer, stands out as a first choice material for hydrogels elaboration in biomedical, cosmetic, and health related applications, owing to its interesting properties (as biocompatibility, biodegradability, antimicrobial capacity, and mucoadhesivity). Moreover, chitosan also allows drugs to go easier through biological barriers. The main objective of this review is to report the various uses of chitosan hydrogels as drug delivery devices to control and/or delay the release of drugs loaded into their three dimensional matrix. A wide spectrum of corresponding biomedical applications of these systems can be encountered in the literature, whatever the physicochemical nature of drugs (hydrophilic, hydrophobic, macromolecular), as detailed in this review.

Development of a Chitosan-Vaseline Gauze Dressing with Wound-Healing Properties in Murine Models

Wound dressings are always needed after skin injury; however, most of the dressings still leave room for improvement. Here, we would like to develop an effective dressing with the ability to improve wound healing. A chitosan-Vaseline gauze (CVG) dressing was developed by coating the chitosan mixture and Vaseline on sterile gauze with subsequent drying. Infrared spectroscopy and electron microscopy were used to investigate the miscibility and structure of the dressing. The cytotoxicity and antibacterial nature were evaluated in vitro. The studies of water retention rate, wound healing, and tissue compatibility were carried out over a period of 14 days on full-thickness skin wounds of male Sprague-Dawley rats. It was observed that the CVG dressing demonstrated functional structure by miscibility, non-cytotoxicity, and good antibacterial effects against both Gram-positive and Gram-negative bacteria. The water retention rate incresased up to 25% after applying CVG for 3 hours. Besides, CVG treatment increased angiogenesis and improved microvascular density in wounds. The wounds treated with CVG showed size deduction with new collagen aggregations similar to those in the normal dermis. All the aforementioned results suggest that CVG dressing could be a promising candidate for wound treatment.

Electrospinning of natural polymers for the production of nanofibres for wound healing applications

Wound healing is a highly regulated process composed of four overlapping phases: (1) coagulation/haemostasis, (2) inflammation, (3) proliferation and (4) remodelling. Comorbidities such as advanced age, diabetes and obesity can impair natural tissue repair, rendering the wound in a pathological state of inflammation. This results in significant discomfort for patients and considerable financial costs for healthcare systems. Due to the complex nature of wound healing, current treatments are ineffective at dealing with delayed healing. With flexible properties that can be tailored, nanomaterials have emerged as alternative therapeutics for many biomedical applications. A nanofibrous network can be made via electrospinning polymers using a high electric field to create a responsive meshwork that can be used as a medical dressing. A nanofibrous device has properties that can overcome the limitations of traditional dressings, such as: (1) adaptability to wound contour; (2) controlled drug delivery of therapeutics; (3) gaseous exchange; (4) exudate absorption and (5) surface functionalisation to further enhance the biological activity of the dressing. This review details emerging trends in nanotechnology to specifically target wound healing applications. Particular focus is given to the most common natural polymers that could address many unmet healthcare needs.

Epidermal growth factor in sacran hydrogel film accelerates fibroblast migration

Epidermal growth factor (EGF) accelerates epidermal regeneration, and it is widely studied as a wound-healing agent. However, the special carrier for the topical administration of EGF is urgently needed to deliver EGF on the wound site. In a preceding study, sacran hydrogel film (Sac-HF) showed a possible use as a dressing material for wound healing, as well as a good capability as a drug carrier. In the current study, we prepared Sac-HF containing EGF (Sac/EGF-HF) and then characterized their physicochemical properties, including thickness, swelling ratio, degradability, tensile strength, and morphology. In addition, we have also conducted thermal and crystallography studies using differential scanning calorimetry (DSC) and X-ray diffraction, respectively. Furthermore, we investigated the in vitro influence of Sac/EGF-HF on cell migration using a fibroblast cell line. Morphology study confirmed that the casting method used for the film preparation resulted in a homogeneous film of Sac/EGF-HF. Furthermore, EGF significantly increased the thickness, tensile strength, and degradability of Sac/EGF-HF compared to Sac-HF. Sac/EGF-HF had a lower swelling ability compared to Sac-HF; this result corroborated the tensile strength result. Interestingly, X-ray diffraction and DSC results showed that Sac/EGF-HF had an amorphous shape. The in vitro studies revealed that Sac/EGF-HF induced the fibroblast migration activity. These results conclude that Sac/EGF-HF has the potential properties of HF for biomedical applications.