Topical delivery of chitosan-capped silver nanoparticles speeds up healing in burn wounds: A preclinical study

Biomaterials for immunomodulation in wound healing

The substantial economic impact of non-healing wounds, scarring, and burns stemming from skin injuries is evident, resulting in a financial burden on both patients and the healthcare system. This review paper provides an overview of the skin's vital role in guarding against various environmental challenges as the body's largest protective organ and associated developments in biomaterials for wound healing. We first introduce the composition of skin tissue and the intricate processes of wound healing, with special attention to the crucial role of immunomodulation in both acute and chronic wounds. This highlights how the imbalance in the immune response, particularly in chronic wounds associated with underlying health conditions such as diabetes and immunosuppression, hinders normal healing stages. Then, this review distinguishes between traditional wound-healing strategies that create an optimal microenvironment and recent peptide-based biomaterials that modulate cellular processes and immune responses to facilitate wound closure. Additionally, we highlight the importance of considering the stages of wounds in the healing process. By integrating advanced materials engineering with an in-depth understanding of wound biology, this approach holds promise for reshaping the field of wound management and ultimately offering improved outcomes for patients with acute and chronic wounds.

Enhanced burn wound healing by controlled-release 3D ADMSC-derived exosome-loaded hyaluronan hydrogel

Adipose mesenchymal stem cell (ADMSC)-derived exosomes (ADMSC-Exos) have shown great potential in regenerative medicine and been evidenced benefiting wound repair such as burns. However, the low yield, easy loss after direct coating, and no suitable loading system to improve their availability and efficacy hinder their clinical application for wound healing. And few studies focused on the comparison of biological functions between exosomes derived from different culture techniques, especially in exosome-releasing hydrogel system. Therefore, we designed a high-performance exosome controllable releasing hydrogel system for burn wound healing, namely loading 3D-printed microfiber culture-derived exosomes in a highly biocompatible hyaluronic acid (HA). In this project, we compared the biological functions in vitro and in a burn model among exosomes derived from the conventional two-dimensional (2D) plate culture (2D-Exos), microcarrier culture (2.5D-Exos), and 3D-printed microfiber culture (3D-Exos). Results showed that compared with 2D-Exos and 2.5D-Exos, 3D-Exos promoted HACATs and HUVECs cell proliferation and migration more significantly. Additionally, 3D-Exos had stronger angiogenesis-promoting effects in tube formation of (HUVECs) cells. Moreover, we found HA-loaded 3D-Exos showed better burn wound healing promotion compared to 2D-Exos and 2.5D-Exos, including accelerated burn wound healing rate and better collagen remodeling. The study findings reveal that the HA-loaded, controllable-release 3D-Exos repair system distinctly augments therapeutic efficacy in terms of wound healing, while concurrently introducing a facile application approach. This system markedly bolsters the exosomal loading efficiency, provides a robust protective milieu, and potentiates the inherent biological functionalities of the exosomes. Our findings provide a rationale for more efficient utilization of high-quality and high-yield 3D exosomes in the future, and a novel strategy for healing severe burns.

Kick-Starting Wound Healing: A Review of Pro-Healing Drugs

Cutaneous wound healing consists of four stages: hemostasis, inflammation, proliferation/repair, and remodeling. While healthy wounds normally heal in four to six weeks, a variety of underlying medical conditions can impair the progression through the stages of wound healing, resulting in the development of chronic, non-healing wounds. Great progress has been made in developing wound dressings and improving surgical techniques, yet challenges remain in finding effective therapeutics that directly promote healing. This review examines the current understanding of the pro-healing effects of targeted pharmaceuticals, re-purposed drugs, natural products, and cell-based therapies on the various cell types present in normal and chronic wounds. Overall, despite several promising studies, there remains only one therapeutic approved by the United States Food and Drug Administration (FDA), Becaplermin, shown to significantly improve wound closure in the clinic. This highlights the need for new approaches aimed at understanding and targeting the underlying mechanisms impeding wound closure and moving the field from the management of chronic wounds towards resolving wounds.

Exploration of inorganic nanoparticles for revolutionary drug delivery applications: a critical review

The nanosystems for delivering drugs which have evolved with time, are being designed for greater drug efficiency and lesser side-effects, and are also complemented by the advancement of numerous innovative materials. In comparison to the organic nanoparticles, the inorganic nanoparticles are stable, have a wide range of physicochemical, mechanical, magnetic, and optical characteristics, and also have the capability to get modified using some ligands to enrich their attraction towards the molecules at the target site, which makes them appealing for bio-imaging and drug delivery applications. One of the strong benefits of using the inorganic nanoparticles-drug conjugate is the possibility of delivering the drugs to the affected cells locally, thus reducing the side-effects like cytotoxicity, and facilitating a higher efficacy of the therapeutic drug. This review features the direct and indirect effects of such inorganic nanoparticles like gold, silver, graphene-based, hydroxyapatite, iron oxide, ZnO, and CeO2 nanoparticles in developing effective drug carrier systems. This article has remarked the peculiarities of these nanoparticle-based systems in pulmonary, ocular, wound healing, and antibacterial drug deliveries as well as in delivering drugs across Blood-Brain-Barrier (BBB) and acting as agents for cancer theranostics. Additionally, the article sheds light on the plausible modifications that can be carried out on the inorganic nanoparticles, from a researcher's perspective, which could open a new pathway.

Effects including photobiomodulation of galactomannan gel from Cassia grandis seeds in the healing process of second-degree burns

The epithelium recovery of skin-burned wounds has been currently achieved by several therapies, for example, hydrogel-based dressings and photobiomodulation therapy (PBMT). Thus, this work aimed to evaluate the healing activity of Cassia grandis seeds' galactomannan gel, associated or not with PBMT, in second-degree burns. Sixty male Wistar rats were assigned to four groups: Control (CG), Gel (GG), Laser/PBMT (LG), and Laser+Gel (GLG). Burns were made with an aluminum bar (90 °C), and submitted to clinical observations diary and area measurements at specific days. Microscopic analysis was based on histological criteria. The results showed that GG, LG, and GLG had a higher contraction rate (p < 0.05) than CG on the 14th experimental day, not differing from each other (∼95 %). At 21 days, all groups showed complete contraction (p > 0.05). Considering the histological results, LG and GLG showed excellent pro-wound healing properties after 14 days; at 21 days, all groups showed wound recovery compared to previous days. In view of the macroscopic and microscopic observations, the isolated treatments (Gel or Laser) effectively accelerated healing; however, the association (Laser+Gel) promoted re-epithelialization and stromal remodeling with better evolution of epithelium recovery due to the positive synergistic effect, thus emerging as a promising therapeutic alternative in the repair of burns.

Application of silver nanoparticles for improving motor recovery after spinal cord injury via reduction of pro-inflammatory M1 macrophages

Silver nanoparticles (AgNPs) possess anti-inflammatory activities and have been widely deployed for promoting tissue repair. Here we explored the efficacy of AgNPs on functional recovery after spinal cord injury (SCI). Our data indicated that, in a SCI rat model, local AgNPs delivery could significantly recover locomotor function and exert neuroprotection through reducing of pro-inflammatory M1 survival. Furthermore, in comparison with Raw 264.7-derived M0 and M2, a higher level of AgNPs uptake and more pronounced cytotoxicity were detected in M1. RNA-seq analysis revealed the apoptotic genes in M1 were upregulated by AgNPs, whereas in M0 and M2, pro-apoptotic genes were downregulated and PI3k-Akt pathway signaling pathway was upregulated. Moreover, AgNPs treatment preferentially reduced cell viability of human monocyte-derived M1 comparing to M2, supporting its effect on M1 in human. Overall, our findings reveal AgNPs could suppress M1 activity and imply its therapeutic potential in promoting post-SCI motor recovery.

Quercetin- and caffeic acid-functionalized chitosan-capped colloidal silver nanoparticles: one-pot synthesis, characterization, and anticancer and antibacterial activities

The presented study comprises the one-pot synthesis and the characterization of quercetin- and caffeic acid-functionalized chitosan-capped colloidal silver nanoparticles (Ch/Q- and Ch/CA-Ag NPs), and their antibacterial and anticancer activities. The formation of Ch/Q- and Ch/CA-Ag NPs has been confirmed by ultraviolet-visible (UV-vis) spectroscopy, Fourier-transform infrared (FTIR) spectroscopy, and transmission electron microscopy (TEM). The characteristic surface plasmon resonance (SPR) absorption band has been found at 417 and 424 nm for Ch/Q- and Ch/CA-Ag NPs, respectively. The formation of a chitosan shell comprising quercetin and caffeic acid, which surround the colloidal core Ag NPs, was confirmed by UV-vis, and FTIR analyses, and monitored by TEM microscopy. The size of nanoparticles has been determined as 11.2 and 10.3 nm for Ch/Q- and Ch/CA-Ag, respectively. The anticancer activity of Ch/Q- and Ch/CA-Ag NPs has been evaluated against U-118 MG (human glioblastoma) and ARPE-19 (human retinal pigment epithelium) cells. Both NPs showed anticancer activity, but Ch/Q-Ag NPs seemed to be more effective on cancer cell lines (U-118 MG) in comparison to healthy ones (ARPE-19). Furthermore, the antibacterial activity of Ch/Q- and Ch/CA-Ag NPs against Gram-negative (P. aeruginosa and E. coli) and Gram-positive (S. aureus and S. epidermidis) bacteria was determined, and dose-dependent antibacterial effects were found.

Fascia Layer-A Novel Target for the Application of Biomaterials in Skin Wound Healing

As the first barrier of the human body, the skin has been of great concern for its wound healing and regeneration. The healing of large, refractory wounds is difficult to be repaired by cell proliferation at the wound edges and usually requires manual intervention for treatment. Therefore, therapeutic tools such as stem cells, biomaterials, and cytokines have been applied to the treatment of skin wounds. Skin microenvironment modulation is a key technology to promote wound repair and skin regeneration. In recent years, a series of novel bioactive materials that modulate the microenvironment and cell behavior have been developed, showing the ability to efficiently facilitate wound repair and skin attachment regeneration. Meanwhile, our lab found that the fascial layer has an indispensable role in wound healing and repair, and this review summarizes the research progress of related bioactive materials and their role in wound healing.

Chitosan-Placental ECM Composite Thermos-Responsive Hydrogel as a Biomimetic Wound Dressing with Angiogenic Property

Attempts are being made to develop an ideal wound dressing with excellent biomechanical and biological properties. Here, a thermos-responsive hydrogel is fabricated using chitosan (CTS) with various concentrations (1%, 2.5%, and 5% w/v) of solubilized placental extracellular matrix (ECM) and 20% β-glycerophosphate to optimize a smart wound dressing hydrogel with improved biological behavior. The thermo-responsive CTS (TCTS) alone or loaded with ECMs (ECM-TCTS) demonstrate uniform morphology using SEM. TCTS and ECM1%-TCTS and ECM2.5%-TCTS show a gelation time of 5 min at 37 °C, while no gel formation is observed at 4 and 25 °C. ECM5%-TCTS forms gel at both 25 and 37 °C. The degradation and swelling ratios increase as the ECM content of the hydrogel increase. All the constructs show excellent biocompatibility in vitro and in vivo, however, the hydrogels with a higher concentration of ECM demonstrate better cell adhesion for fibroblast cells and induce expression of angiogenic factors (VEGF and VEGFR) from HUVEC. Only the ECM5%-TCTS has antibacterial activity against Acinetobacter baumannii ATCC 19606. The data obtained from the current study suggest the ECM2.5%-TCTS as an optimized smart biomimetic wound dressing with improved angiogenic properties now promises to proceed with pre-clinical and clinical investigations.

Functionalized Silver and Gold Nanomaterials with Diagnostic and Therapeutic Applications

The functionalization of nanomaterials with suitable capping ligands or bioactive agents is an interesting strategy in designing nanosystems with suitable applicability and biocompatibility; the physicochemical and biological properties of these nanomaterials can be highly improved for biomedical applications. In this context, numerous explorations have been conducted in the functionalization of silver (Ag) and gold (Au) nanomaterials using suitable functional groups or agents to design nanosystems with unique physicochemical properties such as excellent biosensing capabilities, biocompatibility, targeting features, and multifunctionality for biomedical purposes. Future studies should be undertaken for designing novel functionalization tactics to improve the properties of Au- and Ag-based nanosystems and reduce their toxicity. The possible release of cytotoxic radicals or ions, the internalization of nanomaterials, the alteration of cellular signaling pathways, the translocation of these nanomaterials across the cell membranes into mitochondria, DNA damages, and the damage of cell membranes are the main causes of their toxicity, which ought to be comprehensively explored. In this study, recent advancements in diagnostic and therapeutic applications of functionalized Au and Ag nanomaterials are deliberated, focusing on important challenges and future directions.

Ionic complexation improves wound healing in deep second-degree burns and reduces in-vitro ciprofloxacin cytotoxicity in fibroblasts

The development of new treatments capable of controlling infections and pain related to burns continues to be a challenge. Antimicrobials are necessary tools, but these can be cytotoxic for regenerating cells. In this study, antibiotic-anesthetic (AA) smart systems obtained by ionic complexation of polyelectrolytes with ciprofloxacin and lidocaine were obtained as films and hydrogels. Ionic complexation with sodium alginate and hyaluronate decreased cytotoxicity of ciprofloxacin above 70% in a primary culture of isolated fibroblasts (p < 0.05). In addition, the relative levels of the proteins involved in cell migration, integrin β1 and p-FAK, increased above 1.5 times (p < 0.05) with no significant differences in cell mobility. Evaluation of the systems in a deep second-degree burn model revealed that reepithelization rate was AA-films = AA-hydrogels > control films > no treated > reference cream (silver sulfadiazine cream). In addition, appendage conservation and complete dermis organization were achieved in AA-films and AA-hydrogels. Encouragingly, both the films and the hydrogels showed a significantly superior performance compared to the reference treatment. This work highlights the great potential of this smart system as an attractive dressing for burns, which surpasses currently available treatments.

Significance of Capping Agents of Colloidal Nanoparticles from the Perspective of Drug and Gene Delivery, Bioimaging, and Biosensing: An Insight

The over-growth and coagulation of nanoparticles is prevented using capping agents by the production of stearic effect that plays a pivotal role in stabilizing the interface. This strategy of coating the nanoparticles’ surface with capping agents is an emerging trend in assembling multipurpose nanoparticles that is beneficial for improving their physicochemical and biological behavior. The enhancement of reactivity and negligible toxicity is the outcome. In this review article, an attempt has been made to introduce the significance of different capping agents in the preparation of nanoparticles. Most importantly, we have highlighted the recent progress, existing roadblocks, and upcoming opportunities of using surface modified nanoparticles in nanomedicine from the drug and gene delivery, bioimaging, and biosensing perspectives.

Innovative Treatment Strategies to Accelerate Wound Healing: Trajectory and Recent Advancements

Wound healing is highly specialized dynamic multiple phase process for the repair of damaged/injured tissues through an intricate mechanism. Any failure in the normal wound healing process results in abnormal scar formation, and chronic state which is more susceptible to infections. Chronic wounds affect patients’ quality of life along with increased morbidity and mortality and are huge financial burden to healthcare systems worldwide, and thus requires specialized biomedical intensive treatment for its management. The clinical assessment and management of chronic wounds remains challenging despite the development of various therapeutic regimens owing to its painstakingly long-term treatment requirement and complex wound healing mechanism. Various conventional approaches such as cell therapy, gene therapy, growth factor delivery, wound dressings, and skin grafts etc., are being utilized for promoting wound healing in different types of wounds. However, all these abovementioned therapies are not satisfactory for all wound types, therefore, there is an urgent demand for the development of competitive therapies. Therefore, there is a pertinent requirement to develop newer and innovative treatment modalities for multipart therapeutic regimens for chronic wounds. Recent developments in advanced wound care technology includes nanotherapeutics, stem cells therapy, bioengineered skin grafts, and 3D bioprinting-based strategies for improving therapeutic outcomes with a focus on skin regeneration with minimal side effects. The main objective of this review is to provide an updated overview of progress in therapeutic options in chronic wounds healing and management over the years using next generation innovative approaches. Herein, we have discussed the skin function and anatomy, wounds and wound healing processes, followed by conventional treatment modalities for wound healing and skin regeneration. Furthermore, various emerging and innovative strategies for promoting quality wound healing such as nanotherapeutics, stem cells therapy, 3D bioprinted skin, extracellular matrix-based approaches, platelet-rich plasma-based approaches, and cold plasma treatment therapy have been discussed with their benefits and shortcomings. Finally, challenges of these innovative strategies are reviewed with a note on future prospects.

Chitosans and Nanochitosans: Recent Advances in Skin Protection, Regeneration, and Repair

Chitosan displays a dual function, acting as both an active ingredient and/or carrier for pharmaceutical bioactive molecules and metal ions. Its hydroxyl- and amino-reactive groups and acetylation degree can be used to adjust this biopolymer's physicochemical and pharmacological properties in different forms, including scaffolds, nanoparticles, fibers, sponges, films, and hydrogels, among others. In terms of pharmacological purposes, chitosan association with different polymers and the immobilization or entrapment of bioactive agents are effective strategies to achieve desired biological responses. Chitosan biocompatibility, water entrapment within nanofibrils, antioxidant character, and antimicrobial and anti-inflammatory properties, whether enhanced by other active components or not, ensure skin moisturization, as well as protection against bacteria colonization and oxidative imbalance. Chitosan-based nanomaterials can maintain or reconstruct skin architecture through topical or systemic delivery of hydrophilic or hydrophobic pharmaceuticals at controlled rates to treat skin affections, such as acne, inflammatory manifestations, wounds, or even tumorigenesis, by coating chemotherapy drugs. Herein, chitosan obtention, physicochemical characteristics, chemical modifications, and interactions with bioactive agents are presented and discussed. Molecular mechanisms involved in chitosan skin protection and recovery are highlighted by overlapping the events orchestrated by the signaling molecules secreted by different cell types to reconstitute healthy skin tissue structures and components.

Acceleration of Healing in Full-Thickness Wound by Chitosan-Binding bFGF and Antimicrobial Peptide Modification Chitosan Membrane

Skin wound healing is an important clinical challenge, and the main treatment points are accelerating epidermal regeneration and preventing infection. Therefore, it is necessary to develop a wound dressing that can simultaneously cure bacterial infections and accelerate wound healing. Here, we report a multifunctional composite wound dressing loaded with chitosan (CS)-binding bFGF (CSBD-bFGF) and antimicrobial peptides (P5S9K). First, CS was used as the dressing matrix material, and P5S9K was encapsulated in CS. Then, CSBD-bFGF was designed by combining recombinant DNA technology and tyrosinase treatment and modified on the dressing material surface. The results show that the binding ability of CSBD-bFGF and CS was significantly improved compared with that of commercial bFGF, and CSBD-bFGF could be controllably released from the CS dressing. More importantly, the prepared dressing material showed excellent antibacterial activity in vivo and in vitro and could effectively inhibit the growth of E. coli and S. aureus. Using NIH3T3 cells as cellular models, the results showed that the CSBD-bFGF@CS/P5S9K composite dressing was a friendly material for cell growth. After cells were seeded on the composite dressing surface, collagen-1 (COL-1) and vascular endothelial growth factor (VEGF) genes expression in cells were significantly upregulated. Finally, the full-thickness wound of the rat dorsal model was applied to analyse the tissue repair ability of the composite dressing. The results showed that the composite dressing containing CSBD-bFGF and P5S9K had the strongest ability to repair skin wounds. Therefore, the CSBD-bFGF@CS/P5S9K composite dressing has good antibacterial and accelerated wound healing abilities and has good application prospects in the treatment of skin wounds.

Synergistic efficacy of colistin and silver nanoparticles impregnated human amniotic membrane in a burn wound infected rat model

Antimicrobials used to treat burn wound infections have become multidrug-resistant, thus delaying wound healing. When combined with silver nanoparticles, antibiotics create a multifaceted antibacterial mechanism of action to which bacteria are incapable of developing resistance. Similarly, the amniotic membrane has been found to lower the bacterial number. The purpose of the current study was to observe the antibacterial activity of combined topical colistin with silver nanoparticles and decellularized human amniotic membrane as a dressing in burn wounds infected with bacteria with the goal of promoting faster healing. Bacteria commonly isolated from burn wounds and the most sensitive topical antibiotic were identified. Colistin, silver nanoparticles and combined colistin with silver nanoparticles were impregnated into decellularized human amniotic membranes. These wound dressings were evaluated in third-degree multidrug-resistant bacterial infected thermal burns induced in rats. Out of a total of 708 pus samples from burn wounds, Pseudomonas aeruginosa was the most prevalent pathogen 308 (43.5%), followed by Klebsiella pneumoniae 300 (42.4%). Topical colistin was 100% sensitive for both bacteria. Overall, maximum wound contraction (p < 0.05), and increased collagen deposition (+++) with no isolation of bacteria from wound swabs were noted on day 21 for the combined colistin with silver nanoparticle-loaded human amniotic membrane dressing group. Our study concluded that the increased antimicrobial activity of the novel combination of colistin and silver nanoparticle-loaded decellularized human amniotic membrane manifested its potential as an effective burn wound dressing.

Application of chitosan nanoparticles in skin wound healing

The rising prevalence of impaired wound healing and the consequential healthcare burdens have gained increased attention over recent years. This has prompted research into the development of novel wound dressings with augmented wound healing functions. Nanoparticle (NP)-based delivery systems have become attractive candidates in constructing such wound dressings due to their various favourable attributes. The non-toxicity, biocompatibility and bioactivity of chitosan (CS)-based NPs make them ideal candidates for wound applications. This review focusses on the application of CS-based NP systems for use in wound treatment. An overview of the wound healing process was presented, followed by discussion on the properties and suitability of CS and its NPs in wound healing. The wound healing mechanisms exerted by CS-based NPs were then critically analysed and discussed in sections, namely haemostasis, infection prevention, inflammatory response, oxidative stress, angiogenesis, collagen deposition, and wound closure time. The results of the studies were thoroughly reviewed, and contradicting findings were identified and discussed. Based on the literature, the gap in research and future prospects in this research area were identified and highlighted. Current evidence shows that CS-based NPs possess superior wound healing effects either used on their own, or as drug delivery vehicles to encapsulate wound healing agents. It is concluded that great opportunities and potentials exist surrounding the use of CSNPs in wound healing.

Nanomaterials-based drug delivery approaches for wound healing

Abstract:

Wound healing is a complex and dynamic process that requires intricate synchronization between multiple cell types within appropriate extracellular microenvironment. Wound healing process involves four overlapping phases in a precisely regulated manner, consisting of hemostasis, inflammation, proliferation, and maturation. For an effective wound healing all four phases must follow in a sequential pattern within a time frame. Several factors might interfere with one or more of these phases in healing process, thus causing improper or impaired wound healing resulting in non-healing chronic wounds. The complications associated with chronic non-healing wounds, along with the limitations of existing wound therapies, have led to the development and emergence of novel and innovative therapeutic interventions. Nanotechnology presents unique and alternative approaches to accelerate the healing of chronic wounds by the interaction of nanomaterials during different phases of wound healing. This review focuses on recent innovative nanotechnology-based strategies for wound healing and tissue regeneration based on nanomaterials, including nanoparticles, nanocomposites and scaffolds. The efficacy of the intrinsic therapeutic potential of nanomaterials (including silver, gold, zinc oxide, copper, cerium oxide, etc.) and the ability of nanomaterials as carriers (liposomes, hydrogels, polymeric nanomaterials, nanofibers) as therapeutic agents associated with wound-healing applications have also been addressed. The significance of these nanomaterial-based therapeutic interventions for wound healing needs to be highlighted to engage researchers and clinicians towards this new and exciting area of bio-nanoscience. We believe that these recent developments will offer researchers an updated source on the use of nanomaterials as an advanced approach to improve wound healing.

Topical gel-based biomaterials for the treatment of diabetic foot ulcers

Diabetic foot ulcers (DFUs) are a devastating ailment for many diabetic patients with increasing prevalence and morbidity. The complex pathophysiology of DFU wound environments has made finding effective treatments difficult. Standard wound care treatments have limited efficacy in healing these types of chronic wounds. Topical biomaterial gels have been developed to implement novel treatment approaches to improve therapeutic effects and are advantageous due to their ease of application, tunability, and ability to improve therapeutic release characteristics. Here, we provide an updated, comprehensive review of novel topical biomaterial gels developed for treating chronic DFUs. This review will examine preclinical data for topical gel treatments in diabetic animal models and clinical applications, focusing on gels with protein/peptides, drug, cellular, herbal/antioxidant, and nano/microparticle approaches. STATEMENT OF SIGNIFICANCE: By 2050, 1 in 3 Americans will develop diabetes, and up to 34% of diabetic patients will develop a diabetic foot ulcer (DFU) in their lifetime. Current treatments for DFUs include debridement, infection control, maintaining a moist wound environment, and pressure offloading. Despite these interventions, a large number of DFUs fail to heal and are associated with a cost that exceeds $31 billion annually. Topical biomaterials have been developed to help target specific impairments associated with DFU with the goal to improve healing. A summary of these approaches is needed to help better understand the current state of the research. This review summarizes recent research and advances in topical biomaterials treatments for DFUs.

Advances in Nanotechnology towards Development of Silver Nanoparticle-Based Wound-Healing Agents

Since antiquity, silver-based therapies have been used in wound healing, wound care and management of infections to provide adequate healing. These therapies are associated with certain limitations, such as toxicity, skin discolouration and bacterial resistance, which have limited their use. As a result, new and innovative wound therapies, or strategies to improve the existing therapies, are sought after. Silver nanoparticles (AgNPs) have shown the potential to circumvent the limitations associated with conventional silver-based therapies as described above. AgNPs are effective against a broad spectrum of microorganisms and are less toxic, effective at lower concentrations and produce no skin discolouration. Furthermore, AgNPs can be decorated or coupled with other healing-promoting materials to provide optimum healing. This review details the history and impact of silver-based therapies leading up to AgNPs and AgNP-based nanoformulations in wound healing. It also highlights the properties of AgNPs that aid in wound healing and that make them superior to conventional silver-based wound treatment therapies.

Enhanced Efficacy of Some Antibiotics in Presence of Silver Nanoparticles Against Multidrug Resistant Pseudomonas aeruginosa Recovered From Burn Wound Infections

Burn wound infections with multidrug-resistant (MDR) bacteria are shown in many countries as severe widespread health threats. Consequently, attention has been devoted to new nanoparticle-based materials in the field of antimicrobial chemotherapy for burn wound infections. This study aimed to evaluate both in vitro and in vivo efficacies of nanoparticle–antibiotic combinations as new classes of materials subjected against MDR Pseudomonas aeruginosa. Out of 40 Gram-negative isolates, 23 P. aeruginosa were recovered from patients with burn wound infections attending different hospitals in Tanta, Egypt. The susceptibility test revealed that 95.7% of P. aeruginosa isolates were MDR with a high incidence of resistance against carbenicillin. Antibacterial activities of silver nanoparticles (Ag-NPs) against the isolates examined showed various inhibition zone diameters ranging from 11 to 17 mm. Strong synergistic efficacy of neomycin was reported in combination with Ag-NPs against MDR P. aeruginosa P₈ and P₁₄ isolates. The in vivo effectiveness of various pharmaceutical formulations prepared from a combination of neomycin antibiotic with Ag-NPs in the treatment of induced bacterially infected mice burns showed that maximum healing activity along with faster wound contraction reported with the combination of neomycin-Ag-NPs in the spray formulation. Generally, data indicated that incorporating Ag-NPs in combination with certain antibiotics may be a new, promising application for wound treatments, especially burns infected with MDR P. aeruginosa.

Recent advances in nanotherapeutics for the treatment of burn wounds

Moderate or severe burns are potentially devastating injuries that can even cause death, and many of them occur every year. Infection prevention, anti-inflammation, pain management and administration of growth factors play key roles in the treatment of burn wounds. Novel therapeutic strategies under development, such as nanotherapeutics, are promising prospects for burn wound treatment. Nanotherapeutics, including metallic and polymeric nanoformulations, have been extensively developed to manage various types of burns. Both human and animal studies have demonstrated that nanotherapeutics are biocompatible and effective in this application. Herein, we provide comprehensive knowledge of and an update on the progress of various nanoformulations for the treatment of burn wounds.

Edible Materials in Tissue Regeneration

Edible materials have attracted increasing attention because of their excellent properties including availability, biocompatibility, biological activity, and biodegradability. Natural polysaccharides, phenolic compounds, and proteins are widely used in tissue regeneration. To better characterize their healing effect, this review article describes the applications of edible materials in tissue regeneration including wound healing and bone tissue regeneration. As an introduction to the topic, their sources and main bioactive properties are discussed. Then, the mechanism by which they facilitate wound healing based on their hemostasis, antibacterial, anti-inflammatory, and antioxidant properties is systematically investigated. Moreover, a more comprehensive discussion is presented on the approaches by which edible materials can be used as scaffolds or agents for the provision of the components of natural bones for regulating the level of osteogenesis-related cytokines to enhance bone repair. Finally, the prospects of edible materials for tissue regeneration are discussed.

Hydrogel with silver nanoparticles synthesized by Mimosa tenuiflora for second-degree burns treatment

In this work we use Mimosa tenuiflora (MtE) extracts as reducing agents to synthesize silver nanoparticles (AgMt NPs) which were characterized by DPPH and Total Polyphenols Assays, UV-visible, X-ray diffractometer (XRD), high-resolution transmission electron microscopy (HRTEM), X-ray photoelectron spectroscopy (XPS) and Thermogravimetric analysis (TGA). AgMt NPs possess average sizes of 21 nm and fcc crystalline structure, it was also confirmed that the MtE is present in the AgMt NPs even after the cleaning protocol applied. Subsequently, carbopol hydrogels were made and the MtE and the synthesized AgMt NPs were dispersed in different gels (MtE-G and AgMt NPs-G, respectively) at 100 µg/g concentration. The gels were characterized by UV-Vis, IR, and rheology. Antimicrobial tests were performed using Staphylococcus aureus and Escherichia coli. Burn wound healing was evaluated in a second-degree burn injury on a Wistar rats model for 14 days and additional skin biopsies were examined with histopathological analysis. Gel with commercial silver nanoparticles (Ag NPs) was prepared and employed as a control on the biological assays. Hydrogel system containing silver nanoparticles synthesized with Mimosa tenuiflora (AgMt NPs-G) is a promising therapeutic strategy for burn wound healing, this due to bactericidal and anti-inflammatory effects, which promotes a more effective recovery (in percentage terms) by damaged area.

Enhanced wound repair ability of arginine-chitosan nanocomposite membrane through the antimicrobial peptides-loaded polydopamine-modified graphene oxide

Skin wound healing is a complicated and lengthy process, which is influenced by multiple factors and need a suitable cellular micro-environment. For skin wound, wound dressings remain a cornerstone of dermatologic therapy at present. The dressing material can create an effective protective environment for the wound, and the interactions between the dressing and the wound has a great impact on the wound healing efficiency. An ideal wound dressing materials should have good biocompatibility, moisturizing property, antibacterial property and mechanical strength, and can effectively prevent wound infection and promote wound healing. In this study, in order to design wound dressing materials endowed with excellent antibacterial and tissue repair properties, we attempted to load antimicrobial peptides onto dopmine-modified graphene oxide (PDA@GO) using lysozyme (ly) as a model drug. Then, functionalized GO was used to the surface modification of arginine-modified chitosan (CS-Arg) membrane. To evaluate the potential of the prepared nanocomposite membrane in wound dressing application, the surface morphology, hydrophilic, mechanical properties, antimicrobial activity, and cytocompatibility of the resulting nanocomposite membrane were analyzed. The results revealed that prepared nanocomposite membrane exhibited excellent hydrophilic, mechanical strength and antimicrobial activity, which can effectively promote cell growth and adhesion. In particular, using PDA@GO as drug carrier can effectively maintain the activity of antimicrobial peptides, and can maximize the antibacterial properties of the nanocomposite membrane. Finally, we used rat full-thickness wound models to observe wound healing, and the surface interactions between the prepared nanocomposite membrane and the wound. The results indicated that nanocomposite membrane can obviously accelerated wound closure, and the wounds showed reduced inflammation, improved angiogenesis and accelerated re-epithelialization. Therefore, incorporation of antimicrobial peptides-functionalize graphene oxide (ly-PDA@GO) into CS-Arg membrane was a viable strategy for fabricating excellent wound dressing. Together, this study not only prepared a wound dressing with excellent tissue repair ability, but also provided a novel idea for the development of graphene oxide-based antibacterial dressing.

Evaluation of a novel tilapia-skin acellular dermis matrix rationally processed for enhanced wound healing

Acellular Dermal Matrix (ADM) is mainly made with human or porcine skins and has the risk of zoonotic virus transmission. The fish skin-derived ADM could overcome the shortcoming. Fish skin acellular matrix has been used as wound dressing, but there is few systematic studies on tilapia-skin acellular dermal matrix (TS-ADM). In the present study, a novel TS-ADM was made by an alkaline decellularization process and γ-irradiation. The physical properties, biocompatibility, pre-clinical safety and wound healing activity of TS-ADM were systematically evaluated for its value as a functionally bioactive wound dressing. Histopathological analysis (hematoxylin and eosin staining, 4,6-diamidino-2-phenylindole (DAPI) staining) and DNA quantification both proved that the nuclear components of tilapia skin were removed sufficiently in TS-ADM. Compared to the commercial porcine acellular dermal matrix (DC-ADM), TS-ADM has distinctive features in morphology, thermal stability, degradability and water vapor transmission. TS-ADM was more readily degradable than DC-ADM in vitro and in vivo. In both rat and mini-pig skin wound healing experiments, TS-ADM was shown to significantly promote granulation growth, collagen deposition, angiogenesis and re-epithelialization, which may be attributed to the high expression of transforming growth factor-beta 1 (TGF-β1), alpha-smooth muscle actin (α-SMA) and CD31. Herein, the novel TS-ADM, used as a low-cost bioactive dressing, could form a microenvironment conducive to wound healing.

3D bioprinting of integral ADSCs-NO hydrogel scaffolds to promote severe burn wound healing

Severe burns are challenging to heal and result in significant death throughout the world. Adipose-derived mesenchymal stem cells (ADSCs) have emerged as a promising treatment for full-thickness burn healing but are impeded by their low viability and efficiency after grafting in vivo. Nitric oxide (NO) is beneficial in promoting stem cell bioactivity, but whether it can function effectively in vivo is still largely unknown. In this study, we bioprinted an efficient biological scaffold loaded with ADSCs and NO (3D-ADSCs/NO) to evaluate its biological efficacy in promoting severe burn wound healing. The integral 3D-ADSCs/NO hydrogel scaffolds were constructed via 3D bioprinting. Our results shown that 3D-ADSCs/NO can enhance the migration and angiogenesis of Human Umbilical Vein Endothelial Cells (HUVECs). Burn wound healing experiments in mice revealed that 3D-ADSCs/NO accelerated the wound healing by promoting faster epithelialization and collagen deposition. Notably, immunohistochemistry of CD31 suggested an increase in neovascularization, supported by the upregulation of vascular endothelial growth factor (VEGF) mRNA in ADSCs in the 3D biosystem. These findings indicated that 3D-ADSC/NO hydrogel scaffold can promote severe burn wound healing through increased neovascularization via the VEGF signalling pathway. This scaffold may be considered a promising strategy for healing severe burns.

Wound-healing activity of glycoproteins from white jade snail (Achatina fulica) on experimentally burned mice

Burns are a global public health problem and the treatment of burn wounds is a major medical and economic issue. White jade snails (Achatina fulica) are now widely distributed in Asia, and they have been used to treat burns in folk medicine of China. In this study, the glycoproteins from white jade snails were investigated and their effect on burn healing was evaluated by a mouse burn model. The results showed that the snail mucus was mainly composed of proteins and polysaccharides, and it had good adhesion. The main component of snail mucus was glycoprotein from the results of DEAE Sepharose FF ion exchange chromatography. The 2,2-Diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging effect of 1 mg/mL snail mucus reached 13.77%. The wound healing rate of the snail mucus group was higher than that of the control group (p < 0.0001). Histopathological results showed that mice in the snail mucus group had a faster healing than that of the control group. The biochemical analysis was in agreement with the histopathological findings. These results suggested that glycoproteins from snail mucus showed effective wound healing activities in the skin of experimentally burned mice.

Preparation of polyacrylonitrile-based fibres with chelated Ag ions for antibacterial applications

The need for an excellent antibacterial material that is sufficiently powerful to never develop bacterial resistance is urgent. In this study, a series of novel polyacrylonitrile-based fibres with chelated Ag ions (referred to as Ag-SH-PANF) were prepared by a two-step chemical modification process: grafting and chelating. The properties of the as-prepared Ag-SH-PANF were characterized by Fourier transform infrared (FT-IR) spectroscopy, thermogravimetric analysis (TGA), X-ray diffraction (XRD), scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS). The antibacterial activities of Ag-SH-PANF were examined against pathogenic bacteria, and an antibacterial mechanism was explicated based on the release of Ag ions from the fibres' surfaces. The results showed that, although chelation occurred between the Ag ions and the grafted amino, sulfhydryl and disulfide groups, Ag-SH-PANF retained its fine microstructure and thermal stability. Moreover, Ag-SH-PANF displayed excellent antibacterial ability against pathogenic bacteria as well as good washing durability. In terms of the antibacterial mechanism, Ag ions are the main bactericidal agents in the role of catalysts and are not consumed in the antibacterial process. Nonetheless, a relatively higher concentration of Ag ions can accelerate the bactericidal process.

Wound dressings functionalized with silver nanoparticles: promises and pitfalls

Infections are the main reason why most people die from burns and diabetic wounds. The clinical challenge for treating wound infections through traditional antibiotics has been growing steadily and has now reached a critical status requiring a paradigm shift for improved chronic wound care. The US Centers for Disease Control have predicted more deaths from antimicrobial-resistant bacteria than from all types of cancers combined by 2050. Thus, the development of new wound dressing materials that do not rely on antibiotics is of paramount importance. Currently, incorporating nanoparticles into scaffolds represents a new concept of 'nanoparticle dressing' which has gained considerable attention for wound healing. Silver nanoparticles (Ag-NPs) have been categorized as metal-based nanoparticles and are intriguing materials for wound healing because of their excellent antimicrobial properties. Ag-NPs embedded in wound dressing polymers promote wound healing and control microorganism growth. However, there have been several recent disadvantages of using Ag-NPs to fight infections, such as bacterial resistance. This review highlights the therapeutic approaches of using wound dressings functionalized with Ag-NPs and their potential role in revolutionizing wound healing. Moreover, the physiology of the skin and wounds is discussed to place the use of Ag-NPs in wound care into perspective.

The in vivo effect of Lacto-N-neotetraose (LNnT) on the expression of type 2 immune response involved genes in the wound healing process

Lacto-n-neotatraose (LNnT) oligosaccharide shows properties such as anti-inflammatory, type 2 immune response induction, induced angiogenesis, and anti-bacterial effects. Here, we hypothesized that the application of LnNT in the skin full-thickness wound can accelerate the healing process through its anti-inflammatory effect as well as induction of type 2 immune responses. In this study, we evaluated the cell viability of fibroblasts in the presence of LNnT. The full-thickness wound model was created by punch biopsy. The mice were treated intradermaly with LNnT at the concentrations of 100 and 200 µg or PBS as a control group. The wounds samples were compared based on the macroscopic and histological evaluations. The amount of collagen deposition and expression of genes involved in type 2 immunity were measured by the hydroxyproline assay and real time PCR method, respectively. Our results showed that LNnT had no negative effect on the cell viability of fibroblasts. LNnT increased the wound closure rate on day 7 post-wounding. H&E stain analysis revealed that mice treated with 200 µg LNnT exhibited better healing score, follicle formation, and lower epidermal thickness index. The mice treated with LNnT exhibited a lower collagen deposition on day 21 and higher collagen content on days 7 and 14 post-treatment. The LNnT groups also exhibited a lower number of neutrophils and a higher number of basal cells and fibroblasts. The expression rate of IL-10, IL-4, and IL-13 was higher in the LNnT groups. These results showed the high potential of LNnT for use in treatment of full-thickness wounds.

Advances in Lipid and Metal Nanoparticles for Antimicrobial Peptide Delivery

Antimicrobial peptides (AMPs) have been described as excellent candidates to overcome antibiotic resistance. Frequently, AMPs exhibit a wide therapeutic window, with low cytotoxicity and broad-spectrum antimicrobial activity against a variety of pathogens. In addition, some AMPs are also able to modulate the immune response, decreasing potential harmful effects such as sepsis. Despite these benefits, only a few formulations have successfully reached clinics. A common flaw in the druggability of AMPs is their poor pharmacokinetics, common to several peptide drugs, as they may be degraded by a myriad of proteases inside the organism. The combination of AMPs with carrier nanoparticles to improve delivery may enhance their half-life, decreasing the dosage and thus, reducing production costs and eventual toxicity. Here, we present the most recent advances in lipid and metal nanodevices for AMP delivery, with a special focus on metal nanoparticles and liposome formulations.

Application of honey as a protective material in maintaining the viability of adipose stem cells in burn wound healing: A histological, molecular and biochemical study

Enhanced resistance to oxidative stress makes the adipose stem cells (ASCs) able to promote wound repair and regeneration. Such cells can be achieved by addition of an anti-oxidant to cell culture medium. In this study, a combination of honey (H) and ASCs was applied on burn wounds and the injured area was then covered by a tegaderm (T) dressing in a rat model. Wound healing was evaluated by histopathological, histomorphometrical, molecular, scanning electron microscopy, and biochemical assessments on days 7, 14, and 28 post-wounding. Treatment with ASCs-containing honey (T-H/ASC) resulted in substantial reduction in the level of pro-inflammatory cytokines including interleukin-1β (IL-1β) and transforming growth factor-β1 (TGF-β1) in wound bed, at 7 day post-surgery. T-H/ASCs also elevated the level of bFGF expression, indicating that ASCs enhanced angiogenesis, at 7 day post-wounding. T-H/ASCs significantly improved angiogenesis, re-epithelialization, and granulation tissue formation compared to other treatment regimes, at 14 day post-surgery. These outcomes were in exceptionally good agreement with the histological and biochemical findings. Increased bFGF level in the T-H/ASCs treated wounds at the 28th day post-surgery showed the anti-scarring activity of ASCs. Honey can be considered as a protective material in maintaining the viability of ASCs and improving the cellular resistance to oxidative stress. Furthermore, combination of ASCs and honey can provide a nutrient media for the ASCs and enhance the ability of regeneration of the ASC-based therapies.

Hyaluronic acid hydrogel loaded by adipose stem cells enhances wound healing by modulating IL-1β, TGF-β1, and bFGF in burn wound model in rat

Application of hydrogels can be an effective technique in transferring the adipose-derived stem cells (ASCs) to injured tissue and their protection from further complications. Besides, acellular dermal matrix (ADM) has successfully been used in treatment of wounds. In this study, a combination of hylauronic acid (HA) and ASCs (HA/ASCs) was applied on burn wounds and the injured area was then covered by an ADM dressing in a rat model (ADM-HA/ASCs). Wound healing was evaluated by histopathological, histomorphometrical, molecular, biochemical, and scanning electron microscopy assessments on days 7, 14, and 28 post-wounding. ADM-HA/ASCs stimulated healing significantly more than the ADM-HA and ADM treated wounds, as it led to reduced inflammation, and improved angiogenesis and enhanced granulation tissue formation. Expression of interleukin-1β (IL-1β) and transforming growth factor-β1 (TGF-β1) was lower in the ADM-HA/ASCs treated wounds than the ADM-HA and ADM groups, at the seventh post-wounding day. ADM-HA/ASCs also enhanced the expression level of TGF-β1 mRNA at 14 day post-wounding that was parallel to the experimental data from histological and biochemical assessments and confirmed the positive role of ASCs in repair of burn wounds. Additionally, increase in basic fibroblast growth factor (bFGF) expression and decreased TGF-β1 level on the 28th post-wounding day indicated the anti-scarring activity of ASCs. HA loaded by adipose stem cells can represent a promising strategy in accelerating burn wound healing.

The wound healing and antibacterial potential of triple-component nanocomposite (chitosan-silver-sericin) films loaded with moxifloxacin

AIM

The current study reports the development and evaluation of chitosan-sericin-silver nanocomposite (CSSN) films without and with moxifloxacin (Mox).

METHODOLOGY

The film preparation method involved the in-situ synthesis of silver nanoparticles within the chitosan-sericin colloidal composite followed by preparation into a film by solvent casting technique. In-situ formation and the particle size analysis of the silver nanoparticles was performed via UV-Visible and zeta-size spectrometer. The prepared films were tested for swelling ratio, contents uniformity, in-vitro Mox release, and permeation analysis. The morphological (SEM), elemental (EDX), spectral (FT-IR), structural (XRD), and thermal (TGA and DSC) properties of the composites were also inspected. The antibacterial activity of the CSSN films was performed against seven pathogenic bacterial strains including five ATCC and two clinical strains. The potential wound healing activity of the composite films was evaluated on burn wound model induced in Sprague Dawley male rats.

RESULTS

The prepared films displayed good swelling profile with a sustained in-vitro Mox release and permeation profile; attaining maximum of 78.57% (CSSM3) release and 55.05% (CSSM1) permeation (CSSM1) in 24 h. The prepared films, particularly the Mox-loaded CSSN films displayed a promising antibacterial activity against all the tested strains with the activity being highest against MRSA (clinical isolates). The prepared films indicated a remarkable wound healing applications with successful fibrosis, collagen reorganization, neovascularization, and mild epidermal regeneration after 7 days of treatment with no silver ions detection in animal's blood.

CONCLUSION

The obtained findings strongly suggest the use of the prepared novel composite dressing for wound care applications.

Biosynthesis and Potential Applications of Silver and Gold Nanoparticles and Their Chitosan-Based Nanocomposites in Nanomedicine

Biosynthesized or biogenic metallic nanoparticles, particularly silver and gold nanoparticles (AgNPs and AuNPs, respectively), have been increasingly used because of their advantages, including high stability and loading capacity; moreover, these nanoparticles are synthesized using a green and cost-effective method. Previous studies have investigated reducing and/or stabilizing agents from various biological sources, including plants, microorganisms, and marine-derived products, using either a one-pot or a multistep process at different conditions. In addition, extensive studies have been performed to determine the biological or pharmacological effects of these nanoparticles, such as antimicrobial, antitumor, anti-inflammatory, and antioxidant effects. In the recent years, chitosan, a natural cationic polysaccharide, has been increasingly investigated as a reducing and/or stabilizing agent in the synthesis of biogenic metallic nanoparticles with potential applications in nanomedicine. Here, we have reviewed the mechanism of biosynthesis and potential applications of AgNPs and AuNPs and their chitosan-mediated nanocomposites in nanomedicine.