Berberine coated biocomposite hemostatic film based alginate as absorbable biomaterial for wound healing

A natural carboxylated sisal fiber/chitosan/kaolin porous sponge for rapid and effective hemostasis

To improve chitosan hemostasis, carboxylated sisal fiber and kaolin were introduced to obtain carboxylated sisal fiber/chitosan/kaolin (SF/CS/K) composite sponges (the weight ratio of 3: 3:4, 4:4:2, 5:5:0) by freeze-drying method. The results showed that the ionic cross-linking of the carboxylated sisal fiber with chitosan and kaolin-loading endowed the composite sponges with not only oriented groove porous structure, high mechanical strength, porosity, water absorption and compress recovery, but also suitable biodegradation, good cytocompatibility, hemocompatibility, protein adsorption, antibacterial activity. Especially, compared with commercial gelatin hemostatic sponges, the composite sponge of SF/CS/K displayed better coagulation ability and hemostatic effect, and animal experiments further demonstrated that the bleeding amount and hemostatic time of SF/CS/K were greatly reduced in rat hemostatic models of tail amputation, femoral vein trauma and liver injury, owing to the synergistic hemostatic effect of chitosan, kaolin and sisal fiber, as well as the groove porous structure, which endowed them with strong adhesion for red blood cells. Conclusively, SF/CS/K2 composite sponge had the best hemostatic effect because of the most appropriate component ratio, which is a novel promising natural hemostatic sponge for effective and rapid hemostasis in deep massive bleeding sites.

Latest advance anti-inflammatory hydrogel wound dressings and traditional Lignosus rhinoceros used for wound healing agents

Wound healing is a physiological process occurring after the onset of a skin lesion aiming to reconstruct the dermal barrier between the external environment and the body. Depending on the nature and duration of the healing process, wounds are classified as acute (e.g., trauma, surgical wounds) and chronic (e.g., diabetic ulcers) wounds. The latter, often affect millions of people globally, take months to heal or not heal non-healing chronic wounds, are typically susceptible to microbial infection, and are a major cause of morbidity. Wounds can be treated with a variety of non-surgical (topical formulations, wound dressings) and surgical (debridement, skin grafts/flaps) methods. Three-dimensional (3D)-(bio) printing and traditional wound dressings are two examples of modern experimental techniques. This review focuses on several types of anti-inflammatory wound dressings, especially focusing on hydrogels and traditional macro-fungi like L. rhinocerotis as agents that promote wound healing. In this study, we introduced novel anti-inflammatory hydrogel dressings and offered innovative methods for application and preparation to aid in the healing. Additionally, we summarize the key elements required for wound healing and discuss our analysis of potential future issues. These findings suggest that L. rhinocerotis and various anti-inflammatory hydrogels can be considered as conventional and alternative macro-fungi for the treatment of non-communicable diseases. We summarized the development of functional hydrogel dressings and traditional Lignosus rhinoceros used for wound healing agents in recent years, as well as the current situation and future trends, in light of their preparation mechanisms and functional effects.

A chitosan-based hydrogel loaded with fenofibrate for diabetic wound healing

Diabetic wounds represent a common chronic condition, posing significant challenges in the treatment process due to bacterial infections, increased generation of reactive oxygen species (ROS) and exacerbated inflammation. Fenofibrate (FEN) is a clinical medication used for lipid regulation. In this study, it was utilized for the first time as an effective component of wound dressings for treating diabetic ulcers, exploring its novel applications further. Therefore, we prepared a polyvinyl alcohol/chitosan/FEN (PCF) hydrogel using a freeze-thaw method and conducted physicochemical characterization of the PCF hydrogel to further elucidate its biological functions. In vitro studies demonstrated that the PCF hydrogel exhibits excellent biocompatibility along with significant antimicrobial, pro-angiogenic, ROS-scavenging, and anti-inflammatory properties. Subsequent animal experiments indicated that the PCF hydrogel has the ability to promote blood vessel formation and collagen deposition. Additionally, the PCF hydrogel showed a significant inhibitory effect on the inflammatory response, as evidenced by the reductions in the levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). These compelling findings accentuate the promising application of the PCF hydrogel in the treatment of diabetic wounds.

What else should hemostatic materials do beyond hemostasis: A review

Massive blood loss due to injury is the leading cause of prehospital deaths in disasters and emergencies. Hemostatic materials are used to realize rapid hemostasis and protect patients from death. Researchers have designed and developed a variety of hemostatic materials. However, in addition to their hemostatic effect, hemostatic materials must be endowed with additional functions to meet the practical application requirements in different scenarios. Here, strategies for modifications of hemostatic materials for use in different application scenarios are listed: effective positioning at the site of deep and narrow wounds to stop bleeding, resistance to high blood pressure and wound movement to maintain wound formation, rapid and easy removal from the wound without affecting further treatment after hemostasis is completed, and continued function when retained in the wound as a dressing (such as antibacterial, antiadhesion, tissue repair, etc.). The problems encountered in the practical use of hemostatic materials and the strategies and progress of researchers will be further discussed in this review. We hope to provide valuable references for the design of more comprehensive and practical hemostatic materials.

Alginate based biomaterials for hemostatic applications: Innovations and developments

Development of the efficient hemostatic materials is an essential requirement for the management of hemorrhage caused by the emergency situations to avert most of the casualties. Such injuries require the use of external hemostats to facilitate the immediate blood clotting. A variety of commercially available hemostats are present in the market but most of them are associated with limitations such as exothermic reactions, low biocompatibility, and painful removal. Thus, fabrication of an ideal hemostatic composition for rapid blood clot formation, biocompatibility, and antimicrobial nature presents a real challenge to the bioengineers. Benefiting from their tunable fabrication properties, alginate-based hemostats are gaining importance due to their excellent biocompatibility, with >85 % cell viability, high absorption capacity exceeding 500 %, and cost-effectiveness. Furthermore, studies have estimated that wounds treated with sodium alginate exhibited a blood loss of 0.40 ± 0.05 mL, compared to the control group with 1.15 ± 0.13 mL, indicating its inherent hemostatic activity. This serves as a solid foundation for designing future hemostatic materials. Nevertheless, various combinations have been explored to further enhance the hemostatic potential of sodium alginate. In this review, we have discussed the possible role of alginate based composite hemostats incorporated with different hemostatic agents, such as inorganic materials, polymers, biological agents, herbal agents, and synthetic drugs. This article outlines the challenges which need to be addressed before the clinical trials and give an overview of the future research directions.

Granular Hemostatic Composite of Alginate, Calcium, and Zinc for Rapid and Effective Management of Post-Traumatic Hemorrhage

Post-traumatic hemorrhage, which can result from accidents or battlefield injuries, is a significant global concern due to the high prehospital mortality rate. Substantial efforts have been made to develop hemostatic agents that can effectively reduce hemorrhage in the immediate aftermath of a traumatic event. The present study investigated the potential efficacy of Ca2+ and Zn2+ supplemented sodium alginate-based dry hemostatic particles (SA-CZ DHP) to manage excessive blood loss or post-traumatic hemorrhage. SA-CZ DHP were developed, followed by their physical and biochemical characterization, cytocompatibility and hemocompatibility testing, and critical evaluation of the hemostatic potential in vitro and in vivo. The safe SA-CZ DHP showed high absorption and accelerated blood clotting kinetics with reduced coagulation time (≈70%, p < 0.0001) in whole human blood, observed with insignificant hemolysis and uninterrupted RBC morphology. SA-CZ DHP significantly reduced the mean blood loss (≈90% in SD rats tail incision), and bleeding time (≈60% in BALB/c mice tail incision) was at par with commercially available Celox hemostatic granules. In conclusion, the biocompatible SA-CZ DHP exhibited rapid and effective management of excessive blood loss. It is also pertinent to note that the developed formulation could be a cost-effective alternative to its commercial counterparts.

Chitosan nonwoven fabric composited calcium alginate and adenosine diphosphate as a hemostatic bandage for acute bleeding wounds

Acute bleeding following accidental injury is a leading cause of mortality. However, conventional hemostatic bandages impede wound healing by inducing excessive blood loss, dehydration, and adherence to granulation tissue. Strategies such as incorporating active hemostatic agents and implementing chemical modifications can augment the properties of these bandages. Nevertheless, the presence of remote thrombosis and initiators may pose risks to human health. Here, a hemostatic bandage was developed by physically combined chitosan nonwoven fabric, calcium alginate sponge, and adenosine diphosphate. The presented hemostatic bandage not only exhibits active and passive mechanisms for promoting clotting but also demonstrates excellent mechanical properties, breathability, ease of removal without causing damage to the wound bed or surrounding tissues, as well as maintaining an optimal moist environment conducive to wound healing. In vitro evaluation results indicated that the hemostatic bandage possesses favorable cytocompatibility with low levels of hemolysis. Furthermore, it effectively aggregates various blood cells while activating platelets synergistically to promote both extrinsic and intrinsic coagulation pathways. In an in vivo rat model study involving liver laceration and femoral artery injury scenarios, our developed hemostatic bandage demonstrated rapid clot formation capabilities along with reduced blood loss compared to commercially available fabrics.

Green synthetic sodium alginate-glycerol-MXene nanocomposite membrane with excellent flexibility and mineralization ability for guided bone regeneration

Developing a novel bioactive material as a barrier membrane for guided bone regeneration (GBR) surgery remains challenging. As a new member of two-dimensional (2D) material family, MXene is a promising candidate component for barrier membranes due to its high specific surface area and osteogenic differentiation ability. In this work, a green and simple SA/glycerol/MXene (SgM) composite membrane was prepared via solvent casting method by using sodium alginate (SA) and MXene (M) as raw materials while employing glycerol (g) as a plasticizer. The addition of glycerol significantly increased the elongation at the break of SA from 10%-20% to 240%-360%, while the introduction of MXene promoted the deposition of calcium and phosphorus to form hydroxyapatite. At the same time, the roughness of the SgM composite membrane is apparently improved, which is conducive to cell adhesion and proliferation. This work provides a basis for further research on SgM composite membrane as GBR membrane for the treatment of bone defects.

Randomized controlled trial of new hemostatic material "sodium calcium alginate" in a preclinical model

BACKGROUND

The demand for nonbiological hemostatic materials has increased in surgical practice; however, few have sufficient hemostatic efficacy. This study investigated whether optimizing the composition of sodium calcium alginate, which forms a stable gel, improves hemostatic efficacy.

METHODS

The sodium calcium alginate was changed for each composition, including powder size, calcium substitution rate, molecular weight, and mannuronic/guluronic acid ratio. The hemostasis in liver punch-out injury and bleeding was evaluated using swine. For the study, sodium calcium alginate with different compositions was randomly applied to bleeding sites. Previous hemostatic materials, including cellulose and sodium alginate, were used as a control. We investigated hemostasis at 2 and 5 minutes after application.

RESULTS

Each powder size (53-150 μm, 150-250 μm, 53-250 μm) had a similar hemostatic effect. However, the hemostatic rate was significantly higher in sodium calcium alginate than in previous hemostatic materials (P value < .01). A 74.1% calcium substitution rate had the highest hemostasis at 2 and 5 minutes after application (2 minutes: 100%, 5 minutes: 95.2%). Regarding molecular weight, the hemostatic rate was significantly higher in 333,000 than in 50,000 (2 minutes: 95% vs 70%, 5 minutes: 95% vs 70%, P = .038). Moreover, a 1.9 mannuronic/guluronic acid ratio had the highest hemostasis compared with the 0.4 mannuronic/guluronic acid ratio (2 minutes: 58.8% vs 11.8%, 5 minutes: 58.8% vs 0%, P = .033) CONCLUSION: The composition of sodium calcium alginate with a high hemostatic effect was optimized. This new hemostatic material demonstrated potential usefulness for bleeding during surgery.

Multifunctional and theranostic hydrogels for wound healing acceleration: An emphasis on diabetic-related chronic wounds

Hydrogels represent intricate three-dimensional polymeric structures, renowned for their compatibility with living systems and their ability to naturally degrade. These networks stand as promising and viable foundations for a range of biomedical uses. The practical feasibility of employing hydrogels in clinical trials has been well-demonstrated. Among the prevalent biomedical uses of hydrogels, a significant application arises in the context of wound healing. This intricate progression involves distinct phases of inflammation, proliferation, and remodeling, often triggered by trauma, skin injuries, and various diseases. Metabolic conditions like diabetes have the potential to give rise to persistent wounds, leading to delayed healing processes. This current review consolidates a collection of experiments focused on the utilization of hydrogels to expedite the recovery of wounds. Hydrogels have the capacity to improve the inflammatory conditions at the wound site, and they achieve this by diminishing levels of reactive oxygen species (ROS), thereby exhibiting antioxidant effects. Hydrogels have the potential to enhance the growth of fibroblasts and keratinocytes at the wound site. They also possess the capability to inhibit both Gram-positive and Gram-negative bacteria, effectively managing wounds infected by drug-resistant bacteria. Hydrogels can trigger angiogenesis and neovascularization processes, while also promoting the M2 polarization of macrophages, which in turn mitigates inflammation at the wound site. Intelligent and versatile hydrogels, encompassing features such as pH sensitivity, reactivity to reactive oxygen species (ROS), and responsiveness to light and temperature, have proven advantageous in expediting wound healing. Furthermore, hydrogels synthesized using environmentally friendly methods, characterized by high levels of biocompatibility and biodegradability, hold the potential for enhancing the wound healing process. Hydrogels can facilitate the controlled discharge of bioactive substances. More recently, there has been progress in the creation of conductive hydrogels, which, when subjected to electrical stimulation, contribute to the enhancement of wound healing. Diabetes mellitus, a metabolic disorder, leads to a slowdown in the wound healing process, often resulting in the formation of persistent wounds. Hydrogels have the capability to expedite the healing of diabetic wounds, facilitating the transition from the inflammatory phase to the proliferative stage. The current review sheds light on the biological functionalities of hydrogels, encompassing their role in modulating diverse mechanisms and cell types, including inflammation, oxidative stress, macrophages, and bacteriology. Additionally, this review emphasizes the significance of smart hydrogels with responsiveness to external stimuli, as well as conductive hydrogels for promoting wound healing. Lastly, the discussion delves into the advancement of environmentally friendly hydrogels with high biocompatibility, aimed at accelerating the wound healing process.

A Berberine-Loaded Bletilla striata Polysaccharide Hydrogel as a New Medical Dressing for Diabetic Wound Healing

The healing process of a diabetic wound (DW) is often impeded by a series of interrelated factors, including severe infection, persistent inflammation, and excessive oxidative stress. Therefore, it is particularly crucial to develop a medical dressing that can address these issues simultaneously. To this end, different ratios of Bletilla striata polysaccharide (BSP) and berberine (BER) were physically blended with Carbomer 940 (CBM940) to develop a composite hydrogel as a medical dressing. The BSP/BER hydrogel was characterized using SEM, FTIR, rheological testing and other techniques. The anti-inflammatory, antioxidant, and antibacterial properties of the hydrogel were evaluated using cell and bacterial models in vitro. A DW model of ICR mice was established to evaluate the effect of the hydrogel on DW healing in vivo. The hydrogel exhibited excellent biocompatibility and remarkable antibacterial, anti-inflammatory, and antioxidant properties. In addition, animal experiments showed that the BSP/BER hydrogel significantly accelerated wound healing in DW mice. Among the different formulations, the LBSP/BER hydrogel (2% BSP, mBER:mBSP = 1:40) demonstrated the most remarkable efficacy. In conclusion, the BSP/BER hydrogel developed exhibited immense properties and great potential as a medical dressing for the repair of DW, addressing a crucial need in clinical practice.

Kaolin-loaded carboxymethyl chitosan/sodium alginate composite sponges for rapid hemostasis

There are several factors that contribute to the mortality of people who suffer from unmanageable bleeding. Therefore, the development of rapid hemostatic materials is necessary. Herein, novel rapid hemostatic composite sponges were developed by incorporation of kaolin (K) into carboxymethyl chitosan (CMCS)/sodium alginate (SA) via a combination of methods that includes ionic crosslinking, polyelectrolyte action, and freeze-drying. The CMCS/SA-K composite sponges were cross-linked with calcium ions provided by a sustained-release system consisting of D-gluconolactone (GDL) and Ca-EDTA, and the hemostatic ability of the sponges was enhanced by loading the inorganic hemostatic agent-kaolin (K). It was demonstrated that the CMCS/SA-K composite sponges had a good porous structure and water absorption properties, excellent mechanical properties, outstanding biodegradability, and biocompatibility. Simultaneously, they exhibited rapid hemostatic properties, both in vitro and in vivo. Significantly, the hemostatic time of the CMCS/SA-K₆₀ sponge was improved by 82.76 %, 191.82 %, and 153.05 %, compared with those of commercially available gelatin sponges in the rat tail amputation, femoral vein, and liver injury hemorrhage models respectively, indicating that its hemostatic ability was superior to that of commercially available hemostatic materials. Therefore, CMCS/SA-K composite sponges show great promise for rapid hemostasis.

Development of Crosslinker-Free Polysaccharide-Lysozyme Microspheres for Treatment Enteric Infection

Antibiotic abuse in the conventional treatment of microbial infections, such as inflammatory bowel disease, induces cumulative toxicity and antimicrobial resistance which requires the development of new antibiotics or novel strategies for infection control. Crosslinker-free polysaccharide-lysozyme microspheres were constructed via an electrostatic layer-by-layer self-assembly technique by adjusting the assembly behaviors of carboxymethyl starch (CMS) on lysozyme and subsequently outer cationic chitosan (CS) deposition. The relative enzymatic activity and in vitro release profile of lysozyme under simulated gastric and intestinal fluids were investigated. The highest loading efficiency of the optimized CS/CMS-lysozyme micro-gels reached 84.9% by tailoring CMS/CS content. The mild particle preparation procedure retained relative activity of 107.4% compared with free lysozyme, and successfully enhanced the antibacterial activity against E. coli due to the superposition effect of CS and lysozyme. Additionally, the particle system showed no toxicity to human cells. In vitro digestibility testified that almost 70% was recorded in the simulated intestinal fluid within 6 h. Results demonstrated that the cross-linker-free CS/CMS-lysozyme microspheres could be a promising antibacterial additive for enteric infection treatment due to its highest effective dose (573.08 μg/mL) and fast release at the intestinal tract.

Potential Hemostatic and Wound Healing Effects of Thermoresponsive Wound Dressing Gel Loaded with Lignosus rhinocerotis and Punica granatum Extracts

Biologically active compounds in Lignosus rhinocerotis and Punica granatum are found to facilitate wound healing and exhibit hemostatic activity, making them a good combination as bioactives for wound dressings. This study, therefore, aimed to evaluate the potential of thermoresponsive gels loaded with L. rhinocerotis (HLRE) and P. granatum (PPE) extracts as dressings for wound treatment. The gels were prepared using Pluronic PF127 polymer and mixed with PEG 400 and/or starch prior to incorporation with both extracts (0.06 to 1 mg/mL). The gelation temperature (Tgel) at the skin temperature was achieved when Pluronic PF127 was mixed with 22% w/v PEG 400 and reduced to 25.7 ± 0.3-26.7 ± 1.2 °C after adding HLRE and PPE. The gels exhibited satisfactory hardness (2.02 ± 0.19-6.45 ± 0.53 N), cohesiveness (0.9 ± 0.07-2.28 ± 0.4 mJ), adhesiveness (5.07 ± 2.41-19.6 ± 1.1 mJ), and viscosity (0.15 ± 0.04-0.95 ± 0.03 Pa.s), suitable for wound dressings. The optimized gels displayed high thrombin activity and cell migration rate (wound closure of 74% ± 12-89% ± 2 within 24 h), demonstrating hemostatic and healing effects. The thermoresponsive gels demonstrated advantages to be used as dressings for treating acute and open wounds.

Polylactide-Based Films Incorporated with Berberine-Physicochemical and Antibacterial Properties

A series of new polymeric materials consisting of polylactide (PLA), polyethylene glycol (PEG) and berberine chloride (B) was evaluated. PEG was incorporated into the polymer matrix with the aim of obtaining a plasticizing effect, while berberine was added in order to obtain antibacterial properties in formed packaging materials. Materials were formed using the solvent-casting procedure. Fourier transform infrared spectroscopy and scanning electron microscopy were used so as to establish the structural changes resulting from the introduction of berberine. Thermogravimetry and differential scanning calorimetry were applied to study the thermal properties. Further, mechanical properties and differences in colour and transparency between the control sample and films containing berberine were also studied. The recorded data indicates that berberine formed a network on the surface of the PLA-based materials. Introduction of an active compound significantly improved thermal stability and greatly affected the Young's modulus values of the studied polymeric films. Moreover, it should be stressed that the addition of the studied active compound leads to an improvement of the antibacterial properties, resulting in a significant decrease in growth of E. coli and the S. aureus bacteria cultures.

Physicochemical Characterization of Star Anise Silver Nanoparticles Incorporated Chitosan Biomaterial for Absorb Water and Cure Wounds

Chronic wounds threaten the geriatric society worldwide irrespective of their social status. The current treatment approach to cure chronic ailments is associated with its demerits. A novel treatment approach that is coordinated is required to adsorb water from wounds and cure chronic wounds. Star anise condiment used in the Indian kitchen is shown to have the potency to cure various ailments. In this study, silver nanoparticles were prepared using the star anise extract. The biological potency of star anise extract was confirmed through Gas Chromatography Mass Spectroscopy, antioxidant assay, and anti-inflammatory study. From the DPPH assay result, it was inferred that star anise extract was able to scavenge the free radicals at the concentration of 10 μg/ml using the aqueous extract silver nanoparticles were prepared. The prepared particles were characterized by UV-visible, scanning electron microscopy, and their biological efficacy was determined for their potency against bacteria and prevention of protein aggregation. The anti-inflammatory assay suggests that nanoparticles prevent the aggregation of proteins in a dose-dependent manner. IC50 was found to be 20 μg/ml. The synthesized nanoparticle was incorporated into the chitosan biomaterial and characterized by various physicochemical parameters such as differential scanning calorimetry, scanning electron microscopy, FTIR, and thermogravimetric analysis. According to the findings, silver nanoparticles incorporated in chitosan biomaterials can be used to adsorb water from wounds and wound healing materials.