In vitro evaluation of drug release and antibacterial activity of a silver-loaded wound dressing coated with a multilayer system

Cytotoxicity and concentration of silver ions released from dressings in the treatment of infected wounds: a systematic review

Introduction

Silver-releasing dressings are used in the treatment of infected wounds. Despite their widespread use, neither the amount of silver released nor the potential in vivo toxicity is known. The aim of this study was to evaluate the cytotoxic effects and the amount of silver released from commercially available dressings with infected wounds.

Methods

The review was conducted according to the PRISMA statement. The Web of Science, PubMed, Embase, Scopus, and CINAHL databases were searched for studies from 2002 through December 2022. The criteria were as follows: population (human patients with infected wounds); intervention (commercial dressings with clinical silver authorized for use in humans); and outcomes (concentrations of silver ions released into tissues and plasma). Any study based on silver-free dressings, experimental dressings, or dressings not for clinical use in humans should be excluded. According to the type of study, systematic reviews, experimental, quasi-experimental, and observational studies in English, Spanish, or Portuguese were considered. The quality of the selected studies was assessed using the JBI critical appraisal tools. Studies that assessed at least 65% of the included items were included. Data were extracted independently by two reviewers.

Results

740 articles were found and five were finally selected (all of them quasi-experimental). Heterogeneity was found in terms of study design, application of silver dressings, and methods of assessment, which limited the comparability between studies.

Conclusion

In vivo comparative studies of clinical dressings for control of infection lack a standardized methodology that allows observation of all the variables of silver performance at local and systemic levels, as well as evaluation of its cytotoxicity. It cannot be concluded whether the assessed concentrations of released silver in commercial dressings for the topical treatment of infected wounds are cytotoxic to skin cells.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022351041, PROSPERO [CRD42022351041].

Polysaccharide-based antibacterial coating technologies

To tackle antimicrobial resistance, a global threat identified by the United Nations, is a common cause of healthcare-associated infections (HAI) and is responsible for significant costs on healthcare systems, a substantial amount of research has been devoted to developing polysaccharide-based strategies that prevent bacterial attachment and biofilm formation on surfaces. Polysaccharides are essential building blocks for life and an abundant renewable resource that have attracted much attention due to their intrinsic remarkable biological potential antibacterial activities. If converted into efficient antibacterial coatings that could be applied to a broad range of surfaces and applications, polysaccharide-based coatings could have a significant potential global impact. However, the ultimate success of polysaccharide-based antibacterial materials will be determined by their potential for use in manufacturing processes that are scalable, versatile, and affordable. Therefore, in this review we focus on recent advances in polysaccharide-based antibacterial coatings from the perspective of fabrication methods. We first provide an overview of strategies for designing polysaccharide-based antimicrobial formulations and methods to assess the antibacterial properties of coatings. Recent advances on manufacturing polysaccharide-based coatings using some of the most common polysaccharides and fabrication methods are then detailed, followed by a critical comparative overview of associated challenges and opportunities for future developments. STATEMENT OF SIGNIFICANCE: Our review presents a timely perspective by being the first review in the field to focus on advances on polysaccharide-based antibacterial coatings from the perspective of fabrication methods along with an overview of strategies for designing polysaccharide-based antimicrobial formulations, methods to assess the antibacterial properties of coatings as well as a critical comparative overview of associated challenges and opportunities for future developments. Meanwhile this work is specifically targeted at an audience focused on featuring critical information and guidelines for developing polysaccharide-based coatings. Including such a complementary work in the journal could lead to further developments on polysaccharide antibacterial applications.

Dopamine-Mediated Biopolymer Multilayer Coatings for Modulating Cell Behavior, Lubrication, and Drug Release

Biopolymer coatings on implants mediate the interactions between the synthetic material and its biological environment. Owing to its ease of preparation and the possibility to incorporate other bioactive molecules, layer-by-layer deposition is a method commonly used in the construction of biopolymer multilayers. However, this method typically requires at least two types of oppositely charged biopolymers, thus limiting the range of macromolecular options by excluding uncharged biopolymers. Here, we present a layer-by-layer approach that employs mussel-inspired polydopamine as the adhesive intermediate layer to build biopolymer multilayer coatings without requiring any additional chemical modifications. We select three biopolymers with different charge states─anionic alginate, neutral dextran, and cationic polylysine─and successfully assemble them into mono-, double-, or triple-layers. Our results demonstrate that both the layer number and the polymer type modulate the coating properties. Overall, increasing the number of layers in the coatings leads to reduced cell attachment, lower friction, and higher drug loading capacity but does not alter the surface potential. Moreover, varying the biopolymer type affects the surface potential, macrophage differentiation, lubrication performance, and drug release behavior. This proof-of-concept study offers a straightforward and universal coating method, which may broaden the use of multilayer coatings in biomedical applications.

Injectable Chitosan-Based Hydrogels for Trans-Cinnamaldehyde Delivery in the Treatment of Diabetic Foot Ulcer Infections

Diabetic foot ulcers (DFU) are among the most common complications in diabetic patients and affect 6.8% of people worldwide. Challenges in the management of this disease are decreased blood diffusion, sclerotic tissues, infection, and antibiotic resistance. Hydrogels are now being used as a new treatment option since they can be used for drug delivery and to improve wound healing. This project aims to combine the properties of hydrogels based on chitosan (CHT) and the polymer of β cyclodextrin (PCD) for local delivery of cinnamaldehyde (CN) in diabetic foot ulcers. This work consisted of the development and characterisation of the hydrogel, the evaluation of the CN release kinetics and cell viability (on a MC3T3 pre-osteoblast cell line), and the evaluation of the antimicrobial and antibiofilm activity (S. aureus and P. aeruginosa). The results demonstrated the successful development of a cytocompatible (ISO 10993-5) injectable hydrogel with antibacterial (99.99% bacterial reduction) and antibiofilm activity. Furthermore, a partial active molecule release and an increase in hydrogel elasticity were observed in the presence of CN. This leads us to hypothesise that a reaction between CHT and CN (a Schiff base) can occur and that CN could act as a physical crosslinker, thus improving the viscoelastic properties of the hydrogel and limiting CN release.

Polysaccharides and Metal Nanoparticles for Functional Textiles: A Review

Nanotechnology is a powerful tool for engineering functional materials that has the potential to transform textiles into high-performance, value-added products. In recent years, there has been considerable interest in the development of functional textiles using metal nanoparticles (MNPs). The incorporation of MNPs in textiles allows for the obtention of multifunctional properties, such as ultraviolet (UV) protection, self-cleaning, and electrical conductivity, as well as antimicrobial, antistatic, antiwrinkle, and flame retardant properties, without compromising the inherent characteristics of the textile. Environmental sustainability is also one of the main motivations in development and innovation in the textile industry. Thus, the synthesis of MNPs using ecofriendly sources, such as polysaccharides, is of high importance. The main functions of polysaccharides in these processes are the reduction and stabilization of MNPs, as well as the adhesion of MNPs onto fabrics. This review covers the major research attempts to obtain textiles with different functional properties using polysaccharides and MNPs. The main polysaccharides reported include chitosan, alginate, starch, cyclodextrins, and cellulose, with silver, zinc, copper, and titanium being the most explored MNPs. The potential applications of these functionalized textiles are also reported, and they include healthcare (wound dressing, drug release), protection (antimicrobial activity, UV protection, flame retardant), and environmental remediation (catalysts).

How Adding Chlorhexidine or Metallic Nanoparticles Affects the Antimicrobial Performance of Calcium Hydroxide Paste as an Intracanal Medication: An In Vitro Study

The aim of our study was to explore the potential value of metallic (Ag, Cu, and Zn) salts, polymer/metallic nanoparticles, and chlorhexidine (CHX) for improving the antimicrobial activity of calcium hydroxide (CH) against E. faecalis and C. albicans, associated with persistent endodontic infections. A first screening was performed by determining minimum inhibitory/bactericidal concentrations (MIC/MBC). Antimicrobial activity of the CH paste mixed with metallic salts, chitosan or cyclodextrin polymer metallic nanoparticles was compared to the antimicrobial activity of CH paste alone and CH + CHX using a time-kill kinetics assay. The effect of the antimicrobials on the rheological and the key mechanical properties were also examined. Copper and zinc were discarded because of their MIC/MBC values and silver because of its kill time curve profile. Except for a slower setting time after 24 h and a higher weight loss after 1 week of incubation, the mechanical behavior of the CH paste was unaffected by the addition of CHX. Polymeric/metallic nanoparticles failed to potentiate the antimicrobial effect of CH. By contrast, CHX increased this effect and thus could help eradicate E. faecalis associated with persistent root canal infections without altering the desired key physical properties of the CH paste.

In Vitro Microbiological and Drug Release of Silver/Ibuprofen Loaded Wound Dressing Designed for the Treatment of Chronically Infected Painful Wounds

This study consisted of developing a dressing loaded with silver (Ag) and ibuprofen (IBU) that provides a dual therapy, antibacterial and antalgic, intended for infected painful wounds. Therefore, non-woven polyethyleneterephtalate (PET) textiles nonwovens were pre-treated by cyclodextrin crosslinked with citric acid by a pad/dry/cure process. Then, textiles were impregnated in silver solution followed by a thermal treatment and were then coated by Layer-by-Layer (L-b-L) deposition of a polyelectrolyte multilayer (PEM) system consisting of anionic water-soluble poly(betacyclodextrin citrate) (PCD) and cationic chitosan. Finally, ibuprofen lysinate (IBU-L) was loaded on the PEM coating. We demonstrated the complexation of IBU with native βCD and PCD by phase solubility diagram and ¹H NMR. PEM system allowed complete IBU-L release in 6 h in PBS pH 7.4 batch (USP IV). On the other hand, microbiological tests demonstrated that loaded silver induced bacterial reduction of 4 Log₁₀ against S. aureus and E. coli and tests revealed that ibuprofen lysinate loading did not interfere with the antibacterial properties of the dressing.

Investigating the effect of multi-coated hydrogel layer on characteristics of electrospun PCL membrane coated with gelatin/silver nanoparticles for wound dressing application

In this study, the effect of coated hydrogel layer on characteristics of the whole gelatin/silver nanoparticles multi-coated polycaprolactone membrane (PCLGelAg) was investigated through systematic and typical wound dressing characterizations to select the optimal number of layers for practical applications. Scanning electron microscopy, free swell absorptive capacity and tensile test in both wet and dry conditions were conducted to characterize all fabricated membranes of six coating times. In vitro cytotoxicity and agar diffusion evaluation were also carried out to assess the biocompatibility and antibacterial activity of the membranes. The findings illustrated that as the coated layers increase, the absorptive capacity, and degradation rate were higher, the membranes were stiffer in dry state while the tensile strength in wet state, elongation, and cell viability were significantly decreased. PCLGelAg3 was chosen to be the best fit for wound healing since it maintained quite sufficient maximum buffer uptake, elasticity, cell viability along with inducing abnormalities in bacterial morphology and preventing biofilm formation.

Release-killing properties of a textile modified by a layer-by-layer coating based on two oppositely charged cyclodextrin polyelectrolytes

Infections represent a major medical concern and have severe impact on the public health economy. Antimicrobial coatings represent one major solution and are the subject of many investigations in academic and industrial research. Polyelectrolyte multilayers (PEMs) consist in the step-by-step deposition of polyanions and polycations films on surfaces. The wide range of disposable polyelectrolytes makes this approach among the most versatile methods as it allows to design surfaces that prevent bacterial adhesion, and kill bacteria by contact or by releasing antibacterial agents. The present work focused on the release-killing effect of an active PEM coating of a polyethylene terephthalate (PET) textile support. This activity was obtained thanks to the PEM film build up using cationic and anionic polyelectrolytes both based on cyclodextrins (PCD- and PCD+) that provided a reservoir property and prolonged release of triclosan (TCS). To this effect, a PET non-woven preliminarily modified with carboxylate groups by applying a thermofixation process was then treated by dip-coating, alternating soaking cycles in cationic PCD+ and in anionic PCD- solutions. Samples coated with such PEM film were then loaded with TCS whose release was assessed in dynamic mode in a phosphate buffered saline solution (PBS) at 37 °C. In parallel, TCS/PCD+ and TCS/PCD- interactions were investigated by Nuclear Magnetic Resonance (NMR) and phase solubility study, and the biocide activity was assessed against S. aureus and E. coli. Finally, the present study has demonstrated that our PCD+/PCD- PEM system presented release-killing properties that supplement the contact-killing effect of this system that was reported in a previous paper.

Chitosan/Polycyclodextrin (CHT/PCD)-Based Sponges Delivering VEGF to Enhance Angiogenesis for Bone Regeneration

Vascularization is one of the main challenges in bone tissue engineering (BTE). In this study, vascular endothelial growth factor (VEGF), known for its angiogenic effect, was delivered by our developed sponge, derived from a polyelectrolyte complexes hydrogel between chitosan (CHT) and anionic cyclodextrin polymer (PCD). This sponge, as a scaffold for growth factor delivery, was formed by freeze-drying a homogeneous CHT/PCD hydrogel, and thereafter stabilized by a thermal treatment. Microstructure, water-uptake, biodegradation, mechanical properties, and cytocompatibility of sponges were assessed. VEGF-delivery following incubation in medium was then evaluated by monitoring the VEGF-release profile and its bioactivity. CHT/PCD sponge showed a porous (open porosity of 87.5%) interconnected microstructure with pores of different sizes (an average pore size of 153 μm), a slow biodegradation (12% till 21 days), a high water-uptake capacity (~600% in 2 h), an elastic property under compression (elastic modulus of compression 256 ± 4 kPa), and a good cytocompatibility in contact with osteoblast and endothelial cells. The kinetic release of VEGF was found to exert a pro-proliferation and a pro-migration effect on endothelial cells, which are two important processes during scaffold vascularization. Hence, CHT/PCD sponges were promising vehicles for the delivery of growth factors in BTE.

Nanomaterials for Wound Dressings: An Up-to-Date Overview

As wound healing continues to be a challenge for the medical field, wound management has become an essential factor for healthcare systems. Nanotechnology is a domain that could provide different new approaches concerning regenerative medicine. It is worth mentioning the importance of nanoparticles, which, when embedded in biomaterials, can induce specific properties that make them of interest in applications as materials for wound dressings. In the last years, nano research has taken steps to develop molecular engineering strategies for different self-assembling biocompatible nanoparticles. It is well-known that nanomaterials can improve burn treatment and also the delayed wound healing process. In this review, the first-line of bioactive nanomaterials-based dressing categories frequently applied in clinical practice, including semi-permeable films, semipermeable foam dressings, hydrogel dressings, hydrocolloid dressings, alginate dressings, non-adherent contact layer dressings, and multilayer dressings will be discussed. Additionally, this review will highlight the lack of high-quality evidence and the necessity for future advanced trials because current wound healing therapies generally fail to provide an excellent clinical outcome, either structurally or functionally. The use of nanomaterials in wound management represents a unique tool that can be specifically designed to closely reflect the underlying physiological processes in tissue repair.

Stent coating by electrospinning with chitosan/poly-cyclodextrin based nanofibers loaded with simvastatin for restenosis prevention

The main cause of failure of angioplasty stenting is restenosis due to neointimal hyperplasia, a too high proliferation of smooth muscle cells (SMC). The local and sustained delivery of selective pleiotropic drugs to limit SMC proliferation seems to be the hopeful solution to minimize this post surgery complication. The aim of this study is to develop a stent covered by nanofibers (NFs) produced by electrospinning, loaded with simvastatin (SV), a drug commonly used for restenosis prevention. NFs were prepared from the electrospinning of a solution containing SV and a mixture of chitosan (cationic) and β-cyclodextrin (CD) polymer (anionic) which form together a polyelectrolyte complex that makes up the NFs matrix. First, the SV/CD interactions were studied by phase solubility diagram, DRX and DSC. The electrospinning process was then optimized to cover a self-expandable NiTiNOL stent and the mechanical resistance of the NFs sheath upon its introduction inside the delivery catheter was considered, using a crimper apparatus. The morphology, coating thicknesses and diameters of nanofibers were studied by scanning electron microscopy. The SV loading rates on the stents were controlled by the electrospinning time, and the presence of SV in the NFs was confirmed by FTIR. NFs stability in PBS pH 7.4 buffer could be improved after thermal post-treatment of NFs and in vitro release of SV in dynamic conditions demonstrated that the release profiles were influenced by the presence of CD polymer in NFs and by the thickness of the NFs sheath. Finally, a covered stent delivering 3 µg/mm² of SV within 6 h was obtained, whose efficiency will be investigated in a further in vivo study.

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 Advances in Biomedical Applications of Carbon Nanotubes

Unique chemical, physical, and biological features of carbon nanotubes make them an ideal candidate for myriad applications in industry and biomedicine. Carbon nanotubes have excellent electrical and thermal conductivity, high biocompatibility, flexibility, resistance to corrosion, nano-size, and a high surface area, which can be tailored and functionalized on demand. This review discusses the progress and main fields of bio-medical applications of carbon nanotubes based on recently-published reports. It encompasses the synthesis of carbon nanotubes and their application for bio-sensing, cancer treatment, hyperthermia induction, antibacterial therapy, and tissue engineering. Other areas of carbon nanotube applications were out of the scope of this review. Special attention has been paid to the problem of the toxicity of carbon nanotubes.

Influence of the Soluble⁻Insoluble Ratios of Cyclodextrins Polymers on the Viscoelastic Properties of Injectable Chitosan⁻Based Hydrogels for Biomedical Application

Injectable pre-formed physical hydrogels provide many advantages for biomedical applications. Polyelectrolyte complexes (PEC) formed between cationic chitosan (CHT) and anionic polymers of cyclodextrin (PCD) render a hydrogel of great interest. Given the difference between water-soluble (PCDs) and water-insoluble PCD (PCDi) in the extension of polymerization, the present study aims to explore their impact on the formation and properties of CHT/PCD hydrogel obtained from the variable ratios of PCDi and PCDs in the formulation. Hydrogels CHT/PCDi/PCDs at weight ratios of 3:0:3, 3:1.5:1.5, and 3:3:0 were elaborated in a double–syringe system. The chemical composition, microstructure, viscoelastic properties, injectability, and structural integrity of the hydrogels were investigated. The cytotoxicity of the hydrogel was also evaluated by indirect contact with pre-osteoblast cells. Despite having similar shear–thinning and self-healing behaviors, the three hydrogels showed a marked difference in their rheological characteristics, injectability, structural stability, etc., depending on their PCDi and PCDs contents. Among the three, all the best above-mentioned properties, in addition to a high cytocompatibility, were found in the hydrogel 3:1.5:1.5. For the first time, we gained a deeper understanding of the role of the PCDi/PCDs in the injectable pre-formed hydrogels (CHT/PCDi/PCDs), which could be further fine-tuned to enhance their performance in biomedical applications.