Effects of chitin and chitosan on blood coagulation

Chitosan-based materials for dental implantology: A comprehensive review

Chitosan, a versatile biopolymer, has gained recognition in the discipline of dental implantology due to possessing salient properties. This comprehensive review explores the potential of chitosan in dental implants, focusing on its biocompatibility, bioactivity, and the various chitosan-based materials that have been utilized for dental implant therapy. The review also highlights the importance of surface treatment in dental implants to enhance osseointegration and inhibit bacterial biofilm formation. Additionally, the chemical structure, properties, and sources of chitosan are described, along with its different structural forms. The characteristics of chitosan particularly color, molecular weight, viscosity, and degree of deacetylation are discussed about their influence on its applications. This review provides valuable insights into the promising utilization of polymeric chitosan in enhancing the success and functionality of dental implants. This study highlights the potential applications of chitosan in oral implantology. Chitosan possesses various advantageous properties, including muco-adhesiveness, hemostatic action, biocompatibility, biodegradability, bioactivity, and antibacterial and antifungal activities, which enhance its uses in dental implantology. However, it has limited aqueous solubility at the physiological pH, which sometimes restricts its biological application, but this problem can be overcome by using modified chitosan or chitosan derivatives, which have also shown encouraging results. Recent research suggests that chitosan may act as a promising material for coating titanium-based implants, improving osteointegration together with antibacterial properties.

Chitosan-based dressing for management of palatal donor site: A randomized clinical trial

AIMS

This study aimed to evaluate the effectiveness of a chitosan-based dressing (CD) in achieving early wound healing and hemostasis at palatal donor sites in patients undergoing free gingival graft (FGG) surgery.

METHODS

Thirty-two patients requiring FGG were treated in this randomized controlled clinical trial. Complete epithelialization (CE) and color match (CM) at donor sites were assessed by a blinded examiner on postoperative days 7, 14, 21, and 28. Donor sites were compressed for 2 min with wet gauze (WG) alone in control group (CG) or WG + CD in test group (TG) immediately after graft harvesting, and immediate bleeding (IB) was recorded (yes/no). Delayed bleeding (DB) (for 1 week), and number of analgesic tablets consumed, and VAS scores for pain (for 2 weeks) were recorded by patient every day.

RESULTS

Twenty-eight patients (14 in each group) were included in final analysis. The prevalence of CE (at weeks 2 and 3) and VAS scores for CM scores were higher in TG but the intergroup differences were statistically significant only for CM (at week 4). Number of patients exhibiting IB and DB was significantly fewer in the TG (p < .05). Although average pain scores and analgesic consumption were higher in TG up to 5 days, differences between two groups were not statistically significant at any time point.

CONCLUSION

Our data suggests that the application of CD increased re-epithelialization and accelerated wound healing process, although it did not reach statistical significance. Moreover, CD was found to significantly reduce bleeding complications, but it did not decrease the pain levels.

Antibiofilm and antithrombotic hydrogel coating based on superhydrophilic zwitterionic carboxymethyl chitosan for blood-contacting devices

Blood-contacting devices must be designed to minimize the risk of bloodstream-associated infections, thrombosis, and intimal lesions caused by surface friction. However, achieving effective prevention of both bloodstream-associated infections and thrombosis poses a challenge due to the conflicting nature of antibacterial and antithrombotic activities, specifically regarding electrostatic interactions. This study introduced a novel biocompatible hydrogel of sodium alginate and zwitterionic carboxymethyl chitosan (ZW@CMC) with antibacterial and antithrombotic activities for use in catheters. The ZW@CMC hydrogel demonstrates a superhydrophilic surface and good hygroscopic properties, which facilitate the formation of a stable hydration layer with low friction. The zwitterionic-functionalized CMC incorporates an additional negative sulfone group and increased negative charge density in the carboxyl group. This augmentation enhances electrostatic repulsion and facilitates the formation of hydration layer. This leads to exceptional prevention of blood clotting factor adhesion and inhibition of biofilm formation. Subsequently, the ZW@CMC hydrogel exhibited biocompatibility with tests of in vitro cytotoxicity, hemolysis, and catheter friction. Furthermore, in vivo tests of antithrombotic and systemic inflammation models with catheterization indicated that ZW@CMC has significant advantages for practical applications in cardiovascular-related and sepsis treatment. This study opens a new avenue for the development of chitosan-based multifunctional hydrogel for applications in blood-contacting devices.

Enhancing immune response, antioxidant capacity, and gut health in growing beagles through a chitooligosaccharide diet

Chitooligosaccharides (COS) have attracted significant attention due to their unique biological activities, water solubility, and absorbable properties. The objective of the present study was to investigate the impact of COS-supplemented diets on the immune response, antioxidative capacity, hematology, serum biochemistry, and modulation of intestinal microbiota in growing beagles. Twelve weaning male beagles (6 weeks old; weighing 3.6 ± 0.6 kg) were fed either a control diet (food without COS, n = 6) or a COS-supplemented diet (n = 6) twice daily for 7 weeks. Blood samples collected at weeks 4 and 7 indicated that hematology and serum biochemistry remained unaffected by COS supplementation. Compared with the control group, the test group showed higher levels of serum antibodies against the canine distemper virus and parvovirus, higher levels of immunoglobulin A, G, and M, and increased activities of superoxide dismutase, glutathione peroxidase, and catalase. In addition, COS was observed to modulate the intestinal flora by enhancing the presence of probiotics, such as Muribaculaceae, Prevotellaceae_Ga6A1_group, Lactobacillus, Collinsella, Blautia, and Lachnospiraceae_NK4A136_group. In summary, a COS-supplemented diet could effectively improve dog health by regulating immune function and antioxidant responses and modulating intestinal microbiota. This study highlights the potentiality of using COS as a valuable nutraceutical for growing dogs.

Progress in injectable hydrogels for the treatment of incompressible bleeding: an update

Uncontrollable haemorrhage from deep, noncompressible wounds remains a persistent and intractable challenge, accounting for a very high proportion of deaths in both war and disaster situations. Recently, injectable hydrogels have been increasingly studied as potential haemostatic materials, highlighting their enormous potential for the management of noncompressible haemorrhages. In this review, we summarize haemostatic mechanisms, commonly used clinical haemostatic methods, and the research progress on injectable haemostatic hydrogels. We emphasize the current status of injectable hydrogels as haemostatic materials, including their physical and chemical properties, design strategy, haemostatic mechanisms, and application in various types of wounds. We discuss the advantages and disadvantages of injectable hydrogels as haemostatic materials, as well as the opportunities and challenges involved. Finally, we propose cutting-edge research avenues to address these challenges and opportunities, including the combination of injectable hydrogels with advanced materials and innovative strategies to increase their biocompatibility and tune their degradation profile. Surface modifications for promoting cell adhesion and proliferation, as well as the delivery of growth factors or other biologics for optimal wound healing, are also suggested. We believe that this paper will inform researchers about the current status of the use of injectable haemostatic hydrogels for noncompressible haemorrhage and spark new ideas for those striving to propel this field forward.

Chitosan thread in the healing of the cecal wall of rabbits (Oryctolagus cuniculus) submitted to cecorrhaphy

The development and evaluation of synthesis materials are crucial to reducing the morbidity and magnitude of post-enterorrhaphy surgical complications. Despite the possibility of production, chitosan thread has not yet been used in enterorrhaphy, and its effects on intestinal healing have not been evaluated. Therefore, this study aimed to evaluate the effects of chitosan thread on the intestinal wall repair of rabbits submitted to cecorrhaphy. For this, 42 rabbits were allocated into two groups with 21 animals. One group was submitted to cecorrhaphy with chitosan suture thread (CG) and the other with poliglecaprone suture thread (PG). The occurrence of postoperative complications, the intensity of edema, cellular response, formation of granulation tissue, as well as the deposition and maturation of collagen fibers, and the intensity of vascular endothelial growth factor (VEGF-α) expression, were evaluated during the intestinal wall repair process. The evaluations occurred on the 5th, 15th, and 25th postoperative (PO) days. The animals did not develop peritonitis, but adherence was observed in six animals from CG and seven from PG, with no difference between groups. The polymorphonuclear infiltrate showed higher intensity and higher amount of type III collagen fibers in CG on the 15th PO day. In contrast, a lower amount of type I collagen fibers was observed in CG samples on the 25th PO day. Therefore, the chitosan thread used for cecorrhaphy in rabbits results in minimal postoperative complications, presents biocompatibility, and bioactively assists the tissue repair process of the cecal wall, inducing minimal tissue reaction, stimulating the deposition of type III collagen fibers in the proliferative phase, with sustained VEGF-α expression, but with reduced deposition of type I fibers, indicating a delay in collagen maturation.

Sterilized Polyhexanide-Releasing Chitosan Membranes with Potential for Use in Antimicrobial Wound Dressings

Wound infection is a common complication of chronic wounds. It can impair healing, which may not occur without external help. Antimicrobial dressings (AMDs) are a type of external help to infected chronic wounds. In this study, highly porous membranes made of only chitosan and containing the antiseptic polyhexanide (poly(hexamethylene biguanide); PHMB) were prepared by cryogelation, aiming to be used in AMDs. These membranes exhibited a water swelling capacity of 748%, a water drop penetration time of 11 s in a dry membrane and a water vapor transmission rate of 34,400 g H2O/m2/24 h when in contact with water. The best drug loading method involved simultaneous loading by soaking in a PHMB solution and sterilization by autoclaving, resulting in sterilized, drug-loaded membranes. When these membranes and a commercial PHMB-releasing AMD were assayed under the same conditions, albeit far from the in vivo conditions, their drug release kinetics were comparable, releasing PHMB for ca. 6 and 4 h, respectively. These membranes exhibited high antibacterial activity against Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa, which are bacterial species commonly found in infected wounds and blood clotting activity. The obtained results suggest that these membranes may have potential for use in the development of AMDs.

Neem (Azadirachta Indica) and silk fibroin associated hydrogel: Boon for wound healing treatment regimen

Background & Objectives

Wound healing is the complex physiological process of replacing damaged cells or tissue layers. The neem (Azadirachta Indica) has a variety of biological activities, which may hasten the rate at which the wound healing mechanism occurs. Silk fibroin is a biomaterial that is reported for its tissue regeneration activity. So, the present study was designed to assess the effectiveness of a hydrogel comprising neem and silk fibroin biomaterials for the treatment of wounds.

Methods

Topical neem hydrogels (N-HG) with and without silk fibroin (N-SFB-HG) were prepared using neem extract, silk fibroin, and guar gum, which act by entrapping the components by forming a gel. Evaluation tests such as Fourier transform infrared spectroscopy (FT-IR), visual emergence, pH, rheological behavior, spreading capacity, drug content, skin irritation, anti-microbial action, in vivo wound healing activity, and stability were carried out.

Results

The FT-IR results showed no chemical interaction between the constituents. The formed hydrogels had pH values of 5.87 ± 0.3 for N-HG and 5.76 ± 0.2 for N-SFB-HG. The preferred topical gel viscosity was observed in the N-HG (54.2 ± 3.2cPs) and N-SFB-HG (59.9 ± 4.8cPs) formulations. The formulated hydrogels were sterile and did not irritate the skin. The in vivo wound healing investigation results reveal that the N-SF-HG treatment speeds up the regeneration of the injured area faster when compared to control and N-HG treated groups.

Interpretation & Conclusion

These results support the efficacy of the topical hydrogel formulation, including neem and silk fibroin. Therefore, the neem-silk fibroin hydrogel formulation is a therapeutically viable choice that, following necessary clinical research, might be utilized in novel formulations for managing chronic wounds.

Chitosan-Based Biomaterials for Hemostatic Applications: A Review of Recent Advances

Hemorrhage is a detrimental event present in traumatic injury, surgery, and disorders of bleeding that can become life-threatening if not properly managed. Moreover, uncontrolled bleeding can complicate surgical interventions, altering the outcome of surgical procedures. Therefore, to reduce the risk of complications and decrease the risk of morbidity and mortality associated with hemorrhage, it is necessary to use an effective hemostatic agent that ensures the immediate control of bleeding. In recent years, there have been increasingly rapid advances in developing a novel generation of biomaterials with hemostatic properties. Nowadays, a wide array of topical hemostatic agents is available, including chitosan-based biomaterials that have shown outstanding properties such as antibacterial, antifungal, hemostatic, and analgesic activity in addition to their biocompatibility, biodegradability, and wound-healing effects. This review provides an analysis of chitosan-based hemostatic biomaterials and discusses the progress made in their performance, mechanism of action, efficacy, cost, and safety in recent years.

Chitosan-based hydrogel wound dressing: From mechanism to applications, a review

As promising biomaterials, hydrogels are widely used in the medical engineering field, especially in wound repairing. Compared with traditional wound dressings, such as gauze and bandage, hydrogel could absorb and retain more water without dissolving or losing its three-dimensional structure, thus avoiding secondary injury and promoting wound healing. Chitosan and its derivatives have become hot research topics for hydrogel wound dressing production due to their unique molecular structure and diverse biological activities. In this review, the mechanism of wound healing was introduced systematically. The mechanism of action of chitosan in the first three stages of wound repair (hemostasis, antimicrobial properties and progranulation), the effect of chitosan deacetylation and the molecular weight on its performance are analyzed. Additionally, the recent progress in intelligent and drug-loaded chitosan-based hydrogels and the features and advantages of chitosan were discussed. Finally, the challenges and prospects for the future development of chitosan-based hydrogels were discussed.

Nondigestible Functional Oligosaccharides: Enzymatic Production and Food Applications for Intestinal Health

Nondigestible functional oligosaccharides are of particular interest in recent years because of their unique prebiotic activities, technological characteristics, and physiological effects. Among different types of strategies for the production of nondigestible functional oligosaccharides, enzymatic methods are preferred owing to the predictability and controllability of the structure and composition of the reaction products. Nondigestible functional oligosaccharides have been proved to show excellent prebiotic effects as well as other benefits to intestinal health. They have exhibited great application potential as functional food ingredients for various food products with improved quality and physicochemical characteristics. This article reviews the research progress on the enzymatic production of several typical nondigestible functional oligosaccharides in the food industry, including galacto-oligosaccharides, xylo-oligosaccharides, manno-oligosaccharides, chito-oligosaccharides, and human milk oligosaccharides. Moreover, their physicochemical properties and prebiotic activities are discussed as well as their contributions to intestinal health and applications in foods.

The Effects of Chitosan on the Healing Process of Oral Mucosa: An Observational Cohort Feasibility Split-Mouth Study

The healing process is a dynamic process accompanied by some classical symptoms of inflammation such as redness, swelling, pain, and loss of function. Chitosan is a natural polymer with properties that contribute to tissue healing, with properties that could be applied in periodontal therapy, such as the wound healing of oral mucosa. This experimental split-mouth study aims to assess the possibilities of chitosan influencing the healing process of oral mucosa in eight patients, where the studied group was subjected to two oral surgeries: one with chitosan hydrogel into the socket and other without the biomaterial. A semi-quantitative analysis of the data was performed. Some classic signs of inflammation in a short period of time were observed where chitosan acted, compared to the control. An absence of bleeding was observed in the chitosan cases. According to the literature, chitosan recruits and activates neutrophils and macrophages and stimulates angiogenesis. Hemostatic and antimicrobial activity of chitosan also play an important role in wound healing. Chitosan seems to improve the postoperative quality of patients, allowing rapid wound healing with less complications.

A Review of Pickering Emulsions: Perspectives and Applications

Pickering emulsions are systems composed of two immiscible fluids stabilized by organic or inorganic solid particles. These solid particles of certain dimensions (micro- or nano-particles), and desired wettability, have been shown to be an alternative to conventional emulsifiers. The use of biodegradable and biocompatible stabilizers of natural origin, such as clay minerals, presents a promising future for the development of Pickering emulsions and, with this, they deliver some advantages, especially in the area of biomedicine. In this review, the effects and characteristics of microparticles in the preparation and properties of Pickering emulsions are presented. The objective of this review is to provide a theoretical basis for a broader type of emulsion, in addition to reviewing the main aspects related to the mechanisms and applications to promote its stability. Through this review, we highlight the use of this type of emulsion and its excellent properties as permeability promoters of solid particles, providing ideal results for local drug delivery and use in Pickering emulsions.

Chitosan Nanoparticles: A Versatile Platform for Biomedical Applications

Chitosan is a biodegradable and biocompatible natural polymer that has been extensively explored in recent decades. The Food and Drug Administration has approved chitosan for wound treatment and nutritional use. Furthermore, chitosan has paved the way for advancements in different biomedical applications including as a nanocarrier and tissue-engineering scaffold. Its antibacterial, antioxidant, and haemostatic properties make it an excellent option for wound dressings. Because of its hydrophilic nature, chitosan is an ideal starting material for biocompatible and biodegradable hydrogels. To suit specific application demands, chitosan can be combined with fillers, such as hydroxyapatite, to modify the mechanical characteristics of pH-sensitive hydrogels. Furthermore, the cationic characteristics of chitosan have made it a popular choice for gene delivery and cancer therapy. Thus, the use of chitosan nanoparticles in developing novel drug delivery systems has received special attention. This review aims to provide an overview of chitosan-based nanoparticles, focusing on their versatile properties and different applications in biomedical sciences and engineering.

Regioselective sulfated chitosan produces a biocompatible and antibacterial wound dressing with low inflammatory response

The aim of current study is to tailor chitosan derivate which is water-soluble while presents original biological features of chitosan. For this purpose, the 6-O chitosan sulfate (CS) with naked amine groups was synthesized via regioselective modification of chitosan (C) during which both crosslinking capacity and antibacterial properties of the C were remained intact. This was achieved by sulfation the C under controlled acidic conditions using chlorosulfonic acid/sulfuric acid mixture. Subsequently, a chemically crosslinked hydrogel of the CS was used as a wound dressing substrate. The modified sulfate groups retained the biocompatibility of C and showed antibacterial effects against gram-positive and gram-negative bacteria. In addition, the presence of sulfate groups in the CS chemical structure improved its anticoagulant activity compared to the unmodified C. Both in vitro and in vivo enzyme-linked immunosorbent assay (ELISA) measurements showed that CS had a higher potential to bind and scavenger anti-inflammatory cytokines, including IL-6 and transforming growth factor-β (TGF-β), both of which play critical roles in the early stage of the wound healing process. After treatment of full-thickness wounds with CS hydrogels, the macrophage cells (c.a. 6 × 10⁴ cells) expressed significantly more M2 phenotype markers compared to the C group (4.2 × 10⁴ cells). Furthermore, the CS hydrogel induced better re-epithelialization and vascularization of full-thickness wounds in mice compared to the C hydrogel during 30 days.

Increased production of chitinase by a Paenibacillus illinoisensis isolated from Brazilian coastal soil when immobilized in alginate beads

The accumulation of chitin waste from the seafood industry is a serious environmental problem. However, this residue can be degraded by chitinases and its subproducts, such as chitosan, economically exploited. In this study, a chitinase producer bacteria, identified as Paenibacillus illinoisensis, was isolated from the Brazilian coastal city of Terra de Areia - Rio Grande Do Sul (RS) and was immobilized within alginate beads to evaluate its chitinase production. The alginate beads containing cells presented an average size of 4 mm, 99% of immobilization efficiency and increased the enzymatic activity in 40.71% compared to the free cells. The biomass during enzymatic production increased 62.01% and the total cells leaked from the alginate beads corresponded to 6.46% after 96 h. Immobilized cells were reused in a sequential batch system and remained stable for production for up to four 96-h cycles, decreasing only 21.04% of the initial activity at the end of the fourth cycle. Therefore, the methodology used for cell immobilization resulted in adequate beads to maintain cell viability during the enzymatic production, increasing enzymatic activity, showing low cell leakage from the support and appropriate recyclable capacity.

Surveying the Oral Drug Delivery Avenues of Novel Chitosan Derivatives

Chitosan has come a long way in biomedical applications: drug delivery is one of its core areas of imminent application. Chitosan derivatives are the new generation variants of chitosan. These modified chitosans have overcome limitations and progressed in the area of drug delivery. This review briefly surveys the current chitosan derivatives available for biomedical applications. The biomedical applications of chitosan derivatives are revisited and their key inputs for oral drug delivery have been discussed. The limited use of the vast chitosan resources for oral drug delivery applications, speculated to be probably due to the interdisciplinary nature of this research, is pointed out in the discussion. Chitosan-derivative synthesis and practical implementation for oral drug delivery require distinct expertise from chemists and pharmacists. The lack of enthusiasm could be related to the inadequacy in the smooth transfer of the synthesized derivatives to the actual implementers. With thiolated chitosan derivatives predominating the oral delivery of drugs, the need for representation from the vast array of ready-to-use chitosan derivatives is emphasized. There is plenty to explore in this direction.

Multifunctional Hemostatic PVA/Chitosan Sponges Loaded with Hydroxyapatite and Ciprofloxacin

The present study describes the development of multifunctional hemostatic sponges to control bleeding. Chitosan (Ch) and poly(vinyl alcohol) (PVA) were selected as the basic polymeric matrix [Ch/PVA] for sponges. Glycerol and citric acid were used as crosslinkers [Ch/PVA/G(Cl)] to enhance the mechanical properties of the developed sponges. Ciprofloxacin (AB) was added to the developed sponge to impart antibacterial activity. Hydroxyapatite (HA) was also added, which would make the sponge suitable for bone surgery. Among the developed sponges, the Ch/PVA/G(Cl)-HA-AB sponge demonstrated enhanced cell viability, mechanical properties, and strong antimicrobial effect against Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus, in addition to platelet aggregation activity. The addition of ciprofloxacin and hydroxyapatite promotes a unique synergistic effect of antimicrobial activity and hemostasis. Thus, the present study introduces Ch/PVA/G(Cl)-HA-AB, a multifunctional hemostatic sponge that would be suitable for bone surgical applications.

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

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

MXene-Enhanced Chitin Composite Sponges with Antibacterial and Hemostatic Activity for Wound Healing

This study shows the effective use of MXene-based nanomaterials to improve the performance of biocomposite sponges in wound healing. In this way, diverse chitin/MXene composite sponges are fabricated by incorporating MXene-based nanomaterials with various morphology (accordion-shaped, intercalated, single-layer, gold nanoparticles (AuNPs)-loaded single-layer) into the network of chitin sponge (CH), which can prevent massive blood losses and promote the healing process of bacterial-infected wounds. With the addition of MXene-based nanomaterials, the hemostatic efficacy of CH is enhanced due to the improved hemophilicity and accelerated blood coagulation kinetics. Furthermore, the composite sponges show a predominant antibacterial activity through the synergy between the capture and the photothermal effects. Importantly, the addition of AuNPs to composite sponges further improves hemostatic performance and promotes normal skin cell migration to heal the infected wound, achieving wound closure rates of 84% on day 9. These initial studies expand the applications of MXene-based nanomaterials in biomedical fields.

Hyaluronic acid and chitosan-based electrospun wound dressings: Problems and solutions

To date, available review papers related to the electrospinning of biopolymers including polysaccharides for wound healing were focused on summarizing the process conditions for two candidates, namely chitosan and hyaluronic acid. However, most reviews lack the discussion of problems of hyaluronan and chitosan electrospun nanofibers for wound dressing applications. For this reason, it is required to update information by providing a comprehensive overview of all factors which may play a role in the electrospinning of hyaluronic acid and chitosan for applications of wound dressings. This review summarizes the fabricated chitosan and hyaluronic acid electrospun nanofibers as wound dressings in the last years, including methods of preparations of nanofibers and challenges for the electrospinning of both pure chitosan and hyaluronic acid and strategies how to overcome the existing difficulties. Moreover, in this review the biological roles and mechanisms of chitosan and hyaluronic acid in the wound healing process are explained including the advantages of nanofibers for ideal wound management using the common solvents, copolymers enhancing spinning process, and the most biologically active incorporated substances thereby providing drug delivery in wound healing.

The potential of chitosan-based haemostats for use in neurosurgical setting - Literature review

Haemorrhage is a major nuance in neurosurgery since blood can distort the surgeon's field of view and increase the risk of post-operative complications. Currently a variety of commercially available haemostats have been approved for use in neurosurgery, but they have caveats to their use in the brain, including, localised tissue compression, neural toxicity, induce immune reaction or form thrombus within the vessel. Thus, there is a need for haemostats that are efficacious and safe for application on brain and spinal tissue. Chitosan is a naturally occurring bio-polymer that is found on the exoskeleton of arthropods and the cell wall of fungi. Chitosan has been shown to accelerate haemostasis through a myriad of physiological pathways. These findings have led to the development of multiple chitosan-based haemostats, for use in peripheral human tissue. Although, clinical data regarding the use of chitosan-based haemostats in the brain is lacking, a range on in vivo studies have proven chitosan to be efficacious and safe in managing neurosurgical bleeds. Similarly, literature comparing chitosan-based haemostats with commercial haemostats used commonly in neurosurgery, have all demonstrated chitosan to be the superior agent. Additionally, clinical trials of chitosan-based haemostat used in peripheral tissue have all demonstrated chitosan to be safe for human use. The marriage of these findings indicates that the safety and superior efficacy of chitosan-based haemostat, makes it a potentially suitable haemostat for use in neurosurgical setting. However, further research pertaining to the clinical use of chitosan-based haemostat within the central nervous system needs to be conducted.

Multi-functional nanocellulose-chitosan dressing loaded with antibacterial lawsone for rapid hemostasis and cutaneous wound healing

Cutaneous wounds accompanied by massive bleeding, bacterial infections might be lethal and cause fundamental therapeutic impediments in clinical fields. As part of the push for a solution, biomaterial having hemostatic-antibacterial features is highly desirable. Inspired by this concept, freeze dried sponges were developed followed by combining tempo-oxidized nanocellulose (TOCN), chitosan using EDC/NHS cross-linker with antibacterial lawsone loading for controlled delivery of this compound during wound healing. The pore diameter decreased upon increasing chitosan (2.5, 3.5, 4.5, 5.5% w/v) while TOCN ensured scaffold's mechanical stability. The in vitro degradation, lawsone release from fibroblast cell-compatible sponge was faster in acidic pH 5.5 than physiologic pH 7.4 indicating adaptability to physiological skin milieu of wounds. The rat tail amputation model, 14 days rat full-thickness cutaneous-wound model ensured hemostasis, dramatic wound closure after TLC4.5 (optimized scaffold) treatment suggesting its potential as functional wound healing substitute showing obvious avenue for hemostatis and skin tissue reconstruction arena.

Synthetic hydrogels as blood clot mimicking wound healing materials

Excessive bleeding-or hemorrhage-causes millions of civilian and non-civilian casualties every year. Additionally, wound sequelae, such as infections, are a significant source of chronic morbidity, even if the initial bleeding is successfully stopped. To treat acute and chronic wounds, numerous wound healing materials have been identified, tested, and adopted. Among them are topical dressings, such as gauzes, as well as natural and biomimetic materials. However, none of these materials successfully mimic the complex and dynamic properties of the body's own wound healing material: the blood clot. Specifically, blood clots exhibit complex mechanical and biochemical properties that vary across spatial and temporal scales to guide the wound healing response, which make them the ideal wound healing material. In this manuscript, we review blood clots' complex mechanical and biochemical properties, review current wound healing materials, and identify opportunities where new materials can provide additional functionality, with a specific focus on hydrogels. We highlight recent developments in synthetic hydrogels that make them capable of mimicking a larger subset of blood clot features: as plugs and as stimuli for tissue repair. We conclude that future hydrogel materials designed to mimic blood clot biochemistry, mechanics, and architecture can be combined with exciting platelet-like particles to serve as hemostats that also promote the biological wound healing response. Thus, we believe synthetic hydrogels are ideal candidates to address the clear need for better wound healing materials.

Study on the Hemostasis Characteristics of Biomaterial Frustules Obtained from Diatom Navicula australoshetlandica sp

Diatoms, known as photosynthetic unicellular algae, can produce natural biosilica frustules that exhibit great biocompatibility, superhydrophilicity, and superhemophilicity. In our study, the diatom Navicula australoshetlandica sp. was isolated from aquaculture wastewater and pretreated to obtain frustules so as to explore their hemostasis characteristics. A special “porous web” (6–8 nm) substructure in the ordered nanopores (165–350 nm) of boat-shaped diatom frustule was observed in Navicula australoshetlandica sp. using SEM and TEM analysis. Moreover, X-ray, N₂ adsorption–desorption isotherms, and BET analysis showed that the diatom frustule is a mesoporous material with a surface area of 401.45 m² g⁻¹ amorphous silica. FTIR analysis showed that Navicula australoshetlandica sp. frustules possessed abundant OH functional groups. A low hemolysis ratio was observed for 1–5 mg mL⁻¹ diatom frustules that did not exceed 1.55 ± 0.06%, which indicates favorable hemocompatibility. The diatom frustules exhibited the shortest clotting time (134.99 ± 7.00 s) with a hemostasis material/blood (mg/μL) ratio of 1:100, which is 1.83 times (112.32 s) shorter than that of chitosan. The activated partial thromboplastin time (aPTT) of diatom frustule was also 44.53 s shorter than the control. Our results demonstrate the potential of Navicula australoshetlandica sp. diatom frustules to be used as medical hemostasis material.

Procoagulant and Antimicrobial Effects of Chitosan in Wound Healing

Chitosan, a polysaccharide derived from chitin, has excellent wound healing properties, including intrinsic antimicrobial and hemostatic activities. This study investigated the effectiveness of chitosan dressing and compared it with that of regular gauze dressing in controlling clinically surgical bleeding wounds and profiled the community structure of the microbiota affected by these treatments. The dressings were evaluated based on biocompatibility, blood coagulation factors in rat, as well as antimicrobial and procoagulant activities, and the microbial phylogenetic profile in patients with abdominal surgical wounds. The chitosan dressing exhibited a uniformly fibrous morphology with a large surface area and good biocompatibility. Compared to regular gauze dressing, the chitosan dressing accelerated platelet aggregation, indicated by the lower ratio of prothrombin time and activated partial thromboplastin time, and had outstanding blood absorption ability. Adenosine triphosphate assay results revealed that the chitosan dressing inhibited bacterial growth up to 8 d post-surgery. Moreover, 16S rRNA-based sequencing revealed that the chitosan dressing effectively protected the wound from microbial infection and promoted the growth of probiotic microbes, thereby improving skin immunity and promoting wound healing. Our findings suggest that chitosan dressing is an effective antimicrobial and procoagulant and promotes wound repair by providing a suitable environment for beneficial microbiota.

Preparation and Antimicrobial Activity of Chitosan and Its Derivatives: A Concise Review

Despite the advantages presented by synthetic polymers such as strength and durability, the lack of biodegradability associated with the persistence in the environment for a long time turned the attention of researchers to natural polymers. Being biodegradable, biopolymers proved to be extremely beneficial to the environment. At present, they represent an important class of materials with applications in all economic sectors, but also in medicine. They find applications as absorbers, cosmetics, controlled drug delivery, tissue engineering, etc. Chitosan is one of the natural polymers which raised a strong interest for researchers due to some exceptional properties such as biodegradability, biocompatibility, nontoxicity, non-antigenicity, low-cost and numerous pharmacological properties as antimicrobial, antitumor, antioxidant, antidiabetic, immunoenhancing. In addition to this, the free amino and hydroxyl groups make it susceptible to a series of structural modulations, obtaining some derivatives with different biomedical applications. This review approaches the physico-chemical and pharmacological properties of chitosan and its derivatives, focusing on the antimicrobial potential including mechanism of action, factors that influence the antimicrobial activity and the activity against resistant strains, topics of great interest in the context of the concern raised by the available therapeutic options for infections, especially with resistant strains.

Rapid Distance-Based Cardiac Troponin Quantification Using Paper Analytical Devices for the Screening and the Follow-Up of Acute Myocardial Infarction, Using a Single Drop of Human Whole Blood

This work introduces the procedure of using non-immunoassay distance-based paper analytical devices (dPADs) to accurately measure any traces of the cardiac troponin I (TnI) in whole blood samples without the use of any external blood separation. This enables a rapid clinical diagnosis and the subsequent follow-up in regard to identifying acute myocardial infarction. These dPADs are designed and constructed to accommodate three parts: (1) a blood separation zone that is immobilized with a hemostatic agent, this no longer requires a blood separation membrane for the isolation of the plasma from the blood element, (2) a pretreatment zone, and (3) a detection zone coated with thymol blue. The quantitative TnI level in the whole blood was determined by measuring the blue color length found in the detection zone, which is proportional to the concentration, owing to the dry protein binding principle. Correspondingly, a mere single drop of human whole blood performs adequately within our proposed method. This reduces both the size of the collection process and the sample volumes needed in the respective medical fields. As we cover all of the optimization studies, our dPADs provide an evaluation of the linearity range from 0.025 to 2.5 ng/mL (R² = 0.9989) of TnI, with a detection limit as low as 0.025 ng/mL by use of an observation just using the naked eye. To validate the clinical utilities of our proposed method, our dPADs were then applied for the detection of TnI in humans using the whole blood sample of 15 volunteers. A great amount of accuracy was required in this assay because there was no significant difference between both methods, with the confidence level being as high as 95%. This technique also showed that the recoveries ranged from 99.40 to 104.27%, with the highest relative standard deviation being at 3.77%. Thus, our proposed dPADs offer more benefits for a rapid TnI determination.

Taxifolin and gastro-adhesive microparticles containing taxifolin promotes gastric healing in vivo, inhibits Helicobacter pylori in vitro and proton pump reversibly in silico

Taxifolin (3,5,7,3,4-pentahydroxy flavanone or dihydroquercetin, Tax) was identified as a gastroprotective compound and a gastroadhesive formulation was recently developed to prolong its residence time and release in the stomach. So, the gastric healing effectiveness of Tax and gastro-mucoadhesive microparticles containing Tax (MPTax) against the acetic acid induced-gastric ulcer in rats was investigated in this study. Moreover, the interactions between Tax and H⁺/K⁺-ATPase were investigated in silico, and its anti- H. pylori activity was determined in vitro. The oral treatment with MPTax (81.37 mg/kg, containing 12.29% of Tax) twice a day for seven days reduced the ulcer area by 63%, compared to vehicle-treated group (Veh: 91.9 ± 10.3 mm²). Tax (10 mg/kg, p.o) reduced the ulcer by 40% but with a p = 0.07 versus Veh group. Histological analysis confirmed these effects. Tax and MPTax increased the gastric mucin amount, reduced the myeloperoxidase activity, and increased the glutathione reduced content at ulcer site. However, only MPTax decreased the lipoperoxide accumulation at ulcer site. Besides, Tax and MPTax normalize the catalase and glutathione S-transferase activity. Tax showed reversible interaction with H⁺/K⁺-ATPase in silico and its anti-H. pylori effects was confirmed (MIC = 625 μg/mL). These results suggest that the antiulcer property of Tax involves the strengthening of the gastric protective factors in parallel to its inhibitory interaction with H⁺/K⁺-ATPase and H. pylori. Considering that ulcer healing action displayed by Tax was favored by gastroadhesive microparticles, this approach seems to be promising for its oral delivery to treat acid-peptic diseases.

Rapid Hemostasis Resulting from the Synergism of Self-Assembling Short Peptide and O-Carboxymethyl Chitosan

The development of novel hemostatic agents with distinct modes of action from traditional ones remains a formidable challenge. Self-assembling peptide hydrogels have emerged as a new hemostatic material, not only because of their inherent biocompatibility and biodegradability but also their designability. Especially, rational molecular design can make peptides and their hydrogelation responsive to biological cues. In this study, we demonstrated that transglutaminase-catalyzed reactions not only occurred among designed short peptide I₃QGK molecules but also between the peptide and a natural polysaccharide O-carboxymethyl chitosan. Because Factor XIII in the blood can rapidly convert into activated transglutaminase (Factor XIIIa) upon bleeding, these enzymatic reactions, together with the electrostatic attraction between the two hemostatic agents, induced a strong synergetic effect in promoting hydrogelation, blood coagulation, and platelet adhesion, eventually leading to rapid hemostasis. The study presents a promising strategy for developing alternative hemostatic materials and methods.

Polymeric Hydrogel Systems as Emerging Biomaterial Platforms to Enable Hemostasis and Wound Healing

Broad interest in developing new hemostatic technologies arises from unmet needs in mitigating uncontrolled hemorrhage in emergency, surgical, and battlefield settings. Although a variety of hemostats, sealants, and adhesives are available, development of ideal hemostatic compositions that offer a range of remarkable properties including capability to effectively and immediately manage bleeding, excellent mechanical properties, biocompatibility, biodegradability, antibacterial effect, and strong tissue adhesion properties, under wet and dynamic conditions, still remains a challenge. Benefiting from tunable mechanical properties, high porosity, biocompatibility, injectability and ease of handling, polymeric hydrogels with outstanding hemostatic properties have been receiving increasing attention over the past several years. In this review, after shedding light on hemostasis and wound healing processes, the most recent progresses in hydrogel systems engineered from natural and synthetic polymers for hemostatic applications are discussed based on a comprehensive literature review. Most studies described used in vivo models with accessible and compressible wounds to assess the hemostatic performance of hydrogels. The challenges that need to be tackled to accelerate the translation of these novel hemostatic hydrogel systems to clinical practice are emphasized and future directions for research in the field are presented.

Research Advances in Chitosan Oligosaccharides: From Multiple Biological Activities to Clinical Applications

Chitosan oligosaccharides (COS), hydrolysed products of chitosan, are low-molecular weight polymers with a positive charge and good biocompatibility. COS have recently been reported to possess various biological activities, including hypoglycaemic, hypolipidaemic, antioxidantantioxidant, immune regulation, anti-inflammatory, antitumour, antibacterial, and tissue engineering activities, exhibiting extensive application prospects. Currently, the biological processes and mechanisms of COS are attractive topics of study, ranging from the genetic, molecular and protein levels. This article reviews the recent discoveries about COS, especially in metabolic regulation, immune function and tissue repair, providing important insights into their multiple biological activities, medical benefits, and therapeutic mechanisms.

Emerging chitin nanogels/rectorite nanocomposites for safe and effective hemorrhage control

Excessive bleeding due to trauma, surgery and diseases may cause severe mortalities. Here, an emerging chitin nanogel/rectorite nanocomposite is developed for effective hemorrhage control. Chitin chains are intercalated into rectorite and subsequent mechanical high speed stirring generates chitin nanogels, which assemble on the surface of the rectorite nanoplates through electrostatic interactions to form a sandwich structure. The in vitro experiments reveal that the nanocomposite exhibits favorable biocompatibility and negligible hemolysis (<3.5%) as compared to rectorite (40%). The nanocomposite stops bleeding in 121 s in rat tail incision and exhibits higher hemostatic activity in the rabbit artery injury model as compared to a commercialized chitosan hemostat, Celox. The efficient blood clotting activity is attributed to the induction of a coagulation cascade by rectorite and the quick adsorption and aggregation of platelets and red blood cells by chitin. The enhanced biocompatibility and hemostatic activity of the chitin/rectorite nanocomposite make it a safe and cost effective hemostat to control bleeding.

Use of hemostatic agents for surgical bleeding in laparoscopic partial nephrectomy: Biomaterials perspective

In recent years, there was an abrupt increase in the incidence of renal tumors, which prompt up the appearance of cutting-edge technology, including minimally invasive and organ-preserving approaches, such as laparoscopic partial nephrectomy (LPN). LPN is an innovative technique used to treat small renal masses that have been gaining popularity in the last few decades due to its promissory results. However, the bleeding control remains the main challenge since the majority of currently available hemostatic agents (HAs) used in other surgical specialities are inefficient in LPN. This hurried the search for effective HAs adapted for LPN surgical peculiarities, which resulted on the emergence of different types of topical HAs. The most promising are the natural origin HAs because of their inherent biodegradability, biocompatibility, and lowest toxicity. These properties turn them top interests' candidates as HAs in LPN. In this review, we present a deep overview on the progress achieved in the design of HAs based on natural origin polymers, highlighting their distinguishable characteristics and providing a clear understanding of their hemostat's role in LPN. This way it may be possible to establish a structure-composition properties relation, so that novel HAs for LPN can be designed to explore current unmet medical needs.

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

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

Towards advanced wound regeneration

Wound management is a major contributor towards the economic burden placed upon the national health service (NHS), serving as an important target for the development of advanced therapeutic interventions. The economic expenditure of wound care for the NHS exceeds £5 billion per annum, thus presenting a significant opportunity for the introduction of alternative treatments in regards to their approach in tackling the ever increasing prevalence of wound management associated problems. As most wounds typically fall under the acute or chronic category, it is therefore necessary to design a therapeutic intervention capable of effectively resolving the pathologies associated with each problem. Such an intervention should be of increased economic viability and therapeutic effectiveness when compared to standardized treatments, thus helping to alleviate the financial burden imposed upon the NHS. The purpose of this review is to critically analyse the various aspects associated with wound management, detailing the fundamental concepts of dermal regeneration, whilst also providing an evaluation of the different materials and methods that can be utilised to achieve maximal wound regeneration. The primary aspects of this review revolve around the three concepts of antibacterial methodology, enhancement of dermal regeneration and the utilisation of a carrier medium to facilitate the regenerative process. Each aspect is explored, conveying its justifications as a target for dermal regeneration, whilst offering various solutions towards the fulfilment of a therapeutic design that is both effective and financially feasible.

Efficient Hydrolysis of Chitin in a Deep Eutectic Solvent Synergism for Production of Chitin Nanocrystals

A deep eutectic solvent (DES) derived from ferric chloride hexahydrate and betaine chloride (molar ratio of 1:1) was used as hydrolytic media for production of chitin nanocrystals (ChNCs) with a high yield (up to 88.5%). The synergistic effect of Lewis acid and released Brønsted acid from betaine hydrochloride enabled the efficient hydrolysis of chitin for production of ChNCs coupled with ultrasonication with low energy consumption. The obtained ChNCs were with an average diameter of 10 nm and length of 268 nm, and a crystallinity of 89.2% with optimal synthesis conditions (at 100 °C for 1 h with chitin-to-DES mass ratio of 1:20). The ChNCs were further investigated as efficient emulsion stabilizers, and they resulted in stable o/w emulsions even at a high oil content of 50% with a low ChNC dosage of 1 mg/g. Therefore, a potential approach based on a DES on the production of chitin-based nanoparticles as emulsifiers is introduced.

Biological Safety and Biodistribution of Chitosan Nanoparticles

The effect of unmodified chitosan nanoparticles with a size of ~100 nm and a weakly positive charge on blood coagulation, metabolic activity of cultured cardiomyocytes, general toxicity, biodistribution, and reactive changes in rat organs in response to their single intravenous administration at doses of 1, 2, and 4 mg/kg was studied. Chitosan nanoparticles (CNPs) have a small cytotoxic effect and have a weak antiplatelet and anticoagulant effect. Intravenous administration of CNPs does not cause significant hemodynamic changes, and 30 min after the CNPs administration, they mainly accumulate in the liver and lungs, without causing hemolysis and leukocytosis. The toxicity of chitosan nanoparticles was manifested in a dose-dependent short-term delay in weight gain with subsequent recovery, while in the 2-week observation period no signs of pain and distress were observed in rats. Granulomas found in the lungs and liver indicate slow biodegradation of chitosan nanoparticles. In general, the obtained results indicate a good tolerance of intravenous administration of an unmodified chitosan suspension in the studied dose range.