Antibacterial and Antifouling Hybrid Ionic-Covalent Hydrogels with Tunable Mechanical Properties

Zwitterionic Polymers for Biomedical Applications: Antimicrobial and Antifouling Strategies toward Implantable Medical Devices and Drug Delivery

Poly(ethylene glycol) (PEG) is extensively utilized in biomedical applications due to its biocompatibility; however, its thermal instability and susceptibility to oxidative degradation significantly constrain its long-term effectiveness. Zwitterionic polymers, characterized by their distinctive structure, enhanced stability, and superior biocompatibility, offer a more advantageous alternative. These polymers exhibit super hydrophilicity, resist nonspecific protein adsorption, and maintain stability in biological environments due to their charge-neutral ionic nature. Zwitterionic polymers enhance anticancer drug delivery by precisely targeting tumor cells and facilitating an efficient drug release. Their inherent antifouling properties and prolonged circulation within the bloodstream render them highly suitable for redox-sensitive drug carriers, thereby augmenting the antitumor efficacy. Moreover, zwitterionic polymers markedly mitigate biofouling in implants, biosensors, and wound dressings, thereby improving both their functionality and their therapeutic outcomes. These advantages arise from the formation of robust hydration layers, which significantly enhance the hemocompatibility and inhibit the adhesion of proteins, platelets, and bacteria. Zwitterionic polymers, including sulfobetaine (SB), phosphorylcholine (PC), and carboxybetaine (CB), are increasingly employed in blood-contacting devices and as effective coating materials for implantable devices. This mini-review paper aims to explore the recent diverse biomedical applications of zwitterionic polymers and highlight their advantageous properties compared with unmodified polymers. We will cover their use in drug delivery systems, tumor targeting nanocarriers, antibiofouling and antibacterial activities in implantable devices, tissue engineering, and diagnostic devices, demonstrating how their unique properties can translate into different applications. Through this exploration, this Perspective will display the potential of zwitterionic polymers as innovative polymer materials in the field of biomedical engineering and beyond.

On-demand bactericidal and self-adaptive antifouling hydrogels for self-healing and lubricant coatings of catheters

Catheter-related infections are one of the most common nosocomial infections with increasing morbidity and mortality, and robust antibacterial or antifouling catheter coatings remain great challenges for long-term implantation. Herein, multifunctional hydrogel coatings were developed to provide persistent and self-adaptive antifouling and antibacterial effects with self-healing and lubricant capabilities. Polyvinyl alcohol (PVA) with β-cyclodextrin (β-CD) grafts (PVA-Cd) and 4-arm polyethylene glycol (PEG) with adamantane and quaternary ammonium compound (QAC) terminals (QA-PEG-Ad) were crosslinked through host-guest recognitions between adamantane and β-CD moieties to acquire PVEQ coatings. In response to bacterial infections, QACs exhibit reversible transformation between zwitterions (pH 7.4) and cationic lactones (pH 5.5) to generate on-demand bactericidal effect. Highly hydrophilic PEG/PVA backbones and zwitterionic QACs build a lubricate surface and decrease the friction coefficient 10 times compared with that of bare catheters. The antifouling hydrated layer significantly inhibits blood protein adsorption and platelet activation and reveals negligible hemolysis and cytotoxicity. The dynamic host-guest crosslinking achieves full self-healing of cracks in PVEQ hydrogels, and the mechanical profiles were recovered to over 90 % after rejuvenating the broken hydrogels, exhibiting a long-term stability after mechanical stretching, twisting, knotting and compression. After subcutaneous implantation and local bacterial infection, the retrieved PVEQ-coated catheters display no tissue adhesion and 3 log folds lower bacterial number than that of bare catheters. PVEQ coatings effectively prevent the repeated bacterial infections and there are few inflammatory reactions in the surrounding tissue, while substantial lymphoid infiltration and inflammatory cell aggregation occur in muscle tissues around the bare catheter. Thus, this study demonstrates a catheter coating strategy by on-demand bactericidal, self-adaptive antifouling, self-healing and lubricant hydrogels to address medical devices-related infections. STATEMENT OF SIGNIFICANCE: It is estimated over two billion peripheral intravenous catheters are annually used in hospitals around the world, and catheter-associated infection has become a great clinical challenge with rapidly rising morbidity and mortality. Surface coating is considered a promising approach, but substantial challenges remain in the development of coatings that simultaneously satisfy both anti-fouling and antibacterial attributes. Even more, few attempts have been made to design mechanically robust coatings and reversible antibacterial or antifouling capabilities, which are critical for long-term medical implants. To address these challenges, we propose a concise strategy to develop hydrogel coatings from commercially available poly(ethylene glycol) and polyvinyl alcohol. In addition to self-healing and lubricant capabilities, the reversible conversion between zwitterionic and cationic lactones of quaternary ammonium compounds enables on-demand bactericidal and self-adaptive antifouling effects.

A comprehensive review on the inherent and enhanced antifouling mechanisms of hydrogels and their applications

Biofouling remains a persistent challenge within the domains of biomedicine, tissue engineering, marine industry, and membrane separation processes. Multifunctional hydrogels have garnered substantial attention due to their complex three-dimensional architecture, hydrophilicity, biocompatibility, and flexibility. These hydrogels have shown notable advances across various engineering disciplines. The antifouling efficacy of hydrogels typically covers a range of strategies to mitigate or inhibit the adhesion of particulate matter, biological entities, or extraneous pollutants onto their external or internal surfaces. This review provides a comprehensive review of the antifouling properties and applications of hydrogels. We first focus on elucidating the fundamental principles for the inherent resistance of hydrogels to fouling. This is followed by a comprehensive investigation of the methods employed to enhance the antifouling properties enabled by the hydrogels' composition, network structure, conductivity, photothermal properties, release of reactive oxygen species (ROS), and incorporation of silicon and fluorine compounds. Additionally, we explore the emerging prospects of antifouling hydrogels to alleviate the severe challenges posed by surface contamination, membrane separation and wound dressings. The inclusion of detailed mechanistic insights and the judicious selection of antifouling hydrogels are geared toward identifying extant gaps that must be bridged to meet practical requisites while concurrently addressing long-term antifouling applications.

Recent advances in double network hydrogels based on naturally-derived polymers: synthesis, properties, and biological applications

Hydrogels composed of naturally-derived biopolymers have garnered significant research interest due to the bioavailability and biocompatibility of starting materials. However, translating these advantages to practical use is challenged by limitations of mechanical properties and stability of the resulting materials. The development of double network (DN) hydrogels has led to greatly enhanced mechanical properties and shows promise toward broadening the applications of conventional synthetic or natural hydrogels. This review highlights recently developed protein-based and polysaccharide-based DN hydrogels. For each biopolymer, we focus on a subset of DN hydrogels centered around a theme related to synthetic design or applications. Network structures and crosslinking mechanisms that endow enhanced mechanical properties and performance to the materials are discussed. Important applications, including tissue engineering, drug delivery, bioadhesives, wound healing, and wearable sensors, that arise from the inherent properties of the natural polymer or its combination with other materials are also emphasized. Finally, we discuss ongoing challenges to stimulate the discovery of new design principles for the future of DN hydrogels based on naturally-derived polymers for biological applications.

Natural Polysaccharide Delivery Platforms with Multiscale Structure Used for Cancer Chemoimmunotherapy

Chemoimmunotherapy is an effective cancer treatment method. Drugs are always combined and used in treating cancer. However, the characteristic of drugs varies, making it challenging to control their release kinetics utilizing delivery devices with a single microstructure. In this study, we attempted to uniformly size drugs of varying molecular weights and confine them in a compartment where immune cells may be recruited and moved freely. Dextran microgels were created as modular drug libraries to address the cryogel burst release of small molecule drugs. Then, modular drug libraries and granulocyte-macrophage colony-stimulating factor (GM-CSF) were integrated into cryogels for a combined treatment. Herein, alginate was zwitterion modified to avoid the immune reaction generated by the material. Because of its macroporous structure, the cryogel could be injected into the body, eliminating invasive surgical procedures. Results demonstrated that multiscale delivery platforms could improve the synergistic effect of various medications on tumor treatment.

Nano-CeO2-Loaded Polyzwitterionic Double-Network High-Strength Hydrogel for Highly Enhanced Synergistic Marine Antifouling

Although many antibiofouling materials have been developed based on either bacterial-killing or antiadhesion effects, the integration of both the effects in one material remains challenging for achieving highly enhanced synergistic antibiofouling. In this study, we have explored a nano-CeO2-loaded double-network hydrogel by introducing CeO2 nanorods into a polyzwitterionic hydrogel via a simple one-pot method for achieving highly efficient antifouling. First, the CeO2 nanorods dispersed in the hydrogel, as an outstanding nanozyme, have highly efficient bacterial-killing performance. Second, the superhydrophilic polyzwitterionic hydrogel provides a dense hydrated layer on the surface and subsequently excellent broad-spectrum antiadhesion behavior. Most importantly, the bacterial killing and antiadhesion of this hydrogel can work synergistically to largely improve the marine-antifouling performance. Moreover, the double-network structure of this hydrogel, including the covalently cross-linked polyzwitterion hard network and the physically cross-linked poly(vinyl alcohol) soft network, can provide greatly improved mechanical properties (2.44 MPa of tensile strength reaches and 21.87 MPa of compressive strength). As a result, among the existing marine-antifouling hydrogels, the CeO2-loaded polyzwitterionic double-network hydrogel can achieve outstanding antifouling performance, which can sustain for over 6 months in a real marine environment. This work provides a promising marine-antifouling hydrogel, which will also inspire antifouling research of a new strategy and materials.

Peptide hydrogels: Synthesis, properties, and applications in food science

Due to the unique and excellent biological, physical, and chemical properties of peptide hydrogels, their application in the biomedical field is extremely wide. The applications of peptide hydrogels are closely related to their unique responsiveness and excellent properties. However, its defects in mechanical properties, stability, and toxicity limit its application in the food field. In this review, we focus on the fabrication methods of peptide hydrogels through the physical, chemical, and biological stimulations. In addition, the functional design of peptide hydrogels by the incorporation with materials is discussed. Meanwhile, the excellent properties of peptide hydrogels such as the stimulus responsiveness, biocompatibility, antimicrobial properties, rheology, and stability are reviewed. Finally, the application of peptide hydrogel in the food field is summarized and prospected.

Smart Hydrogels for Bone Reconstruction via Modulating the Microenvironment

Rapid and effective repair of injured or diseased bone defects remains a major challenge due to shortages of implants. Smart hydrogels that respond to internal and external stimuli to achieve therapeutic actions in a spatially and temporally controlled manner have recently attracted much attention for bone therapy and regeneration. These hydrogels can be modified by introducing responsive moieties or embedding nanoparticles to increase their capacity for bone repair. Under specific stimuli, smart hydrogels can achieve variable, programmable, and controllable changes on demand to modulate the microenvironment for promoting bone healing. In this review, we highlight the advantages of smart hydrogels and summarize their materials, gelation methods, and properties. Then, we overview the recent advances in developing hydrogels that respond to biochemical signals, electromagnetic energy, and physical stimuli, including single, dual, and multiple types of stimuli, to enable physiological and pathological bone repair by modulating the microenvironment. Then, we discuss the current challenges and future perspectives regarding the clinical translation of smart hydrogels.

Injectable zwitterionic cryogels for accurate and sustained chemoimmunotherapy

Chemoimmunotherapy is an effective method to treat cancer, and thus various vehicles have been constructed to co-deliver immune agents and anticancer drugs. But the immune induction process in vivo is highly susceptible to the influence of the material itself. To avoid immune reactions by the materials of delivery systems, herein, a new kind of zwitterionic cryogels (SH cryogels) with extremely low immunogenicity was prepared for chemoimmunotherapy of cancer. Their macroporous structure enabled the SH cryogels to have good compressibility and be injected through a conventional syringe. The loaded chemotherapeutic drugs and immune adjuvants were accurately, locally and long-termly released in the vicinity of tumors, enhancing the outcome of tumor therapy and minimizing the damage caused by the chemotherapeutic drugs to other organ tissues. In vivo tumor treatment experiments indicated that chemoimmunotherapy using the SH cryogel platform could inhibit the growth of breast cancer tumors to the greatest extent. Furthermore, macropores of SH cryogels supported cells to move freely in the cryogels, which could promote the dendritic cells to capture the in situ produced tumor antigens and present them to T cells. The ability to act as cradles for cell infiltration made the SH cryogels promising for applications as vaccine platforms.

Recent advances in bio-inspired ionic liquid-based interfacial materials from preparation to application

Natural creatures always display unique and charming functions, such as the adhesion of mussels and the lubrication of Nepenthes, to maintain their life activities. Bio-inspired interfacial materials infused with liquid, especially for ionic liquids (ILs), have been designed and prepared to meet the emerging and rising needs of human beings. In this review, we first summarize the recent development of bio-inspired IL-based interfacial materials (BILIMs), ranging from the synthesis strategy to the design principle. Then, we discuss the advanced applications of BILIMs from anti-adhesive aspects (e.g., anti-biofouling, anti-liquid fouling, and anti-solid fouling) to adhesive aspects (e.g., biological sensor, adhesive tape, and wound dressing). Finally, the current limitations and future prospects of BILIMs are provided to feed the actual needs.

"Self-Defensive" Antifouling Zwitterionic Hydrogel Coatings on Polymeric Substrates

In biomedicine fields, biofouling can easily occur on devices such as sensors and catheters, causing some iatrogenic infections, which menace the lives and health of patients greatly. Therefore, it is of great significance to solve the problems of bacterial infection on the surfaces of medical devices. In this paper, "self-defensive" and antifouling zwitterionic hydrogel coatings were prepared by network interpenetration of the hydrogel and the polymeric substrates. The zwitterionic polysulfobetaine methacrylate (PSBMA) hydrogel coatings resisted most of the bacteria to adhere on the substrates. When a few bacteria were lucky to escape the antifouling defense and adhered to the coatings, gentamicin sulfate (GS) would be released under the trigger of a weakly acidic environment caused by bacterial metabolism to kill these bacteria. Simultaneously, the coatings of the bacteria-adhering sites would be degraded by hyaluronidase secreted by these bacteria and peeled off to remove the bacteria and renew the antifouling surfaces. The antifouling properties and mechanism of the self-defensive behavior of the hydrogel coatings on polymeric substrates were investigated. Furthermore, the in vitro and in vivo antibacterial performances, as well as the biocompatibility of the coatings, were demonstrated. The results suggested that the self-defensive antifouling zwitterionic hydrogel coatings hold great potential to be used on the surfaces of polymeric medical devices.

Mucosa-interfacing electronics

The surface mucosa that lines many of our organs houses myriad biometric signals and, therefore, has great potential as a sensor-tissue interface for high-fidelity and long-term biosensing. However, progress is still nascent for mucosa-interfacing electronics owing to challenges with establishing robust sensor-tissue interfaces; device localization, retention and removal; and power and data transfer. This is in sharp contrast to the rapidly advancing field of skin-interfacing electronics, which are replacing traditional hospital visits with minimally invasive, real-time, continuous and untethered biosensing. This Review aims to bridge the gap between skin-interfacing electronics and mucosa-interfacing electronics systems through a comparison of the properties and functions of the skin and internal mucosal surfaces. The major physiological signals accessible through mucosa-lined organs are surveyed and design considerations for the next generation of mucosa-interfacing electronics are outlined based on state-of-the-art developments in bio-integrated electronics. With this Review, we aim to inspire hardware solutions that can serve as a foundation for developing personalized biosensing from the mucosa, a relatively uncharted field with great scientific and clinical potential.

Injectable Hybrid-Crosslinked Hydrogels as Fatigue-Resistant and Shape-Stable Skin Depots

Injectable hydrogels have gained considerable attention, but they are typically mechanically weak and subject to repeated physiological stresses in the body. Herein, we prepared polyurethane diacrylate (EPC-DA) hydrogels, which are injectable and can be photocrosslinked into fatigue-resistant implants. The mechanical properties can be tuned by changing photocrosslinking conditions, and the hybrid-crosslinked EPC-DA hydrogels exhibited high stability and sustained release properties. In contrast to common injectable hydrogels, EPC-DA hydrogels exhibited excellent antifatigue properties with >90% recovery during cyclic compression tests and showed shape stability after application of force and immersion in an aqueous buffer for 35 days. The EPC-DA hydrogel formed a shape-stable hydrogel depot in an ex vivo porcine skin model, with establishment of a temporary soft gel before in situ fixing by UV crosslinking. Hybrid crosslinking using injectable polymeric micelles or nanoparticles may be a general strategy for producing hydrogel implants resistant to physiological stresses.

Cationic peptide-based salt-responsive antibacterial hydrogel dressings for wound healing

Development of biological dressings has received widespread attentions due to their good breathability, biocompatibility, wettability, and the ability to absorb wound exudate without sticking to the wound. However, current proposed antibacterial hydrogels are limited antibacterial ability, short service life and insufficient biocompatibility, which are still challenging to address intricate practical applications. Here we develop a cationic peptide-based, salt-responsive hydrogel dressing with triple functions of antifouling, bactericidal, and bacterial release by combining ε-poly-l-lysine, poly(ethylene glycol) diglycidyl ether, and poly(DVBAPS-co-GMA) via a one-pot method. These designed hydrogels enabled to further quaternize to enhance antibacterial property due to the presence of amine residues. The resultant hydrogels present good antibacterial activity (>90%), biocompatibility, cell proliferation efficacy (~400%) and adhesiveness. Through in vivo and in vitro antibacterial capability tests, it is also found that hydrogels have good antifouling and sterilization capabilities, and the sterilization rate could reach up to ~96%. In addition, ~94% of the attached bacterial can be released after saline/water switching for several cycles. Taken together, the designed multiple antibacterial dressing prolongs the lifespan relying on reversible salt-responsive release and meet special requirements for wound healing. This work not only provides a platform to highlight its promising potentials in wound management but also gives a custom strategy to biomedical applications.

Functional hydrogels for diabetic wound management

Diabetic wounds often have a slow healing process and become easily infected owing to hyperglycemia in wound beds. Once planktonic bacterial cells develop into biofilms, the diabetic wound becomes more resistant to treatment. Although it remains challenging to accelerate healing in a diabetic wound due to complex pathology, including bacterial infection, high reactive oxygen species, chronic inflammation, and impaired angiogenesis, the development of multifunctional hydrogels is a promising strategy. Multiple functions, including antibacterial, pro-angiogenesis, and overall pro-healing, are high priorities. Here, design strategies, mechanisms of action, performance, and application of functional hydrogels are systematically discussed. The unique properties of hydrogels, including bactericidal and wound healing promotive effects, are reviewed. Considering the clinical need, stimuli-responsive and multifunctional hydrogels that can accelerate diabetic wound healing are likely to form an important part of future diabetic wound management.

Highly antifouling, biocompatible and tough double network hydrogel based on carboxybetaine-type zwitterionic polymer and alginate

Because of resistance to bio-macromolecular adhesion, antifouling hydrogels have attracted great attention in biomedical field. But traditional antifouling hydrogels made by hydrophilic polymers are always poor of mechanical properties. Herein, a new hybrid ionic-covalent cross-linked double network (DN) hydrogel was prepared by a simple one-pot method based on sodium alginate and the zwitterionic material carboxybetaine acrylamide (CBAA). The DN hydrogel has good mechanical properties, including high elastic modulus (0.28 MPa), high tensile strength (0.69 MPa), as well as good self-recovery capability. More importantly, the DN hydrogel is highly resistance to the adsorption of non-specific protein, cells, bacteria and algae, exhibiting an outstanding antifouling property. The in vitro and in vivo experiments prove that the DN hydrogel is highly biocompatible. This study provides a new strategy for the preparation of antifouling DN hydrogels with good mechanical properties for different needs, such as tissue scaffolds, wound dressings, implantable devices, and other fields.

Hydrogel-Coated Dental Device with Adhesion-Inhibiting and Colony-Suppressing Properties

Bacterial infection is the main cause of implantation failure worldwide, and the importance of antibiotics on medical devices has been undermined because of antibiotic resistance. Antimicrobial hydrogels have emerged as a promising approach to combat infections associated with medical devices and wound healing. However, hydrogel coatings that simultaneously possess both antifouling and antimicrobial attributes are scarce. Herein, we report an antimicrobial hydrogel that incorporates adhesion-inhibiting polyethylene glycol (PEG) and colony-suppressing chitosan (CS) as a dressing to combat bacterial infections. These two polymers have important environmentally benign characteristics including low toxicity, low volatility, and biocompatibility. Although hydrogels containing PEG and CS have been reported for applications in the fields of wound dressing, tissue repair, water purification, drug delivery, and scaffolds for bone regeneration, there still has been no report on the application of CS/PEG hydrogel coatings in dental applications. Herein, this biointerface shows superior activity in early-stage adhesion inhibition (98.8%, 5 h) and displays remarkably long-lasting colony-suppression activity (93.3%, 7 d). Thus, this novel nanomaterial, which has potential as a dual-functional platform with integrated antifouling and antimicrobial functions with excellent biocompatibility, might be used as a safe and effective antimicrobial coating in biomedical device applications.

Fe-TCPP@CS nanoparticles as photodynamic and photothermal agents for efficient antimicrobial therapy

Photodynamic and photothermal agents for efficient antimicrobial therapy.