Moldable and Removable Wound Dressing Based on Dynamic Covalent Cross-Linking of Thiol-Aldehyde Addition

Hydrogel crosslinking modulates macrophages, fibroblasts, and their communication, during wound healing

Biomaterial wound dressings, such as hydrogels, interact with host cells to regulate tissue repair. This study investigates how crosslinking of gelatin-based hydrogels influences immune and stromal cell behavior and wound healing in female mice. We observe that softer, lightly crosslinked hydrogels promote greater cellular infiltration and result in smaller scars compared to stiffer, heavily crosslinked hydrogels. Using single-cell RNA sequencing, we further show that heavily crosslinked hydrogels increase inflammation and lead to the formation of a distinct macrophage subpopulation exhibiting signs of oxidative activity and cell fusion. Conversely, lightly crosslinked hydrogels are more readily taken up by macrophages and integrated within the tissue. The physical properties differentially affect macrophage and fibroblast interactions, with heavily crosslinked hydrogels promoting pro-fibrotic fibroblast activity that drives macrophage fusion through RANKL signaling. These findings suggest that tuning the physical properties of hydrogels can guide cellular responses and improve healing, offering insights for designing better biomaterials for wound treatment.

Hydrogels for Local and Sustained Delivery of Bacteriophages to Treat Wound Infections

Bacteriophages (phages) are viruses that specifically target and kill bacteria, serving as a promising therapeutic to combat multidrug-resistant (MDR) pathogens such as Pseudomonas aeruginosa (Pa). However, delivering adequate concentrations of active phages directly to the infection site over sufficient times to eradicate infections remains an outstanding challenge to phage therapy (PT). Here we present "HydroPhage", a biocompatible hydrogel system for the sustained release of high-titre phages to effectively treat infections caused by MDR pathogens. We develop injectable hydrogels comprised of hyaluronic acid (HA) and polyethylene glycol (PEG) crosslinked through static covalent thioether bonds and hemithioacetal-based dynamic covalent crosslinks (DCC), which encapsulate phages at concentration up to 1011 PFU per mL gel, and achieve sustained release over a week with more than 60% total phage recovery. In a preclinical mouse model of extended wound infection, we demonstrate enhanced bacterial clearance compared to intravenous treatment. Thus, using hydrogels for local and sustained delivery of phage may represent an effective approach to eradicating MDR infections broadly.

Hyaluronic Acid/Chondroitin Sulfate-Based Dynamic Thiol-Aldehyde Addition Hydrogel: An Injectable, Self-Healing, On-Demand Dissolution Wound Dressing

Frequent removal and reapplication of wound dressings can cause mechanical disruption to the healing process and significant physical discomfort for patients. In response to this challenge, a dynamic covalent hydrogel has been developed to advance wound care strategies. This system comprises aldehyde functionalized chondroitin sulfate (CS-CHO) and thiolated hyaluronic acid (HA-SH), with the distinct ability to form in situ via thiol-aldehyde addition and dissolve on-demand via the thiol-hemithioacetal exchange reaction. Although rarely reported, the dynamic covalent reaction of thiol-aldehyde addition holds great promise for the preparation of dynamic hydrogels due to its rapid reaction kinetics and easy reversible dissociation. The thiol-aldehyde addition chemistry provides the hydrogel system with highly desirable characteristics of rapid gelation (within seconds), self-healing, and on-demand dissolution (within 30 min). The mechanical and dissolution properties of the hydrogel can be easily tuned by utilizing CS-CHO materials of different aldehyde functional group contents. The chemical structure, rheology, self-healing, swelling profile, degradation rate, and cell biocompatibility of the hydrogels are characterized. The hydrogel possesses excellent biocompatibility and proves to be significant in promoting cell proliferation in vitro when compared to a commercial hydrogel (HyStem® Cell Culture Scaffold Kit). This study introduces the simple fabrication of a new dynamic hydrogel system that can serve as an ideal platform for biomedical applications, particularly in wound care treatments as an on-demand dissolvable wound dressing.

Antibacterial adhesive based on oxidized tannic acid-chitosan for rapid hemostasis

Currently, bacterial infections and bleeding interfere with wound healing, and multifunctional hydrogels with appropriate blood homeostasis, skin adhesion, and antibacterial activity are desirable. In this study, chitosan-based hydrogels were synthesized using oxidized tannic acid (OTA) and Fe3+ as cross-linkers (CS-OTA-Fe) by forming covalent, non-covalent, and metal coordination bonds between Fe3+ and OTA. Our results demonstrated that CS-OTA-Fe hydrogels showed antibacterial properties against Gram-positive bacteria (Staphylococcus aureus)and Gram-negative bacteria (Escherichia coli), low hemolysis rate (< 2 %), rapid blood clotting ability, in vitro (< 2 min), and in vivo (90 s) in mouse liver bleeding. Additionally, increasing the chitosan concentration from 3 wt% to 4.5 wt% enhanced cross-linking in the network, leading to a significant improvement in the strength (from 106 ± 8 kPa to 168 ± 12 kPa) and compressive modulus (from 50 ± 9 kPa to 102 ± 14 kPa) of hydrogels. Moreover, CS-OTA-Fe hydrogels revealed significant adhesive strength (87 ± 8 kPa) to the cow's skin tissue and cytocompatibility against L929 fibroblasts. Overall, multifunctional CS-OTA-Fe hydrogels with tunable mechanical properties, excellent tissue adhesive, self-healing ability, good cytocompatibility, and fast hemostasis and antibacterial properties could be promising candidates for biomedical applications.

Stimuli-Responsive Hydrogel Adhesives for Wound Closure and Tissue Regeneration

Sutures and staplers, as gold standards for clinical wound closure, usually cause secondary tissue injury and require professional technicians and equipment. The noninvasive hydrogel adhesives are used in various biomedical applications, such as wound closure, tissue sealing, and tissue regeneration, due to their remarkable properties. Recently-developed hydrogel adhesives, especially stimuli-responsive hydrogels, have shown great potential owing to their advantages in regulating their performance and functions according to the wound situations or external conditions, thus allowing the wounds to heal gradually. However, comprehensive summary on stimuli-responsive hydrogels as tissue adhesives is rarely reported to date. This review focuses on the advances in the design of various stimuli-responsive hydrogel adhesives over the past decade, including the systems responsive to pH, temperature, photo, and enzymes. Their potential biomedical applications, such as skin closure, cardiovascular and liver hemostasis, and gastrointestinal sealing, are emphasized. Meanwhile, the challenges and future development of stimuli-responsive hydrogel adhesives are discussed. This review aims to provide meaningful insights for the further design of next-generation of hydrogel adhesives for wound closure and tissue regeneration.

Advancements and applications of upconversion nanoparticles in wound dressings

Wound healing is a complex process that requires effective management to prevent infections and promote efficient tissue regeneration. In recent years, upconversion nanoparticles (UCNPs) have emerged as promising materials for wound dressing applications due to their unique optical properties and potential therapeutic functionalities. These nanoparticles possess enhanced antibacterial properties when functionalized with antibacterial agents, helping to prevent infections, a common complication in wound healing. They can serve as carriers for controlled drug delivery, enabling targeted release of therapeutic agents to the wound site, allowing for tailored treatment and optimal healing conditions. These nanoparticles possess the ability to convert near-infrared (NIR) light into the visible and/or ultraviolet (UV) regions, making them suitable for therapeutic (photothermal therapy and photodynamic therapy) and diagnostic applications. In the context of wound healing, these nanoparticles can be combined with other materials such as hydrogels, fibers, metal-organic frameworks (MOFs), graphene oxide, etc., to enhance the healing process and prevent the growth of microbial infections. Notably, UCNPs can act as sensors for real-time monitoring of the wound healing progress, providing valuable feedback to healthcare professionals. Despite their potential, the use of UCNPs in wound dressing applications faces several challenges. Ensuring the stability and biocompatibility of UCNPs under physiological conditions is crucial for their effective integration into dressings. Comprehensive safety and efficacy evaluations are necessary to understand potential risks and optimize UCNP-based dressings. Scalability and cost-effectiveness of UCNP synthesis and manufacturing processes are important considerations for practical applications. In addition, efficient incorporation of UCNPs into dressings, achieving uniform distribution, poses an important challenge that needs to be addressed. Future research should prioritize addressing concerns regarding stability and biocompatibility, efficient integration into dressings, rigorous safety evaluation, scalability, and cost-effectiveness. The purpose of this review is to critically evaluate the advantages, challenges, and key properties of UCNPs in wound dressing applications to provide insights into their potential as innovative solutions for enhancing wound healing outcomes. We have provided a detailed description of various types of smart wound dressings, focusing on the synthesis and biomedical applications of UCNPs, specifically their utilization in different types of wound dressings.

Novel Injectable, Self-Healing, Long-Effective Bacteriostatic, and Healed-Promoting Hydrogel Wound Dressing and Controlled Drug Delivery Mechanisms

Multivalent ion cross-linking has been used to form hydrogels between sodium alginate (SA) and hyaluronic acid (HA) in previous studies. However, more stable and robust covalent cross-linking is rarely reported. Herein, we present a facile approach to fabricate a SA and HA hydrogel for wound dressings with injectable, good biocompatibility, and high ductility. HA was first reacted with ethylenediamine to graft an amino group. Then, it was cross-linked with oxidized SA with dialdehyde to form hydrogel networks. The dressing can effectively promote cell migration and wound healing. To increase the antibacterial property of the dressing, we successfully loaded tetracycline hydrochloride into the hydrogel as a model drug. The drug can be released slowly in the alkaline environment of chronic wounds, and the hydrogel releases drugs again in the more acidic environment with wound healing, achieving a long-term antibacterial effect. In addition, one-dimensional partial differential equations based on Fickian diffusion with time-varying diffusion coefficients and hydrogel thicknesses were used to model the entire complex drug release process and to predict drug release.

Bioadhesive Technology Platforms

Bioadhesives have emerged as transformative and versatile tools in healthcare, offering the ability to attach tissues with ease and minimal damage. These materials present numerous opportunities for tissue repair and biomedical device integration, creating a broad landscape of applications that have captivated clinical and scientific interest alike. However, fully unlocking their potential requires multifaceted design strategies involving optimal adhesion, suitable biological interactions, and efficient signal communication. In this Review, we delve into these pivotal aspects of bioadhesive design, highlight the latest advances in their biomedical applications, and identify potential opportunities that lie ahead for bioadhesives as multifunctional technology platforms.

A facile bioorthogonal chemistry-based reversible to irreversible strategy to surmount the dilemma between injectability and stability of hyaluronic acid hydrogels

Injectable and stable hydrogels have great promise for clinical applications. Fine-tuning the injectability and the stability of the hydrogels at different stages has been challenging due to the limited number of coupling reactions. A distinct "reversible to irreversible" concept using a thiazolidine-based bioorthogonal reaction between 1,2-aminothiols and aldehydes in physiological conditions to surmount the dilemma between injectability and stability is presented for the first time. Upon mixing aqueous solutions of aldehyde-functionalized hyaluronic acid (SA-HA) and cysteine-capped ethylenediamine (DI-Cys), SA-HA/DI-Cys hydrogels formed through reversible hemithioacetal crosslinking within 2 min. The reversible kinetic intermediate facilitated thiol-triggered gel-to-sol transition, shear-thinning and injectability of the SA-HA/DI-Cys hydrogel but then converted to the irreversible thermodynamic network after injection, thereby permitting the resulting gel with improved stability. As compared to the Schiff base hydrogels, the hydrogels generated from this simple, yet effective concept awarded improved protection to the embedded mesenchymal stem cells and fibroblast during injection, retained the cells homogeneously within the gel, and allowed them further proliferation in vitro and in vivo. There is potential for the proposed approach of "reversible to irreversible" based on thiazolidine chemistry to be applied as a general coupling technique for developing injectable and stable hydrogels for biomedical applications.

Dynamically crosslinked thermoresponsive granular hydrogels

Granular hydrogels are a promising biomaterial for a wide range of biomedical applications, including tissue regeneration, drug/cell delivery, and 3D printing. These granular hydrogels are created by assembling microgels through the jamming process. However, current methods for interconnecting the microgels often limit their use due to the reliance on postprocessing for crosslinking through photoinitiated reactions or enzymatic catalysis. To address this limitation, we incorporated a thiol-functionalized thermo-responsive polymer into oxidized hyaluronic acid microgel assemblies. The rapid exchange rate of thiol-aldehyde dynamic covalent bonds allows the microgel assembly to be shear-thinning and self-healing, with the phase transition behavior of the thermo-responsive polymer serving as secondary crosslinking to stabilize the granular hydrogels network at body temperature. This two-stage crosslinking system provides excellent injectability and shape stability, while maintaining mechanical integrity. In addition, the aldehyde groups of the microgels act as covalent binding sites for sustained drug release. These granular hydrogels can be used as scaffolds for cell delivery and encapsulation, and can be 3D printed without the need for post-printing processing to maintain mechanical stability. Overall, our work introduces thermo-responsive granular hydrogels with promising potential for various biomedical applications.

Smart and versatile biomaterials for cutaneous wound healing

The global increase of cutaneous wounds imposes huge health and financial burdens on patients and society. Despite improved wound healing outcomes, conventional wound dressings are far from ideal, owing to the complex healing process. Smart wound dressings, which are sensitive to or interact with changes in wound condition or environment, have been proposed as appealing therapeutic platforms to effectively facilitate wound healing. In this review, the wound healing processes and features of existing biomaterials are firstly introduced, followed by summarizing the mechanisms of smart responsive materials. Afterwards, recent advances and designs in smart and versatile materials of extensive applications for cutaneous wound healing were submarined. Finally, clinical progresses, challenges and future perspectives of the smart wound dressing are discussed. Overall, by mapping the composition and intrinsic structure of smart responsive materials to their individual needs of cutaneous wounds, with particular attention to the responsive mechanisms, this review is promising to advance further progress in designing smart responsive materials for wounds and drive clinical translation.

Cartilage Regeneration Units Based on Hydrogel Microcarriers for Injectable Cartilage Regeneration in an Autologous Goat Model

Despite numerous studies on tissue-engineered injectable cartilage, it is still difficult to realize stable cartilage formation in preclinical large animal models because of suboptimal biocompatibility, which hinders further application in clinical settings. In this study, we proposed a novel concept of cartilage regeneration units (CRUs) based on hydrogel microcarriers for injectable cartilage regeneration in goats. To achieve this goal, hyaluronic acid (HA) was chosen as the microparticle to integrate gelatin (GT) chemical modification and a freeze-drying technology to create biocompatible and biodegradable HA-GT microcarriers with suitable mechanical strength, uniform particle size, a high swelling ratio, and cell adhesive ability. CRUs were then prepared by seeding goat autologous chondrocytes on the HA-GT microcarriers and culturing in vitro. Compared with traditional injectable cartilage methods, the proposed method forms relatively mature cartilage microtissue in vitro and improves the utilization rate of the culture space to facilitate nutrient exchange, which is necessary for mature and stable cartilage regeneration. Finally, these precultured CRUs were used to successfully regenerate mature cartilage in nude mice and in the nasal dorsum of autologous goats for cartilage filling. This study provides support for the future clinical application of injectable cartilage.

Emerging Graphitic Carbon Nitride-based Nanobiomaterials for Biological Applications

Graphitic carbon nitride (g-CN) based nanostructures are distinctive materials with unique compositional, structural, optical, and electronic properties with exceptional band structure, moderate surface area, and exceptional thermal and chemical stability. Because of these properties, g-CN based nanomaterials have shown promising applications and higher performance in the biological avenue. This review covers the state-of-the-art synthetic strategies used for the preparation of the materials, the basic structure, and a panorama of different optimization strategies leading to improved physicochemical properties responsible for the biological application. The following sections include the recent progress in the use of g-CN based nanobiomaterials for biosensors, bioimaging, photodynamic therapy, drug delivery, chemotherapy, and the antimicrobial segment. Furthermore, we have summarized the role and evaluation of biosafety and biocompatibility of the material. Finally, the unresolved issues, plausible challenges, current status, and future perspectives for the development and design of g-CN have been summarized and are expected to promote a clinical path for the medical sector and human well-being.

On-Demand Changeable Theranostic Hydrogels and Visual Imaging-Guided Antibacterial Photodynamic Therapy to Promote Wound Healing

Antibacterial wound dressings are confronted with the challenges in real-time imaging of infected wounds and effective removal of bacterial debris after sterilization to promote the healing process. Herein, injectable theranostic hydrogels were constructed from antimicrobial peptide ε-polylysine (ePL) and polydopamine (PDA) nanoparticles for real-time diagnosis of infected wounds, imaging-guided antibacterial photodynamic therapy (PDT), and on-demand removal of bacterial debris. Ureido-pyrimidinone was conjugated on ePL to produce PLU hydrogels through quadruple hydrogen bonding, and the inoculation of tetrakis(4-carboxyphenyl)porphyrin (TCPP)-loaded PDA (PTc) nanoparticles introduced Schiff base linkages in PLU@PTc hydrogels. The double-cross-linked networks enhance mechanical performance, adhesion strength, and self-healing properties of hydrogels, and the dynamic cross-linking enables their photothermal removal. The injection of PLU precursors and PTc NPs generates in situ sol-gel transformation, and the acid-triggered release of TCPP restores fluorescence emissions for real-time imaging of infected wounds under 410 nm illumination. Then, the released TCPP in the infected wounds is illuminated at 660 nm to launch a precise antibacterial PDT, which is strengthened by the bacterial capture on hydrogels. Hydrogels with wrapped bacterial debris are removed under illumination at 808 nm, and the hydrogel dressing change accelerates healing of infected wounds through simultaneous relief of oxidative stress, regulation of inflammatory factors, acceleration of collagen deposition, and promotion of angiogenesis. Thus, this study demonstrates a feasible strategy for wound infection theranostics through bacterial infection-triggered visual imaging, efficient nonantibiotic sterilization, and on-demand dressing change and bacterial debris removal.

Injectable adaptive self-healing hyaluronic acid/poly (γ-glutamic acid) hydrogel for cutaneous wound healing

The most significant challenge in designing wound dressings is to mimic the tissue microenvironment because of the pro-regenerative structural and functional properties of skin. Herein, we developed a type of bionic extracellular matrix (ECM) hydrogels based on thiol-modified poly (γ-glutamic acid) (γ-PGA-SH) and oxidized hyaluronic acid (HA-CHO). The rapid and reversible thiol-aldehyde addition reaction of thiols in γ-PGA-SH and aldehyde groups in HA-CHO provided hydrogels with a dynamic covalent network and endowed them with properties of adaptability and self-healing capability, which are conducive for initial wound coverage and for prolonging the lifespan of the dressing. Interestingly, these hydrogels also showed typical viscoelastic characteristics similar to those of natural ECM, degradation property in vitro and in vivo, and free radical scavenging capability. In addition, the gelation time, rheological behavior, mechanical property, porous structure, and degradation process of the hydrogels could be tuned by adjusting polymer content. Furthermore, the ECM-inspired hydrogels significantly enhanced the wound healing process in vivo in a full-thickness skin defect model compared to those by commercial dressing (Tegaderm™) by facilitating angiogenesis and promoting collagen deposition. The successful application of the multifunctional hydrogel as an antioxidant wound dressing for wound treatment significantly exhibited its great application potential for biomedical areas. STATEMENT OF SIGNIFICANCE: The application of tissue engineering techniques to repair full-thickness skin wounds remains a great challenge in clinical trials. Among the recent approaches used for wound healing, in situ forming injectable hydrogels have gained much attention, and few of them have shown satisfactory overall performance, such as integration into the wound bed, biodegradability, immunocompatibility, vascularization, and recapitulation of the structure and function of skin. In the present study, we designed a simple and convenient in situ forming injectable adaptable self-healing hydrogels with biodegradability and antioxidative properties, which could substantially improve wound healing quality at an affordable cost. The hydrogel-based wound dressing is expected to solve the abovementioned problems and help in promoting cutaneous wound healing.

Polymeric Tissue Adhesives

Polymeric tissue adhesives provide versatile materials for wound management and are widely used in a variety of medical settings ranging from minor to life-threatening tissue injuries. Compared to the traditional methods of wound closure (i.e., suturing and stapling), they are relatively easy to use, enable rapid application, and introduce minimal tissue damage. Furthermore, they can act as hemostats to control bleeding and provide a tissue-healing environment at the wound site. Despite their numerous current applications, tissue adhesives still face several limitations and unresolved challenges (e.g., weak adhesion strength and poor mechanical properties) that limit their use, leaving ample room for future improvements. Successful development of next-generation adhesives will likely require a holistic understanding of the chemical and physical properties of the tissue-adhesive interface, fundamental mechanisms of tissue adhesion, and requirements for specific clinical applications. In this review, we discuss a set of rational guidelines for design of adhesives, recent progress in the field along with examples of commercially available adhesives and those under development, tissue-specific considerations, and finally potential functions for future adhesives. Advances in tissue adhesives will open new avenues for wound care and potentially provide potent therapeutics for various medical applications.

Hyperbranched polymer with dynamic thiol-aldehyde crosslinking and its application as a self-healable bioadhesive

Bioadhesives crosslinked with dynamic bonds exhibit shear-thinning, self-healing, and on-demand detachment properties, but generally show a weak bonding performance due to their poor bulk strength. Obtaining a strong bioadhesive with reversible crosslinking remains a challenge. To address this issue, herein we engineered a dynamic thiol-aldehyde crosslinked solvent-free adhesive based on hyperbranched polymer. The adhesive was obtained by directly mixing a liquid hyperbranched polymer with thiol end groups (HBPTE) and benzaldehyde-terminated polyethylene glycol (PEGCHO) without any additional catalyst or solvent. The solvent-free strategy yielded a dense crosslinking structure with many aldehyde groups, so this HBPTE-PEGCHO adhesive can strongly bond to tissue and various non-biological substrates. In addition, the HBPTE-PEGCHO adhesive has self-healing and thermo-reversible bonding properties due to the dynamic thiol-aldehyde crosslinking matrix. In vivo wound healing experiments show that this HBPTE-PEGCHO adhesive is tissue-benign, suggesting it can be applied in clinical practice. Combining the hyperbranched polymer-based solvent-free strategy and dynamic thiol-aldehyde crosslinking chemistry provides a simple but effective way to engineer a multifunctional bioadhesive with the desired bonding performance.

Dynamic Covalent Polymers for Biomedical Applications

The rapid development of supramolecular polymer chemistry and constitutional dynamic chemistry over the last decades has made tremendous impact on the emergence of dynamic covalent polymers. These materials are formed through reversible covalent bonds, endowing them with adaptive and responsive features that have resulted in high interest throughout the community. Owing to their intriguing properties, such as self-healing, shape-memory effects, recyclability, degradability, stimuli-responsiveness, etc., the materials have found multiple uses in a wide range of areas. Of special interest is their increasing use for biomedical applications, and many examples have been demonstrated in recent years. These materials have thus been used for the recognition and sensing of biologically active compounds, for the modulation of enzyme activity, for gene delivery, and as materials for cell culture, delivery, and wound-dressing. In this review, some of these endeavors are discussed, highlighting the many advantages and unique properties of dynamic covalent polymers for use in biology and biomedicine.