Tannic acid-reinforced zwitterionic hydrogels with multi-functionalities for diabetic wound treatment

Polyzwitterions: controlled synthesis, soft materials and applications

Polyzwitterions refer to polymers containing both positive and negative charged groups in one side chain, which have shown unique physicochemical properties and significant potential in diverse applications due to their amphiphilic and net-neutral charged properties. This review aims to highlight the recent advances in the design and synthesis of polyzwitterions including direct polymerization of zwitterionic monomers and deionization of polymers. Furthermore, the formation of polyzwitterion based soft materials such as nanoparticles by self-assembly, hydrogels, coatings and polyzwitterion brushes, as well as the influence of the microstructure on their properties and applications are discussed. The potential applications of polyzwitterions in drug delivery, antifouling, lubrication, energy storage and antibacterial are also summarized. Finally, the prospects of polyzwitterions are proposed.

Multi-responsive sodium hyaluronate/tannic acid hydrogels with ROS scavenging ability promote the healing of diabetic wounds

Oxidative stress caused by excessive reactive oxygen species (ROS) accumulation significantly hinders wound healing in patients with diabetes. Scavenging ROS and reducing inflammation are crucial for rapid healing. In this work, a multi-responsive sodium hyaluronate (HA)/tannic acid (TA) hydrogel was developed based on boronate ester bonds. Sodium hyaluronate with 3-aminophenyl boronic acid modification (HA-APBA) was mixed and crosslinked with TA to form HA-APBA/TA hydrogels. These hydrogels are injectable, self-healing, and biocompatible. The HA-APBA/TA hydrogels could release free TA through the collapse of the structure at low pH, high H2O2 concentration, and high glucose concentration, thus possessing good ROS scavenging ability. In full-thickness skin wounds of db/db mice, the HA-APBA/TA hydrogels promoted wound healing, collagen deposition, and significant angiogenesis. Furthermore, they have been shown to effectively reduce the levels of inflammatory factors in wounds and lower the expression of CD86, a pro-inflammatory macrophage surface marker. This resulted in a more effective transition of wound healing from the inflammatory phase to the proliferative phase. This study provides an optional strategy for alleviating oxidative stress and controlling excessive inflammation, thereby promoting diabetic wound healing.

Polydopamine-armored zeolitic imidazolate framework-8-incorporated zwitterionic hydrogel with multifunctional properties for infected wound healing

Diabetic skin wound healing is compromised by bacterial infections, oxidative stress, and vascular disruption, leading to delayed recovery and potential complications. This study developed an antibacterial, antioxidant, and adhesive hydrogel dressing that promotes rapid bacterial-infected diabetic wound healing using the biological macromolecule of polydopamine (PDA). This hydrogel comprised PDA-armored zeolitic imidazolate framework-8 nanoparticles (PDA@ZIF-8 NPs) combined with a second armor of zwitterionic polymer network (poly(acrylamide-co-sulfobetaine methacrylate); PAS), realizing low concentration Zn2+ release, good adhesion (14.7 kPa for porcine skin), and improved tensile strength (83.2 kPa). The hydrogel exhibited good antibacterial efficacy against both Staphylococcus aureus (S. aureus, 92.8 %), Escherichia coli (E. coli, 99.6 %) and methicillin-resistant S. aureus (MRSA, 99.2 %), which was attributed to the properties of the incorporated PDA@ZIF-8 NPs. Notably, in vitro, the PDA@ZIF-8 PAS hydrogel not only promoted fibroblast proliferation and migration but also facilitated endothelial cell angiogenesis. In vivo, the PDA@ZIF-8 PAS hydrogel retained its Zn2+-releasing function and effectively suppressed bacterial growth in infected wounds, thereby accelerating the regeneration of both normal and diabetic wounds. This multiarmored hydrogel is a promising sustained-release carrier for functional metal ions and drugs, making it applicable for not only skin healing, but potentially the regeneration of other complex tissues.

Advances and Challenges in Immune-Modulatory Biomaterials for Wound Healing Applications

Wound healing progresses through three distinct stages: inflammation, proliferation, and remodeling. Immune regulation is a central component throughout, crucial for orchestrating inflammatory responses, facilitating tissue repair, and restraining scar tissue formation. Elements such as mitochondria, reactive oxygen species (ROS), macrophages, autophagy, ferroptosis, and cytokines collaboratively shape immune regulation in this healing process. Skin wound dressings, recognized for their ability to augment biomaterials' immunomodulatory characteristics via antimicrobial, antioxidative, pro- or anti-inflammatory, and tissue-regenerative capacities, have garnered heightened attention. Notwithstanding, a lack of comprehensive research addressing how these dressings attain immunomodulatory properties and the mechanisms thereof persists. Hence, this paper pioneers a systematic review of biomaterials, emphasizing immune regulation and their underlying immunological mechanisms. It begins by highlighting the importance of immune regulation in wound healing and the peculiarities and obstacles faced in skin injury recovery. This segment explores the impact of wound metabolism, infections, systemic illnesses, and local immobilization on the immune response during healing. Subsequently, the review examines a spectrum of biomaterials utilized in skin wound therapy, including hydrogels, aerogels, electrospun nanofiber membranes, collagen scaffolds, microneedles, sponges, and 3D-printed constructs. It elaborates on the immunomodulatory approaches employed by these materials, focusing on mitochondrial and ROS modulation, autophagic processes, ferroptosis, macrophage modulation, and the influence of cytokines on wound healing. Acknowledging the challenge of antibiotic resistance, the paper also summarizes promising plant-based alternatives for biomaterial integration, including curcumin. In its concluding sections, the review charts recent advancements and prospects in biomaterials that accelerate skin wound healing via immune modulation. This includes exploring mitochondrial transplantation materials, biomaterial morphology optimization, metal ion incorporation, electrostimulation-enabled immune response control, and the benefits of composite materials in immune-regulatory wound dressings. The ultimate objective is to establish a theoretical foundation and guide future investigations in the realm of skin wound healing and related materials science disciplines.

Recent advances in reactive oxygen species scavenging nanomaterials for wound healing

Reactive oxygen species play a crucial role in cell signaling pathways during wound healing phases. Treatment strategies to balance the redox level in the deep wound tissue are emerging for wound management. In recent years, reactive oxygen species scavenging agents including natural antioxidants, reactive oxygen species (ROS) scavenging nanozymes, and antioxidant delivery systems have been widely employed to inhibit oxidative stress and promote skin regeneration. Here, the importance of reactive oxygen species in different wound healing phases is critically analyzed. Various cutting-edge bioactive ROS nanoscavengers and antioxidant delivery platforms are discussed. This review also highlights the future directions for wound therapies via reactive oxygen species scavenging. This comprehensive review offers a map of the research on ROS scavengers with redox balancing mechanisms of action in the wound healing process, which benefits development and clinical applications of next-generation ROS scavenging-based nanomaterials in skin regeneration.

Multifunctional antibacterial hydrogels for chronic wound management

Chronic wounds have gradually evolved into a global health challenge, comprising long-term non-healing wounds, local tissue necrosis, and even amputation in severe cases. Accordingly, chronic wounds place a considerable psychological and economic burden on patients and society. Chronic wounds have multifaceted pathogenesis involving excessive inflammation, insufficient angiogenesis, and elevated reactive oxygen species levels, with bacterial infection playing a crucial role. Hydrogels, renowned for their excellent biocompatibility, moisture retention, swelling properties, and oxygen permeability, have emerged as promising wound repair dressings. However, hydrogels with singular functions fall short of addressing the complex requirements associated with chronic wound healing. Hence, current research emphasises the development of multifunctional antibacterial hydrogels. This article reviews chronic wound characteristics and the properties and classification of antibacterial hydrogels, as well as their potential application in chronic wound management.

A pH responsive tannic acid/quaternized carboxymethyl chitosan/oxidized sodium alginate hydrogels for accelerated diabetic wound healing and real-time monitoring

Treatment of diabetic wounds is a major clinical issue. Diabetic wound dressings have higher requirements for anti-oxidant, antibacterial and wound monitoring properties compared to conventional wound dressings. In this study, a novel tannic acid (TA)/quaternized carboxymethyl chitosan (QCMCS)/oxidized sodium alginate (OSA)@carbon quantum dots (CQD) (TA/QCMCS/OSA@CQD) hydrogels for promoting diabetic wound healing and real-time monitoring have been developed. The TA/QCMCS/OSA@CQD hydrogels exhibited excellent self-healing, antibacterial and antioxidant properties. Besides, these hydrogels possessed good biocompatibility and effective hemostasis in a mouse liver injury model and significantly facilitated the healing process in a diabetic wound model. In addition, these hydrogels can reliable and timely measure the diabetic wound pH information by collecting image signals of hydrogels to monitor the healing status. Therefore, the pH responsive TA/QCMCS/OSA@CQD hydrogels could be utilized as wound dressing for promoting diabetic wound healing and real-time monitoring.

The complex of tannic acid and cetylpyridinium chloride: An antibacterial and stain-removal cleaner for aligners

INTRODUCTION

Effective aligner hygiene is recognized as an important part of orthodontic treatments and oral hygiene. However, there is no effective cleansing method for removable aligners.

METHODS

In this study, we incorporated tannic acid (TA) with cetylpyridinium chloride (CPC) to develop the TA-CPC complex. The antibacterial properties of 15.8 mg/mL TA-CPC against Escherichia coli and Staphylococcus aureus were evaluated in vitro, which were compared with 5.1 mg/mL TA, 10.7 mg/mL CPC, a commercial denture cleansing solution (YA; 15 mg/mL), and water. As for the assessment of stain-removal ability, the aligners stained by coffee were soaked in cleansing solutions, and the color changes (ΔE∗) were calculated on the basis of the CIE L∗a∗b∗ color system, and the National Bureau of Standards system was used for the clinical interpretation of the color change. Atomic force microscope examination, tensile property assessment, and wavelength dispersive x-ray fluorescence analysis were performed to investigate the material compatibility of TA-CPC, and Cell Counting Kit-8 assay and live/dead assay were used to test the cytotoxicity of TA-CPC.

RESULTS

The results showed that TA-CPC had a positive zeta-potential, and cation-π interaction changed the chemical environments of the phenyl group in TA-CPC, resulting in greater inhibition zones of S. aureus and E. coli than other cleaners. The quantification of the biofilm biomass and the fluorescent intensities also reflected that the TA-CPC solution exhibited better antibacterial ability. As for the ability of stain removal, ΔE∗ value of group TA-CPC was 2.84 ± 0.55, whereas those of stained aligners immersed with deionized distilled water, TA, YA, and CPC were 10.26 ± 0.04, 9.54 ± 0.24, 5.93 ± 0.36, and 4.69 ± 0.35, respectively. The visual inspection and National Bureau of Standards ratings also showed that the color of stained aligners cleansed by TA-CPC was much lighter than those of the other groups. Meanwhile, TA-CPC had good compatibility with the aligner material and cells.

CONCLUSIONS

TA-CPC is a promising strategy to inhibit the formation of biofilms and remove the stains on the aligners safely, which may disinfect the aligners to improve oral health and help keep the transparent appearances of aligners without impacting the morphology and mechanical properties.

Multifunctional Hydrogels for the Healing of Diabetic Wounds

The healing of diabetic wounds is hindered by various factors, including bacterial infection, macrophage dysfunction, excess proinflammatory cytokines, high levels of reactive oxygen species, and sustained hypoxia. These factors collectively impede cellular behaviors and the healing process. Consequently, this review presents intelligent hydrogels equipped with multifunctional capacities, which enable them to dynamically respond to the microenvironment and accelerate wound healing in various ways, including stimuli -responsiveness, injectable self-healing, shape -memory, and conductive and real-time monitoring properties. The relationship between the multiple functions and wound healing is also discussed. Based on the microenvironment of diabetic wounds, antibacterial, anti-inflammatory, immunomodulatory, antioxidant, and pro-angiogenic strategies are combined with multifunctional hydrogels. The application of multifunctional hydrogels in the repair of diabetic wounds is systematically discussed, aiming to provide guidelines for fabricating hydrogels for diabetic wound healing and exploring the role of intelligent hydrogels in the therapeutic processes.

PMN-incorporated multifunctional chitosan hydrogel for postoperative synergistic photothermal melanoma therapy and skin regeneration

Melanoma excision surgery is usually accompanied by neoplasm residual, tissue defect, and bacterial infection, resulting in high tumor recurrence and chronic wound. Nanocomposite hydrogels can satisfy the twin requirements of avoiding tumor recurrence and skin wound healing following skin melanoma surgery due to their photothermal anti-tumor and anti-bacterial activities. In this study, carboxymethyl chitosan, oxidized fucoidan and polyphenol-metal nanoparticle (PMN) of tannic acid capped gold nanoparticles were used to fabricate multifunctional nanocomposite hydrogels through Schiff base reaction. The prepared hydrogel demonstrated outstanding photothermal effect, and the controlled high temperature will rapidly kill melanoma cells as well as bacteria within 10 min. Good injectability, self-healing and adhesion combined with high reactive oxygen species (ROS) scavenging capacity, hemostasis and biocompatibility made this hydrogel platform perfect for the postoperative treatment of melanoma and promoting wound healing. With the assistance of NIR irradiance, hydrogel can inhibit tumor tissue proliferation and promote tumor cell apoptosis, thereby helping to prevent melanoma recurrence after surgical removal of tumors. Simultaneously, the irradiance heat and polyphenol component kill bacteria on the wound surface, eliminate ROS, inhibit inflammatory responses, and promote angiogenesis, collagen deposition, and skin regeneration, all of which help to speed up wound healing.

Photothermal-promoted multi-functional gallic acid grafted chitosan hydrogel containing tannic acid miniaturized particles for peri-implantitis

Peri-implantitis, a leading cause of implant failure, currently lacks effective therapeutic strategies. Given that bacterial infection and reactive oxygen species overabundance serve as primary pathogenic and triggering factors, respectively, an adhesive hydrogel has been created for in-situ injection. The hydrogel is a gallic acid-grafted chitosan (CS-GA) hydrogel containing tannic acid miniaturized particles (TAMP). This provides antibacterial and antioxidant properties. Therefore, this study aims to evaluate the potential role of this hydrogel in preventing and treating peri-implantitis via several experiments. It undergoes rapid formation within a span of over 20 s via an oxidative crosslinking reaction catalyzed by horseradish peroxidase and hydrogen peroxide, demonstrating robust adhesion, superior cell compatibility, and a sealing effect. Furthermore, the incorporation of TAMP offer photothermal properties to the hydrogel, enabling it to enhance the viability, migration, and antioxidant activity of co-cultured human gingival fibroblasts when subjected 0.5 W/cm2 808 nm near-infrared (NIR) irradiation. At higher irradiation power, the hydrogel exhibits progressive improvements in its antibacterial efficacy against Porphyromonas gingivalis and Fusobacterium nucleatum. It attains rates of 83.11 ± 5.42 % and 83.48 ± 6.855 %, respectively, under 1 W/cm2 NIR irradiation. In summary, the NIR-controlled CS-GA/TAMP hydrogel, exhibiting antibacterial and antioxidant properties, represents a promising approach for the prophylaxis and management of peri-implantitis.

Biomimetic Gradient Hydrogels with High Toughness and Antibacterial Properties

Traditional hydrogels, as wound dressings, usually exhibit poor mechanical strength and slow drug release performance in clinical biomedical applications. Although various strategies have been investigated to address the above issues, it remains a challenge to develop a simple method for preparing hydrogels with both toughness and controlled drug release performance. In this study, a tannic acid-reinforced poly (sulfobetaine methacrylate) (TAPS) hydrogel was fabricated via free radical polymerization, and the TAPS hydrogel was subjected to a simple electrophoresis process to obtain the hydrogels with a gradient distribution of copper ions. These gradient hydrogels showed tunable mechanical properties by changing the electrophoresis time. When the electrophoresis time reached 15 min, the hydrogel had a tensile strength of 368.14 kPa, a tensile modulus of 16.17 kPa, and a compressive strength of 42.77 MPa. It could be loaded at 50% compressive strain and then unloaded for up to 70 cycles and maintained a constant compressive stress of 1.50 MPa. The controlled release of copper from different sides of the gradient hydrogels was observed. After 6 h of incubation, the hydrogel exhibited a strong bactericidal effect on Gram-positive Staphylococcus aureus and Gram-negative Escherichia coli, with low toxicity to NIH/3T3 fibroblasts. The high toughness, controlled release of copper, and enhanced antimicrobial properties of the gradient hydrogels make them excellent candidates for wound dressings in biomedical applications.

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

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

A lubricant and adhesive hydrogel cross-linked from hyaluronic acid and chitosan for articular cartilage regeneration

Trauma-induced articular cartilage damages are common in clinical practice. Hydrogels have been used to fill the cartilage defects and act as extracellular matrices for cell migration and tissue regeneration. Lubrication and stability of the filler materials are essential to achieve a satisfying healing effect in cartilage regeneration. However, conventional hydrogels failed to provide a lubricous effect, or could not anchor to the wound to maintain a stable curing effect. Herein, we fabricated dually cross-linked hydrogels using oxidized hyaluronic acid (OHA) and N-(2-hydroxypropyl)-3-trimethylammonium chitosan chloride (HTCC) methacrylate (HTCCMA). The OHA/HTCCMA hydrogels, which were dynamically cross-linked and then covalently cross-linked by photo-irradiation, showed appropriate rheological properties and self-healing capability. The hydrogels exhibited moderate and stable tissue adhesion property due to formation of dynamic covalent bonds with the cartilage surface. The coefficient of friction values were 0.065 and 0.078 for the dynamically cross-linked and double-cross-linked hydrogels, respectively, demonstrating superior lubrication. In vitro studies showed that the hydrogels had good antibacterial ability and promoted cell proliferation. In vivo studies confirmed that the hydrogels were biocompatible and biodegradable, and exhibited a robust regenerating ability for articular cartilage. This lubricant-adhesive hydrogel is expected to be promising for the treatment of joint injuries as well as regeneration.

Multifunctional hydrogel coatings with high antimicrobial loading efficiency and pH-responsive properties for urinary catheter applications

Catheter-associated urinary tract infections are one of the most common hospital-acquired infections. Encrustation formation results from infection of urease-producing bacteria and further complicates the situation. A typical sign of the initial onset of encrustation formation is the alkalization of the urine (pH up to 9-10). However, effective antibacterial strategies with high antimicrobial loading efficiency and pH-responsiveness of antimicrobial release are still lacking. In this study, we developed a poly(sulfobetaine methacrylate)-tannic acid (polySBMA-TA) hydrogel coating, which served as a universal, efficient, and responsive carrier for antimicrobials on urinary catheters. Common antimicrobials, including poly(vinylpyrrolidone)-iodine, copper ions, and nitrofurazone were loaded into the polySBMA-TA coating in high efficiency (several fold higher than that of the polySBMA coating), via the formation of multiple non-covalent interactions between the antimicrobials and hydrogel coating. The hydrogel coatings maintained good antibacterial properties under neutral conditions. More importantly, the pH-responsive release of antibacterial agents under alkaline conditions further enhanced the antibacterial activity of the coatings, which was advantageous for killing the urease-producing bacteria and preventing encrustation. In vitro and in vivo tests confirmed that the hydrogel coating has good biocompatibility, and could effectively inhibit bacterial colonization and encrustation formation. This study offers new opportunities for the utilization of a simple and universal antimicrobial-loaded hydrogel coating with smart pH-responsive properties to combat bacterial colonization and encrustation formation in urinary catheters.

A pressure-resistant zwitterionic skin sensor for domestic real-time monitoring and pro-healing of pressure injury

Pressure injury (PI) is a hard-to-heal wound to patients with the limited mobility, especially paralyzed or elderly persons. These patients also commonly suffer from sensation loss or dementia that is unable to indicate symptoms in time, resulting in missing the "golden period" for treatment. Therefore, it is highly required to domestic continously real-time monitoring as well as promoting wound healing of PI. However, no existing device has realized these functions for PI. Herein, we prepare a zwitterionic skin sensor that enables pro-healing as well as domestic real-time monitoring the multi-indicators of PI. To apply for a PI dressing that requires to tolerate patient body weight, organosilicon nanoparticles (OSNPs) are designed as crosslinks in the zwitterionic conductive hydrogel (CH-OSNP), which exhibits pressure-resistant properties (99.81% compression to recovery) as well as anti-bacterial adhesion. Moreover, the CH-OSNP-based skin sensor is developed, and the resultant sensor can be sensitive to stress stimuli even under a long-term constant heavy load, which stimulates the pressure of a PI person lying down. In vivo results show that this sensor can not only promote PI healing, but also continuously monitor and distinguish multiple information, such as exudate, swelling, and infection, to prevent PI from being worsen. This work provides a domestic feasible device to cure and monitor the PI of patients.

Recent Advances in Mechanical Reinforcement of Zwitterionic Hydrogels

As a nonspecific protein adsorption material, a strong hydration layer provides zwitterionic hydrogels with excellent application potential while weakening the interaction between zwitterionic units, leading to poor mechanical properties. The unique anti-polyelectrolyte effect in ionic solution further restricts the application value due to the worsening mechanical strength. To overcome the limitations of zwitterionic hydrogels that can only be used in scenarios that do not require mechanical properties, several methods for strengthening mechanical properties based on enhancing intermolecular interaction forces and polymer network structure design have been extensively studied. Here, we review the works on preparing tough zwitterionic hydrogel. Based on the spatial and molecular structure design, tough zwitterionic hydrogels have been considered as an important candidate for advanced biomedical and soft ionotronic devices.