Antimicrobial Wound Dressing Containing Silver Sulfadiazine With High Biocompatibility: In Vitro Study

Advances in ionic liquid-based antimicrobial wound healing platforms

Wound infections, marked by the proliferation of microorganisms at surgical sites, necessitate the development of innovative wound dressings with potent bactericidal properties to curb microbial growth and prevent bacterial infiltration. This study explores the recent strides in utilizing ionic liquid-based polymers as highly promising antimicrobial agents for advanced wound healing applications. Specifically, cationic polymers containing quaternary ammonium, imidazolium, guanidinium, pyridinium, triazolium, or phosphonium groups have emerged as exceptionally effective antimicrobial compounds. Their mechanism of action involves disrupting bacterial membranes, thereby preventing the development of resistance and minimizing toxicity to mammalian cells. This comprehensive review not only elucidates the intricate dynamics of the skin's immune response and the various stages of wound healing but also delves into the synthesis methodologies of ionic liquid-based polymers. By spotlighting the practical applications of antimicrobial wound dressings, particularly those incorporating ionic liquid-based materials, this review aims to lay the groundwork for future research endeavors in this burgeoning field. Through a nuanced examination of these advancements, this article seeks to contribute to the ongoing progress in developing cutting-edge wound healing platforms that can effectively address the challenges posed by microbial infections in surgical wounds.

Resveratrol-coated chitosan mats promote angiogenesis for enhanced wound healing in animal model

BACKGROUND

Growing incidences of chronic wounds recommend the development of optimal therapeutic wound dressings. Electrospun nanofibers have been considered to show potential wound healing properties when accompanied by other wound dressing materials. This study aimed to explore the potential role of Chitosan (CS) nanofibrous mats coated with resveratrol (RS) as an antioxidant and pro-angiogenic agent in rat models of skin wound healing.

METHODS

Electrospun chitosan/polyethylene oxide (PEO) nanofibers were prepared using electrospinning technology and coated by 0.05 and 0.1 mg.ml resveratrol named as (CS/RS 0.05) and (CS/RS 0.1), respectively. The scaffolds were characterized physiochemically such as in vitro release study, TGA, FTIR spectroscopy analysis, biodegradability, and human dermal fibroblast seeding assay. The scaffold was subsequently used in vivo as a skin substitute on a rat skin wound model.

RESULTS

In vitro tests revealed that all scaffolds promoted cell adhesion and proliferation. However, more cell viability was observed in CS/RS 0.1 scaffold. The biocompatibility of the scaffolds was validated by MTT assay, and the results did not show any toxic effects on human dermal fibroblasts. It was observed that RS-coated scaffolds had the ability to release RS in a controlled manner. In in vivo tests CS/RS 0.1 scaffold had the greatest impact on the healing process by improving the neodermis formation and modulated inflammation in wound granulation tissue. Histological analysis revealed enhanced vascular endothelial growth factor expression, epithelialization and increased depth of wound granulation tissue.

CONCLUSIONS

The RS-coated CS/PEO nanofibrous scaffold accelerates wound healing and may be useful as a dressing for cell transfer and clinical skin regeneration.

Defining wound bed conformability: a new testing methodology to assess the relative swelling rise of foam dressings

OBJECTIVE

Using a dressing that expands and conforms to the wound bed upon exudate absorption is one of the best ways to promote wound healing. While many products claim wound bed conformability, no externally replicated or verified test methodology had been developed to quantify a wound dressing's ability to conform to the wound bed. The Relative Swelling Rise (RSR) test methodology was developed to measure the relative swelling rise of foam dressings upon fluid absorption, and offers a quantifiable and easily replicated method to measure wound bed conformability.

METHOD

The RSR test method was developed, validated and reliability tested by Coloplast A/S, Denmark. External replication was provided by ALS Odense, Denmark (previously DB Lab). Circular fences provide a fixed diameter to apply and contain the fluid and prevent horizontal spreading in the test set-up. The swelling height is quantified relative to the fence's inner diameter, i.e., the ratio alpha (α), and allows evaluation of a material's ability to conform to the wound bed.

RESULTS

Biatain Silicone foam products (n=3, Coloplast A/S, Denmark) were tested, all afforded an average α-ratio from 0.30 to 0.60. The relative standard deviations were between 1-3%, demonstrating the strength of the test. Robustness of the methodology was demonstrated through the internal validation study, the reliability study, and both an internal and external replication study, as well as a systematic literature review and expert review of the construct, content, criterion and generalisability of the method.

CONCLUSION

Having a validated, effective and easily replicable testing method to quantify wound bed conformability of foam dressings is an important step towards achieving better healing outcomes.

Fabrication and multiscale modeling of polycaprolactone/amniotic membrane electrospun nanofiber scaffolds for wound healing

BACKGROUND

Enhancing the efficiency of cell-based skin tissue engineering (TE) approaches is possible via designing electrospun scaffolds possessing natural materials like amniotic membrane (AM) with wound healing characteristics. Concentrating on this aim, we fabricated innovative polycaprolactone (PCL)/AM scaffolds through the electrospinning process.

METHODS

The manufactured structures were characterized by employing scanning electron microscope (SEM), attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy, tensile testing, Bradford protein assay, etc. In addition, the mechanical properties of scaffolds were simulated by the multiscale modeling method.

RESULTS

As a result of conducting various tests, it was concluded that the uniformity and distribution of fibers decreased with an increase in the amniotic content. Furthermore, PCL-AM scaffolds contained amniotic and PCL characteristic bands. In the case of protein release, greater content of AM led to the release of higher amounts of collagen. Tensile testing revealed that scaffolds' ultimate strength increased when the AM content augmented. The multiscale modeling demonstrated that the scaffold had elastoplastic behavior. In order to assess cellular attachment, viability, and differentiation, human adipose-derived stem cells (ASCs) were seeded on the scaffolds. In this regard, SEM and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assays showed significant cellular proliferation and viability on the proposed scaffolds, and these analyses illustrated that higher cell survival and adhesion could be achieved when scaffolds possessed a larger amount of AM. After 21 days of cultivation, particular keratinocyte markers, such as keratin I and involucrin, were identified through utilizing immunofluorescence and real-time polymerase chain reaction (PCR) tests. The markers' expressions were higher in the PCL-AM scaffold with a ratio of 90:10 v v-1 compared with the PCL-epidermal growth factor (EGF) structure. Moreover, the presence of AM in the scaffolds resulted in the keratinogenic differentiation of ASCs even without employing EGF. Consequently, this state-of-the-art experiment suggests that the PCL-AM scaffold can be a promising candidate in skin bioengineering.

CONCLUSION

This study showed that mixing AM with PCL, a widely used polymer, in different concentrations can overcome PCL disadvantages such as high hydrophobicity and low cellular compatibility.

Nanoengineered therapeutic scaffolds for burn wound management

BACKGROUND

Wound healing is a complex process, and selecting an appropriate treatment is crucial and varies from one wound to another. Among injuries, burn wounds are more challenging to treat. Different dressings and scaffolds come into play when skin is injured. These scaffolds provide the optimum environment for wound healing. With the advancements of nanoengineering, scaffolds have been engineered to improve wound healing with lower fatality rates.

OBJECTIVES

Nanoengineered systems have emerged as one of the promising candidates for burn wound management. This review paper aims to provide an in-depth understanding of burn wounds and the role of nanoengineering in burn wound management. The advantages of nanoengineered scaffolds, their properties, and their proven effectiveness have been discussed. Nanoparticles and nanofibers-based nanoengineered therapeutic scaffolds provide optimum protection, infection management, and accelerated wound healing due to their unique characteristics. These scaffolds increase cell attachment and proliferation for desired results.

RESULTS

The literature review suggested that the utilization of nanoengineered scaffolds has accelerated burn wound healing. Nanofibers provide better cell attachment and proliferation among different nanoengineered scaffolds due to their 3D structure mimics the body's extracellular matrix.

CONCLUSION

With the application of these advanced nanoengineered scaffolds, better burn wound management is possible due to sustained drug delivery, better cell attachment, and an infection-free environment.

Use of a Silver-Impregnated Vascular Graft: Single-Center Experience

INTRODUCTION

Vascular graft infection is a life threatening situation with significant morbidity and mortality. Bacterial graft infection can lead to false aneurysms, bleeding and sepsis. There are a lot of risky situations where grafts can become infected. It is therefore highly desirable to have a vascular graft that is resistant to infection. In this retrospective clinical study, a silver-impregnated vascular graft was evaluated in various indications.

METHODS

Our study included a total of 71 patients who received a silver-impregnated vascular graft during the period from 2013 to 2018. Patients had an aortoiliac localization of vascular graft in 61 cases (86%), and a peripheral localization on the lower limbs in 10 cases (14%). Indications for the use of these special vascular grafts were trophic lesions or gangrene in the lower limbs in 24 cases (34%), suspicious mycotic abdominal aortic aneurysm (mAAA) in 4 cases (5.5%), salmonela aortitis or aneurysms in 4 cases (5.5%), infection of the previous vascular graft in 11 cases (15.5%), other infections in 12 cases (17%), AAA rupture in 10 cases (14%) and other reasons (pre-transplant condition, multiple trauma, graft-enteric fistula) in 6 cases (8.5%). Thirty-day mortality, morbidity, the need for reintervention and amputation, primary and secondary graft patency, and finally the presence of a proven vascular graft infection were evaluated.

RESULTS

The 30-day mortality was 19.7%, and morbidity was 42.2%. The primary patency of the vascular graft was 91.5%. Reoperation was necessary in 10 cases (14%) and amputation was necessary in 10 cases (14%). The median length of hospital stay was 13 days and the mean follow-up period was 48 ± 9 months. During the follow-up period, six patients (8.5%) died from reasons unrelated to surgery or without any relation to the vascular graft. Secondary patency after one year was 88%. Infection of the silver graft was observed in three patients (4.2%).

CONCLUSIONS

Based on our results, the silver graft is a very suitable alternative for solving infectious, or potentially infectious, situations in vascular surgery. In particular, in urgent or acute cases, a silver graft is often the only option.

Medicinal Herbs from Phyto-informatics: An aid for Skin Burn Management

Skin burn injury is the most common cause of trauma that is still considered a dreadful condition in healthcare emergencies around the globe. Due to the availability of a variety of regimes, their management remains a dynamical challenge for the entire medical and paramedical community. Indeed, skin burn injuries are accompanied by a series of several devastating events that lead to sepsis and multiple organ dysfunction syndromes. Hence the challenge lies in to develop better understanding as well as clear diagnostic criteria and predictive biomarkers which are important in their management. Though there are several regimes available in the market, there are still numerous limitations and challenges in the management. In this review article, we have discussed the various biomarkers that could be targeted for managing skin burn injuries. Instead of focusing on allopathic medication which has its adverse events per se, we have discussed the history, ethnopharmacology properties, and prospects of identified phytomedicines from a well-established herbal informatics model. This review article not only discusses the benefits of scrutinized phytocompounds but also leads to develop novel druggable Phyto-compounds to target skin burn injury at lower cost with no adverse effects.

Silver sulfadiazine loaded core-shell airbrushed nanofibers for burn wound healing application

Ideal dressing materials for complex and large asymmetric burns should have the dual properties of anti-bacterial and regenerative with advanced applicability of direct deposit on the wound at the patient bedside. In this study, core-shell nanofibers (polycaprolactone; PCL and polyethylene oxide; PEO) with different percent of silver sulfadiazine (SSD) loading (2-10%) were prepared by the airbrushing method using a custom build device. Results indicate a sustained release profile of silver sulfadiazine (SSD) up to 28 days and concentration-dependent anti-bacterial activity. The morphology and proliferation of human dermal fibroblast (HDF) cells and human dental follicle stem cells (HDFSC) on the silver sulfadiazine loaded nanofibers confirm the biocompatibility of airbrushed nanofibers. Moreover, upregulation of extracellular matrix (ECM) proteins (Col I, Col III, and elastin) support the differentiation and regenerative properties of silver sulfadiazine nanofiber mats. This was further confirmed by the complete recovery of rabbit burn wound models within 7 days of silver sulfadiazine loaded nanofiber dressing. Histopathology data show silver sulfadiazine loaded core-shell nanofibers' anti-inflammatory and proliferative activity without any adverse response on the tissue. Overall data display that the airbrushed silver sulfadiazine-loaded core-shell nanofibers are effective dressing material with the possibility of direct fiber deposition on the wound to cover, heal, and regenerate large asymmetric burn wounds.

Phytochemical-Based Nano-Pharmacotherapeutics for Management of Burn Wound Healing

Medicinal plants have been used since ancient times for their various therapeutic activities and are safer compared to modern medicines, especially when properly identifying and preparing them and choosing an adequate dose administration. The phytochemical compounds present in plants are progressively yielding evidence in modern drug delivery systems by treating various diseases like cancers, coronary heart disease, diabetes, high blood pressure, inflammation, microbial, viral and parasitic infections, psychotic diseases, spasmodic conditions, ulcers, etc. The phytochemical requires a rational approach to deliver the compounds to enhance the efficacy and to improve patients’ compatibility. Nanotechnology is emerging as one of the most promising strategies in disease control. Nano-formulations could target certain parts of the body and control drug release. Different studies report that phytochemical-loaded nano-formulations have been tested successfully both in vitro and in vivo for healing of skin wounds. The use of nano systems as drug carriers may reduce the toxicity and enhance the bioavailability of the incorporated drug. In this review, we focus on various nano-phytomedicines that have been used in treating skin burn wounds, and how both nanotechnology and phytochemicals are effective for treating skin burns.

AK, Ramakrishna S, Amirul AAA. Surface Characterization and Physiochemical Evaluation of P(3HB-co-4HB)-Collagen Peptide Scaffolds with Silver Sulfadiazine as Antimicrobial Agent for Potential Infection-Resistance Biomaterial

Poly(3-hydroxybutyrate-co-4-hydroxybutyrate) [P(3HB-co-4HB)] is a bacterial derived biopolymer widely known for its unique physical and mechanical properties to be used in biomedical application. In this study, antimicrobial agent silver sulfadiazine (SSD) coat/collagen peptide coat-P(3HB-co-4HB) (SCCC) and SSD blend/collagen peptide coat-P(3HB-co-4HB) scaffolds (SBCC) were fabricated using a green salt leaching technique combined with freeze-drying. This was then followed by the incorporation of collagen peptides at various concentrations (2.5-12.5 wt.%) to P(3HB-co-4HB) using collagen-coating. As a result, two types of P(3HB-co-4HB) scaffolds were fabricated, including SCCC and SBCC scaffolds. The increasing concentrations of collagen peptides from 2.5 wt.% to 12.5 wt.% exhibited a decline in their porosity. The wettability and hydrophilicity increased as the concentration of collagen peptides in the scaffolds increased. In terms of the cytotoxic results, MTS assay demonstrated the L929 fibroblast scaffolds adhered well to the fabricated scaffolds. The 10 wt.% collagen peptides coated SCCC and SBCC scaffolds displayed highest cell proliferation rate. The antimicrobial analysis of the fabricated scaffolds exhibited 100% inhibition towards various pathogenic microorganisms. However, the SCCC scaffold exhibited 100% inhibition between 12 and 24 h, but the SBCC scaffolds with SSD impregnated in the scaffold had controlled release of the antimicrobial agent. Thus, this study will elucidate the surface interface-cell interactions of the SSD-P(3HB-co-4HB)-collagen peptide scaffolds and controlled release of SSD, antimicrobial agent.

A call for action to the biomaterial community to tackle antimicrobial resistance

The global surge of antimicrobial resistance (AMR) is a major concern for public health and proving to be a key challenge in modern disease treatment, requiring action plans at all levels. Microorganisms regularly and rapidly acquire resistance to antibiotic treatments and new drugs are continuously required. However, the inherent cost and risk to develop such molecules has resulted in a drying of the pipeline with very few compounds currently in development. Over the last two decades, efforts have been made to tackle the main sources of AMR. Nevertheless, these require the involvement of large governmental bodies, further increasing the complexity of the problem. As a group with a long innovation history, the biomaterials community is perfectly situated to push forward novel antimicrobial technologies to combat AMR. Although this involvement has been felt, it is necessary to ensure that the field offers a united front with special focus in areas that will facilitate the development and implementation of such systems. This paper reviews state of the art biomaterials strategies striving to limit AMR. Promising broad-spectrum antimicrobials and device modifications are showcased through two case studies for different applications, namely topical and implantables, demonstrating the potential for a highly efficacious physical and chemical approach. Finally, a critical review on barriers and limitations of these methods has been developed to provide a list of short and long-term focus areas in order to ensure the full potential of the biomaterials community is directed to helping tackle the AMR pandemic.

Nanotechnology Development for Formulating Essential Oils in Wound Dressing Materials to Promote the Wound-Healing Process: A Review

Wound healing refers to the replacement of damaged tissue through strongly coordinated cellular events. The patient’s condition and different types of wounds complicate the already intricate healing process. Conventional wound dressing materials seem to be insufficient to facilitate and support this mechanism. Nanotechnology could provide the physicochemical properties and specific biological responses needed to promote the healing process. For nanoparticulate dressing design, growing interest has focused on natural biopolymers due to their biocompatibility and good adaptability to technological needs. Polysaccharides are the most common natural biopolymers used for wound-healing materials. In particular, alginate and chitosan polymers exhibit intrinsic antibacterial and anti-inflammatory effects, useful for guaranteeing efficient treatment. Recent studies highlight that several natural plant-derived molecules can influence healing stages. In particular, essential oils show excellent antibacterial, antifungal, antioxidant, and anti-inflammatory properties that can be amplified by combining them with nanotechnological strategies. This review summarizes recent studies concerning essential oils as active secondary compounds in polysaccharide-based wound dressings.

Recent Advances and Applications of Bacterial Cellulose in Biomedicine

Bacterial cellulose (BC) is an extracellular polymer produced by Komagateibacter xylinus, which has been shown to possess a multitude of properties, which makes it innately useful as a next-generation biopolymer. The structure of BC is comprised of glucose monomer units polymerised by cellulose synthase in β-1-4 glucan chains which form uniaxially orientated BC fibril bundles which measure 3-8 nm in diameter. BC is chemically identical to vegetal cellulose. However, when BC is compared with other natural or synthetic analogues, it shows a much higher performance in biomedical applications, potable treatment, nano-filters and functional applications. The main reason for this superiority is due to the high level of chemical purity, nano-fibrillar matrix and crystallinity. Upon using BC as a carrier or scaffold with other materials, unique and novel characteristics can be observed, which are all relatable to the features of BC. These properties, which include high tensile strength, high water holding capabilities and microfibrillar matrices, coupled with the overall physicochemical assets of bacterial cellulose makes it an ideal candidate for further scientific research into biopolymer development. This review thoroughly explores several areas in which BC is being investigated, ranging from biomedical applications to electronic applications, with a focus on the use as a next-generation wound dressing. The purpose of this review is to consolidate and discuss the most recent advancements in the applications of bacterial cellulose, primarily in biomedicine, but also in biotechnology.

Silver sulfadiazine-loaded electrospun ethyl cellulose/polylactic acid/collagen nanofibrous mats with antibacterial properties for wound healing

Recently, the electrospun nanofiber mats with appropriate properties for applications in the biomedical area has been more considered. In this regard, we successfully fabricated a novel antibacterial nanofiber mat (ethyl cellulose/poly lactic acid/collagen) (EC/PLA/collagen) incorporated with silver sulfadiazine (AgSD) and then analyzed with the required tests. AgSD was loaded in the developed mats with different contents (0.25%, 0.5% and 0.75%) and then electrospun to prepare nanofiber mats. To check the chemical structure of the developed mat, Fourier transform infrared spectroscopy (FTIR) was assessed. Surface morphological studies were performed by Scanning Electron Microscopy (SEM), which displayed uniform nanofiber mats without any bead formation. When the hydrophilicity was enhanced by decreasing the blending ratios of EC/PLA, the thermal stability of the nanofibers was reduced. The water contact angle (WCA) of NFs enhanced by decreasing the blending ratios of EC/PLA. The antibacterial properties showed the inhibition activity against Bacillus (9.71 ± 1.15 mm) and E. coli (12.46 ± 1.31 mm) bacteria. Besides, nanofibers have improved cell proliferation and adhesion with any cytotoxic effect on NIH 3T3 fibroblast cells. According these results, it seems that the developed mats would be effective scaffold for application in wound dressings.

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.

Development of a polyvinyl alcohol/sodium alginate hydrogel-based scaffold incorporating bFGF-encapsulated microspheres for accelerated wound healing

In the present study, a hybrid microsphere/hydrogel system, consisting of polyvinyl alcohol (PVA)/sodium alginate (SA) hydrogel incorporating PCL microspheres is introduced as a skin scaffold to accelerate wound healing. The hydrogel substrate was developed using the freeze-thawing method, and the proportion of the involved polymers in its structure was optimized based on the in-vitro assessments. The bFGF-encapsulated PCL microspheres were also fabricated utilizing the double-emulsion solvent evaporation technique. The achieved freeze-dried hybrid system was then characterized by in-vitro and in-vivo experiments. The results obtained from the optimization of the hydrogel showed that increasing the concentration of SA resulted in a more porous structure, and higher swelling ability, elasticity and degradation rate, but decreased the maximum strength and elongation at break. The embedding of PCL microspheres into the optimized hydrogel structure provided sustained and burst-free release kinetics of bFGF. Besides, the addition of drug-loaded microspheres led to no significant change in the degradation mechanism of the hydrogel substrate; however, it reduced its mechanical strength. Furthermore, the MTT assay represented no cytotoxic effect for the hybrid system. The in-vivo studies on a burn-wound rat model, including the evaluation of the wound closure mechanism, and histological analyses indicated that the fabricated scaffold efficiently contributed to promoting cell-induced tissue regeneration and burn-wound healing.

A novel hemostat and antibacterial nanofibrous scaffold based on poly(vinyl alcohol)/poly(lactic acid)

Today, an advanced wound dressing with the ability of blood clotting and antibacterial activity is the main subject of many studies to consider their necessity in modern society. In this study, it was aimed to present a novel scaffold with both abilities simultaneously. Poly(vinyl alcohol)/poly(lactic acid) nanofibrous scaffolds containing ceftriaxone antimicrobial agent (PVA-CTX/PLA) and tranexamic acid coagulant (PVA-CTX-TXA/PLA) were fabricated by electrospinning method. Morphology, antimicrobial activity, blood coagulation and bioavailability indexes, and swelling ability (gel formation) of produced samples were determined. Morphological results showed that the hybrid nanofibers were form successfully. The antibacterial efficiency of them against Gram-negative ( Escherichia coli) and Gram-positive ( Staphylococcus aureus) bacteria was more than 90% for PVA-CTX/PLA and it reached 100% for PVA-CTX-TXA/PLA. Both PVA-CTX-TXA/PLA and PVA-TXA/PLA scaffolds showed acceptable blood coagulation ability with an average absorption of 0.043 and 0.036 nm, respectively. PVA-CTX-TXA/PLA scaffolds had a gel formation ability of about 45 min. All scaffolds were successful in cell proliferation (L929 fibroblast cell) after 48 h.

Freeze-gelled alginate/gelatin scaffolds for wound healing applications: An in vitro, in vivo study

In this study, fabrication of a three-dimensional porous scaffold was performed using freeze gelation method. Recently, fabrication of scaffolds using polymer blends has become common for many tissue engineering applications due to their unique tunable properties. In this work, we fabricated alginate-gelatin porous hydrogels for wound healing application using a new method based on some modifications to the freeze-gelation method. Alginate and gelatin were mixed in three different ratios and the resulting solutions underwent freeze gelation to obtain 3D porous matrices. We analyzed the samples using different characterization tests. The scanning electron microscopy (SEM) results indicated that the freeze gelation method was successful in obtaining porous morphologies for all the fabricated alginate-gelatin samples as previously was seen in single-polymer fabrication using this method. The alginate to gelatin ratio affected swelling, biodegradation, cell culture and mechanical properties of the matrices. The scaffold with the lowest content of gelatin had the highest swelling ratio while biodegradation and cell proliferation and viability were increased with the gelatin content. Regarding the mechanical properties, as the gelatin content increased, the scaffold became more ductile and showed higher tensile strength. The in-vivo results also showed the biocompatibility of the blend scaffold and its positive role in wound healing process in rats. The low-cost procedure used in this study to fabricate the porous alginate-gelatin scaffolds can be adapted and modified to suit different tissue engineering applications.

Wound healing and antimicrobial effect of active secondary metabolites in chitosan-based wound dressings: A review

Wound healing can lead to complex clinical problems, hence finding an efficient approach to enhance the healing process is necessary. An ideal wound dressing should treat wounds at reasonable costs, with minimal inconveniences for the patient. Chitosan is one of the most investigated biopolymers for wound healing applications due to its biocompatibility, biodegradability, non-toxicity, and antimicrobial activity. Moreover, chitosan and its derivative have attracted numerous attentions because of the accelerating wound healing, and easy processability into different forms (gels, foams, membranes, and beads). All these properties make chitosan-based materials particularly versatile and promising for wound dressings. Besides, secondary natural metabolites could potentially act like the antimicrobial and anti-inflammatory agents and accelerate the healing process. This review collected almost all studies regarding natural compounds applications in wound healing by focusing on the chitosan-based bioactive wound dressing systems. An accurate analysis of different chitosan formulations and the influence of bioactive compounds on their wound healing properties are reported.

Incorporation of Silver Sulfadiazine into An Electrospun Composite of Polycaprolactone as An Antibacterial Scaffold for Wound Healing in Rats

Objective

Fabrication of an antibiotic-loaded scaffold with controlled release properties for wound dressing is one of tissue engineering challenges. The aim of this study was to evaluate the wound-healing effectiveness of 500-µm thick polycaprolactone (PCL) nanofibrous mat containing silver sulfadiazine (SSD) as an antibacterial agent.

Materials and Methods

In this experimental study, an electrospun membrane of PCL nanofibrous mat containing 0.3% weight SSD with 500 µm thickness, was prepared. Morphological and thermomechanical characteristics of nanofibers were evaluated. Drug content and drug release properties as well as the surface hydrophobicity of the nanofibrous membrane were determined. Antimicrobial properties and cellular viability of the scaffold were also examined. A full thickness wound of 400 mm² was created in rats, to evaluate the wound-healing effects of PCL/SSD blend in comparison with PCL and vaseline gas used as the control group.

Results

SSD at a concentration of 0.3% improved physicochemical properties of PCL. This concentration of SSD did not inhibit the attachment of human dermal fibroblasts (HDFs) to nanofibers in vitro, but showed antibacterial activity against Gram-positive Staphylococcus aureus (ST) and Gram-negative Pseudomonas aeruginosa (PS). Overall, results showed that SSD improves characteristics of PCL nanofibrous film and improves wound-healing process in one-week earlier compared to control.

Conclusion

Cytotoxicity of SSD in fabricated nanofibrous mat is a critical challenge in designing an effective wound dressing that neutralizes cellular toxicity and improves antimicrobial activity. The PCL/SSD nanofibrous membrane with 500- µm thickness and 0.3% (w/v) SSD showed applicable characteristics as a wound dressing and it accelerated wound healing process in vivo.

Ionic silver functionalized ovine forestomach matrix - a non-cytotoxic antimicrobial biomaterial for tissue regeneration applications

BACKGROUND

Antimicrobial technologies, including silver-containing medical devices, are increasingly utilized in clinical regimens to mitigate risks of microbial colonization. Silver-functionalized resorbable biomaterials for use in wound management and tissue regeneration applications have a narrow therapeutic index where antimicrobial effectiveness may be outweighed by adverse cytotoxicity. We examined the effects of ionic silver functionalization of an extracellular matrix (ECM) biomaterial derived from ovine forestomach (OFM-Ag) in terms of material properties, antimicrobial effectiveness and cytotoxicity profile.

METHODS

Material properties of OFM-Ag were assessed by via biochemical analysis, microscopy, atomic absorption spectroscopy (AAS) and differential scanning calorimetry. The silver release profile of OFM-Ag was profiled by AAS and antimicrobial effectiveness testing utilized to determine the minimum effective concentration of silver in OFM-Ag in addition to the antimicrobial spectrum and wear time. Biofilm prevention properties of OFM-Ag in comparison to silver containing collagen dressing materials was quantified via in vitro crystal violet assay using a polymicrobial model. Toxicity of ionic silver, OFM-Ag and silver containing collagen dressing materials was assessed toward mammalian fibroblasts using elution cytoxicity testing.

RESULTS

OFM-Ag retained the native ECM compositional and structural characteristic of non-silver functionalized ECM material while imparting broad spectrum antimicrobial effectiveness toward 11 clinically relevant microbial species including fungi and drug resistant strains, maintaining effectiveness over a wear time duration of 7-days. OFM-Ag demonstrated significant prevention of polymicrobial biofilm formation compared to non-antimicrobial and silver-containing collagen dressing materials. Where silver-containing collagen dressing materials exhibited cytotoxic effects toward mammalian fibroblasts, OFM-Ag was determined to be non-cytotoxic, silver elution studies indicated sustained retention of silver in OFM-Ag as a possible mechanism for the attenuated cytotoxicity.

CONCLUSIONS

This work demonstrates ECM biomaterials may be functionalized with silver to favourably shift the balance between detrimental cytotoxic potential and beneficial antimicrobial effects, while preserving the ECM structure and function of utility in tissue regeneration applications.

Sputtering of Electrospun Polymer-Based Nanofibers for Biomedical Applications: A Perspective

Electrospinning has gained wide attention recently in biomedical applications. Electrospun biocompatible scaffolds are well-known for biomedical applications such as drug delivery, wound dressing, and tissue engineering applications. In this review, the synthesis of polymer-based fiber composites using an electrospinning technique is discussed. Formerly, metal particles were then deposited on the surface of electrospun fibers using sputtering technology. Key nanometals for biomedical applications including silver and copper nanoparticles are discussed throughout this review. The formulated scaffolds were found to be suitable candidates for biomedical uses such as antibacterial coatings, surface modification for improving biocompatibility, and tissue engineering. This review briefly mentions the characteristics of the nanostructures while focusing on how nanostructures hold potential for a wide range of biomedical applications.

Fibrin-Modified Cellulose as a Promising Dressing for Accelerated Wound Healing

Dermal injuries and chronic wounds usually regenerate with scar formation. Successful treatment without scarring might be achieved by pre-seeding a wound dressing with cells. We aimed to prepare a wound dressing fabricated from sodium carboxymethylcellulose (Hcel^® NaT), combined with fibrin and seeded with dermal fibroblasts in vitro. We fabricated the Hcel^® NaT in a porous and homogeneous form (P form and H form, respectively) differing in structural morphology and in the degree of substitution of hydroxyl groups. Each form of Hcel^® NaT was functionalized with two morphologically different fibrin structures to improve cell adhesion and proliferation, estimated by an MTS assay. Fibrin functionalization of the Hcel^® NaT strongly enhanced colonization of the material with human dermal fibroblasts. Moreover, the type of fibrin structures influenced the ability of the cells to adhere to the material and proliferate on it. The fibrin mesh filling the void spaces between cellulose fibers better supported cell attachment and subsequent proliferation than the fibrin coating, which only enwrapped individual cellulose fibers. On the fibrin mesh, the cell proliferation activity on day 3 was higher on the H form than on the P form of Hcel^® NaT, while on the fibrin coating, the cell proliferation on day 7 was higher on the P form. The Hcel^® NaT wound dressing functionalized with fibrin, especially when in the form of a mesh, can accelerate wound healing by supporting fibroblast adhesion and proliferation.

Recent advances on topical antimicrobials for skin and soft tissue infections and their safety concerns

Antimicrobial resistance of disease-related microorganisms is considered a worldwide prevalent and serious issue which increases the failure of treatment outcomes and leads to high mortality. Considering that the increased resistance to systemic antimicrobial therapy often needs of the use of more toxic agents, topical antimicrobial therapy emerges as an attractive route for the treatment of infectious diseases. The topical antimicrobial therapy is based on the absorption of high drug doses in a readily accessible skin surface, resulting in a reduction of microbial proliferation at infected skin sites. Topical antimicrobials retain the following features: (a) they are able to escape the enzymatic degradation and rapid clearance in the gastrointestinal tract or the first-pass metabolism during oral administration; (b) alleviate the physical discomfort related to intravenous injection; (c) reduce possible adverse effects and drug interactions of systemic administrations; (d) increase patient compliance and convenience; and (e) reduce the treatment costs. Novel antimicrobials for topical application have been widely exploited to control the emergence of drug-resistant microorganisms. This review provides a description of antimicrobial resistance, common microorganisms causing skin and soft tissue infections, topical delivery route of antimicrobials, safety concerns of topical antimicrobials, recent advances, challenges and future prospective in topical antimicrobial development.

Nanomedicine and advanced technologies for burns: Preventing infection and facilitating wound healing

According to the latest report from the World Health Organization, an estimated 265,000 deaths still occur every year as a direct result of burn injuries. A widespread range of these deaths induced by burn wound happens in low- and middle-income countries, where survivors face a lifetime of morbidity. Most of the deaths occur due to infections when a high percentage of the external regions of the body area is affected. Microbial nutrient availability, skin barrier disruption, and vascular supply destruction in burn injuries as well as systemic immunosuppression are important parameters that cause burns to be susceptible to infections. Topical antimicrobials and dressings are generally employed to inhibit burn infections followed by a burn wound therapy, because systemic antibiotics have problems in reaching the infected site, coupled with increasing microbial drug resistance. Nanotechnology has provided a range of molecular designed nanostructures (NS) that can be used in both therapeutic and diagnostic applications in burns. These NSs can be divided into organic and non-organic (such as polymeric nanoparticles (NPs) and silver NPs, respectively), and many have been designed to display multifunctional activity. The present review covers the physiology of skin, burn classification, burn wound pathogenesis, animal models of burn wound infection, and various topical therapeutic approaches designed to combat infection and stimulate healing. These include biological based approaches (e.g. immune-based antimicrobial molecules, therapeutic microorganisms, antimicrobial agents, etc.), antimicrobial photo- and ultrasound-therapy, as well as nanotechnology-based wound healing approaches as a revolutionizing area. Thus, we focus on organic and non-organic NSs designed to deliver growth factors to burned skin, and scaffolds, dressings, etc. for exogenous stem cells to aid skin regeneration. Eventually, recent breakthroughs and technologies with substantial potentials in tissue regeneration and skin wound therapy (that are as the basis of burn wound therapies) are briefly taken into consideration including 3D-printing, cell-imprinted substrates, nano-architectured surfaces, and novel gene-editing tools such as CRISPR-Cas.

Ketoprofen-loaded Eudragit electrospun nanofibers for the treatment of oral mucositis

Purpose

The purpose of this study was to formulate ketoprofen (KET)-loaded Eudragit L and Eudragit S nanofibers (NFs) by the electrospinning technique for buccal administration to treat oral mucositis as a safe alternative to orally administered KET, which causes gastrointestinal tract (GIT) side effects.

Materials and methods

NFs were prepared by electrospinning using Eudragit L and Eudragit S. Several variables were evaluated to optimize NF formulation, such as polymer types and concentrations, applied voltage, flow rate and drug concentrations. Differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM) and analyses of drug contents, hydration capacity, surface pH, drug release and ex vivo permeation were performed to evaluate the NFs. The selected formulation (F1) was evaluated in vivo on induced oral mucositis in rabbits.

Results

SEM revealed that 20% polymer formed smooth and bead-free NFs. DSC results confirmed the amorphous nature of KET in the NFs. FTIR confirmed hydrogen bond formation between the drug and polymer, which stabilized the NFs. Both formulations (F1 and F2) had an acceptable surface pH. The drug loading was >90%. The amount of KET released from NF formulations was statistically significantly higher (P≤0.001) than that released from the corresponding solvent-casted films. The complete release of KET from F1 occurred within 2 hours. Ex vivo permeation study revealed that only a small fraction of drug permeated from F1, which was a better candidate than F2 for local buccal delivery. In vivo evaluation of F1 on oral mucositis induced in rabbits demonstrated that F1 reduced the clinical severity of mucositis in rabbits under the current experimental conditions. The attenuated clinical severity was accompanied by a marked reduction in inflammatory infiltrate and re-epithelization of the epithelial layer.

Conclusion

Eudragit L100 nanofibers (EL-NF) loaded with KET (F1) suppressed the inflammatory response associated with mucositis, which confirmed the efficacy of local buccal delivery of KET-loaded EL-NF in treating oral mucositis.

Artificial Organs 2016: A Year in Review

In this Editor's Review, articles published in 2016 are organized by category and briefly summarized. We aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, the International Society for Mechanical Circulatory Support, the International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We were pleased to publish our second Virtual Issue in April 2016 on "Tissue Engineering in Bone" by Professor Tsuyoshi Takato. Our first was published in 2011 titled "Intra-Aortic Balloon Pumping" by Dr. Ashraf Khir. Other peer-reviewed Special Issues this year included contributions from the 11th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr. Akif Ündar and selections from the 23rd Congress of the International Society for Rotary Blood Pumps edited by Dr. Bojan Biocina. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.

Utilization of Molecular Dynamics Simulation Coupled with Experimental Assays to Optimize Biocompatibility of an Electrospun PCL/PVA Scaffold

The main focus of this study is to address the possibility of using molecular dynamics (MD) simulation, as a computational framework, coupled with experimental assays, to optimize composite structures of a particular electrospun scaffold. To this aim, first, MD simulations were performed to obtain an initial theoretical insight into the capability of heterogeneous surfaces for protein adsorption. The surfaces were composed of six different blends of PVA (polyvinyl alcohol) and PCL (polycaprolactone) with completely unlike hydrophobicity. Next, MTT assay was performed on the electrospun scaffolds made from the same percentages of polymers as in MD models to gain an understanding of the correlation between protein adsorption on the composite surfaces and their capability for cell proliferation. To perform simulations, two ECM (extracellular matrix) protein fragments, namely, collagen type I and fibronectin, two essential proteins for initial cell attachment and eventual cell proliferation, were considered. To evaluate the strength of protein adsorption, adhesion energy and final conformations of proteins were studied. For MTT analysis, different blends of PCL/PVA electrospun scaffolds were prepared, on which endothelial cells were cultured for one week. Theoretical results indicated that the samples with more than 50% of PCL significantly represented stronger protein adsorption. In agreement with simulation results, experimental analysis also demonstrated that the more hydrophobic the surface became, the better initial cell attachment and cell proliferation could be achieved, which was particularly better observed in samples with more than 70% of PCL.

Poly(ethylene glycol)-Based Hyperbranched Polymer from RAFT and Its Application as a Silver-Sulfadiazine-Loaded Antibacterial Hydrogel in Wound Care

A multifunctional branched copolymer was synthesized by Reversible Addition-Fragmentation Chain Transfer polymerization (RAFT) of poly(ethylene glycol) diacrylate (PEGDA M_n = 575) and poly(ethylene glycol) methyl methacrylate (PEGMEMA M_n = 500) at a feed molar ratio of 50:50. Proton nuclear magnetic resonance spectroscopy (¹H NMR) confirmed a hyperbranched molecular structure and a high degree of vinyl functionality. An in situ cross-linkable hydrogel system was generated via a "click" thiol-ene-type Michael addition reaction of vinyl functional groups from this PEGDA/PEGMEMA copolymer system in combination with thiol-modified hyaluronic acid. Furthermore, encapsulation of antimicrobial silver sulfadiazine (SSD) into the copolymer system was conducted to create an advanced antimicrobial wound care dressing. This hydrogel demonstrated a sustained antibacterial activity against the bacterial strains Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli in comparison to the direct topical application of SSD. In addition, in vitro toxicology evaluations demonstrated that this hydrogel-with low concentrations of encapsulated SSD-supported the survival of embedded human adipose derived stem cells (hADSCs) and inhibited growth of the aforementioned pathogens. Here we demonstrate that this hydrogel encapsulated with a low concentration (1.0% w/v) of SSD can be utilized as a carrier system for stem cells with the ability to inhibit growth of pathogens and without adverse effects on hADSCs.