Acceleration of the healing process of full-thickness wounds using hydrophilic chitosan-silica hybrid sponge in a porcine model

Targeting Signalling Pathways in Chronic Wound Healing

Chronic wounds fail to achieve complete closure and are an economic burden to healthcare systems due to the limited treatment options and constant medical attention. Chronic wounds are characterised by dysregulated signalling pathways. Research has focused on naturally derived compounds, stem-cell-based therapy, small molecule drugs, oligonucleotide delivery nanoparticles, exosomes and peptide-based platforms. The phosphoinositide-3-kinase (PI3K)/protein kinase B (AKT), Wingless-related integration (Wnt)/β-catenin, transforming growth factor-β (TGF-β), nuclear factor erythroid 2-related factor 2 (Nrf2), Notch and hypoxia-inducible factor 1 (HIF-1) signalling pathways have critical roles in wound healing by modulating the inflammatory, proliferative and remodelling phases. Moreover, several regulators of the signalling pathways were demonstrated to be potential treatment targets. In this review, the current research on targeting signalling pathways under chronic wound conditions will be discussed together with implications for future studies.

Development of Cissus quadrangularis-Loaded POSS-Reinforced Chitosan-Based Bilayer Sponges for Wound Healing Applications: Drug Release and In Vitro Bioactivity

Nowadays, antibiotic-loaded biomaterials have been widely used in wound healing applications. However, the use of natural extracts has come into prominence as an alternative to these antimicrobial agents in the recent period. Among natural sources, Cissus quadrangularis (CQ) herbal extract is used for treatment of bone and skin diseases in ayurvedic medicine due to its antibacterial and anti-inflammatory effects. In this study, chitosan-based bilayer wound dressings were fabricated with electrospinning and freeze-drying techniques. CQ extract-loaded chitosan nanofibers were coated on chitosan/POSS nanocomposite sponges using an electrospinning method. The bilayer sponge is designed to treat exudate wounds while mimicking the layered structure of skin tissue. Bilayer wound dressings were investigated with regard to the morphology and physical and mechanical properties. In addition, CQ release from bilayer wound dressings and in vitro bioactivity studies were performed to determine the effect of POSS nanoparticles and CQ extract loading on NIH/3T3 and HS2 cells. The morphology of nanofibers was investigated with SEM analysis. Physical characteristics of bilayer wound dressings were determined with FT-IR analysis, swelling study, open porosity determination, and mechanical test. The antimicrobial activity of CQ extract released from bilayer sponges was investigated with a disc diffusion method. Bilayer wound dressings' in vitro bioactivity was examined using cytotoxicity determination, wound healing assay, proliferation, and the secretion of biomarkers for skin tissue regeneration. The nanofiber layer diameter was obtained in the range of 77.9-97.4 nm. The water vapor permeability of the bilayer dressing was obtained as 4021 to 4609 g/m2day, as it is in the ideal range for wound repair. The release of the CQ extract over 4 days reached 78-80% cumulative release. The release media were found to be antibacterial against Gram-negative and Gram-positive bacteria. In vitro studies showed that both CQ extract and POSS incorporation induced cell proliferation as well as wound healing activity and collagen deposition. As a result, CQ-loaded bilayer CHI-POSS nanocomposites were found as a potential candidate for wound healing applications.

Nanofiber Wound Dressing Materials-A Comparative Study of Wound Healing on a Porcine Model

BACKGROUND

Nanofiber wound dressings remain the domain of in vitro studies. The purpose of our study was to verify the benefits of chitosan (CTS) and polylactide (PLA)-based nanofiber wound dressings on a porcine model of a naturally contaminated standardized wound and compare them with the conventional dressings, i.e., gauze and Inadine.

MATERIAL AND METHODS

The study group included 32 pigs randomized into four homogeneous groups according to the wound dressing type. Standardized wounds were created on their backs, and wound dressings were regularly changed. We evaluated difficulty of handling individual dressing materials and macroscopic appearance of the wounds. Wound swabs were taken for bacteriological examination. Blood samples were obtained to determine blood count values and serum levels of acute phase proteins (serum amyloid A, C-reactive protein, and haptoglobin). The crucial point of the study was histological analysis. Microscopic evaluation was focused on the defect depth and tissue reactions, including formation of the fibrin exudate with neutrophil granulocytes, the layer of granulation and cellular connective tissue, and the reepithelialization. Statistical analysis was performed by using SPSS software. The analysis was based on the Kruskal-Wallis H test and Mann-Whitney U test followed by Bonferroni correction. Significance was set at P < .05.

RESULTS

Macroscopic examination did not show any difference in wound healing among the groups. However, evaluation of histological findings demonstrated that PLA-based nanofiber dressing accelerated the proliferative (P = .025) and reepithelialization (P < .001) healing phases, while chitosan-based nanofiber dressing potentiated and accelerated the inflammatory phase (P = .006). No statistically significant changes were observed in the blood count or acute inflammatory phase proteins during the trial. Different dynamics were noted in serum amyloid A values in the group treated with PLA-based nanofiber dressing (P = .006).

CONCLUSION

Based on the microscopic examination, we have documented a positive effect of nanofiber wound dressings on acceleration of individual phases of the healing process. Nanofiber wound dressings have a potential to become in future part of the common wound care practice.

An agonistic monoclonal antibody targeting cMet attenuates inflammation and upregulates collagen synthesis and angiogenesis in Type 2 diabetic mouse wounds

BACKGROUND

Diabetic wounds account for 25%-50% of total diabetic healthcare costs annually, and present overall healing rates of less than 50%. Since delayed diabetic wound healing is associated with impaired fibroblast function, we hypothesize that tyrosine kinase Met (cMet) agonistic monoclonal antibody (mAb) will promote diabetic wound healing via stable activation of HGF/cMet signaling.

METHODS

Two 6 mm dorsal wounds were created in each mice (6-week-old, male BKS.Cg-Dock7m+/+Leprdb/J, n=5). After subcutaneous injections of agonist (20 mg/kg) at 0 and 72h, the wound sizes were measured at days 0, 1, 3, 6, and 10. Histological and immunohistochemical analyses were performed at day 10 (cMet, α-SMA, CD68, and TGF-β). In vitro cytotoxicity and migration tests with diabetic fibroblasts were performed with/without agonist treatment (1 or 10 nM). cMet pathway activation of fibroblasts was confirmed through p-p44/42MAPK, p-mTOR, p-cMet, and ROCK-1 expression.

RESULTS

cMet agonistic mAb-treated group showed 1.60-fold lower wound area (p=0.027), 1.54-fold higher collagen synthesis (p=0.001), and 1.79-fold lower inflammatory cell infiltration (p=0.032) than the saline-treated control. The agonist increased cMet (1.86-fold, p=0.029), α-SMA (1.20-fold, p=0.018), and VEGF (1.68-fold, p=0.029) expression but suppressed CD68 (1.25-fold, p=0.043), TFG-β (1.25-fold, p=0.022), and MMP-2 (2.59-fold, p=0.029) expression. In vitro agonist treatment (10 nM) of diabetic fibroblasts increased their migration by 8.98-fold (p=0.029) and activated HGF/cMet pathway.

CONCLUSIONS

cMet agonistic mAb treatment improved diabetic wound healing in mice and reduced wound-site inflammatory cell infiltration. These results need to be validated in large animals before piloting human trials.

Antibacterial and Wound-Healing Activities of Statistically Optimized Nitrofurazone- and Lidocaine-Loaded Silica Microspheres by the Box-Behnken Design

In the current study, nitrofurazone- (NFZ) and lidocaine-loaded (LD) silica microspheres were fabricated to address pathological indications of skin infections. The microspheres were prepared by the sol–gel method applying the Box–Behnken design and evaluated for size distribution, morphology, zeta potential, physico-chemical compatibility, XRD, thermogravimetric analysis, antibacterial and cytotoxicity activities. The comparative in vitro drug release study of microspheres revealed a 30% release of NFZ and 33% of LD after 8 h. The microspheres showed 81% percentage yield (PY) and 71.9% entrapment efficiency. XRD patterns confirmed the entrapment of NFZ–LD in silica microspheres with a significant reduction in crystallinity of the drugs. Thermal and FTIR studies proved the absence of any profound interactions of the formulation ingredients. The smooth spherical microspheres had a −28 mV zeta potential and a 10–100 µm size distribution. In vitro antibacterial activities of the NFZ–LD microspheres showed an increased zone of inhibition compared to pure drug suspensions. The in vivo efficacy tested on rabbits showed a comparatively rapid wound healing with complete lack of skin irritation impact. The cytotoxicity studies revealed more acceptability of silica microspheres with negligible harm to cells. The study suggests that the NFZ- and LD-loaded silica microspheres would be an ideal system for accelerating and promoting rapid healing of various acute and chronic wounds.

Advancement in Nanoformulations for the Management of Diabetic Wound Healing

People with diabetes have a very slow tendency for wound healing. Wound healing is a vast process where several factors inhibit the sequence of healing. Nano formulation plays a major role during acute and chronic wound healing. The present manuscript aims to discuss the role of nanoformulation in the treatment of diabetic wound healing. Diabetes is a common disease that has harmful consequences which lead to bad health. During the literature survey, it was observed that nanotechnology has significant advantages in the treatment of diabetic wound healing. The present manuscript summarized the role of nanomaterials in wound healing, challenges in diabetic wound healing, physiology of wound healing, a limitation that comes during wound repair, and treatments available for wound healing. After a comprehensive literature survey, it can be concluded that health worker needs more focus on the area of wound healing in diabetic patients. Medical practitioners, pharmaceutical and biomedical researchers need more attention towards the utilization of nanoformulations for the treatment of wound healing, specifically in the case of diabetes.

Fabrication and evaluation of Cs/PVP sponge containing platelet-rich fibrin as a wound healing accelerator: An in vitro and in vivo study

Despite significant advances in surgery and postoperative care, there are still challenges in the treatment of wounds. In the current study, a freeze-dried chitosan (Cs)/polyvinylpyrrolidone (PVP) sponges containing platelet-rich fibrin (PRF at 1, 1.5 and 2% w/v) for wound dressing application is fabricated and fully characterized. Addition of 1% w/v of PRF to Cs/PVP (CS/PVP/1PRF) sample significantly increased the tensile strength (from 0.147 ± 0.005 to 0.242 ± 0.001 MPa), elastic modulus (from 0.414 ± 0.014 to 0.611 ± 0.022 MPa) and strain at break (from 53.4 ± 0.9 to 61.83 ± 1.17%) compared to Cs sample, and was hence selected as the optimal sample. The antibacterial activity of Cs/PVP/1PRF sponge wound dressing against E. coli and S. aureus was confirmed to be effective. Enzyme-linked immunosorbent assays revealed that the release of both VEGF and PDGF-AB from PRF powder, as well as PDGF-AB from Cs/PVP/1PRF sample was time-independent, but the release of VEGF from Cs/PVP/1PRF sample increased significantly with time. According to MTT and CAM assays, the Cs/PVP/1PRF sample significantly increased proliferation and angiogenic potential, respectively. Furthermore, in vivo studies demonstrated a 97.16 ± 1.55% wound closure for Cs/PVP/1PRF group after 14 days.

Novel Chitosan-Silica Hybrid Hydrogels for Cell Encapsulation and Drug Delivery

Hydrogels constructed from naturally derived polymers provide an aqueous environment that encourages cell growth, however, mechanical properties are poor and degradation can be difficult to predict. Whilst, synthetic hydrogels exhibit some improved mechanical properties, these materials lack biochemical cues for cells growing and have limited biodegradation. To produce hydrogels that support 3D cell cultures to form tissue mimics, materials must exhibit appropriate biological and mechanical properties. In this study, novel organic-inorganic hybrid hydrogels based on chitosan and silica were prepared using the sol-gel technique. The chemical, physical and biological properties of the hydrogels were assessed. Statistical analysis was performed using One-Way ANOVAs and independent-sample t-tests. Fourier transform infrared spectroscopy showed characteristic absorption bands including amide II, Si-O and Si-O-Si confirming formation of hybrid networks. Oscillatory rheometry was used to characterise the sol to gel transition and viscoelastic behaviour of hydrogels. Furthermore, in vitro degradation revealed both chitosan and silica were released over 21 days. The hydrogels exhibited high loading efficiency as total protein loading was released in a week. There were significant differences between TC₂G and C₂G at all-time points (p < 0.05). The viability of osteoblasts seeded on, and encapsulated within, the hydrogels was >70% over 168 h culture and antimicrobial activity was demonstrated against Pseudomonas aeruginosa and Enterococcus faecalis. The hydrogels developed here offer alternatives for biopolymer hydrogels for biomedical use, including for application in drug/cell delivery and for bone tissue engineering.

Silica/Protein and Silica/Polysaccharide Interactions and Their Contributions to the Functional Properties of Derived Hybrid Wound Dressing Hydrogels

Multifunctional and biocompatible hydrogels are on the focus of wound healing treatments. Protein and polysaccharides silica hybrids are interesting wound dressing alternatives. The objective of this review is to answer questions such as why silica for wound dressings reinforcement? What are the roles and contributions of silane precursors and silica on the functional properties of hydrogel wound dressings? The effects of tailoring the porous, morphological, and chemical characteristics of synthetic silicas on the bioactivity of hybrid wound dressings hydrogels are explored in the first part of the review. This is followed by a commented review of the mechanisms of silica/protein and silica/polysaccharide interactions and their impact on the barrier, scaffold, and delivery matrix functions of the derived hydrogels. Such information has important consequences for wound healing and paves the way to multidisciplinary researches on the production, processing, and biomedical application of this kind of hybrid materials.

Tuning the biomimetic behavior of hybrid scaffolds for bone tissue engineering through surface modifications and drug immobilization

Bone defects arising from injury and/or disease are a common and debilitating clinical lesion. While the development of tissue microenvironments utilizing biomimetic constructs is an emerging approach for bone tissue engineering. In this context, bioactive glass nanoparticles (BGNPs) were embedded within polycaprolactone (PCL) scaffolds. The scaffolds exhibit an engineered unidirectional pore structure which are surface activated via oxygen plasma to allow immobilization of simvastatin (SIM) on the pore surface. Microscopic observation indicated the surface modification did not disturb the lamellar orientation of the pores improving the biomimetic formation of hydroxyapatite. Mathematically modelled release profiles reveal that the oxygen plasma pre-treatment can be utilized to modulate the release profile of SIM from the scaffolds. With the release mechanism controlled by the balance between the diffusion and erosion mechanisms. Computational modelling shows that Human Serum Albumin and Human α₂-macroglobulin can be utilized to increase SIM bioavailability for cells via a molecular docking mechanism. Cellular studies show positive MG-63 cell attachment and viability on optimized scaffolds with alkaline phosphatase activity enhanced along with enhanced expression of osteocalcoin biomarker.

Improving Fibrin Hydrogels' Mechanical Properties, through Addition of Silica or Chitosan-Silica Materials, for Potential Application as Wound Dressings

Fibrin is a protein-based hydrogel formed during blood coagulation. It can also be produced in vitro from human blood plasma, and it is capable of resisting high deformations. However, after each deformation process, it loses high amounts of water, which subsequently makes it mechanically unstable and, finally, difficult to manipulate. The objective of this work was to overcome the in vitro fibrin mechanical instability. The strategy consists of adding silica or chitosan-silica materials and comparing how the different materials electrokinetic-surface properties affect the achieved improvement. The siliceous materials electrostatic and steric stabilization mechanisms, together with plasma protein adsorption on their surfaces, were corroborated by DLS and ζ-potential measurements before fibrin gelling. These properties avoid phase separation, favoring homogeneous incorporation of the solid into the forming fibrin network. Young's modulus of modified fibrin hydrogels was evaluated by AFM to quantitatively measure stiffness. It increased 2.5 times with the addition of 4 mg/mL silica. A similar improvement was achieved with only 0.7 mg/mL chitosan-silica, which highlighted the contribution of hydrophilic chitosan chains to fibrinogen crosslinking. Moreover, these chains avoided the fibroblast growth inhibition onto modified fibrin hydrogels 3D culture observed with silica. In conclusion, 0.7 mg/mL chitosan-silica improved the mechanical stability of fibrin hydrogels with low risks of cytotoxicity. This easy-to-manipulate modified fibrin hydrogel makes it suitable as a wound dressing biomaterial.

Pharmaco-Technical Evaluation of Statistically Formulated and Optimized Dual Drug-Loaded Silica Nanoparticles for Improved Antifungal Efficacy and Wound Healing

The current research aimed at designing mesoporous silica nanoparticles (MSNs) for a controlled coadministration of salicylic acid (SA) and ketoconazole (KCZ) to effectively treat highly resistant fungal infections. The sol-gel method was used to formulate MSNs, which were further optimized using central composite rotatable design (CCRD) by investigating mathematical impact of independent formulation variables such as pH, stirring time, and stirring speed on dependent variables entrapment efficiency (EE) and drug release. The selected optimized MSNs and pure drugs were subjected to comparative in vitro/in vivo antifungal studies, skin irritation, cytotoxicity, and histopathological evaluations. The obtained negatively charged (-23.1), free flowing spherical, highly porous structured MSNs having a size distribution of 300-500 nm were suggestive of high storage stability and improved cell proliferation due to enhanced oxygen supply to cells. The physico-chemical evaluation of SA/KCZ-loaded MSNs performed through powder X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), and thermal gravimetric analysis (TGA) indicates absolute lack of any interaction between formulation components and successful encapsulation of both drugs in MSNs. The EE_SA, EE_KCZ, SA release, and KCZ release varied significantly from 34 to 89%, 36 to 85%, 39 to 88%, and 43 to 90%, respectively, indicating the quadratic impact of formulation variables on obtained MSNs. For MSNs, the skin tolerability and cell viability percentage rate were also having an extraordinary advantage over suspension of pure drugs. The optimized SA/KCZ-loaded MSNs demonstrated comparatively enhanced in vitro/in vivo antifungal activities and rapid wound healing efficacy in histopathological evaluation without any skin irritation impact, suggesting the MSNs potential for the simultaneous codelivery of antifungal and keratolyic agents in sustained release fashion.

Production of a novel poly(ɛ-caprolactone)-methylcellulose electrospun wound dressing by incorporating bioactive glass and Manuka honey

Wound dressings produced by electrospinning exhibit a fibrous structure close to the one of the extracellular matrix of the skin. In this article, electrospinning was used to fabricate fiber mats based on the well-known biopolymers poly(ɛ-caprolactone) (PCL) and methylcellulose (MC) using benign solvents. The blend fiber mats were cross-linked using Manuka honey and additionally used as a biodegradable platform to deliver bioactive glass particles. It was hypothesized that a dual therapeutic effect can be achieved by combining Manuka honey and bioactive glass. Morphological and chemical examinations confirmed the successful production of submicrometric PCL-MC fiber mats containing Manuka honey and bioactive glass particles. The multifunctional fiber mats exhibited improved wettability and suitable mechanical properties (ultimate tensile strength of 3-5 MPa). By performing dissolution tests using simulated body fluid, the improved bioactivity of the fiber mats by the addition of bioactive glass was confirmed. Additionally, cell biology tests using human dermal fibroblasts and human keratinocytes-like HaCaT cells showed the potential of the fabricated composite fiber mats to be used as wound dressing, specially due to the ability to support wound closure influenced by the presence of bioactive glass. Moreover, based on the results of the antibacterial tests, it is apparent that an optimization of the electrospun fiber mats is required to develop suitable wound dressing for the treatment of infected wounds.

Electroassembly of Chitin Nanoparticles to Construct Freestanding Hydrogels and High Porous Aerogels for Wound Healing

The construction of polymeric nanocomponents into a hierarchical structure poses great importance for subsequent biomedical applications. Herein, we report for the first time the electroassembly of chitin nanoparticles (14 nm ± 3 nm from transmission electron microscopy) to construct thick and freestanding hydrogels, which can be further dried to obtain high porous and tough aerogels for wound healing. The electroassembly is a simple, straightforward, and controllable process, which crucially depends on the pH of the chitin nanoparticle suspension and the degree of deacetylation of chitin. Interestingly, the electroassembly of chitin nanoparticles is completely reversible, suggesting the physical assembly feature of the freestanding hydrogel. By using supercritical CO₂ drying and freeze-drying, chitin aerogels and cryogels can be facilely obtained. Because of the intriguing features (i.e., large surface area, interconnected porous structure, and enhanced hydrophilicity), chitin aerogels demonstrate adorable performance to accelerate the healing of wounds.