Efficacy, safety, and physicochemical properties of a flowable hemostatic agent made from absorbable gelatin sponge via vacuum pressure steam sterilization

Sodium alginate/carboxymethylcellulose gel formulations containing Capparis sepieria plant extract for wound healing

Aim: Using appropriate wound dressings is crucial when treating burn wounds to promote accelerated healing.Materials & methods: Sodium alginate (SA)-based gels containing Carboxymethyl cellulose (CMC) and Pluronic F127 were prepared. The formulations. SA/CMC/Carbopol and SA/CMC/PluronicF127 were loaded with aqueous root extract of Capparis sepiaria. The formulations were characterized using appropriate techniques.Results: The gels' viscosity was in the range of 676.33 ± 121.76 to 20.00 ± 9.78 cP and in vitro whole blood kinetics showed their capability to induce a faster clotting rate. They also supported high cell viability of 80% with cellular migration and proliferation. Their antibacterial activity was significant against most bacteria strains used in the study.Conclusion: The gels' distinct features reveal their potential application as wound dressings for burn wounds.

Mesenchymal stem cell-loaded hydrogel to inhibit inflammatory reaction in surgical brain injury via mitochondria transfer

Neurosurgical procedures are the key therapeutic interventions for the cerebral hemorrhage and brain tumors. However, neurosurgical procedures inevitably cause surgical brain injury (SBI), which will induce hemorrhage and inflammation. Gelatin Sponges are still the primary hemostatic materials used in clinical, but their anti-inflammatory efficacy is poor. Herein, we developed a cross-linked gelatin hydrogel (GelMA) to load mesenchymal stem cells (MSC) and directly implant them to the SBI site. Upon contacting the SBI site, the GelMA showed better clotting performance than Gelatin Sponges. Moreover, the MSC can reduce oxidative stress and enhance mitochondrial fusion via mitochondria transfer, resulting in ameliorating mitochondrial damage and reducing inflammation. Thus, the GelMA containing MSC can effectively reduce brain edema and inflammation and improve neurological function in SBI mouse models. In addition, GelMA exhibits excellent hemocompatibility and low cytotoxicity. It also enhances the proliferation of MSCs and decelerates the rapid depletion of MSCs. Therefore, MSC-loaded GelMA exhibits excellent hemostatic and anti-inflammatory effects, making it a potential new-generation biomaterial for SBI.

Capparis sepiaria-Loaded Sodium Alginate Single- and Double-Layer Membrane Composites for Wound Healing

Background: Effective wound dressing is the key solution to combating the increased death rate and prolonged hospital stay common to patients with wounds. Methods: Sodium alginate-based single- and double-layer membranes incorporated with Capparis sepiaria root extract were designed using the solvent-casting method from a combination of polyvinyl alcohol (PVA), Pluronic F127 (PF127), and gum acacia. Results: The successful preparation of the membranes and loading of the extract were confirmed using Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD). The prepared membranes were biodegradable and non-toxic to human skin cells (HaCaT), with high biocompatibility of 92 to 112% cell viability and good hemocompatibility with absorbance ranging from 0.17 to 0.30. The membrane's highest water vapor transmission rate was 1654.7333 ± 0.736 g/m2/day and the highest % porosity was 76%. The membranes supported cellular adhesion and migration, with the highest closure being 68% after 4 days compared with the commercial wound dressings. This membrane exhibited enhanced antimicrobial activity against the pathogens responsible for wound infections. Conclusions: The distinct features of the membranes make them promising wound dressings for treating infected wounds.

A novel hydrogel with inherent antibacterial and hemostatic properties for burn wound healing

The skin is the immune system's first line of defense. Extensive skin burns can lead to tissue necrosis, sepsis, and even death. Anti-infectious care of burn wounds is a major challenge in clinical medicine. However, the extensive use of antibiotics led to the emergence of multi-drug-resistant bacteria and silver dressings with antibacterial effects are also cytotoxic. We used the natural cationic antibacterial agent ε-polylysine (EPL) to graft Epigallocatechin-3-gallate (EGCG) to synthesize EPL-EGCG. Then, we used methacrylated gelatin (GelMA) with arginine-glycine-aspartate-rich acid (RGD) sequence and EPL-EGCG form interpenetrating polymer network hydrogels with excellent swelling properties. The hydrogel's inherent antibacterial properties and photo-cross-linking properties can cover irregular burn wounds and isolate bacteria to prevent infection. In addition, we used polydopamine (PDA) to coat GelMA microspheres with excellent hemostatic efficacy and load platelet-rich plasma (PRP) to enhance the hemostatic efficacy of the microspheres and impart inflammation-regulating functions. The hydrogel showed excellent hemostatic efficacy in rat liver injury and tail vein injury models. In the rat infected burn model, the hydrogel exhibited favorable antimicrobial, pro-angiogenic, and anti-inflammatory phenotype polarization of macrophages. Our study shows that GelMA/EPL-EGCG/GM-PDA@PRP hydrogel application has excellent antibacterial, hemostatic and anti-inflammatory effects, providing a new treatment strategy for wound care before burn skin grafting.

Novel Flowable Hemostatic Agent ActiClot: Efficacy and Safety Assessment in Rat and Porcine Models

Background/Objectives: This study evaluated the hemostatic performance and safety of ActiClot (ATC), a new flowable hemostatic agent, through in vivo tests. Methods: ATC was compared with the commercially available FLOSEAL®. ATC consists of carboxymethyl starch, thrombin, and sorbitol powders in Syringe I, and a calcium chloride solution in Syringe II. In vivo evaluation used rat liver bleeding and porcine heart bleeding models. Safety was assessed using a rat subcutaneous implantation model. Results: ATC significantly reduced hemostasis time (70.00 ± 7.35 s) compared to gauze control (240.63 ± 32.31 s) in the rat liver model, showing a 70% reduction. There was no significant difference between ATC and FLOSEAL® (58.75 ± 13.42 s). In the porcine heart model, both agents achieved 100% hemostasis within 3 min, with no significant difference in success rates within 2 min (ATC 87.5%, FLOSEAL® 75%). The gauze control group failed in all tests. The rat subcutaneous implantation model showed no visual ATC observation after 48 h, indicating biocompatibility, with no inflammation observed. Conclusions: ATC demonstrated effective hemostatic performance similar to FLOSEAL® in two in vivo models, with faster hemostasis in the rat liver model. It also showed excellent safety and biocompatibility, indicating its potential for surgical and emergency bleeding control.

Stem cell exosome-loaded Gelfoam improves locomotor dysfunction and neuropathic pain in a rat model of spinal cord injury

BACKGROUND

Spinal cord injury (SCI) is a debilitating illness in humans that causes permanent loss of movement or sensation. To treat SCI, exosomes, with their unique benefits, can circumvent limitations through direct stem cell transplantation. Therefore, we utilized Gelfoam encapsulated with exosomes derived from human umbilical cord mesenchymal stem cells (HucMSC-EX) in a rat SCI model.

METHODS

SCI model was established through hemisection surgery in T9 spinal cord of female Sprague-Dawley rats. Exosome-loaded Gelfoam was implanted into the lesion site. An in vivo uptake assay using labeled exosomes was conducted on day 3 post-implantation. Locomotor functions and gait analyses were assessed using Basso-Beattie-Bresnahan (BBB) locomotor rating scale and DigiGait Imaging System from weeks 1 to 8. Nociceptive responses were evaluated through von Frey filament and noxious radiant heat tests. The therapeutic effects and potential mechanisms were analyzed using Western blotting and immunofluorescence staining at week 8 post-SCI.

RESULTS

For the in vivo exosome uptake assay, we observed the uptake of labeled exosomes by NeuN+, Iba1+, GFAP+, and OLIG2+ cells around the injured area. Exosome treatment consistently increased the BBB score from 1 to 8 weeks compared with the Gelfoam-saline and SCI control groups. Additionally, exosome treatment significantly improved gait abnormalities including right-to-left hind paw contact area ratio, stance/stride, stride length, stride frequency, and swing duration, validating motor function recovery. Immunostaining and Western blotting revealed high expression of NF200, MBP, GAP43, synaptophysin, and PSD95 in exosome treatment group, indicating the promotion of nerve regeneration, remyelination, and synapse formation. Interestingly, exosome treatment reduced SCI-induced upregulation of GFAP and CSPG. Furthermore, levels of Bax, p75NTR, Iba1, and iNOS were reduced around the injured area, suggesting anti-inflammatory and anti-apoptotic effects. Moreover, exosome treatment alleviated SCI-induced pain behaviors and reduced pain-associated proteins (BDNF, TRPV1, and Cav3.2). Exosomal miRNA analysis revealed several promising therapeutic miRNAs. The cell culture study also confirmed the neurotrophic effect of HucMSCs-EX.

CONCLUSION

Implantation of HucMSCs-EX-encapsulated Gelfoam improves SCI-induced motor dysfunction and neuropathic pain, possibly through its capabilities in nerve regeneration, remyelination, anti-inflammation, and anti-apoptosis. Overall, exosomes could serve as a promising therapeutic alternative for SCI treatment.

TAVAC: comprehensive review of currently available hemostatic products as adjunct to surgical hemostasis

BACKGROUND

The use of hemostatic agents by general surgeons during abdominal operations is commonplace as an adjunctive measure to minimize risks of postoperative bleeding and its downstream complications. Proper selection of products can be hampered by marginal understanding of their pharmacokinetics and pharmacodynamics. While a variety of hemostatic agents are currently available on the market, the choice of those products is often confusing for surgeons. This paper aims to summarize and compare the available hemostatic products for each clinical indication and to ultimately better guide surgeons in the selection and proper use of hemostatic agents in daily clinical practice.

METHODS

We utilized PubMed electronic database and published product information from the respective pharmaceutical companies to collect information on the characteristics of the hemostatic products.

RESULTS

All commercially available hemostatic agents in the US are described with a description of their mechanism of action, indications, contraindications, circumstances in which they are best utilized, and expected results.

CONCLUSION

Hemostatic products come with many different types and specifications. They are valuable tools to serve as an adjunct to surgical hemostasis. Proper education and knowledge of their characteristics are important for the selection of the right agent and optimal utilization.

Recent advances of chitosan as a hemostatic material: Hemostatic mechanism, material design and prospective application

Uncontrolled hemorrhage arising from surgery or trauma may cause morbidity and even mortality. Therefore, facilitating control of severe bleeding is imperative for health care worldwide. Among diverse hemostatic materials, chitosan (CS) is becoming the most promising material owing to its non-toxic feature, as well as inherently hemostatic performance. However, further enhancing hemostatic property of CS-based materials without compromising more beneficial functions remains a challenge. In this review, representative hemostatic mechanisms of CS-based materials are firstly discussed in detail, mostly including red blood cells (RBCs) aggregation, platelet adherence and aggregation, as well as interaction with plasma proteins. Also, various forms (involving powder/particle, sponge, hydrogel, nanofiber, and other forms) of CS-based hemostatic materials are systematically summarized, mainly focusing on their design and preparation, characteristics, and comparative analysis of various forms. In addition, varied hemostatic applications are described in detail, such as skin wound hemostasis, liver hemostasis, artery hemostasis, and heart hemostasis. Finally, current challenges and future directions of functional design of CS-based hemostatic materials in diverse hemostatic applications are proposed to inspire more intensive researches.

A fast hemostatic and enhanced photodynamic 2-dimensional metal-organic framework loaded aerogel patch for wound management

Achieving rapid hemostasis and highly effective antibacterial holds significant importance in the early-stage treatment of wounds. In this study, a hybrid aerogel patch comprising carbon quantum dots (CQDs) modified 2-dimensional (2D) porphyrinic metal-organic framework (MOF) nanosheets was designed by incorporating gelatin methacrylate (GelMA) and polyacrylamide (PAM) based matrix. On one hand, CQDs were stably doped onto the surface of the 2D MOF nanosheets, thereby enhancing the photodynamic activity through fluorescence resonance energy transfer (FRET) process. After the preparation of hybrid aerogel patch, the patch loaded with CQDs-doped 2D MOF exhibited excellent photodynamic bactericidal activity against Gram-positive Staphylococcus aureus (>99.99 %) and Gram-negative Escherichia coli (>99.99 %). On the other hand, the hybrid patch with highly porous and absorbent structure can rapidly absorb blood to aggregate clotting components and form a hydration barrier covering the wound to enhance hemostasis. Besides, the hemolysis and cytotoxicity assays demonstrated a good biocompatibility of this designed patch. In summary, this 2D MOF-loaded aerogel patch holds a potential to achieve rapid hemostasis and effective anti-infection in the early-stage treatment of traumatic wounds.

Bioadhesive Technology Platforms

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

Gelatin-based hemostatic agents for medical and dental application at a glance: A narrative literature review

Uncontrolled bleeding is linked to higher treatment costs, risk of post-surgical infection and increased disease and death. Hemostatic agents are used to treat excessive bleeding. A good hemostatic agent controls bleeding effectively, reduces the need for blood transfusion, removes the need for systemic drugs to control bleeding, results in shorter surgery time, and reduces the cost and length of hospital stay of the patient. Gelatin-based hemostatic agents have been widely used in medical and dental procedures, owing to their biodegradability and biocompatibility, as well as availability and low cost of raw materials. In this narrative literature review, we discuss the background and different types of gelatin-based hemostatic agents in medical and dental procedures, the comparison of gelatin-based and non-gelatin-based hemostatic agents, and the usage and development of enhanced or novel gelatin-based hemostatic agents. Gelatin-based hemostatic agents are effective and important part of bleeding control, as evidenced by its wide application in medicine and dentistry. The development of novel combination gelatin-based hemostatic agents has much potential for effective control of excessive bleeding.

Dual-Driven Hemostats Featured with Puncturing Erythrocytes for Severe Bleeding in Complex Wounds

Achieving rapid hemostasis in complex and deep wounds with secluded hemorrhagic sites is still a challenge because of the difficulty in delivering hemostats to these sites. In this study, a Janus particle, SEC-Fe@CaT with dual-driven forces, bubble-driving, and magnetic field– (MF–) mediated driving, was prepared via in situ loading of Fe₃O₄ on a sunflower sporopollenin exine capsule (SEC), and followed by growth of flower-shaped CaCO₃ clusters. The bubble-driving forces enabled SEC-Fe@CaT to self-diffuse in the blood to eliminate agglomeration, and the MF-mediated driving force facilitated the SEC-Fe@CaT countercurrent against blood to access deep bleeding sites in the wounds. During the movement in blood flow, the meteor hammer-like SEC from SEC-Fe@CaT can puncture red blood cells (RBCs) to release procoagulants, thus promoting activation of platelet and rapid hemostasis. Animal tests suggested that SEC-Fe@CaT stopped bleeding in as short as 30 and 45 s in femoral artery and liver hemorrhage models, respectively. In contrast, the similar commercial product Celox™ required approximately 70 s to stop the bleeding in both bleeding modes. This study demonstrates a new hemostat platform for rapid hemostasis in deep and complex wounds. It was the first attempt integrating geometric structure of sunflower pollen with dual-driven movement in hemostasis.

Polymeric Materials for Hemostatic Wound Healing

Hemorrhage is one of the greatest threats to life on the battlefield, accounting for 50% of total deaths. Nearly 86% of combat deaths occur within the first 30 min after wounding. While external wound injuries can be treated mostly using visual inspection, abdominal or internal hemorrhages are more challenging to treat with regular hemostatic dressings because of deep wounds and points of injury that cannot be located properly. The need to treat trauma wounds from limbs, abdomen, liver, stomach, colon, spleen, arterial, venous, and/or parenchymal hemorrhage accompanied by severe bleeding requires an immediate solution that the first responders can apply to reduce rapid exsanguinations from external wounds, including in military operations. This necessitates the development of a unique, easy-to-use, FDA-approved hemostatic treatment that can deliver the agent in less than 30 s and stop bleeding within the first 1 to 2 min at the point of injury without application of manual pressure on the wounded area.

Haemostatic materials for wound healing applications

Wounds are one of the most common health issues, and the cost of wound care and healing has continued to increase over the past decade. The first step in wound healing is haemostasis, and the development of haemostatic materials that aid wound healing has accelerated in the past 5 years. Numerous haemostatic materials have been fabricated, composed of different active components (including natural polymers, synthetic polymers, silicon-based materials and metal-containing materials) and in various forms (including sponges, hydrogels, nanofibres and particles). In this Review, we provide an overview of haemostatic materials in wound healing, focusing on their chemical design and operation. We describe the physiological process of haemostasis to elucidate the principles that underpin the design of haemostatic wound dressings. We also highlight the advantages and limitations of the different active components and forms of haemostatic materials. The main challenges and future directions in the development of haemostatic materials for wound healing are proposed.

Gelatin methacryloyl hydrogels functionalized with endothelin-1 for angiogenesis and full-thickness wound healing

Natural polymer hydrogels are widely used as wound dressings, but they do not have enough bioactivity to accelerate angiogenesis and re-epithelialization. Herein, a therapeutic system was firstly constructed in which endothelin-1 (ET-1), as an endogenous vasoconstrictor peptide, was embedded in a photo-crosslinking gelatin methacryloyl (GelMA) hydrogel for full-thickness wound healing. The multifunctional GelMA-ET-1 hydrogels contained the arginine-glycine-aspartate (RGD) motifs of gelatin that provided adhesive sites for cell proliferation and migration. The ET-1 was wrapped within the network of crosslinked GelMA hydrogels via intermolecular hydrogen bonding interactions, effectively avoiding oxidization by atmospheric oxygen and in vivo enzymatic biodegradation. Notably, the ET-1 in the functional hydrogels significantly promoted the proliferation, migration and angiogenesis-related gene expression of human umbilical vein endothelial cells (HUVECs) and fibroblasts. The full-thickness skin defect model of rats further revealed that the GelMA-ET-1 hydrogels significantly accelerated new blood vessel formation, collagen deposition and re-epithelialization. After 14 days, the full-thickness skin defects almost closed and were filled with the newly formed tissue. Hence, the photo-crosslinking GelMA-ET-1 hydrogels functionalized with ET-1 can be employed as a promising therapeutic system for wound healing.