Characterization and Hemostatic Potential of Two Kaolins from Southern China

Synergistic Procoagulant Mechanism and Application of Kaolin-Zeolite Composite Hemostat for Effective Hemorrhage Control

Achieving timely and effective hemorrhage control is imperative for the survival of individuals with severe bleeding. Hemostatic materials, by enhancing the natural cell-based coagulation response, are essential tools in modern and military medical practice for controlling bleeding, especially in emergency and surgical settings. Here, we report a new type of composite hemostatic material with two different aluminosilicate-based components, kaolin and zeolite, which synergistically work together in different stages of the coagulation cascade reactions. Kaolin can effectively activate the clotting factor FXII in the early stage, and zeolite can accumulate and assemble FXa and FVa on its surface and thereafter lead to the formation of highly active thrombin in the later stage. The synergistic action mechanism between kaolin and zeolite significantly boosts the levels of FXIIa and FXa, and it also greatly enhances plateau thrombin activity. For practical application, a kaolin-modified zeolite gauze is fabricated, and it demonstrates excellent hemostatic effectiveness. Compared to the combat gauze currently used in front-line treatment, it reduces blood loss by 75% and shortens hemostasis time by 33% in a rabbit femoral artery injury model. In addition, this kaolin-zeolite gauze has no heat release problem and a nearly zero particle shedding rate, which greatly decreases the safety risk compared to current commercial inorganic-based hemostatic gauzes.

Development of Polyphosphate/Nanokaolin-Modified Alginate Sponge by Gas-Foaming and Plasma Glow Discharge Methods for Ultrarapid Hemostasis in Noncompressible Bleeding

Effective bleeding management strategies in uncontrollable and noncompressible massive hemorrhage are becoming important in both clinical and combat situations. Here, a novel approach was developed to create a superporous and highly absorbable hemostatic sponge through a facile chemical gas-foaming method by cross-linking long-chain polyphosphate along with nanokaolin and Ca2+ in an alginate structure to synergistically activate the coagulation pathway. Natural kaolin obtained from the Marand mine in East Azarbaijan was converted into pseudohexagonal-shaped kaolin nanoparticles (30 to 150 nm) using ball milling followed by a newly developed glow discharge plasma treatment method. The obtained ultralight sponges (>90% porosity) exhibit ultrarapid water/blood absorption capacity (∼4000%) and excellent shape memory, which effectively concentrates coagulation factors. The results of in vitro tests demonstrated that the proposed sponges exhibited enhanced blood clotting ability (BCI < 10%) and superior cohesion with red blood cells (∼100) and platelets (∼80%) compared to commercially available hemostatic products. The in vivo host response results exhibited biosafety with no systemic and significant local inflammatory response by hematological, pathological, and biochemical parameter assessments. In a rat femoral artery complete excision model, the application of alginate/k/polyp nanocomposite sponges resulted in a complete hemostasis time of 60 s by significant reduction of hemostasis time (∼6.7-8.3 fold) and blood loss (∼2-2.8-fold) compared to commercially available hemostatic agents (P < 0.001). In conclusion, distinct physical characteristics accompanied by unique chemical composition multifunctional sponges activate hemostasis synergistically by triggering the XII, XI, X, IX, V, and II factors and the contact pathway and have the ability of rapid hemostasis in noncompressible severe bleeding.

Silk Fibroin and Its Nanocomposites for Wound Care: A Comprehensive Review

For most individuals, wound healing is a highly organized, straightforward process, wherein the body transitions through different phases in a timely manner. However, there are instances where external intervention becomes necessary to support and facilitate different phases of the body's innate healing mechanism. Furthermore, in developing countries, the cost of the intervention significantly impacts access to treatment options as affordability becomes a determining factor. This is particularly true in cases of long-term wound treatment and management, such as chronic wounds and infections. Silk fibroin (SF) and its nanocomposites have emerged as promising biomaterials with potent wound-healing activity. Driven by this motivation, this Review presents a critical overview of the recent advancements in different aspects of wound care using SF and SF-based nanocomposites. In this context, we explore various formats of hemostats and assess their suitability for different bleeding situations. The subsequent sections discuss the primary causes of nonhealing wounds, i.e., prolonged inflammation and infections. Herein, different treatment strategies to achieve immunomodulatory and antibacterial properties in a wound dressing were reviewed. Despite exhibiting excellent pro-healing properties, few silk-based products reach the market. This Review concludes by highlighting the bottlenecks in translating silk-based products into the market and the prospects for the future.

Recent Advances in Topical Hemostatic Materials

Untimely or improper treatment of traumatic bleeding may cause secondary injuries and even death. The traditional hemostatic modes can no longer meet requirements of coping with complicated bleeding emergencies. With scientific and technological advancements, a variety of topical hemostatic materials have been investigated involving inorganic, biological, polysaccharide, and carbon-based hemostatic materials. These materials have their respective merits and defects. In this work, the application and mechanism of the major hemostatic materials, especially some hemostatic nanomaterials with excellent adhesion, good biocompatibility, low toxicity, and high adsorption capacity, are summarized. In the future, it is the prospect to develop multifunctional hemostatic materials with hemostasis and antibacterial and anti-inflammatory properties for promoting wound healing.

Recent advances in the application of clay-containing hydrogels for hemostasis and wound healing

INTRODUCTION

Immediate control of bleeding and anti-infection play important roles in wound management. Multiple organ dysfunction syndrome and death may occur if persistent bleeding, hemodynamic instability, and hypoxemia are not addressed. The combination of clay and hydrogel provides a new outlet for wound hemostasis. In this review, the current research progress of hydrogel/clay composite hemostatic agents was reviewed.

AREAS COVERED

This paper summarizes the characteristics of several kinds of clay including kaolinite, montmorillonite, laponite, sepiolite, and palygorskite. The advantages and disadvantages of its application in hemostasis were also summarized. Future directions for the application of hydrogel/clay composite hemostatic agents are presented.

EXPERT OPINION

Clay can activate the endogenous hemostatic pathway by increasing blood cell concentration and promoting plasma absorption to accelerate the hemostasis. Clay is antimicrobial due to the slow release of metal ions and has a rich surface charge with a high affinity for proteins and cells to promote tissue repair. Hydrogels have some properties such as good biocompatibility, strong adhesion, high stretchability, and good self-healing. Despite promising advances, hydrogel/clay composite hemostasis remains a limitation. Therefore, more evidence is needed to further elucidate the risk factors and therapeutic effects of hydrogel/clay in hemostasis and wound healing.

Safe and Efficacious Near Superhydrophobic Hemostat for Reduced Blood Loss and Easy Detachment in Traumatic Wounds

Hemorrhage is the leading cause of trauma death, and innovation in hemostatic technology is important. The strongly hydrophobic carbon nanofiber (CNF) coating has previously been shown to have excellent hemostatic properties. However, the understanding of how CNF coating guides the coagulation cascade and the biosafety of CNF as hemostatic agents has yet to be explored. Here, our thrombin generation assay investigation showed that CNF induced fast blood coagulation via factor (F) XII activation of the intrinsic pathway. We further performed studies of a rat vein injury and demonstrated that the CNF gauze enabled a substantial reduction of blood loss compared to both the plain gauze and kaolin-imbued gauze (QuikClot). Analysis of blood samples from the model revealed no acute toxicity from the CNF gauze, with no detectable CNF deposition in any organ, suggesting that the immobilization of CNF on our gauze prevented the infiltration of CNF into the bloodstream. Direct injection of CNF into the rat vein was also investigated and found not to elicit overt acute toxicity or affect animal survival or behavior. Finally, toxicity assays with primary keratinocytes revealed minimal toxicity responses to CNF. Our studies thus supported the safety and efficacy of the CNF hemostatic gauze, highlighting its potential as a promising approach in the field of hemostatic control.

Local Clays from China as Alternative Hemostatic Agents

In recent years, the coagulation properties of inorganic minerals such as kaolin and zeolite have been demonstrated. This study aimed to assess the hemostatic properties of three local clays from China: natural kaolin from Hainan, natural halloysite from Yunnan, and zeolite synthesized by our group. The physical and chemical properties, blood coagulation performance, and cell biocompatibility of the three materials were tested. The studied materials were characterized by using scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), X-ray fluorescence spectroscopy (XRF), thermogravimetric analysis (TGA), and differential scanning calorimetry (DSC). All three clays showed different morphologies and particle size, and exhibited negative potentials between pH 6 and 8. The TGA and DSC curves for kaolin and halloysite were highly similar. Kaolin showed the highest water absorption capacity (approximately 93.8% ± 0.8%). All three clays were noncytotoxic toward L929 mouse fibroblasts. Kaolin and halloysite showed blood coagulation effects similar to that exhibited by zeolite, indicating that kaolin and halloysite are promising alternative hemostatic materials.

Progress and future prospects of hemostatic materials based on nanostructured clay minerals

The occurrence of uncontrolled hemorrhage is a significant threat to human life and health. Although hemostatic materials have made remarkable advances in the biomaterials field, it remains a challenge to develop safe and effective hemostatic materials for global medical use. Natural clay minerals (CMs) have long been used as traditional inorganic hemostatic agents due to their good hemostatic capability, biocompatibility and easy availability. With the advancement of science, technology and ideology, CM-based hemostatic materials have undergone continuous innovations by integrating new inspirations with conventional concepts. This review systematically summarizes the hemostatic mechanisms of different natural CMs based on their nanostructures. Moreover, it also comprehensively reviews the latest research progress for CM-based hemostatic hybrid and nanocomposite materials, and discusses the challenges and developments in this field.

The Emergence of Extracellular Electron Mediating Functionality in Rice Straw-Artificial Soil Mixture during Humification

This study aimed to elucidate the origin of extracellular electron mediating (EEM) functionality and redox-active center(s) in humic substances, where they are ubiquitously distributed. Here, we show the emergence of EEM functionality during the humification of rice straw in artificial soil (kaolin and sand) with a matric potential of -100 cm at 20 °C for one year. We used the dechlorination activity of an EEM material-dependent pentachlorophenol-dechlorinating anaerobic microbial consortium as an index of the EEM functionality. Although rice straw and its mixture with artificial soil did not initially have EEM functionality, it emerged after one month of humification and increased until six months after which the functionality was maintained for one year. Chemical and electrochemical characterizations demonstrated that the emergence and increase in EEM functionality were correlated with the degradation of rice straw, formation of quinone structures, a decrease in aromatic structures, an increase in nitrogenous and aliphatic structures, and specific electric capacitance during humification. The newly formed quinone structure was suggested as a potential redox-active center for the EEM functionality. These findings provide novel insights into the dynamic changes in EEM functionality during the humification of organic materials.

Experimental study on fabrication, biocompatibility and mechanical characterization of polyhydroxybutyrate-ball clay bionanocomposites for bone tissue engineering

The poly (3-hydroxybutyrate) (PHB)/ball clay nanocomposites (B1-B10) were synthesized using solvent casting method with different weight percentage of ball clay in PHB matrix. Scanning electron microscope (SEM) showed maximum root mean square roughness (188.73 μm) for 10% ball clay loading. Fourier transforms infrared spectroscopy (FT-IR) and X-ray diffraction (XRD) showed establishment of intercalated structure and formation of hydrogen bond between ball clay and PHB matrix. Contact angle values (67.3 - 51.3°) exhibited that the nanocomposites (B1-B10) are more hydrophilic than neat PHB (70.30°). Thermogravimetric (TGA) and differential scanning calorimetry (DSC) revealed maximum T_max (278 °C) and T_m (175 °C) for the nanocomposite B10 (PHB/PEG/ball clay: 80%/10%/10%). Maximum tensile strength (38.21 ± 0.15 MPa) and Young's modulus (1.74 ± 0.016 GPa) was observed for B10 nanocomposite. The values of protein adsorption, platelet adhesion, PT, APTT and complement activation for B10 nanocomposites were 165 ± 2 μg/cm², 72 ± 3 × 10⁹ platelets/cm², 23 ± 1 s, 44 ± 2 s, 102 ± 2 mg/dL and 631 ± 3 mg/dL, respectively. Hydroxyapatite formation was also observed for nanocomposite (B10) in in vitro simulated body fluid (SBF) study. Finally, the nanocomposite (B10) showed no harmful effect on MG-63 cells, indicating that they are physiologically safe.

Preparation of Chitosan/Clay Composites for Safe and Effective Hemorrhage Control

Uncontrolled hemorrhage from trauma or surgery can lead to death. In this study, chitosan/kaolin (CSK) and chitosan/montmorillonite (CSMMT) composites were prepared from chitosan (CS), kaolin (K), and montmorillonite (MMT) as raw materials to control bleeding. The physiochemical properties and surface morphology of CSK and CSMMT composites were analyzed by Fourier transform infrared spectrometry (FT-IR), X-ray diffraction (XRD), scanning electron microscopy (SEM), zeta potentials, and X-ray fluorescence (XRF). The hemostatic mechanism was measured in vitro by activated partial thromboplastin time (APTT), prothrombin time (PT), in vitro clotting time, erythrocyte aggregation, and thromboelastogram (TEG). The hemostasis ability was further verified by using tail amputation and arteriovenous injury models in rats. The biocompatibility of CSK and CSMMT was evaluated by in vitro hemolysis, cytotoxicity assays, as well as acute toxicity test and skin irritation tests. The results show that CSK and CSMMT are promising composite materials with excellent biocompatibility and hemostatic properties that can effectively control bleeding.

Evaluation of Novel Tranexamic Acid/Montmorillonite Intercalation Composite, as a New Type of Hemostatic Material

Radiation enteritis-clinically manifested as diarrhea, intestinal bleeding, and so on-is frequently caused when the body is exposed to radiation or radiotherapy because the intestine is radiation-sensitive as an abdominal organ. Therefore, strategies to modulate intestinal hemostasis had inspired an important research trend in the process of preventing and treating radiation enteritis. Based on the structural characteristics of montmorillonite (MMT) and the hemostatic drug tranexamic acid (TXA) which was used clinically to treat enteritis, the tranexamic acid-montmorillonite composite material (TXA-MMT) was prepared through intercalation composite technology. According to the analysis of FTIR, XRD, TG-DTG, SEM, and XRF, the prepared TXA-MMT was verified that tranexamic acid could intercalate into layers of montmorillonite. To evaluate the biocompatibility, two experiments were conducted by in vitro hemolysis and in vitro cytotoxicity experiments and results showed that TXA-MMT exhibited good visible biocompatibility. Activated partial thromboplastin time, prothrombin time, and in vitro clotting time were adopted to determine the hemostatic effect of TXA-MMT. Compared with other groups, TXA-MMT revealed a significant decrease in clotting time variations, APTT, and PT. In addition, to investigate the preventive effect of TXA-MMT by the intervention of radiation enteritis mice, inflammatory factors IL-1β, IL-6, and TNF-α and the content of endotoxin in the serum of mice were detected. It demonstrated that TXA-MMT reduced the levels of these factors. Besides, the expression and the pathological changes of the small intestine tissue of mice were relieved. Our findings suggests that TXA-MMT as a promising intercalation composite has a great potential for application in the field of intestinal hemostasis.

A Bioinspired Hemostatic Powder Derived from the Skin Secretion of Andrias davidianus for Rapid Hemostasis and Intraoral Wound Healing

High-performance hemostasis has become increasingly essential in treating various traumas. However, available topical hemostats still have various drawbacks and side-effects. Herein, hemostatic powders derived from the skin secretion of Andrias davidianus (SSAD) with controllable particle size are prepared using feasible frozen-ball milling following lyophilization for hemorrhage-control. Scanning electron microscopy, rheometry, and Brunauer-Emmett-Teller test are used to characterize the coagulation-promoting surface topography, rheological properties, and porous structure of the SSAD particles. The blood-coagulation assays showed that the SSAD powders can induce blood-absorption in a particle size-dependent manner. Particle sizes of the SSAD powders larger than 200 µm and smaller than 800 µm greatly affect the blood-clotting rate. Associated with the thromboelastography (TEG) and amino acid/protein composition analyses, the accessibility and diffusion of blood are mainly dependent on the wettability, adhesivity, and clotting factors of the SSAD particles. Rapid hemostasis in vivo further involves three hemorrhage models (liver, femoral artery, and tail) as well as an oral wound model, which suggest favorable hemostatic and simultaneous regenerative effects of the SSAD hemostatic powder. Considering its degradability and good biocompatibility, SSAD can be an optimal candidate for a new class of inexpensive, natural, and promising hemostatic and wound-dressing agent.

Fungal Chitosan-Derived Biomaterials Modified with Kalanchoe pinnata as Potential Hemostatic Agents-Development and Characterization

Massive blood loss is still a great challenge for modern medicine. To stop the hemorrhage during the surgery or after injury apart from suturing or electrocoagulation, the most efficient method of hemostasis restoration is the use of hemostatic agents. Although there are numerous products on the market, there is still a need for biomaterials that are capable of fast and efficient bleeding management without affecting wound closure or embolism. Chitosan is known for its hemostatic activity; however, its quite poor mechanical properties and heterogenous chemical composition still needs some improvements to become superior compared to biological adhesives. The following study deals with the preparation and evaluation of chitosan-derived natural biomaterials containing Kalanchoe pinnata extract with the potential application as a blood-clotting agent. The materials were obtained under microwave-assisted conditions in two different forms (granules/dressing), whose chemical structure and morphology were studied. Their antioxidant properties have been proven. The chitosan-derived hemostatic agents exhibited superior blood sorption abilities and lack of cytotoxicity to L929 mouse fibroblasts. The study also showed the differences in biological properties depending on their preparation method. The potential mechanism of action was proposed as well as their potential in hemostasis revival.

Nanoclay-based drug delivery systems and their therapeutic potentials

Safe, therapeutically effective, and patient-compliant drug delivery systems are needed to design novel tools and strategies to combat the deadliest of diseases such as cancer, SARS, H7N9 avian influenza, and dengue infection. The major challenges in drug delivery are cytotoxicity, poor biodistribution, insufficient functionality, ineffective drug incorporation in delivery devices, and subsequent drug release. Clay minerals are a class of nanolayered silicates that have good biocompatibility, high specific surface area, chemical inertness, colloid, and thixotropy, and are attractive practical and potential nanomaterials in medicine. These properties enable the usage of nanoclays as drug carriers for the delivery of antibiotics, antihypertensive drugs, anti-psychotic, and anticancer drugs. The review examines the latest advances in nanoclay-based drug delivery systems and related applications in gene therapy and tissue engineering. Clay minerals, particularly montmorillonite, kaolinite, and halloysite are used to delay and/or target drug release or even improve drug dissolution due to their surface charge. Chemical modification of clay minerals such as intercalation of ions into the interlayer space of clay minerals or surface modification of clay minerals is a strategy to tune the properties of nanoclays for the loading and release of a drug. The modified nanoclay can take up drugs by encapsulation, immobilization, ion exchange reaction, or electrostatic interactions. Controlled drug release from the drug-clay originates from the incorporation and interactions between the drug and inorganic layers, including electrostatic interactions and hydrogen bonding. Montmorillonite has proven non-toxic through hematological, biochemical, and histopathological analyses in rat. Montmorillonite can also act as a potent detoxifier. Halloysite nanotubes can bind synthetic and biological components such as chitosan, gelatin, and alginate innate nanocarriers for the improved loading and controlled release of drugs, proteins, and DNA. The peculiar properties of clay nanoparticles lead to promising applications in drug delivery, gene delivery, tissue engineering, cancer and stem cell isolation, and bioimaging.