Nanofibers reinforced injectable hydrogel with self-healing, antibacterial, and hemostatic properties for chronic wound healing

Recent advances of the nanocomposite hydrogel as a local drug delivery for diabetic ulcers

Diabetic ulcer is a serious complication of diabetes. Compared with that of healthy people, the skin of patients with a diabetic ulcer is more easily damaged and difficult to heal. Without early intervention, the disease will become increasingly serious, often leading to amputation or even death. Most current treatment methods cannot achieve a good wound healing effect. Numerous studies have shown that a nanocomposite hydrogel serves as an ideal drug delivery method to promote the healing of a diabetic ulcer because of its better drug loading capacity and stability. Nanocomposite hydrogels can be loaded with one or more drugs for application to chronic ulcer wounds to promote rapid wound healing. Therefore, this paper reviews the latest progress of delivery systems based on nanocomposite hydrogels in promoting diabetic ulcer healing. Through a review of the recent literature, we put forward the shortcomings and improvement strategies of nanocomposite hydrogels in the treatment of diabetic ulcers.

An agar-polyvinyl alcohol hydrogel loaded with tannic acid with efficient hemostatic and antibacterial capacity for wound dressing

Rapid hemostasis, antibacterial effect and promotion of wound healing are the most important functions that wound dressings need to have. In this work, we designed and prepared a hydrogel with antibacterial effect, hemostatic ability and wound healing promotion using agar, polyvinyl alcohol (PVA) and tannic acid (TA). We performed a series of tests to characterize the structure and properties of AGAR@PVA-TA hydrogels. The results showed that the AGAR@PVA-TA hydrogels had good mechanical properties and excellent antibacterial ability as well as good hemocompatibility. The cytotoxicity results showed that the AGAR@PVA-TA hydrogels had good cytocompatibility. And the TA loaded hydrogels also presented some good performances in animal studies. In the liver hemostasis model, the AGAR@PVA-TA hydrogel showed good hemostatic ability. Also, the AGAR@PVA-TA hydrogel was able to promote wound healing in an S. aureus-infected rat wound model. More importantly, our research results demonstrated that compared to other polyphenols (such as proanthocyanidins), TA could better improve the mechanical properties, antibacterial ability and rapid hemostasis of hydrogels, which illustrated the uniqueness of TA. Therefore, the TA loaded hydrogel (AGAR@PVA-TA hydrogel) has the potential to be applied as a wound dressing.

Self-Healing Injectable Hydrogels for Tissue Regeneration

Biomaterials with the ability to self-heal and recover their structural integrity offer many advantages for applications in biomedicine. The past decade has witnessed the rapid emergence of a new class of self-healing biomaterials commonly termed injectable, or printable in the context of 3D printing. These self-healing injectable biomaterials, mostly hydrogels and other soft condensed matter based on reversible chemistry, are able to temporarily fluidize under shear stress and subsequently recover their original mechanical properties. Self-healing injectable hydrogels offer distinct advantages compared to traditional biomaterials. Most notably, they can be administered in a locally targeted and minimally invasive manner through a narrow syringe without the need for invasive surgery. Their moldability allows for a patient-specific intervention and shows great prospects for personalized medicine. Injected hydrogels can facilitate tissue regeneration in multiple ways owing to their viscoelastic and diffusive nature, ranging from simple mechanical support, spatiotemporally controlled delivery of cells or therapeutics, to local recruitment and modulation of host cells to promote tissue regeneration. Consequently, self-healing injectable hydrogels have been at the forefront of many cutting-edge tissue regeneration strategies. This study provides a critical review of the current state of self-healing injectable hydrogels for tissue regeneration. As key challenges toward further maturation of this exciting research field, we identify (i) the trade-off between the self-healing and injectability of hydrogels vs their physical stability, (ii) the lack of consensus on rheological characterization and quantitative benchmarks for self-healing injectable hydrogels, particularly regarding the capillary flow in syringes, and (iii) practical limitations regarding translation toward therapeutically effective formulations for regeneration of specific tissues. Hence, here we (i) review chemical and physical design strategies for self-healing injectable hydrogels, (ii) provide a practical guide for their rheological analysis, and (iii) showcase their applicability for regeneration of various tissues and 3D printing of complex tissues and organoids.

Current Advances in the Development of Hydrogel-Based Wound Dressings for Diabetic Foot Ulcer Treatment

Diabetic foot ulcers (DFUs) are one of the most prevalent complications associated with diabetes mellitus. DFUs are chronic injuries that often lead to non-traumatic lower extremity amputations, due to persistent infection and other ulcer-related side effects. Moreover, these complications represent a significant economic burden for the healthcare system, as expensive medical interventions are required. In addition to this, the clinical treatments that are currently available have only proven moderately effective, evidencing a great need to develop novel strategies for the improved treatment of DFUs. Hydrogels are three-dimensional systems that can be fabricated from natural and/or synthetic polymers. Due to their unique versatility, tunability, and hydrophilic properties, these materials have been extensively studied for different types of biomedical applications, including drug delivery and tissue engineering applications. Therefore, this review paper addresses the most recent advances in hydrogel wound dressings for effective DFU treatment, providing an overview of current perspectives and challenges in this research field.

Diabetes mellitus and diabetic foot ulcer: Etiology, biochemical and molecular based treatment strategies via gene and nanotherapy

Diabetes mellitus (DM) is a collection of metabolic and pathophysiological disorders manifested with high glucose levels in the blood due to the inability of β-pancreatic cells to secrete an adequate amount of insulin or insensitivity of insulin towards receptor to oxidize blood glucose. Nevertheless, the preceding definition is only applicable to people who do not have inherited or metabolic disorders. Suppose a person who has been diagnosed with Type 1 or Type 2DM sustains an injury and the treatment of the damage is complicated and prolonged. In that case, the injury is referred to as a diabetic foot ulcer (DFU). In the presence of many proliferating macrophages in the injury site for an extended period causes the damage to worsen and become a diabetic wound. In this review, the scientific information and therapeutic management of DM/DFU with nanomedicine, and other related data were collected (Web of Science and PubMed) from January 2000 to January 2022. Most of the articles revealed that standard drugs are usually prescribed along with hypoglycaemic medications. Conversely, such drugs stabilize the glucose transporters and homeostasis for a limited period, resulting in side effects such as kidney damage/failure, absorption/gastrointestinal problems, and hypoglycemic issues. In this paper, we review the current basic and clinical evidence about the potential of medicinal plants, gene therapy, chemical/green synthesized nanoparticles to improving the metabolic profile, and facilitating the DM and DFU associated complications. Preclinical studies also reported lower plasma glucose with molecular targets in DM and DFU. Research is underway to explore chemical/green synthesized nanoparticle-based medications to avoid such side effects. Hence, the present review is intended to address the current challenges, recently recognized factors responsible for DM and DFU, their pathophysiology, insulin receptors associated with DM, medications in trend, and related complications.

Electrospun fiber-based strategies for controlling early innate immune cell responses: Towards immunomodulatory mesh designs that facilitate robust tissue repair

Electrospun fibrous meshes are widely used for tissue repair due to their ability to guide a host of cell responses including phenotypic differentiation and tissue maturation. A critical factor determining the eventual biological outcomes of mesh-based regeneration strategies is the early innate immune response following implantation. The natural healing process involves a sequence of tightly regulated, temporally varying and delicately balanced pro-/anti-inflammatory events which together promote mesh integration with host tissue. Matrix designs that do not account for the immune milieu can result in dysregulation, chronic inflammation and fibrous capsule formation, thus obliterating potential therapeutic outcomes. In this review, we provide systematic insights into the effects of specific fiber/mesh properties and mechanical stimulation on the responses of early innate immune modulators viz., neutrophils, monocytes and macrophages. We identify matrix characteristics that promote anti-inflammatory immune phenotypes, and we correlate such responses with pro-regenerative in vivo outcomes. We also discuss recent advances in 3D fabrication technologies, bioactive functionalization approaches and biomimetic/bioinspired immunomodulatory mesh design strategies for tissue repair and wound healing. The mechanobiological insights and immunoregulatory strategies discussed herein can help improve the translational outcomes of fiber-based regeneration and may also be leveraged for intervention in degenerative diseases associated with dysfunctional immune responses. STATEMENT OF SIGNIFICANCE: The crucial role played by immune cells in promoting biomaterial-based tissue regeneration is being increasingly recognized. In this review focusing on the interactions of innate immune cells (primarily neutrophils, monocytes and macrophages) with electrospun fibrous meshes, we systematically elucidate the effects of the fiber microenvironment and mechanical stimulation on biological responses, and build upon these insights to inform the rational design of immunomodulatory meshes for effective tissue repair. We discuss state-of-the-art fabrication methods and mechanobiological advances that permit the orchestration of temporally controlled phenotypic switches in immune cells during different phases of healing. The design strategies discussed herein can also be leveraged to target several complex autoimmune and inflammatory diseases.

Hydrogels for Antitumor and Antibacterial Therapy

As a highly absorbent and hydrophobic material with a three-dimensional network structure, hydrogels are widely used in biomedical fields for their excellent biocompatibility, low immunogenicity, adjustable physicochemical properties, ability to encapsulate a variety of drugs, controllability, and degradability. Hydrogels can be used not only for wound dressings and tissue repair, but also as drug carriers for the treatment of tumors. As multifunctional hydrogels are the focus for many researchers, this review focuses on hydrogels for antitumor therapy, hydrogels for antibacterial therapy, and hydrogels for co-use in tumor therapy and bacterial infection. We highlighted the advantages and representative applications of hydrogels in these fields and also outlined the shortages and future orientations of this useful tool, which might give inspirations for future studies.

Adaptive injectable carboxymethyl cellulose/poly (γ-glutamic acid) hydrogels promote wound healing

The clinical acceleration of skin autogenous healing remains a great challenge, especially in the early stage after injury. In this work, a novel directly injectable hydrogel with high self-adaptability is designed as a provisional matrix to close the apposition of wound edges, using carboxymethyl cellulose and poly (γ-glutamic acid) through Schiff-base reaction. Benefiting from the dynamic covalent cross-linking structure, the functional biodegradable hydrogels are easy to prepare (gel time 5-180 s), demonstrating adequate mechanical strength (40-120 kPa), anti-fatigue abilities, and rapid self-healing (5-10 min at skin defect). Furthermore, the hydrogels exhibit biocompatibility and proliferation-promoting activity with murine fibroblasts. In the full-thickness dermal animal models, it significantly promoted collagen deposition, skin-function restoration, and VEGF expression. This hydrogel shows potential as a dressing available for skin regeneration during the healing of dermal injuries.

Multifunctional hydrogel platform for biofilm scavenging and O2 generating with photothermal effect on diabetic chronic wound healing

Diabetic wound treatment remains a major challenge due to the difficulties of eliminating bacterial biofilm and relieving wound hypoxia. To address these issues simultaneously, a multifunctional Dex-SA-AEMA/MnO₂/PDA (DSAMP) hydrogel platform was developed with excellent biocompatibility and porous structure. The hydrogel could absorb the exudate, maintain humidity and permeate oxygen, which was prepared by encapsulating polydopamine (PDA) and manganese dioxide (MnO₂) into Dex-SA-AEMA (DSA) hydrogel by UV irradiation. With the addition of PDA, the DSAMP hydrogel was proved to eliminate the biofilm after NIR photodynamic therapy (PTT, 808 nm) irradiation at 54 °C. Furthermore, in order to mitigate hypoxia wound microenvironment, MnO₂ nanoparticles were added to convert the endogenous hydrogen peroxide (H₂O₂) into oxygen (O₂, 16 mg L^-1). The diabetic wound in vivo treated by DSAMP hydrogel was completely healed on 14 days. It was revealed that the DSAMP hydrogel possessed a great potential as dressing for diabetic chronic wound healing.

Wound Microenvironment-Responsive Protein Hydrogel Drug-Loaded System with Accelerating Healing and Antibacterial Property

Growth factors play a vital role in wound healing, and novel hydrogel carriers suitable for growth factors have always been a research hotspot in the wound healthcare field. In this work, a wound microenvironment-responsive hydrogel drug-loading system was constructed by cross-linking of the internal electron-deficient polyester and bovine serum albumin (BSA) via catalyst-free amino-yne bioconjugation. The slightly acidic microenvironment of wound tissues induces the charge removal of BSA chains, thus releasing the basic fibroblast growth factor (bFGF) loaded through electrostatic action. Besides, the BSA chains in the gel network further endow their excellent biocompatibility and biodegradability, also making them more suitable for bFGF loading. The wound caring evaluation of the hydrogel in the full-thickness skin wound indicated that the protein-based hydrogel significantly promotes the proliferation and differentiation of fibroblasts, collagen accumulation, and epidermal layer stacking, thus significantly shortening the healing process. This strategy paved the way for broadening the application of the growth factors in the wound care field.

Rational Design and Preparation of Functional Hydrogels for Skin Wound Healing

Skin wound healing often contains a series of dynamic and complex physiological healing processes. It is a great clinical challenge to effectively treat the cutaneous wound and regenerate the damaged skin. Hydrogels have shown great promise for skin wound healing through the rational design and preparation to endow with specific functionalities. In the mini review, we firstly introduce the design and construction of various types of hydrogels based on their bonding chemistry during cross-linking. Then, we summarize the recent research progress on the functionalization of bioactive hydrogel dressings for skin wound healing, including anti-bacteria, anti-inflammatory, tissue proliferation and remodeling. In addition, we highlight the design strategies of responsive hydrogels to external physical stimuli. Ultimately, we provide perspectives on future directions and challenges of functional hydrogels for skin wound healing.

Ultrafast gelation of multifunctional hydrogel/composite based on self-catalytic Fe3+/Tannic acid-cellulose nanofibers

Multifunctional hydrogels with transparency, ultraviolet (UV)-blocking, stretchable, self-healing, adhesive, antioxidant and antibacterial properties are promising materials for biomedical and relevant applications. However, preparation of these hydrogels at ambient environment without stimuli is still a challenge. Here, a series of hydrogels possessing ultrashort gelation time (~30 s) at room or cold temperature were fabricated based on self-catalytic Fe³⁺/Tannic acid-cellulose nanofiber (Fe³⁺/TA-CNF). Fe³⁺/TA-CNF formed stable redox pairs to activate ammonium persulfate (initiator), generating abundant free radicals to trigger the ultrafast polymerization of acrylic acid (AA). To improve the antibacterial ability of hydrogel, a bilayer hydrogel composite (NF@HG) composed of tetracycline hydrochloride (TH)-loaded electrospun nanofibers and hydrogel layer was fabricated via a mild casting method. The NF@HG exhibited enhanced antibacterial ability and the sustained release of TH can provide long-term antibacterial activity. Besides, cell viability results demonstrated that NF@HG was non-cytotoxic. Taken together, this strategy based on self-catalytic Fe³⁺/TA-CNF system may inspire new aspects on fast and economical preparation of multifunctional hydrogels or composites, which have attractive industrial applications for biomedical materials.

Naked-eye sensing and target-guiding treatment of bacterial infection using pH-tunable multicolor luminescent lanthanide-based hydrogel

In this work, a pH-tunable multicolor luminescent lanthanide-based hydrogel (CS/DEX/CP) was prepared based on lanthanide coordination polymer (CP), dextran aldehyde (DEX) and chitosan (CS). The CP was obtained by the self-assembly of guanosine acid (GMP), ciprofloxacin (CIP), Eu³⁺, and Tb³⁺. As-prepared CS/DEX/CP hydrogel could emit blue, green, and red luminescence of CIP, Tb³⁺, and Eu³⁺, respectively. It was also found that the luminescence of CS/DEX/CP hydrogel exhibited visual color change in the pH range of 5.5 to 8. Such pH-sensitive hydrogel was multicolor-responsive to protons produced by bacterial growth, therefore, it could provide early warning of bacterial infection by naked-eye. In addition, the increased acidity resulted in not only the degradation of acid-labile Schiff base linkages between DEX and CS, but also the fracture of coordination between CIP and lanthanide ions. As a result, the released CIP and CS showed significantly antibacterial activity against both S. aureus and E. coli.

Directional Transportation in a Self-Pumping Dressing Based on a Melt Electrospinning Hydrophobic Mesh

Self-pumping wound dressings with directional water transport ability have been widely studied for their function of directional extraction of excessive biofluid from wounds while keeping the wound in a moderately humid environment to realize rapid wound healing. However, the existing solutions have not paid close attention to the fabrication of a nonirritating hydrophobic layer facing the wounds, which may cause irritation to wounds and thereby further worsen inflammation. Herein, a flexible and elastic thermoplastic polyurethane (TPU) hydrophobic microfiber mesh (TPU-HMM) produced by melt electrospinning (MES) is reported. The TPU-HMM was compounded to a hydrophilic nanofiber membrane, which was fabricated by blending with polyamide 6 and poly(ethylene glycol) (PA6-PEG) to form a composite self-pumping dressing, for which the breakthrough pressure in a reverse direction was 12.8 times than that in a positive direction and the forward water transmission rate was increased by 700%. It shows good directional water transport ability and is expected to absorb excessive biofluid of the wounds. This solvent-free and easy-process TPU-HMM provides a new strategy for the development of functional self-pumping textiles, and the solvent-free fabrication method for fibers, which eliminates the potential toxicity brought by solvent residues, offers more possibilities for its applications in biomedicine.

Synergistic antibacterial polyacrylonitrile/gelatin nanofibers coated with metal-organic frameworks for accelerating wound repair

Bacterial infections prolong the wound healing time and increase the suffering of patients, thus it is important to develop wound dressing that can inhibit bacterial infection. Herein, we use two methods including "doping method" and "secondary growth method" to prepare ZIF-8@gentamicin embedded in and coated on polyacrylonitrile/gelatin (PG) nanofibers, separately. Composite nanofibers prepared by the secondary growth method achieve higher drug loading than that of the doping method, and the release rate can be adjusted by pH. Simultaneously increasing drug loading and regulating its release rate are achieved in the secondary growth method, which cannot be achieved by the doping method. Furthermore, synergistic antibacterial property occurs in the composite nanofibers prepared by the secondary growth method, and gentamicin loaded on ZIF-8 promotes the antibacterial effect, which shows better antibacterial effect than the doping method. As a result, during the wound infection of mouse, composite nanofibers prepared by the secondary growth method exhibit a faster recovery effect than the doping method, which effectively shortened the wound healing time from 21 days to 16 days.

A multifunctional green antibacterial rapid hemostasis composite wound dressing for wound healing

Rapid hemostasis and antibacterial properties are essential for novel wound dressings to promote wound healing. In particular, timely and rapid hemostasis could be of benefit to reduce the mortality caused by excessive bleeding loss. Herein, we present a novel strategy of combining electrospinning technology with post-modification technology to prepare a multifunctional wound dressing, cellulose diacetate-based composite wound dressing (CDCE), with rapid hemostasis and antibacterial activity. It is interesting that the CDCE wound dressing had superhydrophilicity, high water absorption, and strong absorbing capacity, which could eliminate the exudate around the wound in a timely manner and further promote rapid hemostasis. Additionally, its excellent antibacterial properties could inhibit severe infection in the wound and accelerate wound healing. Based on these advantages, the novel CDCE wound dressing could promote wound contraction and further accelerate wound healing compared with the common traditional wound dressing gauze. Taken together, the multifunctional CDCE wound dressing has high potential for clinical application in the future.

Shark Tooth-Inspired Microneedle Dressing for Intelligent Wound Management

Intelligent management beyond therapeutic drug treating holds significant prospects in facilitating the recovery of intractable chronic wounds. Here, inspired by the flat and inclined structure of shark teeth, we present a shark tooth-inspired microneedle patch for intelligent wound management. By simply replicating negative molds fabricated by laser engraving and using origami, such a biomimetic microneedle patch can be fabricated easily and rapidly. The biomimetic structures endow the microneedle patch with stable adhesion during the long-term recovery process of chronic wounds. Porous ordered structures and a temperature-responsive hydrogel are utilized to construct a controllable drug release system on the microneedle patch. The microfluidic channel composed of microneedle arrays and porous ordered structures enables a microneedle patch with the capacity to analyze several inflammatory factors. In addition, MXene electronics was patterned on the microneedle patch in order to achieve sensitive motion monitoring. Also, it was demonstrated from invivo diabetic rat experiments that recovery of full-thickness cutaneous wounds including stripe-shaped and circular wounds can be facilitated by employing the drug-loaded biomimetic microneedle patch.