Multifunctional Biomedical Adhesives

Modulus-tunable multifunctional hydrogel ink with nanofillers for 3D-Printed soft electronics

Seamless integration and conformal contact of soft electronics with tissue surfaces have emerged as major challenges in realizing accurate monitoring of biological signals. However, the mechanical mismatch between the electronics and biological tissues impedes the conformal interfacing between them. Attempts have been made to utilize soft hydrogels as the bioelectronic materials to realize tissue-comfortable bioelectronics. However, hydrogels have several limitations in terms of their electrical and mechanical properties. In this study, we present the development of a 3D-printable modulus-tunable hydrogel with multiple functionalities. The hydrogel has a cross-linked double network, which greatly improves its mechanical properties. Functional fillers such as XLG or functionalized carbon nanotubes (fCNT) can be incorporated into the hydrogel to provide tunable mechanics (Young's modulus of 10-300 kPa) and electrical conductivity (electrical conductivity of ∼20 S/m). The developed hydrogel exhibits stretchability (∼1000% strain), self-healing ability (within 5 min), toughness (400-731 kJ/m3) viscoelasticity, tissue conformability, and biocompatibility. Upon examining the rheological properties in the modulated region, hydrogels can be 3D printed to customize the shape and design of the bioelectronics. These hydrogels can be fabricated into ring-shaped strain sensors for wearable sensor applications.

Multifunctional Self-Healing Carbon Dot-Gelatin Bioadhesive: Improved Tissue Adhesion with Simultaneous Drug Delivery, Optical Tracking, and Photoactivated Sterilization

Bioadhesives with all-inclusive properties for simultaneous strong and robust adhesion, cohesion, tracking, drug delivery, self-sterilization, and nontoxicity are still farfetched. Herein, a carbon dot (CD) is made to infuse each of the above-desired aspects with gelatin, an inexpensive edible protein. The CD derived through controlled hydrothermal pyrolysis of dopamine and terephthaldehyde retained -NH2, -OH, -COOH, and, most importantly, -CHO functionality on the CD surface for efficient skin adhesion and cross-linking. Facile fabrication of CD-gelatin bioadhesive through covalent conjugation of -CHO of the CD with -NH2 of gelatin through Schiff base formation was accomplished. This imparts remarkable self-healing attributes as well as excellent adhesion and cohesion evident from physicomechanical analysis in a porcine skin model. Improved porosity of the bioadhesive allows loading hemin as a model drug whose disembarkment is tracked with intrinsic CD photoluminescence. In a significant achievement, antibiotic-free self-sterilization of bioadhesive is demonstrated through visible light (white LED, 23 W)-irradiated photosensitization of the CD to produce reactive oxygen species for annihilation of both Gram-positive and Gram-negative bacteria with exceptional efficacy (99.9%). Thus, a comprehensive CD-gelatin bioadhesive for superficial and localized wound management is reported as a promising step for the transformation of the bioadhesive domain through controlled nanotization for futuristic clinical translations.

Stimuli‐Responsive Hydrogels for Antibacterial Applications

Hydrogels have emerged as promising candidates for biomedical applications, especially in the field of antibacterial therapeutics, due to their unique structural properties, highly tunable physicochemical properties, and excellent biocompatibility. The integration of stimuli-responsive functions into antibacterial hydrogels holds the potential to enhance their antibacterial properties and therapeutic efficacy, dynamically responding to different external or internal stimuli, such as pH, temperature, enzymes, and light. Therefore, this review describes the applications of hydrogel dressings responsive to different stimuli in antibacterial therapy. The collaborative interaction between stimuli-responsive hydrogels and antibacterial materials is discussed. This synergistic approach, in contrast to conventional antibacterial materials, not only amplifies the antibacterial effect but also alleviates adverse side effects and diminishes the incidence of multiple infections and drug resistance. The review provides a comprehensive overview of the current challenges and outlines future research directions for stimuli-responsive antibacterial hydrogels. It underscores the imperative for ongoing interdisciplinary research aimed at unraveling the mechanisms of wound healing. This understanding is crucial for optimizing the design and implementation of stimuli-responsive antibacterial hydrogels. Ultimately, this review aims to offer scientific guidance for the development and practical clinical application of stimuli-responsive antibacterial hydrogel dressings.

A controlled light-induced gas-foaming porous hydrogel with adhesion property for infected wound healing

Porous hydrogels as scaffolds have great potential in tissue engineering. However, there are still challenges in preparing porous hydrogels with tunable pore size and controlled porosity. Here, we successfully established a photoinduced gas-foaming method of porous hydrogels with controlled macro-micro-nano multiscale. A diazirine (DZ)-modified gelatin (GelDZ) biomaterial was prepared by introducing photocrosslinked DZ group into gelatin. Upon exposure to 365 nm UV light, DZ could be converted to the active group carbene, which could randomly insert into OH, NH, or CH bonds to form covalent crosslinks. GelDZ generated N2 by photodegradation and formed gas-induced porous hydrogels by intermolecular crosslinking without initiator. The loose porous structure of the hydrogel can promote the infiltration of host cells and blood vessels, which was conducive to tissue repair. The interfacial crosslinking of photoactivated GelDZ with tissue proteins imparted adhesion properties to the hydrogel. GelDZ also possessed photoreduction ability, which can reduce silver ions from metal precursors to silver nanoparticles (Ag NPs) in situ, and showed great antibacterial activity due to the sustained release of Ag NPs. GelDZ-Ag NPs prepared by in situ photoreaction can effectively inhibit wound infection and promote skin wound healing, providing a new strategy for designing porous hydrogel in tissue engineering.

Stimuli-Responsive Hydrogel Adhesives for Wound Closure and Tissue Regeneration

Sutures and staplers, as gold standards for clinical wound closure, usually cause secondary tissue injury and require professional technicians and equipment. The noninvasive hydrogel adhesives are used in various biomedical applications, such as wound closure, tissue sealing, and tissue regeneration, due to their remarkable properties. Recently-developed hydrogel adhesives, especially stimuli-responsive hydrogels, have shown great potential owing to their advantages in regulating their performance and functions according to the wound situations or external conditions, thus allowing the wounds to heal gradually. However, comprehensive summary on stimuli-responsive hydrogels as tissue adhesives is rarely reported to date. This review focuses on the advances in the design of various stimuli-responsive hydrogel adhesives over the past decade, including the systems responsive to pH, temperature, photo, and enzymes. Their potential biomedical applications, such as skin closure, cardiovascular and liver hemostasis, and gastrointestinal sealing, are emphasized. Meanwhile, the challenges and future development of stimuli-responsive hydrogel adhesives are discussed. This review aims to provide meaningful insights for the further design of next-generation of hydrogel adhesives for wound closure and tissue regeneration.

Progress of polysaccharide-based tissue adhesives

Recently, polymer-based tissue adhesives (TAs) have gained the attention of scientists and industries as alternatives to sutures for sealing and closing wounds or incisions because of their ease of use, low cost, minimal tissue damage, and short application time. However, poor mechanical properties and weak adhesion strength limit the application of TAs, although numerous studies have attempted to develop new TAs with enhanced performance. Therefore, next-generation TAs with improved multifunctional properties are required. In this review, we address the requirements of polymeric TAs, adhesive characteristics, adhesion strength assessment methods, adhesion mechanisms, applications, advantages and disadvantages, and commercial products of polysaccharide (PS)-based TAs, including chitosan (CS), alginate (AL), dextran (DE), and hyaluronic acid (HA). Additionally, future perspectives are discussed.

Black phosphorus boosts wet-tissue adhesion of composite patches by enhancing water absorption and mechanical properties

Wet-tissue adhesives have long been attractive materials for realizing complicated biomedical functions. However, the hydration film on wet tissues can generate a boundary, forming hydrogen bonds with the adhesives that weaken adhesive strength. Introducing black phosphorus (BP) is believed to enhance the water absorption capacity of tape-type adhesives and effectively eliminate hydration layers between the tissue and adhesive. This study reports a composite patch integrated with BP nanosheets (CPB) for wet-tissue adhesion. The patch's improved water absorption and mechanical properties ensure its immediate and robust adhesion to wet tissues. Various bioapplications of CPB are demonstrated, such as rapid hemostasis (within ~1-2 seconds), monitoring of physical-activity and prevention of tumour-recurrence, all validated via in vivo studies. Given the good practicability, histocompatibility and biodegradability of CPB, the proposed patches hold significant promise for a wide range of biomedical applications.

A 3D printable tissue adhesive

Tissue adhesives are promising alternatives to sutures and staples for joining tissues, sealing defects, and immobilizing devices. However, existing adhesives mostly take the forms of glues or hydrogels, which offer limited versatility. We report a direct-ink-write 3D printable tissue adhesive which can be used to fabricate bioadhesive patches and devices with programmable architectures, unlocking new potential for application-specific designs. The adhesive is conformable and stretchable, achieves robust adhesion with wet tissues within seconds, and exhibits favorable biocompatibility. In vivo rat trachea and colon defect models demonstrate the fluid-tight tissue sealing capability of the printed patches, which maintained adhesion over 4 weeks. Moreover, incorporation of a blood-repelling hydrophobic matrix enables the printed patches to seal actively bleeding tissues. Beyond wound closure, the 3D printable adhesive has broad applicability across various tissue-interfacing devices, highlighted through representative proof-of-concept designs. Together, this platform offers a promising strategy toward developing advanced tissue adhesive technologies.

Manipulating mechanical properties of PEG-based hydrogel nanocomposite: A potential versatile bio-adhesive for the suture-less repair of tissue

Multifunctional bio-adhesives with tunable mechanical properties are obtained by controlling the orientation of anisotropic particles in a blend of fast-curing hydrogel with an imposed capillary flow. The suspensions' microstructural evolution was monitored by the small-angle light scattering (SALS) method during flow up to the critical Péclet number (Pe≈1) necessary for particle orientation and hydrogel crosslinking. The multifunctional bio-adhesives were obtained by combining flow and UV light exposure for rapid photo-curing of PEGDA medium and freezing titania rods' ordered microstructures. Blending the low- and high-molecular weight of PEGDA polymer improved the mechanical properties of the final hydrogel. All the hydrogel samples were non-cytotoxic up to 72 h after cell culturing. The system shows rapid blood hemostasis and promotes adhesive and cohesive strength matching targeted tissue properties with an applicating methodology compatible with surgical conditions. The developed SALS approach to optimize nanoparticles' microstructures in bio-adhesive applies to virtually any optically transparent nanocomposite and any type of anisotropic nanoparticles. As such, this method enables rational design of bio-adhesives with enhanced anisotropic mechanical properties which can be tailored to potentially any type of tissue.

Progress in injectable hydrogels for the treatment of incompressible bleeding: an update

Uncontrollable haemorrhage from deep, noncompressible wounds remains a persistent and intractable challenge, accounting for a very high proportion of deaths in both war and disaster situations. Recently, injectable hydrogels have been increasingly studied as potential haemostatic materials, highlighting their enormous potential for the management of noncompressible haemorrhages. In this review, we summarize haemostatic mechanisms, commonly used clinical haemostatic methods, and the research progress on injectable haemostatic hydrogels. We emphasize the current status of injectable hydrogels as haemostatic materials, including their physical and chemical properties, design strategy, haemostatic mechanisms, and application in various types of wounds. We discuss the advantages and disadvantages of injectable hydrogels as haemostatic materials, as well as the opportunities and challenges involved. Finally, we propose cutting-edge research avenues to address these challenges and opportunities, including the combination of injectable hydrogels with advanced materials and innovative strategies to increase their biocompatibility and tune their degradation profile. Surface modifications for promoting cell adhesion and proliferation, as well as the delivery of growth factors or other biologics for optimal wound healing, are also suggested. We believe that this paper will inform researchers about the current status of the use of injectable haemostatic hydrogels for noncompressible haemorrhage and spark new ideas for those striving to propel this field forward.

Laponite nanoparticle-crosslinked carboxymethyl cellulose-based injectable hydrogels with efficient underwater-specific adhesion for rapid hemostasis

Tissue adhesives have attracted intense and increasing interest due to their multiple biomedical applications. Despite the rapid development of adhesive hydrogels, huge challenges remain for materials that can ensure strong adhesion and seal hemostasis in aqueous and blood environments. To address this issue, we have developed an innovative design of PAA-based coacervate hydrogel with strong wet adhesion capability through a simple mixture of PAA copolymers with oxidized-carboxymethylcellulose (OCMC), and tannic acid (TA) as the main components, and structurally enhanced with natural clays (Laponite XLG). The absorbed TA provides solid adhesion to dry and wet substrates via multiple interactions, which endows the XLG-enhanced coacervate with the desired underwater adhesive strength. More importantly, the dielectric constant is introduced to evaluate the polarity of the tested samples, which may be used as guidance for the design of mussel-inspired adhesives with even better underwater adhesive properties. In vivo hemorrhage experiments further confirmed that the hydrogel adhesive dramatically shortened the hemostatic time to tens of seconds. Overall, the persistent adhesion and acceptable cytocompatibility of the hydrogel nanocomposite make it a promising alternative suture-free approach for rapid hemostasis at different length scales and is expected to be extended to clinical application for other organ injuries.

Photothermal-promoted multi-functional gallic acid grafted chitosan hydrogel containing tannic acid miniaturized particles for peri-implantitis

Peri-implantitis, a leading cause of implant failure, currently lacks effective therapeutic strategies. Given that bacterial infection and reactive oxygen species overabundance serve as primary pathogenic and triggering factors, respectively, an adhesive hydrogel has been created for in-situ injection. The hydrogel is a gallic acid-grafted chitosan (CS-GA) hydrogel containing tannic acid miniaturized particles (TAMP). This provides antibacterial and antioxidant properties. Therefore, this study aims to evaluate the potential role of this hydrogel in preventing and treating peri-implantitis via several experiments. It undergoes rapid formation within a span of over 20 s via an oxidative crosslinking reaction catalyzed by horseradish peroxidase and hydrogen peroxide, demonstrating robust adhesion, superior cell compatibility, and a sealing effect. Furthermore, the incorporation of TAMP offer photothermal properties to the hydrogel, enabling it to enhance the viability, migration, and antioxidant activity of co-cultured human gingival fibroblasts when subjected 0.5 W/cm2 808 nm near-infrared (NIR) irradiation. At higher irradiation power, the hydrogel exhibits progressive improvements in its antibacterial efficacy against Porphyromonas gingivalis and Fusobacterium nucleatum. It attains rates of 83.11 ± 5.42 % and 83.48 ± 6.855 %, respectively, under 1 W/cm2 NIR irradiation. In summary, the NIR-controlled CS-GA/TAMP hydrogel, exhibiting antibacterial and antioxidant properties, represents a promising approach for the prophylaxis and management of peri-implantitis.

Bioadhesives with Antimicrobial Properties

Bioadhesives with antimicrobial properties enable easier and safer treatment of wounds as compared to the traditional methods such as suturing and stapling. Composed of natural or synthetic polymers, these bioadhesives seal wounds and facilitate healing while preventing infections through the activity of locally released antimicrobial drugs, nanocomponents, or inherently antimicrobial polers. Although many different materials and strategies are employed to develop antimicrobial bioadhesives, the design of these biomaterials necessitates a prudent approach as achieving all the required properties including optimal adhesive and cohesive properties, biocompatibility, and antimicrobial activity can be challenging. Designing antimicrobial bioadhesives with tunable physical, chemical, and biological properties will shed light on the path for future advancement of bioadhesives with antimicrobial properties. In this review, the requirements and commonly used strategies for developing bioadhesives with antimicrobial properties are discussed. In particular, different methods for their synthesis and their experimental and clinical applications on a variety of organs are reviewed. Advances in the design of bioadhesives with antimicrobial properties will pave the way for a better management of wounds to increase positive clinical outcomes.

Tough and On-Demand Detachable Wet Tissue Adhesive Hydrogel Made from Catechol Derivatives with a Long Aliphatic Side Chain

Wet adhesion is critical in cases of wound closure, but it is usually deterred by the hydration layer on tissues. Inspired by dopamine-mediated underwater adhesion in mussel foot proteins, wet tissue adhesives containing catechol with 2-3 carbons side chains are reported mostly. To make wet adhesion of this type of adhesives much tougher, catechol derivatives with a long aliphatic side chain (≈10 atoms length) are synthesized. Then, a series of strong wet tissue adhesive hydrogels are prepared through photoinduced copolymerization of acrylic acid with synthetic monomers. The adhesive hydrogel has a high cohesion strength, that is, tensile strength and strain, and toughness of ≈1800 kPa, ≈540%, and ≈4100 kJ m-3 , respectively. Its interfacial toughness on wet and underwater porcine skin is respectively ≈1300 and ≈1100 J m-2 , and its adhesion strength to wet porcine skin is ≈153 kPa. These values are much higher than those of dopamine-based adhesives in the same conditions, demonstrating that the long aliphatic side chain on catechol can greatly improve the wet tissue-adhesion. Additionally, the tough interfacial adhesion can be broken on demand with 5 wt.% aqueous urea solution. This adhesive hydrogel is highly promising in safe wound closure.

Double-Cross-Linked Hydrogel with Long-Lasting Underwater Adhesion: Enhancement of Maxillofacial In Situ and Onlay Bone Retention

Bone retention is a usual clinical problem existing in a lot of maxillofacial surgeries involving bone reconstruction and bone transplantation, which puts forward the requirements for bone adhesives that are stable, durable, biosafe, and biodegradable in wet environment. To relieve the suffering of patients during maxillofacial surgery with one-step operation and satisfying repair, herein, we developed a double-cross-linked A-O hydrogel named by its two components: [(3-Aminopropyl) methacrylamide]-co-{[Tris(hydroxymethyl) methyl] acrylamide} and oxidated methylcellulose. With excellent bone adhesion ability, it can maintain long-lasting stable underwater bone adhesion for over 14 days, holding a maximum adhesion strength of 2.32 MPa. Schiff-base reaction and high-density hydrogen bonds endow the hydrogel with strong cohesion and adhesion performance as well as maneuverable properties such as easy formation and injectability. A-O hydrogel not only presents rarely reported long-lasting underwater adhesion of hard tissue but also owns inherent biocompatibility and biodegradation properties with a porous structure that facilitates the survival of bone graft. Compared to the commercial cyanoacrylate adhesive (3 M Vetbond Tissue Adhesive), the A-O hydrogel is confirmed to be safer, more stable, and more effective in calvarial in situ bone retention model and onlay bone retention model of rat, providing a practical solution for the everyday scenario of clinical bone retention.

Advances in the Preparation of Tough Conductive Hydrogels for Flexible Sensors

The rapid development of tough conductive hydrogels has led to considerable progress in the fields of tissue engineering, soft robots, flexible electronics, etc. Compared to other kinds of traditional sensing materials, tough conductive hydrogels have advantages in flexibility, stretchability and biocompatibility due to their biological structures. Numerous hydrogel flexible sensors have been developed based on specific demands for practical applications. This review focuses on tough conductive hydrogels for flexible sensors. Representative tactics to construct tough hydrogels and strategies to fulfill conductivity, which are of significance to fabricating tough conductive hydrogels, are briefly reviewed. Then, diverse tough conductive hydrogels are presented and discussed. Additionally, recent advancements in flexible sensors assembled with different tough conductive hydrogels as well as various designed structures and their sensing performances are demonstrated in detail. Applications, including the wearable skins, bionic muscles and robotic systems of these hydrogel-based flexible sensors with resistive and capacitive modes are discussed. Some perspectives on tough conductive hydrogels for flexible sensors are also stated at the end. This review will provide a comprehensive understanding of tough conductive hydrogels and will offer clues to researchers who have interests in pursuing flexible sensors.

Designing self-healing hydrogels for biomedical applications

Self-healing hydrogels have emerged as the most promising alternatives to conventional brittle hydrogels used in the biomedical field due to the features of long-term stability and durability. However, the incompatibility between the fast self-healing property and enough mechanical strength of hydrogels remains a challenge. Therefore, hydrogels that possess not only mechanical toughness but also autonomous self-healing capacity are sought after. This review presents a comprehensive summary of the latest self-healing mechanisms. Specifically, we review various systems based on dynamic bonds, ranging from dynamic covalent bonds to non-covalent bonds. Additionally, this review presents different characterization methods for self-healing hydrogels, and also highlights their potential applications in the biomedical field, such as tissue engineering, drug delivery, cell therapy, and wound dressing. Furthermore, this review aims to provide valuable guidance for constructing diverse self-healing hydrogels with tailored functions.

Extracellular Matrix-Mimetic Immunomodulatory Hydrogel for Accelerating Wound Healing

Macrophages play a crucial role in the complete processes of tissue repair and regeneration, and the activation of M2 polarization is an effective approach to provide a pro-regenerative immune microenvironment. Natural extracellular matrix (ECM) has the capability to modulate macrophage activities via its molecular, physical, and mechanical properties. Inspired by this, an ECM-mimetic hydrogel strategy to modulate macrophages via its dynamic structural characteristics and bioactive cell adhesion sites is proposed. The LZM-SC/SS hydrogel is in situ formed through the amidation reaction between lysozyme (LZM), 4-arm-PEG-SC, and 4-arm-PEG-SS, where LZM provides DGR tripeptide for cell adhesion, 4-arm-PEG-SS provides succinyl ester for dynamic hydrolysis, and 4-arm-PEG-SC balances the stability and dynamics of the network. In vitro and subcutaneous tests indicate the dynamic structural evolution and cell adhesion capacity promotes macrophage movement and M2 polarization synergistically. Comprehensive bioinformatic analysis further confirms the immunomodulatory ability, and reveals a significant correlation between M2 polarization and cell adhesion. A full-thickness wound model is employed to validate the induced M2 polarization, vessel development, and accelerated healing by LZM-SC/SS. This study represents a pioneering exploration of macrophage modulation by biomaterials' structures and components rather than drug or cytokines and provides new strategies to promote tissue repair and regeneration.

A Mechanically Resilient and Tissue-Conformable Hydrogel with Hemostatic and Antibacterial Capabilities for Wound Care

Hydrogels are used in wound dressings because of their tissue-like softness and biocompatibility. However, the clinical translation of hydrogels remains challenging because of their long-term stability, water swellability, and poor tissue adhesiveness. Here, tannic acid (TA) is introduced into a double network (DN) hydrogel consisting of poly(vinyl alcohol) (PVA) and poly(acrylic acid) (PAA) to realize a tough, self-healable, nonswellable, conformally tissue-adhesive, hemostatic, and antibacterial hydrogel. The TA within the DN hydrogel forms a dynamic network, enabling rapid self-healing (within 5 min) and offering effective energy dissipation for toughness and viscoelasticity. Furthermore, the hydrophobic moieties of TA provide a water-shielding effect, rendering the hydrogel nonswellable. A simple chemical modification to the hydrogel further strengthens its interfacial adhesion with tissues (shear strength of ≈31 kPa). Interestingly, the TA also can serve as an effective hemostatic (blood-clotting index of 58.40 ± 1.5) and antibacterial component, which are required for a successful wound dressing. The antibacterial effects of the hydrogel are tested against Escherichia coli and Staphylococcus aureus. Finally, the hydrogel is prepared in patch form and applied to a mouse model to test in vivo biocompatibility and hemostatic performances.

Peptide/glycyrrhizic acid supramolecular polymer: An emerging medical adhesive for dural sealing and repairing

Medical adhesives have emerged as potential materials for sealing, hemostasis and wound repairing in modern clinical surgery. However, most of existing medical adhesives are still far away from the clinical requirements for simultaneously meeting desirable tissue adhesion, safety, biodegradability, anti-swelling property, and convenient operability. Here, we present an entirely new kind of peptide-based underwater adhesives, which are constructed via cross-linked supramolecular copolymerization between cationic short peptides and glycyrrhizic acid (GA) in an aqueous solution. We revealed the unique molecular mechanism of the peptide/GA supramolecular polymers and underlined the importance of arginine residues in the enhancement of the bulk cohesion of the peptide/GA adhesive. We thus concluded a design guideline that the peptide sequence has to be encoded with multiple arginine termini and hydrophobic residues. The resulting adhesives exhibited effective tissue adhesion, robust cohesion, low cell cytotoxicity, acceptable hemocompatibility, inappreciable inflammation response, appropriate biodegradability, and excellent anti-swelling property. More attractively, the dried peptide/GA powder was able to rapidly self-gel into adhesives by absorbing water, suggesting conveniently clinical operability. Animal experiments showed that the peptide/GA supramolecular polymers could be utilized as reliable medical adhesives for dural sealing and repairing.

Tunable backbone-degradable robust tissue adhesives via in situ radical ring-opening polymerization

Adhesives with both robust adhesion and tunable degradability are clinically and ecologically vital, but their fabrication remains a formidable challenge. Here we propose an in situ radical ring-opening polymerization (rROP) strategy to design a backbone-degradable robust adhesive (BDRA) in physiological environment. The hydrophobic cyclic ketene acetal and hydrophilic acrylate monomer mixture of the BDRA precursor allows it to effectively wet and penetrate substrates, subsequently forming a deep covalently interpenetrating network with a degradable backbone via redox-initiated in situ rROP. The resulting BDRAs show good adhesion strength on diverse materials and tissues (e.g., wet bone >16 MPa, and porcine skin >150 kPa), higher than that of commercial cyanoacrylate superglue (~4 MPa and 56 kPa). Moreover, the BDRAs have enhanced tunable degradability, mechanical modulus (100 kPa-10 GPa) and setting time (seconds-hours), and have good biocompatibility in vitro and in vivo. This family of BDRAs expands the scope of medical adhesive applications and offers an easy and environmentally friendly approach for engineering.

Current state of the art and future directions for implantable sensors in medical technology: Clinical needs and engineering challenges

Implantable sensors have revolutionized the way we monitor biophysical and biochemical parameters by enabling real-time closed-loop intervention or therapy. These technologies align with the new era of healthcare known as healthcare 5.0, which encompasses smart disease control and detection, virtual care, intelligent health management, smart monitoring, and decision-making. This review explores the diverse biomedical applications of implantable temperature, mechanical, electrophysiological, optical, and electrochemical sensors. We delve into the engineering principles that serve as the foundation for their development. We also address the challenges faced by researchers and designers in bridging the gap between implantable sensor research and their clinical adoption by emphasizing the importance of careful consideration of clinical requirements and engineering challenges. We highlight the need for future research to explore issues such as long-term performance, biocompatibility, and power sources, as well as the potential for implantable sensors to transform healthcare across multiple disciplines. It is evident that implantable sensors have immense potential in the field of medical technology. However, the gap between research and clinical adoption remains wide, and there are still major obstacles to overcome before they can become a widely adopted part of medical practice.

Synthesis and Evaluation of Metal Lipoate Adhesives

The development of new bioadhesives with integrated properties remains an unmet clinical need to replace staples or sutures. Current bioadhesives do not allow electronic activation, which would allow expansion into laparoscopic and robotic surgeries. To address this deficiency, voltage-activated adhesives have been developed on both carbene- and catechol-based chemical precursors. Herein, a third platform of voltage-activated adhesive is evaluated based on lipoic acid, a non-toxic dithiolane found in aerobic metabolism and capable of ring-opening polymerization. The electro-rheological and adhesive properties of lithium, sodium, and potassium salts of lipoic acid are applied for wet tissue adhesion. At ambient conditions, potassium lipoate displays higher storage modulus than lithium or sodium salt under similar conditions. Voltage stimulation significantly improves gelation kinetics to Na- and K-lipoates, while Li-lipoate is found to not require voltage stimulation for gelation. Lap shear adhesion strength on wetted collagen substrates reveals that the synthetic metal lipoates have comparable adhesion strength to fibrin sealants without viral or ethical risks.

Evolution of nanostructured skin patches towards multifunctional wearable platforms for biomedical applications

Recent advances in the field of skin patches have promoted the development of wearable and implantable bioelectronics for long-term, continuous healthcare management and targeted therapy. However, the design of electronic skin (e-skin) patches with stretchable components is still challenging and requires an in-depth understanding of the skin-attachable substrate layer, functional biomaterials and advanced self-powered electronics. In this comprehensive review, we present the evolution of skin patches from functional nanostructured materials to multi-functional and stimuli-responsive patches towards flexible substrates and emerging biomaterials for e-skin patches, including the material selection, structure design and promising applications. Stretchable sensors and self-powered e-skin patches are also discussed, ranging from electrical stimulation for clinical procedures to continuous health monitoring and integrated systems for comprehensive healthcare management. Moreover, an integrated energy harvester with bioelectronics enables the fabrication of self-powered electronic skin patches, which can effectively solve the energy supply and overcome the drawbacks induced by bulky battery-driven devices. However, to realize the full potential offered by these advancements, several challenges must be addressed for next-generation e-skin patches. Finally, future opportunities and positive outlooks are presented on the future directions of bioelectronics. It is believed that innovative material design, structure engineering, and in-depth study of fundamental principles can foster the rapid evolution of electronic skin patches, and eventually enable self-powered close-looped bioelectronic systems to benefit mankind.

Intrinsically Nonswellable Multifunctional Hydrogel with Dynamic Nanoconfinement Networks for Robust Tissue-Adaptable Bioelectronics

Developing bioelectronics that retains their long-term functionalities in the human body during daily activities is a current critical issue. To accomplish this, robust tissue adaptability and biointerfacing of bioelectronics should be achieved. Hydrogels have emerged as promising materials for bioelectronics that can softly adapt to and interface with tissues. However, hydrogels lack toughness, requisite electrical properties, and fabrication methodologies. Additionally, the water-swellable property of hydrogels weakens their mechanical properties. In this work, an intrinsically nonswellable multifunctional hydrogel exhibiting tissue-like moduli ranging from 10 to 100 kPa, toughness (400-873 J m^-3 ), stretchability (≈1000% strain), and rapid self-healing ability (within 5 min), is developed. The incorporation of carboxyl- and hydroxyl-functionalized carbon nanotubes (fCNTs) ensures high conductivity of the hydrogel (≈40 S m^-1 ), which can be maintained and recovered even after stretching or rupture. After a simple chemical modification, the hydrogel shows tissue-adhesive properties (≈50 kPa) against the target tissues. Moreover, the hydrogel can be 3D printed with a high resolution (≈100 µm) through heat treatment owing to its shear-thinning capacity, endowing it with fabrication versatility. The hydrogel is successfully applied to underwater electromyography (EMG) detection and ex vivo bladder expansion monitoring, demonstrating its potential for practical bioelectronics.

Enhanced Rupture Force in a Cut-Dispersed Double-Network Hydrogel

The Kirigami approach is an effective way to realize controllable deformation of intelligent materials via introducing cuts into bulk materials. For materials ranging from ordinary stiff materials such as glass, ceramics, and metals to soft materials, including ordinary hydrogels and elastomers, all of them are all sensitive to the presence of cuts, which usually act as defects to deteriorate mechanical properties. Herein, we study the influence of the cuts on the mechanical properties by introducing "dispersed macro-scale cuts" into a model tough double network (DN) hydrogel (named D-cut gel), which consists of a rigid and brittle first network and a ductile stretchable second network. For comparison, DN gels with "continuous cuts" having the same number of interconnected cuts (named C-cut gel) were chosen. The fracture tests of D-cut gel and C-cut gel with different cut patterns were performed. The fracture observation revealed that crack blunting occurred at each cut tip, and a large wrinkle-like zone was formed where the wrinkles were parallel to the propagation direction of the cut. By utilizing homemade circular polarizing optical systems, we found that introducing dispersed cuts increases the rupture force by homogenizing the stress around the crack tip surrounding every cut, which reduces stress concentration in one certain cut. We believe this work reveals the fracture mechanism of tough soft materials with a kirigami cut structure, which should guide the design of advanced soft and tough materials along this line.

Synthesis and characterization of mussel-inspired nanocomposites based on dopamine-chitosan-iron oxide for wound healing: In vitro study

There are many challenges faced the soft tissue adhesives in the medical application field. For example, there is a limited effective binding between the medical adhesive and different types of soft tissues. Chitosan (CS) and dopamine (DA) were used as structural units for synthesizing nanocomposites utilized as a wet tissue adhesive. To produce dopamine-chitosan-iron oxide nanocomposites (DA-CS-Fe₃O₄ NCs), DA was loaded onto chitosan-iron oxide nanocomposites. The nanocomposites have been prepared using ionic gelation method under vigorous homogenization and characterized by different techniques. Fourier-transform infrared spectroscopy (FTIR) have shown that DA-CS- Fe₃O₄ NCs could attach to the tissue through two possible functional groups, namely, the catechol and amine groups. The results of in vitro scratch wound-healing assay suggested that the prepared DA-CS- Fe₃O₄ NCs facilitate cell migration (the wound-closure percentage reached 96% at 72 h). All experimental results confirm that DA-CS- Fe₃O₄ NCs are strongly recommended for use as a soft medical tissue adhesive in wound healing and surgeries such as vascular surgery. In addition, the results of the whole blood clotting, antibacterial assessment, live and dead assay, cytotoxicity test, and wound-healing assay indicate that DA-CS-Fe₃O₄ NCs can be used as a multifunctional biomedical adhesive.

Antibacterial, Adhesive, and Conductive Hydrogel for Diabetic Wound Healing

Diabetic mellitus is one of the leading causes of chronic wounds and remains a challenging issue to be resolved. Herein, a hydrogel with conformal tissue adhesivity, skin-like conductivity, robust mechanical characteristics, as well as active antibacterial function is developed. In this hydrogel, silver nanoparticles decorated polypyrrole nanotubes (AgPPy) and cobalt ions (Co²⁺ ) are introduced into an in situ polymerized poly(acrylic acid) (PAA) and branched poly(ethylenimine) (PEI) network (PPCA hydrogel). The PPCA hydrogel provides active antibacterial function through synergic effects from protonated PEI and AgPPy nanotubes, with a tissue-like mechanical property (≈16.8 ± 4.5 kPa) and skin-like electrical conductivity (≈0.048 S m^-1 ). The tensile and shear adhesive strength (≈15.88 and ≈12.76 kPa, respectively) of the PPCA hydrogel is about two- to threefold better than that of fibrin glue. In vitro studies show the PPCA hydrogel is highly effective against both gram-positive and gram-negative bacteria. In vivo results demonstrate that the PPCA hydrogel promotes diabetic wounds with accelerated healing, with notable inflammatory reduction and prominent angiogenesis regeneration. These results suggest the PPCA hydrogel provide a promising approach to promote diabetic wound healing.

Injectable Dopamine-Polysaccharide In Situ Composite Hydrogels with Enhanced Adhesiveness

Polysaccharide bio-adhesives used for non-invasive repair often show weak mechanical strength and tissue adhesion, even when covalently modified with dopamine (DA) from mussel proteins and its derivatives. Low cohesion of the polysaccharide adhesives and easy oxidation of DA may result in the low adhesion properties of the polysaccharide-DA adhesives. In this work, we aimed to prepare a series of injectable hydrogel adhesives to improve their cohesion and adhesion by in situ mixing DA with the polysaccharide without covalent modification. The injectable and rapid curing adhesives were prepared by mixing oxidized dextran (ODE) and chitosan (CS) through a Schiff base reaction in the presence (or absence) of DA. The gelation time of the adhesive was customized to be less than 20 s by controlling the amount of ODE, regardless of the amount of DA. Multi-cross-linked (MC) hydrogels were further prepared by adding cross-linking agents such as sodium periodate (NaIO₄) and ferric trichloride (FeCl₃), and their sol-gel transitions were easily adjusted by changing the amounts of the cross-linking agents. The MC-FeCl₃ hydrogel adhesive displayed good tissue adhesion with a lap shear adhesion strength of 345 kPa, which was 43 times that of fibrin glue. Results from Raman spectra, texture profile analyses, and atomic force microscopy images confirmed the enhanced adhesion induced by a higher cohesion of MC-FeCl₃, owing to the coordination of Fe³⁺ and DA and non-covalent and covalent bonds of DA. Moreover, the adhesives showed good biodegradability and biocompatibility. These results demonstrate that the injectable and sticky hydrogels with good adhesion are promising materials for tissue repair.

Bio-Inspired Muco-Adhesive Polymers for Drug Delivery Applications

Muco-adhesive drug delivery systems continue to be one of the most studied for controlled pharmacokinetics and pharmacodynamics. Briefly, muco-adhesive polymers, can be described as bio-polymers that adhere to the mucosal (mucus) surface layer, for an extended residency period of time at the site of application, by the help of interfacial forces resulting in improved drug delivery. When compared to traditional drug delivery systems, muco-adhesive carriers have the potential to enhance therapeutic performance and efficacy, locally and systematically, in oral, rectal, vaginal, amongst other routes. Yet, the achieving successful muco-adhesion in a novel polymeric drug delivery solution is a complex process involving key physico-chemico-mechanical parameters such as adsorption, wettability, polymer chain length, inter-penetration and cross-linking, to list a few. Hence, and in light of accruing progress, evidence and interest, during the last decade, this review aims to provide the reader with an overview of the theories, principles, properties, and underlying mechanisms of muco-adhesive polymers for pharmaceutics; from basics to design to characterization to optimization to evaluation to market. A special focus is devoted to recent advances incorporating bio-inspired polymers for designing controlled muco-adhesive drug delivery systems.

Enhancing bioactivity and stability of polymer-based material-tissue interface through coupling multiscale interfacial interactions with atomic-thin TiO2 nanosheets

Stable and bioactive material-tissue interface (MTF) basically determines the clinical applications of biomaterials in wound healing, sustained drug release, and tissue engineering. Although many inorganic nanomaterials have been widely explored to enhance the stability and bioactivity of polymer-based biomaterials, most are still restricted by their stability and biocompatibility. Here we demonstrate the enhanced bioactivity and stability of polymer-matrix bio-composite through coupling multiscale material-tissue interfacial interactions with atomically thin TiO2 nanosheets. Resin modified with TiO2 nanosheets displays improved mechanical properties, hydrophilicity, and stability. Also, we confirm that this resin can effectively stimulate the adhesion, proliferation, and differentiation into osteogenic and odontogenic lineages of human dental pulp stem cells using in vitro cell-resin interface model. TiO2 nanosheets can also enhance the interaction between demineralized dentinal collagen and resin. Our results suggest an approach to effectively up-regulate the stability and bioactivity of MTFs by designing biocompatible materials at the sub-nanoscale.

Electronic Supplementary Material

Supplementary material (further details of fabrication and characterization of TiO2 NSs and TiO2-ARCs, the bioactivity evaluation of TiO2-ARCs on hDPSCs, and the measurement of interaction with demineralized dentin collagen) is available in the online version of this article at 10.1007/s12274-022-5153-1.

Design strategies for adhesive hydrogels with natural antibacterial agents as wound dressings: Status and trends

The wound healing process is usually susceptible to different bacterial infections due to the complex physiological environment, which significantly impairs wound healing. The topical application of antibiotics is not desirable for wound healing because the excessive use of antibiotics might cause bacteria to develop resistance and even the production of super bacteria, posing significant harm to human well-being. Wound dressings based on adhesive, biocompatible, and multi-functional hydrogels with natural antibacterial agents have been widely recognized as effective wound treatments. Hydrogels, which are three-dimensional (3D) polymer networks cross-linked through physical interactions or covalent bonds, are promising for topical antibacterial applications because of their excellent adhesion, antibacterial properties, and biocompatibility. To further improve the healing performance of hydrogels, various modification methods have been developed with superior biocompatibility, antibacterial activity, mechanical properties, and wound repair capabilities. This review summarizes hundreds of typical studies on various ingredients, preparation methods, antibacterial mechanisms, and internal antibacterial factors to understand adhesive hydrogels with natural antibacterial agents for wound dressings. Additionally, we provide prospects for adhesive and antibacterial hydrogels in biomedical applications and clinical research.

Modular stimuli-responsive hydrogel sealants for early gastrointestinal leak detection and containment

Millions of patients every year undergo gastrointestinal surgery. While often lifesaving, sutured and stapled reconnections leak in around 10% of cases. Currently, surgeons rely on the monitoring of surrogate markers and clinical symptoms, which often lack sensitivity and specificity, hence only offering late-stage detection of fully developed leaks. Here, we present a holistic solution in the form of a modular, intelligent suture support sealant patch capable of containing and detecting leaks early. The pH and/or enzyme-responsive triggerable sensing elements can be read out by point-of-need ultrasound imaging. We demonstrate reliable detection of the breaching of sutures, in as little as 3 hours in intestinal leak scenarios and 15 minutes in gastric leak conditions. This technology paves the way for next-generation suture support materials that seal and offer disambiguation in cases of anastomotic leaks based on point-of-need monitoring, without reliance on complex electronics or bulky (bio)electronic implantables.

Hot-Melt and Pressure-Sensitive Adhesives Based on Styrene-Isoprene-Styrene Triblock Copolymer, Asphaltene/Resin Blend and Naphthenic Oil

Asphaltene/resin blend (ARB) extracted from heavy crude oil was used to modify poly(styrene-block-isoprene-block-styrene) (SIS) to make it an adhesive. There were prepared double and triple mixtures containing 10-60% SIS, 10-40% ARB, and 10-50% naphthenic oil used as an additional plasticizer. The viscoelasticity of the mixtures at 25 °C and 120 °C was studied, their flow curves were obtained, and the temperature dependences of the loss tangent and the components of the complex modulus were measured. In addition, the mixtures were used as hot-melt adhesives (HMAs) and pressure-sensitive adhesives (PSAs) in the shear, peel, and pull-off tests of the adhesive bonds that they formed with steel. Both naphthenic oil and ARB act as plasticizers for SIS and make it sticky. However, only the combined use of ARB and the oil allows for achieving the best set of adhesive properties of the SIS-based mixture. High-quality HMA requires low oil content (optimal SIS/ARB/oil ratio is 50/40/10, pull-off adhesion strength (τt) of 1990 kPa), whereas a lot of the oil is needed to give SIS characteristics of a PSA (SIS/ARB/oil is 20/40/40, τt of 100 kPa). At the same time, the resulting PSA can be used as a hot-melt pressure-sensitive adhesive (HMPSA) that has many times lower viscosity than HMA (13.9 Pa·s versus 2640 Pa·s at 120 °C and 1 s-1) but provides a less strong adhesive bond (τt of 960 kPa).

Molecularly Engineered Protein Glues with Superior Adhesion Performance

Naturally inspired proteins are investigated for the development of bioglues that combine adhesion performance and biocompatibility for biomedical applications. However, engineering such adhesives by rational design of the proteins at the molecular level is rarely reported. Herein, it is shown that a new generation of protein-based glues is generated by supramolecular assembly through de novo designed structural proteins in which arginine triggers robust liquid-liquid phase separation. The encoded arginine moieties significantly strengthen multiple molecular interactions in the complex, leading to ultrastrong adhesion on various surfaces, outperforming many chemically reacted and biomimetic glues. Such adhesive materials enable quick visceral hemostasis in 10 s and outstanding tissue regeneration due to their robust adhesion, good biocompatibility, and superior antibacterial capacity. Remarkably, their minimum inhibitory concentrations are orders of magnitude lower than clinical antibiotics. These advances offer insights into molecular engineering of de novo designed protein glues and outline a general strategy to fabricate mechanically strong protein-based materials for surgical applications.

Biodegradable Block Copolymer-Tannic Acid Glue

Bioadhesives are becoming an essential and important ingredient in medical science. Despite numerous reports, developing adhesive materials that combine strong adhesion, biocompatibility, and biodegradation remains a challenging task. Here, we present a biocompatible yet biodegradable block copolymer-based waterborne superglue that leads to an application of follicle-free hair transplantation. Our design strategy bridges self-assembled, temperature-sensitive block copolymer nanostructures with tannic acid as a sticky and biodegradable polyphenolic compound. The formulation further uniquely offers step-by-step increases in adhesion strength via heating-cooling cycles. Combining the modular design with the thermal treating process enhances the mechanical properties up to 5 orders of magnitude compared to the homopolymer formulation. This study opens a new direction in bioadhesive formulation strategies utilizing block copolymer nanotechnology for systematic and synergistic control of the material's properties.

Highly Resilient Dual-Crosslinked Hydrogel Adhesives Based on a Dopamine-Modified Crosslinker

Hydrogels are promising material for wound dressing and tissue engineering. However, owing to their low tissue adhesion in a moist environment and lack of flexibility, hydrogels are still not widely applied in movable parts, such as joints. Herein, we report a dual-crosslinked hydrogel adhesive using a dopamine-modified and acrylate-terminated crosslinker, tri(ethylene glycol) diacrylate-dopamine crosslinker (TDC). The covalent crosslinking was formed by photopolymerization between acrylic acid (AA) and TDC, and the noncovalent crosslinking was formed by intermolecular dopamine-dopamine and dopamine-AA interactions. Our resultant hydrogel demonstrated strong tissue adhesion in a moist environment (approximately 71 kPa) and high mechanical resilience (approximately 94%) with immediate recovery at a 200% strain rate. Moreover, it accelerated wound healing upon dressing the wound site properly. Our study provides the potential for advanced polymer synthesis by introducing a functional crosslinking agent.

A starch-regulated adhesive hydrogel dressing with controllable separation properties for painless dressing change

The development of hydrogel dressings provides unprecedented opportunities for clinical medicine. However, the traditional hydrogel dressings cannot achieve controllable adhesion and separation, which often brings unbearable pain and secondary damage to patients during removal. In this work, a starch-regulated adhesive hydrogel dressing with controllable separation properties is reported. This hydrogel dressing can achieve rapid separation through the dissociation competition mechanism of polar small molecules, which will not cause any damage or discomfort to the skin or tissues, and greatly facilitate dressing replacement. The adhesive strength of the hydrogel reaches 0.06 MPa, and remains relatively stable after repeated utilization. Meanwhile, the inhibition rate of the hydrogel for E. coli, S. aureus and C. albicans is more than 99.9%. At the same time, the hydrogel also has good swelling properties, mechanical properties and biocompatibility, and exhibits a high healing efficiency (95.01 ± 3.76%) in a rat full-thickness skin defect model. This novel hydrogel dressing with controllable separation properties provides a facile and effective method for wound management and treatment, and has great promise for long-term application of wound dressings.

Adhesion advances: from nanomaterials to biomimetic adhesion and applications

The field of adhesion has revealed a significant impact on numerous applications such as wound healing, drug delivery, electrically conductive adhesive, dental adhesive, and wood industry. Nanotechnology has continued to be the primary means to achieve adhesion. Among them, biological systems based on the unique structure of the nano-levels have developed excellent adhesion capabilities after billions of years of evolution and natural selection. Therefore, the research on bionic adhesion inspired by biological systems has gradually emerged. This review firstly focuses on the mechanism of adhesion, and secondly reports the effects of different nanomaterials on adhesion properties. Then based on the structure of mussels, geckos, tree frogs, octopuses, and other organisms, the research progress of biomimetic nanotechnology to achieve adhesion is summarized. Finally, the applications, challenges, and future directions of nanotechnology in new adhesive materials are provided.

Ascidian-inspired aciduric hydrogels with high stretchability and adhesiveness promote gastric hemostasis and wound healing

Adhesives for gastric hemorrhage are of great clinical significance. However, it remains a major challenge in clinics due to its poor stability under acidic environments and low adhesion to wet tissues. Herein, inspired by the high adhesiveness of the ascidian secretory protein, we designed a series of aciduric bionic hydrogel adhesives (PDTAs) based on poly(γ-glutamic acid) (γ-PGA) and tannic acid (TA). The formation of hydrogel adhesives was attributed to the abundant hydrogen bonds between amide groups of PGA-DA and polyphenol groups of TA. These hydrogel adhesives exhibited enhanced wet tissue adhesion (400%), higher stretchability (800% elongation), and aciduric stability (7 days) compared with commercial fibrin glue. Rodent wound models indicated that the hydrogel adhesives demonstrated significant healing promotion due to ameliorating collagen deposition and angiogenesis. These hydrogel adhesives show great potential in treating gastric hemorrhages and promoting wound healing.

Bio-inspired hydrogels with fibrous structure: A review on design and biomedical applications

Numerous tissues in the human body have fibrous structures, including the extracellular matrix, muscles, and heart, which perform critical biological functions and have exceptional mechanical strength. Due to their high-water content, softness, biocompatibility and elastic nature, hydrogels resemble biological tissues. Traditional hydrogels, on the other hand, have weak mechanical properties and lack tissue-like fibrous structures, limiting their potential applications. Thus, bio-inspired hydrogels with fibrous architectures have piqued the curiosity of biomedical researchers. Here, we review fabrication strategies for fibrous hydrogels and their recent progress in the biomedical fields of wound dressings, drug delivery, tissue engineering scaffolds and bioadhesives. Challenges and future perspectives are also discussed.

Cutting-Edge Progress in Stimuli-Responsive Bioadhesives: From Synthesis to Clinical Applications

With the advent of “intelligent” materials, the design of smart bioadhesives responding to chemical, physical, or biological stimuli has been widely developed in biomedical applications to minimize the risk of wounds reopening, chronic pain, and inflammation. Intelligent bioadhesives are free-flowing liquid solutions passing through a phase shift in the physiological environment due to stimuli such as light, temperature, pH, and electric field. They possess great merits, such as ease to access and the ability to sustained release as well as the spatial transfer of a biomolecule with reduced side effects. Tissue engineering, wound healing, drug delivery, regenerative biomedicine, cancer therapy, and other fields have benefited from smart bioadhesives. Recently, many disciplinary attempts have been performed to promote the functionality of smart bioadhesives and discover innovative compositions. However, according to our knowledge, the development of multifunctional bioadhesives for various biomedical applications has not been adequately explored. This review aims to summarize the most recent cutting-edge strategies (years 2015–2021) developed for stimuli-sensitive bioadhesives responding to external stimuli. We first focus on five primary categories of stimuli-responsive bioadhesive systems (pH, thermal, light, electric field, and biomolecules), their properties, and limitations. Following the introduction of principal criteria for smart bioadhesives, their performances are discussed, and certain smart polymeric materials employed in their creation in 2015 are studied. Finally, advantages, disadvantages, and future directions regarding smart bioadhesives for biomedical applications are surveyed.

Biodegradation and Immunological Parameters of Polyurethane-based Tissue Adhesive in Arterial Microvascular Anastomoses - a Long-term in Vivo Study

In microsurgical anastomosis, non-synthetic fibrin-based adhesives have predominantly shown superior properties to synthetic cyanoacrylates, but they have hardly any clinical application. This study aimed to investigate the local and systemic effects of synthetically produced biodegradable adhesive VIVO when used in microsurgical anastomosis. VIVO was used in two different anastomosis procedures in the common carotid artery in a rat model: VIVO in addition to a temporary catheter (VIVO TC) and VIVO with a custom-shaped memory nitinol stent (VIVO SM). Conventionally sutured anastomoses served as controls (C). Tissue response was assessed by in vivo fluorescence imaging and histological examination. The systemic effects of biodegradation were measured using hematologic parameters and serum levels of transaminase activity and lactate dehydrogenase. Finally, the degree of local adhesion of the different anastomotic procedures was evaluated. Fluorescence imaging showed reduced inflammatory blood flow in the VIVO TC group. Histological analysis of the anastomosed vessels also revealed significantly more inflammation in C than in the two adhesive groups. The severity of VIVO adhesions proved acceptable, and no histotoxic effects of VIVO were detected. The data demonstrated that the synthetic tissue adhesive VIVO is a reliable and- compared to sutures-tissue-friendly adhesive for microsurgical anastomoses. This article is protected by copyright. All rights reserved.

Supramolecular Adhesive Hydrogels for Tissue Engineering Applications

Tissue engineering is a promising and revolutionary strategy to treat patients who suffer the loss or failure of an organ or tissue, with the aim to restore the dysfunctional tissues and enhance life expectancy. Supramolecular adhesive hydrogels are emerging as appealing materials for tissue engineering applications owing to their favorable attributes such as tailorable structure, inherent flexibility, excellent biocompatibility, near-physiological environment, dynamic mechanical strength, and particularly attractive self-adhesiveness. In this review, the key design principles and various supramolecular strategies to construct adhesive hydrogels are comprehensively summarized. Thereafter, the recent research progress regarding their tissue engineering applications, including primarily dermal tissue repair, muscle tissue repair, bone tissue repair, neural tissue repair, vascular tissue repair, oral tissue repair, corneal tissue repair, cardiac tissue repair, fetal membrane repair, hepatic tissue repair, and gastric tissue repair, is systematically highlighted. Finally, the scientific challenges and the remaining opportunities are underlined to show a full picture of the supramolecular adhesive hydrogels. This review is expected to offer comparative views and critical insights to inspire more advanced studies on supramolecular adhesive hydrogels and pave the way for different fields even beyond tissue engineering applications.

Polyphosphazene and Non-Catechol-Based Antibacterial Injectable Hydrogel for Adhesion of Wet Tissues as Wound Dressing

Wound dressings with excellent adhesiveness, antibacterial, self-healing, hemostasis properties, and therapeutic effects have great significance for the treatment of acute trauma. So far, numerous mussel-inspired catechol-based wet adhesives have been reported, opening a pathway for the treatment of acute trauma. However, catechol-based hydrogels are easily oxidized, which limits their applications. Here, the design of a polyphosphazene and non-catechol based antibacterial injectable hydrogel is reported as a multifunctional first aid bandage. Inspired by barnacle cement proteins, a series of dynamic phenylborate ester based adhesive hydrogels are prepared by combining the cation-π structure modified polyphosphazene with polyvinyl alcohol. The inherent antibacterial property (4 h antibacterial rate 99.6 ± 0.2%), anti-mechanical damage, and hemostatic behavior are investigated to confirm multi-functions of wound dressings. In water, the hydrogels firmly adhere to tissue surfaces through cation-π and π-π interactions as well as hydrogen bonding (adhesion strength = 45 kPa). Moreover, in vivo experiments indicate the hydrogels can shorten the bleeding time and reduce the amount of bleeding by 88%, and significantly accelerate the wound healing rate. These hydrogels have a promising application in the treatment of acute trauma, which is in urgent need of anti-infection and hemostasis.

Exploiting Redox-Complementary Peptide/Polyoxometalate Coacervates for Spontaneously Curing into Antimicrobial Adhesives

Recently, there has been a wave of reports on the fabrication of peptide-based underwater adhesives with the aim of understanding the adhesion mechanism of marine sessile organisms or creating new biomaterials beyond nature. However, the poor shear adhesion performance of the current peptide adhesives has largely hindered their applications. Herein, we proposed to sequentially perform the interfacial adhesion and bulk cohesion of peptide-based underwater adhesives using two redox-complementary peptide/polyoxometalate (POM) coacervates. The oxidative coacervates were prepared by mixing oxidative H₅PMo₁₀V₂O₄₀ and cationic peptides in an aqueous solution. The reductive coacervates consisted of K₅BW₁₂O₄₀ and cysteine-containing reductive peptides. Each of the individual coacervate has well-defined spreading capacity to achieve fast interfacial attachment and adhesion, but their cohesion is poor. However, after mixing the two redox-complementary coacervates at the target surface, effective adhesion and spontaneous curing were observed. We identified that the spontaneous curing resulted from the H₅PMo₁₀V₂O₄₀-regulated oxidization of cysteine-containing peptides. The formed intermolecular disulfide bonds improved the cross-linking density of the dual-peptide/POM coacervates, giving rise to the enhanced bulk cohesion and mechanical strength. More importantly, the resultant adhesives showcased excellent bioactivity to selectively suppress the growth of Gram-positive bacteria due to the presence of the polyoxometalates. This work raises further potential in the creation of biomimetic adhesives through the orchestrating of covalent and noncovalent interactions in a sequential fashion.

Fabrication of adhesive hydrogels based on poly (acrylic acid) and modified hyaluronic acid

Hydrogel wound dressings with good flexibility and adhesiveness to resist deformation during wound movement are urgently needed in clinical application. In this work, the hydrogels based on poly (acrylic acid) and N-hydroxysuccinimide grafted hyaluronic acid (PAA/HA_-NHS) with good elasticity and adhesiveness were prepared by chemical cross-linking and hydrogen bonding. The elastic and adhesive properties within the PAA hydrogels could reach a balance by adjusting the concentration of potassium persulfate (KPS) and N, N'-methylenebisacrylamide (MBA). Subsequently, HA_-NHS was incorporated into the PAA hydrogel system. The mechanical test revealed that the elongation at break and interfacial toughness of the PAA/HA_-NHS hydrogels could reach 265.79 ± 21.93% and 52.88 ± 3.51 J/m², respectively. In addition, the hydrogels possess a connected porous network and well water absorption ability (with porosity of 51.90 ± 0.11% and swelling ratio in wet state of 122.17 ± 2.78%). In vitro experiment demonstrates that the PAA/HA_-NHS hydrogels exhibit nontoxic and cell in-adhesive properties. The PAA/HA_-NHS hydrogels could cover the wound spots directly, stretch with the skin movement and gently remove from the wound tissue due to the suitable adhesiveness and poor cell adhesion. In conclusion, the PAA/HA_-NHS hydrogels show great application value in the field of wound dressing.

Hydrogel tapes for fault-tolerant strong wet adhesion

Fast and strong bio-adhesives are in high demand for many biomedical applications, including closing wounds in surgeries, fixing implantable devices, and haemostasis. However, most strong bio-adhesives rely on the instant formation of irreversible covalent crosslinks to provide strong surface binding. Repositioning misplaced adhesives during surgical operations may cause severe secondary damage to tissues. Here, we report hydrogel tapes that can form strong physical interactions with tissues in seconds and gradually form covalent bonds in hours. This timescale-dependent adhesion mechanism allows instant and robust wet adhesion to be combined with fault-tolerant convenient surgical operations. Specifically, inspired by the catechol chemistry discovered in mussel foot proteins, we develop an electrical oxidation approach to controllably oxidize catechol to catecholquinone, which reacts slowly with amino groups on the tissue surface. We demonstrate that the tapes show fast and reversible adhesion at the initial stage and ultrastrong adhesion after the formation of covalent linkages over hours for various tissues and electronic devices. Given that the hydrogel tapes are biocompatible, easy to use, and robust for bio-adhesion, we anticipate that they may find broad biomedical and clinical applications.

Mussel-Inspired Epoxy Bioadhesive with Enhanced Interfacial Interactions for Wound Repair

The balance between high mechanical properties and strong adhesion strength is crucial in designing and preparing a bio-based hydrogel adhesive for wound closure. Although the adhesion performance of bioadhesives has been remarkably improved by modification with catechol groups, their mechanical properties are yet to meet the biomedical requirements. In this study, mussel-inspired epoxy bioadhesives (CSD-PEG) were synthesized based on catechol-modified chitosan oligosaccharide (CSD) and polyethylene glycol diglycidyl ether (PEGDGE) through nucleophilic substitution. Notably, the CSD-PEG adhesive showed high mechanical and adhesion strengths, which were up to 50.7 kPa and 136.7 kPa, respectively. It was confirmed that a certain amount of the epoxy and catechol groups provided multiple interfacial interactions among the adhesives, substrates, and polymer chains for enhancing the performance of adhesives. The adhesives showed good binding and repairing effects for wound closure and favorable biocompatibility in vivo. The prepared CSD-PEG adhesives are expected to be a promising candidate for surgical tissue repair, wound closure, and tissue engineering fields. STATEMENT OF SIGNIFICANCE: Current reported adhesives composed of biopolymers generally suffer from poor mechanical properties or weak tissue adhesiveness. Therefore, to achieve simultaneously high mechanical and adhesion properties in a bio-based adhesive for wound closure is a big challenge. In this study, mussel-inspired adhesive hydrogels (CSD-PEG) were prepared based on catechol-modified chitosan oligosaccharide (CSD) and polyethylene glycol diglycidyl ether (PEGDGE). The tensile strength and adhesive strength of CSD-PEG on porcine skin reached 50.7 kPa and 136.7 kPa, respectively, which were higher than those for most reported biopolymeric adhesives, mainly due to the multiple interfacial interactions between the catechol and epoxy groups. The CSD-PEG bioadhesives also showed good binding and repairing effects for wound closure and tissue regeneration in vivo.