Multifunctional two-component in-situ hydrogel for esophageal submucosal dissection for mucosa uplift, postoperative wound closure and rapid healing

Acid-Triggered Charge-Switchable Antibacterial Hydrogel for Accelerated Healing of Gastric Mucosal Wounds

Infection with Helicobacter pylori (H. pylori) is a primary etiological factor for chronic gastritis, peptic ulcers, and gastric cancer. The limited specificity of antibiotics against H. pylori, combined with the risk of severe adverse events from endoscopic submucosal dissection (ESD), presents a major global health challenge in treating gastric mucosal injuries. To address this issue, we developed a targeted antibacterial hydrogel based on a charge-reversal amphiphilic molecule, designed for the harsh gastric acid environment and capable of immediate and strong adhesion. The hydrogel is composed of acryl aspartate (AASP) and cysteine-grafted carboxymethyl chitosan (CMCS-NAC) as the base matrix, integrated with gastric acid-responsive charge-reversal antibacterial molecules (C16N-DCA). Simulated studies show that C16N-DCA undergoes charge reversal under acidic conditions (pH 3), enabling targeted H. pylori eradication mediated by gastric acid, with 98% efficacy and sustained antibacterial activity for up to 36 h. In vitro and in vivo experiments in rodent and porcine models confirmed its safety and efficacy in acidic gastric conditions. This hydrogel offers strong tissue protection and effectively modulates the gastric wound microenvironment, facilitating wound healing and presenting an easily adoptable solution for gastric wound management.

Polysaccharides as submucosal injection materials (SIMs) in endoscopic resection: A comprehensive review

Submucosal injection materials (SIMs) play a vital role in the endoscopic treatment of benign and early malignant gastrointestinal lesions by effectively elevating lesions while significantly reducing the risks of thermal injury and bleeding. However, the traditional use of normal saline (NS) presents challenges due to its rapid absorption, which necessitates frequent reapplications and complicates procedural efficiency. Therefore, there is a pressing need for ideal SIMs that are cost-effective, readily available, and suitable for personalized therapy, while also demonstrating excellent biocompatibility and physicochemical stability. Recent advancements have highlighted the potential of polysaccharide-based natural polymers, such as sodium hyaluronate, cellulose, starch derivatives, chitosan, and sodium alginate, due to their superior biocompatibility and biodegradability. These polysaccharides have exhibited enhanced operational characteristics and therapeutic efficacy in animal and clinical studies. Nevertheless, ongoing research must address several challenges, including optimizing cost-effectiveness, improving mechanical strength and bioactivity, and mitigating intraoperative and postoperative complications. This review systematically examines the progress of polysaccharide-based natural polymers in SIMs, evaluates their current status and challenges in both research and clinical applications, and proposes future directions to enhance their utilization in gastrointestinal endoscopic therapy.

Konjac glucomannan/sodium alginate/ε-poly-l-lysine hydrogel promotes esophageal and colonic wound healing

Endoscopic submucosal dissection (ESD) is widely used to treat gastrointestinal mucosal and submucosal lesions. However, it may cause bleeding, perforation, and stricture. Although these complications can be avoided by introducing materials such as polyglycolic acid and carboxymethyl cellulose sheets, such approaches are expensive and time-consuming. Herein, we report a hydrogel prepared by combining a colloidal solution composed of konjac glucomannan (KGM) and sodium alginate (SA) and a fixative solution containing ε-poly-l-lysine (ε-PLL) and calcium chloride. The two solutions were mixed on the wound surface to form the KGM/SA/ε-PLL hydrogel through hydrogen bonds, coordination bonds, and electrostatic attraction. The effectiveness and convenience of applying the KGM/SA/ε-PLL hydrogel to promote wound healing in the esophagus and colon were assessed in vitro and in vivo. We found that the hydrogel stimulated epithelial proliferation, reduced inflammation, promoted recapillarization, and inhibited fibrosis in the esophagus and colon. Therefore, the KGM/SA/ε-PLL hydrogel is an effective and convenient agent that can promote post-ESD wound healing and is recommended for ulcer bed protection in daily clinical practice.

Unleashing the power within: Enhancing hydrogel bio-mimetic polymer actuators (HBPA) through sodium alginate crosslinking with cordyceps polysaccharide (CO-PS)

Hydrogel crosslinking varies in properties and stability, with many physiochemical crosslinkers boosting hydrogel performance but raising issues about biotoxicity, sourcing, and compatibility. Cordyceps polysaccharide, from the rare Chinese herb cordyceps, offers antioxidant and anti-cancer benefits without biological toxicity. This study developed a new hydrogel actuating membrane by crosslinking cordyceps polysaccharide with sodium alginate. Hydrogel Bio-mimetic Polymer Actuators (HBPA) were then assembled using non-metallic electrode membranes and tested for electrical actuation properties. A mechanoelectric coupling model was used to study the electrically actuated deflection system of HBPA. Results showed that a crosslinking ratio of 3:5 increased the peak output force density of HBPA to 21.95 mN/g. The actuation speed increased by 8.05 % compared to the basement membrane, while the duty ratio dropped by 80.8 %, significantly enhancing the tremor index. Tremor frequency and amplitude decreased by 43.52 % and 64.88 %, respectively. Electrochemically, specific capacitance grew 3.9 times, resistance fell by 21.7 %, and specific energy rose by 102.42 %. The actuating membrane featured a dense, uniform structure with evenly distributed pores and well-coordinated active groups at the optimal crosslinking ratio. At 4 V, HBPA demonstrated excellent electrical actuation and significant rebound at 0.1 Hz. Moreover, the mechanoelectric coupling model effectively applied to electroactive polymer materials.

A self-hygroscopic, rapidly self-gelling polysaccharide-based sponge with robust wet adhesion for non-compressible hemorrhage control and infected wounds healing

Uncontrollable non-compressible hemorrhage and traumatic infection have been major causes of mortality and disability in both civilian and military populations. A dressing designed for point-of-care control of non-compressible hemorrhage and prevention of traumatic infections represents an urgent medical need. Here, a novel self-gelling sponge OHN@ε-pL is developed, integrating N-succinimidyl ester oxidized hyaluronic acid (OHN) and ε-poly-L-lysine (ε-pL). Upon application to the wound site, the sponge can rapidly absorb interfacial fluids and undergo a phase transition from sponge to gel. The transformed gel facilitates robust tissue adhesion and achieves synergistic hemostasis by enriching coagulation factors within the sponge phase and providing a barrier effect in the gel phase. The in vitro and in vivo studies revealed that the optimized OHN@ε-pL3 sponge possesses self-gelling capability, tissue adhesion, enhanced coagulation ability, and exhibits excellent biocompatibility and antibacterial efficacy. In hemostasis, OHN@ε-pL3 sponges exhibited reduced blood loss and decreased hemostatic time compared to commercial hemostatic agents, as demonstrated in rat liver, femoral vein, and tail truncation bleeding models. Furthermore, the OHN@ε-pL3 sponge exhibited superior performance in accelerating wound closure and healing of S. aureus-infected wounds. Collectively, OHN@ε-pL sponges represent a promising candidate for medical dressings, specifically for managing uncontrollable non-compressible hemorrhage and traumatic infections.

Biointegration of soft tissue-inspired hydrogels on the chorioallantoic membrane: An experimental characterization

Soft scaffold materials for cell cultures grafted onto the chorioallantoic membrane (CAM) provide innovative solutions for creating physiologically relevant environments by mimicking the host tissue. Biocompatible hydrogels represent an ideal medium for such applications, but the relationship between scaffold mechanical properties and reactions at the biological interface remains poorly understood. This study examines the attachment and integration of soft hydrogels on the CAM using an accessible ex ovo system. Composite hydrogels of polyvinyl alcohol and Phytagel were fabricated by sterile freeze-thawing. CAM assays, as an alternative to traditional in vivo models, enabled the evaluation of the compatibility, attachment, and biointegration of hydrogels with three distinct compositions. The mechanomimetic properties of the hydrogels were assessed through cyclic compression-tension tests, with nominal peak stresses ranging from 0 . 26 to 2 . 82  kPa in tension and - 0 . 33 to - 2 . 92  kPa in compression. Mechanical attachment to the CAM was measured by pull-off tests after five days of incubation. On the first day, the interface strength was similar for all hydrogel compositions. On day 5 , softer hydrogels showed the greatest increase ( p = 0 . 008 ), followed by intermediate hydrogels ( p = 0 . 020 ), while the denser hydrogels showed negligible changes ( p = 0 . 073 ). Histological analyses revealed cell infiltration in 100 % of soft, 75 % of intermediate, and 13 % of dense hydrogels, suggesting that softer hydrogels integrate better into the CAM by facilitating cell migration and enhancing interface strength. Chicken embryo survival rates and cytotoxicity assays confirmed the biocompatibility of the hydrogels and supported their potential for use in soft, hydrated three-dimensional scaffolds that mimic tissue environments in dynamic biological systems. Statement of significance Current research on soft scaffold materials for cell cultures often overlooks the critical relationship between mechanical properties and biological integration of these materials with host tissues. Although hydrogels, as soft porous materials, hold promise for creating physiologically relevant environments, the mechanisms driving their attachment and biointegration, especially on the chorioallantoic membrane (CAM), remain largely unexplored. This study addresses this gap by investigating the interaction between soft hydrogels and the CAM, providing valuable insights into how material properties and microstructure influence cellular responses. Our findings emphasize the importance of understanding these dynamics to develop biocompatible scaffolds that better mimic tissue environments, advancing applications in three-dimensional cell cultures on CAM assays and other biological systems.

Glucose oxidase: An emerging multidimensional treatment option for diabetic wound healing

The healing of diabetic skin wounds is a complex process significantly affected by the hyperglycemic environment. In this context, glucose oxidase (GOx), by catalyzing glucose to produce gluconic acid and hydrogen peroxide, not only modulates the hyperglycemic microenvironment but also possesses antibacterial and oxygen-supplying functions, thereby demonstrating immense potential in the treatment of diabetic wounds. Despite the growing interest in GOx-based therapeutic strategies in recent years, a systematic summary and review of these efforts have been lacking. To address this gap, this review article outlines the advancements in the application of GOx and GOx-like nanozymes in the treatment of diabetic wounds, including reaction mechanisms, the selection of carrier materials, and synergistic therapeutic strategies such as multi-enzyme combinations, microneedle structures, and gas therapy. Finally, the article looks forward to the application prospects of GOx in aiding the healing of diabetic wounds and the challenges faced in translating these innovations to clinical practice. We sincerely hope that this review can provide readers with a comprehensive understanding of GOx-based diabetic treatment strategies, facilitate the rigorous construction of more robust multifunctional therapeutic systems, and ultimately benefit patients with diabetic wounds.

Injectable Hyaluronic Acid-Based Hydrogels for Rapid Endoscopic Submucosal Dissection

Endoscopic submucosal dissection (ESD) is a widely used procedure for the treatment of early and precancerous gastrointestinal lesions and has become the standard treatment. In this procedure, the commonly used materials have a short retention time and a limited lifting capacity, which will prolong the duration of the ESD procedure. Furthermore, these liquids tend to diffuse after ESD surgery, failing to adequately protect the wound. Therefore, we designed and developed injectable hydrogels based on hyaluronic acid. A series of oxidized hyaluronic acid (OHA) and hydrazide hyaluronic acid (AHA) were synthesized, and 16 kinds of injectable hydrogels were fabricated to investigate the effects of molecular structures on the properties of the hydrogels. Among these, the O1A3 hydrogel exhibited a suitable injection performance, gelation time, and mechanical properties, along with good blood and cell compatibility in vitro. Subsequently, in a porcine model of the ESD procedure, the results demonstrated that the O1A3 hydrogel exhibited a good retention time and lifting performance while also significantly reducing the operation time from 1-2 h to ∼10 min. Furthermore, the adhesive property of the O1A3 hydrogel on small bleeding spots and wounds could be observed, which was beneficial in protecting the wound from the complex environment of the gastrointestinal tract. The present work of injectable hyaluronic acid-based hydrogels could be promising to improve the efficiency of ESD surgery.

Emerging Frontiers in In Situ Forming Hydrogels for Enhanced Hemostasis and Accelerated Wound Healing

With a surge in the number of accidents and chronic wounds worldwide, there is a growing need for advanced hemostatic and wound care solutions. In this regard, in situ forming hydrogels have emerged as a revolutionary biomaterial due to their inherent properties, which include biocompatibility, biodegradability, porosity, and extracellular matrix (ECM)-like mechanical strength, that render them ideal for biomedical applications. This review demonstrates the advancements of in situ forming hydrogels, tracing their evolution from injectable to more sophisticated forms, such as sprayable and 3-D printed hydrogels. These hydrogels are designed to modulate the pathophysiology of wounds, enhancing hemostasis and facilitating wound repair. The review presents different methodologies for in situ forming hydrogel synthesis, spanning a spectrum of physical and chemical cross-linking techniques. Furthermore, it showcases the adaptability of hydrogels to the dynamic requirements of wound healing processes. Through a detailed discussion, this article sheds light on the multifunctional capabilities of these hydrogels such as their antibacterial, anti-inflammatory, and antioxidant properties. This review aims to inform and inspire continued advancement in the field, ultimately contributing to the development of sophisticated wound care solutions that meet the complexity of clinical needs.

Progress in chitin/chitosan and their derivatives for biomedical applications: Where we stand

Chitin and its deacetylated form, chitosan, have demonstrated remarkable versatility in the realm of biomaterials. Their exceptional biocompatibility, antibacterial properties, pro- and anticoagulant characteristics, robust antioxidant capacity, and anti-inflammatory potential make them highly sought-after in various applications. This review delves into the mechanisms underlying chitin/chitosan's biological activity and provides a comprehensive overview of their derivatives in fields such as tissue engineering, hemostasis, wound healing, drug delivery, and hemoperfusion. However, despite the wealth of studies on chitin/chitosan, there exists a notable trend of homogeneity in research, which could hinder the comprehensive development of these biomaterials. This review, taking a clinician's perspective, identifies current research gaps and medical challenges yet to be addressed, aiming to pave the way for a more sustainable future in chitin/chitosan research and application.

An Injectable Hydrogel with Ultrahigh Burst Pressure and Innate Antibacterial Activity for Emergency Hemostasis and Wound Repair

Uncontrolled bleeding and wound infections following severe trauma pose significant challenges for existing tissue adhesives, primarily due to their weak wet adhesion, slow adhesion formation, cytotoxicity concerns, and lack of antibacterial properties. Herein, an injectable hydrogel (denoted as ES gel) with rapid, robust adhesive sealing and inherent antibacterial activity based on ε-polylysine and a poly(ethylene glycol) derivative is developed. The engineered hydrogel exhibits rapid gelation behavior, high mechanical strength, strong adhesion to various tissues, and can sustain an ultrahigh burst pressure of 450 mmHg. It also presents excellent biocompatibility, biodegradability, antibacterial properties, and on-demand removability. Significantly improved hemostatic efficacy of ES gel compared to fibrin glue is demonstrated using various injury models in rats and rabbits. Remarkably, the adhesive hydrogel can effectively halt lethal non-compressible hemorrhages in visceral organs (liver, spleen, and heart) and femoral artery injury models in fully anticoagulated pigs. Furthermore, the hydrogel outperforms commercial products in sutureless wound closure and repair in the rat liver defect, skin incision, and infected full-thickness skin wound models. Overall, this study highlights the promising clinical applications of ES gel for managing uncontrolled hemorrhage, sutureless wound closure, and infected wound repair.

Facilitating safe and sustained submucosal lift through an endoscopically injectable shear-thinning carboxymethyl starch sodium hydrogel

Traditional submucosal filling materials frequently show insufficient lifting height and duration during clinical procedures. Here, the anionic polysaccharide polymer sodium carboxymethyl starch and cationic Laponite to prepare a hydrogel with excellent shear-thinning ability through physical cross-linking, so that it can achieve continuous improvement of the mucosal cushion through endoscopic injection. The results showed that the hydrogel (56.54 kPa) had a lower injection pressure compared to MucoUp (68.56 kPa). The height of submucosal lifting height produced by hydrogel was higher than MucoUp, and the height maintenance ability after 2 h was 3.20 times that of MucoUp. At the same time, the hydrogel also showed satisfactory degradability and biosafety, completely degrading within 200 h. The hemolysis rate is as low as 0.76 %, and the cell survival rate > 80 %. Subcutaneous implantation experiments confirmed that the hydrogel showed no obvious systemic toxicity. Animal experiments clearly demonstrated the in vivo feasibility of using hydrogels for submucosal uplift. Furthermore, successful endoscopic submucosal dissection was executed on a live pig stomach, affirming the capacity of hydrogel to safely and effectively facilitate submucosal dissection and mitigate adverse events, such as bleeding. These results indicate that shear-thinning hydrogels have a wide range applications as submucosal injection materials.

Self-Assembly Reinforced Alginate Fibers for Enhanced Strength, Toughness, and Bone Regeneration

Material reinforcement commonly exists in a contradiction between strength and toughness enhancement. Herein, a reinforced strategy through self-assembly is proposed for alginate fibers. Sodium alginate (SA) microstructures with regulated secondary structures are assembled in acidic and ethanol as reinforcing units for alginate fibers. Acidity increases the flexibility of the helix and contributes to enhanced extendibility. Ethanol is responsible for formation of a stiff β-sheet, which enhances the modulus and strength. The structurally engineered SA assembly exhibits robust mechanical compatibility, and thus reinforced alginate fibers possess an improved tensile strength of 2.1 times, a prolonged elongation of 1.5 times, and an enhanced toughness of 3.0 times compared with SA fibers without reinforcement. The reinforcement through self-assembly provides an understanding of strengthening and toughening mechanism based on secondary structures. Due to a similar modulus with bones, reinforced alginate fibers exhibit good efficacy in accelerating bone regeneration in vivo.

In situ bioprinting of double network anti-digestive xanthan gum derived hydrogel scaffolds for the treatment of enterocutaneous fistulas

The clinical treatment of enterocutaneous fistula is challenging and causes significant patient discomfort. Fibrin gel can be used to seal tubular enterocutaneous fistulas, but it has low strength and poor digestion resistance. Based on in situ bioprinting and the anti-digestive properties of xanthan gum (XG), we used carboxymethyl chitosan (CMC) and xanthan gum modified by grafted glycidyl methacrylate (GMA) and aldehyde (GCX) as the ink to print a double network hydrogel that exhibited high strength and an excellent anti-digestive performance. In addition, in vitro studies confirmed the biocompatibility, degradability, and self-healing of hydrogels. In our rabbit tubular enterocutaneous fistula model, the in situ printed hydrogel resisted corrosion due to the intestinal fluid and acted as a scaffold for intestinal mucosal cells to proliferate on its surface. To summarize, in situ bioprinting GCX/CMC double network hydrogel can effectively block tubular enterocutaneous fistulas and provide a stable scaffold for intestinal mucosal regeneration.