Injectable baicalin/F127 hydrogel with antioxidant activity for enhanced wound healing

Oxidized fucoidan-based nanocomposite hydrogel for cryptotanshinone delivery and prevention of postoperative abdominal adhesions

Postoperative abdominal adhesions (PAA) are common diseases following abdominal surgery and can cause various serious complications. The excessive inflammation and oxidative stress are the main causes of PAA formation. Herein, we developed a nanomicellar hydrogel, OFu/HF@CTS, composed of oxidized fucoidan (OFu) and cryptotanshinone (CTS)-loaded hydrazine-functionalized pluronic F127 nanomicelles (HF127@CTS) for the effective prevention of PAA. The hydrogels exhibited satisfactory viscoelasticity, rapid self-healing ability, and good tissue adhesion properties, and were able to slowly release CTS for one week, with a cumulative release rate of 80 % on the 7th day. Additionally, the hydrogels could effectively reduce fibroblast cells and protein adhesions due to the high negative charge of OFu and have good biocompatibility towards RAW 264.7 and L929 cells. Moreover, CTS released from OFu/HF@CTS could efficiently reduce oxidative stress in macrophages and promote M1 macrophages polarized to M2 phenotype to relieve inflammation. In vivo results showed that OFu/HF@CTS hydrogel had good biodegradability and biosafety, and could effectively reduce PAA formation in a rat cecum-abdominal wall abrasion model through the mechanism of alleviating oxidative stress and inflammation, regulating fibrinolysis, and inhibiting fibrosis. This work highlights the therapeutic potential of drug-loaded nanomicellar hydrogels as a preventive strategy for PAA in clinical applications.

Baicalin loaded monodispersed polycaprolactone (PCL) microspheres preparation by polyvinylidene fluoride (PVDF) membrane emulsification for wound healing in dermal fibroblasts

The development of injectable bio-stimulating polycaprolactone (PCL) microspheres for wound healing has strict requirement on size and morphology control, particularly favoring microspheres within the range between 20-50 µm. PCL microspheres with smaller sizes are phagocyted at rapid rate while larger microspheres could cause inflammation. Homogenization can be regarded as an irreversible process to generate microspheres of particular size range while it still remains as the most common approach for microspheres production. Membrane emulsification technology shows great potential in fine tailoring of microspheres while still holds promising ability for scale-up production. Membranes with uniform large pores and dual hydrophilicity might be capable of the production of large microspheres via emulsification with tailorable size distribution. The aim of this study is to verify the feasibility of PVDF membranes with large pores on the generation of PCL microspheres via the combined crystallization diffusion (CCD) approach. The effect of dope solution concentration and PVDF molecular weights on membrane morphologies and the corresponding microspheres characteristics were investigated. Results showed that concentration of 20 wt% produced microspheres at desirable size of 24.14 µm and the optimal span of 0.53. Microspheres with narrow distribution showed the highest drug loading efficiency of baicalin at 8.42 %. The baicalin loaded PCL microspheres presented gradual release of drug release over 33-day of in vitro testing and significantly improved cell growth rate of 111.67 % as compared to the ones prepared by homogenization approach. The wound healing ability was enhanced after the treatment of baicalin-loaded PCL microspheres as compared to empty loaded PCL microspheres.

Poloxamer 407-Based Hydrogels Containing Rutin Increase the In Vitro and In Vivo Wound Healing Phenomena

Rutin is a flavonoid glycoside found in many plants, known for its various pharmacological properties. However, its therapeutic potential is limited by its low water solubility, which restricts its bioavailability. Poloxamer 407 (P407) is a multifunctional excipient, which has proven effective in delivering poorly water-soluble drugs and promoting the healing process. Based on this information, this study investigates the wound healing potential of rutin-loaded P407 hydrogels, as an innovative pharmaceutical formulation. In vitro scratch assays on human keratinocytes revealed that combining rutin with P407 significantly enhances cell proliferation as compared to the single components. Moreover, the proposed hydrogel improved wound healing more effectively in rats than the free drug or the commercial wound dressing DuoDERM. Histological analyses confirmed that the formulation increased epithelialization and collagen synthesis in injured epidermises. These findings provide a strong rationale for the use of rutin-loaded P407 hydrogels for the treatment of skin injuries.

Natural Protein-Based Multifunctional Hydrogel Dressing Formed by Rapid Photocuring and Zinc Ion Coordination to Accelerate Wound Healing

This study explores the use of chicken egg white (EW), a rich source of natural proteins, to address challenges in wound healing management. Herein, a novel Zn2+-infused EW/GelMA (EW/Gel) hybrid hydrogel is developed, featuring an interpenetrating network (IPN) structure, where the first network consists of photo-cross-linked GelMA and the second network consists of Zn2+-infused EW (Zn-EW) through ion-protein binding. By optimizing the design and formulation, the resulting Zn-EW/Gel hydrogel exhibited enhanced mechanical stability and self-adhesive properties. In vitro experiments demonstrated that the combined effects of functional proteins and active ions within the Zn-EW/Gel hydrogel promote fibroblast proliferation and type I collagen expression, modulate the immune microenvironment, and enhance angiogenesis. The hydrogel also demonstrated excellent biocompatibility and bioactivity in vivo, showing strong promise for restoring the physiological properties of the damaged wound tissue.

One-pot rapid preparation of long-term antioxidant and antibacterial biomedical gels based on lipoic acid and eugenol for accelerating cutaneous wound healing

The complex battlefield environment often puts great pressure on the treatment of open wounds caused by burns and trauma, which cannot heal for a long time due to the lack of medical resources. Once wounds are not sutured and severely infected, they can lead to infective endocarditis, sepsis, and even death. Therefore, it is urgent to develop advanced dressings to replace sutures and antibiotics, which can quickly seal wounds and maintain long-term stability of antibacterial and antioxidant properties. In this study, novel biobased antibacterial adhesive gels composed of natural small molecule lipoic acid and eugenol were prepared via a one-pot solvent-free reaction for wound management. The gels were crosslinked via the ring-opening polymerization of lipoic acid and hydrogen bond interaction. Due to its structure feature, the PLA-E1 gel displayed excellent flexibility, transparency, self-healing and adhesiveness. The gel system showed long-term high antioxidant activity (95%) after exposure to air at room temperature for one year. Meanwhile, the reactive oxygen species (ROS) scavenging efficacy was kept around 52%. Both trauma and burn in vivo experiments demonstrated that the PLA-E1 gel could accelerate wound healing through antibacterial, antioxidant, angiogenic and tissue regenerative effects, indicating the potential applications of cutaneous wound healing on the battlefield.

A pH-responsive dual-network biopolysaccharide hydrogel with enhanced self-healing and controlled drug release properties

Traditional hydrogels based on Schiff base reactions frequently encounter issues with rapid drug release when employed as drug delivery systems owing to their susceptibility to hydrolysis under acidic conditions. It is, therefore, necessary to implement improvements to regulate the drug release behavior. In this study, a dual-network and pH-responsive biopolysaccharide hydrogel was developed, which is self-healing, injectable and biocompatible. Most importantly, the hydrogel has excellent tunability for controlled drug release. The hydrogel consisted of a primary network of dibenzaldehyde-functionalized poly(ethylene glycol) (DP) and chitosan (CS) formed through a Schiff base reaction and a secondary network of sodium alginate (SA) and CS formed through electrostatic interactions. It was found that the DP-CS-2%SA hydrogel can prolong the release duration up to four-fold compared to the single-network DP-CS hydrogel at a given release threshold. Significantly, by adjusting the relationship between the two effects through the amount of SA, the release modifiability of drug delivery systems has been greatly enhanced. This study could significantly enhance the tunability of hydrogel drug delivery systems.

Biological macromolecule-based hydrogels with antibacterial and antioxidant activities for wound dressing: A review

Because of the complex symptoms resulting from metabolic dysfunction in the wound microenvironment during bacterial infections, along with the necessity to combat free radicals, achieving prompt and thorough wound healing remains a significant medical challenge that has yet to be fully addressed. Moreover, the misuse of common antibiotics has contributed to the emergence of drug-resistant bacteria, underscoring the need for enhancements in the practical and commonly utilized approach to wound treatment. In this context, hydrogel dressings based on biological macromolecules with antibacterial and antioxidant properties present a promising new avenue for skin wound treatment due to their multifunctional characteristics. Despite the considerable potential of this innovative approach to wound care, comprehensive research on these multifunctional dressings is still insufficient. Consequently, the development of advanced biological macromolecule-based hydrogels, such as chitosan, alginate, cellulose, hyaluronic acid, and others, has been the primary focus of this study. These materials have been enriched with various antibacterial and antioxidant agents to confer multifunctional attributes for wound healing purposes. This review article aims to offer a comprehensive overview of the latest progress in this field, providing a critical theoretical basis for future advancements in the utilization of these advanced biological macromolecule-based hydrogels for wound healing.

Coordination-Driven Nanomedicine Mitigates One-Lung Ventilation-Induced Lung Injury via Radicals Scavenging and Cell Pyroptosis Inhibition

One-lung ventilation (OLV) during thoracic surgery often leads to post-operative complications, yet effective pharmacological interventions are lacking. This study reports a baicalin-based metal-coordination nanomedicine with disulfiram (DSF) co-loading to address one-lung ventilation-induced lung injury and reperfusion injury (OLV-LIRI). Baicalin, known for its robust antioxidant properties, suffers from poor water solubility and stability. Leveraging nanotechnology, baicalin's coordination is systematically explored with seven common metal ions, designing iron/copper-mediated binary coordination nanoparticles to overcome these limitations. The self-assembled nanoparticles, primarily formed through metal coordination and π-π stacking forces, encapsulated DSF, ensuring high colloidal stability in diverse physiological matrices. Upon a single-dose administration via endotracheal intubation, the nanoparticles efficiently accumulate in lung tissues and swiftly penetrate the pulmonary mucosa. Intracellularly, baicalin exhibits free radical scavenging activity to suppress inflammation. Concurrently, the release of Cu2+ and DSF enables the in situ generation of CuET, a potent inhibitor of cell pyroptosis. Harnessing these multifaceted mechanisms, the nanoparticles alleviate lung injury symptoms without notable toxic side effects, suggesting a promising preventive strategy for OLV-LIRI.

Essential oils loaded carboxymethylated Cassia fistula gum-based novel hydrogel films for wound healing

Carboxymethylated Cassia fistula gum (CCFG) and citric acid (CA) based wound healing film, (CCFG-CA) was developed using the solvent casting method. Glycerol was added as a plasticizing agent. The synthesized Carboxymethylated Cassia fistula gum cross-linked citric acid based hydrogel film (CCFG-CA) was evaluated morphologically, thermally, and structurally using FESEM, TGA, XRD and FTIR. Three essential oils (EO), rosemary (Rosmarinus officinalis), turmeric (Curcuma longa) and thuja (Thuja occidentalis L), known for antimicrobial and antioxidant activities, were loaded into the CCFG-CA film to develop essential oils loaded carboxymethylated Cassia fistula gum cross-linked citric acid based hydrogel film (CCFG-CA-EO). In vitro studies (MTT assay, disk diffusion assay, permeability tests and DPPH assay) confirm the biocompatibility, anti-oxidant and anti-microbial properties of the CCFG-CA-EO film. In vivo (wound healing studies on wistar rats and their histology) shows 99 % of wound healing and re-epithelialization in 14 days. Degradability (within 15 days), protein adsorption (12.05 μg/mL) and contact angle determination (69.43°ׄׄ ± 0.48) tests confirmed the potential of CCFG-CA-EO as an effective wound-healing material.

Composite Polysaccharide Hydrogel Loaded with Scutellaria baicalensis Extract for Diabetic Wound Treatment

Diabetic wounds present significant burdens to both patients and the healthcare system due to their prolonged inflammatory phase and adverse microenvironment. Traditional Chinese medicine (TCM), particularly Scutellaria baicalensis extract (SE), has shown promise in wound healing. Herein, sesbania gum (SG) was oxidized and formed hydrogel with carboxymethyl chitosan (CMCS) through the imine bond. Then, SE was loaded into the hydrogel as a wound dressing (CMCS-OSG@SE hydrogel). In vitro experiments demonstrated the mechanical properties and ROS scavenging efficiency of the hydrogel, as well as the release of SE and its biocompatibility. In an vivo study, diabetic mice with S. aureus infection were used, and the CMCS--OSG@SE hydrogel dressing accelerated wound healing by promoting epidermal regeneration and collagen deposition. This composite polysaccharide hydrogel loaded with SE shows great potential for diabetic wound treatment.

Composite hydrogels with antioxidant and robust adhesive properties for the prevention of radiation-induced dermatitis

Radiotherapy is a pivotal means of cancer treatment, but it often leads to radiation dermatitis, a skin injury caused by radiation-induced excess reactive oxygen species (ROS). Scavenging free radicals in the course of radiation therapy will be an effective means to prevent radiation dermatitis. This study demonstrates a novel double network hydrogel doped with MoS2 nanosheets for the prevention of radiation-induced dermatitis. The resultant SPM hydrogel constructed from polyacrylamide (PAM) and sodium alginate (SA) nanofiber presented favorable mechanical and adhesion properties. It could conform well to the human body's irregular contours without secondary dressing fixation, making it suitable for skin protection applications. The in vitro and in vivo experiments showed that the antioxidant properties conferred by MoS2 nanosheets enable SPM to effectively mitigate excessive ROS and reduce oxidative stress, thereby preventing radiation dermatitis caused by oxidative damage. Biosafety assessments indicated good biocompatibility of the composite hydrogel, suggesting SPM's practicality and potential as an external dressing for skin radiation protection.

A dynamically cross-linked catechol-grafted chitosan/gelatin hydrogel dressing synergised with photothermal therapy and baicalin reduces wound infection and accelerates wound healing

Superior multifunctional hydrogel dressings are of considerable interest in wound healing. In clinical practice, it is useful to investigate hydrogel dressings that offer multifunctional benefits to expedite the process of wound healing. In this study, Catechol-grafted Chitosan, Gelatin, and Fe3+ as substrates to construct a hydrogel network. The network was dynamically cross-linked to form Ccg@Fe hydrogel substrate. Fe3O4 nanoparticles and baicalin, which possess antimicrobial and anti-inflammatory properties, were loaded onto the substrate to form a photothermal antibacterial composite hydrogel dressing (Ccg@Fe/Bai@Fe3O4 NPs). The Ccg@Fe hydrogel was characterised using Fourier transform infrared spectroscopy (FTIR) and Ultraviolet-visible spectrophotometry (UV-Vis). The morphological, mechanical, and adhesion properties of the hydrogel were determined using scanning electron microscopy (SEM) and a universal testing machine. The hydrogel's swelling, hemostasis, and self-healing properties were also evaluated. Additionally, the study determined the release rate of hydrogel-loaded antimicrobial and anti-inflammatory Baicalin (Ccg@Fe/Bai) and evaluated the photothermal antimicrobial properties of hydrogel-loaded Fe3O4 nanoparticles (Ccg@Fe/Bai@Fe3O4 NPs) through synergistic photothermal therapy (PTT). Histological staining of mice skin wound tissues using Masson and H&E revealed that the Ccg@Fe/Bai@Fe3O4 NPs hydrogel dressing demonstrated potential healing ability with the aid of PTT. The study suggests that this multifunctional hydrogel dressing has great potential for wound healing.

Eggshell membrane powder reinforces adhesive polysaccharide hydrogels for wound repair

Multifunctional polysaccharide hydrogels with strong tissue adhesion, and antimicrobial and hemostatic properties are attractive wound healing materials. In this study, a chitosan-based hydrogel (HCS) was designed, and its properties were enhanced by incorporating oxidized eggshell membrane (OEM). Hydrogel characterization and testing results showed that the hydrogel had excellent antimicrobial properties, cytocompatibility, satisfactory adhesion properties on common substrates, and wet-state adhesion capacity. A rat liver injury model confirmed the significant hemostatic effect of the hydrogel. Finally, the ability of the hydrogel to promote wound healing was verified using rat skin wound repair experiments. Our findings indicate that HCS/OEM hydrogels with added eggshell membrane fibers have better self-healing properties, mechanical strength, adhesion, hemostatic properties, and biocompatibility than HCS hydrogels, in addition to having superior repair performance in wound repair experiments. Overall, the multifunctional polysaccharide hydrogels fabricated in this study are ideal for wound repair.

Thermoresponsive Gels with Embedded Starch Microspheres for Optimized Antibacterial and Hemostatic Properties

Apart from single hemostasis, antibacterial and other functionalities are also desirable for hemostatic materials to meet clinical needs. Cationic materials have attracted great interest for antibacterial/hemostatic applications, and it is still desirable to explore rational structure design to address the challenges in balanced hemostatic/antibacterial/biocompatible properties. In this work, a series of cationic microspheres (QMS) were prepared by the facile surface modification of microporous starch microspheres with a cationic tannic acid derivate, the coating contents of which were adopted for the first optimization of surface structure and property. Thermoresponsive gels with embedded QMS (F-QMS) were further prepared by mixing a neutral thermosensitive polymer and QMS for second structure/function optimization through different QMS and loading contents. In vitro and in vivo results confirmed that the coating content plays a crucial role in the hemostatic/antibacterial/biocompatible properties of QMS, but varied coating contents of QMS only lead to a classical imperfect performance of cationic materials. Inspiringly, the F-QMS-4 gel with an optimal loading content of QMS4 (with the highest coating content) achieved a superior balanced in vitro hemostatic/antibacterial/biocompatible properties, the mechanism of which was revealed as the second regulation of cell-material/protein-material interactions. Moreover, the optimal F-QMS-4 gel exhibited a high hemostatic performance in a femoral artery injury model accompanied by the easy on-demand removal for wound healing endowed by the thermoresponsive transformation. The present work offers a promising approach for the rational design and facile preparation of cationic materials with balanced hemostatic/antibacterial/biocompatible properties.

A TA/Cu2+ Nanoparticle Enhanced Carboxymethyl Chitosan-Based Hydrogel Dressing with Antioxidant Properties and Promoting Wound Healing

Background

As the first line of immune defense and the largest organ of body, skin is vulnerable to damage caused by surgery, burns, collisions and other factors. Wound healing in the skin is a long and complex physiological process that is influenced by a number of different factors. Proper wound care can greatly improve the speed of wound healing and reduce the generation of scars. However, traditional wound dressings (bandages, gauze, etc.) often used in clinical practice have a single function, lack of active ingredients and are limited in use. Hydrogels with three-dimensional network structure are a potential biomedical material because of their physical and chemical environment similar to extracellular matrix. In particular, hydrogel dressings with low price, good biocompatibility, degradability, antibacterial and angiogenic activity are favored by the public.

Methods

Here, a carboxymethyl chitosan-based hydrogel dressing (CMCS-TA/Cu2+) reinforced by copper ion crosslinked tannic acid (TA/Cu2+) nanoparticles was developed. This study investigated the physical and chemical characteristics, cytotoxicity, and angiogenesis of TA/Cu2+ nanoparticles and CMCS-TA/Cu2+ hydrogels. Furthermore, a full-thickness skin defect wound model was employed to assess the in vivo wound healing capacity of hydrogel dressings.

Results

The introduction of TA/Cu2+ nanoparticles not only could increase the mechanical properties of the hydrogel but also continuously releases copper ions to promote cell migration (the cell migration could reach 92% at 48 h) and tubule formation, remove free radicals and promote wound healing (repair rate could reach 90% at 9 days).

Conclusion

Experiments have proved that CMCS-TA/Cu2+ hydrogel has good cytocompatibility, antioxidant and wound healing ability, providing an advantageous solution for skin repair.

Photo-Controllable Smart Hydrogels for Biomedical Application: A Review

Nowadays, smart hydrogels are being widely studied by researchers because of their advantages such as simple preparation, stable performance, response to external stimuli, and easy control of response behavior. Photo-controllable smart hydrogels (PCHs) are a class of responsive hydrogels whose physical and chemical properties can be changed when stimulated by light at specific wavelengths. Since the light source is safe, clean, simple to operate, and easy to control, PCHs have broad application prospects in the biomedical field. Therefore, this review timely summarizes the latest progress in the PCHs field, with an emphasis on the design principles of typical PCHs and their multiple biomedical applications in tissue regeneration, tumor therapy, antibacterial therapy, diseases diagnosis and monitoring, etc. Meanwhile, the challenges and perspectives of widespread practical implementation of PCHs are presented in biomedical applications. This study hopes that PCHs will flourish in the biomedical field and this review will provide useful information for interested researchers.

Multifunctional Hydrogels for the Healing of Diabetic Wounds

The healing of diabetic wounds is hindered by various factors, including bacterial infection, macrophage dysfunction, excess proinflammatory cytokines, high levels of reactive oxygen species, and sustained hypoxia. These factors collectively impede cellular behaviors and the healing process. Consequently, this review presents intelligent hydrogels equipped with multifunctional capacities, which enable them to dynamically respond to the microenvironment and accelerate wound healing in various ways, including stimuli -responsiveness, injectable self-healing, shape -memory, and conductive and real-time monitoring properties. The relationship between the multiple functions and wound healing is also discussed. Based on the microenvironment of diabetic wounds, antibacterial, anti-inflammatory, immunomodulatory, antioxidant, and pro-angiogenic strategies are combined with multifunctional hydrogels. The application of multifunctional hydrogels in the repair of diabetic wounds is systematically discussed, aiming to provide guidelines for fabricating hydrogels for diabetic wound healing and exploring the role of intelligent hydrogels in the therapeutic processes.

Grape seed proanthocyanidins regulate mitophagy of endothelial cells and promote wound healing in mice through p-JNK/FOXO3a/ROS signal pathway

Skin wound healing is a dynamic and complex process that involves multiple physiological and cellular events. Grape seed proanthocyanidins (GSP) have strong anti-oxidation and elimination of oxygen free radicals, and have been shown to significantly promote wound healing, but the underlying mechanism remains unclear. Studies have indicated that reactive oxygen species (ROS) acts as an upstream signal to induce mitophagy, suggesting that GSP can regulate mitophagy through the signal pathway. This study aimed to investigate whether GSP regulates mitophagy by down-regulating oxidative stress to promote wound healing. In vivo, GSP treatment accelerated wound healing, granulation tissue formation, collagen deposition, and angiogenesis in mice. Moreover, GSP down-regulated ROS levels and promoted the expression of antioxidant proteins by up-regulating the expression of p-JNK/FOXO3a protein, thereby regulating the expression of mitophagy-related proteins. In vitro, 4 μg/mL GSP showed no apparent toxic effects on cells and effectively reduce the oxidative stress damage of cells induced by H2O2. Western blot and superoxide anion fluorescence probe further confirmed that GSP effectively reduced Dihydroethidium content and up-regulated the expression of antioxidant proteins by activation of p-JNK/FOXO3a protein expression, thereby regulating mitophagy. Taken together, the findings from in vitro and in vivo experiments provide new insights into the promotion of wound healing by GSP.

Stimuli-responsive (nano)architectures for phytochemical delivery in cancer therapy

The use of phytochemicals for purpose of cancer therapy has been accelerated due to resistance of tumor cells to conventional chemotherapy drugs and therefore, monotherapy does not cause significant improvement in the prognosis and survival of patients. Therefore, administration of natural products alone or in combination with chemotherapy drugs due to various mechanisms of action has been suggested. However, cancer therapy using phytochemicals requires more attention because of poor bioavailability of compounds and lack of specific accumulation at tumor site. Hence, nanocarriers for specific delivery of phytochemicals in tumor therapy has been suggested. The pharmacokinetic profile of natural products and their therapeutic indices can be improved. The nanocarriers can improve potential of natural products in crossing over BBB and also, promote internalization in cancer cells through endocytosis. Moreover, (nano)platforms can deliver both natural and synthetic anti-cancer drugs in combination cancer therapy. The surface functionalization of nanostructures with ligands improves ability in internalization in tumor cells and improving cytotoxicity of natural compounds. Interestingly, stimuli-responsive nanostructures that respond to endogenous and exogenous stimuli have been employed for delivery of natural compounds in cancer therapy. The decrease in pH in tumor microenvironment causes degradation of bonds in nanostructures to release cargo and when changes in GSH levels occur, it also mediates drug release from nanocarriers. Moreover, enzymes in the tumor microenvironment such as MMP-2 can mediate drug release from nanocarriers and more progresses in targeted drug delivery obtained by application of nanoparticles that are responsive to exogenous stimulus including light.

Preparation of Antibacterial, Arginine-Modified Ag Nanoclusters in the Hydrogel Used for Promoting Diabetic, Infected Wound Healing

Diabetic foot ulcers with complex healing wounds accompanied by bacterial infection are considered a significant clinical problem which are made worse by the lack of effective treatments. Traditional antibiotics and dressings have failed to address wound infection and healing, and multifunctional combination therapies are attractive for treating chronic wounds. In this study, arginine (Arg) was loaded onto the surface of silver nanoclusters and encapsulated in a hydrogel to achieve antibacterial, anti-inflammatory, angiogenic, and collagen deposition functions through the slow release of Arg combined with silver nanoclusters. In vitro studies indicated that Arg-Ag@H composites inhibited methicillin-resistant Staphylococcus aureus and Escherichia coli by 94 and 97%, respectively. The inhibition of bacterial biofilms reached 85%, and the migration ability of human venous endothelial cells (HUVECs) increased by 50%. In vitro studies showed that Arg-Ag@H composites increased the healing area of wounds by 26% and resulted in a 98% skin wound-healing rate. Safety studies confirmed the excellent biocompatibility of Arg-Ag@H. The results suggest that Arg-Ag@H offers new possibilities for treating chronic diabetic wounds.

Tomato based gelatin methacryloyl hydrogel as an effective natural and low-cost scaffold for accelerative wound healing

Oxidative stress and infection are the main reasons for postponement of wound healing rate. They can potentially lead to serious inflammation and eventually lead to a longer and more painful recovery phase. Although wound dressings based on synthetic materials with antioxidative property have been proved to exhibit remarkable effect in controlling ROS level and improving wound healing, issues, such as high cost in raw materials, complicated procedures, usage of various toxic additives, and potential allergies, have significantly confined further clinical applications. In this study, a novel type of tissue engineering scaffold, based on tomatoes (Solanum lycopersicon) and gelatin methacryloyl (GelMA), was prepared via facile lyophilization and photo cross-link method (SL/GelMA). By taking advantages of various antioxidative components, such as carotenoids, flavonoids, phenolic acids, vitamin E, and vitamin C in tomatoes, SL/GelMA can effectively regulate ROS level, relieve the oxidative stress in wound bed, promote cell migration and angiogenesis, contribute to collagen deposition, and thus accelerate the rate of wound enclosure. Along with its high biocompatibility and low allergic potential, we believe that the food-derived wound dressing with facile preparation method, easy accessibility, and high cost-effectiveness can be translated for clinical treatments of various chronic wounds.

Multi-functional plant flavonoids regulate pathological microenvironments for vascular stent surface engineering

In-stent restenosis (ISR) and late thrombosis, usually caused by excessive smooth muscle cell (SMC) proliferation and delayed endothelial layer repair, respectively, are the main risks for the failure of vascular stent implantation. For years, modification of stents with biomolecules that could selectively inhibit SMC proliferation and support endothelial cell (EC) growth had drawn extensive attention. However, the modulatory effect of these biomolecules faces the impact of oxidative stress, inflammation, and hyperlipidemia of the pathological vascular microenvironment, which is caused by the stent implantation injury and atherosclerosis lesions. Here, we modified stents with a natural and multi-functional flavonoid, baicalin (BCL), using poly-dopamine (PDA) coating technology to combat the harmful impact of the pathological microenvironment. Stent with an appropriate BCL immobilization density (approximately 2.03 μg/cm2) successfully supported ECs growth while inhibited SMC proliferation. Furthermore, baicalin-modified surfaces regulated the oxidative stress, inflammation, and high-lipid of the pathological microenvironment to inhibit endothelial dysfunction and the oxidized low-density lipoprotein (ox-LDL)-induced macrophage foam cells formation. In vivo results showed that baicalin-modified stents exhibited significant anti-ISR, anti-inflammatory, and endothelialization-promoting functions. Our study suggests that the multi-functional baicalin with pathological microenvironment-regulation (PMR) effect has potential use in the surface engineering of cardiovascular devices. STATEMENT OF SIGNIFICANCE: Empowering vascular stents with selective modulation of smooth muscle cells and endothelial cells by surface technology has become an important research direction for stent surface engineering. However, stent coatings that can furthermodulate the pathological microenvironment of blood vessels have been rarely reported. In this study, we constructed a multifunctional coating based on a flavonoid, baicalin, which can selectively modulate vascular wall cells and improve the pathological microenvironment. This study may provide a reference for developing advanced vascular stents.

Photothermal Hydrogels for Promoting Infected Wound Healing

Photothermal therapies (PTT), with spatiotemporally controllable antibacterial capabilities without inducing resistance, have shown encouraging prospects in the field of infected wound treatments. As an important platform for PTT, photothermal hydrogels exhibit attractive advantages in the field of infected wound treatment due to their excellent biochemical properties and have been intensively explored in recent years. This review summarizes the progress of the photothermal hydrogels for promoting infected wound healing. Three major elements of photothermal hydrogels, i.e., photothermal materials, hydrogel matrix, and construction methods, are introduced. Furthermore, different strategies of photothermal hydrogels in the treatment of infected wounds are summarized. Finally, the challenges and prospects in the clinical treatment of photothermal hydrogels are discussed.

Disc regeneration by injectable fucoidan-methacrylated dextran hydrogels through mechanical transduction and macrophage immunomodulation

Modulating a favorable inflammatory microenvironment that facilitates the recovery of degenerated discs is a key strategy in the treatment of intervertebral disc (IVD) degeneration (IDD). More interestingly, well-mechanized tissue-engineered scaffolds have been proven in recent years to be capable of sensing mechanical transduction to enhance the proliferation and activation of nucleus pulposus cells (NPC) and have demonstrated an increased potential in the treatment and recovery of degenerative discs. Additionally, existing surgical procedures may not be suitable for IDD treatment, warranting the requirement of new regenerative therapies for the restoration of disc structure and function. In this study, a light-sensitive injectable polysaccharide composite hydrogel with excellent mechanical properties was prepared using dextrose methacrylate (DexMA) and fucoidan with inflammation-modulating properties. Through numerous in vivo experiments, it was shown that the co-culture of this composite hydrogel with interleukin-1β-stimulated NPCs was able to promote cell proliferation whilst preventing inflammation. Additionally, activation of the caveolin1-yes-associated protein (CAV1-YAP) mechanotransduction axis promoted extracellular matrix (ECM) metabolism and thus jointly promoted IVD regeneration. After injection into an IDD rat model, the composite hydrogel inhibited the local inflammatory response by inducing macrophage M2 polarization and gradually reducing the ECM degradation. In this study, we propose a fucoidan-DexMA composite hydrogel, which provides an attractive approach for IVD regeneration.

Engineering Antioxidative Cascade Metal-Phenolic Nanozymes for Alleviating Oxidative Stress during Extracorporeal Blood Purification

Oxidative stress is a compelling risk factor in chronic kidney diseases and is further aggravated for individuals during extracorporeal blood purification, ultimately leading to multiple complications. Herein, antioxidative cascade metal-phenolic nanozymes (metal-tannic acid nanozymes, M-TA NMs) are synthesized via metal ions-mediated oxidative coupling of polyphenols; then M-TA NMs engineered hemoperfusion microspheres (Cu-TAn@PMS) are constructed for alleviating oxidative stress. M-TA NMs show adjustable broad-spectrum antioxidative activities toward multiple reactive nitrogen and oxygen species (RNOS) due to the adjustable catalytic active centers. Importantly, M-TA NMs could mimic the cascade processes of superoxide dismutase and catalase to maintain intracellular redox balance. Detailed structural and spectral analyses reveal that the existence of a transition metal could decrease the electronic energy band gaps of M-TA NMs to offer better electron transfers for RNOS scavenging. Notably, dynamic blood experiments demonstrate that Cu-TAn@PMS could serve as an antioxidant defense system for blood in hemoperfusion to scavenge intracellular reactive oxygen species (ROS) effectively even in the complex blood environment and further protect endogenous antioxidative enzymes and molecules. In general, this work developed antioxidative cascade nanozymes engineered microspheres with excellent therapeutic efficacy for the treatment of oxidative stress-related diseases, which exhibited potential for clinical blood purification and extended the biomedical applications of nanozymes.

Nanoenzyme-chitosan hydrogel complex with cascade catalytic and self-reinforced antibacterial performance for accelerated healing of diabetic wounds

The significant disability and fatality rate of diabetes chronic wounds necessitates the development of efficient diabetic wound healing techniques. The present oxygen treatments for wound healing is restricted by issues such as poor penetration, inadequate supply, and absorption difficulties as well as tanglesome diabetic wound microenvironment issues such as hyperglycemia, excessive reactive oxygen species (ROS), and hypoxia. Herein, we designed a multifunctional glucose oxidase (GOx) and catalase (CAT) nanoenzyme-chitosan (GCNC) hydrogel complex to improve the microenvironment of diabetic wounds and provide continuous oxygen delivery for efficient wound healing. By simultaneously forming the GOx-CAT nanoenzyme (GCNE) composite, the GCNC hydrogel complex could effectively reduce glucose and ROS (H₂O₂) concentrations in diabetic wounds through cascade catalytic reactions and achieve continuous oxygen supply, which promoted cell proliferation, migration, and angiogenesis, thereby accelerating diabetic wound healing. In addition, the byproduct gluconic acid produced by the cascade reaction can activate the amino group of chitosan to reinforce the antibacterial performance and prevent microbial infection. This multifunctional GCNC hydrogel complex with continuous oxygen supply, self-reinforcing antibacterial properties, and byproduct-free features provides a general strategy for repairing the extensive tissue damage in diabetes.

Recent advances in redox-responsive nanoparticles for combined cancer therapy

The combination of multiple therapeutic modalities has attracted increasing attention as it can achieve better therapeutic effects through different treatment mechanisms. However, traditional small molecule agents are non-specific to the tumor tissue, which leads to off-target toxic effects for healthy tissues. To solve this problem, a number of stimuli-responsive nanoscale drug-delivery systems have been developed. Among these stimuli, a high concentration of reactive oxygen species (ROS) and glutathione (GSH) are characteristic of the tumor microenvironment (TME), which can distinguish it from normal tissue. In this review, we summarize the redox-responsive nanoparticles (NPs) reported in the past three years classified by different functional groups, including GSH-responsive disulfide, ditelluride, and multivalent metal ions, ROS-responsive thioketal, arylboronic ester, aminoacrylate, and bilirubin as well as GSH/ROS dual-responsive diselenide and dicarbonyl thioethers. The prospects and challenges of redox-responsive NPs are also discussed.

Enzyme-manipulated hydrogelation of small molecules for biomedical applications

Enzyme-manipulated hydrogelation based on self-assembly of small molecules is an attractive methodology for development of functional biomaterials. Upon the catalysis of enzymes, small-molecular precursors are converted into assemblable building blocks, which arrange into high-ordered nanofibers via non-covalent interactions at the molecular level, and further trap water to form hydrogels at the macroscopic level. Such approach has numerous advantages of region- and enantioselectivity, and mild reaction conditions for encapsulation of biomedications or cells that are fragile to environmental change. In addition to the common applications as drug reservoirs or cell scaffolds, the utilization of endogenous enzymes as stimuli to initiate self-assembly in the living cells and tissue is considered as an intelligent spatiotemporally controllable hydrogelation strategy for biomedical applications. The enzyme-instructed in situ self-assembly and hydrogelation can modulate the cell behavior, and even present therapeutic bioactivities, which provides a new perspective in the field of disease treatment. In this review, we categorize distinct enzymatic stimuli and elaborate substrate design, catalytic characteristics, and mechanisms of self-assembly and hydrogelation. The biomedical applications in drug delivery, tissue engineering, bioimaging, and in situ gelation-produced bioactivity are outlined. Advantages and limitations regarding the state-of-the-art enzyme-driven hydrogelation technologies and future perspectives are also discussed. STATEMENT OF SIGNIFICANCE: Hydrogel is a semi-solid soft material containing a large amount of water. Due to the features of adjustable flexibility, extremely porous architecture, and the high similarity of structure to natural extracellular matrices, the hydrogel has broad application prospects in biomedicine. In recent 20 years, enzyme-manipulated hydrogelation based on self-assembly of small molecules has developed rapidly as an attractive methodology for the construction of functional biomaterials. Upon the catalysis of enzymes, small-molecular precursors are converted into assemblable building blocks, which arrange into high-ordered nanofibers via non-covalent interactions at the molecular level, and further trap water to form hydrogels at the macroscopic level. This review summarized the characteristics of enzymatic hydrogel, as well as the traditional application and emerging prospect of enzyme-instructed self-assembly and hydrogelation.

Biomaterials and advanced technologies for the evaluation and treatment of ovarian aging

Ovarian aging is characterized by a progressive decline in ovarian function. With the increase in life expectancy worldwide, ovarian aging has gradually become a key health problem among women. Over the years, various strategies have been developed to preserve fertility in women, while there are currently no clinical treatments to delay ovarian aging. Recently, advances in biomaterials and technologies, such as three-dimensional (3D) printing and microfluidics for the encapsulation of follicles and nanoparticles as delivery systems for drugs, have shown potential to be translational strategies for ovarian aging. This review introduces the research progress on the mechanisms underlying ovarian aging, and summarizes the current state of biomaterials in the evaluation and treatment of ovarian aging, including safety, potential applications, future directions and difficulties in translation.

Eggshell membrane-mimicking multifunctional nanofiber for in-situ skin wound healing

Eggshell membrane is a naturally-occurring protective barrier layer for chickens' incubation and shows the close similarity with extracellular matrix. To fully explore and utilize its' structure and active components via a mimicking way will be of great interest for wounds healing. Herein, the well-dispersed CuS nanoparticles were prepared by using eggshell membranes as templates with strong near-infrared absorption and photothermal properties. Furthermore, the as-prepared solution was combined with polyvinyl pyrrolidone and chitosan-derived fluorescent carbon dots for the mimetic synthesis of multifunctional nanofibrous membrane by a hand-held electrospinning device, which has the merits of in-situ operation, the extracellular matrix (ECM)-like architecture, hemostatic, radical scavenging, antibacterial, as well as accelerated healing of skin injury, etc. The electrospun-nanofiber membrane with optimal addition of 100 mg/L CuS nanoparticles was confirmed to be noncytotoxic on human fibroblasts and showed strong antibacterial activities against S. aureus and E. coli under NIR irradiation (980 nm). In addition, the radical scavenging ability was also proved by DPPH experiments. The animal experiments revealed that the nanofiber membrane could accelerate the wound healing process. The work lays down a simple and environmentally-friendly approach for the fabrication and development of promising wound healing materials in skin tissue engineering applications.

Bioactive Injectable Hydrogel Dressings for Bacteria-Infected Diabetic Wound Healing: A "Pull-Push" Approach

Chronic diabetic wound healing remains a challenge due to the existence of excessive danger molecules and bacteria in the inflammatory microenvironment. There is an urgent need for advanced wound dressings that target both inflammation and infection. Here, a bioactive hydrogel without loading any anti-inflammatory ingredients is rationally designed to achieve a "Pull-Push" approach for efficient and safe bacteria-infected diabetic wound healing by integrating danger molecule scavenging (Pull) with antibiotic delivery (Push) in the inflammatory microenvironment. The cationic hydrogel, termed the OCMC-Tob/PEI hydrogel, is fabricated by the conjugation of polyethylenimine (PEI) and tobramycin (Tob) on an oxidized carboxymethyl cellulose (OCMC) backbone via the Schiff base reaction with injectable, self-healing, and biocompatible properties. The OCMC-Tob/PEI hydrogel not only displays the remarkable capability of capturing multiple negatively charged danger molecules (e.g., cell-free DNA, lipopolysaccharides, and tumor necrosis factor-α) to ameliorate anti-inflammation effects but also achieves controllable long-term antibacterial activity by the pH-sensitive release of Tob. Consequently, this multifunctional hydrogel greatly expedites the wound closure rate with combined anti-inflammation and anti-infection effects on Pseudomonas aeruginosa-infected diabetic wounds. Our work provides a highly versatile treatment approach for chronic diabetic wounds and a promising dressing for regenerative medicine.

Physically Entangled Anti-Swelling Hydrogels with High Stiffness

Physically crosslinked hydrogels have great potential for tissue engineering because of their excellent biocompatibility and easy fabrication. However, physical crosslinking points are typically weaker compared to chemical ones and therefore cannot form robust hydrogels with excellent water stability, which greatly hinder their further applications. In this work, we report a novel hydrogel with high stiffness and outstanding anti-swelling performance crosslinked by hydrophobic polymer chains entanglements. The hydrophobic polymer polyimide (PI) was mixed with the hydrophilic polymer poly(vinyl pyrrolidone) (PVP) to form crosslinking points between the chains. At the equilibrium swelling state, tensile moduli of the hydrogel can be up to 22.57 MPa (higher than most existing hydrogels) and the equilibrium water swelling ratio (ESR) can be as low as 125.0%. By decreasing the PI mass ratio, tensile moduli and ESR of the hydrogel can be tuned in a wide range from 22.57 MPa to 0.005 MPa and 125.0% to 765.6%, respectively. Using PVP/PI solutions as inks, we fabricate uniform structures and multi-material structures whose mechanical properties are close to cartilage through a direct ink writing 3D printing platform. The current work demonstrates that entangled PVP/PI hydrogels have excellent tailoring capabilities and are promising candidates for tissue engineering applications. This article is protected by copyright. All rights reserved.

Restorative biodegradable two-layered hybrid microneedles for melanoma photothermal/chemo co-therapy and wound healing

Tumor killing and wound healing are two complementary and influential processes during the treatment of melanoma. Herein, a two-layered microneedle platform was developed with bifunctional effect of chemo-photothermal synergistic melanoma therapy and skin regeneration. The bifunctional platform composed of embeddable curcumin nanodrugs/new Indocyanine Green/hyaluronic acid (Cur NDs/IR820/HA) microneedles and sodium alginate/gelatin/hyaluronic acid (SA/Ge/HA) supporting backing layer was prepared through a two-step casting process. With uniform incorporation of curcumin nanodrugs and IR820, the microneedles exhibited excellent photothermal performance under external near-infrared (NIR) light stimulation and tumor co-therapy ability. Once the embeddable microneedles were inserted into skin, they would rapidly dissolve and activate drug release successfully for tumor treatment. Moreover, the SA/Ge/HA supporting backing layer was left behind to cover the wound and promote the proliferation of endothelial and fibroblasts cells for enhanced skin regeneration. The two-layered microneedles platform can simultaneously eliminate the tumor and accelerate wounding healing, which may be potentially employed as a competitive strategy for the treatment of melanoma.

A Vehicle-Free Antimicrobial Polymer Hybrid Gold Nanoparticle as Synergistically Therapeutic Platforms for Staphylococcus aureus Infected Wound Healing

Pathogenic bacteria infection is a serious threat to human public health due to the high morbidity and mortality rates. Nano delivery system for delivering antibiotics provides an alternative option to improve the efficiency compared to conventional therapeutic agents. In addition to the drug loading capacity of nanocarriers, which is typically around 10%, further lowers the drug dose that pathological bacteria are exposed to. Moreover, nanocarriers that are not eliminated from the body may cause side effects. These limitations have motivated the development of self-delivery systems that are formed by the self-assembly of different therapeutic agents. In this study, a vehicle-free antimicrobial polymer polyhexamethylene biguanide (PHMB, with bactericidal and anti-biofilm functions) hybrid gold nanoparticle (Au NPs, with photothermal therapy (PTT)) platform (PHMB@Au NPs) is developed. This platform exhibits an excellent synergistic effect to enhance the photothermal bactericidal effect for Staphylococcus aureus under near-infrared irradiation. Furthermore, the results showed that PHMB@Au NPs inhibit the formation of biofilms, quickly remove bacteria to promote wound healing through PTT in infection model in vivo, and even mediate the transition of macrophages from M1 to M2 type, and accelerate tissue angiogenesis. PHMB@Au NPs will have promising value as highly effective antimicrobial agents for patient management.

Antibacterial biomaterials for skin wound dressing

Bacterial infection and the ever-increasing bacterial resistance have imposed severe threat to human health. And bacterial contamination could significantly menace the wound healing process. Considering the sophisticated wound healing process, novel strategies for skin tissue engineering are focused on the integration of bioactive ingredients, antibacterial agents included, into biomaterials with different morphologies to improve cell behaviors and promote wound healing. However, a comprehensive review on anti-bacterial wound dressing to enhance wound healing has not been reported. In this review, various antibacterial biomaterials as wound dressings will be discussed. Different kinds of antibacterial agents, including antibiotics, nanoparticles (metal and metallic oxides, light-induced antibacterial agents), cationic organic agents, and others, and their recent advances are summarized. Biomaterial selection and fabrication of biomaterials with different structures and forms, including films, hydrogel, electrospun nanofibers, sponge, foam and three-dimension (3D) printed scaffold for skin regeneration, are elaborated discussed. Current challenges and the future perspectives are presented in this multidisciplinary field. We envision that this review will provide a general insight to the elegant design and further refinement of wound dressing.

Effects of the Chinese Herb Medicine Formula "She-Xiang-Yu-Hong" Ointment on Wound Healing Promotion in Diabetic Mice

Wound healing in diabetic patients is a difficult problem to be solved at present. In addition, patients with diabetes have an increased risk of postoperative wound complications. "She-Xiang-Yu-Hong" (SXYH) ointment is a type of traditional Chinese medicine (TCM) compound used to treat wounds. Over the past few years, SXYH has been applied in the Affiliated Hospital of Chengdu University of TCM (Chengdu, China) for the treatment of diabetic foot infections and bedsores, whereas there has been rare research on the effect of SXYH ointment on wound healing. In this study, SXYH ointment was first applied to streptozotocin (STZ)-triggered diabetic ICR mice (4-6 weeks, 20 ± 2 g) to observe the accelerated wound healing and the shortened wound healing period. As indicated by the histology and biochemistry analyses of skin biopsies, the wounds treated using SXYH ointment showed an increase in the granulation tissue. Moreover, SXYH also modulated the inflammation response by regulating affinity proinflammatory cytokines release (e.g., IL-6 and TNF-α). Furthermore, SXYH ointment obviously improved collagen fiber deposition and tissue on the wound surface. On the whole, this study indicated that SXYH ointment could accelerate wound healing, promote blood vessel formation, and suppress inflammations. Thus, the clinical potential of SXYH ointment was demonstrated in the treatment of diabetes and refractory wounds.

Characterization and diabetic wound healing benefits of protein-polysaccharide complexes isolated from an animal ethno-medicine Periplaneta americana L

Periplaneta americana L. (PA), a type of animal medicine, has been widely used for wound healing in clinical settings. In order to further investigate the bioactive wound healing substances in PA, crude PA protein-polysaccharide complexes were further purified by cellulose DE-52 and Sephadex G100 chromatography in succession. Among these isolated fractions, two fractions eluted by 0.3 M and 0.5 M NaCl with the higher yield, respectively named PaPPc2 and PaPPc3 respectively, were chosen for the wound healing experiments. Mediated by HPGPC, amino acid and monosaccharide composition analysis, circular dichroism spectrum, glycosylation type, FT-IR, and ¹H NMR analysis, the characterization of PaPPc2 and PaPPc3 was implemented. And then, the benefits of PaPPcs to promote cell proliferation, migration, and tube formation of HUVECs were determined in vitro, indicated these fractions would facilitate angiogenesis. Finally, as proof of concept, PaPPc2 and PaPPc3 were employed to accelerate the acute wounds of diabetic mice, involving in increase blood vessels and the amounts of angiogenesis-related cytokines (α-SMA, VEGF, and CD31). In short, this study provides an experimental basis to demonstrate the protein-polysaccharide complexes of Periplaneta americana L. as its wound healing bioactive substances.

Anti-Vascular Endothelial Growth Factor Drug Conbercept-Loaded Peptide Hydrogel Reduced Angiogenesis in the Neovascular Age-Related Macular Degeneration

Age-related macular degeneration (AMD) accounts for 8.7% of the global blindness and neovascular form of AMD (nAMD) occupies a large proportion of severe visual loss and legal blindness caused by AMD with a relatively low incidence rate. Choroidal neovascularization (CNV) is overwhelmingly responsible for the occurrence of nAMD as bleeding and fluid leakage followed by abnormal formation of blood vessels could directly lead to loss of central vision so that reduce the choroidal angiogenesis is an ideal treatment method of nAMD. VEGF is an important cytokine which promote the signaling pathway of angiogenesis and the abnormal expression of VEGF is verified in great many CNV cases. Several anti-VEGF drugs have been widely used in clinical treatments such as ranibizumab, bevacizumab and aflibercept. Conbercept, as an originally developed drug in China, has attracted great attention. For the purpose of better treatment efficacy, our group designed a short chain peptide (Sequence: DDIIIRH-NH₂, M.W.880.99) for controlled drug release to remedy the drawback of the short half-time period. The peptide could self-assembled into a stable 'hydrogel under pH 7.4 condition and the 3D structure was clearly observed in TEM study. Rheological study exhibited its great injectability so that the hydrogel was a material for intravitreal injection. Statistics exhibited that the hydrogel could release approximately 50% of total conbercept. The In vitro experiments showed that either dose-dependent or the time-dependent incubation with peptide would not decrease the cell viability of HREC, revealing that the peptide was biocompatible. The most important is that co-incubation with HREC obviously reduced the HREC proliferation and tube formation induced by VEGF, ensuring its potential for the treatment efficacy of nAMD.