Porous chitosan microspheres containing zinc ion for enhanced thrombosis and hemostasis

Hemostatic and antimicrobial properties of chitosan-based wound healing dressings: A review

Uncontrolled bleeding and microbial infections pose significant hurdles in wound healing, and the use of specialized functional dressings is pivotal in overcoming these obstacles. Among the various wound dressings currently under investigation, those based on chitosan and its derivatives have garnered significant attention due to their superior biocompatibility, antimicrobial properties, hemostatic capabilities, and healing promoting ability. In this comprehensive review, we initially delve into the hemostatic capabilities of chitosan, elucidating its interactions with blood cells and plasma proteins. We also dissect the intricate antimicrobial mechanisms of chitosan, which operate through both intracellular and extracellular pathways. The centerpiece of this review is the systematic classification of dressings based on chitosan and its derivatives, across various forms, such as hydrogels, sponges, membranes, fibers, and powders. This is followed by an exhaustive analysis of their hemostatic and antibacterial efficacy in wound healing, providing a robust foundation for further research and the advancement of clinical applications in the field.

Morphology and topography of chitosan-Zn complex/PEO fiber mats influence cell viability and attachment

Electrospun fiber mats with therapeutic potential show great promise as wound healing biomaterials. This study aims to compare the biophysical properties and biocompatibility of four different biodegradable fiber mats; namely chitosan and chitosan‑zinc complex (ChiZn)/(polyethylene oxide) PEO fibers, each with either nanometer-sized (~200 nm) or micron-sized (~1000 nm) diameters. Zn was incorporated to impact antibacterial properties of the fibers, ChiZn was synthesized using the in-situ precipitation method, and the influence of zinc chelation on the material structure and morphology was assessed using XRD, FTIR, XPS, and EDX, documenting the complexation and homogeneous distribution of zinc. ChiZn was then blended with PEO for electrospinning in a benign solvent system and crosslinked with glutaraldehyde vapor. SEM was used to examine fiber morphology while AFM documented a correlation between the roughness and fiber diameter. The effects of topography and composition on the viability, adhesion, and proliferation of stromal cells and mouse fibroblasts were investigated, showing higher cell viability on mats composed of nanosized fibers, whereas complex fiber mats composed of micron-sized fibers exhibited reduced cell viability. SEM evaluations showed that cells spread only on the surface of the nanosized fibers, independently of the presence of Zn, while cell infiltration into the mats was observed for micron-sized fibers.

Recent progress in polysaccharide microsphere-based hemostatic material for intravascular and extravascular hemostasis: A review

Hemorrhage, a common consequence of diseases, surgical procedures, and traffic accidents, poses a significant threat to public health. Effective hemostasis is crucial for patient survival and prognosis, particular in case of internal bleeding. While polysaccharide microsphere-based hemostatic materials have gained clinical acceptance due to their effectiveness, good biocompatibility, and versatility in both intravascular and extravascular hemostasis, they are limited by their single function and insufficient hemostatic properties. Recently, booming developments have been witnessed in microsphere-based biomaterials to achieve a combination therapy for hemostasis. This review first examines the fundamentals of coagulation process, hemostatic mechanisms, and microsphere fabrication techniques. We then discuss the latest investigations in functionalized microsphere-based hemostatic materials for controlling intravascular and extravascular hemorrhage, focusing on design strategies, hemostatic properties, and clinical implementation. Finally, we also propose some limitations and challenges of these hemostatic materials, aiming to provide valuable insights for future research in novel polysaccharide microsphere-based biomaterial.

Bioadhesives and bioactive hydrogels for wound management

Delayed wound healing remains a major challenge in biomedical research, often leading to complications such as scarring, acute trauma, and chronic diseases. Effective wound management is crucial for enhancing treatment outcomes, preventing complications, and promoting tissue regeneration. In response to this need, a variety of polymeric biomaterials have been developed. A growing focus in the field involves the design of bioadhesives and bioactive materials, which offer promising solutions for wound management. Recent advances in materials engineering have led to the development of polymer biomaterials with excellent biocompatibility, strong adhesion to biological surfaces, and bioactive properties that support rapid wound closure and tissue repair. This review discusses the latest progress in the development and application of bioadhesives and bioactive hydrogels for wound management and tissue regeneration, highlighting potential directions for future biomaterial research.

A five-in-one novel MOF-modified injectable hydrogel with thermo-sensitive and adhesive properties for promoting alveolar bone repair in periodontitis: Antibacterial, hemostasis, immune reprogramming, pro-osteo-/angiogenesis and recruitment

Periodontitis is a chronic inflammatory disease caused by plaque that destroys the alveolar bone tissues, resulting in tooth loss. Poor eradication of pathogenic microorganisms, persistent malignant inflammation and impaired osteo-/angiogenesis are currently the primary challenges to control disease progression and rebuild damaged alveolar bone. However, existing treatments for periodontitis fail to comprehensively address these issues. Herein, an injectable composite hydrogel (SFD/CS/ZIF-8@QCT) encapsulating quercetin-modified zeolitic imidazolate framework-8 (ZIF-8@QCT) is developed. This hydrogel possesses thermo-sensitive and adhesive properties, which can provide excellent flowability and post-injection stability, resist oral fluid washout as well as achieve effective tissue adhesion. Inspirationally, it is observed that SFD/CS/ZIF-8@QCT exhibits a rapid localized hemostatic effect following implantation, and then by virtue of the sustained release of zinc ions and quercetin exerts excellent collective functions including antibacterial, immunomodulation, pro-osteo-/angiogenesis and pro-recruitment, ultimately facilitating excellent alveolar bone regeneration. Notably, our study also demonstrates that the inhibition of osteo-/angiogenesis of PDLSCs under the periodontitis is due to the strong inhibition of energy metabolism as well as the powerful activation of oxidative stress and autophagy, whereas the synergistic effects of quercetin and zinc ions released by SFD/CS/ZIF-8@QCT are effective in reversing these biological processes. Overall, our study presents innovative insights into the advancement of biomaterials to regenerate alveolar bone in periodontitis.

Chitosan/β-glycerophosphate porous microsphere prepared by facile water-in-water emulsion as a topical hemostatic material

Acute hemorrhage is a major cause of death in many emergency cases. Although many hemostatic materials have been studied in recent years, it is still necessary to develop new hemostatic materials with remarkable efficiency, biosafety, convenient preparation, low cost, and good biodegradability. In this work, novel chitosan (CS)/β-glycerophosphate (β-GP) composite porous microsphere with a uniform size of 210.00 ± 2.14 μm was fabricated through water-in-water (W/W) emulsion via microencapsulation, which can avoid the use of toxic crosslink chemicals and organic solvents to achieve facile and efficient preparation of microspheres. β-GP could promote the formation of microspheres by enhancing the hydrogen-bonding interaction between CS chains, which contributed to the macro-porous structure. Owing to their large pore size (6.0 μm) and high specific surface area (37.8 m2/g), the CS/β-GP microspheres could absorb water quickly and adsorb protein, red blood cells, and platelets through electrostatic forces to promote blood coagulation. Furthermore, the CS/β-GP microspheres achieved a significantly shortened hemostatic time (45 s) and reduced blood loss (0.03 g) in a rat liver injury model. Rat tail amputation test also showed a satisfactory hemostatic effect. Overall, the green and porous CS/β-GP microspheres can be used as a facile and topical rapid hemostatic material.

Quaternized oxidized sodium alginate injectable hydrogel with high antimicrobial and hemostatic efficacy promotes diabetic wound healing

In this paper, a hydrogel material with efficient antibacterial, hemostatic, self-healing, and injectable properties was designed for the treatment of diabetic wounds. Firstly, quaternary ammonium salts were grafted with oxidized sodium alginate, and quaternized oxidized sodium alginate (QOSA) was synthesized. Due to the introduction of quaternary ammonium group it has antibacterial and hemostatic effects, at the same time, due to the presence of aldehyde group it can be reacted with carboxymethyl chitosan (CMCS) to form a hydrogel through the Schiff base reaction. Furthermore, deer antler blood polypeptide (DABP) was loaded into the hydrogel (QOSA&CMCS&DABP), showing good swelling ratio and bacteriostatic effect. In vitro and in vivo experiments demonstrated that the hydrogel not only quickly inhibited hepatic hemorrhage in mice and reduced coagulation index and clotting time in vitro, but also significantly enhanced collagen deposition at the wound site, accelerating wound healing. This demonstrates that the multifunctional hydrogel materials (QOSA&CMCS&DABP) have promising applications in the acceleration of skin wound healing and antibacterial promotion.

Recent research advances in polysaccharide-based hemostatic materials: A review

Massive bleeding resulting from civil and martial accidents can often lead to shock or even death, highlighting the critical need for the development of rapid and efficient hemostatic materials. While various types of hemostatic materials are currently utilized in clinical practice, they often come with limitations such as poor biocompatibility, toxicity, and biodegradability. Polysaccharides, such as alginate (AG), chitosan (CS), cellulose, starch, hyaluronic acid (HA), and dextran, have exhibit excellent biocompatibility and in vivo biodegradability. Their degradation products are non-toxic to surrounding tissues and can be absorbed by the body. As a result, polysaccharides have been extensively utilized in the development of hemostatic materials and have gained significant attention in the field of in vivo hemostasis. This review offers an overview of the different forms, hemostatic mechanisms, and specific applications of polysaccharides. Additionally, it discusses the future opportunities and challenges associated with polysaccharide-based hemostats.

Antibacterial polyurethane foams with quaternized-chitosan as a chain extender for nasal packing and hemostasis

Endoscopic surgery is an effective and common clinical practice for chronic sinusitis. Nasal packing materials are applied in nasal surgery to prevent hemorrhage and promote wound healing. In this study, a degradable polyurethane foam dressing is successfully developed as a promising nasal packing material with good biocompatibility and antibacterial capability. Specifically, quaternized chitosan (QCS) serves as the crosslinker instead of polyols to offer polyurethane foam (PUF-QCS) antibacterial capability. The PUF-QCS2.0 % (with 2.0 wt% QCS) exhibits satisfactory liquid absorption capacity (19.4 g/g), high compressive strengths at both wet (14.5 kPa) and dry states (7.7 kPa), and a good degradation rate (8.3 %) within 7 days. Meanwhile, PUF-QCS2.0 % retains long-term antibacterial activity for 7 days and kills 97.3 % of S. aureus and 91.8 % of E. coli within 6 hours in antibacterial testing. Furthermore, PUF-QCS2.0 % demonstrates a positive hemostatic response in the rabbit nasal septum mucosa trauma model by reducing hemostatic time over 50.0 % and decreasing blood loss up to 76.1 % compared to the commercial PVA nasal packing sponge. Importantly, PUF-QCS also exhibits a significant antibacterial activity in nasal cavity. This nasal packing material has advantages in post-surgery bleeding control and infection prevention. STATEMENT OF SIGNIFICANCE: The performance of a nasal packing sponge requires good mechanical properties, fast and high liquid absorption rate, effective degradability and strong antibacterial activity. These features are helpful for improving the postoperative recovery and patient healing. However, integrating these into a single polyurethane foam is a challenge. In this study, quaternized chitosan (QCS) is synthesized and used as a chain extender and antibacterial agent in preparing a degradable polyurethane foam (PUF-QCS) dressing. PUF-QCS undergoes partial degradation and exhibits effective broad-spectrum antibacterial activity in 7 days. The reduction of postoperative bleeding and infection observed in the animal experiment further demonstrates that the PUF-QCS developed here outperforms the existing commercial nasal packing materials.

Clays and Wound Healing

Aluminosilicates, such as montmorillonite, kaolinite, halloysite, and diatomite, have a uniform bidimensional structure, a high surface-to-volume ratio, inherent stiffness, a dual charge distribution, chemical inertness, biocompatibility, abundant active groups on the surface, such as silanol (Si-OH) and/or aluminol (Al-OH) groups. These compounds are on the list of U.S. Food and Drug Administration-approved active compounds and excipients and are used for various medicinal products, such as wound healing agents, antidiarrheals, and cosmetics. This review summarizes the wound healing mechanisms related to the material characteristics and the chemical components. Numerous wound dressings with different active components and multiple forms have been studied. Then, medicinal mineral resources for use in hemostatic materials can be developed.

Alginate based biomaterials for hemostatic applications: Innovations and developments

Development of the efficient hemostatic materials is an essential requirement for the management of hemorrhage caused by the emergency situations to avert most of the casualties. Such injuries require the use of external hemostats to facilitate the immediate blood clotting. A variety of commercially available hemostats are present in the market but most of them are associated with limitations such as exothermic reactions, low biocompatibility, and painful removal. Thus, fabrication of an ideal hemostatic composition for rapid blood clot formation, biocompatibility, and antimicrobial nature presents a real challenge to the bioengineers. Benefiting from their tunable fabrication properties, alginate-based hemostats are gaining importance due to their excellent biocompatibility, with >85 % cell viability, high absorption capacity exceeding 500 %, and cost-effectiveness. Furthermore, studies have estimated that wounds treated with sodium alginate exhibited a blood loss of 0.40 ± 0.05 mL, compared to the control group with 1.15 ± 0.13 mL, indicating its inherent hemostatic activity. This serves as a solid foundation for designing future hemostatic materials. Nevertheless, various combinations have been explored to further enhance the hemostatic potential of sodium alginate. In this review, we have discussed the possible role of alginate based composite hemostats incorporated with different hemostatic agents, such as inorganic materials, polymers, biological agents, herbal agents, and synthetic drugs. This article outlines the challenges which need to be addressed before the clinical trials and give an overview of the future research directions.

Recent research advances on polysaccharide-, peptide-, and protein-based hemostatic materials: A review

Hemorrhage is a potentially life-threatening emergency that can occur at any time or place. Whether traumatic, congenital, surgical, disease-related, or drug-induced, bleeding can lead to severe complications or death. Therefore, the development of efficient hemostatic materials is critical. However, the results and prognosis demonstrated by clinical means of hemostasis do not reach expectations. With the development of technology, novel hemostatic materials have been developed from polysaccharides (chitosan, hyaluronic acid, alginate, cellulose, cyclodextrins, starch, dextran, and carrageenan), peptides (self-assembling peptides), and proteins (silk fibroin, collagen, gelatin, keratin, and thrombin). These new materials exhibit high hemostatic efficacy due to the enhancement or interaction of various hemostatic mechanisms. The main forms include adhesives, sealants, bandages, hemostatic powders, and hemostatic sponges. This article introduces the clotting process and principles of hemostatic methods and reviews the research on polysaccharide-, peptide-, and protein-based hemostatic materials in the last five years. The design ideas and hemostatic principles of polysaccharide-, peptide-, and protein-based hemostatic materials are mainly introduced. Finally, we summarize material designs, advantages, disadvantages, and challenges regarding hemostatic materials.

Preparation and application of hemostatic microspheres containing biological macromolecules and others

Bleeding from uncontrollable wounds can be fatal, and the body's clotting mechanisms are unable to control bleeding in a timely and effective manner in emergencies such as battlefields and traffic accidents. For irregular and inaccessible wounds, hemostatic materials are needed to intervene to stop bleeding. Hemostatic microspheres are promising for hemostasis, as their unique structural features can promote coagulation. There is a wide choice of materials for the preparation of microspheres, and the modification of natural macromolecular materials such as chitosan to enhance the hemostatic properties and make up for the deficiencies of synthetic macromolecular materials makes the hemostatic microspheres multifunctional and expands the application fields of hemostatic microspheres. Here, we focus on the hemostatic mechanism of different materials and the preparation methods of microspheres, and introduce the modification methods, related properties and applications (in cancer therapy) for the structural characteristics of hemostatic microspheres. Finally, we discuss the future trends of hemostatic microspheres and research opportunities for developing the next generation of hemostatic microsphere materials.

Wool keratin/zeolitic imidazolate framework-8 composite shape memory sponge with synergistic hemostatic performance for rapid hemorrhage control

Uncontrollable hemorrhage and subsequent wound infection pose severe threats to life, especially in the case of deep, non-compressible, massive bleeding. Here, a wool keratin/zeolitic imidazolate framework-8 (WK/ZIF-8) composite shape memory sponge is prepared by incorporating ZIF-8 nanoparticles into wool keratin. The combination of keratin and ZIF-8 particles not only reduces the effect of ZIF-8 particles on cell viability but also bolsters the mechanical properties of the keratin sponge and endows it with antibacterial efficacy. Due to the synergistic effect of the excellent hemostatic performance of keratin and Zn2+ release from ZIF-8 nanoparticles, the porous structure suitable for blood cell adhesion and the shape recovery ability of sponges, the WK/ZIF-8 composite sponge exhibits superior hemostatic performance to commercial medical sponges in SD rat and rabbit hemorrhage models. In addition, in vitro and in vivo antibacterial experiments demonstrate the anti-infection activity of the composite sponge. Overall, the WK/ZIF-8 composite sponge provides a promising approach to rapidly control bleeding and promote wound healing.

Benzeneboronic-alginate/quaternized chitosan-catechol powder with rapid self-gelation, wet adhesion, biodegradation and antibacterial activity for non-compressible hemorrhage control

Although hemostatic powders have excellent adaptability for irregular and inaccessible wounds, their hemostasis for continuous bleeding or bleeding wounds of non-compressible organs remains a critical challenge. Herein, a series of benzeneboronic acid-modified sodium alginate/catechol-modified quaternized chitosan (SA-BA/QCS-C, SBQCC) powders is developed by borate ester crosslinking for non-compressible hemorrhage control. SBQCC powders possess remarkable tissue adhesion, rapid self-gelation, good cytocompatibility and antibacterial activity against S. aureus and E. coil. The blood coagulation assays show that SBQCC powders display excellent blood clotting ability due to the synergistic effect of SA-BA and QCS-C. The SBQCC2 powder with the SA-BA to QCS-C mass ratio of 5 to 3 has the greatest effect on the blood-clotting rate. Upon depositing SBQCC2 powder to bleeding wounds of rabbit liver, the powder can absorb a large amount of blood and form a stable hydrogel physical barrier at the bleeding wounds in situ to achieve non-pressing rapid hemostasis. The SBQCC2 powder also has good biocompatibility and can be degraded in vivo. Altogether, the SBQCC powders can be a promising candidate for rapid hemostasis, and these findings may provide a new perspective for improving the hemostatic efficiency of the hemostatic powder in biomedical fields.

Self-assembled carboxymethyl chitosan/zinc alginate composite film with excellent water resistant and antimicrobial properties for chilled meat preservation

A major way to reduce meat waste is to extend the shelf life of chilled meat with appropriate packaging. However, most of the packaging film cannot keep meat fresh because of its poor antibacterial and water resistance performance. In this paper, a composite film for chilled meat packaging was synthesized by simple self-assembly of zinc ions with chelating carboxyl groups. Introducing zinc ions into the composite system endows excellent water resistance and antibacterial properties to the film, which are demonstrated by the water vapor permeability and Escherichia coli and Staphylococcus aureus antibacterial tests. The as-prepared composite film also showed enhanced mechanical properties due to the formation of chelation bonds between zinc ions and carboxyl groups. Moreover, the chilled meat preservation test demonstrated the as-prepared composite film can significantly extend the shelf life of pork by five days, indicating its outstanding freshness preservation property. This work demonstrated a facile method to synthesize water-resistant and antimicrobial composite film, which can appear as an effective packaging material for chilled meat and offer a new idea to solve its short shelf-life problem.

Chitosan-Based Biomaterials for Hemostatic Applications: A Review of Recent Advances

Hemorrhage is a detrimental event present in traumatic injury, surgery, and disorders of bleeding that can become life-threatening if not properly managed. Moreover, uncontrolled bleeding can complicate surgical interventions, altering the outcome of surgical procedures. Therefore, to reduce the risk of complications and decrease the risk of morbidity and mortality associated with hemorrhage, it is necessary to use an effective hemostatic agent that ensures the immediate control of bleeding. In recent years, there have been increasingly rapid advances in developing a novel generation of biomaterials with hemostatic properties. Nowadays, a wide array of topical hemostatic agents is available, including chitosan-based biomaterials that have shown outstanding properties such as antibacterial, antifungal, hemostatic, and analgesic activity in addition to their biocompatibility, biodegradability, and wound-healing effects. This review provides an analysis of chitosan-based hemostatic biomaterials and discusses the progress made in their performance, mechanism of action, efficacy, cost, and safety in recent years.

Nano zinc oxide-functionalized nanofibrous microspheres: A bioactive hybrid platform with antimicrobial, regenerative and hemostatic activities

Bioactive hybrid constructs are at the cutting edge of innovative biomaterials. PLA nanofibrous microspheres (NF-MS) were functionalized with zinc oxide nanoparticles (nZnO) and DDAB-modified nZnO (D-nZnO) for developing inorganic/nano-microparticulate hybrid constructs (nZnO@NF-MS and D-nZnO@NF-MS) merging antibacterial, regenerative, and haemostatic functionalities. The hybrids appeared as three-dimensional NF-MS frameworks made-up entirely of interconnecting nanofibers embedding nZnO or D-nZnO. Both systems achieved faster release of Zn²⁺ than their respective nanoparticles and D-nZnO@NF-MS exhibited significantly greater surface wettability than nZnO@NF-MS. Regarding bioactivity, D-nZnO@NF-MS displayed a significantly greater and fast-killing effect against Staphylococcus aureus. Both nZnO@NF-MS and D-nZnO@NF-MS showed controllable concentration-dependent cytotoxicity to human gingival fibroblasts (HGF) compared with pristine NF-MS. They were also more effective than pristine NF-MS in promoting migration of human gingival fibroblasts (HGF) in the in vitro wound healing assay. Although D-nZnO@NF-MS showed greater in vitro hemostatic activity than nZnO@NF-MS, (blood-clotting index 22.82 ± 0.65% vs.54.67 ±2.32%) both structures exhibited instant hemostasis (0 s) with no blood loss (0 mg) in the rat-tail cutting technique. By merging the multiple therapeutic bioactivities of D-nZnO and the 3D-structural properties of NF-MS, the innovative D-nZnO@NF-MS hybrid construct provides a versatile bioactive material platform for different biomedical applications.

Armoring a liposome-integrated tissue factor with sacrificial CaCO3 to form potent self-propelled hemostats

The development of hemostatic materials suitable for diverse emergency scenarios is of paramount significance, and there is growing interest in wound-site delivery of hemostasis-enhancing agents that can leverage the body's inherent mechanisms. Herein we report the design and performance of a biomimetic nanoparticle system enclosing tissue factor (TF), the most potent known blood coagulation trigger, which was reconstituted into liposomes and shielded by the liposome-templated CaCO₃ mineralization. The mineral coatings, which mainly comprised water-soluble amorphous and vateritic phases, synergized with the lipidated TF to improve blood coagulation in vitro. These coatings served as sacrificial masks capable of releasing Ca²⁺ coagulation factors or propelling the TF-liposomes via acid-aided generation of CO₂ bubbles while endowing them with high thermostability under dry conditions. In comparison to commercially available hemostatic particles, CaCO₃ mineralized TF-liposomes yielded significantly shorter hemostasis times and less blood loss in vivo. When mixed with organic acids, the CO₂-generating formulation further improved hemostasis by delivering TF-liposomes deep into actively bleeding wounds with good biocompatibility, as observed in a rat hepatic injury model. Therefore, the designed composite mimicry of coagulatory components exhibited strong hemostatic efficacy, which in combination with the propulsion mechanism would serve as a versatile approach to treating a variety of severe hemorrhages.

Chitosan-based hemostatic sponges as new generation hemostatic materials for uncontrolled bleeding emergency: Modification, composition, and applications

The choice of hemostatic technique is a curial concern for surgery and as first-aid treatment in combat. To treat uncontrolled bleeding in complex wound environments, chitosan-based hemostatic sponges have attracted significant attention in recent years because of the excellent biocompatibility, degradability, hemostasis and antibacterial properties of chitosan and their unique sponge-like morphology for high fluid absorption rate and priority aggregation of blood cells/platelets to achieve rapid hemostasis. In this review, we provide a historical perspective on the use of chitosan hemostatic sponges as the new generation of hemostatic materials for uncontrolled bleeding emergencies in complex wounds. We summarize the modification of chitosan, review the current status of preparation protocols of chitosan sponges based on various composite systems, and highlight the recent achievements on the detailed breakdown of the existing chitosan sponges to present the relationship between their composition, physical properties, and hemostatic capacity. Finally, the future opportunities and challenges of chitosan hemostatic sponges are also proposed.

Root-shaped antibacterial alginate sponges with enhanced hemostasis and osteogenesis for the prevention of dry socket

Tooth extraction commonly causes uncontrolled bleeding, loss of blood clots, and bacterial infection, leading to the dry socket and bone resorption. Thus, it is highly attractive to design a bio-multifunctional scaffold with outstanding antimicrobial, hemostatic, and osteogenic performances for avoiding dry sockets in clinical applications. Herein, alginate (AG)/quaternized chitosan (Qch)/diatomite (Di) sponges were fabricated via electrostatic interaction, Ca²⁺ cross-linking, as well as lyophilization methods. The composite sponges are facilely made into the shape of the tooth root, which could be well integrated into the alveolar fossa. The sponge shows a highly interconnected and hierarchical porous structure at the macro/micro/nano levels. The prepared sponges also possess enhanced hemostatic and antibacterial abilities. Moreover, in vitro cellular assessment indicates that the developed sponges have favorable cytocompatibility and significantly facilitate osteogenesis by upregulating the formation of alkaline phosphatase and calcium nodules. The designed bio-multifunctional sponges display great potential for trauma treatment after tooth extraction.

All-Aqueous Microfluidics Fabrication of Multifunctional Bioactive Microcapsules Promotes Wound Healing

Wound healing involves multiple stages of body responses, including hemostasis, inflammation, cell proliferation, and tissue remodeling. New material design satisfying all demands throughout different stages of wound healing is cherished but rarely discussed. Here we introduce all-aqueous multiphase microfluidics as a novel strategy to fabricate self-assembled, multifunctional alkylated chitosan/alginate microcapsules (SAAMs) as novel therapeutic materials for rapid blood coagulation and wound healing. SAAMs are structurally distinguished by their ultrathin shells with polycationic surface for rapid activation of clotting cascade and their internal porous dextran-rich cores for fast absorption of blood and exudate. These features endow SAAMs with excellent hemostatic properties for acute hemorrhage. Moreover, the alkylated chitosan within the microcapsules exhibits persistent antimicrobial activities against bactericidal infections due to their amphiphilic and cationic surfaces. Besides, cytokines can be safely loaded into the organic-solvent-free microcapsules and released precisely to promote the proliferation of epidermal cells, supporting the subsequent development of granulation tissue and suppression of inflammation in the last stages of wound healing. With the ability to fabricate size-tailored soft microcapsules and to realize time-sequential functions for tissue repairing, the presented "all-aqueous microfluidics generation of multifunctional bioactive SAAMs" create a versatile and robust paradigm for wound treatment.

Iota-carrageenan/xyloglucan/serine powders loaded with tranexamic acid for simultaneously hemostatic, antibacterial, and antioxidant performance

This study sought to prepare powder hemostats based on iota-carrageenan (ιC), xyloglucan (XYL), l-serine (SER), and tranexamic acid (TA). The powder form was chosen because it enables the hemostat to be used in wounds of any shape and depth. The powder hemostats showed irregular shapes and specific surface areas ranging from 34 to 46 m²/g. Increasing TA amount decreases the specific surface area, bulk density, water and blood absorption, and the antibacterial activities of the powder hemostats, but not the water retention ability. Conversely, in vitro biodegradation was positively impacted by increasing the TA content in the powder hemostats. In both the in vitro and in vivo tests, powder hemostats showed reduced bleeding time, significant adhesion of red blood cells, great hemocompatibility, moderate antioxidant activity, and high biocompatibility. These findings shed new light on designing powder hemostats with intrinsic antibacterial and antioxidant activity and excellent hemostatic performance.

Polylysine-decorated macroporous microcarriers laden with adipose-derived stem cells promote nerve regeneration in vivo

Cell transplantation is an effective strategy to improve the repair effect of nerve guide conduits (NGCs). However, problems such as low loading efficiency and cell anoikis undermine the outcomes. Microcarriers are efficient 3D cell culture scaffolds, which can also prevent cell anoikis by providing substrate for adhesion during transplantation. Here, we demonstrate for the first time microcarrier-based cell transplantation in peripheral nerve repair. We first prepared macroporous chitosan microcarriers (CSMCs) by the emulsion-phase separation method, and then decorated the CSMCs with polylysine (pl-CSMCs) to improve cell affinity. We then loaded the pl-CSMCs with adipose-derived stem cells (ADSCs) and injected them into electrospun polycaprolactone/chitosan NGCs to repair rat sciatic nerve defects. The ADSCs-laden pl-CSMCs effectively improved nerve regeneration as demonstrated by evaluation of histology, motor function recovery, electrophysiology, and gastrocnemius recovery. With efficient cell transplantation, convenient operation, and the multiple merits of ADSCs, the ADSCs-laden pl-CSMCs hold good potential in peripheral nerve repair.

Porous gelatin microspheres for controlled drug delivery with high hemostatic efficacy

Effective hemostasis and antibacterial efficacy for extensive trauma in a warzone and civilian accidents are important for reducing mortalities and serious complications. Gelatin has been widely used as a hemostatic agent and has the potential for use in drug delivery systems. To enhance its hemostatic efficiency and create conducive conditions for sustained drug release, we developed Vancomycin-impregnated porous gelatin microspheres (Van-MS) by introducing the porous structure into gelatin. Results showed that Van-MS can be successfully developed via the ice crystal pore-making method combined with hydration maintaining its stability. We also explored the use of biodegradable porous materials for treatment of infections and bleeding in soft tissue, and analyzed Van-MS via scanning electron microscopy (SEM), scanning electron microscopy and energy dispersive X-ray spectrometry (SEM-EDS), Fourier Transform infrared spectroscopy (FTIR) and High-Performance Liquid Chromatography (HPLC). Results from Van-MS showed high hemostatic both efficacies in vivo and in vitro. Moreover, muscle lesions treated by Van-MS showed formation of fibrous connective tissue and were nearly sealed after 10 days in a rabbit traumatic infection model. This antibacterial performance was attributed to absorption of exudates and sustained drug release. Hemostatic effects were due to: (1) particles water swelling form a physical barrier that led to physical hemostasis; (2) activation of the endogenous coagulation pathway which resulted in physiological hemostasis; (3) aggregation of platelets and erythrocytes after absorbing water; and (4) stronger hemostatic properties owing to their porous structure with high specific surface area.

Determination of indicators allowing to evaluating the hemostatic activity of chitosan without a biological experiment

The biopolymer chitosan is widely used for the development of local hemostatic agents. However, the physicochemical parameters of chitosan that determine its hemostatic properties have not yet been determined. Standard quality control of chitosan-containing raw materials and medical products on its basis do not allow us to make a conclusion about the effectiveness of their use for stopping bleeding. The most reliable method for assessing hemostatic activity remains in vivo experiment on large animals. The aim of this study was to determine additional physicochemical parameters of chitosan, which would make it possible to predict its hemostatic activity without conducting a biological experiment. In this work, using the methods of nuclear magnetic resonance spectroscopy, spectrophotometry and viscometry, it has been shown that the ability to initiate hemostasis is depending of the molecular weight and degree of deacetylation of chitosan, but not enough linearly. The hemostatic properties in vitro increases in a series of samples with a relatively constant molecular weight with an increase in the degree of deacetylation. As well as in a series with the same degree of deacetylation with an increase in molecular weight. However, at molecular weight values more than 300 kDa, the viscosity of the polymer causes the opposite effect: with an increase in the degree of deacetylation, the hemostatic activity decreases. The best ability to initiate hemostasis have chitosan samples with a degree of deacetylation of 90.0%–97.4% and molecular weight 145.7–284.7 kDa, in which at pH of solution close to physiological, a significant part of the molecules transitioned from conformation state rigid rod to state globule. It was accompanied by an abrupt change in light transmission of the solution. It was concluded, that it is possible to study conformational states by spectrophotometry to assess the hemostatic activity of chitosan samples without performing biological experiment.

Application and outlook of topical hemostatic materials: a narrative review

Bleeding complications can cause significant morbidities and mortalities in both civilian and military conditions. The formation of stable blood clots or hemostasis is essential to prevent major blood loss and death from excessive bleeding. However, the body's self-coagulation process cannot accomplish timely hemostasis without the assistance of hemostatic agents under some conditions. In the past two decades, topical hemostatic materials and devices containing platelets, fibrin, and polysaccharides have been gradually developed and introduced to induce faster or more stable blood clot formation, updating or iterating traditional hemostatic materials. Despite the various forms and functions of topical hemostatic materials that have been developed for different clinical conditions, uncontrolled hemorrhage still causes over 30% of trauma deaths across the world. Therefore, it is important to fabricate fast, efficient, safe, and ready-to-use novel hemostatic materials. It is necessary to understand the coagulation process and the hemostatic mechanism of different materials to develop novel topical hemostatic agents, such as tissue adhesives and sealants from various natural and synthetic materials. This review discusses the structural features of topical hemostatic materials related to the stimulation of hemostasis, summarizes the commercially available products and their applications, and reviews the ongoing clinical trials and recent studies concerning the development of different hemostatic materials.

Chitosan-Based Thermo-Sensitive Hydrogel Loading Oyster Peptides for Hemostasis Application

Uncontrolled massive hemorrhage is one of the principal causes of death in trauma emergencies. By using catechol-modified chitosan (CS-C) as the matrix material and β glycerol phosphate (β-GP) as a thermo-sensitive agent, chitosan-based thermo-sensitive hydrogel loading oyster peptides (CS-C/OP/β-GP) were prepared at physiological temperature. The hemostatic performance of CS-C/OP/β-GP hydrogel was tested in vivo and in vitro, and its biological safety was evaluated. The results showed that the in vitro coagulation time and blood coagulation index of CS-C/OP/β-GP hydrogel were better than those of a commercial gelatin sponge. Notably, compared with the gelatin sponge, CS-C/OP/β-GP hydrogel showed that the platelet adhesion and erythrocyte adsorption rates were 38.98% and 95.87% higher, respectively. Additionally, the hemostasis time in mouse liver injury was shortened by 19.5%, and the mass of blood loss in the mouse tail amputation model was reduced by 18.9%. The safety evaluation results demonstrated that CS-C/OP/β-GP had no cytotoxicity to L929 cells, and the hemolysis rates were less than 5% within 1 mg/mL, suggesting good biocompatibility. In conclusion, our results indicate that CS-C/OP/β-GP is expected to be a promising dressing in the field of medical hemostasis.

Chitosan/Diatom-Biosilica Aerogel with Controlled Porous Structure for Rapid Hemostasis

Uncontrolled hemorrhage is the main reason of possible preventable death after accidental injury. It is necessary to develop a hemostatic agent with rapid hemostatic performance and good biocompatibility. In this study, a chitosan/diatom-biosilica-based aerogel is developed using dopamine as cross-linker by simple alkaline precipitation and tert-butyl alcohol replacement. The chitosan/diatom-biosilica aerogel exhibits favorable biocompatibility and multiscale hierarchical porous structure (from nanometer to micrometer), which can be controlled by the concentration of tert-butyl alcohol. The displacement of tert-butyl alcohol can keep the porosity of diatom-biosilica in aerogel and give it large surface with efficient water absorption ratio. 30% tert-butyl alcohol replacement of aerogel possesses the largest surface area (74.441 m² g^-1 ), water absorption capacity (316.83 ± 2.04%), and excellent hemostatic performance in vitro blood coagulation (≈70 s). Furthermore, this aerogel exhibits the shortest clotting time and lowest blood loss in rat hemorrhage model. The strong interface effect between aerogel and blood is able to promote erythrocytes aggregation, platelets adhesion, and activation, as well as, activate the intrinsic coagulation pathway to accelerate blood coagulation. All the above results demonstrate that chitosan/diatom-biosilica aerogel has great potential to be a safe and rapid hemostatic material.

Chitosan-Based Aerogel Particles as Highly Effective Local Hemostatic Agents. Production Process and In Vivo Evaluations

Chitosan aerogels with potential applications as effective local hemostatic agents were prepared using supercritical carbon dioxide drying to preserve the chitosan network structure featuring high internal surfaces and porosities of up to 300 m²/g and 98%, respectively. For the first time, hemostatic efficacy of chitosan-based aerogel particles was studied in vivo on a model of damage of a large vessel in the deep wound. Pigs were used as test animals. It was shown that primary hemostasis was achieved, there were no signs of rebleeding and aerogel particles were tightly fixed to the walls of the wound canal. A dense clot was formed inside the wound (at the femoral artery), which indicates stable hemostasis. This study demonstrated that chitosan-based aerogel particles have a high sorption capacity and are highly effective as local hemostatic agents which can be used to stop massive bleeding.

Chitosan-glucan complex hollow fibers reinforced collagen wound dressing embedded with aloe vera. II. Multifunctional properties to promote cutaneous wound healing

This study presents an innovative multifunctional system in fabricating new functional wound dressing (FWD) products that could be used for skin regeneration, especially in cases of infected chronic wounds and ulcers. The innovation is based on the extraction, characterization, and application of collagen (CO)/chitosan-glucan complex hollow fibers (CSGC)/aloe vera (AV) as a novel FWS. For the first time, specific hollow fibers were extracted with controlled inner (500-900 nm)/outer (2-3 µm) diameters from mycelium of Schizophyllum commune. Further on, research and evaluation of morphology, hydrolytic stability, and swelling characteristics of CO/CSGC@AV were carried out. The obtained FWS showed high hydrolytic stability with enhanced swelling characteristics compared to native collagen. The hemostatic effect of FWS increased significantly in the presence of CSGC, compared to native CO and displayed excellent biocompatibility which was tested by using normal human dermal fibroblast (NHDF). The FWS showed high antibacterial activity against different types of bacteria (positive/negative grams). From in vivo measurements, the novel FWS increased the percentage of wound closure after one week of treatment. All these results imply that the new CO/CSGC@AV-FWD has the potential for clinical skin regeneration and applying for controlled drug release.

Biocompatible Self-Healing Coating Based on Schiff Base for Promoting Adhesion of Coral Cells

Layer-by-layer self-assembly (LBL) technique is a very efficient and convenient method to modify the substrate surface. In this study, we report a self-repairing surface coating that can promote cell adhesion, especially for enhancing the adhesion of coral cells on the basal surface. The results confirmed that the modified chitosan-dialdehyde starch film based on Schiff base has good biocompatibility for common mammalian cells, such as normal human dermal fibroblasts (NHDFs) and relatively special cells (coral cells). The cytotoxicity test indicated that the optical density values of the experimental group films at 490 nm were higher than those of the control group in this study. In addition, the self-repairing coating modified by phase transition lysozyme can maintain its adhesion ability underwater for a period of time. Therefore, they have great application on substrates requiring underwater adhesion. Our results confirmed that the modified chitosan-dialdehyde starch self-healing films could provide a biocompatible coating material to promote the adhesion of normal human epidermal fibroblasts or coral cells.

Polysaccharide-Based Lotus Seedpod Surface-Like Porous Microsphere with Precise and Controllable Micromorphology for Ultrarapid Hemostasis

Rapid water absorption rate has become a bottleneck that limits ultrarapid hemostatic performance of hemostatic microspheres. Herein, we reported a "lotus seedpod surface-like" polysaccharide hemostatic microsphere (PHM) with "macropits on surface" morphology and "micropores in macropits" structure. Unique macropits on surface can promote the water absorption rate because they are advantageous to quickly guide blood into the micropores. Special micropores are internally connected with each other, which endows PHM₄ with high water absorption ratio. During the process of blood entering the micropores from micropits, the pore size decreases gradually. In this way, blood clotting factors could be rapidly concentrated. PHM₄ showed the highest water absorption rate (40.7 mL/s/cm²) and rapid hemostatic property in vivo (hemostatic time shortened from 210 to 45 s). Lotus seedpod surface-like PHMs are believed to have further clinical application as an effective hemostasis.

Evidences of Biomimetic and Nonantibiotic Characteristics of the Zinc-Carboxymethyl Chitosan-Genipin Organometallic Complex and Its Biocompatibility Aspects

Bioinspired nonantibiotics can prove to be a better and an efficient tool to fight against antimicrobial resistance. In our study, biomaterial composed of zinc-carboxymethyl chitosan (CMC)-genipin was investigated for this purpose. Briefly, CMC was synthesized and transformed to porous scaffolds using the freeze drying method. The scaffolds were cross-linked and stabilized with genipin and zinc (2 M zinc acetate), respectively. FTIR spectroscopic data testified Zn complex formation and pointed out the absence of water molecule like that of zinc motif containing proteins. Hence, the complex may be termed as biomimetic. Genipin (0.5%) cross-linking appeared to contribute additively to the wet compressive strength of the zinc-CMC scaffolds. Biodegradation data revealed better stability of CMC-genipin-zinc scaffolds in enzymatic and nonenzymatic conditions than their redundant controls. The scaffolds seem to support adhesion and proliferation of human dental pulp stem cells and were hemocompatible to human red blood corpuscles, as revealed by scanning electron microscopy. The scaffolds were found to be antibacterial and mildly antibiofilm when tested against biofilm-forming bacteria, that is, Staphylococcus aureus (ATCC 9144), making it a potential nonantibiotic-like biomaterial. To conclude, this organometallic complex-based biomaterial may potentially serve as a weapon against antimicrobial resistance. Furthermore, the biomaterial potentially finds its application in dental, maxillofacial, and orthopedic tissue engineering applications.

In situ synthesis of poly (γ- glutamic acid)/alginate/AgNP composite microspheres with antibacterial and hemostatic properties

In the present work, a poly(γ-glutamic acid)/alginate/silver nanoparticle (PGA/Alg/AgNP) composite microsphere with excellent antibacterial and hemostatic properties was prepared by the in situ UV reduction and emulsion internal gelation method, and its potential application for antibacterial hemostatic dressing was explored. Well dispersed AgNPs were in situ synthesized by a UV reduction method with alginate as stabilizer and reductant. The AgNPs showed excellent antibacterial activities against both gram-negative and gram-positive bacteria. Additionally, the AgNPs prepared by the in-situ UV reduction exhibited better biocompatibility and antibacterial effects than those prepared by the conventional chemical reduction method. PGA/Alg/AgNP composite microspheres were then prepared with the AgNPs by an emulsion internal gelation method. Such microspheres were found to be a porous and hollow network with pH-sensitive swelling properties and excellent hemostatic performance, indicating its application potentials as an advanced antibacterial hemostatic material.

Absorbable hemostatic hydrogels comprising composites of sacrificial templates and honeycomb-like nanofibrous mats of chitosan

The development of hemostatic technologies that suit a diverse range of emergency scenarios is a critical initiative, and there is an increasing interest in the development of absorbable dressings that can be left in the injury site and degrade to reduce the duration of interventional procedures. In the current study, β-cyclodextrin polyester (CDPE) hydrogels serve as sacrificial macroporous carriers, capable of degradation under physiological conditions. The CDPE template enables the assembly of imprinted chitosan honeycomb-like monolithic mats, containing highly entangled nanofibers with diameters of 9.2 ± 3.7 nm, thereby achieving an increase in the surface area of chitosan to improve hemostatic efficiency. In vivo, chitosan-loaded cyclodextrin (CDPE-Cs) hydrogels yield significantly lower amounts of blood loss and shorter times to hemostasis compared with commercially available absorbable hemostatic dressings, and are highly biocompatible. The designed hydrogels demonstrate promising hemostatic efficiency, as a physiologically-benign approach to mitigating blood loss in tissue-injury scenarios.