Injectable PEG/polyester thermogel: A new liquid embolization agent for temporary vascular interventional therapy

Synthetic Reversible Fibrous Network Hydrogels Based on a Double-Helical Polyelectrolyte

The unique mechanical properties of fibrous networks in biological tissues have inspired the development of synthetic fibrous network hydrogels, yet few polymers can reversibly form such structures. Here, we report the first reversible fibrous network hydrogel composed of synthetic polyelectrolytes with extremely rigid conformation (persistence length is ∼1 µm), made up of double-helical poly(2,2'-disulfonyl-4,4'-benzidine terephthalamide) (PBDT) and tetrabutylphosphonium bromide ([P4444]Br). The hydrogel exhibits a unique sol-gel transition, triggered by the hydrophobicity increase of [P4444]Br above lower critical solution temperature (LCST). This drives PBDT aggregation into fibrous bundles through electrostatic interactions. These bundles grow and branch into a continuous network, with the molecular rigidity of PBDT's double-helix conformation being key to gel formation. The hydrogel displays strain-stiffening mechanical responses akin to biological systems and shows a significant hysteresis (21 °C) between heating and cooling cycles. Uniquely, the effects of salts on the transition temperature deviate from the Hofmeister series, highlighting coordination with sulfonate groups as the dominant factor. Leveraging its modulus change during gelation, the hydrogel was successfully applied as a spray coating on superhydrophobic vertical Teflon surfaces. This study broadens the scope of thermoreversible hydrogels introducing gelation mechanisms for rigid polyelectrolytes and demonstrates their potential in advanced coatings.

Bioactive hydrogel formulations for regeneration of pathological bone defects

Bone defects caused by osteoporosis, infection, diabetes, post-tumor resection, and nonunion often cause severe pain and markedly increase morbidity and mortality, which remain a significant challenge for orthopedic surgeons. The precise local treatments for these pathological complications are essential to avoid poor or failed bone repair. Hydrogel formulations serve as injectable innovative platforms that overcome microenvironmental obstacles and as delivery systems for controlled release of various bioactive substances to bone defects in a targeted manner. Additionally, hydrogel formulations can be tailored for specific mechanical strengths and degradation profiles by adjusting their physical and chemical properties, which are crucial for prolonged drug retention and effective bone repair. This review summarizes recent advances in bioactive hydrogel formulations as three-dimensional scaffolds that support cell proliferation and differentiation. It also highlights their role as smart drug-delivery systems with capable of continuously releasing antibacterial agents, anti-inflammatory drugs, chemotherapeutic agents, and osteogenesis-related factors to enhance bone regeneration in pathological areas. Furthermore, the limitations of hydrogel formulations in pathological bone repair are discussed, and future development directions are proposed, which is expected to pave the way for the repair of pathological bone defects.

In Situ Forming Supramolecular Nanofiber Hydrogel as a Biodegradable Liquid Embolic Agent for Postembolization Tissue Remodeling

Embolic agents have been widely used to treat blood vessel abnormalities in interventional radiology as a minimally invasive procedure. However, only a few biodegradable liquid embolic agents exhibit high embolization performance, biodegradability, and operability. Herein, the design of in situ-forming supramolecular nanofiber (SNF) hydrogels is reported as biodegradable liquid embolic agents with the assistance of Bayesian optimization through an active learning pipeline. Chemically modified gelatin with hydrogen-bonding moieties produces fibrin-inspired nanofiber-based hydrogels with a high blood coagulation capacity. The low viscosity of the SNF hydrogels makes them injectable using a microcatheter, and the hydrogel shows sufficient tissue adhesion to the blood vessel walls and very weak adhesion to the catheter tubes. Moreover, the SNF hydrogels exhibit high blood compatibility, cytocompatibility, cell-adhesive properties, and biodegradability (in vitro and in vivo). Intravascularly delivered SNF hydrogels induce embolization of rat femoral arteries. This biodegradable liquid embolic agent could be a powerful tool for interventional radiology in the treatment of various diseases, including aortic aneurysm stent grafting, gynecological diseases, and liver cancer.

Advancements in hydrogel-based embolic agents: Categorized by therapeutic mechanisms

BACKGROUND

Transcatheter arterial embolization (TAE) is a crucial technique in interventional radiology. Hydrogel-based embolic agents show promise due to their phase transition and drug-loading capabilities. However, existing categorizations of these agents are confusing.

AIMS

This review tackles the challenge of categorizing hydrogel-based embolic agents based on their therapeutic mechanisms, including transportation, accumulation, interaction, and elimination. It also addresses current challenges and controversies in the field while highlighting future directions for hydrogel-based embolicagents.

MATERIALS AND METHODS

We conducted a systematic review of papers published in PUBMED from 2004 to 2024, focusing primarily on preclinical trials.

RESULTS

Various kinds of hydrogel embolic agents were introduced according to their therapeutic mechanisms.

DISCUSSION

Most hydrogel embolic agents were specifically designed for effective accumulation and interaction. Recent advancement highlight the potential of multifunctional hydrogel embolic agents.

CONCLUSION

This new categorizations provided valuable insights into hydrogel embolic agents, potentially guiding material scientists and interventional radiologists in the development of novel hydrogel embolic agents in transarterial embolization.

Biocompatible Liquid Embolic for the Treatment of Microvascular Hemorrhage

Persistent or recurrent bleeding from microvessels inaccessible for direct endovascular intervention is a major problem in medicine today. Here, an innovative catheter-directed liquid embolic (P-LE) is bioengineered for rapid microvessel embolization to treat small vessel hemorrhage. Tested in rodent, porcine, and canine animal models under normal and coagulopathic conditions, P-LE outperformed clinically used embolic materials in both survival and non-survival experiments, effectively occluding vessels as small as 40 microns with no signs of recanalization. P-LE occlusion is independent of the coagulation cascade, and its resistance to displacement is ≈ 8 times greater than systolic blood pressure. P-LE is also found to be biocompatible and x-ray visible and does not require polymerization or a chemical reaction to embolize. To simulate the clinical scenario, acute microvascular hemorrhage is created in the pig kidney, liver, or stomach; these are successfully treated with P-LE achieving immediate hemostasis. Furthermore, P-LE is found to be bactericidal to highly resistant patient-derived bacteria, suggesting that P-LE may also protect against infectious complications that may occur following embolization procedures. P-LE is safe, easy to use, and effective in treating -microvessel hemorrhage.

The role of hydrogels in the management of brain tumours: a narrative review

Conventional therapeutic techniques for brain tumours have limitations and side effects, necessitating the need for alternative treatment options. MRI-monitored therapeutic hydrogel systems show potential as a non-surgical approach for brain tumour treatment. Hydrogels have unique physical and chemical properties that make them promising for brain tumour treatment, including the ability to encapsulate therapeutic agents, provide sustained and controlled drug release, and overcome the blood-brain barrier for better penetration. By combining hydrogel systems with MRI techniques, it is possible to develop therapeutic approaches that provide real-time monitoring and controlled release of therapeutic agents. Surgical resection remains important, but there is a growing need for alternative approaches that can complement or replace traditional methods. The objective of this comprehensive narrative review is to evaluate the potential of MRI-monitored therapeutic hydrogel systems in non-surgical brain tumour treatment.

Smart "Thrombus": Self-Localizing UCST-Type Microcage

Embolization is often used to block blood supply for controlling the growth of fibroids and malignant tumors, but limited by embolic agents lacking spontaneous targeting and post-treatment removal. So we first adopted nonionic poly(acrylamide-co-acrylonitrile) with an upper critical solution temperature (UCST) to build up self-localizing microcages by inverse emulsification. The results showed that these UCST-type microcages behaved with the appropriate phase-transition threshold value around 40 °C, and spontaneously underwent an expansion-fusion-fission cycle under the stimulus of mild temperature hyperthermia. Given the simultaneous local release of cargoes, this simple but smart microcage is expected to act as a multifunctional embolic agent for tumorous starving therapy, tumor chemotherapy, and imaging.

The recent advancement in the PLGA-based thermo-sensitive hydrogel for smart drug delivery

To date, hydrogels have opened new prospects for potential applications for drug delivery. The thermo-sensitive hydrogels have the great potential to provide more effective and controllable release of therapeutic/bioactive agents in response to changes in temperature. PLGA is a safe FDA-approved copolymer with good biocompatibility and biodegradability. Recently, PLGA-based formulation have attracted a lot of interest for thermo-sensitive hydrogels. Thermo-sensitive PLGA-based hydrogels provide the delivery system with good spatial and temporal control, and have been widely applied in drug delivery. This review is focused on the recent progression of the thermo-sensitive and biodegradable PLGA-based hydrogels that have been reported for smart drug delivery to the different organs. Eventually, future perspectives and challenges of thermo-sensitive PLGA-based hydrogels are discussed briefly.

A systematic study on the effects of the structure of block copolymers of PEG and poly(ε-caprolactone-co-glycolic acid) on their temperature-responsive sol-to-gel transition behavior

The effects of the molecular structure on the temperature-responsive sol-to-gel transition behavior and neat morphology of the block copolymers of poly(ethylene glycol) and poly(ε-caprolactone-co-glycolic acid) were systematically investigated.

Gluing blood into gel by electrostatic interaction using a water-soluble polymer as an embolic agent

Liquid embolic agents are widely used for the endovascular embolization of vascular conditions. However, embolization based on phase transition is limited by the adhesion of the microcatheter to the embolic agent, use of an organic solvent, unintentional catheter retention, and other complications. By mimicking thrombus formation, a water-soluble polymer that rapidly glues blood into a gel without triggering coagulation was developed. The polymer, which consists of cationic and aromatic residues with adjacent sequences, shows electrostatic adhesion with negatively charged blood substances in a physiological environment, while common polycations cannot. Aqueous polymer solutions are injectable through clinical microcatheters and needles. The formed blood gel neither adhered to the catheter nor blocked the port. Postoperative computed tomography imaging showed that the polymer can block the rat femoral artery in vivo and remain at the injection site without nontarget embolization. This study provides an alternative for the development of waterborne embolic agents.

Recent progress in liquid embolic agents

Vascular embolization is a non-surgical procedure used to treat diseases or morbid conditions related to blood vessels, such as bleeding, arteriovenous malformation, aneurysm, and hypervascular tumors, through the intentional occlusion of blood vessels. Among various types of embolic agents that have been applied, liquid embolic agents are gaining an increasing amount of attention owing to their advantages in distal infiltration into regions where solid embolic agents cannot reach, enabling more extensive embolization. Meanwhile, recent advances in biomaterials and technologies have also contributed to the development of novel liquid embolic agents that can resolve the challenges faced while using the existing embolic materials. In this review, we briefly summarize the clinically used embolic agents and their applications, and then present selected research results that overcome the limitations of the embolic agents in use. Through this review, we suggest the required properties of liquid embolic agents that ensure efficacy, which can replace the existing agents, providing directions for the future development in this field.

An injectable hemostatic PEG-based hydrogel with on-demand dissolution features for emergency care

Uncontrolled bleeding from internal noncompressible wounds is a major cause of prehospital death in military personnel and civilian populations. An ideal hemostatic sealant for emergency care should quickly control blood loss and be removed without debridement for the follow-up treatment in the operating room, yet the lack of suitable materials to meet both requirements is the bottleneck. Herein, we suggest an injectable and dissolvable hydrogel sealant for hemorrhage management of noncompressible wounds. To this end, a 4-arm poly(ethylene glycol) (PEG) crosslinker modified with thioester linkages and terminated with aldehyde groups is designed and synthesized, and to modulate the gel properties and make it suitable as a hemostatic sealant, a mixed amino component composed of poly(ethylene imine) and adipic dihydrazide is employed to react with the PEG crosslinker to form the adhesive and elastic sealant for the first time. The aldehyde groups provide the adhesion to the tissues, and the amino component affords the procoagulant ability. More importantly, the thioester moieties allow the on-demand dissolution of sealant via a thiol-thioester exchange reaction upon exposure to an exogenous thiolate solution. In the rat femoral artery puncture and liver injury models, the administration of the hydrogel sealant dramatically reduces blood loss, and its subsequent removal does not induce rebleeding. Consequently, this hydrogel sealant with the unique feature of on-demand dissolution can not only efficiently control bleeding in emergent scenarios, but also allow non-traumatic re-exposure of wounds during subsequent surgical care. STATEMENT OF SIGNIFICANCE: Sealants, adhesives or hemostatic dressings currently used in emergency situations not only require manual pressure to control bleeding, but also face removal by cutting and mechanical debridement to enable eventual surgical treatment. In this study, we design and develop an injectable and adhesive hydrogel sealant with good procoagulant capacity and on-demand dissolution feature. The application of the hydrogel sealant substantially reduces bleeding from internal noncompressible wounds without the need for direct pressure, and demonstrates for the first time that its controlled removal without debridement does not cause rebleeding. Considering that there are currently no commercial wound sealant systems with the feature of on-demand dissolution, the hydrogel sealant developed by us is expected to address an unmet clinical need.

Special Features of Polyester-Based Materials for Medical Applications

This article presents current possibilities of using polyester-based materials in hard and soft tissue engineering, wound dressings, surgical implants, vascular reconstructive surgery, ophthalmology, and other medical applications. The review summarizes the recent literature on the key features of processing methods and potential suitable combinations of polyester-based materials with improved physicochemical and biological properties that meet the specific requirements for selected medical fields. The polyester materials used in multiresistant infection prevention, including during the COVID-19 pandemic, as well as aspects covering environmental concerns, current risks and limitations, and potential future directions are also addressed. Depending on the different features of polyester types, as well as their specific medical applications, it can be generally estimated that 25-50% polyesters are used in the medical field, while an increase of at least 20% has been achieved since the COVID-19 pandemic started. The remaining percentage is provided by other types of natural or synthetic polymers; i.e., 25% polyolefins in personal protection equipment (PPE).

An oxygen-enriched thermosensitive hydrogel for the relief of a hypoxic tumor microenvironment and enhancement of radiotherapy

The rapid proliferation of tumor cells and tortuous vasculature in solid tumors often bring about a hypoxic tumor microenvironment, which renders tumor cells more resistant to many cancer treatments, including radiotherapy. In this study, an injectable and thermosensitive composite hydrogel composed of perfluorooctanoic acid (PFOA) modified monomethoxy poly(ethylene glycol)-poly(D,L-lactide-co-glycolide) (mPEG-PLGA-PFOA) and perfluorooctyl bromide (PFOB) that presented a thermoreversible sol-gel transition upon heating was developed to deliver exogenous oxygen for the relief of tumor hypoxia and enhancement of radiotherapy. The fluorinated modification of copolymers significantly increased the stability of PFOB in the mPEG-PLGA-PFOA aqueous solution owing to the fluorophilic interaction between PFOB and PFOA-modified copolymers. The introduction of PFOB not only efficiently heightened the oxygen loading capacity of the composite hydrogel, but also endowed it with excellent X-ray opacity, allowing the visual observation of the hydrogel via micro-CT imaging. After peritumoral injection of the oxygen-enriched composite hydrogel, the continuous supply of oxygen effectively relieved tumor hypoxia and down-regulated the expression of hypoxia-inducible factor-1α. Profiting from this, the hyposensitivity of tumor cells to radiation was successfully reversed, and the tumor growth in mice was significantly suppressed and the survival of mice was prolonged when combined with multiple X-ray exposure. As a result, the oxygen-enriched composite hydrogel shows a great potential for radiosensitization to improve the radiotherapeutic efficacy.

Temperature-responsive biodegradable injectable polymers with tissue adhesive properties

Injectable polymers (IPs) exhibiting in situ hydrogel formation have attracted attention as vascular embolization and postoperative adhesion prevention materials. While utilizing hydrogels for such purposes, it is essential to ensure that they have appropriate and controllable tissue adhesion property, as it is crucial for them to not detach from their deposited location in the blood vessel or abdominal cavity. Additionally, it is important to maintain gel state in vivo for the desired period at such locations, where large amounts of body fluid exist. We had previously reported on a biodegradable IP system exhibiting temperature-responsive gelation and subsequent covalent cross-link formation. We had utilized triblock copolymers of aliphatic polyester and poly(ethylene glycol) (tri-PCGs) and its derivative containing acrylate group at the termini (tri-PCG-Acryl), exhibiting a longer and more controllable duration time of the gel state. In this study, the introduction of aldehyde groups by the addition of aldehyde-modified Pluronic (PL-CHO) was performed for conferring controllable and appropriate tissue adhesive properties on these IP systems. The IP systems containing PL-CHO, which were not covalently incorporated into the hydrogel network, exhibited tissue adhesive properties through Schiff base formation. The adhesion strength could be controlled by the amount of PL-CHO added. The IP system showed good vascular embolization performance and pressure resistance in the blood vessels. The IP hydrogel remained at the administration site in the abdominal space for 2 days and displayed effective adhesion prevention performance. STATEMENT OF SIGNIFICANCE: Injectable polymers (IPs), which exhibit in situ hydrogel formation, are expected to be utilized as vascular embolization and postoperative adhesion prevention materials. The tissue adhesion properties of hydrogels are important for such applications. We succeeded in conferring tissue adhesion properties onto a previously reported IP system by mixing it with Pluronic modified with aldehyde groups (PL-CHO). The aldehyde groups allowed for the formation of Schiff bases at the tissue surfaces. The tissue adhesion property could be conveniently controlled by altering the amount of PL-CHO. We revealed that the in vitro embolization properties of IPs in blood vessels could be substantially improved by mixing with PL-CHO. The IP system containing PL-CHO also exhibited good in vivo performance for postoperative adhesion prevention.

Intrinsically radiopaque biomaterial assortments: a short review on the physical principles, X-ray imageability, and state-of-the-art developments

X-ray attenuation ability, otherwise known as radiopacity of a material, could be indisputably tagged as the central and decisive parameter that produces contrast in an X-ray image. Radiopaque biomaterials are vital in the healthcare sector that helps clinicians to track them unambiguously during pre and post interventional radiological procedures. Medical imaging is one of the most powerful resources in the diagnostic sector that aids improved treatment outcomes for patients. Intrinsically radiopaque biomaterials enable themselves for visual targeting/positioning as well as to monitor their fate and further provide the radiologists with critical insights about the surgical site. Moreover, the emergence of advanced real-time imaging modalities is a boon to the contemporary healthcare systems that allow to perform minimally invasive surgical procedures and thereby reduce the healthcare costs and minimize patient trauma. X-ray based imaging is one such technologically upgraded diagnostic tool with many variants like digital X-ray, computed tomography, digital subtraction angiography, and fluoroscopy. In light of these facts, this review is aimed to briefly consolidate the physical principles of X-ray attenuation by a radiopaque material, measurement of radiopacity, classification of radiopaque biomaterials, and their recent advanced applications.

Emerging Biomaterials-Based Strategies for Inhibiting Vasculature Function in Cancer Therapy

The constant feeding of oxygen and nutrients through the blood vasculature has a vital role in maintaining tumor growth. Interestingly, recent endeavors have shown that nanotherapeutics with the strategy to block tumor blood vessels feeding nutrients and oxygen for starvation therapy can be helpful in cancer treatment. However, this field has not been detailed. Hence, this review will present an exhaustive summary of the existing biomaterial based strategies to disrupt tumor vascular function for effective cancer treatment, including hydrogel or nanogel-mediated local arterial embolism, thrombosis activator loaded nano-material-mediated vascular occlusion and anti-vascular drugs that block tumor vascular function, which may be beneficial to the design of anti-cancer nanomedicine by targeting the tumor vascular system.

Structurally Dynamic Hydrogels for Biomedical Applications: Pursuing a Fine Balance between Macroscopic Stability and Microscopic Dynamics

Owing to their unique chemical and physical properties, hydrogels are attracting increasing attention in both basic and translational biomedical studies. Although the classical hydrogels with static networks have been widely reported for decades, a growing number of recent studies have shown that structurally dynamic hydrogels can better mimic the dynamics and functions of natural extracellular matrix (ECM) in soft tissues. These synthetic materials with defined compositions can recapitulate key chemical and biophysical properties of living tissues, providing an important means to understanding the mechanisms by which cells sense and remodel their surrounding microenvironments. This review begins with the overall expectation and design principles of dynamic hydrogels. We then highlight recent progress in the fabrication strategies of dynamic hydrogels including both degradation-dependent and degradation-independent approaches, followed by their unique properties and use in biomedical applications such as regenerative medicine, drug delivery, and 3D culture. Finally, challenges and emerging trends in the development and application of dynamic hydrogels are discussed.

Injectable and thermosensitive hydrogels mediating a universal macromolecular contrast agent with radiopacity for noninvasive imaging of deep tissues

It is very challenging to visualize implantable medical devices made of biodegradable polymers in deep tissues. Herein, we designed a novel macromolecular contrast agent with ultrahigh radiopacity (iodinate content > 50%) via polymerizing an iodinated trimethylene carbonate monomer into the two ends of poly(ethylene glycol) (PEG). A set of thermosensitive and biodegradable polyester-PEG-polyester triblock copolymers with varied polyester compositions synthesized by us, which were soluble in water at room temperature and could spontaneously form hydrogels at body temperature, were selected as the demonstration materials. The addition of macromolecular contrast agent did not obviously compromise the injectability and thermogelation properties of polymeric hydrogels, but conferred them with excellent X-ray opacity, enabling visualization of the hydrogels at clinically relevant depths through X-ray fluoroscopy or Micro-CT. In a mouse model, the 3D morphology of the radiopaque hydrogels after injection into different target sites was visible using Micro-CT imaging, and their injection volume could be accurately obtained. Furthermore, the subcutaneous degradation process of a radiopaque hydrogel could be non-invasively monitored in a real-time and quantitative manner. In particular, the corrected degradation curve based on Micro-CT imaging well matched with the degradation profile of virgin polymer hydrogel determined by the gravimetric method. These findings indicate that the macromolecular contrast agent has good universality for the construction of various radiopaque polymer hydrogels, and can nondestructively trace and quantify their degradation in vivo. Meanwhile, the present methodology developed by us affords a platform technology for deep tissue imaging of polymeric materials.

Advances and trends of hydrogel therapy platform in localized tumor treatment: A review

Due to limitations of treatment and the stubbornness of infiltrative tumor cells, the outcome of conventional antitumor treatment is often compromised by a variety of factors, including severe side effects, unexpected recurrence, and massive tissue loss during the treatment. Hydrogel-based therapy is becoming a promising option of cancer treatment, because of its controllability, biocompatibility, high drug loading, prolonged drug release, and specific stimuli-sensitivity. Hydrogel-based therapy has good malleability and can reach some areas that cannot be easily touched by surgeons. Furthermore, hydrogel can be used not only as a carrier for tumor treatment agents, but also as a scaffold for tissue repair. In this review, we presented the latest researches in hydrogel applications of localized tumor therapy and highlighted the recent progress of hydrogel-based therapy in preventing postoperative tumor recurrence and improving tissue repair, thus proposing a new trend of hydrogel-based technology in localized tumor therapy. And this review aims to provide a novel reference and inspire thoughts for a more accurate and individualized cancer treatment.