Wound pH-Modulating Strategies for Diabetic Wound Healing

Significance: Chronic diabetic wounds on the lower extremities (diabetic foot ulcers, DFU) are one of the most prevalent and life-threatening complications of diabetes, responsible for significant loss of quality of life and cost to the health care system. Available pharmacologic treatments fail to achieve complete healing in many patients. Recent studies and investigational treatments have highlighted the potential of modulating wound pH in DFU. Recent Advances: Data from in vitro, preclinical, and clinical studies highlight the role of pH in the pathophysiology of DFU, and topical administration of pH-lowering agents have shown promise as a therapeutic strategy for diabetic wounds. In this critical review, we describe the role of pH in DFU pathophysiology and present selected low-molecular-weight and hydrogel-based pH-modulating systems for wound healing and infection control in diabetic wounds. Critical Issues: The molecular mechanisms leading to pH alterations in diabetic wounds are complex and may differ between in vitro models, animal models of diabetes, and the human pathophysiology. Wound pH-lowering bandages for DFU therapy must be tested in established animal models of diabetic wound healing and patients with diabetes to establish a comprehensive benefit-risk profile. Future Directions: As our understanding of the role of pH in the pathophysiology of diabetic wounds is deepening, new treatments for this therapeutic target are being developed and will be tested in preclinical and clinical studies. These therapeutic systems will establish a target product profile for pH-lowering treatments such as an optimal pH profile for each wound healing stage. Thus, controlling wound bed pH could become a powerful tool to accelerate chronic diabetic wound healing.

Zeolite-Loaded Hydrogels as Wound pH-Modulating Dressings for Diabetic Wound Healing

Wound pH has emerged as a promising therapeutic target in diabetic foot ulcers (DFU). Here, we aimed to develop a microparticle-loaded hydrogel for pH modulation in wound fluid. In a screen of polymeric and inorganic microparticles, zeolites were identified as pH-modulating microparticles. Zeolites were encapsulated in a calcium cross-linked alginate hydrogel, a biocompatible matrix clinically used as a wound dressing. This hydrogel potently neutralized hydroxide ions in serum-containing simulated wound fluid. These findings encourage a further development of this pH-modulating device as a molecular therapeutic system for DFUs.

A novel ratiometric fluorescent sensor from modified coumarin-grafted cellulose for precise pH detection in strongly alkaline conditions

Accurate and convenient monitoring of pH under extreme alkaline conditions is still a challenge. In this work, 4-(3-(7-hydroxy-2-oxo-2H-chromen-3-yl)-3-oxoprop-1-en-1-yl)benzamide (HCB), a coumarin derivative, was grafted onto dialdehyde cellulose (DAC) to obtain a sensor DAC-HCB, which exhibited a ratiometric fluorescent response to the pH of alkaline solutions, resulting in a significant fluorescent color change from yellow to blue (FI459 nm/FI577 nm) at pH 7.5-14. The structure of DAC-HCB was characterized through FT-IR, XRD, XPS, SEM. The pKa of sensor DAC-HCB was 13.16, and the fluorescent intensity ratio FI459 nm/FI577 nm possessed an excellent linear characteristic with pH in the scope of 9.0-13.0. Meanwhile, sensor DAC-HCB showed good selectivity, anti-interference, and fast response time to basic pH, which is an effective fluorescent sensor for examination of pH in alkali circumstance. The recognition mechanism of DAC-HCB to OH- was elucidated with HRMS and density-functional theory (DFT) computational analyses. Sensor DAC-HCB was successfully used for precise detection of environmental water samples pH. This work furnished a new protocol for test strips as a convenient and highly efficient pH detection tool for the high pH environment, and it has great potential for application in environmental monitoring.

Recent studies on proteins and polysaccharides-based pH-responsive fluorescent materials

Polymer-based pH-responsive fluorescent materials have the characteristics of fast response, real-time monitoring, visualisation, and easy forming. Consequently, they have attracted widespread attention in wound healing, sweat monitoring, security and anti-counterfeiting, freshness detection of aquatic products, metal-ion sensing and bioimaging. This paper analyses the preparation principles and characteristics of pH-responsive fluorescent materials based on cellulose, chitosan and proteins. It then outlines the fluorescence properties, environmental response mechanisms and applications of various luminescent materials. Next, the research indicates that amines, N-heterocyclic rings, carboxyl groups and amino plasmonic groups on the fluorescent molecule structure and polymer skeleton appear to change the degree of ionisation under acid or alkali stimulation, which affects the light absorption ability of chromophore electrons, thus producing fluorescence changes in fluorescent materials under different pH stimuli. On this basis, the challenges and growth encountered in the development of proteins and polysaccharides-based pH-responsive fluorescent materials were prospected to provide theoretical references and technical support for constructing pH-responsive fluorescent materials with high stability, high sensitivity, long-lasting pH-response and wide detection range.

Novel Injectable, Self-Healing, Long-Effective Bacteriostatic, and Healed-Promoting Hydrogel Wound Dressing and Controlled Drug Delivery Mechanisms

Multivalent ion cross-linking has been used to form hydrogels between sodium alginate (SA) and hyaluronic acid (HA) in previous studies. However, more stable and robust covalent cross-linking is rarely reported. Herein, we present a facile approach to fabricate a SA and HA hydrogel for wound dressings with injectable, good biocompatibility, and high ductility. HA was first reacted with ethylenediamine to graft an amino group. Then, it was cross-linked with oxidized SA with dialdehyde to form hydrogel networks. The dressing can effectively promote cell migration and wound healing. To increase the antibacterial property of the dressing, we successfully loaded tetracycline hydrochloride into the hydrogel as a model drug. The drug can be released slowly in the alkaline environment of chronic wounds, and the hydrogel releases drugs again in the more acidic environment with wound healing, achieving a long-term antibacterial effect. In addition, one-dimensional partial differential equations based on Fickian diffusion with time-varying diffusion coefficients and hydrogel thicknesses were used to model the entire complex drug release process and to predict drug release.

Microenvironmental dynamics of diabetic wounds and insights for hydrogel-based therapeutics

The rising prevalence of diabetes has underscored concerns surrounding diabetic wounds and their potential to induce disability. The intricate healing mechanisms of diabetic wounds are multifaceted, influenced by ambient microenvironment, including prolonged hyperglycemia, severe infection, inflammation, elevated levels of reactive oxygen species (ROS), ischemia, impaired vascularization, and altered wound physicochemical properties. In recent years, hydrogels have emerged as promising candidates for diabetic wound treatment owing to their exceptional biocompatibility and resemblance to the extracellular matrix (ECM) through a three-dimensional (3D) porous network. This review will first summarize the microenvironment alterations occurring in the diabetic wounds, aiming to provide a comprehensive understanding of its pathogenesis, then a comprehensive classification of recently developed hydrogels will be presented, encompassing properties such as hypoglycemic effects, anti-inflammatory capabilities, antibacterial attributes, ROS scavenging abilities, promotion of angiogenesis, pH responsiveness, and more. The primary objective is to offer a valuable reference for repairing diabetic wounds based on their unique microenvironment. Moreover, this paper outlines potential avenues for future advancements in hydrogel dressings to facilitate and expedite the healing process of diabetic wounds.

Photoinduced electron transfer (PeT) based fluorescent probes for cellular imaging and disease therapy

Typical PeT-based fluorescent probes are multi-component systems where a fluorophore is connected to a recognition/activating group by an unconjugated linker. PeT-based fluorescent probes are powerful tools for cell imaging and disease diagnosis due to their low fluorescence background and significant fluorescence enhancement towards the target. This review provides research progress towards PeT-based fluorescent probes that target cell polarity, pH and biological species (reactive oxygen species, biothiols, biomacromolecules, etc.) over the last five years. In particular, we emphasise the molecular design strategies, mechanisms, and application of these probes. As such, this review aims to provide guidance and to enable researchers to develop new and improved PeT-based fluorescent probes, as well as promoting the use of PeT-based systems for sensing, imaging, and disease therapy.

Next-Generation Diagnostic Wound Dressings for Diabetic Wounds

Chronic lower extremity wounds (diabetic foot ulcers) are a serious and prevalent complication of diabetes. These wounds exhibit low healing rates and present a high risk of amputation. Current diagnostic options for foot ulcers are limited to macroscopic wound analysis such as wound depth, implicated tissues, and infection. Molecular diagnostics promises to improve foot ulcer diagnosis, staging, and assessment of the treatment response. In this perspective, we report recent progress in understanding the pathophysiology of diabetic wound healing and point to recently emerged novel molecular targets for wound diagnostics. We discuss selected diagnostic wound dressings under preclinical development that detect one or several inflammatory markers, bacterial secretions, hyperglycemia, and mechanical stress. We also highlight key translational challenges of investigational diagnostic bandages for diabetic foot ulcers.

Natural flavylium-inspired far-red to NIR-II dyes and their applications as fluorescent probes for biomedical sensing

Fluorescent probes that emit in the far-red (600-700 nm), first near-infrared (NIR-I, 700-900 nm), and second NIR (NIR-II, 900-1700 nm) regions possess unique advantages, including low photodamage and deep penetration into biological samples. Notably, NIR-II optical imaging can achieve tissue penetration as deep as 5-20 mm, which is critical for biomedical sensing and clinical applications. Much research has focused on developing far-red to NIR-II dyes to meet the needs of modern biomedicine. Flavylium compounds are natural colorants found in many flowers and fruits. Flavylium-inspired dyes are ideal platforms for constructing fluorescent probes because of their far-red to NIR emissions, high quantum yields, high molar extinction coefficients, and good water solubilities. The synthetic and structural diversities of flavylium dyes also enable NIR-II probe development, which markedly advance the field of NIR-II in vivo imaging. In the last decade, there have been huge developments in flavylium-inspired dyes and their applications as far-red to NIR fluorescent probes for biomedical applications. In this review, we highlight the optical properties of representative flavylium dyes, design strategies, sensing mechanisms, and applications as fluorescent probes for detecting and visualizing important biomedical species and events. This review will prompt further research not only on flavylium dyes, but also into all far-red to NIR fluorophores and fluorescent probes. Moreover, this interest will hopefully spillover into applications related to complex biological systems and clinical treatments, ranging in focus from the sub-organelle to whole-animal levels.

Recent Progress in Fluorescent Probes for Diabetes Visualization and Drug Therapy

Diabetes has become one of the most prevalent endocrine and metabolic diseases that threaten human health, and it is accompanied by serious complications. Therefore, it is vital and pressing to develop novel strategies or tools for prewarning and therapy of diabetes and its complications. Fluorescent probes have been widely applied in the detection of diabetes due to the fact of their attractive advantages. In this report, we comprehensively summarize the recent progress and development of fluorescent probes in detecting the changes in the various biomolecules in diabetes and its complications. We also discuss the design of fluorescent probes for monitoring diabetes in detail. We expect this review will provide new ideas for the development of fluorescent probes suitable for the prewarning and therapy of diabetes in future clinical transformation and application.

Topical pH Sensing NIR Fluorophores for Intraoperative Imaging and Surgery of Disseminated Ovarian Cancer

Fluorescence-guided surgery (FGS) aids surgeons with real-time visualization of small cancer foci and borders, which improves surgical and prognostic efficacy of cancer. Despite the steady advances in imaging devices, there is a scarcity of fluorophores available to achieve optimal FGS. Here, 1) a pH-sensitive near-infrared fluorophore that exhibits rapid signal changes in acidic tumor microenvironments (TME) caused by the attenuation of intramolecular quenching, 2) the inherent targeting for cancer based on chemical structure (structure inherent targeting, SIT), and 3) mitochondrial and lysosomal retention are reported. After topical application of PH08 on peritoneal tumor regions in ovarian cancer-bearing mice, a rapid fluorescence increase (< 10 min), and extended preservation of signals (> 4 h post-topical application) are observed, which together allow for the visualization of submillimeter tumors with a high tumor-to-background ratio (TBR > 5.0). In addition, PH08 is preferentially transported to cancer cells via organic anion transporter peptides (OATPs) and colocalizes in the mitochondria and lysosomes due to the positive charges, enabling a long retention time during FGS. PH08 not only has a significant impact on surgical and diagnostic applications but also provides an effective and scalable strategy to design therapeutic agents for a wide array of cancers.

Recent Advancements in Colorimetric and Fluorescent pH Chemosensors: From Design Principles to Applications

Due to the immense biological significance of pH in diverse living systems, the design, synthesis, and development of pH chemosensors for pH monitoring has been a very active research field in recent times. In this review, we summarize the designing strategies, sensing mechanisms, biological and environmental applications of fluorogenic and chromogenic pH chemosensors of the last three years (2018-2020). We categorized these pH probes into seven types based on their applications, including 1) Cancer cell discriminating pH probes; 2) Lysosome targetable pH probes; 3) Mitochondria targetable pH probes; 4) Golgi body targetable pH probes; 5) Endoplasmic reticulum targetable pH probes; 6) pH probes used in nonspecific cell imaging; and 7) pH probes without cell imaging. All these different categories exhibit diverse applications of pH probes in biological and environmental fields.

A heptamethine cyanine with meso-N-induced rearrangement for acid-activated tumour imaging and photothermal therapy

Photothermal therapy has been developed as one of the most attractive strategies for tumour therapy. However, most of the reported photothermal probes still suffer from poor selectivity or specificity for...

Recent progress of organic small molecule-based fluorescent probes for intracellular pH sensing

Fluorescent probes along with fluorescence microscopy are essential tools for biomedical research. Various cellular ubiquitous chemical factors such as pH, H₂O₂, and Ca²⁺ are labeled and traced using specific fluorescent probes, therefore helping us to explore their physiological function and pathological change. Among them, intracellular pH value is an important factor that governs biological processes, generally ∼7.2. Furthermore, specific organelles within cells possess unique acid-base homeostasis, involving the acidic lysosomes, alkalescent mitochondria, and neutral endoplasmic reticulum and Golgi apparatus, which undergo various physiological processes such as intracellular digestion, ATP production, and protein folding and processing. In this review, recently reported fluorescent probes targeted toward the lysosomes, mitochondria, endoplasmic reticulum, Golgi apparatus, and cytoplasm for sensing pH change are discussed, which involves molecular structures, fluorescence behavior, and biological applications.

"Turn-on" ratiometric fluorescent probe: Naked-eye detection of acidic pH and citric acid (CA) by using fluorescence spectrum and its application in real food samples and zebrafish

Rapid, accurate and efficient detection of acidic pH and citric acid (CA) changes is of great significance for predicting environmental and food safety problems by fluorescence analysis technique. Herein, a small molecule ratiometric fluorescent probe (BICL) based on benzoindole derivatives is successfully synthesized and characterized and used for quantitatively and qualitatively "turn-on" detection acid pH and CA changes in solution and environment by ultraviolet spectrum and fluorescence emission spectrum. On the one hand, the probe has a good linear relation to acidic pH in the pH range 3.1-4.5 (I₆₀₄/I₅₅₀ = 13.088-2.3878pH, R² = 0.9986). On the other hand, the probe has a good linear relationship in the range of CA concentration of 14.0-23.0 μM (I₆₀₄/I₅₅₀ = 0.5324 [CA]-5.2628, R² = 0.9993) and a low detection limit of 2.967 μM. BICL has a good recovery rate in the range of 114.6 ~ 101.0% and a low relative standard deviation (RSD) (0.0011 ~ 0.0092) in the determination of CA in real samples (water, drinks and fruits), which holds great potential for application in determination of CA in real samples. Importantly, the probe has good blood compatibility, and it has been successfully applied to detect exogenously induced changes in acidic pH and CA in zebrafish with great time-stability by using fluorescence imaging technology, respectively.

A Glucose-Powered Activatable Nanozyme Breaking pH and H2 O2 Limitations for Treating Diabetic Infections

The peroxidase-like activity of nanozymes is promising for chemodynamic therapy by catalyzing H₂ O₂ into ^. OH. However, for most nanozymes, this activity is optimal just in acidic solutions, while the pH of most physiological systems is beyond 7.0 (even >8.0 in chronic wounds) with inadequate H₂ O₂ . We herein communicate an activatable nanozyme with targeting capability to simultaneously break the local pH and H₂ O₂ limitations under physiological conditions. As a proof of concept, aptamer-functionalized nanozymes, glucose oxidase, and hyaluronic acid constitute an activatable nanocapsule "APGH", which can be activated by bacteria-secreted hyaluronidase in infected wounds. Nanozymes bind onto bacteria through aptamer recognition, and glucose oxidation tunes the local pH down and supplements H₂ O₂ for the in-situ generation of ^. OH on bacteria surfaces. The activity switching and enhanced antibacterial effect of the nanocapsule were verified in vitro and in diabetic wounds. This strategy for directly regulating local microenvironment is generally accessible for nanozymes, and significant for facilitating biological applications of nanozymes.

The fluorescence imaging and precise suppression of bacterial infections in chronic wounds by porphyrin-based metal-organic framework nanorods

Nano-antibacterial agents can play a critical role in chronic wound management. However, the design of an intelligent nanosystem that can provide both a visual warning of infection and precise sterilization remains a hurdle. Herein, a rod-like porphyrin-based metal-organic framework theranostic nanosystem (Zn-TCPP nanorods) is fabricated via coordination chelation between tetrakis(4-carboxylphenyl)porphyrin and zinc ions. This system can show significant fluorescence activation in response to the local elevated pH shown by chronic wounds, a main indicator of wound infection. Meanwhile, under the guidance of fluorescence imaging, the highly spatiotemporally precise photodynamic inactivation of microorganisms can be carried out without the destruction of surrounding normal cells and nascent cells. The results demonstrated that the Zn-TCPP nanorods were a highly sensitive and reversible probe for sensing alkaline pH levels. Alterations in the fluorescence of the Zn-TCPP nanorods can accurately indicate the infection status and heterogeneity of infection within the wound bed. Under specific light irradiation, the Zn-TCPP nanorods can exterminate 97% of Staphylococcus aureus via the generation of reactive oxygen species (ROS). Assays of extensive wounds demonstrate that the precise fluorescence-imaging-guided suppression of bacterial infection can significantly reduce the mouse mortality rate and accelerate wound healing. This system provides the opportunity for "precision medicine" relating to chronic wounds and some large-area wounds.

Fluorescence imaging of pathophysiological microenvironments

Abnormal microenvironments (viscosity, polarity, pH, etc.) have been verified to be closely associated with numerous pathophysiological processes such as inflammation, neurodegenerative diseases, and cancer. As a result, deep insights into these pathophysiological microenvironments are particularly beneficial for clinical diagnosis and treatment. However, the monitoring of pathophysiological microenvironments is unattainable by the traditional clinical diagnostic techniques such as magnetic resonance imaging, computed tomography, and positron emission tomography. Recently, fluorescence imaging has shown tremendous advantages and potential in the tracing of pathophysiological microenvironment variations. In this context, a general discussion is provided on the state-of-the-art progress of fluorescent probes for visualizing pathophysiological microenvironments (viscosity, pH, and polarity), since 2016, as well as the future perspectives in this challenging field.

Synthesis of a New Amino-Furopyridine-Based Compound as a Novel Fluorescent pH Sensor in Aqueous Solution

Development of new fluorescent molecules, especially pH-sensitive fluorescent dyes, is always in high demand due to their wide applications in various fields and the limited number of common chromophores. In this work, a family of 3-amino-N-phenylfuro[2,3-b]pyridine-2-carboxamides (AFP) was synthesized as novel fluorescent compounds. Besides fluorescence in an organic solvent, AFP 1 and AFP 2 exhibit good fluorescence properties in both acidic and basic aqueous solution, which could be explained by protonation or different conformations formed in solution. Density functional theory (DFT) calculations on the highest occupied molecular orbital-lowest unoccupied molecular orbital (HOMO-LUMO) of various conformations were performed for further support.

Benzoindole-based bifunctional ratiometric turn-on sensor with an ICT effect for trapping of H+ and Al3+ in dual-channel cell imaging and samples

Abnormal changes in H⁺ and Al³⁺ concentrations in living cells can alter neurological diseases. A small-molecule sensor combined with a fluorescence imaging technique holds great promise for monitoring changes in proton and metal-ion concentration. In this work, a bifunctional ratiometric naked-eye fluorescence sensor (BIBC) was developed for turn-on detection of H⁺ and Al³⁺ in H₂O/EtOH (v/v = 1:1) mixtures. BIBC exhibits a pK_a value of 4.58 within a linear pH variation from 4.1 to 4.7 (R² = 0.9939). Moreover, the fluorescence intensity ratio (I_{566 nm}/I_{524 nm}) shows a good linear relationship (R² = 0.9965) within an Al³⁺ concentration range of 7.0-10.0 μM. The detection limit (DL) for the sensor was calculated to be 1.58 μM. The practical application of BIBC for Al³⁺ detection in real samples was further discussed, and satisfactory results were obtained. Furthermore, the sensor was applied to real-time visualization of changes in H⁺ and Al³⁺ concentration in living cells, with great photostability and low cytotoxicity observed. Fluorescence images of H⁺ and Al³⁺ were collected by using a fluorescence microscope in a dual-channel configuration, wherein they were labeled green and yellow, respectively.

Fluorescent Probe for Simultaneous Discrimination of GSH, Cys, and SO2 Derivatives

Biothiols and SO₂ derivatives, as essential reactive sulfur species (RSS), play vital roles in various physiological processes and have a close network of generation and metabolic pathways among them. To clarify their complex correlations, fluorescent probes to simultaneously detect GSH, Cys, and SO₂ derivatives are highly desirable. Herein, we develop the first fluorescent probe (BO-HEM) to simultaneously discriminate GSH, Cys, and SO₂ derivatives. The fluorescent probe is designed by integration of hemicyanine and BODIPY fluorophores through an ether bond. The ether bond of the probe is rapidly replaced by thiolates through nucleophilic aromatic substitution (S_NAr) to generate hemicyanine with NIR fluorescence and sulfur-BODIPY. The amino groups of Cys but not GSH then further replace the thiolate to form amino-BODIPY. As for SO₃^2-, nucleophilic addition to the double bond of BO-HEM generates adduct O-BODIPY with green fluorescence. To further improve the sensing performance, the nanoprobe with increased reactivity and biocompatibility is constructed by encapsulation of BO-HEM into the polymeric micelle. More importantly, by taking advantage of the hydrophilicity of the reaction products, the spectral discrimination was further enhanced to avoid signal interference. The nanoprobe is applied to discriminate biothiols and SO₂ derivatives in living cells through three-color fluorescence imaging.

A novel water-soluble fluorescent probe with ultra-sensitivity over a wider pH range and its application for differentiating cancer cells from normal cells

A water-soluble fluorescent probe with ultra-sensitivity over a wider pH range was developed to differentiate cancer cells from normal cells.