Osteopromotive carbon dots promote bone regeneration through the PERK-eIF2α-ATF4 pathway

Quantum dots for bone tissue engineering

In confronting the global prevalence of bone-related disorders, bone tissue engineering (BTE) has developed into a critical discipline, seeking innovative materials to revolutionize treatment paradigms. Quantum dots (QDs), nanoscale semiconductor particles with tunable optical properties, are at the cutting edge of improving bone regeneration. This comprehensive review delves into the multifaceted roles that QDs play within the realm of BTE, emphasizing their potential to not only revolutionize imaging but also to osteogenesis, drug delivery, antimicrobial strategies and phototherapy. The customizable nature of QDs, attributed to their size-dependent optical and electronic properties, has been leveraged to develop precise imaging modalities, enabling the visualization of bone growth and scaffold integration at an unprecedented resolution. Their nanoscopic scale facilitates targeted drug delivery systems, ensuring the localized release of therapeutics. QDs also possess the potential to combat infections at bone defect sites, preventing and improving bacterial infections. Additionally, they can be used in phototherapy to stimulate important bone repair processes and work well with the immune system to improve the overall healing environment. In combination with current trendy artificial intelligence (AI) technology, the development of bone organoids can also be combined with QDs. While QDs demonstrate considerable promise in BTE, the transition from laboratory research to clinical application is fraught with challenges. Concerns regarding the biocompatibility, long-term stability of QDs within the biological environment, and the cost-effectiveness of their production pose significant hurdles to their clinical adoption. This review summarizes the potential of QDs in BTE and highlights the challenges that lie ahead. By overcoming these obstacles, more effective, efficient, and personalized bone regeneration strategies will emerge, offering new hope for patients suffering from debilitating bone diseases.

Near-Infrared Carbon Dots With Antibacterial and Osteogenic Activities for Sonodynamic Therapy of Infected Bone Defects

Repairing infected bone defects is hindered by the presence of stubborn bacterial infections and inadequate osteogenic activity. The incorporation of harmful antibiotics not only fosters the emergence of multidrug-resistant bacteria, but also diminishes the osteogenic properties of scaffold materials. In addition, it is essential to continuously monitor the degradation kinetics of scaffold materials at bone defect sites, yet the majority of bone repair materials lack imaging capability. To address these issues, this study reports for the first time the development of a single nanomaterial with triple functionality: efficient sonodynamic antibacterial activity, accelerated bone defect repair capability, and NIR imaging ability for visualized therapy of infected bone defects. Through rationally regulating the surface functional groups, the obtained multifunctional NIR carbon dots (NIR-CD) exhibit p-n junction-enhanced sonodynamic activity, narrow bandgap-facilitated NIR imaging capability, and negative charge-augmented osteogenic activity. The validation of NIR-CDs antibacterial and osteogenic activities in vivo is conducted by constructing 3D injectable hydrogels encapsulated by NIR-CDs (NIR-CD/GelMA). The implantation of multifunctional NIR-CD/GelMA hydrogel scaffolds in a model of MRSA-infected craniotomy defects results in almost complete restoration of the infected bone defects after 60 days. These findings will provide traceable, renewable, repairable and antibacterial candidate biomaterials for bone tissue engineering.

Metal-doped carbon dots for biomedical applications: From design to implementation

Carbon dots (CDs), as a new kind of fluorescent nanomaterials, show great potential for application in several fields due to their unique nano-size effect, easy surface functionalization, controllable photoluminescence, and excellent biocompatibility. Conventional preparation methods for CDs typically involve top-down and bottom-up approaches. Doping is a major step forward in CDs design methodology. Chemical doping includes both non-metal and metal doping, in which non-metal doping is an effective strategy for modulating the fluorescence properties of CDs and improving photocatalytic performance in several areas. In recent years, Metal-doped CDs have aroused the interest of academics as a promising nano-doping technique. This approach has led to improvements in the physicochemical and optical properties of CDs by altering their electron density distribution and bandgap capacity. Additionally, the issues of metal toxicity and utilization have been addressed to a large extent. In this review, we categorize metals into two major groups: transition group metals and rare-earth group metals, and an overview of recent advances in biomedical applications of these two categories, respectively. Meanwhile, the prospects and the challenges of metal-doped CDs for biomedical applications are reviewed and concluded. The aim of this paper is to break through the existing deficiencies of metal-doped CDs and fully exploit their potential. I believe that this review will broaden the insight into the synthesis and biomedical applications of metal-doped CDs.

The applications of carbon dots in oral health: A scoping review

OBJECTIVES

This scoping review aims to provide an overview of the research and potential applications of carbon dots (CDs) for oral health purposes.

DESIGN

Systematic literature searches were performed on PubMed and Web of Science databases (up to February 2023). Two co-authors selected the published works independently and extracted the data in accordance with the PRISMA statement. Studies with the application of CDs for oral health purposes were included.

RESULTS

Among 152 articles, 19 articles were finally selected. Eight studies investigated the anti-microbial effects of CDs against, for example, oral pathogens, eight studies explored the applicability of CDs in relation to oral cancer, and three studies investigated CDs in relation to cell differentiation and tissue regeneration in oral health. The studies showed the promising potential of CDs in oral health, particularly for inducing bacterial killing by increasing reactive oxygen species, killing oral cancer cells via photodynamic therapeutic effects, and inducing dental pulp and periodontal bone regeneration.

CONCLUSION

The findings show that CDs have the potential to be utilized in the future for various oral health purposes. Besides, these results underline the broad-spectrum applicability of CDs, crossing the borders of oral health.

Recent advances in composite hydrogels: synthesis, classification, and application in the treatment of bone defects

Bone defects are often difficult to treat due to their complexity and specificity, and therefore pose a serious threat to human life and health. Currently, the clinical treatment of bone defects is mainly surgical. However, this treatment is often more harmful to patients and there is a potential risk of rejection and infection. Hydrogels have a unique three-dimensional structure that can accommodate a variety of materials, including particles, polymers and small molecules, making them ideal for treating bone defects. Therefore, emerging composite hydrogels are considered one of the most promising candidates for the treatment of bone defects. This review describes the use of different types of composite hydrogel in the treatment of bone defects. We present the basic concepts of hydrogels, different preparation techniques (including chemical and physical crosslinking), and the clinical requirements for hydrogels used to treat bone defects. In addition, a review of numerous promising designs of different types of hydrogel doped with different materials (e.g., nanoparticles, polymers, carbon materials, drugs, and active factors) is also highlighted. Finally, the current challenges and prospects of composite hydrogels for the treatment of bone defects are presented. This review will stimulate research efforts in this field and promote the application of new methods and innovative ideas in the clinical field of composite hydrogels.

Advances in the roles of ATF4 in osteoporosis

Osteoporosis (OP) is characterized by reduced bone mass, decreased strength, and enhanced bone fragility fracture risk. Activating transcription factor 4 (ATF4) plays a role in cell differentiation, proliferation, apoptosis, redox balance, amino acid uptake, and glycolipid metabolism. ATF4 induces the differentiation of bone marrow mesenchymal stem cells (BM-MSCs) into osteoblasts, increases osteoblast activity, and inhibits osteoclast formation, promoting bone formation and remodeling. In addition, ATF4 mediates the energy metabolism in osteoblasts and promotes angiogenesis. ATF4 is also involved in the mediation of adipogenesis. ATF4 can selectively accumulate in osteoblasts. ATF4 can directly interact with RUNT-related transcription factor 2 (RUNX2) and up-regulate the expression of osteocalcin (OCN) and osterix (Osx). Several upstream factors, such as Wnt/β-catenin and BMP2/Smad signaling pathways, have been involved in ATF4-mediated osteoblast differentiation. ATF4 promotes osteoclastogenesis by mediating the receptor activator of nuclear factor κ-B (NF-κB) ligand (RANKL) signaling. Several agents, such as parathyroid (PTH), melatonin, and natural compounds, have been reported to regulate ATF4 expression and mediate bone metabolism. In this review, we comprehensively discuss the biological activities of ATF4 in maintaining bone homeostasis and inhibiting OP development. ATF4 has become a therapeutic target for OP treatment.

Advances in the interaction between endoplasmic reticulum stress and osteoporosis

The endoplasmic reticulum (ER) is the main site for protein synthesis, folding, and secretion, and accumulation of the unfolded/misfolded proteins in the ER may induce ER stress. ER stress is an important participant in various intracellular signaling pathways. Prolonged- or high-intensity ER stress may induce cell apoptosis. Osteoporosis, characterized by imbalanced bone remodeling, is a global disease caused by many factors, such as ER stress. ER stress stimulates osteoblast apoptosis, increases bone loss, and promotes osteoporosis development. Many factors, such as the drug's adverse effects, metabolic disorders, calcium ion imbalance, bad habits, and aging, have been reported to activate ER stress, resulting in the pathological development of osteoporosis. Increasing evidence shows that ER stress regulates osteogenic differentiation, osteoblast activity, and osteoclast formation and function. Various therapeutic agents have been developed to counteract ER stress and thereby suppress osteoporosis development. Thus, inhibition of ER stress has become a potential target for the therapeutic management of osteoporosis. However, the in-depth understanding of ER stress in the pathogenesis of osteoporosis still needs more effort.

Advances and Prospects in Materials for Craniofacial Bone Reconstruction

The craniofacial region is composed of 23 bones, which provide crucial function in keeping the normal position of brain and eyeballs, aesthetics of the craniofacial complex, facial movements, and visual function. Given the complex geometry and architecture, craniofacial bone defects not only affect the normal craniofacial structure but also may result in severe craniofacial dysfunction. Therefore, the exploration of rapid, precise, and effective reconstruction of craniofacial bone defects is urgent. Recently, developments in advanced bone tissue engineering bring new hope for the ideal reconstruction of the craniofacial bone defects. This report, presenting a first-time comprehensive review of recent advances of biomaterials in craniofacial bone tissue engineering, overviews the modification of traditional biomaterials and development of advanced biomaterials applying to craniofacial reconstruction. Challenges and perspectives of biomaterial development in craniofacial fields are discussed in the end.

Endoplasmic reticulum stress: a novel targeted approach to repair bone defects by regulating osteogenesis and angiogenesis

Bone regeneration therapy is clinically important, and targeted regulation of endoplasmic reticulum (ER) stress is important in regenerative medicine. The processing of proteins in the ER controls cell fate. The accumulation of misfolded and unfolded proteins occurs in pathological states, triggering ER stress. ER stress restores homeostasis through three main mechanisms, including protein kinase-R-like ER kinase (PERK), inositol-requiring enzyme 1ɑ (IRE1ɑ) and activating transcription factor 6 (ATF6), collectively known as the unfolded protein response (UPR). However, the UPR has both adaptive and apoptotic effects. Modulation of ER stress has therapeutic potential for numerous diseases. Repair of bone defects involves both angiogenesis and bone regeneration. Here, we review the effects of ER stress on osteogenesis and angiogenesis, with emphasis on ER stress under high glucose (HG) and inflammatory conditions, and the use of ER stress inducers or inhibitors to regulate osteogenesis and angiogenesis. In addition, we highlight the ability for exosomes to regulate ER stress. Recent advances in the regulation of ER stress mediated osteogenesis and angiogenesis suggest novel therapeutic options for bone defects.

Design of carbon dots for bioimaging and behavior regulation of stem cells

Carbon dots (CDs) have been widely used in bioimaging, biosensing and biotherapy because of their good biocompatibility, optical properties and stability. In this review, we comprehensively summarize the research on CDs in terms of synthesis methods, optical properties and biotoxicity. We describe and envisage the directions for CDs application in stem cell imaging and differentiation, with the aim of stimulating the design of future related CDs. We used 'carbon dots', 'stem cells', 'cell imaging', 'cell differentiation' and 'fate control' as keywords to search for important articles. The Web of Science database was used to extract vital information from a total of 357 papers, 126 review articles and 231 article proceedings within 12 years (2011-2022).

Recent advances in carbon dots: synthesis and applications in bone tissue engineering

Bone tissue engineering (BTE), based on the perfect combination of seed cells, scaffold materials and growth factors, has shown unparalleled potential in the treatment of bone defects and related diseases. As the site of cell attachment, proliferation and differentiation, scaffolds composed of biomaterials play a crucial role in BTE. Over the past years, carbon dots (CDs), a new type of carbon-based nanomaterial, have attracted extensive research attention due to their good biocompatibility, unique optical properties, and abundant functional groups. This paper reviews recent research progress in the use of CDs in the field of BTE. Firstly, different preparation methods of CDs are summarized. Then, the properties and categories of CDs applied in BTE are described in detail. Subsequently, the applications of CDs in BTE, including osteogenesis, fluorescence tracing, phototherapy and antibacterial activity, are presented. Finally, the challenges and future perspectives of CDs in BTE are briefly discussed to give a comprehensive picture of CDs. This review provides a theoretical basis and advanced design strategies for the application of CDs in BTE.

In vitro and in vivo toxicological evaluation of carbon quantum dots originating from Spinacia oleracea

Food-derived carbon quantum dots (CQDs) can relatively easily be synthesized and chemically manipulated for a broad spectrum of biomedical applications. However, their toxicity may hinder their actual use. Here, Spinacia oleracea-derived CQDs i.e., CQD-1 and CQD-2, were synthesized by means of different shredding methods and followed by a microwave-assisted hydrothermal approach. Subsequently, these CQDs were analyzed in vitro and in an in vivo mice model to test their biocompatibility and potential use as bioimaging agents and for activation of osteogenic differentiation. When comparing CQD-1 and CQD-2, it was found that CQD-1 exhibited 7.6 times higher photoluminescent (PL) emission intensity around 411 nm compared to CQD-2. Besides, it was found that the size distribution of CQD-1 was 2.05 ± 0.08 nm, compared with 2.14 ± 0.04 nm for CQD-2. Upon exposure to human bone marrow-derived mesenchymal stem cells (hBMSCs) in vitro, CQD-1 was endocytosed into the cytoplasm and significantly increased the differentiation of hBMSCs up to 10 μg mL^-1 after 7 and 14 days. Apparently, the presence of relatively low doses of CQD-1 showed virtually no toxic or histological effects in the major organs in vivo. In contrast, high doses of CQD-1 (1 mg mL^-1) caused cell death in vitro ranging from 35% on day 1 to 80% on day 3 post-exposure, and activated the apoptotic machinery and increased lymphocyte aggregates in the liver tissue. In conclusion, S. oleracea-derived CQDs have the potential for biomedical applications in bioimaging and activation of stem cells osteogenic differentiation. Therefore, it is postulated that CQD-1 from S. oleracea remains potential prospective material at appropriate doses and specifications.

Applications of carbon dots and its modified carbon dots in bone defect repair

Bone defect repair is a continual and complicated process driven by a variety of variables. Because of its bright multicolor luminescence, superior biocompatibility, water dispersibility, and simplicity of synthesis from diverse carbon sources, carbon dots (CDs) have received a lot of interest. It has a broad variety of potential biological uses, including bone defect repair, spinal cord injury, and wound healing. Materials including CDs as the matrix or major component have shown considerable benefits in enabling bone defect healing in recent years. By altering the carbon dots or mixing them with other wound healing-promoting agents or materials, the repair effect may be boosted even further. The report also shows and discusses the use of CDs to heal bone abnormalities. The study first presents the fundamental features of CDs in bone defect healing, then provides CDs manufacturing techniques that should be employed in bone defect repair, and lastly examines their development in the area of bioengineering, particularly in bone defect repair. In this work, we look at how carbon dots and their alteration products may help with bone defect healing by being antibacterial, anti-infective, osteogenic differentiation-promoting, and gene-regulating.

Novel multifunctional dexamethasone carbon dots synthesized using the one-pot green method for anti-inflammatory, osteogenesis, and osteoimmunomodulatory in bone regeneration

Bone tissue regeneration is still a major orthopedic challenge. The process of bone regeneration is often disrupted by inflammation. Elevated levels of reactive oxygen species (ROS) can lead to aggravated inflammation and even hinder tissue repairs. Therefore, inhibiting the inflammatory response during the process of bone regeneration and promoting bone tissue regeneration under inflammatory conditions are the goals that need to be achieved urgently. In this work, dexamethasone carbon dots (DCDs) were developed by a one-pot facile hydrothermal method using citric acid, ammonium fluoride, and a trace amount of dexamethasone. The obtained DCDs exhibited good biocompatibility and could promote the differentiation of rBMSCs under both normal and inflammatory conditions. Owing to the abundant-reducing groups, DCDs could also scavenge ROS (˙OH) and retain the pharmacological activity of dexamethasone, thereby reducing the inflammatory response. Moreover, DCDs presented a good osteoimmunomodulatory activity to induce a bone immune microenvironment and further promote the differentiation of BMSCs. DCDs could promote macrophage phenotype switching (from M1-type macrophages to M2-type macrophages) under inflammatory conditions, which was beneficial to the anti-inflammatory response. All in all, DCDs could reduce the inflammatory response of bone tissue and accelerate bone regeneration in combination with the regulation of the bone immune. Undoubtedly, it also provided a new idea for developing a novel carbon nanomaterial for repairing bone tissue defects.

Nanomaterials in Bone Regeneration

Nanomaterials are promising in the development of innovative therapeutic options that include tissue and organ replacement, as well as bone repair and regeneration. The expansion of new nanoscaled biomaterials is based on progress in the field of nanotechnologies, material sciences, and biomedicine. In recent decades, nanomaterial systems have bridged the line between the synthetic and natural worlds, leading to the emergence of a new science called nanomaterial design for biological applications. Nanomaterials replicating bone properties and providing unique functions help in bone tissue engineering. This review article is focused on nanomaterials utilized in or being explored for the purpose of bone repair and regeneration. After a brief overview of bone biology, including a description of bone cells, matrix, and development, nanostructured materials and different types of nanoparticles are discussed in detail.

Bifunctional scaffolds for tumor therapy and bone regeneration: Synergistic effect and interplay between therapeutic agents and scaffold materials

Bone tumor patients often face the problems with cancer cell residues and bone defects after the operation. Therefore, researchers have developed many bifunctional scaffolds with both tumor treatment and bone repair functions. Therapeutic agents are usually combined with bioactive scaffolds to achieve the "bifunctional". However, the synergistic effect of bifunctional scaffolds on tumor therapy and bone repair, as well as the interplay between therapeutic agents and scaffold materials in bifunctional scaffolds, have not been emphasized and discussed. This review proposes a promising design scheme for bifunctional scaffolds: the synergistic effect and interplay between the therapeutic agents and scaffold materials. This review summarizes the latest research progress in bifunctional scaffolds for therapeutic applications and regeneration. In particular, it summarizes the role of tumor therapeutic agents in bone regeneration and the role of scaffold materials in tumor treatment. Finally, a perspective on the future development of bifunctional scaffolds for tumor therapy and bone regeneration is discussed.

Endoplasmic reticulum stress response mediated by the PERK-eIF2α-ATF4 pathway is involved in odontoblastic differentiation of human dental pulp cells

OBJECTIVE

RNA-activated protein kinase-like ER-resident kinase (PERK) was a major transducer of Endoplasmic reticulum (ER) stress response and it directly phosphorylated α-subunit of eukaryotic initiation factor 2 (eIF2α), which specifically promoted the translation of activating transcription factor 4 (ATF4), an important transcription factor in cells' differentiation. The purpose of this study was to establish whether ER stress mediated by PERK-eIF2α-ATF4 pathway was involved in odontoblastic differentiation of human dental pulp cells (DPCs).

METHODS

DPCs were isolated from extracted teeth and cultured in odontogenic medium. A recombinant lentiviral vector was constructed to transfect DPCs for PERK knockdown. Alkaline phosphatase (ALP) and Alizarin red S staining were used to characterize the odontoblastic differentiation. Real-time polymerase chain reactions (RT-PCR) were performed to analyze the genes' expressions in DPCs' odontoblastic differentiation. The mRNA and protein levels of ER stress markers were examined by RT-PCR and western blot.

RESULTS

DPCs cultured in odontogenic media showed increased ALP activity and mineralized nodule formation. Notably, treatment with differentiation medium resulted in the up-regulation of genes, such as osteocalcin (OCN), bone sialoprotein (BSP), dentin sialophosphoprotein (DSPP), splicing x-box binding protein-1 (sXBP1), ATF4 and glucose-regulated protein 78 (GRP78). Meanwhile, the expressions of PERK-eIF2α-ATF4 pathway proteins, phosphorylated PERK, phosphorylated eIF2α and ATF4, increased in odontoblastic induction cells compared with controls. Furthermore, inhibition of PERK (PERK knockdown) decreased ALP activity and matrix mineralization in DPCs accompanied by the decrease expression of phosphorylated eIF2α and ATF4.

CONCLUSION

These results suggested that PERK-eIF2α-ATF4 pathway was involved in the odontoblastic differentiation of DPCs.

Carbon-Based Nanomaterials for Bone and Cartilage Regeneration: A Review

As the main load-bearing structure in the human body, bone and cartilage are susceptible to damage in sports and other activities. The repair and regeneration of bone and articular cartilage have been extensively studied in the past decades. Traditional approaches have been widely applied in clinical practice, but the effect varies from person to person and may cause side effects. With the rapid development of tissue engineering and regenerative medicine, various biomaterials show great potential in the regeneration of bone and cartilage. Carbon-based nanomaterials are solid materials with different structures and properties composed of allotropes of carbon, which are classified into zero-, one-, and two-dimensional ones. This Review systemically summarizes the different types of carbon-based nanomaterials, including zero-dimensional (fullerene, carbon dots, nanodiamonds), one-dimensional (carbon nanotubes), and two-dimensional (graphenic materials) as well as their applications in bone, cartilage, and osteochondral regeneration. Current limitations and future perspectives of carbon-based nanomaterials are also discussed.

eIF2α-ATF4 Pathway Activated by a Change in the Calcium Environment Participates in BCP-Mediated Bone Regeneration

Biphasic calcium phosphate (BCP) ceramic is a classic bone void filler and a common basis of new materials for bone defect repair. However, the specific mechanism of BCP in osteogenesis has not been fully elucidated. Endoplasmic reticulum stress (ERs) and the subsequent PERK-eIF2α-ATF4 pathway can be activated by various factors, including trauma and intracellular calcium changes, and therefore worth exploring as a potential mechanism in BCP-mediated bone repair. Herein, a rat lateral femoral epicondyle defect model in vivo and a simulated BCP-mediated calcium environment in vitro were constructed for the analysis of BCP-related osteogenesis and the activation of ERs and the eIF2α-ATF4 pathway. An inhibitor of eIF2α dephosphorylation (salubrinal) was also used to explore the effect of the eIF2α-ATF4 pathway on BCP-mediated bone regeneration. The results showed that the ERs and eIF2α-ATF4 pathway activation were observed during 4 weeks of bone repair, with a rapid but brief increase immediately after artificial defect surgery and a re-increase after 4 weeks with the resorption of BCP materials. Mild ERs and the activated eIF2α induced by the calcium changes mediated by BCP regulated the expression of osteogenic-related proteins and had an important role during the defect repair. In conclusion, the eIF2α-ATF4 pathway activated by a change in the calcium environment participates in BCP-mediated bone regeneration. eIF2α-ATF4 and ERs could provide new directions for further studies on new materials in bone tissue engineering.

Recent Advances in Carbon Nanodots: A Promising Nanomaterial for Biomedical Applications

Carbon nanodots (CNDs) are an emerging class of nanomaterials and have generated much interest in the field of biomedicine by way of unique properties, such as superior biocompatibility, stability, excellent photoluminescence, simple green synthesis, and easy surface modification. CNDs have been featured in a host of applications, including bioimaging, biosensing, and therapy. In this review, we summarize the latest research progress of CNDs and discuss key advances in our comprehension of CNDs and their potential as biomedical tools. We highlighted the recent developments in the understanding of the functional tailoring of CNDs by modifying dopants and surface molecules, which have yielded a deeper understanding of their antioxidant behavior and mechanisms of action. The increasing amount of in vitro research regarding CNDs has also spawned interest in in vivo practices. Chief among them, we discuss the emergence of research analyzing CNDs as useful therapeutic agents in various disease states. Each subject is debated with reflection on future studies that may further our grasp of CNDs.

You Don't Learn That in School: An Updated Practical Guide to Carbon Quantum Dots

Carbon quantum dots (CQDs) have started to emerge as candidates for application in cell imaging, biosensing, and targeted drug delivery, amongst other research fields, due to their unique properties. Those applications are possible as the CQDs exhibit tunable fluorescence, biocompatibility, and a versatile surface. This review aims to summarize the recent development in the field of CQDs research, namely the latest synthesis progress concerning materials/methods, surface modifications, characterization methods, and purification techniques. Furthermore, this work will systematically explore the several applications CQDs have been subjected to, such as bioimaging, fluorescence sensing, and cancer/gene therapy. Finally, we will briefly discuss in the concluding section the present and future challenges, as well as future perspectives and views regarding the emerging paradigm that is the CQDs research field.

Hemostatic nanotechnologies for external and internal hemorrhage management

An uncontrolled hemorrhage can easily lead to death during surgery and military operations. Despite the significant advances in hemostatic research, there is still an urgent and increasing need for safer and more effective hemostatic materials. Recently, nanotechnologies have been receiving increasing interest owing to their unique advantages and have been propelling the developement of hemostatic materials. This review summarizes the fundamentals of hemostasis and emphasizes the recent developments regarding hemorrhage-related hemostatic nanotechnologies. In terms of external accessible hemorrhage management, natural and synthetic polymers and inorganic components that have been used in traditional hemostats provide novel nanoscale solutions. Regarding internal noncompressible hemorrhage management, current research endeavors are dedicated to the development of substitutes for blood components, and nanoformulated hemostatic drugs. This review also briefly discusses the main and persistent problems of hemostatic nanomaterials, including safety concerns and clinical translation challenges. This review is hoped to provide critical insight into hemostatic nanomaterial development.